Applications and Error Ratios of Calibration Techniques in EOS, Orthoroentgenogram, and Teleoroentgenogram for Length Measurement: A Comparative Study.

BACKGROUND: Accurate length measurements of extremity bones are essential in treating limb deformities and length discrepancies in children. OBJECTIVE: This study aimed to determine errors in common techniques used to measure lower limb lengths in children. METHODS: Precision and instrument errors in length measurements were studied utilizing electro-optical system (EOS), orthoroentgenogram, and teleoroentgenogram The goal was to measure a 70-cm metallic rod phantom (average length of the lower extremity of a 10-year-old boy in the 50th percentile) in 3 phases. In Phase 1, the length measurements were performed in an EOS unit with internal calibrations, a magball/magstrip in various scan positions, and measurement with TraumaCAD software. In Phase 2, the measurements were repeated utilizing a single radiation "shot" teleoroentgenogram. In Phase 3, an orthoroentgenogram was utilized with a radiopaque ruler reference. The reliability and validity of measurements were calibrated by 4 physicians (a radiologist, senior orthopaedic attending, and 2 orthopaedic fellows). RESULTS: EOS measurements utilizing internal references had excellent accuracy (for a 700-mm real length, magnification error (ME)] of 0.09%. Teleoroentgenogram with a magball reference and measurements performed with automatic calibration by TraumaCAD program results in ME of 1.83% with insignificant intraobserver/interobserver difference. Teleoroentgenogram with a magball or magstrip reference measured manually showed that the magball has higher intraobserver/interobserver variance than magstrip, with a 6.60 and 0.33-mm SD, respectively. The length by manual measurement utilizing the magstrip has ME of 2.21%. Orthoroentgenogram is accurate with ME of 0.26%, but does not allow anatomical analysis and is also radiation-costly. CONCLUSION: EOS and orthoroentgenogram are very accurate for length measurements. Teleoroentgenogram is less accurate in measuring length; however, addition of an external reference (magball, magstrip) placed lateral to the target improves accuracy. Automatic calibration with computer-based analysis of the external reference improves the accuracy more than manual calibration. If manual calibration is utilized, the length measurement is less accurate with the magball than the magstrip. LEVEL OF EVIDENCE: Level II-comparative in vitro study.

Infantile Tibia Vara (Blount Disease) with Iatrogenic Changes Causing Residual Tibial Deformities.

Treatment of infantile tibia vara or Blount disease (ITV/BD) in patients < 3 years old and Langenskiold stages I-III consists of orthosis and, in relapsing cases, proximal tibial osteotomy and/or proximal tibial guided growth laterally with a tension band plate. Our aim was to evaluate the results of treatments in a consecutive group. After Institutional Review Board approval, data from 2002 to 2018 were collected. Thirty-nine knees (average age 22.4 months) with ITV/BD were treated with orthoses, and 10 knees failed. Six knees showed hyperintense T2-weighted signal in the medial proximal tibial epiphyseal cartilage on magnetic resonance imaging. Three of six knees with tibial osteotomy failed and underwent guided growth. Tibial plateau slopes were abnormal medially from the ITV/BD and laterally from the guided growth (triangular physis and depressed plateau deformities) because of factors such as orthotic treatment, tibial osteotomy, magnetic resonance imaging "physis severity score," and guided growth. (Journal of Surgical Orthopaedic Advances 29(3):141-148, 2020).

Side-to-side bowel anastomosis mimicking intussusception in a 2-year-old child with Peutz-Jeghers syndrome.

Peutz-Jeghers syndrome (PJS) is a rare autosomal dominant inherited condition characterized by hamartomatous gastrointestinal polyps, mucocutaneous pigmentation, and a predisposition for malignancy. Most patients with PJS are diagnosed in the second or third decade of life, and commonly have intussusception as a complication. This report describes an unusual case of a 2-year-old male known to have PJS, who had previously developed a small bowel intussusception caused by a polyp requiring a very short segmental small bowel resection. The patient remained asymptomatic several months after the surgery and then presented with acute abdominal discomfort. On abdominal ultrasound, a target sign measuring 2.7 cm was noted in the left upper quadrant of the abdomen, suggesting a small bowel-small bowel intussusception. There was no evidence of intussusception or bowel obstruction otherwise on diagnostic laparoscopy. It was thought that the previous side-to-side anastomosis had mimicked intussusception on the ultrasound examination. A repeat abdominal ultrasound was performed 1 week after the laparoscopy when the patient was asymptomatic. This again demonstrated a target sign identical in appearance to the previous ultrasound and confirmed that the side-to side anastomosis had in fact mimicked intussusception. It is important that the pediatric gastroenterology, radiology, and surgery communities are aware of this ultrasound finding; it could impact the decision on whether to operate emergently. To our knowledge this is the first report describing this unusual scenario in humans.

Multidetector computed tomography arteriography in the preoperative assessment of patients with ureteropelvic junction obstruction.

BACKGROUND: Nowadays, endoscopic management of ureteropelvic junction (UPJ) obstruction is the treatment of choice. However, in the presence of crossing vessels, the success rate of endoscopic management decreases and the risk of hemorrhagic and vascular complications rises. The purpose of this study is to evaluate patients with UPJ obstruction using contrast enhanced multidetector computed tomography (CT) angiography to aid in surgical planning and management. PATIENTS AND METHODS: Between 2001 and 2005, 27 patients (mean age: 43 years; age range: 17-75 years) with UPJ obstruction were studied with multidetector CT angiography. Identification and characterization of crossing vessels was performed with multidirectional images and three-directional reconstructions. RESULTS: 12 patients (44%) were found to have 16 crossing vessels (vessels in contact with the UPJ or within a vicinity of less than 2 mm). Nine of these vessels were arteries and seven were veins. Nine vessels crossed anteriorly, two posteriorly, and one anteromedially. Endopyelotomy was contraindicated in these 12 patients due to the presence of crossing vessels. Eleven out of the 12 patients underwent a pyeloplasty by open surgery or laparoscopy, where the presence of crossing vessels was confirmed. One of the 12 patients did not undergo surgery. CONCLUSION: Multidetector CT angiography permits an adequate preoperative assessment of patients with UPJ obstruction as it is able to identify the presence and location of crossing vessels. Furthermore, it allows to study in detail the anatomy of the renal area and its vascular variants.

MR imaging: Arthropathies and infectious conditions of the elbow, wrist, and hand.

The superior soft tissue contrast and multiplanar capability of MR imaging has contributed to earlier diagnosis and implementation of effective treatment for a variety of arthropathies and infectious conditions of the elbow, wrist, and hand. Because of overlapping clinical signs and symptoms, MR imaging plays an important role in delineating the features and staging of each of these conditions. This article discusses the seropositive and seronegative inflammatory arthropathies, with emphasis on early detection and surveillance, as well as gout, synovial osteochondromatosis, pigmented villonodular synovitis, tenosynovitis, and de Quervain's tenosynovitis. Certain noninflammatory arthritides and infectious conditions are also reviewed.

MR imaging: arthropathies and infectious conditions of the elbow, wrist, and hand.

The superior soft tissue contrast and multiplanar capability of MR imaging has contributed to earlier diagnosis and implementation of effective treatment for a variety of arthropathies and infectious conditions of the elbow, wrist, and hand. Because of overlapping clinical signs and symptoms, MR imaging plays an important role in delineating the features and staging of each of these conditions. This article discusses the seropositive and seronegative inflammatory arthropathies, with emphasis on early detection and surveillance, as well as gout, synovial osteochondromatosis, pigmented villonodular synovitis, tenosynovitis, and de Quervain's tenosynovitis. Certain noninflammatory arthritides and infectious conditions are also reviewed.