Reference radiologic measurements for the assessment of tibial pilon fractures

Objectives: The management of pilon fractures is a challenge and the outcome depends on multiple factors, one of which is the quality of reduction. In the literature, there is no assessment of anatomical reduction in pilon fractures. We also lack standard radiological parameters in large patient groups to measure the reduction. The main aim of this analysis was to define normal standard radiological values and identify potential specific types of ankle joint morphology (morphotypes) that might deserve special attention intraoperatively. Methods: We analyzed data of 103 healthy contralateral ankles collected within an observational and prospective multicenter study about tibial pilon fractures. We divided the patients according to their height into two groups, measured 11 radiological parameters, and compared them with each other and the literature. In addition, using cluster analysis, we could identify three morphotypes. Results: There is a statistically significant difference between the two groups in the lengths of three parameters: Mortise width, medial clear space, and length of the lateral malleolus, but not in the angles. The three morphotypes differ only in body mass index and the length of the lateral malleolus. Conclusion: Reference values from the literature are insufficient to assess a reduction after open reduction and internal fixation of tibial pilon fractures because they depend on the height. This does not apply to angles because they are independent of height. For clinical practice, a radiological control of the contralateral healthy ankle gives the best information about the reduction quality and should always be done, especially in normal weight males.

Suture button versus syndesmotic screw in ankle fractures - evaluation with 3D imaging-based measurements

Background Inadequate reduction of syndesmotic injuries can result in disabling clinical outcomes. The aim of the study was to compare syndesmosis congruity after fixation by syndesmotic screws (SYS) or a suture button system (SBS) using three-dimensional (3D) computed imaging techniques. Methods In a retrospective single-center study, patients with unilateral stabilization of an ankle fracture with a syndesmotic injury and post-operative bilateral CT scans were analyzed using a recently established 3D method. The side-to-side differences were compared for tibio-fibular clear space (∆CS), translation angle (∆α), and vertical offset (∆z) among patients stabilized with syndesmotic screws or suture button system. Syndesmotic malreduction was defined for ∆CS > 2 mm and for |∆α| > 5°. ∆CS and ∆α were correlated with two-dimensional (2D) measurements. Results Eighteen patients stabilized with a syndesmosis screw and 29 stabilized with a suture button system were analyzed. After stabilization, both groups revealed mild diastasis (SYS: mean ∆CS 0.3 mm, SD 1.1 mm vs SBS: mean ∆CS 0.2 mm, SD 1.2 mm, p = 0.710). In addition, both stabilization methods showed slight dorsalization of the fibula (SYS: mean ∆α 0.5°, SD 4.6° vs SBS: mean ∆α 2.1°, SD 3.7°, p = 0.192). Also, restoration of the fibula-to-tibia length ratio also did not differ between the two groups (SYS: mean Δz of 0.5 mm, SD 2.4 mm vs SBS: mean Δz of 0 mm, SD 1.2 mm; p = 0.477). Malreduction according to high ∆α was most common (26% of cases), with equal distribution between the groups (p = 0.234). ∆CS and ∆α showed good correlation with 2D measurements (ρ = 0.567; ρ = 0.671). Conclusion This in vivo analysis of post-operative 3D models showed no differences in immediate post-operative alignment after syndesmotic screws or suture button system. Special attention should be paid to syndesmotic malreduction in the sagittal orientation of the fibula in relation to the tibia in radiological control of the syndesmotic congruity as well as intra-operatively.

The regularities of 137Cs accumulation in the aboveand underground parts of aerial-and-aquatic plants originated from various types of reservoirs in the Polissia and the Forest-Steppe of Ukraine

The aim of the study was to establish the regularities of 137Cs accumulation in the above- and underground parts of aerial-and-aquatic plants originated from various types of reservoirs in the Polissia and the Forest-Steppe of Ukraine, located in territories varying in the degrees of radioactive contamination. The studies were carried out in 2014–2018. Higher aquatic plants were sampled in eutrophic, oligotrophic, and dystrophic reservoirs including large and small ones as well as lakes and ponds used for various purposes. The reservoirs were located in the areas that are considered conditionally clean relative to the density of 137Cs contamination, or are classifed as zones of enhanced radiological control, guaranteed voluntary resettlement, unconditional (guaranteed) resettlement and exclusion zones. The objects of research were 8 species of aerial aquatic plants widespread in the fresh water reservoirs of the Polissya and the Forest-Steppe of Ukraine. The specifc content of 137Cs in the aboveground parts, rhizomes, and roots of the plants was determined by common gamma-spectrometric methods. The analysis of the obtained results revealed a common regularity typical of plants from all the studied reservoirs – the levels of 137Cs in the aboveground parts and the rhizomes did not differ signifcantly, but in the ground roots they were signifcantly higher. The specifc activity of 137Cs in ground roots of Phragmites australis exceeded its activity in above ground parts by 6–25 times, in Tupha angustifolia – by 5–20, Glyceria maxima by 7–10, Scirpus lacustris by 4–9, Alisma plantago-aquatica – by 3 times, Sagittaria saggitifolia - by 2, Butomus umbellatus – by 3, Iris pseudacorus - by 4 times. The levels of 137Cs content in aboveground parts and rhizomes in most of the studied plants did not differ signifcantly. The results of the study will further make it possible to assess the role of aerial-and-aquatic plants in the bottom sediments radioactive contamination and to improve the understanding of the role of higher aquatic plants in the processes of radioactive elements migration and redistribution in aquatic ecosystems. The revealed regularities of 137Cs levels formation in the underground parts of plants should be taken into account in determining the radiation dose of plants growing in radionuclides contaminated reservoirs. Key words: aerial-and-aquatic plants, aboveground parts, underground parts, roots, rhizomes, 137Cs, reservoirs, lakes, ponds.

Scattered radiation during osteosynthesis of the distal radius: A phantom study

Modern fracture surgery requires an increasing number of operative procedures utilising radiological control. During osteosyntheses patients receive scattered radiation when fluoroscopy is used. Unlike operating-room staff, patients are not protected during these procedures. The aim of this study was to measure the amount of scattered radiation in the phantom plane during a simulated osteosynthesis in order to evaluate the patient’s need for protection. A lower arm anthropomorphic phantom was irradiated with the use of a Philips BV Pulsera C-arm. The amounts of scattered radiation at distances from 10 to 160 cm and angles of 0 to 180 degrees in the phantom plane were measured with a real-time dosimeter. The same amount of measurements was repeated with a fixation plate on top of the phantom to simulate a fracture reduction operation. The maximum amount of scattered radiation was 1.63 µSv at a distance of 10 cm from the edge of the radiation beam. This phantom study shows that scattered radiation during osteosyntheses of the distal radius is negligible and therefore no patient protection is needed. The results should be interpreted carefully as this is a phantom study.

An unprecedented case: Salter Harris II Gartland modified IV fracture of the humeral palette with metaphyseal fragment olecranon fossa. Review of literature.

Background. The Salter-Harris II fracture is the most common transphyseal fracture of all types of fractures, per-total and for each bone extremity that has a growth cartilage. This type of fracture rarely occurs in the humeral palette and the metaphyseal fragment is located laterally or medially. No cases with ventral or dorsal metaphyseal fragment have been described. Purpose. To bring into notice a fracture, type Salter-Harris II, with posterior metaphyseal fragment, represented by a posterior corticospongiosis lysereum(thickening) and the olecranon fossa, associated with periosteal rupture and soft tissue interposition. Study design: Case report Methods: A 9-year-old patient shows signs of traumatic injury, as a result of a direct impact on the right elbow. After a radiological examination, the diagnosis of Gartland type III supracondylar fracture is established, a closed reduction is practiced and it is immobilized in a plaster cast. The radiological control after the orthopedic reduction highlighted an unsatisfactory reduction. A surgery and an open reduction and internal fixing in "double X" were performed. Results: The preoperative diagnosis of Salter-Harris II fracture, with posterior Holland fragment, was made with difficulty and may be a surprise on intraoperative exploration. Open anatomical reduction and the fixation in "double X" allowed a firm synthesis of the fracture, verification of stability, intraoperatively, lack of mobilization in the plaster splint, starting recovery on the first postoperative day and full recovery of elbow mobility in 32 days. Conclusions: Salter Harris type II fracture with posterior fragment dislocated by tilting, translation and asymmetric rotation, irreducible is operated by open reduction and internal fixation. The fixation in "double X" ensured a better stabilization and allowed the recovery of flexion and extension in 32 days from surgery.

Correction of Torsional Deformity Following Nail Osteosynthesis of a Subtrochanteric Fracture

Torsional deformity is a frequent complication following nail osteosynthesis of a subtrochanteric fracture. This complication is difficult to assess intraoperatively, but can cause major functional restrictions. The authors consider that a clinical assessment should be complemented by a postoperative radiological control standardised with torsion CT. Thus, torsion deformity can be recognised immediately and easily corrected if necessary. This can help to avoid long-term damage that requires considerable surgery. The video shows details of torsion correction after a ca. 5-week old subtrochanteric femoral fracture, which had been initially treated with a femur nail. Before torsion correction, the internal torsion on the right femur was 22° and the external torsion on the left femur was 2°. Thus, the total deformation of the external torsion on the left side was 24°. We note the indication for removal of the nail, torsion correction and reosteosynthesis with long PFNA. The postoperative CT control confirmed that the torsion correction was adequate with internal torsion of 25° on the operated left side.

Trastorno psiquiátrico asociado a una conducta reiterada de ingesta de cuerpos extraños. Pautas de manejo

Introduction. Foreign body ingestion (FBI) usually occurs accidentally. The 70-80% of the cases occur in children with ages between 6 months and 3 years. Cases. The aim of this original article is present a case series of 4 patients with history of psychiatric disorders, all of whom are residents of the same institution, and who repeatedly perform FBI with self-injurious purposes. The treatment was different according to the episodes, from expectant management with radiological control in most of the cases, and upper digestive endoscopy until the finally surgical treatment. Discussion. Most of the objects use to be small inorganic objects such as piles, buttons, coins and pieces of toys. In adult patients, the objects are usually organics like bones, fish bones or food bowls. The most fragile are usually the elderly with dental prostheses ingestion. There is a special group, those patients who ingest voluntarily for different purposes. In one hand patients who have an intellectual disability, mental illness and / or substance abuse disorder, on the other hand, those who do it with economic purposes, also so-called «mules». The symptoms, complications and management depend on the object itself, evolution and anatomic localization. Conclusion. The clinical performance is difficult because there is no protocoled management established currently to prevent, treat and most important, avoiding new episodes.

Hemorragia digestiva alta y divertículo duodenal. Reporte de un caso

Bleeding duodenal diverticulum is an infrequent pathology in need of emergency treatment due to its high mortality. We present the clinical case of a 72-year-old patient with multiple comorbidities, who was admitted with upper gastrointestinal bleeding, abdominal pain and hemodynamic instability. Once hemodynamic stability was achieved, upper digestive endoscopy was performed, showing duodenal diverticulum in the upper knee with bleeding in the fundus, performing hemostatic control. CT was requested: at the level of the upper duodenal knee, wide base diverticulum. Surgery was scheduled for the high risk of new bleeding. In surgery, cholecystectomy and diverticulectomy were performed laparoscopically with mechanical suture. Anatomopathological report: duodenal wall with parietal thinning of the duodenum, suggestive of diverticulum by pulsion. The discharge was granted with radiological control on the 3rd postoperative day. The aim of this case is to show the importance of endoscopic resolution of urgency and subsequent laparoscopic management in a patient with important risk factors, evidencing the short hospital stay without postoperative complications.

AB0865 EPIDURITIS IN INFECTIOUS SPONDYLODISCITIS

Background:The main problem with infectious spondylodiscitis (ISD) is the diagnosis difficulty. Tuberculosis, with deceptive clinical semiology, remains to date the most common cause in underdeveloped and developing countries.Objectives:To report the frequency and characteristics of epiduritis in ISD and to specify its short and medium-term impact through a series of 70 cases.Methods:A descriptive retrospective study was conducted including patients with ISD, hospitalized in the rheumatology department at Fattouma bourguiba Hospital,Monastir TUNISIA between January 2009 and August 2019. Socio-demographic, clinico_biological and radiological data were collected.Results:34 male and 36 female were included. The average age was 53.91 ±15.3 years. The mean time to visit was 80.3±89 days [4,520]. Co-morbidity was noted in 66.7% of patients: diabetes (22), hypertension (18), hemodialysis (8), heart disease (4), and long term corticosteroid therapy (4). Tuberculosis contagion was present in 7.2% of patients. The most frequent reason for consultation was low back pain (63.8%) with a root syndrome in most patients (>50%). Neurological abnormalities were noted in 8.7% of patients. Skin swelling was noted in 4.3% of patients. Biological inflammatory syndrome and hyperleukocytosis were the moost biological abnormalities reported respectively in 81.2% and 30.4% of patients,. Among 70 ISD: 29 were with common germ, 18 with tuberculosis, 8 with brucellosis, and 14 with an undetermined germ. 91.3% of patients underwent a spinal magnetic resonance imaging (MRI): epiduritis was documented in 72% of cases, frequently anterior (53%). The epidural abscesses association was noted in 33 patients. It was pronounced mostly at the lumbar (19) and dorsal (14) levels. Epiduritis was frequently associated with para-vertebral soft tissues infiltration: pre-vertebral thickening (32), pre-vertebral collection (17), psoas muscle abscesses, (13). Spinal cord compression was noted in 2 patients. On 3-month visit, the ISD associated with epiduritis evolution was characterized by persistence of pain, hence radiological control was justified in 6 patients. A persistent biological inflammatory syndrome was noted in 27% of cases. Furthermore, 2 deaths were observed in this group of patients.Conclusion:Epiduritis rate in ISD requires a well-codified diagnostic and therapeutic strategy that will consider carfelly the neurological prognosis involved.References:doi: 10.1155/2019/7413089.doi: 10.1515/folmed-2016-0035.Acknowledgments:Rheumatology DepartmentDisclosure of Interests:None declared

Analysis of radiouclide contamination of forestry products on the territory of Ukraine 2013–2019

The analysis of the results of radiological studies of food and feed conducted by the specialists of the state laboratories of the State Consumer Service for 2013–2019 is performed. The analyzed results show that in the territories assigned to the radiation contamination zones, samples with a radionuclide content exceeding the maximum admissible levels of 137Cs and 90Sr are constantly detected. Even 33 years after the Chernobyl accident, the specific activity of 137Cs in mushrooms and berries remains high. Specialists of the state laboratories of the State Consumer Service during this period carried out radiological examinations of food and feed for the contents of 137Cs and 90Sr. Exceedance of the maximum permissible levels (DR) of 137Cs was detected in 3.253 samples, of which 1.277 were fresh mushrooms and yagi and 729 were dried and dried mushrooms and berries. It is established that forest mushrooms and berries (fresh and dried) are the critical dose-forming foods, accounting for the largest proportion of about 62 % of the total positive samples. A much better situation was observed in detecting an excess of DR 90Sr. During the study period, contamination of 90Sr food and feed is of a single nature. The dynamics of detecting excesses of DR 137Cs in forest mushrooms and berries (fresh and dried) for 2013–2019 have significant fluctuations related to environmental conditions and the multidirectional migration of man-made radionuclides in forest ecosystems. The use, even in small quantities, of forest origin products with a maximum specific activity of 137Cs can play a significant role in the internal exposure of long-lived radionuclide to the local population. Therefore, the largest proportion of forest food products (62 %) is in the balance of radionuclide-contaminated products during the last seven years. (2013–2019) and other products and feeds are the basis for further radiological control by their state laboratories of the State Consumer Service.