IntroductionThis study compared the feasibility of six different CT-based measurement techniques for establishing an indication for derotational osteotomy in the cases of patellar instability or femoral fracture.Materials and methodsCT scans of 52 single human cadaver femora were measured using six different torsion measurement techniques (described by Waidelich, Murphy, and Yoshioka on transverse images and Hernandez, Jarrett, and Yoshioka on oblique images). All measurements were performed by four observers twice to assess intraobserver and interobserver agreement. The intraclass correlation coefficient (ICC), ANOVA, and Bonferroni post hoc test were used for the statistical analysis.ResultsSignificant differences (P < 0.001) between the values for femoral torsion were observed with all techniques except Yoshioka’s techniques on transverse and oblique slices (P = 1.000) (transverse images: Waidelich 22.4° ± 6.8°, Murphy 17.5° ± 7.0°, Yoshioka 13.4° ± 6.9°; oblique images: Hernandez 11.4° ± 7.4°, Jarrett 14.9° ± 7.5°, Yoshioka oblique 13.4° ± 7.1°). Intraobserver and interobserver agreement showed a high level of reproducibility (ICC 0.877–0.986; mean 0.8°–2.9°) for all techniques, with the greatest difference being observed with Hernandez’s technique (11.4°/10°).ConclusionsFemoral torsion values depend on the measurement technique. When derotational osteotomy is being considered, it is essential to use different threshold values depending on the measurement technique.

Objective: The purpose of this retrospective study was to evaluate transcatheter arterial embolization (TAE) for the management of iatrogenic and blunt traumatic intercostal artery (ICA) injuries associated with hemothorax and clinical deterioration. Methods: From May 1999 through April 2007, 24 consecutive patients (17 men, 7 women; mean age 53 years) presenting with active ICA hemorrhage underwent TAE mainly by means of coils combined with polyvinyl alcohol (PVA) particles. Eleven of them had blunt traumatic injuries (group A, n ‫؍‬ 11) and 13 had iatrogenic injuries (group B, n ‫؍‬ 13). In all patients, ICA injuries resulted in acute bleeding with clinical deterioration and hemothorax. Before discharge, all patients underwent clinical examination, laboratory tests, and chest x-ray. After discharge, no specific follow-up protocol was required, and the patients were questioned on their state of health at regular intervals and underwent CT or chest x-ray as needed. Results: Primary technical success (PTS) was achieved in 21 of 24 patients (87.5%). In group A, it was achieved in all but one patient (90.9%) and in group B in 11 of 13 patients (84.6%). A total of three patients needed secondary interventions, which failed in one of them, amounting to a secondary technical success rate (STS) of 8.3%. The total cumulative mortality rate was 37.5% (n ‫؍‬ 9). In group A, it was 9.1% (n ‫؍‬ 1) and in group B, it was 61.5% (n ‫؍‬ 8). 30-day-mortality was 9.1% in group A, where one patient died due to multiple severe associated injuries, and 30.8% (n ‫؍‬ 4) in group B, where one patient died due to treatment failure and three patients due to severe comorbidities. During follow-up, no more deaths occurred in group A, while in group B, four more patients died due to severe comorbidities, amounting to a late mortality rate of 30.8%.No technical complications and no complications such as chest wall or spinal cord ischemia were observed. The mean observation period was 44.6 months in group A and 23.8 months in group B. Conclusion: TAE of ICAs is a minimally invasive, safe, and reliable treatment option to control massive intrathoracic hemorrhage, especially in patients with serious comorbidities and/or multiple injuries. However, it should be performed only by experienced interventionalists and exact knowledge of the anatomic features of the affected artery and of collateral pathways is mandatory to avoid complications. ( J Vasc Surg 2009;49:1505-13.)

Endovascular repair of isolated IAA is a safe and minimally invasive alternative to surgery. However, it may be associated with several complications and must, therefore, be carefully planned.

Scaphoid intraosseous rotation can be measured using common volume rendering software. The opposite uninjured side provides good reference values for rotation measurement. Assessment of malrotation may impact anatomical reconstruction of scaphoid fractures.