AP pelvis radiograph is insufficient for diagnosis of U-type sacral fractures.

PURPOSE: We investigated the sensitivity of a screening test for pelvic ring disruption, the AP pelvis radiograph, for clinically serious U-type sacral fractures which merit consultation with an orthopedic trauma specialist and may require transfer to a higher level of care. METHODS: Retrospective clinical cohort of 63 consecutive patients presenting with U-type sacral fractures at one level 1 trauma referral center from January 2006 through December 2019. The sensitivity of the first AP pelvis radiograph obtained on admission, interpreted without reference to antecedent or concomitant pelvis computed tomography (CT) by a radiologist and a panel of three blinded orthopedic traumatologists, was determined against a reference diagnosis made from review of all pelvis radiographs, CT images, operative reports, and clinical documentation. RESULTS: Sensitivity of AP pelvis radiograph for U-type sacral fractures was 2% as interpreted by a radiologist and mean 12% (range 5-27%) as interpreted by orthopedic traumatologists with poor inter-rater agreement (Fleiss' κ = 0.11). 94% of sacra were at obscured by radiographic artifact. CONCLUSION: The sensitivity of an AP pelvis radiograph is poor for U-type sacral fractures, whether interpreted by radiologists or orthopedic traumatologists. Pelvis CT should be considered as a screening test to rule out sacral fracture when the patient reports posterior pelvic pain, even if plain radiography demonstrates no injury or a minimally displaced pelvic ring disruption. LEVEL OF EVIDENCE: Diagnostic level III.

Periprosthetic Fractures: A Common Problem with a Disproportionately High Impact on Healthcare Resources.

The present study evaluated the frequency of periprosthetic fractures and tested the hypothesis that this population's demographics and outcomes are unique as compared with other arthroplasty patients. The National Hospital Discharge Survey provided the raw data. Individuals admitted with a primary TKA, primary THA, or revision TJA were selected. Annual rates were then calculated and demographics and outcomes compared. 30,624 patients were reviewed. The proportion of admissions for periprosthetic fractures ranged from 4.2% to 7.4% annually. As compared to patients admitted for other TJA diagnoses, individuals admitted with periprosthetic fracture were older, were more often female, were more often admitted emergently/urgently, had longer lengths of stay, had higher rates of discharge to places other than home, and had a significantly elevated mortality.

What ape proximal femora tell us about femoroacetabular impingement: a comparison.

BACKGROUND: Human hip morphology is variable, and some variations (or hip morphotypes) such as coxa profunda and coxa recta (cam-type hip) are associated with femoroacetabular impingement and the development of osteoarthrosis. Currently, however, this variability is unexplained. A broader perspective with background information on the morphology of the proximal femur of nonhuman apes is lacking. Specifically, no studies exist of nonhuman ape femora that quantify concavity and its variability. QUESTIONS/PURPOSES: We hypothesized that, when compared with modern humans, the nonhuman apes would show (1) greater proximal femoral concavity; (2) less variability in concavity; and (3) less sexual dimorphism in proximal femoral morphology. METHODS: Using identical methods, we compared 10 morphological parameters in 375 human femora that are part of the Hamann-Todd collection at the Cleveland Museum of Natural History with 210 nonhuman ape femora that are part of the collection of the Royal Museum for Central Africa, Tervuren, Belgium, and the Muséum National d'Histoire Naturelle, Paris, France. RESULTS: The nonhuman apes have larger proximal femoral concavity than modern humans. This morphology is almost uniform without large variability or large differences neither between species nor between sexes. CONCLUSIONS: Variability is seen in human but not in nonhuman ape proximal femoral morphology. An evolutionary explanation can be that proximal femoral concavity is more important for the nonhuman apes, for example for climbing, than for modern humans, where a lack of concavity may be related to high loading of the hip, for example in running.

Proximal femoral anatomy in the normal human population.

UNLABELLED: In this study, we developed a complete description of the morphology of the proximal femur. Then, using this framework, we (1) determined normal population means, standard deviations, and ranges; (2) established differences among subpopulations; and (3) showed correlations among the various measurements. To accomplish these objectives, we analyzed 375 adult femurs. Specimens were digitally photographed in standardized positions, measurements being obtained using ImageJ software. Three parameters of the head-neck relationship were assessed. Translation was examined through four raw offset measurements (anterior, posterior, superior, inferior) used to calculate anterior-posterior and superior-inferior ratios. Rotation was investigated through anteroposterior (AP) and lateral physeal angles. Concavity was examined using alpha, beta, gamma, and delta angles. Two parameters of the neck-shaft relationship were assessed, neck version and angle of inclination. Average anterior-posterior and superior-inferior ratios were 1.14 and 0.90. Average AP and lateral physeal angles were 74.33 degrees and 81.83 degrees , respectively. Averages for alpha, beta, gamma, and delta angles were 45.61 degrees , 41.85 degrees , 53.46 degrees , and 42.95 degrees , respectively. Average neck version and angle of inclination were 9.73 degrees and 129.23 degrees , respectively. Differences existed between males and females and between those younger and older than 50 years. Correlations were observed between translation and concavity, and translation and the neck-shaft relationships. LEVEL OF EVIDENCE: Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.