Remodeling in Patients with in Situ Fixation for a Slipped Capital Femoral Epiphysis

Objective: This study has investigated the amount of bone remodeling in patients with a slipped capital femoral epiphysis (SCFE) treated with in situ fixation until closure of the epiphysis and the factors affecting remodeling. Method: Patients who underwent surgery for SCFE between January 2010 and January 2015 were retrospectively screened: Twenty-four male and 7 female patients (mean age 12.6 +- 1.9 years) were included in the study. Gender, age, history, and laterality of trauma, duration of hip pain (acute, chronic, acute on chronic background), and hip radiographs were evaluated. The Southwick and alpha angles were measured, and the factors affecting remodeling were assessed. The statistical analyses were conducted using SPSS 25.0 (IBM Corp., Armonk, NY); 95% confidence levels were calculated and p < 0.05 was considered to indicate statistical significance. Results: The preoperative displacement angles measured on the anteroposterior and lateral radiographs were 15.03° +- 9.1° and 25.93° +- 14.1° and at the last follow-up they were 11.63° +- 8.7° and 21.6° +- 12.1°, respectively. The alpha angles measured on the lateral radiographs preoperatively and at the end of follow-up were 52.33° +- 11.6° and 47.87° +- 11.8°, respectively. Significant remodeling was reflected in the angles measured on the anteroposterior and lateral X-ray images. Greater preoperative displacement angle was associated with less remodeling. Conclusion: Preoperative displacement affects the degree of postoperative remodeling. In patients with severe epiphyseal displacement, open reduction is an option but in situ pinning should be considered in that it is less invasive and more physiological

Sex estimation in a contemporary Turkish population based on CT scans of the calcaneus

Building a reliable biological profile from decomposed remains depends heavily on the accurate estimation of sex. A variety of methods based on every single skeletal element have been developed over the years for different populations employing both osteological and virtual methods. The latter seem to be a reasonable alternative in countries lacking osteological reference collections. The current study used 3D virtual models of calcanei from CT scans of living adults to develop a sex estimation method for contemporary Turkish. Four hundred and twenty eight calcanei CT scans were analysed. The sample was divided in two subsamples: an original (N = 348) and a validation sample (N = 80) with similar distribution of males and females. Nine classical measurements were taken using the 3D models of the calcanei and two different statistical methods (Discriminant function analysis and Binary logistic regression) were used. Classification accuracy ranged from 82% to 98% for the validation sample and it was consistently high using any of the two methods. Sex bias seems to be lower for most of the logistic regression equations compared to the discriminant functions. These results, however, need further testing to be verified. Based on the results of this study we recommend the use of both methods for sex estimation from the measurements of the calcaneus bone in a Turkish population. (C) 2017 Elsevier B.V. All rights reserved

Forensic age diagnostics by magnetic resonance imaging of the proximal humeral epiphysis

The most commonly used radiological method for age estimation of living individuals is X-ray. Computed tomography is not commonly used due to high radiation exposure, which raises ethical concerns. This problem can be solved with the use of magnetic resonance imaging (MRI), which avoids the use of ionizing radiation. The purpose of the present study was to evaluate the utility of MRI analysis of the proximal humeral epiphyses for forensic age estimations of living individuals. In this study, 395 left proximal humeral epiphyses (patient age 12-30years) were evaluated with fast-spin-echo proton density-weighted image (FSE PD) sequences in a coronal oblique orientation on shoulder MRI images. A five-stage scoring system was used following the method of Dedouit et al. The intra- and interobserver reliabilities assessed using Cohen's kappa statistic were =0.818 and =0.798, respectively. According to this study, stage five first appeared at 20 and 21years of age in males and females, respectively. These results are not directly comparable to any other published study due to the lack of MRI data on proximal humeral head development. These findings may provide valuable information for legally important age thresholds using shoulder MRI. The current study demonstrates that MRI of the proximal humerus can support forensic age estimation. Further research is needed to establish a standardized protocol that can be applied worldwide

Applicability of T1-weighted MRI in the assessment of forensic age based on the epiphyseal closure of the humeral head

This work investigates the value of magnetic resonance imaging analysis of proximal epiphyseal fusion in research examining the growth and development of the humerus and its potential utility in establishing forensic age estimation. In this study, 428 proximal humeral epiphyses (patient age, 12-30years) were evaluated with T1-weighted turbo spin echo (T1 TSE) sequences in coronal oblique orientation on shoulder MRI images. A scoring system was created following a combination of the Schmeling and Kellinghaus methods. Spearman's rank correlation analysis revealed a significant positive relationship between age and ossification stage of the proximal humeral epiphysis (all subjects: rho=0.664, p<0.001; males: 0.631, p<0.001; females: rho=0.651, p<0.001). The intra- and inter-observer reliability assessed using Cohen's kappa statistic was =0.898 and =0.828, respectively. The earliest age of epiphysis closure was 17years for females and 18years for males. MRI of the proximal humeral epiphysis can be considered advantageous for forensic age estimation of living individuals in a variety of situations, ranging from monitoring public health to estimating the age of illegal immigrants/asylum seekers, minors engaged in criminal activities, and illegal participants in competitive sports, without the danger of radiation exposure

Evaluation of Clinical and Radiological Results of Humeral Diaphyseal Fractures with Treated Sarmiento Brace

WOS: 000515092400005PubMed: 32226678Aim in our study, we aimed to evaluate the duration and rate of the union of adult humerus diaphysis fractures treated with a functional brace. Methods Forty-six adult patients admitted to our hospital with humeral diaphyseal fracture between January 2010 and April 2014 and treated with a functional brace were evaluated retrospectively. the demographic data, fracture type, level of fracture, and presence of bone union of the patients were evaluated from clinic records. the Disabilities of the Arm, Shoulder and Hand (Quick-DASH) questionnaire score of the patients was registered for patients and analyzed, and its correlation with parameters such as patient age and fracture bone union time was evaluated. Results It was observed that of the patients with the mean age of 45.5 years, six (13.6%) had non-union and five had delayed bone union (10.86%). Three (6.5%) patients had radial nerve injury, and all recovered without sequelae. Out of the patients with the bone union, 12 (30%) had an angulation above give degrees, and 3 (7.5%) had radiological shortness. the mean Quick-DASH score was 6.7, and there was no statistically significant correlation with parameters such as fracture type, level, angulation, radiological shortness and radial nerve involvement (p>0.05). Conclusions A functional brace is a good treatment choice with low complication rates and has satisfactory bone union rates in humerus diaphyseal fractures

The relationship between the level of lesion and progression in Reimer's index of spina bifida patients

WOS: 000396904100017PubMed ID: 27787650Aim We aimed to evaluate the influence of the lesion level and acetabular displasia on the progression of hip dislocation in patients with spina bifida. Material and method Two hundred twelve hips of 106 cases with spina bifida were evaluated both clinically and radiologically. Their vertebral level of lesions, clinical examinations, radiological migration index, and acetabulum terms were noted and were evaluated in terms of their relations with the level of lesion-migration and dysplasia. Data analysis method was evaluated using SPSS 22.0 program. Results Deficiency of acetabulum was present in 33 % of the cases with spina bifida. Dysplastic floor was found to be as equally important as the level of lesion in the progression of hip dislocation (p = 0.002). Progression and dislocation incidences were observed to be higher in the thoracic level (p = 0.008). Reimer's progression index was seen to be a reliable way of assesment. Conclusion The development of hip dislocation and progression are not solely connected with muscle imbalance. Encountered more frequently in these cases, acetabular dysplasia is a factor that is as important as the level of lesion in the formation of hip dislocation and progression. Hip dislocation is associated with more progression in the higher level lesions. Reimer's index is a reliable assessment criteria

Applicability of T1-weighted MRI in the assessment of forensic age based on the epiphyseal closure of the humeral head

This work investigates the value of magnetic resonance imaging analysis of proximal epiphyseal fusion in research examining the growth and development of the humerus and its potential utility in establishing forensic age estimation. In this study, 428 proximal humeral epiphyses (patient age, 12-30years) were evaluated with T1-weighted turbo spin echo (T1 TSE) sequences in coronal oblique orientation on shoulder MRI images. A scoring system was created following a combination of the Schmeling and Kellinghaus methods. Spearman's rank correlation analysis revealed a significant positive relationship between age and ossification stage of the proximal humeral epiphysis (all subjects: rho=0.664, p<0.001; males: 0.631, p<0.001; females: rho=0.651, p<0.001). The intra- and inter-observer reliability assessed using Cohen's kappa statistic was =0.898 and =0.828, respectively. The earliest age of epiphysis closure was 17years for females and 18years for males. MRI of the proximal humeral epiphysis can be considered advantageous for forensic age estimation of living individuals in a variety of situations, ranging from monitoring public health to estimating the age of illegal immigrants/asylum seekers, minors engaged in criminal activities, and illegal participants in competitive sports, without the danger of radiation exposure