Accuracy of C-arm measurements in assessment of paediatric femoral fracture shortening

Boduch, Abigail; Hennrikus, Matthew T.; Adebayo, Temitope; Brian, James M.; Hennrikus, W.

doi:10.1302/1863-2548.11.170116

Cited by 3 publications

(3 citation statements)

References 14 publications

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“…Most other techniques intended to ensure coronal alignment are either complex, expensive, or only applicable at the end of surgery. 10 – 13 , 15 , 18 These techniques determine the mechanical and anatomic axes using fluoroscopic markers and are thus subject to distortion of the fluoroscope. When applying a radiopaque axis board under the patient during surgery the distortion affects the bone and board similarly but requires a more complex patient positioning during surgery.…”

Section: Discussionmentioning

confidence: 99%

The Joint Angle Tool for Intraoperative Assessment of Coronal Alignment of the Lower Limb

Abood

Petruskevicius

Vogt

et al. 2020

Strategies in Trauma and Limb Reconstruction

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A bstract Aim Presentation of the joint angle tool (JAT), a low-cost goniometer for intraoperative assessment of the lower limb alignment. Background Intraoperative assessment of coronal alignment is important when performing corrective osteotomies around the knee and ankle, limb lengthening, and trauma surgery. JAT provides surgeons with information about the anatomic and mechanical axes intraoperatively based on true anteroposterior radiographs. Technique JAT consists of pre-printed joint orientation angles of the anatomic and mechanical axis including normal variations on a plastic sheet. It is placed on the screen of the image intensifier after obtaining a true anteroposterior image. The pre-printed joint orientation angles can assist the surgeons intraoperatively in achieving the pre-planned axis correction. Here, its feasibility is demonstrated in four cases. Conclusion and clinical significance JAT is a modified goniometer that allows intraoperative assessment of the mechanical and anatomic axis. JAT is applicable throughout the entire surgical procedure irrespective of the method of internal fixation and may provide additional reassurance of correct alignment. JAT consists of a plastic sheet with printed joint orientation angles and their normal variation. JAT is freely available from profeedback.dk/JAT/JAT.pdf for use and modification according to the Creative Commons license (CC BY-SA 4.0) if this paper is attributed. How to cite this article Abood AA-H, Petruskevicius J, Vogt B, et al. The Joint Angle Tool for Intraoperative Assessment of Coronal Alignment of the Lower Limb. Strategies Trauma Limb Reconstr 2020;15(3):169–173.

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Section: Discussionmentioning

confidence: 99%

The Joint Angle Tool for Intraoperative Assessment of Coronal Alignment of the Lower Limb

Abood

Petruskevicius

Vogt

et al. 2020

Strategies in Trauma and Limb Reconstruction

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“…While their method achieved good predictive accuracy, our models address a different need by providing earlier risk assessments for postoperative bedridden status at three months using easily obtainable clinical predictors at the time of admission and before discharge. This not only offers a valuable timeframe for clinical intervention but also circumvents the variability introduced by relying on intraoperative measurements, which can differ significantly with the type of C-arm machine used and the surgical setting [25].…”

Section: Discussionmentioning

confidence: 99%

Development and Validation of Two-Step Prediction Models for Postoperative Bedridden Status in Geriatric Intertrochanteric Hip Fractures

Dissaneewate,

Orapiriyakul

et al. 2024

Diagnostics

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Patients with intertrochanteric hip fractures are at an elevated risk of becoming bedridden compared with those with intraarticular hip fractures. Accurate risk assessments can help clinicians select postoperative rehabilitation strategies to mitigate the risk of bedridden status. This study aimed to develop a two-step prediction model to predict bedridden status at 3 months postoperatively: one model (first step) for prediction at the time of admission to help dictate postoperative rehabilitation plans; and another (second step) for prediction at the time before discharge to determine appropriate discharge destinations and home rehabilitation programs. Three-hundred and eighty-four patients were retrospectively reviewed and divided into a development group (n = 291) and external validation group (n = 93). We developed a two-step prediction model to predict the three-month bedridden status of patients with intertrochanteric fractures from the development group. The first (preoperative) model incorporated four simple predictors: age, dementia, American Society of Anesthesiologists physical status classification (ASA), and pre-fracture ambulatory status. The second (predischarge) model used an additional predictor, ambulation status before discharge. Model performances were evaluated using the external validation group. The preoperative model performances were area under ROC curve (AUC) = 0.72 (95%CI 0.61–0.83) and calibration slope = 1.22 (0.40–2.23). The predischarge model performances were AUC = 0.83 (0.74–0.92) and calibration slope = 0.89 (0.51–1.35). A decision curve analysis (DCA) showed a positive net benefit across a threshold probability between 10% and 35%, with a higher positive net benefit for the predischarge model. Our prediction models demonstrated good discrimination, calibration, and net benefit gains. Using readily available predictors for prognostic prediction can assist clinicians in planning individualized postoperative rehabilitation programs, home-based rehabilitation programs, and determining appropriate discharge destinations, especially in environments with limited resources.

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“…However, accurate measurement is not that easy and great care must be given while measuring shortening. 7 The reported proportion of shortening after spica casting is up to 13.35%. 8 For post spica shortening, four types of treatment options are available, shoe lift, epiphysiodesis of the long leg, shortening of the long leg (in patients too old for epiphysiodesis), and lengthening of the short leg.…”

Section: Introductionmentioning

confidence: 99%

Frequency of limb shortening in femoral shaft fractures treated by hip spica casting in children in Tertiary Care Hospital.

Mehmood¹,

Shah²,

Razzaq³

2019

TPMJ

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Objectives: In non-operative methods, hip spica casting is a gold standard for children under six years of age because of excellent bone union and remodeling qualities. The study was conducted to determine the frequency of limb shortening in femur shaft fractures in children treated by hip spica casting. Study Design: Descriptive cross sectional study. Setting: Orthopedics Department of Combined Military Hospital, Rawalakot, Pakistan. Period: One year from July, 2016 to June, 2017. Material and Methods: After approval of the study from institution’s ethical committee, all patients fulfilling the inclusion criteria were admitted through emergency or outpatient department for hip spica casting. It was descriptive cross sectional study and sampling was done by non-probability convenience sampling in 107 femur fracture patients treated by hip spica casting. Diagnosis of the fracture was based upon history of trauma with break in the continuity of shaft as seen by X-ray. Informed consent was obtained from parents/guardian to be included in the study. Results: The mean age was 5(± 2.04) years. Sixty eight percent patients were male and 32% were female. Sixty three percent patients had proximal femoral shaft fracture, 32% had middle femoral shaft fracture and 4% patients had distal femoral shaft fracture. The shortening of limb length was found in14% of patients. Conclusion: In closed femoral shaft fractures, hip spica casting is a safe treatment in children. It has a low risk of complications. We recommend its use except for open fractures, multiple fractures, or fractures in older children.

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Accuracy of C-arm measurements in assessment of paediatric femoral fracture shortening

Cited by 3 publications

References 14 publications

The Joint Angle Tool for Intraoperative Assessment of Coronal Alignment of the Lower Limb

The Joint Angle Tool for Intraoperative Assessment of Coronal Alignment of the Lower Limb

Development and Validation of Two-Step Prediction Models for Postoperative Bedridden Status in Geriatric Intertrochanteric Hip Fractures

Frequency of limb shortening in femoral shaft fractures treated by hip spica casting in children in Tertiary Care Hospital.

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