Evaluation of femoral head coverage following Chiari pelvic osteotomy in adolescents by three-dimensional computed tomography and conventional radiography

Li, Lianyong; Jia, Jingyu; Zhao, Qun; Zhang, Lijun; Ji, Shijun; Wang, Enbo

doi:10.1007/s00402-012-1464-0

Cited by 11 publications

(6 citation statements)

References 28 publications

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“… 8 Over its course of use in clinical settings, the reliability, reproducibility and ability to inform treatment procedures of the Garden classification has been brought to question. 9 , 10 , 18 , 19 …”

Section: Discussionmentioning

confidence: 99%

“… 7 – 9 Although it is the most widely used for treatment decisions, the Garden classification has several disadvantages: it is poorly reproducible; it offers low inter-rater reliability; and it is not considered to have any prognostic value. 9 , 10 The development of a reasonable and effective method for measuring the spatial displacement of the femoral head is now of critical concern. 11 …”

Section: Introductionmentioning

confidence: 99%

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Three-Dimensional Reconstruction Modeling of the Spatial Displacement, Extent and Rotational Orientation of Undisplaced Femoral Neck Fractures

et al. 2015

Medicine

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The purpose of this study was to employ a new three-dimensional (3D) reconstruction and modeling method to measure displacement of undisplaced femoral neck fractures (Garden stages I and II). We also aimed to evaluate the effectiveness of the Garden classification for determining the displacement of undisplaced femoral neck fractures.A total of 120 consecutive patients with undisplaced femoral neck fractures were enrolled between 2012 and 2014, including 60 within the Garden I group and 60 within the Garden II group. The displacements of the femoral head center (d1) and the lowest point of the fovea capitis femoris (d2) and rotational displacement of the femoral head (α) in the 3D model were measured with 3D computed tomography reconstruction and modeling. Five observers, trauma surgeons, were asked to found the centers of the femoral heads and the deepest points of the foveae. The intraobserver and inter-observer agreements were calculated using Fleiss’ kappa.The inter-observer and intra-observer kappa values were 0.937 and 0.985, respectively. Current method has good reliability. We discovered that many participants in our study had been misclassified by an anterior–posterior radiograph as having an “incomplete” fracture. In incomplete fracture of Garden stage I group, the average displacements d1 and d2 were 3.69 ± 1.77 mm and 14.51 ± 1.91 mm, respectively. The mean α was 4.91° ± 2.49°. For impacted fracture of Garden stage I, significant spatial displacement in the impacted fractures was observed (d1: 6.22 ± 3.36 mm; d2: 10.30 ± 5.73 mm; and α: 17.83° ± 10.72°). Similarly, significant spatial displacement was observed among the Garden stage II group (d1: 7.16 ± 4.58 mm; d2: 12.95 ± 8.25 mm; and α: 18.77° ± 9.10°). There was no significant difference in α, d1, and d2 between impacted fracture and Garden stage II groups (P > 0.05). However, significant differences were found between incomplete fracture and Garden stage II groups (P < 0.05).Our findings suggest that 3D reconstruction and modeling may be a better tool for assessing femoral neck fractures than the Garden classification. Undisplaced femoral neck fractures showed variable degrees of displacement and were not undisplaced, stable fractures. Garden classification for undisplaced femoral neck fractures has certain limitations.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Three-Dimensional Reconstruction Modeling of the Spatial Displacement, Extent and Rotational Orientation of Undisplaced Femoral Neck Fractures

et al. 2015

Medicine

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“…The shape variability of the hip joint in patients with DDH has also been evaluated using 2D radiographs in combination with manual landmark identification, 19–23 but these analyses suffer from similar limitations to those associated with 2D coverage measurements and cannot capture the complete morphology of the two bones. Clinical adoption of computed tomography (CT) and magnetic resonance imaging (MRI) provides the ability to quantify both global and regional coverage deficiencies and concomitant deformities in patients with DDH through 3D surface reconstructions of the anatomy 15,24–27 . While these data may enhance diagnosis and preoperative planning, measurements made from reconstructed surfaces are generally still based on planar projections and 2D imaging parameters, which do not fully capture the 3D morphology.…”

Section: Introductionmentioning

confidence: 99%

“…Clinical adoption of computed tomography (CT) and magnetic resonance imaging (MRI) provides the ability to quantify both global and regional coverage deficiencies and concomitant deformities in patients with DDH through 3D surface reconstructions of the anatomy. 15,[24][25][26][27] While these data may enhance diagnosis and preoperative planning, measurements made from reconstructed surfaces are generally still based on planar projections and 2D imaging parameters, which do not fully capture the 3D morphology. Further complicating matters, measurements that define the spatial relationship between the femur and pelvis are likely dependent on the orientation of the participant in the CT or MRI scanner.…”

Section: Introductionmentioning

confidence: 99%

Prediction of femoral head coverage from articulated statistical shape models of patients with developmental dysplasia of the hip

Atkins

Agrawal

Mozingo

et al. 2021

Journal Orthopaedic Research

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Developmental dysplasia of the hip (DDH) is commonly described as reduced femoral head coverage due to anterolateral acetabular deficiency. Although reduced coverage is the defining trait of DDH, more subtle and localized anatomic features of the joint are also thought to contribute to symptom development and degeneration.These features are challenging to identify using conventional approaches. Herein, we assessed the morphology of the full femur and hemi-pelvis using an articulated statistical shape model (SSM). The model determined the morphological and posebased variations associated with DDH in a population of Japanese females and established which of these variations predict coverage. Computed tomography (CT) images of 83 hips from 47 patients were segmented for input into a correspondence-based SSM. The dominant modes of variation in the model initially represented scale and pose. After removal of these factors through individual bone alignment, femoral version and neck-shaft angle, pelvic curvature, and acetabular version dominated the observed variation. Femoral head oblateness and prominence of the acetabular rim and various muscle attachment sites of the femur and hemipelvis were found to predict 3D CT-based coverage measurements (R 2 = 0.5-0.7 for the full bones, R 2 = 0.9 for the joint). Statement of Clinical Significance: Currently, clinical measurements of DDH only consider the morphology of the acetabulum. However, the results of this study demonstrated that variability in femoral head shape and several muscle attachment sites were predictive of femoral head coverage. These morphological differences may provide insight into improved clinical diagnosis and surgical planning based on functional adaptations of patients with DDH.

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“…One technical limitation of the osteotomy may be in providing adequate anterolateral coverage [6]. Therefore, a shelf augmentation can supplement the Chiari osteotomy if such coverage is desired [4].…”

Section: Introductionmentioning

confidence: 99%

Chiari Osteotomy Plus Shelf Procedure in Neuromuscular Hip Dysplasia

M¹,

Mike²,

G³

et al. 2020

Adv Tech Musculoskelet Surg

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Evaluation of femoral head coverage following Chiari pelvic osteotomy in adolescents by three-dimensional computed tomography and conventional radiography

Cited by 11 publications

References 28 publications

Three-Dimensional Reconstruction Modeling of the Spatial Displacement, Extent and Rotational Orientation of Undisplaced Femoral Neck Fractures

Three-Dimensional Reconstruction Modeling of the Spatial Displacement, Extent and Rotational Orientation of Undisplaced Femoral Neck Fractures

Prediction of femoral head coverage from articulated statistical shape models of patients with developmental dysplasia of the hip

Chiari Osteotomy Plus Shelf Procedure in Neuromuscular Hip Dysplasia

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