Reliability and Reproducibility of Sacro-Femoro-Pubic Angle Measurements on Anteroposterior Pelvis Radiographs.

BACKGROUND: The sacro-femoro-pubic (SFP) angle is a surrogate measurement for pelvic tilt obtained on anteroposterior (AP) pelvis radiographs. It is unknown whether the SFP angle can be measured reliably by senior surgeons and trainees alike. METHODS: We conducted an intrareader and interreader reliability study using preoperative AP pelvis radiographs. Using our hospital electronic database, we randomly selected 31 subjects undergoing primary total hip arthroplasty. An attending orthopedic surgeon and two orthopedic surgery residents performed two separate SFP angle measurements for each subject. Intrareader and interreader agreement were measured using intraclass correlation coefficients (ICC). RESULTS: Pairwise intrareader and interreader ICCs ranged from 0.91 to 0.99. Overall ICC was 0.94. Interreader ICCs between the attending surgeon and each orthopedic resident were 0.93 and 0.98, and the ICC between orthopedic residents was 0.91. Interreader mean differences for SFP angle measurements were 2.32 degrees or less: -2.03 (standard deviation: 2.23) and 0.29 (1.64) between the attending surgeon and each orthopedic resident, and 2.32 (2.44) between orthopedic residents. CONCLUSION: SFP angle may be measured reliably on AP pelvis radiographs by senior clinicians and trainees. SFP angle measurement may prove helpful as an alternative to pelvic tilt measurements when lateral pelvic radiographs are not available.

Methods for ray-tracing thermal modelling of Saturn's main rings.

The thermal emission and temperatures of the main rings of Saturn depend on the energy the ring particles absorb, reflect and scatter and/or on their Bond albedo, emissivity, thermal inertia, rotation rate and porosity. However, the energy that each particle absorbs also depends on the amount of energy (e.g., solar energy) that reaches its surface and this latter on the local optical depth, that controls the mutual eclipsing between neighbouring particles and, in general, all shadowing effects on the rings. On the other hand, thermal models of the rings of Saturn based on the energy balance equation strongly depend on a function that described how the non-shadowed area of ring particles changes with solar elevation. Experimental and analytical shadowing functions have been proposed by [6] and [1], respectively. In this work, we propose shadowing functions based on the creation of 3D arrays of spherical particles that simulate specific regions of the main rings of Saturn. The methods implemented to obtain these shadowing functions follow the next general steps: • Arrays are created as a collection of spherical particles with a size distribution that follows a power law constrained to the optical depth of the region of study based on the UVIS instrument data. • The particles of the arrays are then reordered to add some relevant dynamical features observed in actual rings (e.g., wake structures in the case of optically-thick rings). • Under different illumination geometries, images of these arrays are rendered using ray tracing. From these images, an analysis of their pixel brightness values allows us to determine the non-shadowed fractional area of the particles in order to compose the corresponding shadowing functions.

Racial/Ethnic and Socioeconomic Disparities in Osteoarthritis Management.

This article reviews the literature on racial and socioeconomic disparities in the management of osteoarthritis. Treatments investigated include arthritis education, dietary weight management, exercise/physical therapy, pharmacologic therapy with nonsteroidal antiinflammatory drugs and opioids, intra-articular steroid injections, and total joint replacement. The amount of evidence for each treatment modality varied, with the most evidence available for racial and socioeconomic disparities in total joint arthroplasty. Black patients, Hispanic patients, and patients with low socioeconomic status (SES) are less likely to undergo total joint replacement than white patients or patients with high SES, and generally have worse functional outcomes and more complications.

Closed Reduction Percutaneous Pinning Management of a Cuboid Fracture-Dislocation in a 70-Year-Old Man: A Case Report.

CASE: A 70-year-old man sustained a traumatic injury to his right foot after falling from a 3-foot height. Imaging demonstrated a cuboid fracture with inferomedial dislocation and associated nondisplaced midfoot fractures. Treatment consisted of closed reduction and percutaneous pinning (CRPP) using Kirschner wire fixation. His postoperative recovery was uneventful with full return to activities. CONCLUSION: Cuboid fracture-dislocations are exceedingly rare, and subsequently, there is a paucity of treatment recommendations in the literature. To the best of our knowledge, this is the first reported successful closed reduction with percutaneous pinning for a cuboid fracture with associated dislocation. CRPP is a potential treatment option for this injury.

National utilization and inpatient safety measures of lumbar spinal fusion methods by race/ethnicity.

BACKGROUND CONTEXT: Degenerative lumbar conditions are prevalent, disabling, and frequently managed with decompression and fusion. Black patients have lower spinal fusion rates than White patients. PURPOSE: Determine whether specific lumbar fusion procedure utilization differs by race/ethnicity and whether length of stay (LOS) or inpatient complications differ by race/ethnicity after accounting for procedure performed. STUDY DESIGN: Large database retrospective cohort study PATIENT SAMPLE: Lumbar fusion recipients at least age 50 in the 2016 National Inpatient Sample with diagnoses of degenerative lumbar conditions. OUTCOME MEASURES: Type of fusion procedure used and inpatient safety measures including LOS, prolonged LOS, inpatient medical and surgical complications, mortality, and cost. METHODS: We examined the association between race/ethnicity and the safety measures above. Covariates included several patient and hospital factors. We used multiple linear or logistic regression to determine the association between race and fusion type (PLF, P/TLIF, ALIF, PLF + P/TLIF, and PLF + ALIF [anterior-posterior fusion]) and to determine whether race was associated independently with inpatient safety measures, after adjustment for patient and hospital factors. RESULTS: Fusion method use did not differ among racial/ethnic groups, except for somewhat lower anterior-posterior fusion utilization in Black patients compared to White patients (crude odds ratio [OR]: 0.81 [0.67-0.97]). Inpatient safety measures differed by race/ethnicity for rates of prolonged LOS (Blacks 18.1%, Hispanics 14.5%, and Whites 11.7%), medical complications (Blacks 9.9%, Hispanics 8.7%, and Whites 7.7%), and surgical complications (Blacks 5.2%, Hispanics 6.9%, and Whites 5.4%). Differences persisted after adjustment for procedure type as well as patient and hospital factors. Blacks and Hispanics had higher risk for prolonged LOS compared to Whites (adjusted OR Blacks 1.39 [95% confidence interval {CI} 1.22-1.59]; Hispanics 1.24 [95% CI 1.02-1.52]). Blacks had higher risk for inpatient medical complications compared to Whites (adjusted OR 1.24 [95% CI 1.05-1.48]), and Hispanics had higher risk for inpatient surgical complications compared to Whites (adjusted OR 1.34 [95% CI 1.06-1.68]). CONCLUSIONS: Fusion method use was generally similar between racial/ethnic groups. Inpatient safety measures, adjusted for procedure type, patient and hospital factors, were worse for Blacks and Hispanics.

Prognostic value of laboratory values in older patients with cervical spine fractures.

OBJECTIVES: To understand the prognostic value of laboratory markers at presentation on post-treatment survival of patients 50 and older following cervical spine fracture. PATIENTS AND METHODS: We obtained clinical data on patients 50 and older treated for cervical spine fracture in a single healthcare system (2006-2016). Our primary outcome consisted of 1-year mortality, with mortality within 3-months of presentation considered secondarily. Our primary predictors included serum glucose, serum creatinine, platelet-lymphocyte ratio (PLR) and neutrophil-lymphocyte ratio (NLR) at presentation. We used multivariable logistic regression to adjust for confounding from sociodemographic and clinical characteristics. Point estimates and 95 % confidence intervals (CI) from the final model were refined using Bayesian regression techniques. RESULTS: We included 1781 patients in this analysis, with an average age of 75.3 (SD 12.0). The mortality rate at 3-months was 12 % and 17 % at 1-year. In multivariable testing, neither elevated PLR or NLR were significant predictors of 1-year mortality. Elevated serum creatinine was associated with increased mortality at 1-year (OR 1.89; 95 % CI 1.30, 2.74), as was hyperglycemia (OR 1.50; 95 % CI 1.06, 2.13). Elevated serum creatinine remained influential (OR 1.64; 95 % CI 1.06, 2.54) on mortality at 3-months. CONCLUSIONS: This is the first study to evaluate laboratory values at presentation in conjunction with survival following cervical fractures. The results can be used to help forecast natural history and in expectation management. They may also help formulate treatment plans, especially when the need for surgical intervention is not clearly defined.

Methylene blue enteric mapping for intraoperative localization in obscure small bowel hemorrhage: report of a new technique and literature review: combined intraoperative methylene blue mapping and enterectomy.

BACKGROUND: Small bowel sources of obscure gastrointestinal bleeding present both a diagnostic and therapeutic challenge. Due to the normal external appearance of the vast majority of small bowel lesions that cause obscure gastrointestinal bleeding, multiple methods of intraoperative localization have been reported. When an arteriographic abnormality is found, the use of vital dye enteric mapping is one of the most effective localization techniques. CASE REPORT: We present a new technique combining superselective mesenteric angiography with methylene blue enteric mapping and small bowel resection performed during the same operative procedure. This technique was successfully applied in a patient with a jejunal arteriovenous malformation. Included is a review of methods of intraoperative localization with a focus on vital dye staining-guided enterectomy.