Is conventional radiography still relevant for evaluating the acromioclavicular joint?

INTRODUCTION: Conventional radiography using an anteroposterior view of the acromioclavicular (AC) joint is the gold standard for evaluating arthritic degeneration. OBJECTIVE: Based on a standardised AP view of the AC joint, the objective of this study was to determine whether this radiographic view is reliable and reproducible for evaluating the AC joint space. METHODS: A cadaver scapula-clavicle unit, free of osteoarthritis, was used for this study. The scapula was positioned in a stand; and then with fluoroscopy guidance, a strict AP view of the AC joint was taken. Starting from this "0" position, a radiograph was taken by varying the angle by 5°, 10°, and 15° in every plane in space. All radiographs were taken during a single session to ensure the distance between the X-ray tube and scapula did not change. The images were then exported to OsiriX for processing; the superior and inferior AC distance and the joint area were measured. RESULTS: There was no reproducibility in the AC joint measurements as a function of the incidence angle relative to a strict AP view. CONCLUSION: Conventional radiography using an AP view of the AC joint cannot be used to do a fine analysis of arthritic degeneration of this joint. It is likely that only CT scan or MRI is sufficient to analyse osteoarthritis in this joint. LEVEL OF EVIDENCE: IV, basic science study.

Tibial plateau fracture management: ARIF versus ORIF - clinical and radiological comparison.

INTRODUCTION: Arthroscopy has enabled minimally invasive procedures to be developed to treat tibial plateau fracture. The aim of the present study was to assess and compare clinical and radiological results between arthroscopically assisted reduction and internal fixation (ARIF) and open reduction and internal fixation (ORIF) procedures. The study hypothesis was that, in selected tibial plateau fractures, ARIF provides (1) clinical results comparable to those of ORIF, and (2) satisfactory reduction and stable fixation. MATERIAL AND METHOD: A retrospective multicenter study included adult patients with tibial plateau fracture (Schatzker I to III), over the period January 2010 to December 2014, enabling a minimum 2 years' follow-up. Clinical and radiological data (RoM, IKDC, HSS, Lysholm) were collected at 3, 6 and 12 months and at last follow-up. A total of 317 patients (317 fractures), aged 48±14 years (range, 18-82 years) were followed up for 38±23 months (range, 24-90 months), with 77 fractures (24%) in the ARIF group and 240 (76%) in the ORIF group. RESULTS: Clinically, there were no significant inter-group differences for active flexion, passive or active extension or Lysholm and IKDC scores, with significant differences for HSS (ARIF: 74±29; ORIF: 70±31; p<0.01) and passive flexion (ARIF: 130±19° (range, 80-160°); ORIF: 130±15.965° (range, 60-140°); p<0.05). Radiologically, there were no significant inter-group differences for reduction quality, lower-limb mechanical axis or signs of osteoarthritis. There were no secondary displacements. There were 7 complications (7/77, 9%) in the ARIF group and 18 (18/240, 8%) in the ORIF group, and 6 surgical revisions for early infection (2 ARIF, 4 ORIF), with no significant inter-group differences. DISCUSSION: The study hypothesis was confirmed: in Schatzker I-III fractures, ARIF provided clinical results comparable to those of ORIF, with satisfactory reduction and stable fixation. ARIF has its place in the treatment of tibial plateau subsidence and/or separation fracture. LEVEL OF EVIDENCE: III, retrospective comparative study.

Does anatomy explain the origin of a leak after sleeve gastrectomy?

BACKGROUND: Sleeve gastrectomy is a bariatric surgical procedure that may result in particular morbidity or mortality due to gastric fistula in the proximal part of the gastric tube. Two theories are currently proposed to explain this specific leak location. The vascular theory attributes the leaks to reduced perfusion in the gastric tube, and the mechanical theory suggests the etiology as gastric tube hyper-pressure due to pyloric conservation. The aim of this study was to map the arterial gastric vascular supply on fresh cadavers after performing sleeve gastrectomy to evaluate the effect of vascular changes on gastric leakage. METHODS: We performed sleeve gastrectomies on 11 cadaveric trunks with a detailed anatomical study of the gastric vascular supply after latex injection in the three branches arising from the celiac trunk. RESULTS: In 55 % of cases, the sleeve procedure changed the gastric vascular supply. In 9.1 %, it divided the three left gastric artery branches arising from the lesser curvature. Few changes were noted in the antrum or pylorus. CONCLUSIONS: This anatomical study demonstrates that the vascular supply of the proximal part of the gastric tube can be damaged by a sleeve procedure, which can sever one or more of the branches arising from the left gastric artery. Such weakness could be exacerbated by disparities in vascular supply. The uninterrupted vascular supply of the antrum and pylorus may explain the preferential localization of the fistula to the proximal part of the gastric tube.