Measuring tip–apex distance using a picture archiving and communication system (PACS)

Johnson, Luke J.; Cope, Marcus R.; Shahrokhi, Shahram; Tamblyn, Peter

doi:10.1016/j.injury.2007.12.019

Cited by 55 publications

(42 citation statements)

References 9 publications

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“…TAD was measured by the principal author alone on radiographs and errors in uniform measurements was a possibility. This error could be minimize by 4 using digital system such as Picture Archiving and Communication System (PACS) 22 which is more accurate and reproducible but unfortunately which was not available to us. Furthermore bone mineral density (BMD) of our patients could not be evaluated and no pre surgery protocols with regard to TAD and screw position was set.…”

Section: Discussionmentioning

confidence: 99%

Intertrochanteric Fractures; Frequency of Lag Screw Cut Out Fixed With Dynamic Hip Screw

Shah

Alam

Ali

2017

TPMJ

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ABSTRACT… Objectives:To determine the frequency of lag screw cut out in intertrochanteric fractures fixed with dynamic hip screw and to identify the possible contributing factors for screw cut out. Study Design: Descriptive case series. Place and Duration of the Study: Orthopaedic & Traumatology Unit"A" Lady. Reading Hospital Peshawar from January 2014 to January 2017. Material and Methods: Patients of either gender or age with intertrochanteric fractures fulfilling the inclusion and exclusion criteria were fixed with dynamic hip screw (DHS). Post operatively fracture reduction, position of screw in head of femur and tip apex distance were calculated on anterio posterior and lateral radiographs. All the patients were reviewed fortnightly for two month and then monthly for six months for lag screw cut out on radiographs. Results: Total 110 patients mean age 72(range 22 to 98 years) years were fixed with dynamic hip screw. Lag screw cut out was noted in 12(10.9%) patients with 4(33.3%) male and 8(66.6%) female patients. The mean age was 62 years. Right side was involved in two (16.6%) patients while left in ten (83.3%) patients. Radiographically fracture reduction was poor in most (50%, n=6)) patients. The mean tip apex distance (TAD) was 32mm (range 24 to 40 mm). Majority (75%, n=9) of cut out screw were in superior portion of the head of femur. Four (33.3%) patients had screw cut out at 8 th week postoperatively while eight (66.6%) patients had screw cut out at 12 th week. Conclusion: Lag screw cut out wasthe most common mechanical complication after fixation of intertrochanteric fractures and all of the cut out patients were elderly with inadequately reduced fracture, superiorly placed lag screw and longer tip apex distance. Key words:Intertrochanteric fracture, dynamic hip screw, tip apex distance.

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Section: Discussionmentioning

confidence: 99%

Intertrochanteric Fractures; Frequency of Lag Screw Cut Out Fixed With Dynamic Hip Screw

Shah

Alam

Ali

2017

TPMJ

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“…Ten raters independently measured the TAD on 7 cases using the protocol described in Johnson et al (2008). An ellipse was fit to the subchondral bone of the femoral head and a line drawn between the two points where the ellipse met the femoral neck.…”

Section: Methodsmentioning

confidence: 99%

“…This line was then bisected with a second perpendicular line, and where that line intersected, the superior portion of the ellipse was used to define the apex. 28 Two of the graders repeated the measurements at least 3 weeks after the initial measurements.…”

Section: Methodsmentioning

confidence: 99%

Assessing Wire Navigation Performance in the Operating Room

Taylor

Thomas

Karam

et al. 2016

Journal of Surgical Education

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Objective-There are no widely accepted, objective, and reliable tools for measuring surgical skill in the operating room (OR). Ubiquitous video and imaging technology provide opportunities to develop metrics that meet this need. Hip fracture surgery is a promising area in which to develop these measures because hip fractures are common, the surgery is used as a milestone for residents, and it demands technical skill. The study objective is to develop meaningful, objective measures of wire navigation performance in the OR.Design-Resident surgeons wore a head-mounted video camera while performing surgical open reduction and internal fixation using a dynamic hip screw. Data collected from video included: duration of wire navigation, number of fluoroscopic images, and the degree of intervention by the surgeon's supervisor. To determine reliability of these measurements, four independent raters performed them for two cases. Raters independently measured the tip-apex distance (TAD), which reflects the accuracy of the surgical placement of the wire, on all 7 cases. Setting-University of Iowa Hospitals and Clinics in Iowa City, IA -a public tertiary academic center.Participants-Seven surgeries were performed by seven different orthopaedic residents. All ten raters were biomedical engineering graduate students.Results-The means and standard deviations for AP, lateral, and combined TAD measurements of the 10 raters were 2.7, 1.9, and 3.7 mm, respectively, and inter-rater reliability produced a Cronbach's Alpha of 0.97. The inter-rater reliability analysis for all 9 video-based measures produced a Cronbach's Alpha of 0.99.Conclusions-Several video-based metrics were consistent across the four video reviewers and are likely to be useful for performance assessment. The TAD measurement was less reliable than previous reports have suggested but remains a valuable metric of performance. Non-experts can reliably measure these values and they offer an objective assessment of OR performance.

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“…Variable radiological measures have been introduced to help radiologists and orthopedic surgeons to diagnose diseases, evaluate surgeries, and plan for surgical interventions (2)(3)(4). By introduction of picture archiving and communication systems (PACS) which became widespread and the standard radiological viewing tool in many orthopedic clinics, radiologists and orthopedic surgeons became more able to measure angles and distances even in a more precise manner (5,6).…”

Section: Introductionmentioning

confidence: 99%

Femoral Head Fovea Capitis Variant Configurations and Age Related Changes- A Radiological Study

Acar¹,

Karaarslan

Karakaşlı

et al. 2017

Iran J Radiol

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Background: Many studies in the literature focused on the proximal geometry of the femur using cadaveric samples, X-rays or computed tomography, demonstrated substantial differences in the proximal femoral geometry in different patient groups. Many radiological parameters have been introduced in the literature to aid in diagnosis and surgical interventions. Objectives: We aimed to assess the diameter of the femoral head fovea capitis in both genders with different age groups and to record their variant configurations. Patients and Methods: Six-hundred true pelvis anteroposterior radiographs of patients were divided into three different age groups.

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Measuring tip–apex distance using a picture archiving and communication system (PACS)

Cited by 55 publications

References 9 publications

Intertrochanteric Fractures; Frequency of Lag Screw Cut Out Fixed With Dynamic Hip Screw

Intertrochanteric Fractures; Frequency of Lag Screw Cut Out Fixed With Dynamic Hip Screw

Assessing Wire Navigation Performance in the Operating Room

Femoral Head Fovea Capitis Variant Configurations and Age Related Changes- A Radiological Study

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