Background: Computed tomography (CT) provides benefits for 3-dimensional (3D) visualization of femur deformities. However, the potential adverse effects of radiation exposure have become a concern. Consequently, a biplanar imaging system EOS has been proposed to enable reconstruction of the 3D model of the femur. However, this system requires a calibrated apparatus, the cost of which is high, and the area occupied by it is substantial. The purpose of this study was to develop a mobile application that included a new method of 3D reconstruction of the femur from conventional radiographic images and to evaluate the validity and reliability of mobile the application when measuring femoral anteversion. Methods: The statistical shape model, graph-cut algorithm, and iterative Perspective-n-Point algorithm were utilized to develop the application. The anteroposterior and lateral images of a femur can be input using the embedded camera or by file transfer, and the touch interface aids accurate contouring of the femur. Regarding validation, the CT scans and conventional radiographic images of 36 patients with cerebral palsy were used. To evaluate concurrent validity, the femoral anteversion measurements on the images reconstructed from the mobile application were compared with those from the 3D CT images. Three clinicians assessed interobserver reliability. Results: The mobile application, which reconstructs the 3D image from conventional radiographs, was successfully developed. Regarding concurrent validity, the correlation coefficient between femoral anteversion measured using 3D CT and the mobile application was 0.968 (P<0.001). In terms of interobserver reliability, the intraclass correlation coefficient among the 3 clinicians was 0.953. Conclusions: The measurement of femoral anteversion with the mobile application showed excellent concurrent validity and reliability in patients with cerebral palsy. The proposed mobile application can be used with conventional radiographs and does not require additional apparatus. It can be used as a convenient technique in hospitals that cannot afford a CT machine or an EOS system. Level of Evidence: Level III—diagnostic.
Introduction Osteochondroma (solitary) and multiple hereditary exostoses (plural) are defined as a cartilage-capped bony projection arising on the external surface of bone containing a marrow cavity that is continuous with that of the underlying bone. These tumors grow slowly and develop to cause symptoms such as limited range of motion, joint pain, lumps, and deformities. The use of ulnar distraction osteogenesis has gained popularity in treating deformity in forearm osteochondroma. Problems that arise including bone angulation and persistent radial head dislocation. Case presentation We describe eight cases of forearm osteochondroma that came to the Prof. Dr. R. Soeharso Orthopedic Hospital, Surakarta, Indonesia. We found two variations in the classification of Masada in these 8 patients, Masada type I and IIB. The main complaint was a bent arm. We decided to do surgery in the form of tumor resection and reconstruction of the deformity by using ulnar gradual lengthening and osteotomies. The results of the procedure were investigated in this study, using clinical and radiological parameters focusing on medium-term functional and structural outcomes. Discussion and conclusion Eight patients had overall good results, although performed with a different sequence of operating techniques. Ulnar lengthening with a monorail fixator is still the main choice in its implementation. Gradual ulnar lengthening improves not only the deformity but also the functionality of the associated forearm.
Background The distraction osteogenesis procedure has a high potential to treat bone defect problems. The alternative technique to treat nonunion associated with a bone defect is the acute shortening and re-lengthening (ASRL) procedure. This study aimed to evaluate the outcome of ASRL procedure with a monorail fixator to treat femur/tibia nonunion associated with the bone defect. Method Retrospective analysis was performed to patients who received ASRL procedure with monorail fixator for femur or tibia nonunion from October 2018 to October 2020 at Prof. Dr. R. Soeharso Orthopaedic hospital. One case was loss to follow-up and excluded from the study. The rest of 16 cases were included for further analysis. The evaluation was performed to the demographic, intraoperative procedure, problems/complications, additional procedure, and final outcome. Results There were 13 male and three female patients with age ranged from 16 to 64 years old. The follow-up period ranges 9–31 months. ASRL procedures performed to 6 femur and 10 tibias. The problems/complications: two cases with problems associated with callus formation, two cases of fracture at corticotomy site, one case of skin necrosis, one case of osteomyelitis, one case of malrotation. Additional surgical procedures were needed 5/16 (31.2%) cases. Evaluation at the final follow-up period showed 14/16 (87.5%) cases had a complete bone union. Conclusions Acute shortening and re-lengthening (ASRL) could be reliable as a method of treatment for femur/tibia nonunion associated with the bone defect. Several possible complications need to be considered prior to perform this procedure.
<p>The incidence of femoral neck fractures in pediatric patients is rare, including <1% in all cases of fractures in children. The mechanism of injury is a high-energy injury that can cause a fracture in the femoral neck, open fracture cases are rare. Avascular necrosis is the most common complication. We report a fourteen year old boy who was in a road-traffic accident and had a Gustillo Anderson grade IIIA open femoral neck fracture. On the X-ray findings, we classified the type of fracture into Delbet type II. We decided to do the debridement and ORIF accompanied by an osteomuscular pedicle graft using a quadratus femoris muscle tendon fixed with 3 interfragmentary screws. Short-term evaluation shows a clinical union picture and is still well reduced without any signs of infection. Long-term evaluation of the bone healing process is needed and recognizes complications in the form of avascular necrosis of the femoral head.</p>
Introduction: Arthrogryposis multiplex congenita (AMC) is a complex abnormal condition characterized by multiple congenital contractures in the body's joints. Although this condition is not progressive, if not treated properly, it will increase the degree of disability in children. There are two types of AMC. The most common type of AMC is amyoplasia. The second type is distal arthrogryposis (DA), a genetically inherited type characterized by congenital contractures in multiple joints and no neurologic or muscular abnormalities. The incidence of AMC 1:3000 births with clubfeet and congenital hip dislocation is the most common. In this retrospective study, the authors described the profile of AMC patients who underwent surgery at our center with the approach and management. Method: The study design was a descriptive retrospective. The population of this study is all AMC patients who underwent surgery at the orthopedic hospital of Prof. Soeharso Surakarta, Indonesia. We used the total sampling technique who underwent surgery in the 2018-2021 period. Result: In this study, we got eleven AMC patients who underwent surgery. Distribution based on sex found six boys and five girls. Half of the patients underwent surgery under the age of three years, while the other half underwent surgery after the age of five. The presence of patients who are consulted at an older age indicates a lack of public literacy about the abnormal condition of AMC or a lack of concern for the condition. Almost all AMC patients who undergo surgery are in the lower extremities. Conclusion: Rehabilitation plays a very important role in improving the quality of life for AMC patients. A multidisciplinary approach is needed in the treatment of AMC patients. Surgery is performed if stretching and external support splinting/casting cannot achieve functional ROM and repair the deformity.
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