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A roentgen stereophotogrammetric investigation of innominate osteotomy (Salter).

The effect of the innominate osteotomy according to Salter was investigated by a roentgen stereophotogrammetric method in a 17-year-old girl with hip dysplasia as a part of the tricho-rhino-phalangeal (Giedion) syndrome. The osteotomy resulted in a total rotation of 32 degrees about an axis passing cranially to the pubic symphysis and the osteotomy. The acetabulum rotated 22 degrees forwards about a transverse axis, 9 degrees laterally about a longitudinal axis and 24 degrees laterally about a sagittal axis. The acetabulum was translated 2 mm laterally along a transverse axis, 21 mm caudally along a longitudinal axis and 19 mm dorsally along a sagittal axis. The position of the screw axis indicates that some motion also took place in one or both of the sacroiliac joints. The correction as measured with the CE-angle was 25 degrees which was almost the same as the correction about the sagittal axis. It is, however, noted that the CE-angle was also dependent upon the rotations about the transverse and longitudinal axes.

Adolescent↗

Moiré topography for the diagnosis and documentation of scoliosis.

Moiré topography is a biosteriometric method, which produces a three-dimensional image of the shape of the trunk. In structural scoliosis an asymmetry of the two halves of the back is seen. This method has been studied and the range of the asymmetry of the moire pattern has been compared with clinical observations and X-ray findings in 216 cases with structural scoliosis. A statistically significant correlation between these three ways of describing a structural scoliosis was found. Because of the sensitivity of the moire method an asymmetry of at least one fringe interval could be regarded as a positive result. All the observed asymmetries less than one fringe interval had a lateral deviation of the spine of less than 10 degrees according to Cobb when X-rayed examined. The moire method seems to be very suitable for the screening of structural scoliosis, owing to its ability to detect and document even small deformities by photography and the simplicity of the technique which can be carried out even by staff without medical training.

Adolescent↗

Migration of the acetabular socket after total hip replacement determined by roentgen stereophotogrammetry.

UNLABELLED: In order to evaluate the feasibility of a roentgen stereophotogrammetric method for the analysis of the migration pattern of joint prostheses, tantalum balls were implanted into the acetabular socket and the pelvic bone during total hip replacement in four patients with rheumatoid arthritis. During the postoperative period, the migration of the acetabular socket was determined. The observation period varied from 5-24 months. No clinical or radiographic signs of mechanical loosening or infection were noted. All the investigated patients showed a gradual migration of the acetabular socket. The cranial migration measured up to 1.8 mm in 2 years. The migration along the transverse and sagittal axes was less but not constantly directed. The rotatory movements about the three axes varied and measured up to 5.5 degrees in 2 years. The translation and rotation were greatest during the first few months. The results indicate a gradual migration of the acetabular socket in hip arthroplasty in the osteopenic skeleton in rheumatoid arthritis. IN CONCLUSION: roentgen stereophotogrammetry may prove to be a valuable means of analysing the migration of implanted prostheses and detecting prosthetic loosening, thereby increasing the possibility of early and correct diagnosis and therapy.

Acetabulum↗

Moiré topography in school screening for structural scoliosis.

Schoolgirls, aged 10-17 years, were screened for structural scoliosis at school using both conventional clinical screening with a forward bending test and moiré topography. Those suspected of having scoliosis were examined in an orthopaedic clinic for the presence of clinically significant scoliosis, defined as lateral deviation of 10 degrees or more measured according to Cobb. The screening revealed 41 cases of scoliosis, corresponding to a prevalence of 4.1 per cent. In 39 girls the scoliosis had not been recognized previously. In this study moiré topography revealed twice as many cases of scoliosis as did conventional clinical screening. The diagnostic sensitivity of moiré topography proved to be high (0.997). The method is, however, loaded by many false positive results. No correlation between the degree of lateral deviation, judged by X-ray examination, and the difference in contour lines, judged by moiré topography, was found.

Adolescent↗

A comparative study of the efficiency of different types of school screening for scoliosis.

The efficiency of scoliosis screening was studied among school children in the city of Malmö during the seventies. All children were investigated annually during this decade. The efficiency of the screening varied, however, from one in which no specific information at all was given to the school health authorities to the other extreme where a specially trained school nurse carried out a combined moiré -- clinical screening programme. A significant decrease in the mean value of the degree of scoliosis was recorded when diagnosis was made with more effective screening. The best result was achieved when using the combined moiré - clinical screening programme. Furthermore, with this method, the scoliosis was diagnosed at an earlier age and consequently, the number of cases operated on decreased. Thus the cost of effective school screening will be covered merely by avoiding operation in a few cases.

Adolescent↗

Surface replacement of the hip in chronic arthritis. A clinical, radiographic and roentgen stereophotogrammetric evaluation.

Surface replacement of the hip was performed on nine patients (11 hips) with chronic arthritis. The results were evaluated twice clinically, as well as by radiography and roentgen stereophotogrammetry, an average of 15 and 23 months postoperatively. The early clinical results were promising. One or both of the components were loose in five hips and the acetabular socket had migrated in one hip, as revealed by the radiograms. Roentgen stereophotogrammetry revealed loosening in one hip and migration of one or both of the components in eight hips altogether. The radiograms gave the information needed in the daily routine but roentgen stereophotogrammetry gave more accurate information about early migration. At the third clinical follow-up, an average of 35 months postoperatively, two hips had been reoperated on and two had developed pain.

Adolescent↗

Roentgen stereophotogrammetric analysis of growth pattern after pronation ankle injuries in children.

In a prospective study of ankle fractures in children, the posttraumatic growth pattern was registered with a roentgen stereophotogrammetric technique. This method allows determination of growth rates within 3 months after fracture, and the prognosis for future growth can be determined within 6-8 months after fracture. The ankle fractures were classified anatomically according to Salter-Harris and traumatologically according to Gerner-Smidt. Nine cases were classified as due to pronation: two pronation-abduction injuries and seven pronation-eversion injuries. The pronation-abduction injuries had Salter-Harris type I injury in distal fibula and tibia, respectively, and showed initial growth stimulation and symmetric growth. The pronation-eversion injuries had a Salter-Harris type II injury in distal tibia and showed three types of growth pattern: initial growth stimulation (3 cases), growth arrest (2 cases), and progressive growth retardation (1 case), besides one case with no significant growth registered bilaterally. Asymmetric growth within the growth region was found in four cases; in three mainly as a varus position, in one mainly as antecurvation of the ankle joint. In conclusion, the pronation-abduction injuries showed growth stimulation, whereas the older showed progressive growth retardation or growth arrest.

Adolescent↗

Instability, migration and laxity of total hip prostheses. A roentgen stereophotogrammetric study.

Roentgen stereophotogrammetric analysis was used in the evaluation of clinical and/or radiographic problems in 28 total hip replacements without suspicion of infection. Instability of the acetabular and/or the femoral component was revealed in 14 cases. In 21 cases, examined twice, migration of the acetabular component was found in eight cases and migration of the femoral component in 15 cases. The method allows instability and migration of the prosthetic components as well as joint laxity to be determined with a high degree of accuracy.

Acetabulum↗

Instability of total hip prostheses at rotational stress. A roentgen stereophotogrammetric study.

Roentgen stereophotogrammetric analysis (RSA) has been carried out on 24 total hip prostheses (24 patients), which were all painful at weightbearing. The examinations were made with the hip at distraction, compression, external and internal rotation. One acetabular component showed instability only at distraction-compression and one showed instability only at rotation. Four femoral components showed instability at distraction-compression and at rotation, six only at rotation, but none showed instability only at distraction-compression. Thus rotational provocation demonstrated instability in all unstable femoral components; rotational stress must be of importance in mechanical loosening of the femoral component.

Acetabulum↗

Definition of endoprosthetic loosening. Comparison of arthrography, scintigraphy and roentgen stereophotogrammetry in prosthetic hips.

Contrast arthrography, radionuclide arthrography, scintigraphy and roentgen stereophotogrammetric analysis (RSA) were used to detect mechanical loosening in 14 painful total hip replacements. All prosthetic components unstable by RSA, or with abnormal arthrogram, or with increased scintigraphic activity, or loose at revision were migrating, but no non-migrating components demonstrated any of these signs of loosening. Our findings indicate that mechanical loosening should be defined as migration.

Contrast Media↗

Early weight bearing of malleolar fractures.

A prospective randomized investigation of early versus late weight bearing in 46 patients with fracture of the lateral malleolus was performed. In 43/46 patients an exact operative reconstruction of the ankle mortise could be achieved using pins, staples and cerclage (Cedell, 1967). Radiographic and stereophotogrammetric analysis of the ankles after 3 months showed no significant differences, nor did the clinical follow-up.

Adult↗

Mobility of the ankle mortise. A roentgen stereophotogrammetric analysis.

In 7 adult volunteers, a roentgen stereophotogrammetric technique was used to analyze the tibiofibular relationship during active unloaded movements of the ankle. The greatest movements were observed during plantar to dorsiflexion with an average widening of the ankle mortise of 1.0 mm and an average dorsal translation of the fibula of 0.9 mm. No significant rotation of the fibula could be revealed.

Adult↗

Early weight bearing of displaced ankle fractures.

A prospective randomized study was performed comparing immediate and late weight bearing in 53 dislocated bimalleolar and trimalleolar fractures. Using cerlage, staples, and pins (Cedell 1967), an exact reconstruction of the ankle mortise was achieved in 41/53 ankles. At follow-up after 3 and 6 months, the two groups were equal regarding clinical results. Evaluation radiographically and by roentgen stereophotogrammetric analysis (Selvik 1974) indicated that the stability of the ankle mortise was sufficient to allow early postoperative weight bearing.

Ankle Injuries↗

Surface stereophotogrammetry of thoracic kyphosis.

The thoracic kyphosis angles of 16 normal individuals, 10 patients with Scheuermann's disease and 11 with adolescent idiopathic scoliosis were measured both radiographically and from Integrated Shape Imaging System (ISIS) scans obtained by surface stereophotogrammetry. There was a high correlation between the two measures. The method of kyphosis measurement from ISIS scans was then used for 30 patients with adolescent idiopathic scoliosis who underwent corrective surgery. A significant reduction in thoracic kyphosis was observed postoperatively. In another group of 28 patients managed conservatively by bracing, some hypokyphosis developed after treatment. However, we found no association between hypokyphosis and curve progression.

Adolescent↗

Stability of femoral neck fractures. A postoperative roentgen stereophotogrammetric analysis.

Using roentgen stereophotogrammetric analysis, the postoperative stability of femoral neck fractures was measured in 16 patients. During the first day after internal fixation, before weight bearing, the center of the femoral head moved on an average 1.5 mm (total translation) in six undisplaced fractures and 3.7 mm in 10 displaced fractures, which was about one third of the fracture movement during the first postoperative month. Three undisplaced fractures displayed a rotatory instability, mainly after weight bearing had begun. Five of the displaced fractures showed maximal rotatory displacement during the first postoperative day. The recorded fracture movements before weight bearing may question the rationale of peroperative mechanical compression.

Aged↗