Three-dimensional hindfoot alignment measurements based on biplanar radiographs: comparison with standard radiographic measurements

Objective: To establish a hindfoot alignment measurement technique based on low-dose biplanar radiographs and compare with hindfoot alignment measurements on long axial view radiographs, which is the current reference standard. Materials and methods: Long axial view radiographs and low-dose biplanar radiographs of a phantom consisting of a human foot skeleton embedded in acrylic glass (phantom A) and a plastic model of a human foot in three different hindfoot positions (phantoms B1-B3) were imaged in different foot positions (20° internal to 20° external rotation). Two independent readers measured hindfoot alignment on long axial view radiographs and performed 3D hindfoot alignment measurements based on biplanar radiographs on two different occasions. Time for three-dimensional (3D) measurements was determined. Intraclass correlation coefficients (ICC) were calculated. Results: Hindfoot alignment measurements on long axial view radiographs were characterized by a large positional variation, with a range of 14°/13° valgus to 22°/27° varus (reader 1/2 for phantom A), whereas the range of 3D hindfoot alignment measurements was 7.3°/6.0° to 9.0°/10.5° varus (reader 1/2 for phantom A), with a mean and standard deviation of 8.1° ± 0.6/8.7° ± 1.4 respectively. Interobserver agreement was high (ICC = 0.926 for phantom A, and ICC = 0.886 for phantoms B1-B3), and agreement between different readouts was high (ICC = 0.895-0.995 for reader 1, and ICC = 0.987-0.994 for reader 2) for 3D measurements. Mean duration of 3D measurements was 84 ± 15/113 ± 15s for reader 1/2. Conclusion: Three-dimensional hindfoot alignment measurements based on biplanar radiographs were independent of foot positioning during image acquisition and reader independent. In this phantom study, the 3D measurements were substantially more precise than the standard radiographic measurement

Scoliosis correction with pedicle screws in Duchenne muscular dystrophy

This report describes the spinal fixation with pedicle-screw-alone constructs for the posterior correction of scoliosis in patients suffering from Duchene muscular dystrophy (DMD). Twenty consecutive patients were prospectively followed up for an average of 5.2years (min 2years). All patients were instrumented from T3/T4 to the pelvis. Pelvic fixation was done with iliac screws similar to Galveston technique. The combination of L5 pedicle screws and iliac screws provided a stable caudal foundation. An average of 16 pedicle screws was used per patient. The mean total blood loss was 3.7l, stay at the intensive care unit was 77h and hospital stay was 19days. Rigid stabilisation allowed immediate mobilisation of the patient in the wheel chair. Cobb angle improved 77% from 44° to 10°, pelvic tilt improved 65% from 14° to 3°. Lumbar lordosis improved significantly from 20° to 49°, thoracic kyphosis remained unchanged. No problems related to iliac fixation, no pseudarthrosis or implant failures were observed. The average percentage of predicted forced vital capacity (%FVC) of the patients was 55% (22-94%) preoperatively and decreased to 44% at the last follow-up. There were no pulmonary complications. One patient with a known cardiomyopathy died intraoperatively due to a sudden cardiac arrest. The rigid primary stability with pedicle screws allowed early mobilisation of the patients, which helped to avoid pulmonary complication

Análisis del tiempo de respuesta para el cliente externo de la expedición de seguros colectivos de personas en la dirección de operaciones de Suramericana en el 2014

Actualmente las empresas se encuentran orientadas a la satisfacción del cliente, no obstante en la realidad se puede observar que la promesa básica del servicio no se mejora o se incumple, motivo por el cual las organizaciones deben evaluar de manera periódica la forma como gestionan los requerimientos o necesidades del cliente, identificando las variables que tienen mayor impacto y relevancia en la prestación del servicio, permitiendo el desarrollo y perfeccionamiento en los procesos. El presente trabajo de grado, tiene como propósito realizar el análisis del tiempo de respuesta para el cliente externo de la expedición de seguros colectivos de personas en la dirección de operaciones de Suramericana en el 2014. Para dar cumplimiento a este objetivo, se planteó una investigación cuali – cuantitativa con un diseño descriptivo, utilizando la observación y la medición de tiempos como fuente primaria de información. Para la presentación de resultados se usará la matriz DOFA, herramienta por la cual se identificaran las debilidades y amenazas que se evidencian en la prestación de este servicio en la entidad, y se propondrán acciones que ayuden a mejorar y potencializar las fortalezas y oportunidades que permitan optimizar los tiempos de respuesta en los procesos. El planteamiento y desarrollo del presente trabajo, pueden brindar a la dirección de operación de Suramericana la obtención de información de utilidad, con el fin de ofrecer a los clientes un servicio donde se destaquen los atributos de claridad, oportunidad y calidad en los tiempos de respuesta para la expedición de seguros colectivos de personas.Businesses today are oriented to customer satisfaction, however in reality it can be seen that the basic service promise is not fullfilled. Even though the promise is not a failure it is not a success either, because of these reasons organizations should periodically assess how to manage requirements or customer needs. How to identify the variables that have the greatest impact and relevance in providing the service which then will allow the development and improvement of processes. This paper is intended to perform the analysis of the response time for the external client expedition insurance groups of people in the direction of Suramericana operations in 2014. To fulfill this objective, there was a proposed qualitative research - a quantitative descriptive design, using observation and measurement times as the primary sources of information. For the presentation of the results the SWOT tool matrix will be the primary tool used for identifying the weaknesses and threats that are evident in the provision of this service, and actions will be proposed to help improve and empower the strengths and opportunities that allow to optimize response times in the processes. The planning and development of this paper, can provide where to address the operation of Suramericana obtaining useful information, with the purpose to offer clients a service where the attributes of clarity, opportunity and clarity will be highlighted in the times of response for the expedition insurance groups of people

Anatomical considerations of the internal iliac artery in association with the ilioinguinal approach for anterior acetabular fracture fixation

Introduction: Vascular injury may be encountered during an anterior approach to the pelvis or acetabulum—be it due to hematoma decompression, clot dislodgement during fracture manipulation, or iatrogenic. This can be associated with significant bleeding, hemodynamic instability, and subsequent morbidity. If the exact source of bleeding cannot be easily identified, compression of the internal iliac artery may be a lifesaving procedure. Materials and methods: We describe an extension of the lateral window of the ilioinguinal (or Olerud) approach elaborated on cadavers. Results: The approach allows emergent access the internal iliac artery and intraoperative cross-clamping of the internal iliac vessels to control bleeding. Conclusion: The approach allows rapid access to the internal iliac artery. The surgeon should be familiar, however, with the surgical anatomy of this region to avoid potential injury to the ureter, peritoneum, lymphatics, and sympathetic nerves overlying the vessels when using the approach describe

Ligaments of the Lisfranc joint in MRI: 3D-SPACE (sampling perfection with application optimized contrasts using different flip-angle evolution) sequence compared to three orthogonal proton-density fat-saturated (PD fs) sequences

Purpose: To compare the detection rate and visibility of the ligaments in the Lisfranc joint with a single 3D (−SPACE) MR sequence and three orthogonal PD fat-saturated sequences. Materials and methods: Thirty-one asymptomatic feet and 15 patients with posttraumatic pain in the Lisfranc joint were evaluated with a 3D-SPACE-sequence (0.5mm section thickness, acquisition time 10:22min, secondary reformations) and three orthogonal PD fs sequences (2mm section thickness, 9:20min). The Lisfranc-ligament, the dorsal and plantar tarsometatarsal ligaments (TMT), the dorsal, interosseous, and plantar intermetatarsal ligaments (IMT) (24 ligaments for each foot) were assessed. Results: In asymptomatic feet, 692 ligaments were detected with the SPACE sequence, thereof 90.6% exhibited normal signal, and most (96.9%) were completely visible on one single image. A total of 659 ligaments were detected with the PD fs sequence, thereof 86.6% yielded normal signal, and 28.5% were completely visible on one single image. In patients, 327 ligaments were detected with SPACE, thereof 50.6% appeared completely visible with high signal. On PD fs, 308 ligaments were detected, 42.2% of the ligaments had high signals. Conclusions: The ligaments of the Lisfranc joint are better detected with a single 3D-SPACE sequence and secondary reformations than with three orthogonal PD fs sequence

Oedema and fatty degeneration of the soleus and gastrocnemius muscles on MR images in patients with achilles tendon abnormalities

Objective: The purpose of this study was to evaluate the frequency of oedema and fatty degeneration of the soleus and gastrocnemius muscles in patients with Achilles tendon abnormalities. Methods: Forty-five consecutive patients (mean 51years; range 14-84years) with achillodynia were examined with magnetic resonance (MR) images of the calf. The frequency of oedema and fatty degeneration in the soleus and gastrocnemius muscles was determined in patients with normal tendons, tendinopathy and in patients with a partial tear or a complete tear of the Achilles tendon. Results: Oedema was encountered in 35% (7/20) of the patients with tendinopathy (n = 20; range 13-81years), and in 47% (9/19) of the patients with partial tears or complete tears (n = 19; 28-78years). Fatty degeneration was encountered in 10% (2/20) of the patients with tendinopathy, and in 32% (6/19) of the patients with tears. The prevalence of fatty degeneration was significantly more common in patients with a partial or complete tear compared with the patients with a normal Achilles tendon (p = 0.032 and p = 0.021, respectively). Conclusion: Oedema and fatty degeneration of the soleus and gastrocnemius muscles are common in patients with Achilles tendon abnormalitie

The International Documentation and Evaluation System IDES: a single center observational case series for development of an ankle prosthesis documentation questionnaire and study of its feasibility and face validity

ABSTRACT: BACKGROUND: The number of implanted total ankle replacements is increasing and most articles present short- and mid-term results. Comparison of outcomes is difficult because of inconsistent terminology and different use of parameters. MATERIALS AND METHODS: We created a module for total ankle prostheses in the framework of the International Documentation and Evaluation System (IDES). Content development was conducted with an iterative process based on a single surgeon series of 74 HINTEGRA(c) total ankle replacements and expert opinions. RESULTS: The IDES ankle module comprises three forms A, B and C for recording of primary (A), revision (B) and followup (C) procedures. 74 primary interventions, 28 revisions and 92 followups could be documented in detail with the final version of the questionnaires. CONCLUSION: The IDES-forms facilitate a structured and standardized data collection for total ankle arthroplasties. Implemented on the academic MEMdoc portal http://www.memdoc.org of the University of Bern, all registered users can make use of IDES in its online or paper based versions

Therapeutic impact of [18F]fluoride positron-emission tomography/computed tomography on patients with unclear foot pain

Purpose: To evaluate the therapeutic impact of [18F]fluoride positron-emission tomography/computed tomography ([18F]fluoride PET/CT) imaging on patients with unclear foot pain. Methods: Twenty-eight patients were prospectively included in this study. Therapeutic management was defined by two experienced dedicated foot surgeons before and after [18F]fluoride PET/CT imaging. Twenty-six patients underwent cross-sectional imaging [CT, magnetic resonance (MR)] prior to PET/CT. A retrospective analysis of the magnetic resonance imaging (MRI) diagnoses was performed when a therapy change occurred after PET/CT imaging. Results: In 13/28 (46%) patients therapeutic management was changed due to PET/CT results. Management changes occurred in patients with the following diagnoses: os trigonum syndrome; sinus tarsi syndrome; os tibiale externum syndrome; osteoarthritis of several joints; non-consolidated fragments; calcaneo-navicular coalition; plantar fasciitis; insertional tendinopathy; suggestion of periostitis; neoarticulations between metatarsal bones. Os trigonum, os tibiale externum, subtalar osteoarthritis and plantar fasciitis were only seen to be active on PET/CT images but not on MR images. Conclusion: [18F]fluoride PET/CT has a substantial therapeutic impact on management in patients with unclear foot pai

Dixon-based MRI for assessment of muscle-fat content in phantoms, healthy volunteers and patients with achillodynia: comparison to visual assessment of calf muscle quality

Objectives: To quantify the muscle fat-content (MFC) in phantoms, volunteers and patients with achillodynia using two-point Dixon-based magnetic resonance imaging (2pt-MRIDIXON) in comparison to MR spectroscopy (MRS) and visual assessment of MFC. Methods: Two-point Dixon-based MRI was used to measure the MFC of 15 phantoms containing 0-100% fat-content and calf muscles in 30 patients (13 women; 57 ± 15years) with achillodynia and in 20 volunteers (10 women; 30 ± 14years) at 1.5T. The accuracy of 2pt-MRIDIXON in quantification of MFC was assessed in vitro using phantoms and in vivo using MRS as the standard of reference. Fat-fractions derived from 2pt-MRIDIXON (FFDIXON) and MRS (FFMRS) were related to visual assessment of MFC (Goutallier grades 0-4) and Achilles-tendon quality (grade 0-4). Results: Excellent linear correlation was demonstrated for FFDIXON with phantoms and with FFMRS in patients (p c = 0.997/0.995; p  0.05). FFMRS and FFDIXON were significantly higher in subjects with (>grade 1) structural damage of the Achilles-tendon (p = 0.01). Conclusions: Two-point Dixon-based MRI allows for accurate quantification of MFC, outperforming visual assessment of calf muscle fat. Structural damage of the Achilles tendon is associated with a significantly higher MFC. Key points: • Two-point Dixon-based MRI allows accurate quantification of muscular fat content (MFC). • Quantitative analysis outperforms visual analysis in the detection of elevated MFC. • Achillodynia results in an increased MFC of the gastrocnemius muscles. • Structural damage of the Achilles tendon further increases the MFC

Upright Cone CT of the hindfoot: Comparison of the non-weight-bearing with the upright weight-bearing position

Objectives: To prospectively compare computed tomography (CT) of the hindfoot in the supine non-weight-bearing position (NWBCT) with upright weight-bearing position (WBCT). Methods: Institutional review board approval and informed consent of all patients were obtained. NWBCT and WBCT scans of the ankle were obtained in 22 patients (mean age, 46.0 ± 17.1years; range 19-75years) using a conventional 64-row CT for NWBCT and a novel cone-beam CT for WBCT. Two musculoskeletal radiologists independently performed the following measurements: the hindfoot alignment angle, fibulocalcaneal and tibiocalcaneal distances, lateral talocalcaneal joint space width, talocalcaneal overlap and naviculocalcaneal distance. Significant changes between NWBCT and WBCT were sought using Wilcoxon signed-rank test. P values <0.05 were considered statistically significant. Results: Significant differences were found for all measurements except the hindfoot alignment angle and tibiocalcaneal distance. Significant measurement results were as follows (NWBCT/WBCT reader 1; NWBCT/WBCT reader 2, mean ± standard deviation): fibulocalcaneal distance 3.6mm ± 5.2/0.3mm ± 6.0 (P = 0.006); 1.4mm ± 6.3/-1.1mm ± 6.3 (P = 0.002), lateral talocalcaneal joint space width 2.9mm ± 1.7/2.2mm ± 1.1 (P = 0.005); 3.4mm ± 1.9/2.4mm ± 1.3 (P = 0.001), talocalcaneal overlap 4.1mm ± 3.9/1.4mm ± 3.9 (P = 0.001); 4.5mm ± 4.3/1.4mm ± 3.7 (P < 0.001) and naviculocalcaneal distance 13.5mm ± 4.0/15.3mm ± 4.7 (P = 0.037); 14.0mm ± 4.4/15.7mm ± 6.2 (P = 0.100). Interreader agreement was good to excellent (ICC 0.48-0.94). Conclusion: Alignment of the hindfoot significantly changes in the upright weight-bearing CT position. Differences can be visualised and measured using WBCT. Key Points : • Cone-beam computed tomography (CBCT) offers new opportunities for musculoskeletal problems • Visualization and quantification of hindfoot alignment are possible in upright weight-bearing CBCT • Hindfoot alignment changes significantly from non-weight-bearing to weight-bearing CT • The weight-bearing position leads to a decrease in the fibulocalcaneal distance and talocalcaneal overlap • The naviculocalcaneal distance is increased in the weight-bearing positio