First-time anterior dislocation of the shoulder is associated with the development of recurrent instability. It is recognised that patients with recurrent instability often have osseous defects. Using 3D computerised tomography (3DCT) it is possible to quantify these defects. Whether these defects are present after the primary dislocation or occur progressively from multiple dislocations is unclear. We correlated the presence of Hill-Sachs lesions and anterior glenoid bone loss with evidence of recurrent dislocation and clinical outcomes.

78 patients were followed up for two years. All underwent a 3DCT within a week of injury. Standardised images of the humeral head and glenoid were produced. Using standardised digital techniques bone loss was measured.

39% of the patients developed further instability. Average Hill-Sachs circumferential length = 15.23%. Average Hill-Sachs surface area = 5.53%. The length and surface area of the Hill-Sachs lesions were significantly associated with further instability. (p=0.019 and p=0.003). Average en face glenoid surface area loss=1.30% with no association to instability (p=0.685). There was poor correlation between the size of the glenoid lesion and the size of the Hill-Sachs lesion.

Results showed that age and increasing size of the Hill-Sachs lesions result in a higher rate of instability. Interestingly glenoid bone loss was relatively low and did not predict recurrent instability. The size of the Hill-Sachs lesion does not have a linear relationship with glenoid bone loss. Further work defining the morphology of the Hill-Sachs lesion and its engagement with a glenoid defect is required.

INTRODUCTION. Short femoral nail is the most popular instrumentation for femoral trochanteric fractures. PFNA is in widely use and good results are reported. In these papers, fracture classification and evaluation of surgical results were based on plain X-ray. However, some cases of delayed union, non-union, and blade cut out showed no critical problems in immediate postoperative X-ray. Cause of these complications was not able to solve in X-ray analysis. CT scan provides more information about fracture pattern and position of nail and blade. CT analysis is likely to solve the cause of these complications. MATERIALS & METHODS. 20 cases of 36 femoral trochanteric fractures treated with PFNA-II were evaluated by CT scan (pre and post surgery). Four males and 16 females, and average age at surgery was 80.5 (65–100). Eleven cases were A1 fracture and 9 cases were A2 fracture in AO classification. Nail insertion hole was made by custom made Hollow Reamer. Fracture classification with 3D-CT (Nakano's classification), position of nail insertion hole (relationship between neck or head), and postoperative evaluation with 3D-CT insertion part of nail and blade were investigated. RESULTS. Nakano classified femoral trochanteric fracture into 7 types in 3D-CT. Two subtype in 2 part fracture, 4 subtype in 3 part fracture and 4part fracture. Seven cases were two part fracture, 11 were three part, and 2 were four part in our series. Five cases of 11 in 3 part fracture was considered unstable type. Nail insertion hole of six cases was made posteriory to the connecting line between neck center and head center. Fracture line of greater trochnater in lateral wall opened in 4 cases because of nail insertion. DISCUSSION. Femoral trochanteric fracture was classified by Evans classification or AO classification. However, it is very difficult to classify the fracture by plain X-P. Classification with 3D-CT is very usefull to distinguish which the fracture is stable or unstable. CT analysis will solve the postoperative complications in stable type in X-P classification

Aims. The primary aim of this study was to address the hypothesis that fracture morphology might be more important than posterior malleolar fragment size in rotational type posterior malleolar ankle fractures (PMAFs). The secondary aim was to identify clinically important predictors of outcome for each respective PMAF-type, to challenge the current dogma that surgical decision-making should be based on fragment size. Methods. This observational prospective cohort study included 70 patients with operatively treated rotational type PMAFs, respectively: 23 Haraguchi Type I (large posterolateral-oblique), 22 Type II (two-part posterolateral and posteromedial), and 25 (avulsion-) Type III. There was no standardized protocol on how to address the PMAFs and CT-imaging was used to classify fracture morphology and quality of postoperative syndesmotic reduction. Quantitative 3D-CT (Q3DCT) was used to assess the quality of fracture reduction, respectively: the proportion of articular involvement; residual intra-articular: gap, step-off, and 3D-displacement; and residual gap and step-off at the fibular notch. These predictors were correlated with the Foot and Ankle Outcome Score (FAOS) at two-years follow-up. Results. Bivariate analyses revealed that fracture morphology (p = 0.039) as well as fragment size (p = 0.007) were significantly associated with the FAOS. However, in multivariate analyses, fracture morphology (p = 0.001) (but not fragment size (p = 0.432)) and the residual intra-articular gap(s) (p = 0.009) were significantly associated. Haraguchi Type-II PMAFs had poorer FAOS scores compared with Types I and III. Multivariate analyses identified the following independent predictors: step-off in Type I; none of the Q3DCT-measurements in Type II, and quality of syndesmotic reduction in small-avulsion Type III PMAFs. Conclusion. PMAFs are three separate entities based on fracture morphology, with different predictors of outcome for each PMAF type. The current debate on whether or not to fix PMAFs needs to be refined to determine which morphological subtype benefits from fixation. In PMAFs, fracture morphology should guide treatment instead of fragment size. Cite this article: Bone Joint J 2020;102-B(9):1229–1241

Fracture classification of femoral trochanteric fracture is usually based on plain X-ray. However, complications such as delayed union, non-union, and cut out are seen in stable fracture on X-ray. In this study, fracture was classified by 3D-CT and relationship to X-ray classification was investigated. 48 femoral trochanteric fractures (15 males, 33 female, average age: 82.6) treated with PFNA-II were investigated. Fracture was classified to 2part, 3part(5 subgroups), and 4part with combination of 4 fragments in CT; Head (H), Greater trochanter (G), Lesser trochanter (L), and Shaft (S). 5 subgroups of 3 part fracture were (1) H+G (S: small fragment) + L-S, (2) H + G (B:big fragment) + L-S, (3) H + G-L + S, (4) H + G (W:whole) + S, and (5) H + L + G-S. Numbers of each group were as follows; 2 part: 11, 3 part (1) : 7, 3 part (2) : 12, 3 part (3) : 10, 3 part (4) : 2, 3 part (5) : 3, 4 part : 3. 3 part (3), (4), (5) and 4 part are considered as unstable, however, 6 cases in these groups were classified in A1–1 or A1–2 stable fracture in AO classification. 10 fractures in Evans and 5 fractures in Jensen classification classified as stable were unstable in CT evaluation. It is sometimes very difficult to classify the femoral trochanteric fracture by plain X-ray. Classification with 3D-CT is very useful to distinguish which fracture is stable or unstable

Several studies have reported the assessment of the femoral head coverage on plane radiograph and CT data in supine position, though young patients with the dysplastic hip often have symptoms during activities such as standing, walking, and running. On the other hand, some investigators have used a method of CT which allows standardization of the femoral head coverage against an anterior pelvic plane based on the anterior superior iliac spines and the pubic tubercle. We believe both the weight-bearing position and the standardized position to be more relevant for diagnosis and preoperative surgical assessment. So, we show the femoral head coverage in standardized position using 3D-CT method and in weight-bearing position using the plane radiograph and the three-dimensional lower extremity alignment assessment system before and after Curved periacetabular osteotomy (CPO). Especially the covered volume of the femoral head, a new concept, using the three-dimensional lower extremity alignment assessment system which differs from the affected area and is measured by the ratio of the covered area in the medial part of the line connecting the anterior point of the acetabulum with the posterior to the femoral head area in each axial slice, superior slices than the slice passing through the femoral head center, obtained from the reproduced 3D model of the pelvis and the femur in standing position allows us to integrate various measurements reported by past researchers. We studied the consecutive 16 patients treated with CPO. In standardized position the sagittal sectional angles on the slice passing through the femoral head center using 3D-CT method gave us how the anterior, lateral, and posterior coverage was lack compared with normal subjects and whether the adequate transfer of the rotated fragment was performed after operation. The covered volume of the femoral head decides generally the deficiency or the adequateness. In standing position, though the pelvic tilt changes, the femoral head coverage on plane radiograph, representation by the CE angle, the VCA angle, AHI and ARO, was significantly improved, and the covered volume of the femoral head was significantly improved from 25.7% preoperatively to 51.1% postoperatively. Our study showed the improvement of the femoral head coverage, including the covered volume of the femoral head as a new concept, after CPO in weight-bearing and standardized position. The morphological and functional assessment of the femoral head coverage on both pre- and post-CPO should be performed because we can obtain the objective information in standardized position and the femoral head coverage in standing position is closely connected with the pain

Aims

To investigate if preoperative CT improves detection of unstable trochanteric hip fractures.

Aims

The purpose of this study was to develop a convolutional neural network (CNN) for fracture detection, classification, and identification of greater tuberosity displacement ≥ 1 cm, neck-shaft angle (NSA) ≤ 100°, shaft translation, and articular fracture involvement, on plain radiographs.

Aims

The treatment of late presenting fractures of the lateral humeral condyle in children remains controversial.

Aims

To evaluate whether an ultra-low-dose CT protocol can diagnose selected limb fractures as well as conventional CT (C-CT).

Most fractures of the radial head are stable undisplaced or minimally displaced partial fractures without an associated fracture of the elbow or forearm or ligament injury, where stiffness following non-operative management is the primary concern. Displaced unstable fractures of the radial head are usually associated with other fractures or ligament injuries, and restoration of radiocapitellar contact by reconstruction or prosthetic replacement of the fractured head is necessary to prevent subluxation or dislocation of the elbow and forearm. In fractures with three or fewer fragments (two articular fragments and the neck) and little or no metaphyseal comminution, open reduction and internal fixation may give good results. However, fragmented unstable fractures of the radial head are prone to early failure of fixation and nonunion when fixed. Excision of the radial head is associated with good long-term results, but in patients with instability of the elbow or forearm, prosthetic replacement is preferred.

This review considers the characteristics of stable and unstable fractures of the radial head, as well as discussing the debatable aspects of management, in light of the current best evidence.

Cite this article: Bone Joint J 2013;95-B:151–9.