Impact of acetabular roof's angle on precision of cup center of rotation reproduction and placement in total hip arthroplasty.

Introduction: Total hip arthroplasty (THA) is nowadays considered as the most effective treatment option for end-stage hip osteoarthritis (OA) and one of the most successful orthopedic procedures. Precise reproduction of the center of rotation (COR) is among the most important aspects of recreating native hip biomechanics after THA as it is strictly related to muscle tension and force distribution within the hip joint. Both vertical and horizontal shift in cup positioning and COR restoration are commonly observed radiological signs corresponding with lesser functional outcome. The aim of this study was to assess whether the superior border of the native acetabulum morphology has an impact on cup positioning and COR restoration in patients undergoing THA as treatment of primary OA of the hip. Material and methods: A cohort of 150 consecutive patients with diagnosis of end-stage primary hip OA who underwent THA via an anterolateral approach with the same implant in 2021 was analyzed retrospectively. Standard standing pelvic X-rays were performed pre- and postoperatively and appropriate measurements were taken. Several radiological parameters on obtained X-rays were assessed. Statistical analysis of all the measurements was performed. Results: There was a statistically significant positive weak correlation between cup offset and acetabular roof angle (rs = 0.25, p = 0.002). There were statistically insignificant positive correlations between acetabular roof angle and COR restoration (rs = 0.14, p = 0.097), acetabular roof angle and total offset (rs = 0.087, p = 0.29) and a negative correlation between acetabular roof angle and femoral offset (rs = 0.071, p = 0.39). Conclusions: The present study revealed that preoperative acetabular roof angle influences the positioning of the prosthetic cup in the transverse axis. There also seems to be a correlation between the acetabular roof angle and COR restoration, but its significance needs further evaluation. Surgeons could use this knowledge to preoperatively assess the risk of cup malposition and adjust their technique during the THA procedure with probable improvement of hip function.

Liliequist membrane: A systematic review of history, anatomy, clinical importance, and surgical challenges.

BACKGROUND: The Liliequist membrane (LM) represents a crucial yet challenging anatomical structure in neuroanatomy. First observed in 1875 and later elucidated by Bengt Liliequist in 1956, the LM's precise anatomical description and boundaries remain complex. Its significance extends to neurosurgery, impacting various procedures like endoscopic third ventriculocisternostomies, aneurysm and tumor surgeries, treatment of suprasellar arachnoid cysts, and managing perimesencephalic hemorrhages. However, a comprehensive understanding of the LM is hindered by inconsistent anatomical descriptions and limitations in available literature, warranting a systematic review. METHODS: A systematic review was conducted by searching PubMed, Science Direct, and Google Scholar for articles pertaining to Liliequist's membrane. The search employed Mesh terms like "Liliequist membrane," "Liliequist's diaphragm," and related variations. Inclusion criteria encompassed studies exploring the historical evolution, anatomical structure, radiological characteristics, and clinical implications of the LM in neurosurgery. RESULTS: The search yielded 358 articles, with 276 unique articles screened based on relevance. Following a meticulous screening process, 72 articles underwent full-text assessment, resulting in the inclusion of 5 articles meeting the eligibility criteria. The selected studies varied in methodology, including anatomical dissections, radiological evaluations, and clinical significance in neurosurgical procedures. Insights were derived on LM's anatomical variations, radiological visualization, and its critical role in guiding neurosurgical interventions. CONCLUSIONS: Despite advancements in understanding its clinical significance and radiological visualization, challenges persist in precisely delineating its boundaries. Further research, especially on embryological development and histological characterization, is essential. Enhancing comprehension of LM-related pathologies is crucial for accurate preoperative planning and optimizing patient outcomes in neurosurgery.

Radiological evaluation of odontogenic keratocysts in patients with nevoid basal cell carcinoma syndrome: A review.

Background: Nevoid Basal Cell Carcinoma Syndrome (NBCCS) is an autosomal dominant syndrome that has various expressions in each patient. Generally; NBCCS is followed by multiple nevoid basal cell carcinoma of the skin, orbital anomalies, skeletal anomalies, central nervous system anomalies and multiple odontogenic keratocysts (OK). NBCCS is usually diagnosed between the ages of 5-30 years, with multiple basal cell carcinomas of the skin and OKs in the jaws as the initial findings. The purpose of this paper is to describe and compare the radiographic findings of the OKs in NBCCS patients in the literature with additional cases. Materials and Methods: In this study, we evaluated the OKs of the patients with NBCCS in PubMed Database with 5 additional cases from our database. A total of 305 articles were found and the articles in English with full-text access were evaluated. Results: Despite all limitations for a fair discussion; we would like to state that among 59 cases that specified whether a 3D or 2D imaging modality was used, 29 cases were only interpreted with 2D data which should be avoided in OK evaluation. Discussion: According to the World Health Organization's Classification of Head and Neck Tumours Book which was published in 2017, OKs in NBCCS has a higher chance to have small satellite cystic lesions which increase their recurrence possibility post-operatively, thus, a thorough clinical and 3D radiographic evaluation should be performed both to NBCCS patients and non-syndromic OK patients to avoid any recurrence. Conclusion: High recurrence rates of OKs should be reminded all the time. Radiographic examinations with 3D imaging modalities should be done in patients with NBCCS in order to provide a concise diagnosis and optimum treatment.

[An MRI study of lateral vascular safety zones in oblique lumbar interbody fusion surgery].

Objective: To study the anatomical characteristics of blood vessels in the lateral segment of the vertebral body through the surgical approach of oblique lumbar interbody fusion (OLIF) using MRI imaging, and evaluate its potential vascular safety zone. Methods: The lumbar MRI data of 107 patients with low back and leg pain who met the selection criteria between October 2019 and November 2022 were retrospectively analyzed. The vascular emanation angles, vascular travel angles, and the length of vessels in the lateral segments of the left vertebral body of L 1-L 5, as well as the distance between the segmental vessels in different Moro junctions of the vertebral body and their distances from the edges of the vertebrae in the same sequence (bottom marked as I, top as S) were measured. The gap between the large abdominal vessels and the lateral vessels of the vertebral body was set as the lateral vascular safe zones of the lumbar spine, and the extent of the safe zones (namely the area between the vessels) was measured. The anterior 1/3 of the lumbar intervertebral disc was taken as the simulated puncture center, and the area with a diameter of 22 mm around it as the simulated channel area. The proportion of vessels in the channel was further counted. In addition, the proportions of segmental vessels at L 5 without a clear travel and with an emanation angel less than 90° were calculated. Results: Except for the differences in the vascular emanation angles between L 4 and L 5, the vascular travel angles between L 1, L 2 and L 4, L 5, and the length of vessels in the lateral segments of the vertebral body among L 1-L 4 were not significant ( P>0.05), the differences in the vascular emanation angles, vascular travel angles, and the length of vessels between the rest segments were all significant ( P<0.05). There was no significant difference in the distance between vessels of L 1, L 2 and L 2, L 3 at Moro Ⅰ-Ⅳ junctions ( P>0.05), in L 3, L 4 and L 4, L 5 at Ⅱ and Ⅲ junction ( P>0.05). There was no significant difference in the vascular distance of L 2, L 3 between Ⅱ, Ⅲ junction and Ⅲ, Ⅳ junction, and the vascular distance of L 3, L 4 between Ⅰ, Ⅱ junction and Ⅲ, Ⅳ junction ( P>0.05). The vascular distance of the other adjacent vertebral bodies was significant different between different Moro junctions ( P<0.05). Except that there was no significant difference in the distance between L 2I and L 3S at Ⅰ, Ⅱ junction, L 3I and L 4S at Ⅱ, Ⅲ junction, and L 2I and L 3S at Ⅲ, Ⅳ junction ( P>0.05), there was significant difference of the vascular distance between the bottom of one segment and the top of the next in the other segments ( P<0.05). Comparison between junctions: Except for the L 3S between Ⅰ, Ⅱ junction and Ⅱ, Ⅲ junction, and L 5S between Ⅰ, Ⅱ junction and Ⅱ, Ⅲ and Ⅲ, Ⅳ junctions had no significant difference ( P>0.05), there were significant differences in the distance between the other segmental vessels and the vertebral edge of the same sequence in different Moro junctions ( P<0.05). The overall proportion of vessels in the simulated channels was 40.19% (43/107), and the proportion of vessels in L 1 (41.12%, 44/107) and L 5 (18.69%, 20/107) was higher than that in the other segments. The proportion of vessels in the channel of Moro zone Ⅰ (46.73%, 50/107) and zone Ⅱ (32.71%, 35/107) was higher than that in the zone Ⅲ, while no segmental vessels in L 1 and L 2 were found in the channel of zone Ⅲ ( χ 2=74.950, P<0.001). Moreover, 26.17% (28/107) of the segmental vessels of lateral L 5 showed no movement, and 27.10% (29/107) vascular emanation angles of lateral L 5 were less than 90°. Conclusion: L 1 and L 5 segmental vessels are most likely to be injured in Moro zones Ⅰ and Ⅱ, and the placement of OLIF channels in L 4, 5 at Ⅲ, Ⅳ junction should be avoided. It is usually safe to place fixation pins at the vertebral body edge on the cephalic side of the intervertebral space, but it is safer to place them on the caudal side in L 1, 2 (Ⅰ, Ⅱ junction), L 3, 4 (Ⅲ, Ⅳ junction), and L 4, 5 (Ⅱ, Ⅲ, Ⅳ junctions).

The role of radiology in diagnosis of Zinner syndrome in a young man with scrotal pain.

Zinner Syndrome is a rare congenital anomaly. It is considered a rare cause of male infertility and can cause a range of clinical manifestations that may lead to significant morbidity. The diagnosis of Zinner Syndrome requires a high index of suspicion, combined with a detailed clinical evaluation and imaging studies. Ultrasonography, computed tomography, and MRI are the imaging modalities of choice for the diagnosis of this condition. Radiological evaluation also plays a crucial role in the management of Zinner Syndrome. In symptomatic cases, surgical intervention may be necessary, and radiology is essential for surgical planning and postoperative monitoring. In this case report, we describe an uncommon case of a 35-year-old patient with vague scrotal pain and discuss the clinical presentation, diagnosis, and management of this rare condition. Prompt and accurate diagnosis is important to prevent the potential morbidity associated with this condition, such as recurrent epididymitis, urinary tract infections, and infertility.

How to analyze postoperative radiographs after total hip replacement.

Total hip replacement is one of the most widely performed surgeries. It is stated as the most efficient method of treating end-stage osteoarthritis of the hip joint. What is more, it significantly improves the quality of patients' lives, relieves them from pain and restores decreased range of motion, provided that is conducted properly. Aim of this article is to indicate which constituents of prosthetic placement can be easily measured on postoperative radiographs and point out how to interpret obtained results. Multiple mechanical factors, such as center of rotation, femoral offset, acetabular offset, acetabular inclination, acetabular anteversion and leg length discrepancy can be measured on postoperative radiographs. To provide a successful surgery and to acquire both radiological and clinical satisfying results, proper prosthetic placement is crucial. Malpositioning of each element, in varying degrees may lead to dislocation or reoperation.

Liver lesion changes analysis in longitudinal CECT scans by simultaneous deep learning voxel classification with SimU-Net.

The identification and quantification of liver lesions changes in longitudinal contrast enhanced CT (CECT) scans is required to evaluate disease status and to determine treatment efficacy in support of clinical decision-making. This paper describes a fully automatic end-to-end pipeline for liver lesion changes analysis in consecutive (prior and current) abdominal CECT scans of oncology patients. The three key novelties are: (1) SimU-Net, a simultaneous multi-channel 3D R2U-Net model trained on pairs of registered scans of each patient that identifies the liver lesions and their changes based on the lesion and healthy tissue appearance differences; (2) a model-based bipartite graph lesions matching method for the analysis of lesion changes at the lesion level; (3) a method for longitudinal analysis of one or more of consecutive scans of a patient based on SimU-Net that handles major liver deformations and incorporates lesion segmentations from previous analysis. To validate our methods, five experimental studies were conducted on a unique dataset of 3491 liver lesions in 735 pairs from 218 clinical abdominal CECT scans of 71 patients with metastatic disease manually delineated by an expert radiologist. The pipeline with the SimU-Net model, trained and validated on 385 pairs and tested on 249 pairs, yields a mean lesion detection recall of 0.86±0.14, a precision of 0.74±0.23 and a lesion segmentation Dice of 0.82±0.14 for lesions > 5 mm. This outperforms a reference standalone 3D R2-UNet mdel that analyzes each scan individually by ∼50% in precision with similar recall and Dice score on the same training and test datasets. For lesions matching, the precision is 0.86±0.18 and the recall is 0.90±0.15. For lesion classification, the specificity is 0.97±0.07, the precision is 0.85±0.31, and the recall is 0.86±0.23. Our new methods provide accurate and comprehensive results that may help reduce radiologists' time and effort and improve radiological oncology evaluation.

An MRI study of lateral vascular safety zones in oblique lumbar interbody fusion surgery / 中国修复重建外科杂志

OBJECTIVE@#To study the anatomical characteristics of blood vessels in the lateral segment of the vertebral body through the surgical approach of oblique lumbar interbody fusion (OLIF) using MRI imaging, and evaluate its potential vascular safety zone.@*METHODS@#The lumbar MRI data of 107 patients with low back and leg pain who met the selection criteria between October 2019 and November 2022 were retrospectively analyzed. The vascular emanation angles, vascular travel angles, and the length of vessels in the lateral segments of the left vertebral body of L 1-L 5, as well as the distance between the segmental vessels in different Moro junctions of the vertebral body and their distances from the edges of the vertebrae in the same sequence (bottom marked as I, top as S) were measured. The gap between the large abdominal vessels and the lateral vessels of the vertebral body was set as the lateral vascular safe zones of the lumbar spine, and the extent of the safe zones (namely the area between the vessels) was measured. The anterior 1/3 of the lumbar intervertebral disc was taken as the simulated puncture center, and the area with a diameter of 22 mm around it as the simulated channel area. The proportion of vessels in the channel was further counted. In addition, the proportions of segmental vessels at L 5 without a clear travel and with an emanation angel less than 90° were calculated.@*RESULTS@#Except for the differences in the vascular emanation angles between L 4 and L 5, the vascular travel angles between L 1, L 2 and L 4, L 5, and the length of vessels in the lateral segments of the vertebral body among L 1-L 4 were not significant ( P>0.05), the differences in the vascular emanation angles, vascular travel angles, and the length of vessels between the rest segments were all significant ( P<0.05). There was no significant difference in the distance between vessels of L 1, L 2 and L 2, L 3 at Moro Ⅰ-Ⅳ junctions ( P>0.05), in L 3, L 4 and L 4, L 5 at Ⅱ and Ⅲ junction ( P>0.05). There was no significant difference in the vascular distance of L 2, L 3 between Ⅱ, Ⅲ junction and Ⅲ, Ⅳ junction, and the vascular distance of L 3, L 4 between Ⅰ, Ⅱ junction and Ⅲ, Ⅳ junction ( P>0.05). The vascular distance of the other adjacent vertebral bodies was significant different between different Moro junctions ( P<0.05). Except that there was no significant difference in the distance between L 2I and L 3S at Ⅰ, Ⅱ junction, L 3I and L 4S at Ⅱ, Ⅲ junction, and L 2I and L 3S at Ⅲ, Ⅳ junction ( P>0.05), there was significant difference of the vascular distance between the bottom of one segment and the top of the next in the other segments ( P<0.05). Comparison between junctions: Except for the L 3S between Ⅰ, Ⅱ junction and Ⅱ, Ⅲ junction, and L 5S between Ⅰ, Ⅱ junction and Ⅱ, Ⅲ and Ⅲ, Ⅳ junctions had no significant difference ( P>0.05), there were significant differences in the distance between the other segmental vessels and the vertebral edge of the same sequence in different Moro junctions ( P<0.05). The overall proportion of vessels in the simulated channels was 40.19% (43/107), and the proportion of vessels in L 1 (41.12%, 44/107) and L 5 (18.69%, 20/107) was higher than that in the other segments. The proportion of vessels in the channel of Moro zone Ⅰ (46.73%, 50/107) and zone Ⅱ (32.71%, 35/107) was higher than that in the zone Ⅲ, while no segmental vessels in L 1 and L 2 were found in the channel of zone Ⅲ ( χ 2=74.950, P<0.001). Moreover, 26.17% (28/107) of the segmental vessels of lateral L 5 showed no movement, and 27.10% (29/107) vascular emanation angles of lateral L 5 were less than 90°.@*CONCLUSION@#L 1 and L 5 segmental vessels are most likely to be injured in Moro zones Ⅰ and Ⅱ, and the placement of OLIF channels in L 4, 5 at Ⅲ, Ⅳ junction should be avoided. It is usually safe to place fixation pins at the vertebral body edge on the cephalic side of the intervertebral space, but it is safer to place them on the caudal side in L 1, 2 (Ⅰ, Ⅱ junction), L 3, 4 (Ⅲ, Ⅳ junction), and L 4, 5 (Ⅱ, Ⅲ, Ⅳ junctions).

Radiological Association Between Multiple Sclerosis Lesions and Serum Vitamin D Levels.

INTRODUCTION: The primary aim of this study was to determine a plausible association between the radiological location of multiple sclerosis (MS) lesions and serum 25-hydroxyvitamin D (vitamin D) levels at the time of diagnosis. MS is a common immune-mediated neurological condition mainly affecting the central nervous system. Although the association of vitamin D levels is well established, there have not been many studies to propose a connection between the location of the lesions based on serum vitamin D levels. In this study, we determine the association between serum 25-hydroxyvitamin D and the radiological distribution of lesions in patients with MS. METHODS: Twenty patients with a confirmed diagnosis of MS involving new T2-weighted and gadolinium-enhancing T1-weighted lesions in the entire central nervous system (brain and spinal cord) with serum 25-hydroxyvitamin D levels at the time of diagnosis were included in a case group. As a reference, 20 patients with a confirmed diagnosis of MS with isolated new T2-weighted and gadolinium-enhancing T1-weighted lesions (either supratentorial, infratentorial, or spinal cord) with serum 25-hydroxyvitamin D levels at the time of diagnosis were included in the control group. RESULTS: The mean serum 25-hydroxyvitamin D level was significantly low in the case group compared to the control group (36.2 ± 17.2 vs 62.6 ± 21.0; p-value <0.0001). CONCLUSION: There is a plausible inverse relationship between serum vitamin D and the MS lesions involving the entire central nervous system (brain and spinal cord). This evidence may enable clinicians to forecast disease load based on serum vitamin D levels.

Radiological evaluation of patellofemoral instability and possible causes of assessment errors: Letter to the editor.

This letter to the editor is a commentary on the study titled "Radiological evaluation of patellofemoral instability and possible causes of assessment errors". There are some pertinent structural changes and radiological findings that should be considered in the setting of traumatic knee injuries, as their recognition is of paramount importance.

Hip dysplasia in adolescence: osteotomy in childhood improves the results of periacetabular osteotomy in adolescents and young adults : a prospective study.

AIMS: Developmental dysplasia of the hip (DDH) describes a pathological relationship between the femoral head and acetabulum. Periacetabular osteotomy (PAO) may be used to treat this condition. The aim of this study was to evaluate the results of PAO in adolescents and adults with persistent DDH. METHODS: Patients were divided into four groups: A, adolescents who had not undergone surgery for DDH in childhood (25 hips); B, adolescents who had undergone surgery for DDH in childhood (20 hips); C, adults with DDH who had not undergone previous surgery (80 hips); and D, a control group of patients with healthy hips (70 hips). The radiological evaluation of digital anteroposterior views of hips included the Wiberg angle (centre-edge angle (CEA)), femoral head cover (FHC), medialization, distalization, and the ilioischial angle. Clinical assessment involved the Harris Hip Score (HHS) and gluteal muscle performance assessment. RESULTS: Significant improvements in radiological parameters were achieved in all measurements in all groups (p < 0.05). The greatest improvement was in CEA (mean of 19° (17.2° to 22.3°) in Group B), medialization (mean of 3 mm (0.9 to 5.2) in Group C), distalization (mean of 6 mm (3.5 to 8.2) in Group B), FHC (mean of 17% (12.7% to 21.2%) in Group B), and ilioischial angle (mean of 5° (2.3° to 8.1°) in Group B). There were significant improvements in the mean HHS and gluteal muscle performance scores postoperatively in all three groups. CONCLUSION: The greatest correction of radiological parameters and clinical outcomes was found in patients who had undergone hip surgery in childhood. Although the surgical treatment of DDH in childhood makes subsequent hip surgery more difficult due to scarring, adhesions, and altered anatomy, it requires less correction of the deformity and has a beneficial effect on the outcome of PAO in adolescence and early adulthood. Cite this article: Bone Joint J 2022;104-B(7):775-780.

Radiological evaluation of patellofemoral instability and possible causes of assessment errors.

Patellofemoral instability (PI) is the disruption of the patella's relationship with the trochlear groove as a result of abnormal movement of the patella. To identify the presence of PI, conventional radiographs (anteroposterior, lateral, and axial or skyline views), magnetic resonance imaging, and computed tomography are used. In this study, we examined four main instability factors: Trochlear dysplasia, patella alta, tibial tuberosity-trochlear groove distance, and patellar tilt. We also briefly review some of the other assessment methods used in the quantitative and qualitative assessment of the patellofemoral joint, such as patellar size and shape, lateral trochlear inclination, trochlear depth, trochlear angle, and sulcus angle, in cases of PI. In addition, we reviewed the evaluation of coronal alignment, femoral anteversion, and tibial torsion. Possible causes of error that can be made when evaluating these factors are examined. PI is a multi-factorial problem. Many problems affecting bone structure and muscles morphologically and functionally can cause this condition. It is necessary to understand normal anatomy and biomechanics to make more accurate radiological measurements and to identify causes. Knowing the possible causes of measurement errors that may occur during radiological measurements and avoiding these pitfalls can provide a more reliable road map for treatment. This determines whether the disease will be treated medically and with rehabilitation or surgery without causing further complications.

Comparative Analysis of Radiological Evaluation and Early Functional Outcomes of Total Knee Arthroplasty Using an Accelerometer-Based Handheld Navigation System and Conventional Instrumentation: A Prospective Study.

Background An accelerometer-based handheld navigation system (HHNS) for total knee arthroplasty (TKA) does not require a large console needed for computer-assisted navigation systems and has been shown to decrease component malalignment in TKA. The study aimed to use HHNS with conventional instrumentation to compare the radiological evaluation and functional outcomes of TKA. Materials and methods This was a multi-surgeon, prospective, assessor-blinded comparative study of 122 patients undergoing unilateral TKA. We used a stratified randomized sampling method to select 35/48 patients undergoing TKA using a handheld navigation system and 35/74 patients undergoing TKA using conventional instrumentation and divided them into two groups: the HHNS group and (conventional) CONV group. Postoperative radiographic evaluation was based on the tibial and femoral alignment angle, posterior tibial slope, and tibiofemoral angle measured from full-length lower-limb anteroposterior and lateral views of the knee. The Oxford Knee Score (OKS) and Knee Society Score (KSS) with a two-year serial follow-up were used to evaluate functional outcomes. Results The mean tibial alignment angle and posterior tibial slope were 0.78° ± 1.27° and 4.38° ± 0.86°, respectively, in the HHNS cohort and 2.63° ± 1.54° and 2.12° ± 1.82°, respectively, in the CONV group (p < 0.001). There was no significant difference in the femoral alignment angles. The overall alignment using the mean tibiofemoral angle was 179.21° ± 1.82° in the HHNS group and 177.31° ± 2.18° in the CONV group (p = 0.002). There were no significant differences in the KSS and OKS at the two-year follow-up between the groups. Conclusions The use of HHNS in TKA significantly increased accuracy in limb and implant alignment, but there was no significant difference in the two-years functional outcomes.

Radiological evaluation of postoperative osteomyelitis in long bones: Which is the best tool?

Currently, definitive diagnosis of osteomyelitis involves a combination of clinical signs, symptoms, laboratory tests, imaging modalities and cultures from blood, joint or body fluid. Imaging plays a critical role in the osteomyelitis diagnosis. Each of these tests incurs an additional cost to the patient or healthcare system and their use varies according to the preference of the healthcare professional and the healthcare setup. Imaging plays a critical role in the diagnosis and management of postoperative long bone osteomyelitis, with the aim of reducing long-term complications such as non-union, amputation and pathological fractures. In this review, we discuss the key findings on different radiological modalities and correlate them with disease pathophysiology. Currently, magnetic resonance imaging is the best available imaging modality due to its sensitivity in detecting early signs of long bone osteomyelitis and high soft tissue resolution. Other modalities such as radio-nuclear medicine, computed tomography and ultrasound have been proved to be useful in different clinical scenarios as described in this narrative review.

A proposed "Radiological Evaluation Score for Bone Tumors" (REST): An objective system for assessment of a radiograph in patients with suspected bone tumor.

BACKGROUND: Although radiographs have been widely used in the evaluation of patients with suspected bone tumors, the lack of an objective radiological assessment method leads to a challenge in reaching correct diagnosis. The study aimed to propose a Radiological Evaluation Score for Bone Tumors (REST) which includes eight radiological factors [characteristics, content, cortical breach, distinctiveness, distribution, periosteal reaction, fracture, and soft tissue swelling] to form a single score along with its validation by multidisciplinary observers. METHODS: We reviewed the radiographs of 100 patients with a primary bone tumor which were selected at random from the database between January 2017 and January 2019 of a tertiary cancer center. Four reviewers (two orthopedic oncologists and two surgical oncologists) independently assessed the radiographs, based on the reporting system of REST. We constituted two groups according to the probable diagnosis of bone tumor (suspected benign tumor and suspected malignant tumor). RESULTS: The mean score in the suspected benign tumor group was 1.1 (range 0-3, 95% CI 0.8-1.3) and in malignant tumor group was 6.1 (range 2-8, 95% CI 5.8-6.4). A receiver operator characteristic (ROC) curve for REST was with a cutoff of 3.5, with the most diagnostic value area under curve (AUC) of 0.99. The sensitivity was 98% and specificity was 100% with a positive predictive value of 100% and a negative predictive value of 98%. The inter-observer correlation coefficient was 0.985 (p value < 0.05), and Fleiss kappa value for the prediction of the benign or malignant lesion was 0.97 (p value < 0.05). The characteristics and content of tumor, cortical erosion, distinctiveness, distribution, periosteal reaction, and soft tissue mass had a significant correlation with the aggressiveness of bone lesion p value < 0.05. CONCLUSIONS: The Radiological Evaluation Score for Bone Tumors (REST) is a structured reporting and objective method for the assessment of radiographs in patients with suspected bone tumors. This method is a reliable and helpful tool for clinicians in their outdoor patient department to differentiate a radiograph of a suspected benign tumor from a malignant bone tumor.

Complications and Diagnosis of Branchial Cleft Cysts: A Case Report.

Branchial cleft cysts (BCCs) are congenital anomalies that can be found in children and young adults. The exact incidence of these anomalies is unknown as the diagnosis may be missed. Branchial cleft cysts can present in a variety of locations depending on the cleft they are derived from. Regardless of location, branchial cleft cysts are rather benign. However, a variety of complications can arise due to infection, and infections are often recurrent. Diagnosis may occur incidentally on imaging studies as such studies are often performed to rule out a variety of complications from infections alone. Treatment includes first treating any infection and any such complications that exist, followed by surgical excision. Surgical excision is performed to prevent the recurrence of infection. A case of a 14-year-old female with a painful swollen throat, trismus, and difficulty swallowing is reported.

Large Drill Holes Are Still Present in the Long Term After Arthroscopic Bankart Repair With Absorbable Tacks: An 18-Year Randomized Prospective Study.

BACKGROUND: Studies have demonstrated the development of an osseous reaction at the drill sites of anchors after arthroscopic shoulder surgery. PURPOSE: To investigate the drill-hole size at 18 years after arthroscopic Bankart repair using either fast polygluconate acid (PGA) or slow polylevolactic acid (PLLA) absorbable tacks and to compare the functional outcomes and development of osteoarthritis. STUDY DESIGN: Randomized controlled trial; Level of evidence, 2. METHODS: 40 patients with unidirectional anterior shoulder instability, treated with arthroscopic Bankart repair, were randomized into the PGA group (n = 20) or the PLLA group (n = 20). Plain radiographs of both shoulders, as well as computed tomography (CT) images of the operated shoulder, were used to evaluate the drill-hole size, volume, and degenerative changes. Functional outcomes were assessed by use of the Rowe score, Constant score, and Western Ontario Shoulder Instability (WOSI) index. RESULTS: Of the 40 patients, 32 patients returned for the follow-up (15 PGA and 17 PLLA). No significant differences were found in the population characteristics between the study groups. The mean follow-up time was 18 years for both groups. No significant differences were seen in range of motion, strength in abduction, or Constant, Rowe, and WOSI scores between the groups. Recurrence rate was 33% in the PGA group and 6% in the PLLA group during the follow-up period (P = .07). The drill-hole appearance on plain radiographs (invisible/hardly visible/visible/cystic) was 11/2/2/0 and 6/5/5/1 for the PGA and PLLA groups, respectively (P = .036). The mean ± SD drill-hole volume as estimated on CT images was 89 ± 94 and 184 ± 158 mm3 in the PGA and PLLA groups, respectively (P = .051). Degenerative changes (normal/minor/moderate/severe) on plain radiographs were 7/4/4/0 and 3/8/5/1 for the PGA and PLLA groups, respectively (P = .21), and on CT images were 5/7/3/0 and 2/6/6/3 for the PGA and PLLA groups, respectively (P = .030). CONCLUSION: This long-term follow-up study demonstrated that the PLLA group had significantly more visible drill holes than the PGA group on plain radiographs. However, this difference was not evident on CT imaging, with both groups having several visible cystic drill holes and a substantial drill-hole volume defect. No significant differences were found between the study groups in terms of clinical outcomes.

Anatomical Study of the Lumbar Segmental Arteries in Relation to the Oblique Lateral Interbody Fusion Approach.

OBJECTIVE: To use computed tomography angiography to evaluate the regional anatomy of the lumbar segmental arteries (LAs) associated with the surgical field in oblique lateral interbody fusion (OLIF). METHODS: Computed tomography angiography images from 50 patients were reviewed. In the sagittal plane, distances from the LA to the upper and inferior edges of the vertebral body were measured in the anterior quarter of the anterior and median lines of the intervertebral disc (IVD). LAs were classified as types I-IV based on the zone in which they passed through the vertebral body. RESULTS: The LA branch angles were acute (<90°) at L1-L3 and blunt (>90°) at L4-L5. The average distances from the LA to the upper and inferior edges of the vertebral body in the anterior quarter position revealed that La1.2 > Lb1.2 and Lb3.4.5 > La3.4.5. For the IVD of L1-L2, Lb1 < La2; IVD of L2-L3, Lb2 < La3; IVD of L3-L4, Lb3 > La4; IVD of L4-L5, Lb4 > La5. In zone I, the most frequent LA type was type IV at L1 (n = 41; 85.4%) and L2 (n = 42; 84.0%), type III at L3 (n = 20; 40.0%), and type II at L4 (n = 36; 80.0%) and L5 (n = 5; 83.3%). In zone II, the most frequent LA type was type III at L1 (n = 38; 79.2%), L2 (n = 39; 78.0%), L3 (n = 43; 86.0%), and L4 (n = 28; 62.2%), whereas type II was the most frequent LA type at L5 (n = 5; 83.3%). In zone III, type III was the most frequent LA type at L1-L4. In zone IV, type IV was the most frequent LA type at L3 (n = 44; 88.0%), L4 (n = 42; 93.3%), and L5 (n = 6; 100%). CONCLUSIONS: The risk of LA injury during OLIF is the least when the cage is placed in zones II and III. Care is required during OLIF in zone IV of L3-L5. The fixation pin should be fixed on the upper edge of the lower vertebral body at L1-L2 and L2-L3, and on the lower edge of the upper vertebral body at L3-L4 and L4-L5.

A Systematic Review Investigating the Effectiveness of Surgical Versus Conservative Management of Unstable Ankle Fractures in Adults.

Nine percent of all fractures affect the ankle, with an annual incidence of 122/100,000 in Edinburgh, UK. While unstable fractures are usually treated surgically, there has been no recent systematic review of the evidence supporting this decision. In this systematic review, relevant electronic databases (such as MEDLINE and CINHAL) were searched from inception to February 2017. Five randomized controlled trials that examined surgical versus conservative interventions in 951 adults with closed ankle fractures, with follow-up for at least 6 months, were selected for further synthesis of evidence. The risk of selection bias in all selected trials was relatively low. However, most of the trials had a high risk of performance and detection bias. Three of the 5 selected trials used the validated functional Olerud Molander Ankle Score. One trial (n = 43), reported a statistically better score for the surgical group at 27-month follow-up, whereas a second (n = 81) and a third (n = 620) trial found no significant difference at 12 and 6 months, respectively. No significant differences between surgical and conservative treatments were reported in 2 trials (n = 111) and (n = 96) in nonvalidated functional outcome measures. Other outcomes were malunion (9/334 [2.6%] versus 48/301 [15.9%], p < .0001) and nonunion (3/408 [0.7%] versus 28/383 [7.3%], p < .0001) and were considerably higher in the conservatively treated group. Early treatment failure was significantly lower with surgery (7/435 [1.6%] versus 70/419 [16.7%], p < .0001). The risk of malunion, nonunion, and loss of reduction were greater in nonoperative care. However, the 2 treatment approaches provided equivalent functional outcomes.