Is Stage 2 idiopathic osteonecrosis of the hip joint associated with version angles on imaging methods?

OBJECTIVES: In this study, we aimed to investigate whether anatomical variations of acetabulum were associated to idiopathic osteonecrosis (ON) of the femoral head. PATIENTS AND METHODS: Between January 2014 and March 2020, a total of 46 patients (32 males, 14 females; mean age: 43 years; range, 18 to 66 years) who were diagnosed with unilateral or bilateral ON of the hip joint and 44 healthy age- and sex-matched controls (30 males, 14 females; mean age: 46 years; range, 18 to 79 years) with no signs of ON of the hip joint were retrospectively analyzed. For both groups, measurements were taken of the anatomic parameters, including the acetabular version angle (VA), the sharp angle (SA), and the center-edge angle (CEA) on anteroposterior pelvic radiographs and magnetic resonance imaging (MRI) scans. RESULTS: The mean VA of both hips was found to be significantly smaller in Group 1 than in Group 2 on both MRI and X-ray (14.9±4.1 and 14.4±3.1 vs. 17.3±3.9 and 18.0±3.7, respectively; p=0.004, p<0.001). The mean SA of both hips was found to be significantly smaller in Group 1 than in Group 2 on both MRI and X-ray (39.0±2.9 and 38.9±2.8 vs. 41.6±3.9 and 40.8±4.9, respectively; p=0.001, p=0.036). The mean CEA of both hips was found to be significantly larger in ON group than in control group on both MRI and X-ray (36.7±6.1 and 36.9±7.0 vs. 32.0±6.0 and 31.5±7.5, respectively; p<0.001, p=0.001). CONCLUSION: Version angles were found to be smaller in patients with ON and more acetabular coverage was observed. Greater coverage of the acetabulum may indicate early collapses of the femoral head even in Stage 2 ON patients. The smaller version angles may be associated with ON.

Definition of a quantitative measurement method for acetabular version in a plain radiograph in the healthy adult hip.

OBJECTIVES: This study aims to define a quantitative measurement method for acetabular version in a standard anteroposterior hip radiograph, assess the intraobserver and interobserver agreements of this method, and compare it with the gold standard computed tomography (CT). PATIENTS AND METHODS: Anteroposterior standard hip radiographs and simultaneously taken transverse acetabular CT sections of 78 hips of 39 patients (10 males, 29 females; mean age 60 years; range 40 to 81 years) were used in the study. In standard anteroposterior hip radiographs, "acetabular anterior wall line" was identified as the line between the most lateral edge of the acetabulum and the inferolateral edge of the teardrop. "Acetabular posterior wall line" was identified as the line between the most lateral edge of the subchondral sclerosis and the outmost point of acetabulum posterior lunate surface sclerosis. To assess the reliability of this technique, mentioned angles in 78 hips were measured by two authors independently two weeks apart. Direct radiographic values were compared with the acetabular version measurement values in CT examination. RESULTS: Mean acetabular version angles of 78 hips in plain radiographs and CT were 18.0° (9-25°) and 17.2° (12-25°), respectively. Mean intraobserver measurement differences were 1.3° (0-5°) and 1.5° (0-6°). Mean interobserver measurement difference was 1.4° (0-5°). The mean difference between plain radiography measurements and CT measurements was 2.5° (0-6°). A significant correlation was detected between plain radiographic measurements and CT measurements. CONCLUSION: By this quantitative method, acetabular morphology may be measured less invasively, easily, quickly and reliably in plain radiograph in transverse plane.

[Rotational alignment of the lower extremity in adults: no relationship with osteoarthritis of the knee was proved]. / Eriskinlerde alt ekstremitenin rotasyonel dizilimi: Diz osteoartritiyle iliskisi ortaya konamamistir.

OBJECTIVES: In this study the relationship between knee osteoarthritis and rotational alignment of the lower limb was prospectively evaluated. PATIENTS AND METHODS: We evaluated the computed tomographic (CT) scans and conventional radiographs of 85 patients (69 females, 16 males; mean age 60.1; range 43 to 81 years) with knee pain for measurement of acetabular anteversion, femoral torsion, rotation of the knee, and tibial torsion and femoro-tibial alignment. Modified Kellgren-Lawrence classification was used to evaluate knee osteoarthritis in the patients. RESULTS: There was no osteoarthritis in 68 knees. Thirty-one knees had grade I, 37 knees had grade II and 34 knees had grade III osteoarthritis. In the CT examinations of the patients the mean acetabular anteversion was 18.5 degrees for both extremities. The mean femoral torsion was 8.3 degrees on the right extremity and 10.2 degrees on the left extremity. The mean knee torsion was 2.2 degrees on the right extremity and 1.3 degrees on the left extremity. The mean tibial torsion was 30.9 degrees on the right extremity and 31.3 degrees on the left extremity. On the plain X-rays, anatomical axis was 0 degrees on the right extremity and -0.6 degrees on the left extremity. No significant relationship between knee osteoarthritis and rotational alignment of the lower limb was found (p>0.05). CONCLUSION: Often thought to be idiopathic, primary osteoarthritis of the knee joint may occur secondary to mechanical stresses. Although valgus and varus deformities of the knee joint investigated extensively the effects of rotational deformities have not been investigated enough. Our study was not able to show any association between knee osteoarthritis and rotational alignment of the lower limb.

[Our three-year experience with an ultrasonographic hip screening program conducted in infants at 3 to 4 weeks of age]. / Uç-dört haftalik bebeklerde yürütülen ultrasonografik kalça taramasi programinda üç yillik deneyimimiz.

OBJECTIVES: The aim of this study was to evaluate the results of a newborn ultrasonographic hip screening program conducted at 3-4 weeks of life, and to assess its utility and feasibility in Turkey. METHODS: During a three-year period, parents of 1440 newborns were interviewed within 48 hours following birth to be informed in detail about developmental dysplasia of the hip (DDH) and its risk factors. They were asked to bring their infants for clinical and ultrasonographic examinations of the hips 3 to 4 weeks after birth. RESULTS: A total of 975 infants (67.7%; 488 girls, 487 boys; mean age 26 days; range 17 to 34 days) were available on the day of screening. According to the Graf's classification, 1664 hips (85.3%) were considered type I. Immediate treatment was initiated for 22 hips (1.2%) which were considered type IIc, D, or IIIa. All but one hip were found to be type I after eight weeks of treatment. Among type IIa hips with a complete follow-up, 12% required treatment. In total, 45 hips (2.3%) of 35 infants (3.6%) were treated preferably with a Pavlik harness. Of these, 10 infants (28.6%) had at least one risk factor for DDH, the most common being a positive family history (n=7, 20%). Of 45 treated hips, 12 hips (26.7%) exhibited positive clinical findings, the most common being asymmetry of the thigh/inguinal folds. CONCLUSION: Ultrasonographic hip screening program conducted at the age of 3 to 4 weeks is effective for early diagnosis and successful treatment of DDH. However, nearly one-thirds of the infants were not available at the appointed date, despite transmission of detailed information to the parents just after birth.

Assessment of the correlation between commonly used radiographic parameters in normal, subluxated and dislocated hips.

The correlations between the commonly used radiographic parameters, center-edge angle (CEA), acetabular-head index (AHI), acetabular index angle (AIA), acetabular angle (AA) and ACM angle, in normal, subluxated and dislocated hips were investigated in the radiographs of 364 normal, 23 subluxated and 19 dislocated hips of patients between 5 and 18 years of age. A significant correlation was observed between all the parameters in normal hips. A significant correlation between AIA and the other four parameters, and between CEA-AHI and AA-ACM, was noted in subluxated hips. AIA-AA and AIA-ACM had significant correlations in dislocated hips. It was concluded that measurement of more than one radiographic parameter might be better to exactly evaluate the radiographic hip anatomy in developmental dysplasia of the hip.

Recurrent bilateral dislocation of the shoulders due to nocturnal hypoglycemia: a case report.

A 20-year-old male was admitted to emergency room with convulsion. He had insulin-dependent diabetes mellitus for 8 years. He had suffered nocturnal hypoglycemia after strenuous exercise without additional calories. After recovery, the patient complained of bilateral anterior shoulder dislocation. Patient's history revealed another episode of bilateral shoulder dislocations after an hypoglycemic convulsion 3 years ago.

Correlation between iatrogenic ulnar nerve injury and angular insertion of the medial pin in supracondylar humerus fractures.

The aim of this study was to assess the correlation between the occurrence of iatrogenic ulnar nerve injury and frontal and saggital angular insertion of the medial pin in type 3 pediatric supracondylar humerus fractures treated by closed reduction and percutaneous fixation using a cross-pin configuration. Radiographs of 90 children were retrospectively reviewed and two radiographic parameters were measured. The frontal humerus-pin angle was formed between the long axis of the humerus shaft and the axis of the medial pin on an anteroposterior radiograph. The saggital humerus-pin angle was formed between the long axis of the humerus shaft and the axis of the medial pin on a lateral radiograph and expressed as positive and negative values if the insertion direction of the pin was anterior to posterior or posterior to anterior, respectively. There was a significant difference between the mean saggital humerus-pin angle values of ulnar nerve injury and no neurological complication groups (12.1 degrees versus 1.6 degrees , respectively; P=0.001). It was concluded that, anteroposterior insertion of the medial pin in the saggital plane, while the elbow was in hyperflexion, correlated with the occurrence of iatrogenic ulnar nerve injury.

Stress views in the radiography of scapholunate instability.

AIM: On the suspected carpal instabilities stress views are recommended but not often used. The present study evaluates the reliability of the dorsal and volar stress radiographs on patients with posttraumatic wrist pain. PATIENTS AND METHODS: Stress radiographs of the wrists were examined in 22 patients with chronic wrist pain and the results were compared with scaphoid shift test and standard and positional views. The stress examination consists of applying to the wrist dorsal and volar stresses on the hand. RESULTS: Static scapholunate instability was diagnosed in 4 patients in whom 3 of them had positive scaphoid shift test sign as well. There were, however, 18 patients with dynamic scapholunate instability in whom the standard films were normal but dorsal stress radiography showed gap greater than 3mm between the scaphoid and lunate. CONCLUSION: Stress tests may provide considerable information in the evaluation of a patient who has a painful wrist in whom routine and special views do not demonstrate scapholunate dissociation.

Wrist ligaments: their significance in carpal instability.

BACKGROUND: Understanding the exact contribution of the supporting ligaments to the functional integrity of the wrist is crucial for the diagnosis and treatment of carpal instabilities. The present study evaluates functional significance of the wrist ligaments with respect to carpal instabilities. MATERIALS AND METHODS: Sixteen fresh cadaver wrists were dissected. Extrinsic and intrinsic ligaments of the wrists (ligamentum radioscaphocapitatum, ligamentum radiolunotriquetrum and ligamentum triquetrohamatocapitatum) were sectioned sequentially. After sectioning of each ligament, the wrist was examined for clinical signs of instability such as misalignement of carpal bones, limited range of motion and dorsal translation. When instability was suspected, radiographs were taken and if instability was confirmed, then the ligament was repaired. RESULTS: Although none of the dorsal ligaments sectioning resulted in instability, sectioning of ligamentum scaphotrapeziotrapezoideum, ligamentum radioscaphocapitatum, ligamentum radiolunotriquetrum and ligamentum triquetrohamatocapitatum displayed scaphotrapeziotrapezoidal, dorsal intercalated segment, lunotriquetral and capitohamate instability respectively. In two wrists with arthrosis, sectioning of all ligaments didn't lead to any instability. CONCLUSION: Instability of the wrist can be classified on anatomical basis after the name of these four ligaments involved i.e. l. scaphotrapeziotrapezoideum, l. radioscaphocapitatum, l. radiolunotriquetrum and l. triquetrohamatocapitatum respectively . This approach clarifies the etiology and treatment of carpal instabilities.

Assessment of the use of hip ultrasonography by Graf's method between 1 and 6 years of age.

Ultrasonographic examinations of both hips of 133 children whose age ranged from 13 to 72 months were performed using the Graf's method. A standard plane which was mandatory prior to the hip typing could be obtained in 93, 91, 84, 79 and 66% of the sonograms for 13-24, 25-36, 37-48, 49-60 and 61-72 months age groups, respectively. The 61-72 months age group had the lowest percentage of valid sonograms and this difference was considered significant (P=0.001). It was concluded that plain radiography was still the gold standard imaging technique in developmental dysplasia of the hip, but hip ultrasonography by the Graf's method might be an alternative imaging technique in experienced hands for the evaluation of developmental dysplasia of the hip in children between 1 and 5 years of age.

Giant cystic lymphangioma cavernousum of lower limb with overlying lymphangioma circumscriptum.

Lymphangiomas arising outside of the cervicofacial, thoracic, and abdominal areas are extremely rare. We describe a child with a giant cystic lymphangioma cavernousum occurring in the lower leg with overlying lymphangioma circumscriptum, along with its magnetic resonance imaging findings.

Two alternative methods for the measurement of MZ distance on a hip radiograph.

BACKGROUND: The aim of this study was to assess the use of two alternative measurement methods for the MZ distance, the distance between the acetabular centre (M) and the femoral head centre (Z), on an anteroposterior hip radiograph. METHODS: The MZ distance was measured in 900 normal and 34 dysplastic adult hips by using the classic method (MZ-c) and two alternative methods (MZ-m and MZ-x). MZ-m utilized the vectorial distance between points M and Z, like MZ-c, but was expressed as a positive or negative value according to the localization of the points with respect to each other. MZ-x was the projected distance between points M and Z on the x-axis, which was the line perpendicular to the two parallel lines passing through points M and Z, and was expressed as a positive or negative value according to the localization of the points with respect to each other. RESULTS: There was a significant correlation between the centre-edge angle and the three measurement methods in both normal and dysplastic hips. The lowest normal limits for MZ-m and MZ-x in adult hips were considered to be -3 mm and -2 mm, respectively (point Z is lateral to point M). Intraobserver and interobserver measurement variations of both methods were less than 2 mm. CONCLUSION: Both alternative methods were considered more useful than the classic one in the exact determination of the distance between the centres of the femoral head and the acetabulum.

[Normal values of several acetabular angles on hip radiographs obtained from individuals living in the Eskisehir region]. / Eskisehir yöresinde çekilen kalça radyografilerinde yas gruplarina göre asetabulum açilarinin normal degerleri.

OBJECTIVES: To determine the normal values of several radiographic acetabular angles in individuals of Eskisehir region. METHODS: The acetabular index (AI) angle, acetabular angle (AA) of Sharp and the ACM angle were measured in 1162 normal hips (n=581, 251 males, 330 females; mean age 33 years; range 5 to 75 years). For AI angle, Hilgenreiner's line and the line connecting the lower end points of the sclerotic lines of the acetabular roofs were used for reference in subjects between five to 11 years with an open Y cartilage and in those with closed Y cartilage, respectively. AA and ACM angles were measured by the same method in all subjects. RESULTS: The mean AI angle between 5-11 years was 12.9+/-4.5 degrees; the upper normal limit for the Hilgenreiner's AI angle was derived as 22 degrees. The mean AI angle above age 11 was 3.3+/-4.7 degrees and the upper normal limit for the AI angle defined by Tönnis after age 11 was found as 13 degrees. Significant linear correlations were found between the AI angle and age for 5-11 years (p=0.002) and above 11 years (p=0.001), respectively. The mean AA angle was 39.2+/-4.6 degrees. There was a significant linear correlation between the AA angle and age (p=0.001). The upper limits for the AA angle in normal juvenile, adolescent, and adult hips were found as 52 degrees, 49 degrees, and 45 degrees, respectively. The mean ACM angle was 41.9+/-3.3 degrees. A significant linear correlation was observed between the ACM angle and age (p=0.001). The upper limit for the ACM angle in normal hips was assessed as 49 degrees in all age groups. CONCLUSION: The authors of this study propose that the normal limits of acetabular angles obtained from our own population be used as reference values in interpreting standard radiographs of the hip.