Deep learning-based fully automatic Risser stage assessment model using abdominal radiographs.

BACKGROUND: Artificial intelligence has been increasingly used in medical imaging and has demonstrated expert level performance in image classification tasks. OBJECTIVE: To develop a fully automatic approach for determining the Risser stage using deep learning on abdominal radiographs. MATERIALS AND METHODS: In this multicenter study, 1,681 supine abdominal radiographs (age range, 9-18 years, 50% female) obtained between January 2019 and April 2022 were collected retrospectively from three medical institutions and graded manually using the United States Risser staging system. A total of 1,577 images from Hospitals 1 and 2 were used for development, and 104 images from Hospital 3 for external validation. From each radiograph, right and left iliac crest patch images were extracted using the pelvic bone segmentation model DeepLabv3 + with the EfficientNet-B0 encoder trained with 90 digitally reconstructed radiographs from pelvic computed tomography scans with a pelvic bone mask. Using these patch images, ConvNeXt-B was trained to grade according to the Risser classification. The model's performance was evaluated using accuracy, area under the receiver operating characteristic curve (AUROC), and mean absolute error. RESULTS: The fully automatic Risser stage assessment model showed an accuracy of 0.87 and 0.75, mean absolute error of 0.13 and 0.26, and AUROC of 0.99 and 0.95 on internal and external test sets, respectively. CONCLUSION: We developed a deep learning-based, fully automatic segmentation and classification model for Risser stage assessment using abdominal radiographs.

A unique presentation of the rare Nora's lesion, symptomatic bizarre parosteal osteochondromatous proliferation: A case report.

Bizarre parosteal osteochondromatous proliferations, also known as Nora's lesions, are rare benign tumors with a high recurrence rate. They are often difficult to identify because of their similar appearance to other tumors. We describe a 25-year-old healthy female patient with bizarre parosteal osteochondromatous proliferations in an uncommon location on the pelvic ilium, presenting with unique clinical findings of abdominal pain and femoral paresthesia and showing atypical radiographic findings. To the best of our knowledge, this is one of the very few cases ever reported in the literature of Nora's lesion in this particular location and possibly the first case ever with this specific presentation. The lesions' radiographic images, combined orthopedic and general surgery procedures, and histological analysis are detailed. The patient's continued 4-year follow-up has demonstrated no symptoms or evidence of recurrence.

Iliac Crest Bone Graft Harvest for Alveolar Cleft Repair: A Systematic Review Comparing Minimally Invasive Trephine and Conventional Open Techniques.

Background: In the course of developing a standardized pathway for alveolar cleft repair, we conducted a systematic review comparing minimally invasive trephine with conventional open technique for iliac crest bone graft harvest in a pediatric population. Methods: A systematic review was conducted of studies comparing open with minimally invasive trephine techniques in pediatric populations undergoing alveolar cleft repair. Exclusion criteria included reviews, case series, editorials, abstracts, and those with adult-only populations. Data were compiled with outcome variables selected a priori. Results: Of 422 manuscripts screened, five met criteria. These comprised 257 patients (116 open, 141 trephine). Average age was 11 years. Patients undergoing trephine harvest had reduced length of stay (1.0-5.0 days trephine vs 1.25-5.4 days open), time to unassisted ambulation (16-46 hours vs 20-67 hours open), and less postoperative narcotic use (0.31 mg/kg vs 1.64 mg/kg IV morphine). Volume of cancellous bone was reported as 2.53 mL for open versus 1.22 mL for trephine in one study, and trephine graft was supplemented with demineralized bone in 54% of cases in another study. The use of anesthetic adjuncts was inconsistent but had a significant effect on postoperative pain and ambulation. Conclusions: Compared to open techniques, the minimally invasive trephine bone graft harvest is associated with a shorter time to discharge, slightly lower infection rates, and reduced opioid use. The possible benefits of trephine harvest must however be balanced against the risk of insufficient graft harvest. Finally, the choice of perioperative analgesic adjuncts significantly impacts patient outcomes regardless of the technique employed.

Contexte: Dans le cours de l'élaboration d'une méthode standardisée de réparation des fentes palatines, nous avons réalisé une revue systématique comparant la technique par tréphine peu invasive à la technique conventionnelle ouverte pour la collecte d'os de la crête iliaque dans une population pédiatrique. Méthodes: Une revue systématique a été réalisée sur les études comparant les techniques ouvertes avec les techniques utilisant une tréphine peu invasive dans des populations pédiatriques subissant une réparation de fente palatine. Les critères d'exclusion incluaient les revues, les séries de cas, les éditoriaux, les résumés et les études ne portant que sur une population adulte. Les données ont été compilées avec des variables de résultats sélectionnées a priori. Résultats: Parmi les 422 manuscrits sélectionnés, cinq répondaient aux critères. Ils incluaient 257 patients (116 techniques ouvertes, 141 tréphines). L'âge moyen des patients était de 11 ans. Les patients pour lesquels une collecte avait été obtenue par tréphine avaient une durée de séjour plus courte (tréphine : 1,0 à 5,0 jours; contre technique ouverte : 1,25 à 5,4 jours), un délai de déambulation non aidée plus court (16 à 46 heures contre 20 à 67 heures pour la technique ouverte) et un moindre recours aux antalgiques postopératoires (0,31 mg/kg contre 1,64 mg/kg de morphine IV). Le volume d'os spongieux collecté était de 2,53 ml avec les techniques ouvertes contre 1,22 ml avec la tréphine; le greffon par tréphine a été complété par de l'os déminéralisé dans 54% des cas dans une autre étude. L'utilisation de suppléments anesthésiques n'était pas homogène, mais a eu un effet significatif sur la douleur postopératoire et la déambulation. Conclusions: Comparativement aux techniques ouvertes, la collecte peu invasive de greffon osseux par tréphine est associée à une délai de congé plus court, des taux d'infections légèrement inférieurs et à une moindre utilisation d'opioïdes. Toutefois, les avantages éventuels de la collecte par tréphine doivent être soupesés par rapport au risque de collecte insuffisante de greffon. Enfin, le choix de suppléments analgésiques périopératoires a des répercussions significatives sur l'évolution des patients, indépendamment de la technique employée.

Quantitative Volumetric Measurements of Bone Grafting Sites Within the Lower Extremity on Computed Tomography Scans.

The anterior iliac crest is one of the most used options; however, pain and other complications have been reported. Other options for bone harvest in the lower extremity, such as the proximal tibia and calcaneus, can be useful sites for bone grafting. Computed tomography angiography images of the lower extremity were analyzed using 3-D Slicer™ medical imaging software, creating an advanced 3-dimensional model. Bone volume (cm3) and bone mineral density (Hounsfield units) were measured from the cancellous bone in the anterior iliac crest, posterior iliac crest, proximal tibia, and the calcaneus. Fifteen studies were included. The total volume measured it was of 61.88 ± 14.15 cm3, 19.35 ± 4.16 cm3, 32.48 ± 7.49 cm3, 26.40 ± 7.18 cm3, for the proximal tibia, anterior and posterior iliac crest, and calcaneus, respectively. Regarding Hounsfield units, the densities were 116 ± 58.77, 232.4 ± 68.65, 214.4 ± 74.45, 170.5 ± 52.32, for proximal tibia, anterior and posterior iliac crest, and calcaneus. The intraclass correlation coefficients were in average >0.94. In conclusion, the proximal tibia has more cancellous bone than the anterior and posterior iliac crest. The calcaneus has more cancellous bone than the anterior iliac crest. Bone mineral density was highest in the anterior iliac crest and in proximal tibia was the lowest value.

Autologous ilium graft combination with titanium plate for sternal reconstruction: A case report / 中国胸心血管外科临床杂志

@#The sternum is the pivotal component of the thoracic cavity. It is connected with the clavicle and ribs on the upper part and both sides respectively, and plays an important role in protecting the stability of the chest wall. Sternal resection usually results in a large segmental chest wall defect that causes the chest wall to float and requires sternal reconstruction. This paper reports a 62 years male patient with thymic squamous cell carcinoma with sternal metastasis, who underwent thymotomy, sternal tumor resection and autologous lilum graft combined with sternal reconstruction by titanium plate after relevant examination was completed and surgical contraindications were eliminated. The patient was followed up for 6 months, the respiratory and motor functions were normal and the thoracic appearance was good.

Case report: Corpectomy and iliac crest bone autograft as treatment for a vertebral plasma cell tumor in a dachshund dog.

A 7-year-old, 7.5 kg, female spayed dachshund dog presented to a veterinary teaching hospital after being referred for lameness and the inability to urinate. The dog presented as weakly ambulatory paraparetic with intact pain perception. Computed tomographic (CT) imaging showed ventral bony lysis and periosteal proliferation of the L3 vertebra, consistent with a plasma cell tumor. A corpectomy of the L3 vertebra was performed and subsequently stabilized with autogenous cortico-cancellous iliac crest bone staves, autogenous cancellous bone, and bilaterally placed locking plates [String of Pearls (SOP®), Orthomed]. The dog recovered well, with no decrease in neurologic status overnight, and continued to improve until discharge. Upon a recheck exam at 4 weeks postoperatively, the dog appeared neurologically improved with only mild ambulatory proprioceptive ataxia of the hind limbs. This case demonstrates that the transposition of a non-vascularized iliac crest autogenous bone graft with stabilization via SOP® plates and screws can be used in the management of dogs with vertebral plasma cell tumors and should be considered as a surgical option in similarly affected cases.

Unusually Giant Solitary Osteochondroma of the Ilium: A Case Report with Review of Literature.

Introduction: Osteochondroma is the most common benign bone tumor where a chondrogenic lesion is derived from aberrant cartilage from the perichondral ring. Although it commonly arises from the growing ends of long bones, less commonly, it may arise from the scapula, pelvis, or vertebra. Case Report: We encountered a 16-year-old male patient with a painless left pelvic solid mass for 3 years, which was suggestive of osteochondroma on X-ray and magnetic resonance imaging findings. Besides cosmetic issues, the main indication for surgery was the constant discomfort in wearing pants/shorts/belts. He underwent en bloc excision followed by a biopsy of the surgical specimen by two independent histopathologists confirming the tumor to be osteochondroma. He was followed up for 2 years with no signs of post-operative complications or recurrence. This case represents one of the very few reported so affecting the iliac wing, where the excision was performed before skeletal maturation. We also performed a review of the current literature on iliac wing osteochondroma to understand the tumor better, identify gaps in current knowledge, and suggest areas for future research. Conclusion: Since one of the differential diagnoses includes secondary chondrosarcoma, which could be a rare progression of osteochondroma, early recognition and comprehensive evaluation of such unusual cases needs to be dealt with a high index of suspicion to avoid misdiagnosis and to provide effective treatment.

Applicability of the six-phase method for auricular age estimation in an Indian population: A CT-based study.

Age estimation plays a crucial role in human identification. Amongst numerous age markers located throughout the skeletal framework, the auricular surface of the ilium presents as a resilient structure, with different methods for auricular age estimation currently in practice. Amongst these methods, the Osborne method is believed to permit accurate age estimation through its use of robust age categories and discrete phase descriptors. The present study aimed to assess the applicability of the Osborne method in an Indian population through a computed tomographic (CT) examination of the auricular surface, an aspect presently unreported. In order to do so, CT scans of 380 individuals were collected and evaluated using the Osborne method. A CT-based examination indicated that surface texture described by Osborne is difficult to appreciate through 3D CT images. Indistinct definitions associated with certain features, and the mosaic display of features within each phase further prevents applying the method effectively. Overall accuracy percentages of 99.47% and 98.90% were obtained using the method in males and females, respectively, with corresponding inaccuracy values of 10.10 years and 9.04 years. Significantly reduced accuracy percentages were obtained with alternate, more robust age brackets presented within the original study, demonstrating the limited reliability associated with the method. Inaccuracy and bias values computed for each decade indicate the relative utility of the method in aging 40-59-year-old individuals. Low accuracy percentages, high error rates and different methodological hindrances encountered within the present study illustrate the limited applicability of the Osborne method in aging an Indian population.

A geometric morphometric analysis of variation in Australian frog ilia and taxonomic interpretations.

Anurans including frogs and toads exhibit an ilium that is often regarded as taxonomically diagnostic. The ilium, one of the three paired bones that make up the pelvic girdle, has been important in the fossil record for identifying anuran morphotypes. Osteological collections for Australian frogs are rare in herpetological museums, and skeletonizing whole-bodied specimens requires destroying soft tissue morphology which is valuable to anuran specialists working on living species. Computed tomography scans provide the opportunity to study anuran osteology without the loss of soft tissues. Our study, based on microcomputed tomography scans of extant Australian frogs from the public repository Morphosource and from museum collections focuses on the morphological differences between Australian frogs at the familial and generic levels using geometric morphometrics to compare the diagnostic shape of the ilium. Principal component analysis (PCA) and canonical variate analysis (CVA) were conducted to assess differences in the ilium between supraspecific groups of Australian frogs. The canonical variates analysis accurately predicted group membership (i.e., the correct family) with up to 76.2% success for cross-validated predictions and 100% of original group predictions. While the sample was limited to familial and generic level analyses, our research shows that ilial morphology in Australian frogs is taxonomically informative. This research provides a guide for identifying Australian anurans, including fossils, as well as new information relevant to considerations about their phylogenetic relationships, and the potential use of the fossil record to enhance efforts to conserve threatened living frog species.

Age estimation from iliac auricular surface using Bayesian inference and principal component analysis: a CT-based study in an Indian population.

Age estimation constitutes one of the pillars of human identification. The auricular surface of the ilium presents as a durable and robust structure within the human skeletal framework, capable of enabling accurate age estimation in older adults. Amongst different documented auricular age estimation methods, the Buckberry-Chamberlain method offers greater objectivity through its component-based approach. The present study aimed to test the applicability of the Buckberry-Chamberlain method in an Indian population through a CT-based examination of the auricular surface. CT scans of 435 participants undergoing CT examinations following the advice of their treating physicians were scrutinized for different age-related auricular changes. Three of the five morphological features described by Buckberry-Chamberlain could be appreciated on CT scans, and thus further statistical analysis was restricted to these features. Transition analysis coupled with Bayesian inference was undertaken individually for each feature to enable age estimation from individual features, while circumventing age mimicry. A Bayesian analysis of individual features yielded highest accuracy percentages (98.64%) and error rates (12.99 years) with macroporosity. Transverse organization and apical changes yielded accuracy percentages of 91.67% and 94.84%, respectively, with inaccuracy computations of 10.18 years and 11.74 years, respectively. Summary age models, i.e. multivariate age estimation models, derived by taking this differential accuracy and inaccuracy into consideration yielded a reduced inaccuracy value of 8.52 years. While Bayesian analysis undertaken within the present study enables age estimation from individual morphological features, summary age models appropriately weigh all appreciable features to yield more accurate and reliable estimates of age.

Preliminary Study of Confounder-Corrected Fat Fraction and R2* Mapping of Bone Marrow in Children With Acute Leukemia.

BACKGROUND: The bone marrow (BM) evaluation of acute leukemia (AL) mainly depends on invasive BM puncture biopsy. Noninvasive and accurate MR examination technology has potential clinical application value in the BM evaluation of AL patients. Multi-gradient-echo (MGRE) has been found useful to evaluate changes in BM fat and iron content, but has not yet been applied in AL. PURPOSE: To explore the diagnostic capability of BM infiltration of quantitative BM fat fraction (FF) and R2* values obtained from a 3D MGRE sequence in children with primary AL. STUDY TYPE: Prospective. POPULATION/SUBJECTS: Sixty-two pediatric patients with untreated AL and 68 healthy volunteers. AL patients were divided into acute lymphoblastic leukemia (ALL) (n = 39) and acute myeloid leukemia (AML) (n = 23) groups. FIELD STRENGTH/SEQUENCE: 3T, 3D chemical-shift-encoded multi-gradient-echo, T1WI, T2WI, T2_STIR. ASSESSMENT: BM FF and R2* values were assessed by manually drawing regions of interest at the L3, L4, ilium, and 1 cm below the bilateral trochanter of the femur (upper femur). STATISTICAL TESTS: Independent sample t-tests, variance analysis, Spearman correlation. RESULTS: BM FF and R2* at L3, L4, ilium, and upper femur, FFtotal and R2*total were significantly lower in the AL than control group. BM FF did not significantly differ between ALL and AML groups (PL3 = 0.060, PL4 = 0.086, Pilium = 0.179, Pupper femur = 0.149, and Ptotle = 0.097, respectively). The R2* was significantly lower in ALL group than AML group for L3, L4, and R2*total . BM FF was moderately positively correlated with R2* in ALL group, and strongly positively correlated in AML group. Area under the receiver operating characteristic curves showed that BM FF had higher AUC in AL, ALL, and AML (all AUC = 1.000) than R2* (0.976, 0.996, and 0.941, respectively). DATA CONCLUSION: MGRE-MRI mapping can be applied to measure BM FF and R2* values, and help evaluate BM infiltration and iron storage in children with AL. EVIDENCE LEVEL: 1 Technical Efficacy: 2.

Morphometric and topographic evaluations of principal nutrient foramina of the ilium.

BACKGROUND: Nutrient arteries pass through the nutrient foramina and reach the spongious part or medullary cavity of the bones. The arterial blood supply and nutrient foramina of the ilium have not been well described in the literature. The aim of this study is to define the numbers and localizations of nutrient foramina of the ilium on the internal surface in accordance with the pelvic brim, as well as the external surface, and furthermore the distances between these foramina with certain anatomical landmarks. METHODS: This study was performed on 57 dry hip bones. The foramina on the external and internal surfaces of the ilium were evaluated separately. The external surface of the ilium was divided into 4 regions in accordance with the gluteal lines to determine the localizations of the nutrient foramina. The foramina on the internal surface were evaluated according to whether they were above or below the pelvic brim. The diameters of the foramina and their nearest distances to certain anatomical landmarks were measured. Furthermore, the risk area of the region above the pelvic brim was determined. RESULTS: : The foramina that were found on the external surface of the ilium were distributed mainly between anterior and inferior gluteal lines (42 foramina-37.17%) and below the inferior gluteal line (57 foramina-50.44%). On the internal surface, 54 nutrient foramina were found above the pelvic brim and 81 were found below. DISCUSSION: The localizations and configurations of all nutrient foramina on the ilium were evaluated morphometrically for the first time.

Hydatid cyst of the ilium: A case report.

INTRODUCTION AND IMPORTANCE: Hydatid cyst is a common parasitic disease in endemic countries. It frequently occurs in the liver and lungs. Ilium involvement is extremely rare. We report the case of a 47-year-old man presenting with a hydatid cyst of the left ilium. CASE PRESENTATION: A rural 47-year-old patient, presented with pelvic pain and limping on walking for six months. He had a pericystectomy 10 years prior for a hydatid cyst of the left liver. A pelvic computed tomography scan showed an osteolytic remodeling of the left iliac wing associated with a large multiloculated cystic mass fusing along the left ilium. The patient had partial cystectomy and curettage of the ilium. The postoperative course was uneventful. CLINICAL DISCUSSION: Hydatid cysts of the bone are exceptional but aggressive due to the absence of a pericyst limiting the extension of the lesions. We report a rare case of a patient presenting with a hydatid cyst of the ilium. The prognosis is poor even in patients who undergo extensive surgical treatment. CONCLUSION: Early and adequate management can improve the prognosis. We highlight the importance of conservative treatment consisting of partial cystectomy with curettage of the bone to avoid morbidity related to radical surgery.

Optimal insertion positions of anterior-posterior orientation sacroiliac screw.

PURPOSE: To explore the optimal insertion positions of anterior-posterior orientation sacroiliac screw (AP-SIS). METHODS: Pelvic CT data of 80 healthy adults were employed to measure the anatomical parameters including the insertable ranges of S1 and S2, the length, width and height of the channel with three different horizontal and vertical anterior insertion points starting from the ilium-acetabular recess. To compare pelvic stability by replicating a type C Tile lesions, fifteen synthetic pelvises were fixed with an anterior plate and a posterior AP-SIS employing different anterior insertion points, the whole specimen displacements and shifts in the sacroiliac gap under a cyclic vertical load of 300 N in a biomechanical machine recorded. RESULTS: The posterior and anterior insertable ranges averaged 17.9 × 8.5mm2 and 47.1 × 21.2 mm2, respectively. The channel lengths for three horizontal anterior insertion points gradually decreased from front to back with significant difference (p < 0.05), whereas the width and height for three horizontal anterior insertion points and the parameters for the three vertical anterior insertion points were similar (p > 0.05). The displacements and shifts for three horizontal insertion points gradually increased from front to back (p < 0.05) whereas the measurements involving the three vertical insertion points were similar (p > 0.05). CONCLUSION: The posterior insertable range is small, where the center between adjacent nerve roots (foramens) is the optimal posterior insertion point. The anterior insertable range is large, where the iliac-acetabular recess is the optimal anterior insertion point for S1 and S2, providing the longest channel and best stability.

Sessile Pelvic Osteochondroma: A Rare Case That Required Abdominal Wall Reconstruction After Excision.

Osteochondroma are the most common benign tumours of the bone presenting in the young age group. Commonly found at the metaphysis of the long bones and mostly pedunculated; atypical locations and sessile appearances have also been described in literature. Due to the risk of conversion to malignant chondrosarcoma, the recommended treatment of these lesions is complete excision. We encountered a similar sessile growth in the pelvic region of a 21-year-old male with complaints of pain and swelling. After thorough investigation, excisional biopsy was performed and abdominal wall repair was reinforced with a polypropylene mesh. Careful evaluation, adequate investigations and meticulous surgical treatment can avoid potential problems in managing these tumours.

Progressive lateralization and constant hip geometry in children with DDH, NDH, and LCPD following hip reconstructive surgery: a cohort study of 73 patients with a mean follow-up of 4.9 years.

BACKGROUND: Pelvic and femoral osteotomies have been effective methods to treat developmental dysplasia of the hip (DDH), neurogenic dislocation of the hip (NDH), and Legg-Calvé-Perthes disease (LCPD). The aim of this study was to evaluate the mid-term results after hip reconstruction in children with DDH, NDH, and LCPD. METHODS: In a retrospective study, X-rays of 73 children (2-19 years) with DDH, NDH, and LCPD were measured before, 3 months, and at final follow-up (FU) after hip reconstructive surgery (open reduction, and femoral and/or pelvic osteotomy ± soft-tissue procedures between 2008 and 2018). Measurement of hip geometry included acetabular index (AI), center-edge angle (CE), and Reimers migration index (RMI). Mean follow-up time at final FU was 4.9 years. P value was set P < 0.05. RESULTS: After surgery (femoral osteotomy: 84 hips, Salter innominate osteotomy: 21 hips, Pemberton osteotomy: 30 hips, open reduction: 28 hips, Chiari osteotomy: 4 hips, and soft-tissue release: 24 hips), hip geometry parameters improved significantly. Nevertheless, at final FU, there was deterioration in hip geometry with femoral head lateralization (RMI) compared to the data at 3 months after surgery (RMI: preop/3 months/final FU: 40.6 ± 16.1%/6.1 ± 9.0/15.4 ± 16.0%; CE: 11.3° ± 20.0°/30.2° ± 9.5°/27.9 ± 15.4°; AI: 28.8° ± 9.6°/19.1° ± 7.6°/18.3 ± 7.6°). Sub-group analysis did not show differences concerning the progression of RMI in DDH, NDH, and LCPD at final FU. Regardless of basic disease, the lateralization was observed in all three groups (DDH, NDH, and LCPD) and statistically significant comparing X-rays 3 months postoperatively to maximum follow-up (DDH; NDH; LCPD: 2.7 ± 6.8%/7.6 ± 10.1%; 13.7 ± 15.3%/22.8 ± 19.8%; 1.7 ± 4.1%/14.9 ± 11.3%). Additional soft-tissue release techniques in patients with DDH or NDH did not show postoperative differences with statistical significance. Concerning surgical techniques, a connection between the lower RMI and the procedure of osteotomy of the ilium was found. In 25 patients, (34%) complications were observed: superficial skin lesions in 8, deep skin lesions in 3, contraction of adductors in 3, subluxation in 2, dislocations of the cast in 2, osteonecrosis of the femoral head in 2 cases, reluxation in 1, infection of the implanted plate in 1, compliance problem in 1, delayed bone healing in 1, and contraction of knee flexors in 1 case. DISCUSSION: The basic results of this study show a significant improvement of hip geometry at a follow-up of 4.9 years and prove findings of previously published literature. Moreover, the study was able to show a progression of RMI in all patient groups, which have undergone reconstructive surgery, despite basic hip geometry data (AI, CE angle) did not change. Those findings were independent from underlying pathology. Complications were counted in 34% of the patients and involved all known adverse events after hip reconstructive surgery. This makes clear why annual follow-up checks are needed not to miss the right indication for revision surgery. CLINICAL RELEVANCE: Evidence level: Level IV, case series. TRIAL REGISTRATION: This manuscript is part of a prospective randomized clinical trial, registered in the German Clinical Trials Register DRKS-ID: DRKS00016861.

Comparison of Anterior Iliac Crest Versus Proximal Tibia Autologous Bone Graft Harvesting: A Systematic Review and Meta-Analysis.

Anterior iliac crest (AIC) is the preferred option for bone grafting; however, pain and complications are reported. Proximal tibia (PT) is a sourceful site for bone grafting with lower complications. MEDLINE, EMBASE, and Scopus were searched to identify studies comparing AIC and PT autograft procedure. The main outcome was pain and complication rate. As well as cadaveric and cell-based studies were analyzed for quantity and quality of AIC and PT autograft. A meta-analysis was performed using the generic inverse variance method with random or fixed effects model depending on heterogeneity between studies. Heterogeneity was tested with the I2 statistic index. Fifteen studies were included in the meta-analysis. Six studies and 248 patients were included for clinical outcomes. A significant pain reduction favoring PT at 24 hours was detected after meta-analysis and corresponding sensitivity analysis. The estimated effect size ranged from -2.31 to -2.93 cm, with confidence intervals aligned to the left indicating a robust steady decrease in pain across studies. This effect was not observed after 1 month. A total of 18 complications were reported, 13 in the AIC group and 5 in the PT group. Four cadaveric studies were included, 3 favored PT on the quantity of bone graft harvested. Five cell-based studies were included, only one study favored AIC for quality of bone graft. Our study concludes that PT bone harvest is a reliable option for bone grafting regarding morbidity, complications, volume graft obtained, and cellular and molecular properties. However, the current evidence is still insufficient to draw definitive conclusions, especially in terms of bone healing. PROSPERO Register: CRD42020198150.

Auricular surface morphology and surface area does not influence subchondral bone density distribution in the dysfunctional sacroiliac joint.

The subchondral lamella of the sacroiliac auricular surface is morphologically inconsistent. Its morpho-mechanical relationship with dysfunction (SIJD) remains unstudied. Here, the iliac and sacral subchondral bone mineralization is compared between morphological subtypes and in large and small surfaces, in SIJD joints and controls. CT datasets from 29 patients with bilateral or unilateral SIJD were subjected to CT-osteoabsorptiometry. Surface areas and posterior angles were calculated and surfaces were classified by size: small (<15 cm3 ) and large (≥15 cm3 ), and morphological types: 1 (>160°), 2 (130°-160°), and 3 (<130°). Mineralization patterns were identified: two marginal (M1 and M2) and two non-marginal (N1 and N2). Each sacral and iliac surface was subsequently classified. Dysfunctional cohort area averaged 15.0 ± 2.4 cm2 (males 16.2 ± 2.5 cm2 , females 13.7 ± 1.6 cm2 ). No age correlations with surface area were found nor mean Hounsfield Unit differences when comparing sizes, sexes or morphology-type. Controls and dysfunctional cohort comparison revealed differences in female sacra (p = 0.02) and small sacra (p = 0.03). There was low-conformity in marginal and non-marginal patterns, 26% for contralateral non-dysfunctional joints, and 46% for dysfunctional joints. The majority of painful joints was of type 2 morphology (59%), equally distributed between small (49%) and large joints (51%). Larger joints had the highest frequency of dysfunctional joints (72%). Auricular surface morphology seems to have little impact on pain-related subchondral lamella adaptation in SIJD. Larger joints may be predisposed to the onset of pain due to the weakening of the extracapsular structures. Dysfunctional joints reflect common conformity patterns of sacral-apex mineralization with corresponding superior corner iliac mineralization.

Bone resorption after maxillary reconstruction with the vascularized free iliac flap.

The aim of this study was to evaluate the resorption of the iliac bone after maxillary reconstruction with a vascularized free iliac flap. Twenty-seven patients with maxillary defects who underwent maxillary reconstruction with the vascularized free iliac flap between January 2017 and January 2021 were included. Computed tomography (CT) images taken at 1 week, approximately 6 months, and 1 year after the surgery were used for evaluation. The total iliac bone thickness and height, cortical bone thickness, and cancellous bone density were measured in the CT images. Compared with 1 week after the surgery, the total thickness and height of the iliac bone were reduced significantly 1 year after the surgery, and the cortical bone thickness and cancellous bone density were reduced significantly at 6 months and 1 year after the surgery. Compared with 6 months after the surgery, cancellous bone density was reduced significantly 1 year after the surgery. In conclusion, during the first year after maxillary reconstruction with a vascularized free iliac flap, there was significant resorption of iliac bone, including the total iliac bone thickness and height, the cortical bone thickness, and the cancellous bone density.

Optimization strategy of anesthesia in elderly patients undergoing hip fracture surgery: combination of esketamine and fascia iliaca compartment-subarachnoid block / 中华麻醉学杂志

Objective:To evaluate the efficacy of esketamine combined with fascia iliaca compartment-subarachnoid block in optimizing anesthesia in elderly patients undergoing hip fracture surgery.Methods:Sixty-two American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ elderly patients of either sex, aged 60-85 yr, with body mass index of 18.5-30.0 kg/m 2, were divided into 2 groups ( n=31 each) using a random number table method: fascia iliaca compartment-subarachnoid block group (FS group) and esketamine combined with fascia iliaca compartment-subarachnoid block group (ES group). In FS group, patients underwent ultrasound-guided fascia iliaca compartment block at 30 min before the operation of subarachnoid anesthesia on the surgical side. In ES group, esketamine 0.25 mg/kg was intravenously administered at 5 min before skin incision based on the fascia iliaca compartment-subarachnoid block. Patient-controlled intravenous analgesia was used for postoperative analgesia, and tramadol 1 mg/kg was intravenously given for rescue analgesia when numerical rating scale score > 4. The pressing times of patient-controlled analgesic pump, the number of rescue analgesia and consumption of tramadol were recorded within 48 h after operation. The occurrence of postoperative adverse reactions (respiratory depression, nausea and vomiting, dizziness, drowsiness, pruritus, illusion, nightmares) was recorded. Results:Compared with FS group, the consumption of postoperative tramadol was significantly decreased, and the pressing times of patient-controlled analgesic pump and the number of rescue analgesia were reduced in ES group ( P<0.05). There were no significant differences in the incidence of postoperative adverse reactions between the two groups ( P>0.05). Conclusions:Combination of esketamine with fascia iliaca compartment-subarachnoid block for hip fracture surgery can raise postoperative analgesia and optimize clinical management strategies in elderly patients.