Reducing radiation exposure and cancer risk for children with scoliosis: EOS the new gold standard.

PURPOSE: Children are exposed to significant radiation doses during the investigation and treatment phases of scoliosis. EOS is a new form of low-dose radiation scan which also yields great image quality. However, currently its use is discouraged in the UK due to higher costs. We aimed to quantify the additional radiation dose and cancer risk. METHODS: We retrospectively reviewed all paediatric cases who received both standing whole spine roentgenograms and EOS scans as part of their investigations for scoliosis during a six-month period. We compared the radiation doses between the two modalities and estimated the additional mean lifetime cancer risk per study. RESULTS: We identified 206 children (mean age 14.4) who met the criteria of having both scans. Dose area products (dGycm2) were converted to estimated effective doses (mSv). The total mean doses were 0.68 mSv (PA 0.49 + Lat 0.19) for plain films, and 0.13 mSv (PA 0.08 + Lat 0.04) for EOS scans (p < 0.001). Additional lifetime cancer risk of a plain film was 543% greater than EOS for both sexes (1/10727 versus 1/5827 in males, 1/34483 versus 1/6350 in females). CONCLUSION: There is approximately 5.4-fold increase in risk of cancer for both boys and girls with roentgenograms over EOS, with girls being the most impacted. This carries a significant impact when considering the need for repeat imaging on additional lifetime malignancy risk in children. In our opinion, EOS dual planar scanning is the new gold standard when X-ray of the whole spine is required. LEVEL OF EVIDENCE: III.

Thoracolumbar spine trauma: a guide for the FRCS examination.

Thoracolumbar spine injuries are commonly seen in trauma settings and have a high risk of causing serious morbidity. There can be controversy when it comes to classifying thoracolumbar injuries within the spinal community, but there remains a need to classify, evaluate and manage thoracolumbar fractures. This article aims to provide a guide on classification of thoracolumbar spine injuries using the AO Spine Thoracolumbar Injury Classification System (AO TLICS).

Computerized dynamic posturography analysis of balance in individuals with a shoulder stabilization sling.

INTRODUCTION: Sling immobilization of the upper limb may affect balance. Computerized dynamic posturography (CDP) provides a validated, objective assessment of balance control and postural stability under dynamic test conditions. We tested the balance of individuals with a shoulder stabilization sling (SSS) using an EquiTest machine to objectively assess imbalance while wearing a sling. METHODS: Forty-two right hand dominant (RHD) adults (16 females, 26 males; average age 22 years; range 20-35 years) were included in the study, comprising six controls and two SSS groups with 18 dominant hands (DH) and 18 non dominant hands (NDH). CDP assessed balance by the Sensory Organization Test (SOT), Motor Control Test (MCT), and Adaptation Test (ADT). RESULTS: The composite equilibrium scores (CES) were as follows: controls 80.8 %, sling DH 71.1 versus sling NDH 69.6 %. Sling use has lower CES compared to controls (p = 0.025). The use of a sling caused 31 % of subjects to have decreased CES. 22.9 % of sling users had imbalances. Among sling users, the DH group had 19.1 % imbalances compared to 26.8 % for the NDH group (p = 0.044). There were six absolute falls in the DH group versus 12 in the NDH group. CONCLUSIONS: Wearing a sling causes balance decompensation in almost one-third of healthy volunteers, and this is greater when worn in the non dominant hand, with double the number of falls. This has significant implications for patients having prolonged use of a sling. Consideration should be given to operative procedures or conservative management of shoulder pathology where sling use is required and promotion of the early discontinuation of sling use can be considered.

The management and outcome of lateral process fracture of the talus.

BACKGROUND: Lateral process fractures of the talus are a rare injury with significant associated morbidity when missed. Only a small number of case series' and reports are available and the appropriate management of these fractures is not really known. METHODS: We reviewed available English language literature for reports and series of lateral process fractures of talus. Only papers in which the classification of fracture, management and outcome were clear were included in our analyses. RESULTS: 109 Cases in total were identified including four cases from a personal series. 50 Type I, 17 type II and 29 type III fractures were analysed. A significant number of patients required late surgery when the diagnosis was initially missed. CONCLUSION: Type I fractures are best treated with ORIF, type II with excision and type III with casting. Fractures presenting late that are not united should be excised if small and internally fixed if large.

The effect of body mass index on outcomes after total ankle replacement.

Total ankle replacement is an established alternative to ankle fusion in selected patients. One of the possible exclusions used is the presence of a high BMI. This is based on our experience with hip and knee replacements where poor outcomes have been associated with obesity, however little work has been done on this subject in the ankle. We report the first series solely focussing on the impact of BMI on TAR. Forty five consecutive patients were identified and followed up using the SF-36 and VAS-FA. All patients had their BMI collected prospectively and BMI at latest follow-up was calculated. There was an average 5-year follow-up with just 9 (20%) lost to follow-up. At final follow-up 8 (17.7%) patients were deceased, none of the deaths were attributable to their previous ankle surgery. We did not find an association between high BMI and reduced outcomes or need for secondary surgery. In addition there was no significant change in BMI after surgery.