Role of preoperative posterior tilt on the outcomes of internal fixation of non-displaced femoral neck fractures: A systematic review and meta-analysis.

INTRODUCTION: There has been an increased interest in the role of preoperative posterior tilt, as measured on lateral radiographs, on the outcomes of internal fixation of non-displaced femoral neck fractures (FNF). The goal was to assess the available evidence for this in the literature. PATIENTS AND METHODS: PRISMA guidelines were followed. PubMed, Embase and Cochrane were searched on June 10th, 2020 for studies assessing the role of posterior tilt on outcomes of internal fixation of non-displaced FNF. Primary outcomes were non-union and fixation failure, avascular necrosis (AVN), treatment failure, and reoperation (excluding symptomatic hardware removal). Outcomes were reported in Odds Ratio (OR) with 95% confidence intervals [CI]. RESULTS: Fourteen studies and 3729 patients were included (mean age 76 years, 72% female, mean follow-up 25 months). Moderate evidence was noted for the following: patients with greater preoperative posterior tilt had an increased risk of non-union and fixation failure (OR 2.4 [1.3 - 4.3]; p = 0.006), no increased risk of AVN (p = 0.550), an increased risk of treatment failure (OR 6.0 [2.2 - 15.9]; p<0.001) and reoperation (OR 2.5 [1.4 - 4.4]; p = 0.002). Furthermore, a greater preoperative tilt of 9.0° [4.1° - 13.9°] for treatment failure and 6.1° [3.7° - 8.5°] (p<0.001) for reoperation were noted in the unsuccessfully treated groups when compared to the successfully treated groups. Four studies found a threshold for posterior tilt ranging from 7° to 20° CONCLUSION: There is moderate evidence that patients with non-displaced FNF and greater tilt have an increased risk of unsuccessful outcomes following internal fixation. Older patients with a preoperative tilt of ≥20° might benefit from arthroplasty surgery, although studies assessing the optimal threshold are needed.

Treatment of coracoid process fractures: a systematic review.

INTRODUCTION: The coracoid process is a small hook-shaped feature on the scapula and a key structure of the superior shoulder suspensory complex (SSSC). Fractures of the coracoid are rare. Therefore, no consensus exists regarding treatment of coracoid process fractures. Systematically review indications, outcomes and complications of traumatic coracoid process fractures in adults, and to provide a treatment algorithm. MATERIALS AND METHODS: A systematic review was performed to identify all relevant studies on the treatment of coracoid process fractures. The methodological quality of the studies was scored using the Methodological Index for Non-Randomized Studies (MINORS). RESULTS: Eight case series, with a total of 110 coracoid process fractures, were included. All studies were of moderate methodological quality. Of the fractures, 78% were Ogawa type I fractures, 13% Ogawa type II and 9% were unclassified. Conservative treatment showed good results in most Ogawa type II fractures and type I fractures without associated disruptions of the SSSC. Most Ogawa type I fractures with associated disruptions of the SSSC received surgical treatment showing good results. CONCLUSION: Based on moderate quality studies, surgical treatment may be considered in Ogawa type I fractures with multiple disruptions of the SSSC. A conservative treatment seems sufficient in other fracture types.

Multi-functionality of computer-aided quantitative vertebral fracture morphometry analyses.

Osteoporotic vertebral fractures are an increasingly active area of research. Oftentimes assessments are performed by software-assisted quantitative morphometry. Here, we will discuss multi-functionality of these data for research purposes. A team of trained research assistants processed lateral spine radiographs from the population-based Rotterdam Study with SpineAnalyzer(®) software (Optasia Medical Ltd, Cheadle, UK). Next, the raw coordinate data of the two upper corners of Th5 and the two lower corners of Th12 were extracted to calculate the Cobb's kyphosis angle. In addition, two readers performed independent manual measurements of the Cobb's kyphosis angle between Th5 and Th12 for a sample (n=99). The mean kyphosis angle and its standard deviation were 53° and 10° for the SpineAnalyzer(®) software measurements and 54° and 12° by manual measurements, respectively. The Pearson's correlation coefficient was 0.65 [95% confidence interval (CI): 0.53-0.75; P=2×10(-13)]. There was a substantial intraclass correlation with a coefficient of 0.64 (95% CI: 0.51-0.74). The mean difference between methods was 1° (95% CI: -2°-4°), with 95% limits of agreement of -20°-17° and there were no systematic biases. In conclusion, vertebral fracture morphometry data can be used to derive the Cobb's kyphosis angle. Even more quantitative measures could be derived from the raw data, such as vertebral wedging, intervertebral disc space, spondylolisthesis and the lordosis angle. These measures may be of interest for research into musculoskeletal disorders such as osteoporosis, degenerative disease or Scheuermann's disease. Large-scale studies may benefit from efficient capture of multiple quantitative measures in the spine.

Scheuermann disease: evaluation of radiological criteria and population prevalence.

STUDY DESIGN: Observational population-based study. OBJECTIVE: To determine the prevalence of radiographical Scheuermann disease in a Dutch population and evaluate the consistency of diagnostic criteria. SUMMARY OF BACKGROUND DATA: Scheuermann disease is a form of osteochondrosis characterized by increased posterior rounding of the thoracic spine with structural vertebral deformity. Different expert opinion-based radiological criteria exist, yet these have not been validated. The prevalence in the general population reported ranged from 1% to 10%. METHODS: Lateral spine radiographs of 2753 Rotterdam Study participants (aged 45-89 yr) were assessed for Scheuermann disease using Sørensen and Sachs' radiographical criteria in 2 phases. Cohen κ statistics were calculated for interrater agreement. Prevalence estimates were calculated and sex differences were tested with Pearson χ test. We evaluated whether varying the kyphosis angle criterion would change the prevalence estimate. RESULTS: A total of 677 (24.6%) individuals had endplate irregularities and 140 (5.1%) individuals had vertebral wedging. Abnormalities were significantly more prevalent among males (P < 0.05). The interrater agreement κ statistics were 78.8% for vertebral wedging and 79.4% for endplate irregularity. A total of 127 individuals had both criteria, of which 111 had a kyphosis angle greater than 45°, resulting in a prevalence of 4.0% (95% confidence interval [CI]: 3.3%-4.7%). The disease prevalence was 4.5% in males versus 3.6% in females, yet this difference was not statistically significant (P = 0.23). Adjustment of the kyphosis angle criterion from 45° to 40° or 35° increased the number of cases marginally, corresponding to prevalence estimates not significantly different from the estimates using original criteria (4.2% [95% CI: 3.3%-4.7%] and 4.4% [95% CI: 3.6%-5.2%]). CONCLUSION: Our results revealed a prevalence of 4.0% of radiographical Scheuermann disease in Dutch individuals aged 45 years and older. Although there is no current "gold standard" for the radiographical definition, standardized scoring of independent features resulted in substantial interobserver agreement, and different applications of diagnostic criteria did not significantly alter the classification.