Poller (blocking) screw with intramedullary femoral nailing for subtrochanteric femoral non-unions: clinical outcome and review of concepts.

INTRODUCTION: Surgery to treat nonunion resulted from malalignment is challenging since correction and bone union should be achieved simultaneously. To report the clinical outcomes achieved through reconstruction of sub-trochanteric femoral fractures by femoral nailing using a poller screw and to review the current concepts. MATERIALS AND METHODS: Fourteen patients (11 men and 3 women; mean age 56.4 years) who were diagnosed with non-union of subtrochanteric femoral fractures and who underwent intramedullary nailing with blocking screws between August 2013 and March 2019, with at least 1 year follow-up, were analyzed retrospectively. The preoperative and postoperative Centrum-Collum-Diaphyseal angle and anterior angulation angle were measured. Bone union time, position and number of poller screws used, and complications were analyzed. Functional assessment was performed by evaluating the Harris hip score. The related literature was searched, and 14 clinical studies on the treatment of sub-trochanteric non-union were analyzed. RESULTS: Bone union was achieved in 12/14 cases (85.7%) at the final follow-up within a mean of 6.52 (3-12) months. Bone union was also achieved in two patients lacking bone union at the final follow-up through bone grafting and augmented plating. No cases developed complications, including infection and bone necrosis, and the varus deformity and anterior angulation significantly improved from a preoperative mean of 12.4° and 9.4° to postoperative mean 3.8° and 2.4°, respectively. The mean Harris hip score at the final follow-up was 87.07 (73-98) points. Analysis of published literature revealed high rates of bone union (78-100%) through various fixation methods. CONCLUSION: Correction with blocking screws and rigid fixation with intramedullary nailing to treat sub-trochanteric-non-union-caused malalignment can yield good clinical and radiological outcomes.

Matched Comparison of Bone Transport Using External Fixator Over a Nail Versus External Fixator Over a Plate for Segmental Tibial Bone Defects.

OBJECTIVE: To compare the outcomes and complications of bone transport over a nail (BTON) with those of bone transport over a plate (BTOP) for segmental tibial bone defects. DESIGN: Retrospective matched study design. SETTING: A major metropolitan tertiary referral trauma center. PATIENTS: Thirty-six patients with segmental tibial bone defects of >4 cm were included in this study. INTERVENTION: Either BTON or BTOP was performed on 18 patients. MAIN OUTCOME MEASUREMENTS: We compared the healing of the distraction process and of the docking site between the techniques. Distraction parameters including external fixator (EF) time, external fixation index, and healing index were compared. Bone and functional results were compared according to the Paley-Maar classification. Complications associated with each procedure were compared. RESULTS: Both BTON and BTOP achieved similar rates of primary union (83% vs. 89%) at the distraction or docking site. Significantly less time wearing an EF was needed for BTOP than for BTON (2.8 vs. 5.4 months; P < 0.01). The external fixation index was significantly lower for BTOP than for BTON (0.45 vs. 0.94 mo/cm; P < 0.01), whereas the healing indexes were similar. The final outcomes and complication incidences were not significantly different. CONCLUSIONS: The EF time was significantly shorter for BTOP than for BTON; however, the final outcomes were similar. Therefore, BTOP could be considered an attractive option for bone transport in patients with segmental tibial defects. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Conventional bicortical pin substitution with a novel unicortical pin in external fixation: A biomechanical study.

INTRODUCTION: As most patients with polytrauma or open fractures are converted from temporary external fixation to definite stabilization, the prevention of complications such as infection is especially important. To overcome the high risk of infection associated with the use of the conventional bicortical pin for temporary external fixation, the authors developed a novel unicortical pin and analyzed it in a biomechanical study. METHODS: The unicortical pin consisted of an inner screw, purchasing the cortical bone, and an outer sleeve with 6 spikes. A bicortical pin was used for the purpose of comparison. A fracture gap model was stabilized using a monoplanar configuration. Both the unicortical pins (Uni group) and bicortical pins (Bi group) underwent axial compressive and torsional load testing using a servo-hydraulic testing machine. Stiffness, load to failure, and mode of failure were documented. RESULTS: Stiffness and load to failure of the Uni group (average, 40.5 N/mm and 1098.4 N, respectively) were greater than that of the Bi group (average, 33.7 N/mm and 968.6 N, respectively) in the axial compressive load test (P = 0.008 and 0.032). Stiffness and load to failure of the Uni group (average, 1.2 Nm/degree and 1.7 Nm, respectively) were also significantly higher than those of the Bi group (average, 0.8 Nm/degree and 0.6 Nm, respectively) in the torsional load test (P = 0.008 and 0.016). All pins in the Bi group were bent at the pin-synthetic bone interface without synthetic bone failure. Contrarily, the Uni group did not show any pin bending or failure. However, in the axial compression test, partial cracks in the synthetic bone were found at the interface with spikes in the outer shell. In addition, in the torsion test, incomplete fractures were seen through the inner screws' holes. CONCLUSION: Compared with the conventional bicortical pin, the newly designed unicortical pin significantly increased fracture stability under both axial compressive and torsional loads. The unicortical pin can be considered an alternative biomechanical solution to obtain adequate stability when performing external fixation of fractures.

Resolving 500 nm axial separation by multi-slice X-ray ptychography.

Multi-slice X-ray ptychography offers an approach to achieve images with a nanometre-scale resolution from samples with thicknesses larger than the depth of field of the imaging system by modeling a thick sample as a set of thin slices and accounting for the wavefront propagation effects within the specimen. Here, we present an experimental demonstration that resolves two layers of nanostructures separated by 500 nm along the axial direction, with sub-10 nm and sub-20 nm resolutions on two layers, respectively. Fluorescence maps are simultaneously measured in the multi-modality imaging scheme to assist in decoupling the mixture of low-spatial-frequency features across different slices. The enhanced axial sectioning capability using correlative signals obtained from multi-modality measurements demonstrates the great potential of the multi-slice ptychography method for investigating specimens with extended dimensions in 3D with high resolution.

A Look-Up Table-Based Ray Integration Framework for 2-D/3-D Forward and Back Projection in X-Ray CT.

Iterative algorithms have become increasingly popular in computed tomography (CT) image reconstruction, since they better deal with the adverse image artifacts arising from low radiation dose image acquisition. But iterative methods remain computationally expensive. The main cost emerges in the projection and back projection operations, where accurate CT system modeling can greatly improve the quality of the reconstructed image. We present a framework that improves upon one particular aspect-the accurate projection of the image basis functions. It differs from current methods in that it substitutes the high computational complexity associated with accurate voxel projection by a small number of memory operations. Coefficients are computed in advance and stored in look-up tables parameterized by the CT system's projection geometry. The look-up tables only require a few kilobytes of storage and can be efficiently accelerated on the GPU. We demonstrate our framework with both numerical and clinical experiments and compare its performance with the current state-of-the-art scheme-the separable footprint method.

Lateral Femoral Bowing and the Location of Atypical Femoral Fractures.

PURPOSE: Atypical femoral fractures (AFFs) occur in two distinct part, subtrochanter and diaphysis. The aim of this study was to investigate the relationship between the lateral femoral bowing angle and the location of AFF. MATERIALS AND METHODS: This study included a total of 56 cases in 45 patients who underwent surgical treatment between January 2010 and December 2015. For the diaphyseal and subtrochanteric AFFs, we evaluated the relationship between the anatomic location and lateral femoral bowing angle. Lateral femoral bowing angle was measured by two orthopaedic surgeons and average value of two calibrators was used in statistic analysis. Other variables like age, height, weight, body mass index and bone mineral density were also evaluated. We also calculated the cutoff value for the location of the fractures from the raw data. RESULTS: The average lateral femoral bowing angle was 10.10°±3.79° (3°-19°) in diaphyseal group and 3.33°±2.45° (1.5°-11°) in subtrochanter group. Lateral femoral bowing angle was statistically significant in logistic regression analysis. According to the receiver operating characteristic curve, cutoff value for the location of the fracture was 5.25°. In other words, the femoral diaphyseal fractures are more frequent if the lateral femoral bowing angle is greater than 5.25°. CONCLUSION: The lateral femoral bowing angle is associated with the location of the AFFs and the cutoff value of lateral femoral bowing angle was 5.25°.

Real-Time Structural and Electrical Characterization of Metal-Insulator Transition in Strain-Modulated Single-Phase VO2 Wires with Controlled Diameters.

Single-crystal VO2 wires have gained tremendous popularity for enabling the study of the fundamental properties of the metal-insulator transition (MIT); however, it remains tricky to precisely measure the intrinsic properties of the transitional phases with controlled wire-growth properties, such as diameter. Here, we report a facile method for growing VO2 wires with controlled diameters by separating the formation of the liquidus V2O5 seed droplets from the evolution of the VO2 wire using oxygen gas. The kinetic analyses suggest that the growth proceeds via the VS (vapor-solid) mechanism, whereas the droplet determines the size and the location of the wire. In situ Raman spectroscopy combined with analyses of the electrical properties of an individual wire allowed us to construct a diameter-temperature phase diagram from three initial phases (i.e., M1, T, and M2), which were created by misfit stress from the substrate and were preserved at room temperature. We also correlated this relation with resistivity-diameter and activation energy-diameter relations supported by theoretical modeling. These carefully designed approaches enabled us to elucidate the details of the phase transitions over a wide range of stress conditions, offering an opportunity to quantify relevant thermodynamic and electronic parameters (including resistivities, activation energies, and energy barriers of the key insulating phases) and to explain the intriguing behaviors of the T phase during the MIT.

Low dose CT image restoration using a database of image patches.

Reducing the radiation dose in CT imaging has become an active research topic and many solutions have been proposed to remove the significant noise and streak artifacts in the reconstructed images. Most of these methods operate within the domain of the image that is subject to restoration. This, however, poses limitations on the extent of filtering possible. We advocate to take into consideration the vast body of external knowledge that exists in the domain of already acquired medical CT images, since after all, this is what radiologists do when they examine these low quality images. We can incorporate this knowledge by creating a database of prior scans, either of the same patient or a diverse corpus of different patients, to assist in the restoration process. Our paper follows up on our previous work that used a database of images. Using images, however, is challenging since it requires tedious and error prone registration and alignment. Our new method eliminates these problems by storing a diverse set of small image patches in conjunction with a localized similarity matching scheme. We also empirically show that it is sufficient to store these patches without anatomical tags since their statistics are sufficiently strong to yield good similarity matches from the database and as a direct effect, produce image restorations of high quality. A final experiment demonstrates that our global database approach can recover image features that are difficult to preserve with conventional denoising approaches.

Database-assisted low-dose CT image restoration.

PURPOSE: Acquiring data for CT at low radiation doses has become a pressing goal. Unfortunately, the reduced data quality adversely affects the quality of the reconstructions, impeding their readability. In previous work, the authors showed how a prior regular-dose scan of the same patient can efficiently be used to mitigate low-dose artifacts. However, since a prior is not always available, the authors now extend the authors' method to use a database of images of other patients. METHODS: The authors' framework first matches the low-dose (target) scan with the images in the database and then selects a set of images that contain anatomical content similar to the target. These "priors" are then registered to the target and form the set of regular-dose priors for restoration via an extended nonlocal means (NLM) filtering framework. To accommodate the larger spatial variability of the patient scans, the authors subdivide the image area into blocks and perform the filtering locally. The database itself is first preprocessed to map each image from its 2D image space to a corresponding high-D image feature space. From this encoding a visual vocabulary is learned that assists in the query of the database. RESULTS: The authors demonstrate the authors' framework via a lung scan example, for both streak artifacts (resulting from smaller projection sets) as well as noise artifacts (resulting from lower mA settings). The authors find that in the authors' particular example case three priors were sufficient to restore all features faithfully. The authors also observe that the authors' method is quite robust in that it generates good results even when the noise conditions significantly worsen (here by 20%). Finally, the authors find that the restoration quality is significantly better than with conventional NLM filtering. CONCLUSIONS: The authors image restoration algorithm successfully restores images to high quality when the registration is well performed and also when the priors match the target well. When the priors do not contain sufficient information, the affected image regions can only be restored to the quality achieved with conventional regularization. Hence, a sufficiently rich database is a key for successful artifact mitigation with this approach. Finally, the blockwise scheme demonstrates the potential of using small patches of images to form the database.

A Data-Driven Approach to Hue-Preserving Color-Blending.

Color mapping and semitransparent layering play an important role in many visualization scenarios, such as information visualization and volume rendering. The combination of color and transparency is still dominated by standard alpha-compositing using the Porter-Duff over operator which can result in false colors with deceiving impact on the visualization. Other more advanced methods have also been proposed, but the problem is still far from being solved. Here we present an alternative to these existing methods specifically devised to avoid false colors and preserve visual depth ordering. Our approach is data driven and follows the recently formulated knowledge-assisted visualization (KAV) paradigm. Preference data, that have been gathered in web-based user surveys, are used to train a support-vector machine model for automatically predicting an optimized hue-preserving blending. We have applied the resulting model to both volume rendering and a specific information visualization technique, illustrative parallel coordinate plots. Comparative renderings show a significant improvement over previous approaches in the sense that false colors are completely removed and important properties such as depth ordering and blending vividness are better preserved. Due to the generality of the defined data-driven blending operator, it can be easily integrated also into other visualization frameworks.