Retrospective Review of Arthroplasty Radiographs: How to Define an Adequate Radiograph.

Introduction Adequacy of postoperative hip and knee radiographs has a direct impact on its interpretation. We undertook a quality improvement project by creating local standards to meet the arthroplasty team expectations for a satisfactory radiograph. The purposes of the study are 1. Assessment of the adequacy of radiographs according to defined criteria, and 2. Correlation of system and patient factors with inadequate radiographs. Methods Stage I: We conducted a single centre, retrospective audit to check the adequacy of a postoperative radiography following a total hip or knee replacement. A total of 100 radiographs were assessed against the nine criteria laid out with the consensus of orthopaedic surgeons and radiologists. Stage II: We created a quality improvement proforma for use in the radiology department. We re-assessed 100 radiographs during the second cycle against the nine criteria to check the adequacy of hip and knee arthroplasty radiographs, Results Stage I: Of 100 radiographs, 51 were from the knee and 49 from the hip arthroplasty group. Sixty-nine radiographs were adequate considering overall criteria, and 31 radiographs were inadequate. The inadequacy in radiographs was related to the visibility of prosthesis, cement or relevant anatomy. Stage II: We created a quality improvement performa for use in radiology department, highlighting the nine initial criteria. One hundred radiographs of hip and knee arthroplasty were re-assessed. Overall, 84 radiographs fulfilled the criteria of being adequate. Conclusion Adequacy of knee and hip arthroplasty radiographs is essential in picking up pathologies that can be missed otherwise. We present simple criteria to improve the adequacy of x-ray and prevent repetition of radiographs.

Chronic ectopic pregnancy mimicking pelvic malignancy.

Ectopic pregnancy is a common complication of early pregnancy. We present a very atypical case of an ectopic gestation in a woman who presented with a negative pregnancy test, a large pelvic mass, weight loss and bowel obstruction.

Predicting intertrochanteric extension of greater trochanter fractures of the hip on plain radiographs.

INTRODUCTION: It is important to distinct between isolated greater trochanter (GT) fractures and complete intertrochanteric (IT) extension to prevent unwanted morbidities. Aim of this study was to determine if there was any particular fracture pattern, of GT fractures on a plain radiograph of the hip which could predict IT extension. METHOD: Retrospective review of radiographs of 49 patients with a GT fracture who presented in the last 10 years (January 2005-December 2015). All images were reviewed by a consultant musculoskeletal radiologist and an orthopaedic surgeon. The AP plain radiographs were assessed to look for fracture angle and length of the fracture. The fracture length was taken as a percentage and was measured as the length of the fracture crossing the intertrochanteric line/the total length of the intertrochanteric line. The fracture angle was measured as the angle between a line drawn from the most superior point of the fracture on the lateral cortex of the GT, to a perpendicular line along the medial cortex of the femoral shaft. The subsequent MRI and CT scans were assessed to see if there was true intertrochanteric extension. RESULTS: 32 patient were female and 17 male. 27 CT scans of which 8 showed complete IT extension. 22 had MRI scan of which 6 showed complete extension. The mean fracture length of patients with complete extension was 56% with a range of 50%-63%. The mean fracture length of patients with incomplete extension was 33% with a range of 12%-55%. The mean fracture angle for patients with complete extension was 39° with a range of 35-42°. The mean fracture angle for patients with incomplete extension was 58° with a range of 44-124°. CONCLUSION: For greater trochanter fractures that do not cross >50% of the IT line and do not have a fracture angle between 35 and 42° do not require further imaging as they will not have complete intertrochanteric extension.

Bilateral progressive cystic nephroma in a 9-month-old male infant requiring renal replacement therapy.

We report the case of a 3-year-old boy who presented at 9 months of age with abdominal distension and was found to have a triad of bilateral cystic nephroma, pleuropulmonary blastoma (PPB) and juvenile intestinal polyps. There have been three previous reported cases of patients with the same associated diagnoses. Our patient is the first reported patient with PPB who received renal replacement therapy and progressed to successful renal transplantation. The potential increased risk of progression of malignancy of PPB (type 1) with immunosuppression following transplantation remains unknown.

A retrospective evaluation of Randall's plaque theory of nephrolithiasis with CT attenuation values.

PURPOSE: We examined the computed tomography attenuation values (HU) of renal papillae in stone formers (SF) to determine whether nephrolithiasis is associated with radiographic changes in renal papillae to investigate the Randall's plaque theory. MATERIALS AND METHODS: Two observers independently and retrospectively recorded the HU of the renal medullae and cortex in 90 patients with a unilateral single calculus within kidney or ureter, and in 104 cases in control group (CG) matched for age and renal functions. RESULTS: The patient ages were similar in the stone former and control groups. However, the male-female ratio was significantly greater in the SF group (68:22) than in the CG (42:62, P<0.0001). Left-right ratio in SF group was 50:40. The inter-rater agreement was kappa=0.53 (95% CI: 0.42, 0.64). Mean HU of all papillae of affected side in stone-formers (ASSF) was significantly greater than that in CG (39.6 versus 29.6, P<0.0001). When comparing affected and non-affected sides within the SF group, there was no significant difference (39.6 versus 38.4, P=0.16). The receiver operating characteristic (ROC) analysis showed area under curve=0.94 with optimal cut-off at 34 HU. At this point the specificity, sensitivity, PPV and NPV were 90%, 90%, 33% and 99%, respectively. CONCLUSION: HU of the renal papilla is significantly increased in SF in the affected and the non-affected kidneys when compared to the CG. This finding may form one of the risk indicators to determine the future follow up and clinical management for the potential SF.