The clinical diagnosis of distal radioulnar joint (DRUJ) instability remains challenging. The current diagnostic gold standard is a dynamic computerized topography (CT) scan. This investigation compares the affected and normal wrists in multiple static positions of forearm rotation.. However, its accuracy has been questioned, as the wrist is unloaded and not placed under stress. This may fail to capture DRUJ instability that does not result in static malalignment between the ulnar head and sigmoid notch. The purpose of this biomechanical study was to evaluate the effectiveness of both dynamic and stress
The emergence of patient specific instrumentation has seen an expansion from simple radiographs to plan total knee arthroplasty (TKA) with modern systems using computed tomography (CT) or magnetic resonance imaging scans. Concerns have emerged regarding accuracy of these non-weight bearing modalities to assess true mechanical axis. The aim of our study was to compare coronal alignment on full length standing AP imaging generated by the EOS acquisition system with the CT coronal scout image. Eligible patients underwent unilateral or bilateral primary TKA for osteoarthritis under the care of investigating surgeon between 2017 and 2022, with both EOS X-Ray Imaging Acquisition System and
Aim: 1. To assess the role of the
Aim: The aim of the study was to investigate the efficacy of the multidetector
Aim: To assess the implications of implementation of the NICE Guidelines for indication for
Introduction:. 25% of patients with an unknown primary tumour present to the orthopaedic surgeon with skeletal metastases. The onus is on the orthopaedic surgeon to establish the diagnosis, not only to decrease the patient's anxiety but also because the median survival increases from 6–9 months to 23 months when the primary is identified and allows for specific cancer treatment. The diagnostic work up of an unknown primary includes a multitude of special investigations. Since PET/CT has high sensitivity and specificity for detecting the primary tumours, we asked the question: Can you diagnose the unknown primary in patients with skeletal metastases with a PET/CT?. Method:. We included all PET/
Aim: The purpose of this study is to define the hip anatomy in cerebral palsy in a three dimensional geometrical manner and then perhaps plan a better surgical reconstruction for these affected hips. Materials &
Methods: The case notes and radiographs of 18 patients with cerebral palsy who underwent plain radiographs, axial CT and 3D CT scans from October 1993 to June 1995 were reviewed prospectively all being consecutive. The following indices were measured – acetabular anteversion (AA), anterior axial acetabular index (Anterior AAI), posterior axial acetabular index (Posterior AAI), Total axial acetabular index (Total AAI) and acetabular depth/femoral head diameter (AD/FHD) ratio. Results: The acetabular index, and CEA angle clearly showed the hips to be dysplastic in frontal plane. FAV measurements done on
Aim: The aim of this study is to evaluate the efficacy of the multidetector
Mechanical irritation or impingement of the iliopsoas tendon accounts for 2–6% of persistent postoperative pain cases after total hip arthroplasty (THA). The most common trigger is anterior cup overhang. CT-scan can be used to identify and measure this overhang; however, no threshold exists for symptomatic anterior iliopsoas impingement. We conducted a case–control study in which CT-scan was used to define a threshold that differentiates patients with iliopsoas impingement from asymptomatic patients after THA. We analyzed the CT-scans of 622 patients (758 CT-scans) between 2011 and 2020. Out of this population we identified 136 patients with symptoms suggestive of iliopsoas impingement. Among them, 6 were subsequently excluded: three because the diagnosis was reestablished intra-operatively (one metallosis, two anterior instability related to posterior prosthetic impingement) and three because they had another obvious cause of impingement (one protruding screw, one protruding cement plug, one stem collar), leaving 130 patients in the study (impingement) group. They were matched to a control group of 138 patients who were asymptomatic after THA. The anterior cup overhang (anterior margin of cup not covered by anterior wall) was measured by an observer (without knowledge of the clinical status) on an axial CT slice based on anatomical landmarks (orthogonal to pelvic axis). The impingement group had a median overhang of 8 mm [IQR: 5 to 11] versus 0 mm [IQR: 0 to 4] for the control group (p<.001). Using ROC curves, an overhang threshold of 4 mm was best correlated with a diagnosis of impingement (sensitivity 79%, specificity 85%, PPV = 75%, NPV = 85%). Pain after THA related to iliopsoas impingement can be reasonably linked to acetabular overhang if it exceeds 4 mm on a
Patient specific instrumentation (PSI) for elective knee replacements in arthritic knees with severe deformities and in revision scenarios is becoming increasingly popular due to the advantage of restoring the limb axes, improved theatre efficiency and outcomes. Currently available systems use
Introduction:. Fibular malreduction is a common and important cause of pain after surgical fixation following a syndesmosis injury, but it is unclear which components of malreduction correspond to clinical outcome. Plain radiographs have been shown to be unreliable at measuring malreduction when compared to
Introduction: With increasing availability of
The purpose of the study was to assess the accuracy of prereduction and postreduction obturator oblique radiographic views in the diagnosis of simple posterior hip dislocation, and to ascertain whether, in differentiating simple posterior hip dislocations from fracture dislocation, obturator oblique views are a safe diagnostic tool in the hands of junior registrars, trauma officers and community service doctors. A sample group of prereduction and postreduction radiographs of patients who had sustained posterior hip dislocations (Thompson and Epstein type I to III) was collected. All patients then had
Aim: To investigate the natural history and the impact of reconstruction in shoulder deformities due to obstetrical brachial plexus palsy. Methods: Pre and postoperative
Scaphoid fractures are commonly seen fractures following distal radius fractures, yet its diagnosis can be difficult. The present study is to explore the diagnostic approach to suspected scaphoid fractures in a district general hospital in the UK. This is a retrospective study. 286 Suspected scaphoid injuries were seen in our Fracture clinics. 184/286 were known to have normal x-ray findings initially and repeat x-ray in 10 days time. They were all treated as a simple case of a sprained wrist. 40 Patients out of the remaining 102 patients were noted to have scaphoid fractures on follow up x-rays and accordingly treated with cast. The remaining 62 patients were considered for further imaging. 28/102 went for bone scan, which confirmed scaphoid fracture in 4/28 cases. It also picked up other degenerative pathology in 4/28 cases. The rest of the scans were normal. 22/102 Were sent for
In February 2004, our institute began to perform routine cervical
Introduction. Occult hip fractures occur in 3% of cases. Delay in treatment results in significantly increased morbidity and mortality. NICE guidelines recommend cross-sectional imaging within 24 hours and surgery on the day of, or day after, admission. MRI was the standard imaging modality for suspected occult hip fractures in our institution, but since January 2013, we have switched to multi-detector
We want to prove that you cannot make a good fitting stem of a THP before surgery because the resulting shape of the femoral cavity is set after all the tools have been introduced in the femur. We are fully aware that fit and fill alone is not enough to obtain good fixation therefor all the investigated implants were plasma spray coated with HA. We have investigated two groups of patients:. Pre – operative group: custommade implant based on
Primary mechanical fixation and secondary biologic fixation determine the fixation of an uncemented femoral component. An optimized adequacy between the implant design and the proximal femur morphology allows to secure primary fixation. The femoral antetorsion has to be considered in order to reproduce the center of rotation. A so-called «corrected coronal plane » including the center of the femoral head has therefore been defined. The goal of this study was to evaluate the proximal metaphysal volume and to design a straight femoral component adapted to this corrected coronal plane. 205 CT-scans (performed in 151 males and 54 females free of hip arthritis) have been analyzed with a three-dimensional reconstruction. The mean age was 68.5 years (35–93). A corrected coronal plane has been defined including the center of the femoral head and the axis of the intramedullary canal. Five levels of sections (at a defined distance from the center of the femoral head) have been selected: 12.5mm, 50mm, 70mm, 90mm and 120mm. Three intramedullary criteria have been studied: volume between the 50mm and the 90mm sections (C1), the medial-lateral distance of the intramedullary canal (C2) at the 50mm, 70mm, and 90mm levels, and the A-P distance (C3) at the 50mm, 70mm, and 90mm levels (respectively C3–50, C3–70, and C3–90). The femoral head diameter, the femoral offset and the canal flare index (CT flare) have also been measured.Introduction
Materials and Methods
To demonstrate the use of indium-111 white-cell labelled SPECT CT (In111-WC-SPECT-CT) in bone infection. This novel imaging modality is useful in bone infection. We present three cases of complex osteomyelitis to illustrate this. All were imaged with conventional modalities, but conclusive diagnosis could not be achieved. In111-WC-SPECT-CT was used to provide the definitive imaging that allowed successful treatment.Aim
Method