Background Routine anteroposterior radiographs of the acromioclavicular （AC） joint with or without weight bearing have limitations in demonstrating the AC joint. Transarticular fixation with Kirschner wire is a trea...Background Routine anteroposterior radiographs of the acromioclavicular （AC） joint with or without weight bearing have limitations in demonstrating the AC joint. Transarticular fixation with Kirschner wire is a treatment choice for AC dislocations. However, percutaneous fixation of the AC joint is technically demanding. The C-arm fluoroscopy can be used as routine intraoperative guidance to facilitate this procedure. The current study aims to introduce new projections, the axial and tangential views of AC joint, to help evaluate the severity of the injury and facilitate the percutaneous procedure. Methods Three shoulder specimens were used to find the projection directions of the axial and tangential views of the AC joint by using the digital radiography （DR） unit. The axial and tangential views were taken of 20 adult volunteers by referencing the projection directions determined in the shoulder specimens. The angles showed on the DR system and the angles between the coronal plane of the body and the vertical plane of the flat panel detector （FPD） during taking these radiographs were recorded. The C-arm fluoroscopy unit was used to take the axial and tangential views referencing the angles measured on the DR system. Routine anteroposterior radiographs of the AC joint were taken on the volunteers. The minimal distances from the distal clavicle to the acromion were measured on both tangential and anteroposterior radiographs. The data was statistically analyzed. Results The clear axial and tangential radiographs of AC joints of the volunteers were obtained using both DR and C-arm fluoroscopy units. The angles demonstrated on the DR window are （20.8±2.4）° for male and （18.3±2.3）° for female. During taking the axial views, the angles between the coronal plane of the body and vertical plane of FPD are （23.3±3.2）° for male and （20,1±2.4）° for female. During taking tangential views, the corresponding angles are （117.5±3.7）° for male and （113.1±3.3）° for female. On the tangential radiographs, the minimal distance from the distal clavicle to the acromion is （6.1±1.2） mm, wider than the same measurement on the anteroposterior radiographs （P 〈0.05）. Statistical analyses showed no significant differences in the above-mentioned angles and the minimal distances between the left and right AC joints （P 〉0.05）. There were no significant differences in the above-mentioned angles between DR and C-arm fluoroscopy units （P 〉0.05）. Conclusions The axial and tangential radiographs of the AC joint can demonstrate the joint clearly and they can be easily obtained with both DR system and C-arm fluoroscopy unit in similar projection directions.展开更多
Background： Postoperative knee soft tissue irritation is a common complication after retrograde nail fixation of femoral fractures. Distal locking screw prominence is one of the causes for soft tissue irritation. Thi...Background： Postoperative knee soft tissue irritation is a common complication after retrograde nail fixation of femoral fractures. Distal locking screw prominence is one of the causes for soft tissue irritation. This study aimed to determine whether the use of the femoral condyles tangential views improve the diagnostic accuracy compared with anteroposterior （A-P） view in detecting distal locking screw penetrations during retrograde femoral nailing. Methods： The angle between the sagittal plane and lateral aspect of the condyle and the angle between the sagittal plane and medial aspect of condyle were measured on computed tomography （CT） images. After the angles were measured and recorded, cadaveric femurs were used in a simulated surgical procedure. The retrograde femoral nail was inserted into the femur and placed distal locking screws, which were let1 2, 4, and 6 mm proud of the medial and lateral condyles for each femur. A-P view, lateral condyle tangential view and medial condyle tangential view were obtained. All fluoroscopic images were recorded and sent to three observers blinded to the experimental procedure to determine whether screws penetrated the condyle cortex or not. Results： According to the results of CT scan, the lateral condyle view was 20.88 ＋ 0.98± and the medial condyle view was 40.46 ± 3.14°. In the A-P view, we detected 0% at 2 mm penetration, 16.7% （lateral condyle screw） and 25.0% （medial condyle screw） at 4 mm, and 41.7% （lateral condyle screw） and 58.3% （medial condyle screw） at 6 mm. In the lateral tangential view, we detected 91.7% at 2 mm penetration of the lateral condyle and 100% at 4 mm and 6 ram. In the medial tangential view, we detected 66.7% at 2 mm penetration of the medial condyle and 100% at 4 mm and 6 ram. The femoral condyle tangential views provided significant improvement in detecting screw penetrations at all lengths （2, 4, and 6 mm） compared with the A-P view （P 〈 0.05）. Conclusions： The femoral condyles tangential views increased the accuracy of detecting screw penetrations on the medial and lateral condyles. Routine clinical use of the femoral condyles tangential views has the potential to increase accuracy in detecting distal locking screw penetration during retrograde femoral nailing.展开更多
文摘Background Routine anteroposterior radiographs of the acromioclavicular （AC） joint with or without weight bearing have limitations in demonstrating the AC joint. Transarticular fixation with Kirschner wire is a treatment choice for AC dislocations. However, percutaneous fixation of the AC joint is technically demanding. The C-arm fluoroscopy can be used as routine intraoperative guidance to facilitate this procedure. The current study aims to introduce new projections, the axial and tangential views of AC joint, to help evaluate the severity of the injury and facilitate the percutaneous procedure. Methods Three shoulder specimens were used to find the projection directions of the axial and tangential views of the AC joint by using the digital radiography （DR） unit. The axial and tangential views were taken of 20 adult volunteers by referencing the projection directions determined in the shoulder specimens. The angles showed on the DR system and the angles between the coronal plane of the body and the vertical plane of the flat panel detector （FPD） during taking these radiographs were recorded. The C-arm fluoroscopy unit was used to take the axial and tangential views referencing the angles measured on the DR system. Routine anteroposterior radiographs of the AC joint were taken on the volunteers. The minimal distances from the distal clavicle to the acromion were measured on both tangential and anteroposterior radiographs. The data was statistically analyzed. Results The clear axial and tangential radiographs of AC joints of the volunteers were obtained using both DR and C-arm fluoroscopy units. The angles demonstrated on the DR window are （20.8±2.4）° for male and （18.3±2.3）° for female. During taking the axial views, the angles between the coronal plane of the body and vertical plane of FPD are （23.3±3.2）° for male and （20,1±2.4）° for female. During taking tangential views, the corresponding angles are （117.5±3.7）° for male and （113.1±3.3）° for female. On the tangential radiographs, the minimal distance from the distal clavicle to the acromion is （6.1±1.2） mm, wider than the same measurement on the anteroposterior radiographs （P 〈0.05）. Statistical analyses showed no significant differences in the above-mentioned angles and the minimal distances between the left and right AC joints （P 〉0.05）. There were no significant differences in the above-mentioned angles between DR and C-arm fluoroscopy units （P 〉0.05）. Conclusions The axial and tangential radiographs of the AC joint can demonstrate the joint clearly and they can be easily obtained with both DR system and C-arm fluoroscopy unit in similar projection directions.
基金This study was supported by grants from the Hebei Medical Science Key Research Plan，the National Natural Science Foundation of China
文摘Background： Postoperative knee soft tissue irritation is a common complication after retrograde nail fixation of femoral fractures. Distal locking screw prominence is one of the causes for soft tissue irritation. This study aimed to determine whether the use of the femoral condyles tangential views improve the diagnostic accuracy compared with anteroposterior （A-P） view in detecting distal locking screw penetrations during retrograde femoral nailing. Methods： The angle between the sagittal plane and lateral aspect of the condyle and the angle between the sagittal plane and medial aspect of condyle were measured on computed tomography （CT） images. After the angles were measured and recorded, cadaveric femurs were used in a simulated surgical procedure. The retrograde femoral nail was inserted into the femur and placed distal locking screws, which were let1 2, 4, and 6 mm proud of the medial and lateral condyles for each femur. A-P view, lateral condyle tangential view and medial condyle tangential view were obtained. All fluoroscopic images were recorded and sent to three observers blinded to the experimental procedure to determine whether screws penetrated the condyle cortex or not. Results： According to the results of CT scan, the lateral condyle view was 20.88 ＋ 0.98± and the medial condyle view was 40.46 ± 3.14°. In the A-P view, we detected 0% at 2 mm penetration, 16.7% （lateral condyle screw） and 25.0% （medial condyle screw） at 4 mm, and 41.7% （lateral condyle screw） and 58.3% （medial condyle screw） at 6 mm. In the lateral tangential view, we detected 91.7% at 2 mm penetration of the lateral condyle and 100% at 4 mm and 6 ram. In the medial tangential view, we detected 66.7% at 2 mm penetration of the medial condyle and 100% at 4 mm and 6 ram. The femoral condyle tangential views provided significant improvement in detecting screw penetrations at all lengths （2, 4, and 6 mm） compared with the A-P view （P 〈 0.05）. Conclusions： The femoral condyles tangential views increased the accuracy of detecting screw penetrations on the medial and lateral condyles. Routine clinical use of the femoral condyles tangential views has the potential to increase accuracy in detecting distal locking screw penetration during retrograde femoral nailing.
