How to obtain and identify the acetabular anterior column axial view projection in patients?

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Management of pelvic ring injuries

Jan Lindahl: MANAGEMENT OF PELVIC RING INJURIES Unstable pelvic ring injuries are relatively rare injuries, but they constitute a major cause of death and disability in high-energy polytrauma patients Massive hemorrhage is the leading cause of potentially preventable death following a blunt pelvic trauma. The overall aim of surgical treatment for unstable pelvic ring injuries is to restore the pelvic anatomy and perform neural decompression, thus allowing normal function with a low rate of complications. This doctoral thesis was initiated to investigate the outcomes of acute and definitive management strategies for unstable pelvic ring injuries. The first study investigated the radiological and functional results of treating type B and C pelvic injuries with an anterior external fixation frame. The second study focused on identifying factors for early predictions of mortality-related outcome and prognosis in patients with pelvic fracture-related arterial bleeding that were treated with transcatheter angiographic embolization (TAE). The third study investigated the outcomes of type C pelvic fractures treated with standardized reduction and internal fixation methods. The fourth study evaluated outcomes and identified prognostic factors for operatively-treated, H-shaped sacral fractures with spinopelvic dissociation. Study I showed that an anterior external fixator failed to achieve and properly maintain reduction in 75% of type B open book injuries and in nearly all (95%) type C pelvic ring injuries. Therefore, an external frame is not a suitable method of treatment for the most unstable pelvic ring injuries as a definitive treatment. The current clinical applications of anterior pelvic external fixators comprise the resuscitation phase, initial fracture stabilization phase, and sometimes, in complex injuries (type C), the definitive phase for fixation of the anterior part of the pelvic ring, in conjunction with posterior internal fixation. Study II of pelvic fracture related arterial bleedings showed that the worst prognosis was related to exsanguinating bleeding from the main trunk of the internal or external iliac artery (large pelvic arteries) or from multiple branches of the internal or external iliac vasculature (high vessel size score). Definitive control of arterial bleeding was achieved with TAE in all patients. In massive hemorrhage with several bleeding arteries uni- or bilaterally, it is reasonable to use non-selective embolization by promptly occluding the main trunk of the internal iliac artery, either uni- or bilaterally. Study III of operatively treated type C pelvic fractures revealed that, internal fixation of injuries in the posterior and anterior pelvic ring provided excellent or good radiological results in 90% of cases. Additionally, because a reduction with displacement less than or equal to 5 mm was more often associated with a good functional outcome, that should be the goal of operative management. However, the prognosis is also often dependent on associated injuries, particularly a permanent lumbosacral plexus injury. The results favoured internal fixation of all the injured elements of the pelvis for improved stability and a more accurate anatomical result in the entire pelvic ring. The H-shaped sacral fracture with spinopelvic dissociation is a rare injury pattern. Study IV revealed that lumbopelvic fixation was a reliable treatment method. The study also showed that neurological recovery and clinical outcome were associated with the degree of initial translational displacement of the transverse sacral fracture component. Permanent neurological deficits were more frequent and the clinical outcome was worst in completely displaced transverse sacral fractures. An accurate operative reduction of all sacral fracture components was associated with better neurological recovery and clinical outcome. We conclude, that with appropriate treatment of unstable pelvic ring injuries, and associated injuries in other organs, it is possible to achieve better survival rates and functional results, and to reduce long-term disability.Jan Lindahl: LANTIORENKAAN MURTUMIEN HOITO (MANAGEMENT OF PELVIC RING INJURIES) Lantiorenkaan murtumat ovat suhteellisen harvinaisia vammoja käsittäen 1% kaikista sairaalahoitoa vaativista murtumista Suomessa. Epätukevat lantiorenkaan murtumat syntyvät yleensä suuren vammaenergian seurauksena ja niihin liittyy usein muiden kehonosien vammoja. Massiivinen verenvuoto on merkittävin ja usein estettävissä oleva kuolinsyy tylpällä vammamekanismilla syntyneissä lantiorenkaan vammoissa. Mikäli akuuttivaiheen hoito ei ole tehokasta, massiivinen verenvuoto johtaa sydämen ja verenkierron pettämiseen ja potilaan kuolemaan. Tämän väitöskirjatutkimuksen tarkoituksena oli selvittää: 1) ulkoisen tukilaitteen soveltuvuus B- ja C-tyypin lantiorenkaan murtumien lopulliseksi hoitomuodoksi, 2) hengenvaarallisten, runsaasti vuotavien lantionmurtumien alkuvaiheen vuodon tukkimista embolisaation (TAE) avulla ja samalla kartoittaa riskitekijöitä, jotka ennustavat huonoa lopputulosta ja potilaan kuolemaa vaikeimmin vammautuneiden lantionmurtumapotilaiden kohdalla, 3) C-tyypin murtumien kohdalla standardoidun leikkaushoidon ja sisäisen kiinnitysmenetelmän luotettavuutta ja hoidon pitkäaikaistulokset ja 4) ristiluun vaikeimpien ns. H-tyypin murtumien leikkaushoidon luotettavuutta sekä saavutetun asennonkorjauksen, murtumakiinnityksen ja hermorakenteiden vapautuksen pitkäaikaistulokset sekä toipumisennusteeseen vaikuttavat tekijät. Ensimmäisen osajulkaisun tulokset osoittivat, että lantiorenkaan etuosaan kiinnitettävä ulkoinen kiinnityslaite (externi fiksaatiolaite) ei ollut luotettava, eikä sillä voitu taata asianmukaista murtuman paikalleen asettamista ja hyvää lopputulosta vaikeimmissa B- ja C-tyypin murtumissa. Toinen osajulkaisu osoitti, että vuotavien lantionmurtumien kohdalla huonoin ennuste liittyi lantiovammoihin, joissa valtimoiden varjoainekuvauksessa (angiografiassa) todettiin lantion päävaltimon (arteria iliaca interna tai externa) repeämä tai useampia samanaikaisia pienempien valtimosuonten repeämiä. Embolisaatio osoittautui luotettavaksi hoitomenetelmäksi ja kaikki valtimoperäiset vuodot pystyttiin tukkimaan. Kriittisessä vuototilanteessa, jossa angiografiassa todetaan useita vuotokohtia lantion valtimoissa, tulee embolisaatio suorittaa ei-selektiivisesti siten, että lantion aluetta suonittava päävaltimo (arteria iliaca interna) tukitaan välittömästi. Näin vuoto saadaan nopeammin hallintaan ja potilaan selviytymisennuste paranee. C-tyypin lantionmurtumien sisäinen kiinnitysmenetelmä, lantiorenkaan kiinnitys edestä levyin sekä takaa ruuvein tai levyin, osoittautui luotettavaksi (kolmas osajulkaisu). Saavutettu asento säilyi seurannassa erinomaisena tai hyvänä 90%:ssa tapauksista. Leikkauksessa saavutettu murtuman hyvä asento korreloi hyvään neurologiseen toipumiseen ja toiminnalliseen tulokseen. Epäanatominen tulos siten, että murtuman lopullinen siirtymä oli yli 5 mm, ennusti huonompaa toiminnallista lopputulosta. Merkittävin toimintakykyä rajoittava tekijä aiheutui lantion alueen hermopunosvauriosta. Tulokset tukevat käsitystä, jonka mukaan C-tyypin vammoissa tulee korjata ja kiinnittää kaikki murtumat lantiorenkaan etu- ja takaosassa, jolloin saavutetaan parempi anatominen tulos ja samalla parempi lantiorenkaan kokonaistukevuus. Ristiluun H-tyypin murtuma, johon liittyy selkärangan ja lantiorenkaan irtoama toisistaan, on harvinainen lantion takaosan alueen vammakokonaisuus. Neljännessä osajulkaisussa käytetty lannerangan ja lantion välinen kiinnitysmenetelmä (lumbopelvinen kiinnitys) osoittautui luotettavaksi. Lantiohermopunoksen (alaraajojen osittainen halvaus) ja ristiluuhermojen vammat (ns. kauda equina syndrooma) ovat tähän vammatyyppiin liittyen yleisiä. Hermovaurion korjaantuminen ja kokonaistoipumisen ennuste oli riippuvainen ristiluun poikittaisen murtuman siirtymän asteesta. Hermovaurio oli vaikeampiasteinen ja toipumistulos huonompi, mikäli siirtymä ensimmäisessä kuvauksessa oli yli ristiluun paksuuden, kun tuloksia verrattiin siihen potilasryhmään, jolla siirtymä oli osittainen. Hyvä leikkauksessa saavutettu asento kaikissa ristiluun murtumalinjoissa oli yhteydessä parempaan toipumisennusteeseen. Systemaattisella tutkimisella sekä määrätietoisella ja vaikuttavalla hoidolla voidaan vähentää lantiorenkaan murtumiin liittyvää kuolleisuutta, sairastavuutta ja pysyvää vammautumista

3D Innovations in Personalized Surgery

Current practice involves the use of 3D surgical planning and patient-specific solutions in multiple surgical areas of expertise. Patient-specific solutions have been endorsed for several years in numerous publications due to their associated benefits around accuracy, safety, and predictability of surgical outcome. The basis of 3D surgical planning is the use of high-quality medical images (e.g., CT, MRI, or PET-scans). The translation from 3D digital planning toward surgical applications was developed hand in hand with a rise in 3D printing applications of multiple biocompatible materials. These technical aspects of medical care require engineers’ or technical physicians’ expertise for optimal safe and effective implementation in daily clinical routines.The aim and scope of this Special Issue is high-tech solutions in personalized surgery, based on 3D technology and, more specifically, bone-related surgery. Full-papers or highly innovative technical notes or (systematic) reviews that relate to innovative personalized surgery are invited. This can include optimization of imaging for 3D VSP, optimization of 3D VSP workflow and its translation toward the surgical procedure, or optimization of personalized implants or devices in relation to bone surgery

Bioabsorbable implants in paediatric supracondylar fractures of the elbow

Background. Operative stabilisation of paediatric supracondylar elbow fractures is most commonly achieved through the use of percutaneous Kirschner wires. These implants are inert, cheap and simple to use. However, the requirement for removal and the possibility of pin site infection provides opportunity for the development of new techniques that eliminate these drawbacks. Bioabsorbable pins that remain in situ and allow definitive closure of skin at the time of surgery could provide such advantages. However, their ability to maintain fracture reduction and their effect on the growth plate has not been adequately evaluated. Hypotheses. The Acumed® Biotrak Helical Nail (a bioabsorbable fixation implant) has comparable strength to Kirschner wires and does not result in significant disruption of the growth plate or subsequent growth. Studies. Three complementary studies were performed. (1) A retrospective cohort analysis was performed to establish the prevalence of complications related to Kirschner wire fixation of paediatric supracondylar elbow fractures. (2) A saw-bone model was designed to compare the mechanical performance of the Helical Nail and Kirschner wires. (3) An ovine model was designed to assess the in vivo effects of the Helical Nail on limb growth and physeal morphology. The surgical practicalities of the device and its potential for use in the paediatric setting were evaluated. The primary outcome was femoral length six months after Helical Nail insertion. Micro-CT evaluation of growth plate thickness, percentage disruption and bony infiltration was undertaken – the first time this technique has been used in a large animal study. Traditional histopathological techniques complimented the Micro-CT analysis and offered comment on the microscopic appearance of the growth plate immediately adjacent to the bioabsorbable nails. Results. The infection rate within a large tertiary referral centre was 9.6%, which was marginally higher than previous cohort studies. Mechanical testing demonstrated that the Helical Nail had comparable strength in rotation, but inferior resistance to posterior translation, when compared to Kirschner wires. In the ovine model, the Helical Nail disrupted 3.4% of the physis. The nails had no effect on femoral growth during the six month study period. Micro-CT analysis of both the helical nail and Kirschner wire groups demonstrated multiple bony bridges, with two cases of physeal tethering in the Helical Nail group. There was no difference in physeal thickness or bony infiltration of the physis. Histopathology did not reveal any significant inflammatory or foreign body reaction adjacent to the nails. Conclusion. The Helical Nail demonstrated a number of encouraging attributes which indicate its potential. However, in its current state the device is not suitable for use in the stabilisation of paediatric supracondylar elbow fractures

Towards Functional Preoperative Planning in Orthopaedic Surgery

Las cirugíıas del aparato locomotor suponen más de 20 millones de intervencionesanuales para la corrección de lesiones que afectan a músculos, articulaciones,ligamentos, tendones, huesos o nervios; elementos que conforman el sistema musculoesquelético. Este tipo de afecciones de la biomecánica pueden tener diversos orígenes; siendo los principales los traumatismos, las lesiones degenerativas en huesos y tejidos blandos, los malos hábitos posturales o motores, y los de origen congénito.El uso de las tecnologías actuales en los procesos de corrección de estas afecciones forma parte del día a día en los quirófanos y en la monitorización de los pacientes.Sin embargo, el uso de técnicas computacionales que permitan la preparación de las intervenciones quirúrgicas antes de proceder con la cirugía están todavía lejos de formar parte del proceso de evaluación preoperatoria en este tipo de lesiones. Por este motivo, el objetivo principal de esta tesis consiste en demostrar la viabilidad del uso de herramientas computacionales en la planificación preoperatoria de diferentes cirugías ortopédicas.Entre los tipos de cirugías más comunes, la mayor parte de ellas se centran en las articulaciones del tren inferior de la anatomía humana. Por este motivo, este trabajo se centraría en el análisis de diferentes cirugías cuya finalidad es solucionar lesiones en las principales articulaciones del tren inferior: región sacrolumbar, cadera, rodilla y tobillo.Para poder realizar el análisis de estas cirugías se hizo uso de algunas de lasherramientas computacionales más usadas habitualmente y cuya capacidad en diversos ámbitos ha sido comprobada. Se ha utilizado la reconstrucción 3D para la obtención de modelos anatómicos sobre los que comprobar la viabilidad de las cirugías. Estas reconstrucciones se basan en las imágenes médicas obtenidas mediante Tomografia Axial Computerizada (TAC) o Resonancia Magnética (RM). Las imágenes procedentes de RM permiten diferenciar todos los tejidos de la anatomía, incluyendo los blandos tales como tendones o cartílagos; mientras que los TAC facilitan la diferenciación de los huesos. Esta última es la prueba más habitual en los diagnósticos.Para su análisis y reconstrucción se hizo uso de los software Mimics v 20.0 y3-matic 11.0 (Materialise NV, Leuven, Belgium). Como alternativa para la generación de los modelos cuando no se dispone de las imágenes necesarias para realizar la reconstrucción o cuando se requiere dotar de flexibilidad a estos modelos, se recurrió al modelado en el software de análisis por elementos finitos Abaqus/CAE v.6.14 (Dassault Syst`emes, Suresnes, France). Dicho software fue además utilizado para la simulación del efecto de las diferentes cirugías sobre la región de interés. Para resalizar las simulaciones, se incluyeron en los modelos aquellos parámetros, elementos y condiciones necesarios para poder representar las caraterísticas propias de cada cirugía. Finalmente, para aquellas situaciones que requerían del análisis de datos se hizo uso de tecnologías de machine learning. La solución seleccionada para estos casos fueron las redes neuronales artificiales (ANN). Dichas redes se desarrollaronhaciendo uso del software MATLAB R2018b (MathWorks, Massachusetts, USA).El estudio de la rodilla se centra en uno de los ligamentos clave en la estabilidad de la rótula y que, sin embargo, es uno de los menos analizados hasta ahora, el ligamento medial patelofemoral. La reconstrucción de este ligamento es la principal solución clínica para solventar esta inestabilidad y diferentes cirugías utilizadas para dicho fin han sido analizadas mediante el desarrollo de un modelo paramétrico en elementos finitos que permita su simulación. En este modelo es posible adaptar la geometría de la rodilla de forma que se puedan simular diferentes condiciones que pueden afectar a la estabilidad de la rótula, tales como la displasia troclear y la patella alta.El estudio de la región sacrolumbar se centra en el análisis de diferentes posibles configuraciones para las cirugías de fusión vertebral. El análisis se centró en la fijación con tornillos y la influencia del Polimetimetacrilato (PMMA) como elemento de fijación en las vértebras. Para ello, se reconstruyó el modelo óseo de diferentes pacientes que necesitaron este tipo de intervención. Sobre estos modelos se simularon mediante elementos finitos las diferentes configuraciones consideradas de forma que se pudiera comparar su comportamiento en diferentes casos.En el caso de la cadera, el estudio se centra en el análisis de la artroplastia total de cadera, que implica el reemplazo de la articulación anatómica por una prótesis habitualmente de titanio. Cuando este tipo de cirugías es realizado, es común que surjan posteriormente problemas derivados de la disposición de la prótesis y que pueden llevar al pinzamiento entre sus componentes y, en algunas ocasiones, su dislocación.Esto ocurre cuando el rango de movimiento de la articulación es reducido. Este tipo de sucesos son más comunes cuando se realizan los movimientos de extensión externa (EE) o de rotación interna (RI) de la extremidad. El estudio se desarrolló con el objetivo de elaborar una herramienta computacional capaz de predecir este choque y dislocación basándose en el diámetro de la cabeza del femur y de los ángulos de abducción y anteversión. Para ello, se recurrió al uso de redes neuronales artificales(ANN). Se configuró una red independiente para cada movimiento (EE y RI) y cada posible evento (pinzamiento y dislocación), de forma que se obtuvieron cuatro redes completamente independientes. Para el entrenamiento y primer testeo de las redes se recurrió a un modelo paramétrico en elementos finitos de la prótesis con el que se realizaron diferentes simulaciones determinando el rango de movimiento para cada caso. Finalmente, las redes fueron de nuevo validadas con el uso de datos procedentes de pacientes que sufrieron dislocación tras ser sometidos a este tipo de cirugías.Finalmente, el estudio de la región del tobillo se centró en la lesión de la sindesmosis del tobillo. Este tipo de lesiones implica la rotura de algunos de los ligamentos que unen los principales huesos de esta articulación (tibia, peroné y astrágalo) junto con parte de la membrana intraósea, que se extiende a lo largo de la tibia y el peroné ligando ambos huesos. Cuando se produce este tipo de lesiones, es necesario recurrir a la inclusión de elementos que fijen la articulación y prevengan la separación de los huesos. Los métodos más comunes y que centran este análisis comprenden la fijación con tornillos y la fijación mediante botón de sutura. Para poder realizar un análisis que permita comparar la efectividad y incidencia de este tipo de cirugías se recurrióa la reconstruccción 3D de la articulación de un paciente que sufrió este tipo de lesión. Con este modelo geométrico, se procedió al desarrollo de diferentes modelos en elementos finitos que incluyeran cada una de las alternativas consideradas. Las simulaciones de estos modelos junto a las situaciones anatómicas y lesionadas, permitió hacer una aproximación sobre la solución quirúrgica que mejor restablece el estado incial sano de la región afectada.Locomotor system surgeries represents more the 20 million interventions per year for the correction of injuries that affect muscles, joints, ligaments, tendons, bones or nerves; elements that form themusculoskeletal system. This kind of biomechanical affections may have several sources, being the main ones traumas, bones and soft tissues degenerative injuries, poor postural or motor habits and those of congenital source. The use of current technologies in the correction process for these injuries is part of the day-to-day in the operating rooms and the monitoring of patients. However, the use of computational tools that allow preoperative planning is still far from being part of the preoperative evaluation process in this kind of injuries. For this reason, the main goal of this thesis consists in demonstrating the viability of the use of computational tools in the preoperative planning of different orthopaedic surgeries. Among the most common surgeries, most of them focus in the lower body joints of the human anatomy. For this reason, this work will focus in the analysis of different surgeries whose purpose is to solve injuries in the main joints of the lower body: lumbosacral region, hip, knee and ankle. Some of the most commonly used computational tools, and whose capability in different fields has been widely proven, were used in order to be able of performing the analysis of these surgeries. 3D reconstruction has been used for obtaining anatomical models in which the viability of the surgeries could be verified. These reconstructions are based on the medical images obtained through Computerized Tomography (CT) or Magnetic Resonance Imaging (RMI). Images from RMI allow differentiating all the tissues of the anatomy, including soft ones such as tendons and cartilages; while CT scans make easier the bones differentiation. This last procedure is the most commonly used in diagnoses. For their analysis and reconstruction software Mimics v 20.0 and 3-Matic 11.0 (Materialise NV, Leuven, Belgium) were used. As alternative for the models generation when the necessary images for the reconstruction are not available or when flexibility is required for these models, modelling in the Finite Element Analysis software Abaqus/CAE v.6.14 (Dassault Syst‘emes, Suresnes, France) was used. This software was also used for the simulation of the effects of the different surgeries in the interest region. In order to perform the simulations, those parameters, elements and conditions necessary to represent the characteristics of each surgery were included. Finally, for those situations requiring data analysis, machine learning technologies were used. The selected solution for these cases were Artificial Neural Networks (ANN). These networks were developed using the software MATLAB R2018b (MathWorks, Massachusetts, USA). The study of the knee joint focuses in one of the key ligaments for the patellar stability and which, however, is one of the least analysed so far, the medial patellofemoral ligament. The reconstruction of this ligament is the main clinical solution for solving this instability and different surgeries used for that purpose have been analysed through the development of a finite element parametric model that allows their simulation. In this model adapting knee geometry is possible so that those conditions that can affect the stability of the patella, such as trochlear dysplasia or patella alta, can be simulated. The study of the lumbosacral region focuses in the analysis of different possible configurations for spine fusion surgeries. The analyses focused in the pedicle screws fixation and the influence of polymethyl methacrylate (PMMA) as fixation element in the vertebrae. To do this, osseous models for different patients that required this kind of intervention were reconstructed. The different configurations considered were simulated on these models through finite element analysis comparing their behaviour. In the case of the hip, the study focuses in the analysis of the total hip arthroplasty, which implies replacing the anatomical joint by a prosthesis, usually made of titanium. When this kind of surgery is performed, it is common for later issues arising from the arrangement of the prosthesis and which can lead to impingement between its components and, on some occasions, their dislocation. This happens when the range of movement of the joint is limited. This kind of events are more common when the external extension (EE) or internal rotation (IR) movements of the leg are performed. The study was developed with the goal of elaborating a computational tool able to predict the impingement and dislocation based on the diameter of the head of the femur and the anteversion and abduction angles. To do this, artificial neural networks (ANN) were used. An independent network was configured for each movement (EE and IR) and for each possible event (impingement and dislocation), so that four completely independent networks. For the training and the first testing of the networks, a parametric finite element model of the hip was used; with which different simulations were performed determining the range of movement for each case. Finally, the networks were validated again with the use of data proceeding from patients that suffered dislocation after going through this kind of surgery. Finally, the study of the ankle region focused in the ankle syndesmosis injury. This kind of injuries implies the tear of some ligaments that connect the main bones of the joint (tibia, fibula and talus) together with part of the intraosseous membrane, which extends along the tibia and fibula linking both bones. When this kind of injuries happens, it is necessary to resort to the inclusion of elements that fix the joint and prevent the bones distance. The most common methods, which focus this analysis, include the screws fixation and the suture button fixation. In order to carry out an analysis that allows comparing the effectiveness and incidence of this kind of surgeries, a 3D reconstruction of the joint from a patient that suffered this kind of injury was used. With this geometrical model, different finite element models including each of the considered alternatives were developed. The simulations of these models, together with the injured and anatomical situations, allowed an approximation of the surgical solution that better restores the initial healthy state of the affected region.<br /

Musculoskeletal Diseases 2021-2024

This open access book focuses on imaging of the musculoskeletal diseases. Over the last few years, there have been considerable advances in this area, driven by clinical as well as technological developments. The authors are all internationally renowned experts in their field. They are also excellent teachers, and provide didactically outstanding chapters. The book is disease-oriented and covers all relevant imaging modalities, with particular emphasis on magnetic resonance imaging. Important aspects of pediatric imaging are also included. IDKD books are completely re-written every four years. As a result, they offer a comprehensive review of the state of the art in imaging. The book is clearly structured with learning objectives, abstracts, subheadings, tables and take-home points, supported by design elements to help readers easily navigate through the text. As an IDKD book, it is particularly valuable for general radiologists, radiology residents, and interventional radiologists who want to update their diagnostic knowledge, and for clinicians interested in imaging as it relates to their specialty

Musculoskeletal Diseases 2021-2024

This open access book focuses on imaging of the musculoskeletal diseases. Over the last few years, there have been considerable advances in this area, driven by clinical as well as technological developments. The authors are all internationally renowned experts in their field. They are also excellent teachers, and provide didactically outstanding chapters. The book is disease-oriented and covers all relevant imaging modalities, with particular emphasis on magnetic resonance imaging. Important aspects of pediatric imaging are also included. IDKD books are completely re-written every four years. As a result, they offer a comprehensive review of the state of the art in imaging. The book is clearly structured with learning objectives, abstracts, subheadings, tables and take-home points, supported by design elements to help readers easily navigate through the text. As an IDKD book, it is particularly valuable for general radiologists, radiology residents, and interventional radiologists who want to update their diagnostic knowledge, and for clinicians interested in imaging as it relates to their specialty

Personalized Hip and Knee Joint Replacement

This open access book describes and illustrates the surgical techniques, implants, and technologies used for the purpose of personalized implantation of hip and knee components. This new and flourishing treatment philosophy offers important benefits over conventional systematic techniques, including component positioning appropriate to individual anatomy, improved surgical reproducibility and prosthetic performance, and a reduction in complications. The techniques described in the book aim to reproduce patients’ native anatomy and physiological joint laxity, thereby improving the prosthetic hip/knee kinematics and functional outcomes in the quest of the forgotten joint. They include kinematically aligned total knee/total hip arthroplasty, partial knee replacement, and hip resurfacing. The relevance of available and emerging technological tools for these personalized approaches is also explained, with coverage of, for example, robotics, computer-assisted surgery, and augmented reality. Contributions from surgeons who are considered world leaders in diverse fields of this novel surgical philosophy make this open access book will invaluable to a wide readership, from trainees at all levels to consultants practicing lower limb surger

CT Scanning

Since its introduction in 1972, X-ray computed tomography (CT) has evolved into an essential diagnostic imaging tool for a continually increasing variety of clinical applications. The goal of this book was not simply to summarize currently available CT imaging techniques but also to provide clinical perspectives, advances in hybrid technologies, new applications other than medicine and an outlook on future developments. Major experts in this growing field contributed to this book, which is geared to radiologists, orthopedic surgeons, engineers, and clinical and basic researchers. We believe that CT scanning is an effective and essential tools in treatment planning, basic understanding of physiology, and and tackling the ever-increasing challenge of diagnosis in our society