Achieving torsional stability of distal femur fractures through a single approach using 90-90 construct.

Distal femoral fractures (DFFs) are frequently characterised by significant comminution, osteoporosis, high implant failure, insufficient fixation because of a shortened distal part, non-union, malunion, and poor outcome. Our report presents two cases treated with dual plating in a 90-90 construct to achieve torsional stability. DFF fixation by dual plating in a 90-90 configuration proved to be a superior fixation similar to 90-90 plating for distal humerus fracture, since 90-90 plate fixation had significantly greater torque to failure load and has more resistance to torsional loading. Two cases of distal femur non-union with implant failure were treated utilising a double plating. These non-union cases exhibited radiological healing and knee range of motion at a mean follow-up of 6 months. This technique offers a modified way of treating these difficult non-union cases through a single incision, providing mechanical stability conducive to fracture healing.

Unveiling the uncommon: diagnostic journey of camurati-engelmann disease in a pediatric patient.

BACKGROUND: Camurati-Engelmann disease (CED), also known as progressive diaphyseal dysplasia, is a rare genetic disorder characterized by abnormal thickening of the long bones' diaphysis. This condition is caused by mutations in the transforming growth factor beta-1 (TGFB-1) gene and is typically inherited in an autosomal dominant pattern. Patients with CED often present with symptoms such as chronic bone pain, muscle weakness, fatigue, and difficulty walking. CASE PRESENTATION: We report a 30-month-old boy who presented with gait abnormality. Initially, toxic synovitis was considered, and non-steroidal anti-inflammatory (NSAI) treatment was administered. The patient did not respond to NSAI treatment. Direct radiographs showed diaphyseal thickening, especially in the long bones. Radiologically, CED was suspected, and clinical exome sequencing identified a TGFB-1: c1121C > G (Pro374Arg) heterozygous mutation, which was interpreted as a possible pathogenic variant for CED. A clinical, radiologic, and genetic diagnosis of CED was made. CONCLUSION: Due to its rarity and variable clinical presentation, the diagnosis of CED can be challenging and often requires a high index of suspicion. Early and accurate diagnosis is crucial for managing symptoms and improving patients' quality of life.

Changes in Selected Radiographic Parameters in Feet after Arthroplasty of First Metatarsophalangeal Joint (MTP-1) - Pilot Study.

BACKGROUND: Hallux rigidus is found in more than 2% of individuals aged 50 and above. As this condition progresses, mobility in the first metatarsophalangeal (MTP-1) joint decreases, leading practically to rigid fixation of the toe in the plantar flexion position, while pain and joint deformity caused by osteophytes intensify over time. Surgical approaches for hallux rigidus include joint arthroplasty of the first metatarsophalangeal joint, which is commonly employed. This study aimed to assess selected radiographic parameters of the foot before and after MTP-1 joint arthroplasty. MATERIAL AND METHODS: The study involved 15 patients (15 feet), comprising 11 women and 4 men, at an average age of 54.7 years (range: 43 to 70). All participants underwent arthroplasty of MTP-1 using the Tornier FGT endoprosthesis. Various radiologic parameters were examined, including the hallux valgus angle, intermetatarsal angle, Horton's index, Meary's angle, Nikolaev's angle, and hallux angle in a lateral view. RESULTS: Radiological measurements were analysed using the R3.6.2 statistical package (R Core Team, 2019). After surgery, Horton's index showed a significant increase, rising from 7.2 to 8. Additionally, the HVA-L angle increased from 11.26 to 14.4. CONCLUSION: Arthroplasty of MTP-1 produces significant changes in radiographic parameters of foot statics.

Artificial intelligence in commercial fracture detection products: a systematic review and meta-analysis of diagnostic test accuracy.

Conventional radiography (CR) is primarily utilized for fracture diagnosis. Artificial intelligence (AI) for CR is a rapidly growing field aimed at enhancing efficiency and increasing diagnostic accuracy. However, the diagnostic performance of commercially available AI fracture detection solutions (CAAI-FDS) for CR in various anatomical regions, their synergy with human assessment, as well as the influence of industry funding on reported accuracy are unknown. Peer-reviewed diagnostic test accuracy (DTA) studies were identified through a systematic review on Pubmed and Embase. Diagnostic performance measures were extracted especially for different subgroups such as product, type of rater (stand-alone AI, human unaided, human aided), funding, and anatomical region. Pooled measures were obtained with a bivariate random effects model. The impact of rater was evaluated with comparative meta-analysis. Seventeen DTA studies of seven CAAI-FDS analyzing 38,978 x-rays with 8,150 fractures were included. Stand-alone AI studies (n = 15) evaluated five CAAI-FDS; four with good sensitivities (> 90%) and moderate specificities (80-90%) and one with very poor sensitivity (< 60%) and excellent specificity (> 95%). Pooled sensitivities were good to excellent, and specificities were moderate to good in all anatomical regions (n = 7) apart from ribs (n = 4; poor sensitivity / moderate specificity) and spine (n = 4; excellent sensitivity / poor specificity). Funded studies (n = 4) had higher sensitivity (+ 5%) and lower specificity (-4%) than non-funded studies (n = 11). Sensitivity did not differ significantly between stand-alone AI and human AI aided ratings (p = 0.316) but specificity was significantly higher the latter group (p < 0.001). Sensitivity was significant lower in human unaided compared to human AI aided respectively stand-alone AI ratings (both p ≤ 0.001); specificity was higher in human unaided ratings compared to stand-alone AI (p < 0.001) and showed no significant differences AI aided ratings (p = 0.316). The study demonstrates good diagnostic accuracy across most CAAI-FDS and anatomical regions, with the highest performance achieved when used in conjunction with human assessment. Diagnostic accuracy appears lower for spine and rib fractures. The impact of industry funding on reported performance is small.

External validation of an artificial intelligence multi-label deep learning model capable of ankle fracture classification.

BACKGROUND: Advances in medical imaging have made it possible to classify ankle fractures using Artificial Intelligence (AI). Recent studies have demonstrated good internal validity for machine learning algorithms using the AO/OTA 2018 classification. This study aimed to externally validate one such model for ankle fracture classification and ways to improve external validity. METHODS: In this retrospective observation study, we trained a deep-learning neural network (7,500 ankle studies) to classify traumatic malleolar fractures according to the AO/OTA classification. Our internal validation dataset (IVD) contained 409 studies collected from Danderyd Hospital in Stockholm, Sweden, between 2002 and 2016. The external validation dataset (EVD) contained 399 studies collected from Flinders Medical Centre, Adelaide, Australia, between 2016 and 2020. Our primary outcome measures were the area under the receiver operating characteristic (AUC) and the area under the precision-recall curve (AUPR) for fracture classification of AO/OTA malleolar (44) fractures. Secondary outcomes were performance on other fractures visible on ankle radiographs and inter-observer reliability of reviewers. RESULTS: Compared to the weighted mean AUC (wAUC) 0.86 (95%CI 0.82-0.89) for fracture detection in the EVD, the network attained wAUC 0.95 (95%CI 0.94-0.97) for the IVD. The area under the precision-recall curve (AUPR) was 0.93 vs. 0.96. The wAUC for individual outcomes (type 44A-C, group 44A1-C3, and subgroup 44A1.1-C3.3) was 0.82 for the EVD and 0.93 for the IVD. The weighted mean AUPR (wAUPR) was 0.59 vs 0.63. Throughout, the performance was superior to that of a random classifier for the EVD. CONCLUSION: Although the two datasets had considerable differences, the model transferred well to the EVD and the alternative clinical scenario it represents. The direct clinical implications of this study are that algorithms developed elsewhere need local validation and that discrepancies can be rectified using targeted training. In a wider sense, we believe this opens up possibilities for building advanced treatment recommendations based on exact fracture types that are more objective than current clinical decisions, often influenced by who is present during rounds.

Clinical and radiological outcomes of flexible flatfoot correction with double calcaneal osteotomy.

BACKGROUND: Although double calcaneal osteotomy (medial displacement calcaneal osteotomy with lateral column lengthening) is widely regarded as an effective treatment option for flexible flatfoot, limited studies have extensively analyzed the degree of deformity correction in three dimensions following double calcaneal osteotomy. This study was performed to evaluate the radiographic and clinical effectiveness of double calcaneal osteotomy to correct flexible flatfoot deformities. METHODS: Thirty-one patients who had 44 symptomatic flexible flatfeet and underwent double calcaneal osteotomy were examined retrospectively with a mean follow-up of 50 months. Visual analog scale, foot and ankle activity measure, and other clinical data were obtained from medical records. Various radiographic variables for assessing flatfoot and osteoarthritic change in tarsal joints were analyzed from weightbearing radiographs. RESULTS: Clinical scores and radiographic variables were significantly improved postoperatively. The mean values of medial sliding and lateral lengthening were 7.6 and 8.7 mm, respectively. No osteoarthritic changes were observed. CONCLUSIONS: Double calcaneal osteotomy could be used to correct flatfoot deformities effectively and sustainably and provide symptomatic relief and patient satisfaction. LEVEL OF EVIDENCE: Level 4, retrospective case series.

Different Radiological Indices of Patellar Height Predict Patients' Diverse Outcomes Following Total Knee Arthroplasty.

Background: Total knee arthroplasty (TKA) is a common surgical procedure for patients with knee osteoarthritis. The patellar component plays a crucial role in knee biomechanics and can influence postoperative outcomes. This study aimed to investigate the relationship between radiological indices of patellar height and patient outcomes following TKA. Methods: A retrospective analysis was conducted on patients who underwent TKA for osteoarthritis. Radiographic measurements of patellar height, including the Insall-Salvati (IS) ratio, modified Blackburne-Peel (mBP) ratio, Caton-Deschamps ratio, and plateau-patellar angle (PPA), were obtained. Clinical outcomes were assessed using the Knee Society Score (KSS) and the Forgotten Joint Score-12 (FJS-12). Patient satisfaction and postoperative complications were also evaluated. Statistical analyses, including correlation analysis and multiple regression models, were performed to determine the association between radiological indices and patient outcomes. Results: The study included 330 cases that met the inclusion criteria. The analysis revealed significant correlations between different radiological indices of patellar height and patient outcomes. Lower postoperative PPA was correlated with worse KSS and range of motion scores. A decreased mBP ratio was associated with poorer FJS-12 responses and higher risks of dissatisfaction and patellar clunk or crepitus. Increased IS ratio was linked to a lower likelihood of incidental giving way of the knee. Advanced age was associated with reduced dissatisfaction and incidental giving way probabilities. Conclusions: The findings of this study demonstrate that radiological indices of patellar height can predict patient outcomes following TKA. Assessing patellar height using various radiographic measurements provides valuable information for surgical planning and prognostic evaluation. Understanding the impact of patellar height on clinical outcomes can aid in optimizing TKA procedures and improving patient satisfaction. These findings emphasize the importance of considering patellar height as a predictive factor in TKA and highlight its potential role in guiding postoperative management and rehabilitation strategies.

A systematic review on how to diagnose deltoid ligament injuries-are we missing a uniform standard?

BACKGROUND: Up to now, there is no convincing evidence, that surgical treatment of deltoid ligament injuries, especially in the setting of ankle fractures, does result in improved outcome. One reason could be a missing diagnostic standard. The aim of the current systematic review was to analyze the applied diagnostic strategies for acute deltoid ligament injuries in outcome studies. METHODS: MEDLINE, Scopus, Central, and EMBASE were searched through February 2022 for any original studies addressing diagnostics of acute deltoid injuries. The study was conducted per the PRISMA guidelines. The inclusion criteria were formed according to the PICOS criteria. The data assessed were study type, level of evidence, included fractures, time point and method of diagnosing deltoid ligament layers, differentiation between layers and syndesmotic injuries. RESULTS: 31 studies were included in the final analysis. Most studies (n = 28) based their decision to treat the deltoid ligament injury on radiologic findings only, with stressed radiographs (n = 18) being the most common. The radiographs were applied at one or more time points (preoperative, before ORIF, after ORIF, after ORIF and syndesmotic repair). The most frequently assessed parameter was the Medial Clear Space (MCS, n = 27) with cut-off-values considered pathological ranging between MCS > 1 mm and MCS > 6 mm. CONCLUSION: Comparing the 31 studies shows that a standardized method to diagnose deltoid ligament injuries is missing. Further research is needed to establish evidence-based guidelines on how to diagnose acute deltoid ligament injuries. TRIAL REGISTRATION: Prospero ID: CRD42022307112. CLINICAL TRIAL NUMBER: not applicable.

Clinical respiratory and radiographic abnormalities in dogs with spontaneous hypercortisolism.

The objective of this study was to characterize respiratory clinical signs, other than panting and respiratory distress, as well as thoracic radiographic abnormalities, in dogs with hypercortisolism. Although there have been case reports and studies evaluating the results of pulmonary scintigraphy, no studies have yet reviewed respiratory clinical signs and radiograph results in dogs with hypercortisolism. This study addresses this gap. A case series was evaluated and the dogs' clinical histories were obtained, including clinical signs and physical examination. Digital thoracic radiographs were analyzed to consider such parameters as the diameter of the main bronchi, lung patterns, and the size of the pulmonary trunk. The most common respiratory symptoms were snoring (61.9%), coughing (57.1%), and fatigue (52.4%). Physical examination revealed a high frequency of changes on lung auscultation (95.2%). The body condition score (BCS) was high in 95% of dogs and a significant correlation was observed between the presence of cyanosis and changes in lung auscultation, both of which present similar risk factors. Furthermore, body weight showed a moderate correlation with respiratory rate (RR = 0.571). Radiographic changes were evident in 47.5% of dogs, with the bronchial pattern being the most common (70%). Based on these results, it was observed that respiratory and radiographic abnormalities are frequent in dogs with spontaneous hypercortisolism and a high body condition score was relevant for exacerbating clinical respiratory signs, such as cyanosis and tachypnea.

L'objectif de cette étude était de caractériser les signes cliniques respiratoires, autres que le halètement et la détresse respiratoire, ainsi que les anomalies radiographiques thoraciques, chez les chiens atteints d'hypercortisolisme. Bien qu'il existe des rapports de cas et des études évaluant les résultats de la scintigraphie pulmonaire, aucune étude n'a encore examiné les signes cliniques respiratoires et les résultats radiographiques chez les chiens atteints d'hypercortisolisme. Cette étude comble cette lacune. Une série de cas a été évaluée et les antécédents cliniques des chiens ont été obtenus, incluant les signes cliniques et l'examen physique. Des radiographies thoraciques numériques ont été analysées pour prendre en compte des paramètres tels que le diamètre des bronches principales, les schémas pulmonaires et la taille du tronc pulmonaire. Les symptômes respiratoires les plus courants étaient le ronflement (61,9 %), la toux (57,1 %) et la fatigue (52,4 %). L'examen physique a révélé une fréquence élevée de changements à l'auscultation pulmonaire (95,2 %). Le score d'état corporel (BCS) était élevé chez 95 % des chiens et une corrélation significative a été observée entre la présence de cyanose et les modifications de l'auscultation pulmonaire, qui présentent toutes deux des facteurs de risque similaires. De plus, le poids corporel a montré une corrélation modérée avec la fréquence respiratoire (RR = 0,571). Des changements radiographiques étaient évidents chez 47,5 % des chiens, le schéma bronchique étant le plus courant (70 %). Sur la base de ces résultats, il a été observé que les anomalies respiratoires et radiographiques sont fréquentes chez les chiens atteints d'hypercortisolisme spontané, et qu'un score d'état corporel élevé était pertinent pour l'exacerbation des signes respiratoires cliniques, tels que la cyanose et la tachypnée.(Traduit par Docteur Serge Messier).

Radiographic Measurements of the Hip Joint in Capuchin Monkeys (Sapajus spp.).

BACKGROUND: Radiographs are useful for the initial evaluation of the hip joints. The information can be utilized for the betterment of animal health or other goals such as anatomic studies and gait analysis, among others. Therefore, this study aimed to evaluate radiographic measurements of the hip joint in capuchin monkeys, kept under human care at a reference center for wildlife. METHODS: Twelve capuchin monkeys (Sapajus spp.) (three adult males, seven adult females, and two sub-adult females) were evaluated. Ventrodorsal radiographic views were taken under chemical restraint. All measurements on the digital images were performed in triplicate by one examiner. RESULTS AND CONCLUSIONS: None of the measurements evaluated were statistically different between males and females. No statistical differences were found between hind limbs. The mean (±SD) Norberg angle was 104.92° (±2.82°) and the Wiberg angle was 15.26° (±1.86°). The percentage of the femoral head covered by the acetabulum was 68.57% (±3.65%) and the acetabular index depth to width ratio was 54.66% (±3.85%). In conclusion, the radiographic measurements showed certain morphological features of the hip joint in Sapajus spp. that contribute to improving species knowledge.

[The Seymour fracture - a fracture that easily can be missed]. / Seymourfraktur ­ öppen fraktur som lätt missas.

The Seymour fracture is a pediatric fracture involving the growth plate of the distal phalanx. It is associated with an overlying nail bed injury, and the child often presents with difficulties to extend fully in the distal joint. If not treated properly it can result in infections such as osteomyelitis or lead to deformities and growth disturbances. Since the extent of the damage of the nail bed can range from more obvious crush injuries to small lacerations of the matrix it can easily be missed in the more subtle cases. Early administration of prophylactic antibiotics, reduction of the fracture and repair of the nail bed are necessary for a good prognosis.

[Radiographic measurements of acetabular component orientation with Widmer´s method in total hip arthroplasty. Descriptive case series]. / Mediciones radiográficas de la orientación del componente acetabular con el método de Widmer en la artroplastía total de cadera. Serie de casos descriptiva.

INTRODUCTION: total hip arthroplasty (THA) is one of the most performed surgeries worldwide, with high satisfaction rates. The orientation of the acetabular component has a direct impact on the risk of dislocation, recently with the support of robotic surgery the margin of error in implant placement has decreased; however, the conventional technique even without fluoroscopic support continues to have satisfactory results within the safety zone. MATERIAL AND METHODS: retrospective, cross-sectional, descriptive case series of patients treated with THA at Hospital General Xoco between 2022 and 2024. Degrees of anteversion and inclination were measured with Widmer's method on postoperative radiographs. RESULTS: the radiographs of 113 patients were studied, 80 female and 33 male, with a mean age of 63.2 ± 13.01 years (95% CI: 60.6-65.4), a mean inclination of 42.2° ± 8.1° (95% CI: 40.7-43.2) and anteversion of 14.3° ± 8.5° (95% CI: 12.5-15.4); 76% of the population was within Lewinnek safe zone; by etiology: osteoarthrosis 74%, sequelae of dysplasia 68% and intracapsular fracture 82%; difference between the values of the affected side: left 65%, right 83%, of 3.9° and 4.7°/6.4o and 9° in relation to the overall values of the population. CONCLUSION: in our population undergoing THA, without the use of robotic technique or support of imaging studies, anteversion and inclination figures were recorded within the Lewinnek safety parameters with a conventional method.

INTRODUCCIÓN: la artroplastía total de cadera (ATC) es una de las cirugías más realizadas a nivel mundial, con altos porcentajes de satisfacción. La orientación del componente acetabular tiene impacto directo en el riesgo de luxación; recientemente, con el apoyo de la cirugía robótica, el margen de error en la colocación de los implantes ha disminuido; sin embargo, la técnica convencional, incluso sin apoyo fluoroscópico, continúa teniendo resultados satisfactorios dentro de la zona de seguridad. MATERIAL Y MÉTODOS: serie de casos retrospectiva, transversal y descriptiva, de pacientes tratados con ATC en Hospital General Xoco entre 2022 y 2024. Se midieron los grados de anteversión e inclinación con el método de Widmer en las radiografías postoperatorias. RESULTADOS: se estudiaron las radiografías de 113 pacientes, 80 mujeres y 33 hombres, con edad media de 63.2 ± 13.01 años (IC95%: 60.6-65.4), se obtuvo una inclinación media de 42.2° ± 8.1° (IC95%: 40.7-43.2) y anteversión de 14.3° ± 8.5° (IC95% 12.5-15.4); 76% de la población se encontraba dentro de la zona segura de Lewinnek; por etiología: osteoartrosis 74%, secuelas de displasia 68% y fractura intracapsular 82%; diferencia entre los valores del lado afectado: izquierdo 65%, derecho 83%, de 3.9° y 4.7°/6.4° y 9° en relación con los valores globales de la población. CONCLUSIÓN: en nuestra población sometida a ATC, sin uso de técnica robótica o apoyo de estudios de imagen, se registraron cifras de anteversión e inclinación dentro de los parámetros de seguridad de Lewinnek con un método convencional.

Pin fixation is an effective method for fixation of bunion osteotomy with various procedures: a retrospective cohort study.

BACKGROUND: Various fixation devices are available for bunion osteotomy. In this study, we evaluated the radiographic outcomes, postoperative complications, and recurrence rate in a series of hallux valgus deformities treated with various osteotomy procedures using a pin for the fixation of the osteotomy. METHODS: Two-hundred forty-seven patients with hallux valgus deformity managed with a Simple, Effective, Rapid and Inexpensive (SERI) osteotomy, distal chevron osteotomy, or proximal crescentic osteotomy and K-wire fixation were included. The mean follow-up of the patients was 53.9 ± 8.9 months. Radiographic evaluations included the assessment of the Hallux valgus angle (HVA), intermetatarsal angle (IMA), and union. Clinical evaluations included the assessment of the range of motion, pain in the first metatarsophalangeal joint, and patient satisfaction. RESULTS: In the last visit, the mean improvement of HVA was 23.9 ± 9.1º (P < 0.001). The mean IMA improvement was 6.1 ± 6º (P < 0.001). The mean metatarsophalangeal flexion and extension were 33 ± 10.7º and 34.6 ± 9.2º, respectively. Postoperative complications included pin tract infection in eight (3.2%) patients, deep infection in five (2%) patients, and early pin complication in four (1.6%) patients. Recurrence was observed in five (2%) patients. Twenty-three (9.3%) patients had slight pain in the last follow-up. The mean surgical time was smaller in the SERI osteotomy (P < 0.001). The mean hospitalization period was longer in the proximal osteotomy group (P = 0.039). The mean metatarsophalangeal flexion and extension were significantly smaller in the distal chevron osteotomy (P = 0.046 and P = 0.037, respectively). 90% of patients were satisfied or very satisfied with the surgical outcomes. CONCLUSION: K-wire fixation is a safe and effective device for the fixation of bunion osteotomy, and this effectiveness is even higher with SERI and proximal crescentic osteotomy.

Nineteen years of radiographic screening: Impact of sepsis and evolution of osteochondrosis dissecans prevalence in Walloon sport horses born between 2004 and 2022.

Osteochondrosis dissecans is a particularly common developmental orthopaedic disorder in equines. Among its causes, the hereditary component is no longer a matter of debate, and, for several decades, the various studbooks for sport horses have been selecting stallions in order to limit the prevalence of this condition in the population. However, to our knowledge, no study has evaluated changes in the prevalence of osteochondrosis dissecans over time through longitudinal monitoring of a population of sport horses. The study presented here is part of a large screening programme for developmental orthopaedic pathologies in Wallonia (Belgium) and assessed the presence of these lesions over a period of 19 years in the Walloon sport horse population according to constant and standardised sampling and diagnostic criteria. The effects of breeding conditions and infection in foals were also assessed by means of questionnaires. The results showed no significant change in the prevalence of osteochondrosis dissecans in a population of 1099 individuals born between 2004 and 2022. Furthermore, individuals who had suffered from sepsis during their growing period were very significantly predisposed (p < 0.001) to the development of osteochondrosis dissecans compared to a control group, with respectively 14/21 (67%) and 103/364 (28%) of individuals affected. This study suggests that the selection programmes applied to the population studied are not sufficiently strong or adapted to reduce the prevalence of osteochondrosis dissecans in the population over a period of 19 years. Moreover, this study confirms that foals with sepsis and concurrent osteochondrosis dissecans lesions should not necessarily be excluded from breeding programmes on this basis.

Factors Associated with Patient Satisfaction After Periacetabular Osteotomy.

BACKGROUND: The periacetabular osteotomy (PAO) was developed to treat acetabular dysplasia and avoid the progression of osteoarthritis. Prior research has correlated demographic and radiographic variables with postoperative patient outcomes but with limited focus on patient expectations and correlation with satisfaction. The purpose of this study was to determine whether any such associations exist with the PAO. METHODS: An anonymous, de-identified satisfaction survey was applied to patients undergoing a PAO between April 2017 and April 2019. Forty patients (26 females) who underwent PAOs were included in the final analysis. The average age of the cohort was 22.0 ± 5.1 years of age. All patients had a minimum of 12 months of follow-up from the date of surgery. Patient demographics, diagnosis, and complications were recorded. Radiographs were then analyzed to determine pre- and postoperative lateral center edge angle (LCEA) and Tönnis roof angle, and correlations between satisfaction and radiographic analyses were performed. Statistical analysis included non-parametric Spearman's correlation and receiver operator characteristic. Statistical significance was set at p < 0.05. RESULTS: Thirty (75%) patients were satisfied with their outcome. There were no statistically significant associations between patient age or sex and postoperative satisfaction (p > 0.05). The average LCEA was 10.9° ± 6.9° preoperatively and 26.0° ± 4.2° postoperatively with an average change of 15.1° ± 5.6°. The average Tönnis angle was 18.8° ± 3.3° preoperatively, decreasing to 11.6° ± 3.2° postoperatively with an average change of -7.2° ± 3.2°. Interobserver reliability was high, ranging from r = 0.782, p < 0.001 for postoperative Tönnis angle to r = 0.958, p < 0.001 for preoperative LCEA. Preoperative LCEA correlated positively with satisfaction, r = 0.351, p = 0.027. Logistic regression demonstrated that for every increasing degree of preoperative LCEA, odds of postoperative satisfaction increased by 1.13 (95% CI: 1.01 to 1.27), p = 0.034. CONCLUSION: This study suggests that postoperative patient satisfaction after PAO may be associated with preoperative patient demographics such as LCEA. It also suggests that more dysplastic hips may have lower rates of postoperative satisfaction than patients with less severe deformity. These associations warrant further study, which may yield prognostic value for future surgery.

An unusual Ogden type V tibial tubercle avulsion fracture: a case report and literature review.

BACKGROUND: Ogden type V tibial tubercle avulsion fracture is an unusual type of physial injury. Thus, little is known about its mechanism of injury and treatment. The type of osteosynthesis is variable and depends on the experience of the surgeon. We commonly used cancellous screws fixation combined with tension band wiring for displaced fracture of the anterior tibial tuberosity. CASE PRESENTATION: The present manuscript describes a case of a Han nationality 13-year-old boy who presented with severe pain of the left knee, which began after landing following a high jump. He had no significant past medical history apart from a high body mass index of 30.3. Radiographs revealed that he had an unusual Ogden type V tibial tubercle avulsion fracture. He was treated by open reduction and combined fixation with cannulated screws and tension-band wiring. After 3 months, the fracture healed without any complications or knee symptoms with full range of motion. He underwent reoperation for symptomatic hardware, which was removed at 5 months after initial surgery, and returned to his prior level of sporting activity at 1 year follow-up. CONCLUSION: Our case suggests that excellent functional outcome could be achievable by open reduction with the combination of internal fixation and tension-band wiring for Ogden type V tibial tubercle avulsion fracture. This type of osteosynthesis could not only achieve anatomical reduction and stable fixation for such fractures, but also avoid further damage to the proximal tibial epiphysis, which prevents serious complications, such difference in leg length.

Comparative analysis of radiological outcomes among cephalomedullary nails: helical, screw and winged screw.

Objective: Cephalomedullary nails (CMN) are implants with a high success rate in the surgical treatment of trochanteric fractures. The aim of this study is to compare the radiological outcomes and mechanical complications of femoral trochanteric fractures treated with three different CMNs. Methods: Intertrochanteric fractures in patients aged 50 years and older treated with CMN between January 2016 and December 2021 were reviewed retrospectively. A total of 158 cases meeting the criteria were included to final analysis. Cases were divided into three groups based on the type of nail used (helical blade: group 1, n = 54; screw: group 2, n = 53; winged screw: group 3, n = 51). Demographic characteristics, mechanical complications, reduction quality, tip-apex distances (TAD) and Cleveland zones were compared between the groups. Femoral neck shortening, varus collapse, lag sliding, changes in abductor length were compared between study groups. Factors affecting mechanical complications were also analyzed. Results: Study groups were homogenic in terms of demographic characteristics, fracture type and reduction quality. Regarding mechanical complications, no statistically significant difference was found between groups. All three implants had similar outcomes on femoral neck shortening, varus collapse and lag sliding. Pooled analysis of 158 cases showed that mechanical complications increase as the quality of reduction decreases (p = 0.000) same applies when TAD alters from the desired range (p = 0.025) and with non-optimally implanted blade according to Cleveland zones (p = 0, 000). Conclusion: The radiological outcomes and mechanical complications of helical blade, screw type blade and winged screw type blade proximal femoral nails are similar in selected group. Regardless of the device type, it is necessary to obtain high reduction quality, obtain TAD within described range and optimally place the blade according to Cleveland Zones to reduce the failure rate and avoid complications.

Navigating challenges in radiography research: radiographers' perspectives in Saudi Arabia.

Introduction: Radiography is a crucial healthcare specialty that requires ongoing research to advance imaging technologies and techniques. Despite this, radiographers are faced with obstacles such as time constraints, lack of resources, and the need for training on new technologies, which can discourage their research involvement. This study aims to provide a more representative understanding of the radiography research culture in Saudi Arabia, building upon previous studies. Methods: Following the approval of an ethics committee at Taibah University (2024/173/302 DRD), a cross-sectional survey was conducted from January to March 2024 among registered radiographers in Saudi Arabia. An online questionnaire was distributed via social media platforms using a snowball sampling strategy to reach a diverse group of radiographers across different regions and institutions. Participants provided informed consent before completing the questionnaire. The questionnaire, originally in English, was translated into Arabic and validated by two bilingual academics. It included sections on demographics, previous research experience, barriers to research involvement, factors encouraging research engagement, and self-assessment of research competencies. Descriptive statistics and Cronbach's alpha were used to analyze the data. Results: A total of 105 radiographers participated in the study, with 41% having prior research involvement. Among those engaged, the most common activity was data collection (65%), followed by preparation of scientific articles (49%). Challenges such as the lack of a research-focused culture (48%), insufficient awareness of opportunities (36%), and time constraints (34%) were prominent barriers to research participation. Encouraging factors included the need for research training (63%), support from research groups (51%), and allocated research time (50%). Respondents assessed their research skills, with confidence varied across skills, with 50% feeling capable of initiating research and 51% of participating, yet a significant proportion expressed uncertainties, especially in statistical knowledge and research methodology. Conclusion: Most of the surveyed radiographers did not engage in research. However, there is a substantial interest in enhancing research involvement, with training, collaborative groups, and organizational support identified as key factors encouraging participation. The findings suggest that addressing these barriers can foster a more robust research culture, leading to improved diagnostic practices.