Interstitial lung disease (ILD) is a major pulmonary manifestation of connective tissue disease (CTD), leading to significant morbidity and mortality. Chest high-resolution computed tomography (HRCT) is presently considered the diagnostic gold standard for pulmonary fibrosis diagnosis and quantification in the clinical arena. However, not negligible doses of ionizing radiation limit the use of HRCT, especially for serial follow-up in younger female patients. In the past decade, lung ultrasound (LUS) has been proposed to assess ILD by detecting and quantifying sonographic B-lines. Previous studies demonstrate that B-lines have a good diagnostic accuracy, especially high sensitivity, and correlate well with HRCT findings, suggesting LUS as a novel, non-invasive, and non-ionizing imaging method to be used in patients with CTD-ILD. Although preliminary data are promising, challenges and controversies still remain. For example, the mechanisms of B-line generation are not fully understood; the diagnostic accuracy and performance characteristics of LUS partially depend on the scanning scheme and scoring system used; and up-to-date B-lines cannot discriminate the early cellular inflammation from the chronic fibrotic phase in CTD-ILD. Therefore it is important for clinicians to understand the strengths and limitations of LUS in CTD-ILD patients, to maximize its value.
Background:
Hoffa fractures, coronal-plane fractures involving the distal femoral condyles, are unstable, intra-articular fractures. The aim of this study was to define the location and frequency of fracture lines and comminution zones in Hoffa fractures using computed tomography (CT) mapping in both 2-dimensional and 3-dimensional contexts.
Methods:
Seventy-five Hoffa fractures (OTA/AO types 33B3.2 and 33B3.3) were retrospectively reviewed. The directions of fracture lines were characterized in the axial and sagittal CT planes. CT images for all fractures were superimposed on one another and oriented to fit a standard template. Mapping of fracture lines and comminution zones in both the axial and sagittal planes was performed. A 3-dimensional map was created by reducing reconstructed fracture fragments to fit to a model of the distal aspect of the femur.
Results:
This study included 1 bicondylar and 74 unicondylar (26 medial and 48 lateral) Hoffa fractures. Comminuted fractures accounted for 35.5% of all fractures and 44.9% of lateral fractures. Axial fracture mapping demonstrated that fracture lines were concentrated in the middle-third area of the lateral condyle but were less concentrated and with greater variation in the medial condyle. The mean angle of fracture lines with respect to the posterior condylar axis was 34.4° and 29.0° in the lateral and medial femoral condyles, respectively. Sagittal fracture mapping also demonstrated that fracture lines were concentrated in the middle third of the lateral condyle but were less concentrated in the medial condyle. The mean angle of fracture lines with respect to the posterior cortex of the distal femoral shaft was 23.1° and 19.3° in the lateral and medial condyles, respectively. Three-dimensional mapping demonstrated comminution zones commonly occurring in the weight-bearing zone of the lateral condylar articular surface.
Conclusions:
Hoffa fractures occurred more frequently in the lateral femoral condyle. In the axial plane, fractures commonly extended from anterolateral to posteromedial in the lateral condyle and from anteromedial to posterolateral in the medial femoral condyle. In the sagittal plane, fractures traversed from anteroinferior to posterosuperior. Articular comminution was more commonly seen in lateral condylar fractures and concentrated in the weight-bearing zone of the articular surface.
Clinical Relevance:
Research in this area is imperative for optimal preoperative planning, such as for the selection of surgical approach and fixation constructs. Our findings lend insight into fracture morphology, which can assist with fracture classification and the design of biomechanical studies, ultimately aiding in treatment.
Schematic model of mechanical performance of short fibre reinforced polyamide 6 composites for thermo-oxidative ageing at different ageing temperatures.
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