OPTY-LINE remote-controlled adjustable intramedullary device implantation in open-wedge high tibial osteotomy: A prospective proof-of-concept pilot and comparison with Tomofix fixed-plate device method.

PURPOSE: The objective was to evaluate the clinical and patient-related short- to medium-term performance of the OPTY-LINE nail device for high tibial osteotomy (HTO), comparing a case series of the said device to the established Tomofix fixed-plate device. PATIENTS AND METHODS: Males with symptomatic medial compartmental osteoarthritis and no serious (co-morbid) knee pathology were followed up, five Tomofix and six OPTY-LINE patients. Patients underwent computed tomography assessment and completed Knee Injury and Osteoarthritis Outcome score (KOOS) and osteotomy surgery patient satisfaction questionnaires, 3 and 6 months post-surgery. A radiologist impression score and a quantitative digital bone density analysis were performed by two independent radiologists. Mann-Whitney U test was applied for inferential statistical tests. RESULTS: At 6 months post-surgery, for Tomofix, the median radiologists' healing impression score was 'progressive healing' versus 'union virtually complete' for the OPTY-LINE nail; bone healing quotient was 1.30 (standard deviation (SD) 1.74) versus 1.78 (SD 1.58), p = 0.18. The post-operative absolute surgical accuracy was a mean 12 (7.5) for Tomofix versus 4.1 (2.3) for OPTY-LINE, p = 0.052. At baseline, however, Tomofix patients had more knee symptoms, as determined by KOOS symptom sub-score, when compared to the OPTY-LINE cohort (p = 0.009). CONCLUSION: This initial, non-randomized, comparative evaluation of the OPTY-LINE device for HTO has produced similar outcomes to patients treated with the established Tomofix device. In particular, the rate of post-surgical bone regeneration and surgical accuracy achieved with the OPTY-LINE device are encouraging. Large-scale randomized controlled studies with longer follow-up are indicated to further evaluate the clinical and patient-related outcome performance for OPTY-LINE.

The role of ultrasonography in the diagnosis of occult scaphoid fractures.

Background: Ultrasonography is widely utilized by emergency physicians and radiologists to diagnose various orthopaedic diseases, including fractures. We aim to derive a definitive estimate of the diagnostic accuracy of ultrasonography in clinically suspected scaphoid fractures. Methods: We undertook a systematic review and meta-analysis of included diagnostic cohort studies that discussed the use of ultrasonography in the diagnosis of occult scaphoid fractures. We searched the National Institute for Health and Care Excellence database using the Healthcare Databases Advanced Search tool. In addition, we utilized the PubMed database to search the Medical Literature Analysis and Retrieval System Online, Excerpta Medica database, Cumulative Index of Nursing and Allied Health and Allied and Complimentary Medicine databases. Studies were included if they discuss the role of ultrasound imaging in the diagnosis of scaphoid fractures based on cortical interruption, radio-carpal effusion and scapho-trapezium-trapezoid effusion. Quality assessment was performed using the methodological index for non-randomized studies scoring system. Results: 6 non-randomized control studies met the inclusion criteria. Collectively, these included 236 patients with a mean age ranging from 18 to 41.2 years. The quality of these articles ranged between moderate and high based on the methodological index for non-randomized studies score. The mean sensitivity was 88.95% (standard deviation 10.03) and mean specificity was 89.50% (standard deviation 12.21). Conclusion: The current literature reveals high sensitivity and specificity in the use of ultrasonography in scaphoid fracture diagnosis. However, multiple factors including technical differences in ultrasound machines and probes, small sample sizes and variability of subsequent confirmatory tests have created a challenge in determining the ultimate reliability of ultrasonography in the diagnosis of occult scaphoid fractures. Considering these factors and limitations, large-sample and high-quality clinical trials are needed to adequately assess its reliability for this purpose. One stop clinics, in the authors' opinion, would be an ideal setting for its introduction as well as for future trials.Background: Ultrasonography is widely utilized by emergency physicians and radiologists to diagnose various orthopaedic diseases, including fractures. We aim to derive a definitive estimate of the diagnostic accuracy of ultrasonography in clinically suspected scaphoid fractures. Methods: We undertook a systematic review and meta-analysis of included diagnostic cohort studies that discussed the use of ultrasonography in the diagnosis of occult scaphoid fractures. We searched the National Institute for Health and Care Excellence database using the Healthcare Databases Advanced Search tool. In addition, we utilized the PubMed database to search the Medical Literature Analysis and Retrieval System Online, Excerpta Medica database, Cumulative Index of Nursing and Allied Health and Allied and Complimentary Medicine databases. Studies were included if they discuss the role of ultrasound imaging in the diagnosis of scaphoid fractures based on cortical interruption, radio-carpal effusion and scapho-trapezium-trapezoid effusion. Quality assessment was performed using the methodological index for non-randomized studies scoring system. Results: 6 non-randomized control studies met the inclusion criteria. Collectively, these included 236 patients with a mean age ranging from 18 to 41.2 years. The quality of these articles ranged between moderate and high based on the methodological index for non-randomized studies score. The mean sensitivity was 88.95% (standard deviation 10.03) and mean specificity was 89.50% (standard deviation 12.21). Conclusion: The current literature reveals high sensitivity and specificity in the use of ultrasonography in scaphoid fracture diagnosis. However, multiple factors including technical differences in ultrasound machines and probes, small sample sizes and variability of subsequent confirmatory tests have created a challenge in determining the ultimate reliability of ultrasonography in the diagnosis of occult scaphoid fractures. Considering these factors and limitations, large-sample and high-quality clinical trials are needed to adequately assess its reliability for this purpose. One stop clinics, in the authors' opinion, would be an ideal setting for its introduction as well as for future trials.

Scaphoid Fracture in a Patient with a Scaphotrapezial Synostosis: A Case Report and Literature Review.

Introduction. Scaphotrapezial synostosis has been rarely reported in the literature and only one case underwent surgical treatment for scaphoid fracture. Presentation of Case. A 15-year-old male presented with a painful left wrist following a fall. The initial radiographs showed a displaced scaphoid proximal pole fracture and a Scaphotrapezial synostosis. The fracture was then fixed percutaneously with satisfactory outcome. Discussion. Scaphotrapezial synostoses are very rare and most found in patients with multiple congenital anomalies or as part of a hereditary syndrome. They have previously been reported; however, we found only one case reporting a concomitant scaphoid fracture. Conclusion. This is the second case of its kind to report surgical treatment of scaphoid fracture associated with a congenital Scaphotrapezial synostosis.

Early MRI diagnostics for suspected scaphoid fractures subsequent to initial plain radiography.

AIM: In the United Kingdom, diagnostic management of patients presenting to emergency department with a scaphoid injury varies. Follow-up plain radiographs, after an initial inconclusive X-ray, are common practice. We optimised the diagnostic pathway for these patients by focusing on the most appropriate diagnostic modality and on minimising the time to follow-up diagnostics. MATERIALS AND METHODS: A baseline audit in the period 2008-2009 involving a total of 184 patients was conducted, and after the introduction of new local guidelines for scaphoid injury diagnostics, a follow-up audit involving 79 patients was undertaken in 2010-2012. RESULTS: In the original audit, 130 patients had only scaphoid radiographs, of which 23 underwent initial and follow-up X-rays, and 107 initial-only radiographs. Of those 23, just one single patient (4%) displayed a scaphoid fracture. Others underwent three imaging procedures: initial radiographs, follow-up radiographs and either bone scan (41 patients) or MRI (13 patients). A further 6/41 (15%) and 4/13 (31%) fractures were detected by bone scan and MRI, respectively. In the re-audit, when MRI replaced follow-up X-rays and bone scans, 7 out of 77 (9%) patients were diagnosed with scaphoid fracture. Time from initial plain radiograph to follow-up MRI was reduced from an original mean of 36 to 14 days during the re-audit period. CONCLUSION: The introduction of early MRI enhances scaphoid injury diagnostics and accelerates patient management. We therefore endorse the introduction of this approach on a wider scale through an update of the clinical guidelines for scaphoid injuries.

Indirect magnetic resonance arthrography of the shoulder; a reliable diagnostic tool for investigation of suspected labral pathology.

PURPOSE: Indirect magnetic resonance arthrography (I-MRA) confers significant logistical advantages over direct MRA and does not require articular injection. In this study, we determined the diagnostic performance of I-MRA in relation to conventional MRI and arthroscopy or surgery in detecting tears of the glenoid labrum, including Bankart lesions and superior labral antero-posterior (SLAP) tears in a standard clinical setting. PATIENTS AND METHODS: Ninety-one symptomatic patients underwent conventional MRI and I-MRA of the affected shoulder, followed by either arthroscopy or open surgery. The scans were interpreted independently by two experienced radiology consultants with a special interest in musculoskeletal radiology. Using the surgical findings as the standard of reference, sensitivity, specificity, and diagnostic accuracy of conventional non-contrast MRI and I-MRA in the detection of labral tears were calculated. RESULTS: The sensitivity of I-MRA was 95 and 97 %, respectively, for two radiologists as opposed to 79 and 83 % for conventional MRI. For both radiologists, the specificity of I-MRA, as well as MRI, was 91 % for detection of labral tears of all types. Accuracy of diagnosis was 93 and 95 %, respectively, for two radiologists with indirect MRA, compared to 84 and 86 % with non-contrast MRI. CONCLUSIONS: This retrospective study shows that I-MRA is a highly accurate and sensitive method for the detection of labral tears. The data obtained supports the use of I-MRA as standard practice in patients with shoulder instability due to suspected labral pathology where further investigative imaging is indicated.