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Virtual reality (VR) simulation is a technology that empowers students and radiographers to practice radiography in a virtual environment that resembles real-life clinical scenarios. The purpose of this randomised study was to examine the relationship between clinical specialty and the ability to assess and obtain a lateral wrist radiograph using a VR simulator. Radiographers and radiography students were recruited from the EFRS Research Hub at the 2024 European Congress of Radiology. After completing a background questionnaire, participants entered a VR simulator where they assessed lateral wrist radiographs and, if necessary, attempted a retake. Fisher's exact test was used to evaluate the relationship between specialties and participants' ability to assess positioning and perform retakes. Rank-biserial correlation estimated the relationship between participants' ability to reposition the VR patient and their VR experience and self-perceived confidence in wrist radiograph positioning. The cohort included 173 participants from 14 specialties across 21 countries. There was a borderline significant trend between clinical specialty and correct positioning assessment (p = 0.052) and between self-perceived confidence in acquiring wrist radiographs and repositioning for a retake (p = 0.052). Neither clinical specialty (p = 0.480) nor previous VR experience (p = 0.409) correlated with ability to reposition for a retake. While results indicated a potential correlation between participants' ability to position a VR patient and both clinical specialty and confidence in wrist radiography, these trends were not statistically significant. Nevertheless, the findings suggest that VR holds promise for radiography training, though further research is necessary to explore the factors that influence performance and learning. The incorporation of VR technology into standard radiography training programs could potentially improve patient outcomes by ensuring that radiography students are more skilled at acquiring quality radiographs prior to their first clinical practice. It should be noted though, that knowledge on positioning criteria and anatomy is an advantage when practicing correct positioning in a VR simulator. [ABSTRACT FROM AUTHOR]

Background: Carpal tunnel syndrome is the commonest upper limb peripheral neuropathy. Diffusion tensor imaging evaluates the tissue microarchitecture and measures the movement of water protons. It is non-time-consuming, not invasive and not operator dependent. The aim of our study was to evaluate whether diffusion tensor imaging can diagnose carpal tunnel syndrome and whether DTI parameters can correlate with severity of carpal tunnel syndrome. Results: Seventy-two wrists were assessed, 36 diagnosed with carpal tunnel syndrome and 36 age and sex matched controls. FA & ADC were measured at four locations (distal radioulnar joint, proximal, middle and distal carpal tunnel), and the mean for the whole median nerve was calculated. FA & ADC showed statistically significant difference between cases and control at each of the measured four locations and the mean of the whole median nerve. FA & ADC at the hook of hamate (distal CT) showed the most significant difference between cases and control. For FA, the cut-off point at the hook of hamate was 0.5 (sensitivity 94.4%, specificity of 88.9%, positive predictive value 89.5% and negative predictive value 94.1%) and the cut-off point for the mean of the whole nerve was 0.545 (sensitivity 97.22%, specificity 77.78%, positive predictive value 81.4% and negative predictive value 96.6%). For ADC, the cut-off point at the hook of hamate was 1.44 (sensitivity 97.22%, specificity 86.11%, positive predictive value 87.5% and negative predictive value 96.9%) and the cut-off point for the mean of the whole nerve was 1.415 (sensitivity 86.11%, specificity, 83.33%, positive predictive value 83.8% and negative predictive value 85.7%). Conclusion: Diffusion tensor imaging can diagnose carpal tunnel syndrome with accuracy compared to the gold standard nerve conduction studies. Both FA and ADC showed statistically significant differences between cases & controls with FA measurements found to be more significant. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this study is to establish the correlation of clinically measured carrying angle with four radiological angles, i.e., Humerus–Elbow–Wrist angle (HEWA), Humero-ulnar angle, Metaphyseal–Diaphyseal angle, and Baumann's angle, and to find out which of the above-mentioned angles co-relates best with the clinically measured carrying angle. Methods: We studied 100 patients in the age group of 2–12 years after Ethics committee approval and informed consent from parents. Clinical angle was measured using goniometer and radiological angles marked on antero-posterior elbow X-ray using a standard method. Collected data were studied using statistical tests to find out correlation. Results: Pearson correlation coefficient for humerus–elbow–wrist angle found to be 0.674 followed by Humero-Ulnar angle (r = 0.417). Regression coefficient for humerus–elbow–wrist angle is 0.635 (p value < 0.001). Conclusion: Humerus–Elbow–Wrist angle correlates better compared to other radiological angles in assessment of varus–valgus angulations of elbow & will not only play a vital role in pre- operative planning of deformity corrections but also in the evaluation & comparison of the post-operative functional outcomes. [ABSTRACT FROM AUTHOR]

Background: The distal end radius's bony anatomy in relation to three variables—Radial Inclination, Volar tilt, and radial height—has been discussed commonly in the adult population and is not very well defined in the growing skeleton. In children aged 8–16 years old, we measured the osseous distal end radius according to radiography standards. The research comprised 130 patients, 65 males and 65 females aged 8–16. In each child, the norms for radial inclination, volar tilt, and radial epiphyseal height were established. This research defines these radiographic parameters for the paediatric population in India for the first time. Methods: This research is an Unicentric Cross-sectional observational analytical study. We studied 130 normal wrist posteroanterior and lateral radiographs of the Indian paediatric population aged 8–16 years who reported to our OPD and calculated the three parameters—(1) Radial height, (2) Volar Tilt, and (3) Radial Inclination. Mean measurement values were analysed statistically. Results: The Mean distal end radius volar tilt is 10.92° ± 1.76° SD with a range from 4° to 15°. The Mean distal end radial inclination is 21.04° ± 2.10° SD with a range from 15° to 25°. The Mean distal end radial height is 11.93 ± 1.44 mm SD with a range from 9.0 to 14.50 mm. Conclusion: In true Postero-anterior and lateral wrist radiographs of the Indian paediatric population, we have established normal values that may be utilized as a guide for the evaluation and treatment of a variety of traumatic and non-traumatic problems in Indian children. [ABSTRACT FROM AUTHOR]

Purpose: Scaphoid nonunion and malunion can be observed after scaphoid fracture. While the diagnosis of nonunion is well defined in the literature, there is no consensus on the diagnostic criteria and clinical outcomes of scaphoid malunion. The aim of the study is to define the direct radiography parameters of scaphoid malunion and determine the clinical outcomes. Methods: Patients applied to our clinic with the diagnosis of scaphoid fracture between January 2020 and June 2021, and were analyzed retrospectively. 32 patients treated with surgical or conservative methods were included in the study. Nonunions and cases with a follow-up period of less than 12 months were excluded. Scapholunate (SL) angles and height-to-length (H/L) ratios of scaphoid were measured on wrist radiography to assess scaphoid malunion. Malunion was defined as SL angle >60∘ and ROC analysis was applied to determine cutoff H/L ratio in wrist radiography. Wrist functionality and pain were evaluated with the Patient-Rated Wrist Evaluation (PRWE) and MAYO scores. The range of motion (ROM) and grip strength were also recorded. Results: Seventeen patients (53.1%) underwent surgery while conservative treatment was applied to the other 15 (46.9%). Of these, six patients (18.8%) met the definition of malunion. According to receiver operating curve (ROC) analysis, the cutoff H/L ratio in posteroanterior wrist radiographs was 0.602 (p < 0.001) and the cutoff H/L ratio in lateral wrist radiographs was 0.692 (p = 0.003). The ROM values for flexion/extension and radial/ulnar deviation was smaller in the malunion group (p = 0.023 and P = 0.014, respectively). However, no significant difference was observed in pronation/supination values (p > 0.05). Mean MAYO score was 75.0 in malunion group and 90.0 in nonmalunion group (p = 0.003). While the mean PRWE value was 24.50 in malunion, it was 14.15 in nonmalunion (p = 0.023). Conclusion: Evaluation of H/L ratio in wrist radiography provides valuable information in the diagnosis of scaphoid malunion. Scaphoid malunions have poorer functional outcomes. [ABSTRACT FROM AUTHOR]

Intra-articular lipomas are infrequently reported, with most reported cases occurring in the knee joint. A case of intra-articular lipoma in the small joints of the hand, specifically in the pisotriquetral joint, has been documented for the first time. A 24-year-old male visited the emergency department after a road traffic accident with a painful and swollen wrist. Radiographic examination revealed fractures of the distal radius and triquetrum. A subsequent wrist computed tomography scan identified an intra-articular lipoma within the pisotriquetral joint, further confirmed by ultrasonography. This article underscores the importance of recognizing that, though exceedingly rare, intra-articular lipomas should be considered in the differential diagnosis of soft-tissue tumors affecting the hand and wrist. [ABSTRACT FROM AUTHOR]

Objectives: The aim of our study is to compare the relationship between hand-wrist and cervical vertebra maturation stages with chronological age and to investigate the effect of malocclusion type on the relationship between these methods. Materials and methods: Hand-wrist and cephalometric radiographs of 1000 patients (526 females, 474 males) with a mean age of 13.41 ± 1.83 were analyzed. The methods of Bacetti et al. were used for the cervical vertebra maturation stage, and Björk, Grave and Brown's methods were used for the hand-wrist maturation stage. One-way ANOVA test was applied to compare skeletal classes between them. Tukey post hoc test was used to determine the differences. The relationship between the malocclusion type, cervical vertebra and hand-wrist maturation stages was evaluated with the Spearman correlation test. Results: Spearman's correlation coefficient was 0.831, 0.831 and 0.760 in Class I, II and III females, respectively. In males, it was calculated as 0.844, 0.889 and 0.906, respectively. When sex and malocclusion were not differentiated, the correlation was found to be 0.887. All were statistically significant (P < 0.001). The highest correlation was observed in class III males, while the lowest was found in class III females. Conclusion: Cervical vertebrae can be used safely to assess pubertal spurt without hand-wrist radiography. Diagnosing growth and development stages from cephalometric images is important in reducing additional workload and preventing radiation risk. [ABSTRACT FROM AUTHOR]

Background: Musculoskeletal cone-beam computed tomography (CBCT) is an imaging technique for wrist assessment. In this study, we compared image quality and patient satisfaction between CBCT and multidetector computed tomography (MDCT) in traumatic wrist patients in a dose-matched setting. Methods: We prospectively enrolled traumatic patients who were scheduled for CT of the wrist. Patients were randomly assigned to CBCT or MDCT. Radiation dose was kept identical between both modalities. Subsequently, patients were asked to complete a questionnaire regarding the examination. Measurements of contrast-to-noise ratio (CNR) were performed. Three blinded readers independently rated image quality on Likert scales. Results: A total of 125 patients (mean age 35 years [standard deviation 16]; 91 men) were included. A total of 108 patients returned the questionnaire. With equivalent dose, CNRs were higher in CBCT compared to MDCT (p < 0.001) and the median ratings of image quality were better for CBCT compared to MDCT (p ≤ 0.04). Patients only rated positioning in CBCT as more comfortable than in MDCT (p < 0.001), while there were no further differences regarding satisfaction with both modalities. Conclusions: At equivalent dose settings to MDCT, CBCT showed a high image quality for the depiction of bony structures, soft tissue and artifacts in wrist examinations of trauma patients. Overall, patients were equally satisfied with both methods. Altogether, CBCT might be a promising alternative for wrist imaging. However, further studies with more different devices are needed. [ABSTRACT FROM AUTHOR]

Background: The primary causes of short stature (SS) are idiopathic short stature (ISS) and growth hormone deficiency (GHD). The diagnosis of GHD relies on growth hormone stimulation tests (GHSTs), while the diagnosis of ISS is achieved through exclusion. Objectives: Growth hormone (GH) and insulin-like growth factor-I are the best therapeutic drugs for treating GHD, but their suitability for ISS remains controversial. Therefore, distinguishing between these two causes of SS is crucial. Currently, the diagnosis of GHD depends on GHSTs, whereas the diagnosis of ISS is achieved through exclusion, which is an invasive process. Thus, developing a noninvasive and convenient method to differentiate between GHD and ISS would be of great importance. Patients and Methods: We enrolled patients aged 3 -14 years who presented with SS and underwent GHSTs and pituitary gland (PG) magnetic resonance imaging (MRI) at our hospital from January 2020 to October 2022 for a cross-sectional study. A total of 205 patients were included, comprising 83 with ISS and 122 with GHD. The GHD patients were further divided into two groups based on the peak GH level in GHSTs. All patients underwent routine physical examinations, GHSTs, PG MRI, and X-rays of the left wrist. Two authors independently recorded the PG features (height, length, width, volume, pituitary stalk diameter, pituitary stalk length, and morphology). The PG morphology was categorized into three types: Convex, flat, and concave. Bone age was estimated from X-rays of the left wrist, which were reviewed by an experienced radiologist. Comparisons between the two groups were conducted using two independent samples t-tests or chi-square (χ²) tests. Results: There were no differences between the two groups regarding baseline clinical characteristics, except for the GH peak in GHSTs (P < 0.05). Pituitary stalk diameter, PG height, PG volume, and the dorsum sellae were significantly lower, while the tuberculum sellae was higher in the GHD group compared to the ISS group (all P < 0.05). The proportion of concave PG was higher, and the proportion of flat PG was lower in the GHD group (all P < 0.05). In subgroup analysis, PG height and PG volume were significantly lower in the absolute GHD (AGHD) group compared to the partial GHD (PGHD) group (all P < 0.05). Correlation analysis showed that PG height (r = 0.635, P < 0.01) and PG volume (r = 0.786, P < 0.01) were positively correlated with the GH peak level. Further analysis also demonstrated the differential diagnostic accuracy of PG height and PG volume, with high sensitivity (PG height: 66.3%; PG volume: 843%) and specificity (PG height: 85.2%; PG volume: 77.9%). Conclusion: pituitary gland height, PG volume, and the concave type of PG morphology may be very helpful in the differential diagnosis of GHD and ISS. [ABSTRACT FROM AUTHOR]

Osteoporosis is a commonly observed systemic metabolic disease characterized by a decrease in bone mineral density and an increased risk of fractures worldwide. Bisphosphonates are commonly preferred for its prevention and treatment. Among the side effects of bisphosphonates used orally and parenterally are gastrointestinal symptoms, musculoskeletal pains, flu-like syndrome, and an increase in acute-phase reactants. In this case report, a rare side effect observed during alendronate treatment, polyarticular synovitis, will be presented. [ABSTRACT FROM AUTHOR]

Common pediatric distal forearm fractures necessitate precise detection. To support prompt treatment planning by clinicians, our study aimed to create a multi-class convolutional neural network (CNN) model for pediatric distal forearm fractures, guided by the AO Foundation/Orthopaedic Trauma Association (AO/ATO) classification system for pediatric fractures. The GRAZPEDWRI-DX dataset (2008–2018) of wrist X-ray images was used. We labeled images into four fracture classes (FRM, FUM, FRE, and FUE with F, fracture; R, radius; U, ulna; M, metaphysis; and E, epiphysis) based on the pediatric AO/ATO classification. We performed multi-class classification by training a YOLOv4-based CNN object detection model with 7006 images from 1809 patients (80% for training and 20% for validation). An 88-image test set from 34 patients was used to evaluate the model performance, which was then compared to the diagnosis performances of two readers—an orthopedist and a radiologist. The overall mean average precision levels on the validation set in four classes of the model were 0.97, 0.92, 0.95, and 0.94, respectively. On the test set, the model's performance included sensitivities of 0.86, 0.71, 0.88, and 0.89; specificities of 0.88, 0.94, 0.97, and 0.98; and area under the curve (AUC) values of 0.87, 0.83, 0.93, and 0.94, respectively. The best performance among the three readers belonged to the radiologist, with a mean AUC of 0.922, followed by our model (0.892) and the orthopedist (0.830). Therefore, using the AO/OTA concept, our multi-class fracture detection model excelled in identifying pediatric distal forearm fractures. [ABSTRACT FROM AUTHOR]

Abstract Introduction This study illustrates image rejection rates of the lateral wrist x‐ray projection at a large, public teaching hospital. Rejected images were evaluated to determine the number of images that needed to be repeated based on the clinical indication. This study highlights the difference in subjective image‐repeat decision‐making skills existing between radiologists, experienced radiographers and junior radiographers. Methods A retrospective review was conducted of all rejected lateral wrist x‐ray images by a panel of three radiologists, three experienced radiographers and six junior radiographers. This review aimed to determine if rejected imaging met the consideration of the clinical indication and assumed appropriate acquisition of an orthogonal projection. A complement of images that had not been rejected were included in the review to create a blinded study. Results The review demonstrated 85.8% of rejected images were deemed to meet clinical requirements according to radiologists. The experienced radiographers agreed with radiologists regarding 75.3% of images. Junior radiographers agreed with radiologists in 34.2% of cases. Junior radiographers were three times more likely to seek repeat imaging than the radiologists and experienced radiographers. Conclusions This review demonstrated a lateral wrist projection reject rate of 38.7% with unnecessary repeats according to clinical indications in 85.8% of cases. The review of experienced radiographers was comparable to radiologists; however, the difference in decision‐making skills was evident in the junior radiographers. This highlights an alarming trend, should similar results be demonstrated at other health services and indicates an unnecessary burden to clinical practice. Inclusion of clinical reasoning for imaging and the need for repeat imaging is recommended for radiography training programs.

Introduction: This study illustrates image rejection rates of the lateral wrist x‐ray projection at a large, public teaching hospital. Rejected images were evaluated to determine the number of images that needed to be repeated based on the clinical indication. This study highlights the difference in subjective image‐repeat decision‐making skills existing between radiologists, experienced radiographers and junior radiographers. Methods: A retrospective review was conducted of all rejected lateral wrist x‐ray images by a panel of three radiologists, three experienced radiographers and six junior radiographers. This review aimed to determine if rejected imaging met the consideration of the clinical indication and assumed appropriate acquisition of an orthogonal projection. A complement of images that had not been rejected were included in the review to create a blinded study. Results: The review demonstrated 85.8% of rejected images were deemed to meet clinical requirements according to radiologists. The experienced radiographers agreed with radiologists regarding 75.3% of images. Junior radiographers agreed with radiologists in 34.2% of cases. Junior radiographers were three times more likely to seek repeat imaging than the radiologists and experienced radiographers. Conclusions: This review demonstrated a lateral wrist projection reject rate of 38.7% with unnecessary repeats according to clinical indications in 85.8% of cases. The review of experienced radiographers was comparable to radiologists; however, the difference in decision‐making skills was evident in the junior radiographers. This highlights an alarming trend, should similar results be demonstrated at other health services and indicates an unnecessary burden to clinical practice. Inclusion of clinical reasoning for imaging and the need for repeat imaging is recommended for radiography training programs. [ABSTRACT FROM AUTHOR]

Objective: The wrist is the second most commonly involved location for GCTB, while distal ulna is a relatively rare location and limited evidence exists on which surgical approaches and reconstruction techniques are optimal. We carried out a multicenter retrospective study to evaluate the recurrence rate of distal ulna GCTB and the long-term functional outcomes of different surgery options. Methods: All 28 patients received surgical treatment for distal ulna GCTB in one of three tertiary bone tumor centers between May 2007 and January 2021 with a minimum two-year follow-up. Surgical options included intralesional curettage or en bloc resection (one of 3 types). Functional outcomes were assessed by the MSTS score, the QuickDASH instrument, MWS, and MHQ according to the latest treatment. Results: Overall recurrence rate was 14.2%. The curettage group (N = 7) had a significantly higher recurrence rate compared to en bloc resection (N = 21) (42.9% vs 4.8%) (mean follow-up: 88.8 mo). Seven patients received the Darrach procedure, 5 received the original Sauvé–Kapandji procedure, and 9 received the modified Sauvé–Kapandji procedure with extensor carpi ulnaris (ECU) tenodesis. Of the 4 patients having a recurrence, 1 received the Darrach EBR, 2 received the modified Sauvé–Kapandji procedure, and 1 received resection for soft tissue recurrence. Only MWS and esthetics in the MHQ scores were different (curettage, Darrach, Sauvé–Kapandji, and Sauvé–Kapandji with ECU tenodesis [MWS: 96.5 ± 1.3 vs 91.5 ± 4.7 vs 90.8 ± 2.8 vs 91.5 ± 3.6; esthetics in MHQ: 98.5 ± 3.1 vs 89.9 ± 4.7 vs 93.8 ± 4.4 vs 92.6 ± 3.8], respectively). Conclusions: En bloc resection for distal ulna GCTB had a significantly lower recurrence rate compared with curettage and achieved favorable functional outcome scores. Given the higher recurrence rate after curettage, patients should be well informed of the potential benefits and risks of selecting the distal radioulnar joint-preserving procedure. Moreover, reconstructions after tumor resection of the ulna head do not appear to be necessary. [ABSTRACT FROM AUTHOR]

Background: To investigate whether fractal dimension (FD) measurements from hand-wrist radiographs and lateral cephalometric radiographs are correlated with each other and with skeletal maturation stages. Methods: In this retrospective study conducted on hand-wrist and lateral cephalometric radiographs obtained from patients between 2017 and 2023, hand-wrist maturation stages (HWMS) and cervical vertebral maturation stages (CVMS) of 144 subjects (6 to 17 years of age) were assessed radiographically. The participants were divided into nine groups (n = 16 each) based on HWMS. Fractal analysis was performed on the radiographs of the radius, the middle finger phalanges (proximal, medial and distal), and the cervical vertebral bodies (C2, C3, C4). Mean and standard deviation values, Spearman's and Pearson correlation analyses, one-way ANOVA, Kruskal-Wallis H tests and Mann-Whitney-U test were used to evaluate the data. Results: Positive correlations were found between the FD values of the radius and HWMS or CVMS (r =.559, P =.001, r =.528 P =.001 respectively). The FD values of the radius were positively correlated with those of all cervical vertebrae (C2, C3, C4), proximal and medial phalanges as well as age. FD values measured from the proximal phalanx, medial phalanx and radius showed significant differences among both HWMS and CVMS (P <.05). HWMS was strongly correlated with CVMS (r =.929, P =.001). Age was strongly correlated with HWMS (r =.795, P =.001) and CVMS (r =.756, P =.001). There was a significant difference in terms of age distribution among HWMS and CVMS (P <.05). Conclusions: FD measurements on hand-wrist radiographs can provide useful information for the assessment of skeletal maturation stage. Especially, FD measurements from the radius are important and more reliable to predict skeletal maturation stage. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study was to investigate the potential of arthroscopic scapholunate ligament repair and dorsal capsulodesis with suture anchor as a treatment option for patients experiencing symptomatic acute and subacute (< 3 months) scapholunate instability. Methods: From Jan. 2017 to Jan 2020, 19 wrists with acute or subacute tears of the SL ligament with symptomatic instability were treated with arthroscopic SL repair and dorsal capsulodesis with a suture anchor. The average time from injury to operation was 8.8 weeks (range, 4–11 weeks) and the regular follow-up mean duration at our clinic was 26.5 months (range, 24–32 months). The pain score according to the visual analog scale, wrist range of motion, grip strength, radiographic outcomes and functional outcomes according to the Modified Mayo Wrist Score (MMWS) were evaluated preoperatively and postoperatively during the follow-up period. Results: All 19 patients had rupture and dissociation of the SL ligament in the radiocarpal joint. The total arc of wrist motion in the flexion–extension plane loss averaged 5.1° (P >.01).The Wilcoxon signed-rank test was used to compare the results: grip force improved significantly with 14.7% improvement of that on the normal side (P <.01); the postoperative MMWS was significantly better than the preoperative scores (P <.01). Of 19 patients of the series, 18 patients (94.7%) achieved good or excellent results according to the MMWS and 16 patients (84.2%) resumed their previous activities. Only one patient (5.3%) had residual laxity of the scapholunate ligament joint at 15 months of follow-up. Conclusions: At a minimum of two years of follow-up, patients with acute or subacute symptomatic dissociation of scapholunate ligament instability who underwent arthroscopic scapholunate ligament repair and dorsal capsulodesis with suture anchor treatment had satisfactory results. Level of Evidence: Level IV, case series. [ABSTRACT FROM AUTHOR]

Growth and maturation are central concerns in the organization of training and competitions in youth sports. This study examined maturity-associated variation in body size and adiposity among adolescent girls participating in competitive age group youth soccer. The sample included 441 players 10.08-16.73 years of age. Stature and body mass were measured and body composition was predicted. The Fels method was used to estimate skeletal age. Skeletally maturity status (late, average or early maturing) was based on the difference between chronological and skeletal age for each player. Mean stature approximated the 50th percentiles of the general population in all competitive age groups, while mean weight fluctuated between 50th and 75th percentiles. Age- and maturity-specific means for estimated fat mass ranged between 18.0% and 28.2%. The number of players classified as skeletally mature increased with competitive age groups (under-13: 0%; under-15: 8%; under-17: 49%). In general, early maturing girls tended to be heavier than their age group peers and especially when compared to late maturing players. [ABSTRACT FROM AUTHOR]

Tubercular tenosynovitis has also been known as compound palmar ganglion which is a misnomer. Cardiovascular complications of tuberculosis (TB) are one of the most common extrapulmonary involvements of the disease. These cardiac complications arising due to tubercular inflammation are many and varies. These range from pericarditis (high prevalence) to acute myocardial infarction, aortitis, myocarditis, and mycotic aneurysms and many others. Cardiovascular complications of TB have a high rate of morbidity and mortality rate. There should be a high index of suspicion and interdisciplinary involvement of the various required specialties in the management of such a swelling with cardiac pathophysiology as well. This case report highlights one such example of tuberculosis with acute myocardial infarction (AMI) which got unmasked post TTS surgery. [ABSTRACT FROM AUTHOR]

Simple Summary: In this paper, we introduce a new technique for enhancing medical image diagnosis through transfer learning (TL). The approach addresses the issue of limited labelled images by pre-training deep learning models on similar medical images and then refining them with a small set of annotated medical images. Our method demonstrated excellent results in classifying the humerus and wrist, surpassing previous methods, and showing greater robustness in various experiments. Furthermore, we demonstrate the adaptability of the approach with a CT case, which showed improvements in the results. Medical image classification poses significant challenges in real-world scenarios. One major obstacle is the scarcity of labelled training data, which hampers the performance of image-classification algorithms and generalisation. Gathering sufficient labelled data is often difficult and time-consuming in the medical domain, but deep learning (DL) has shown remarkable performance, although it typically requires a large amount of labelled data to achieve optimal results. Transfer learning (TL) has played a pivotal role in reducing the time, cost, and need for a large number of labelled images. This paper presents a novel TL approach that aims to overcome the limitations and disadvantages of TL that are characteristic of an ImageNet dataset, which belongs to a different domain. Our proposed TL approach involves training DL models on numerous medical images that are similar to the target dataset. These models were then fine-tuned using a small set of annotated medical images to leverage the knowledge gained from the pre-training phase. We specifically focused on medical X-ray imaging scenarios that involve the humerus and wrist from the musculoskeletal radiographs (MURA) dataset. Both of these tasks face significant challenges regarding accurate classification. The models trained with the proposed TL were used to extract features and were subsequently fused to train several machine learning (ML) classifiers. We combined these diverse features to represent various relevant characteristics in a comprehensive way. Through extensive evaluation, our proposed TL and feature-fusion approach using ML classifiers achieved remarkable results. For the classification of the humerus, we achieved an accuracy of 87.85%, an F1-score of 87.63%, and a Cohen's Kappa coefficient of 75.69%. For wrist classification, our approach achieved an accuracy of 85.58%, an F1-score of 82.70%, and a Cohen's Kappa coefficient of 70.46%. The results demonstrated that the models trained using our proposed TL approach outperformed those trained with ImageNet TL. We employed visualisation techniques to further validate these findings, including a gradient-based class activation heat map (Grad-CAM) and locally interpretable model-independent explanations (LIME). These visualisation tools provided additional evidence to support the superior accuracy of models trained with our proposed TL approach compared to those trained with ImageNet TL. Furthermore, our proposed TL approach exhibited greater robustness in various experiments compared to ImageNet TL. Importantly, the proposed TL approach and the feature-fusion technique are not limited to specific tasks. They can be applied to various medical image applications, thus extending their utility and potential impact. To demonstrate the concept of reusability, a computed tomography (CT) case was adopted. The results obtained from the proposed method showed improvements. [ABSTRACT FROM AUTHOR]

Objectives: Using virtual reality (VR), students of radiography can practice acquisition and positioning of musculoskeletal radiographs and get immediate feedback on their performance within the simulator. The purpose of this study was to assess usability of a newly developed VR simulator and to explore self-perceived clinical readiness (SPCR) of radiography students before and after training acquisition of wrist radiographs in the VR simulator. Material and Methods: A prospective methodology was applied where the students (n = 10) estimated their own SPCR in regard to acquisition of wrist radiographs pre- and post-VR training. A questionnaire on usability, realism, and educational value of the simulator was answered post-VR training. Usability and SPCR scores were calculated. The student’s paired t-test was applied to explore the impact of VR training on SPCR. Results: The students (90%) reported that the simulator was realistic and they thought that it could contribute to learning. The pre- and post-SPCR scores were 75 (95% confidence interval [CI]: 54–96) and 77 (95% CI: 59–95), respectively. There was no significant difference (P = 0.4574) between the pre- and post-SPCR scores. Conclusion: Results indicated that the concept of training acquisition and positioning of wrist radiographs in a VR simulator is feasible with positive feedback from the students. The SPCR scores improved slightly, although not statistically significant, after completion of the training session. [ABSTRACT FROM AUTHOR]

Open Reduction and Internal Fixation (ORIF) with volar locking plates are commonly used to manage distal radial fractures. The anatomical tilt lateral (ATL) wrist X-ray is often required for evaluation of intra-articular screw penetration due to the screw position. This study aims to evaluate the correlation between the tube angulation given by performing radiographers for the ATL projection and the post-examination measurement of radial inclination (RI) on the Posterior Anterior (PA) wrist image. A retrospective review was performed for 36 patients. A standardised method developed by Kreder et al. (1996) was used to measure the RI on the PA wrist image. All ATL images sent into Picture Archiving and Communications System (PACS) have the tube angulation applied annotated on the image. Pearson's correlation was used to analyse the co-relationship between the RI and the tube angle applied for ATL projection. The average angle of RI measured by the four observers was 19. Normality of 0.385 was established. A positive correlation (p = 0.792) between the RI and the tube angle applied for ATL was found. Our study found a strong positive correlation between the tube angulation applied by performing radiographers for the ATL projection and the post-examination RI measured on the PA wrist image by the independent reviewers. This suggests that radiographers can use the measured RI to apply the tube angulation when performing the ATL wrist X-ray, instead of estimating the tube angulation to be applied. Using the measured RI to apply the tube angulation when performing the ATL wrist X-ray will ensure a more reliable and reproducible way that could reduce the number of repeated images and, thus, unnecessary radiation dose to patients. [ABSTRACT FROM AUTHOR]

Purpose: Distal radius fractures have great impact on activities of daily living of affected patients. Repeatedly, a non-anatomic restoration of the volar tilt can be observed in a minimum of 20% in postoperative X-ray control examinations. Hence, the question arises whether the achieved reduction is functionally acceptable, or whether a further attempt should be made to improve the surgical outcome. Methods: The data presented here originate from a prospective analysis including three therapy studies on surgical treatment options for fractures of the distal radius between 2004 and 2011. For this study, the participants were divided into two groups: The first group represents the cases with non-anatomical restoration of the volar tilt with − 5° to 5°. The second group contains patients with an anatomical volar tilt between 6° and 15°. Results: A total of 624 patients were screened according to the inclusion criteria. Radiological evaluation showed consolidation of all fractures. The mean volar tilt as measured in standard x-rays of the wrist was 0° and 8°, respectively. The range of wrist motion in relation of the healthy opposite side was comparable in all directions (for example comparison group 1: Ext/Flex 94/94%; group 2: Ext/Flex 93/93%). Functional assessment of postoperative midterm results employing the Castaing and Gartland & Werley scores 2.3 years after surgery did not reveal significant differences between both groups. Conclusion: According to the available data, a volar tilt in the range of − 5° to 5° can be tolerated intraoperatively without any risk of loss of function regarding the patient's manual abilities. [ABSTRACT FROM AUTHOR]

Purpose: Most patients with a clinically suspected scaphoid fracture and normal initial radiograph are unnecessarily treated. Previously developed prediction rules using demographic and clinical risk are unable to accurately predict occult fractures. Adding other risk factors could enhance this. Therefore, we aim to explore if there are morphological risk factors of the wrist for sustaining a scaphoid fracture. Methods: We retrospectively included adult patients with a clinically suspected scaphoid fracture between 2013 and 2019 in our case–control study. There were 82 patients with a scaphoid fracture and 158 patients with a wrist contusion. Morphological risk factors were identified using statistical shape modelling (SSM) and linear measurements. Independent wrist shape variations on posteroanterior and lateral radiographs were captured in modes using SSM. Associations between outcomes and a scaphoid fracture were explored using logistic regression and the reliability was assessed. Results: Of the 15 posteroanterior modes and 8 lateral modes identified and linear measurements performed, 1 PA mode was associated with a scaphoid fracture (PA mode 4; OR 1.40, CI 1.04–1.93, p = 0.031). We described this mode as an ulna plus and narrower distal radius with more volar tilt and radial inclination. The reliability of the posteroanterior modes and linear measurements was mostly good/excellent and moderate/poor for the lateral modes. Conclusion: There was one complex wrist shape significantly associated with a scaphoid fracture. Since the association was weak and the shape is difficult to identify radiographs, we believe this morphological risk factor would not enhance identifying occult scaphoid fractures in the future. [ABSTRACT FROM AUTHOR]

Most hospitals and clinics utilize commercial grade displays for viewing wrist radiographs. There is no evidence regarding the role of the imaging display used to evaluate the radiographs. The aim of this study was to compare the rates of scaphoid fracture diagnosis by commercial grade and medical grade displays. Wrist radiographs of patients that had clinical signs of scaphoid fracture without findings on plain radiography (suspected scaphoid fractures) were retrospectively collected from ER department and interpreted for radiographic signs of fracture by four orthopedics seniors commercial grade and medical grade displays. The difference in fracture diagnosis rates were studied. Inter- and intra-observer variability were also studied. Study population comprised of 175 high quality wrist radiographs were interpreted. Mean 48.25 (27%) scaphoid fractures were observed on commercial grade display compared to 66 (38.2%) on medical grade display (p = 0.076). The total inter-observer agreement could be defined as a moderate agreement (κ = 0.527, Accuracy = 0.77). Total agreement between all observers were observed in 86 (49.1%) cases compared to 89 (50.9%) cases when reviewing X-rays on commercial and medical displays, respectively. The scaphoid fracture detection rate on medical grade display was not statistically higher compared to non-medical grade displays, but we did find a tendency toward medical grade display. We found that in a substantial number of cases, our observers recognize signs of fracture that were initially evaluated as "suspected fracture" by the ER physicians. As a pilot study, we found evidence that support the need for a prospective study designed to compare the observations to a gold standard modality, such as MRI. We believe utilizing medical grade displays can increase the rate of diagnosis in cases of clinically suspected scaphoid fractures and better manage the clinical scenario of a suspected scaphoid fracture. [ABSTRACT FROM AUTHOR]

Bone age assessment (BAA) based on X-ray imaging of the left hand and wrist can accurately reflect the degree of the body's physiological development and physical condition. However, the traditional manual evaluation method relies too much on inefficient specialist labor. In this paper, to propose automatic BAA, we introduce a hierarchical convolutional neural network to detect the regions of interest (ROI) and classify the bone grade. Firstly, we establish a dataset of children's BAA containing 2518 left hand X-rays. Then, we use the fine-grained classification to obtain the grade of the region of interest via object detection. Specifically, fine-grained classifiers are based on context-aware attention pooling (CAP). Finally, we perform the model assessment of bone age using the third version of the Tanner–Whitehouse (TW3) methodology. The end-to-end BAA system provides bone age values, the detection results of 13 ROIs, and the bone maturity of the ROIs, which are convenient for doctors to obtain information for operation. Experimental results on the public dataset and clinical dataset show that the performance of the proposed method is competitive. The accuracy of bone grading is 86.93%, and the mean absolute error (MAE) of bone age is 7.68 months on the clinical dataset. On public dataset, the MAE is 6.53 months. The proposed method achieves good performance in bone age assessment and is superior to existing fine-grained image classification methods. [ABSTRACT FROM AUTHOR]

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Introduction: Recent innovations in wrist arthroplasty implants have led to remarkable improvements in terms of results with improved stability and preservation of bone stock. Despite the advances in such implants, poor outcomes and frequent complications still affect this procedure, not allowing a wider use of this treatment in wrist arthritis. The purpose of this study is to assess the preliminary mid-term results of a Wrist Arthroplasty System (Freedom®, Integra Lifesciences, Princeton, USA) in patients with rheumatoid arthritis or secondary osteoarthritis of the wrist and to propose a new classification system. Materials and Methods: We examined 12 patients (7 with rheumatoid arthritis and 5 with secondary osteoarthritis of the wrist) who underwent total wrist arthroplasties performed by a single surgeon using the fourth-generation prosthesis. Pre- and post-operative pain on a visual analogue score, functional parameters measured with Mayo Wrist score, patient-rated wrist evaluation score, range of motion, and radiographic analysis were collected. Results: At a mean follow-up of 48 (SD 16.9) months a significant improvement (p < 0.0001) of the mean visual analogue, Mayo and PRWE scores following total wrist arthroplasty was observed. Wrist movements improved significantly (p < 0.001). Conclusion: We achieved significant improvements in pain relief, performance, and satisfaction both in rheumatic and non-rheumatic patients, confirmed by our scoring system. Level of Evidence: Level IV, case series. [ABSTRACT FROM AUTHOR]

Purpose: Temporary spanning plate fixation of the wrist has been described as an alternative treatment method for complex distal radius fractures (DRfs). This systematic review aims to gain insight on clinical and radiological outcomes of this technique currently published in literature. Methods: A comprehensive literature search of Pubmed, Embase, CENTRAL and CINAHL databases was conducted on November 5th 2020. All studies reporting on complications, functional, patient-rated and radiological outcomes of temporary spanning plate wrist fixation of DRFs in adult patients were included. Results: Two prospective and eight retrospective cohort studies were included encompassing 353 patients with of 357 DRFs. The overall mean age was 53 years (range 19–95 years). Overall mean follow-up ranged from 6 months to 8.8 years. The union rate was 99.4%. Plate removal was performed on average 4.5 months after initial operation (range 1.1–28.9 months). The most frequently reported complication was implant failure with an incidence of 3.1%. Mean flexion/extension, pronation/supination and radial/ulnar inclination arc averaged 96.6°, 151.5° and 36.5°, respectively. Grip strength averaged 79.7% of the contralateral side. Mean DASH and PRWE scores were 22.9 and 16 points, respectively. Radiological indices were all within the acceptable limits. Conclusions: Temporary spanning plate wrist fixation is a safe method for the treatment of complex DRFs. This technique can exploit the advantages of temporary wrist immobilization without the disadvantages of external fixation. With these aspects in mind, the spanning plate can serve as a valuable tool in the treatment of complex intra-articular DRFs. [ABSTRACT FROM AUTHOR]

Background: Anatomical parameters of the wrist bones obtained with radiographic images are important for diagnosis and treatment because the ankle pathologies are associated with certain anatomical patterns. The purpose of the present study was to surgically examine the morphometric measurements obtained from wrist radiographs of adult individuals and to develop regression equations for the estimation of bilateral wrist sizes from the obtained measurements. Materials and Methods: The study had a retrospective design and was performed on 200 radiological images (100 right, 100 left) of healthy adult individuals aged 18-65 (50 male, 50 female) applying to the Department of Radiology in the Department of Medicine at the University of Cukurova from 2012 to 2022. The IBM SPSS 21.0 program was used for statistical analyzes, and statistical significance was assumed to be p<0.05. Results: The radiographic measurements were classified according to the right and left hands, and when the bilateral (right and left sides) differences were examined, no statistically significant differences were detected between the right and left hands in all of the angle and length measurements obtained from the wrist images (p>0.05). In addition, the correlation between the angle and length measurements obtained from the wrist radiological images was examined and the statistically significant correlation coefficients between the measurement values we obtained ranged from 0.139 to 0.917. Especially, a very strong positive correlation was found between RA and SFA (r=0.917, p<0.001) measurements. Conclusions: In line with our results, we think that the regression equations developed can be used successfully in terms of using contralateral wrist radiographs as a template in reconstructive surgery of the wrist, since there is no statistically significant difference in right and left (bilateral) wrist measurements and there is sufficient symmetry. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to determine the radial styloid osseous changes observed on posteroanterior wrist radiographs of patients with de Quervain's tenosynovitis who required surgery or conservative treatment. Materials and Methods: The surgically treated group included 24 patients with de Quervain's tenosynovitis. The conservative treatment group and the healthy control group each comprised 24 age- and sex-matched subjects. We evaluated the presence of bone apposition, periosteal reaction, sclerosis, osteopenia, erosion, and contour bulge in the epiphyseal remnant at the radial styloid. The incidences of abnormal radiographic findings were compared between these three groups. The correlation of radial styloid bony changes with the duration of symptoms was also analyzed. Results: No significant differences were found between the three groups in terms of periosteal reaction, erosion, and contour bulge at the epiphysial remnant. Significant differences were found between the three groups in the incidence of bone apposition, sclerosis, and osteopenia (p < 0.001). Bone apposition incidence in the surgically and conservatively treated groups was significantly higher than that in the control group (p < 0.001). Sclerosis and osteopenia significantly differed between the surgically and conservatively treated groups (p < 0.001, p = 0.002, respectively). No significant association was observed between the duration of symptoms and the radial styloid osseous changes (p > 0.05). Conclusion: We found a variable incidence of abnormal radiographic findings on the radial styloid in patients with de Quervain's tenosynovitis and asymptomatic individuals. The presence of sclerosis and osteopenia may be potential risk factors for patients who do not respond to conservative treatment and need surgical intervention. [ABSTRACT FROM AUTHOR]

Objective To investigate whether high-resolution peripheral quantitative CT (HR-pQCT) of two metacarpophalangeal (MCP) joints can more accurately classify patients as having erosive RA compared with conventional radiography (CR) of 44 joints in the hands, wrists and feet. Methods In this single-centre cross-sectional study, patients with established RA (disease duration ≥5 years) were investigated by HR-pQCT and CR. The second and third MCP joints of the dominant hand were assessed for erosions by HR-pQCT. CR of the hands, wrists and feet were scored according to the Sharp–van der Heijde (SHS) method. Results In total, 353 patients were included; 66 (18.7%) patients were classified as having non-erosive RA, and 287 (81.3%) had erosive RA by CR. The sensitivity and specificity (95% CI) of HR-pQCT for classifying patients as having erosive RA when standard CR of hands, wrists and feet was used as the reference was 89% (84, 92%) and 30% (20, 43%), respectively. Using HR-pQCT as the reference, the sensitivity and specificity of CR for classifying patients having erosive RA were 85% (80, 89%) and 38% (25, 52%), respectively. McNemar's χ2 test showed no significant difference between the sensitivities of patients classified as having erosive RA by HR-pQCT or by CR (2.14, P  = 0.177). Conclusion The diagnostic accuracy of HR-pQCT scanning of only two MCP joints and CR of 44 joints suggests the two modalities were comparable for classifying patients with established RA as having erosive disease. Clinical trial registration ClinicalTrials.gov (NCT03429426). [ABSTRACT FROM AUTHOR]

Background: One of the most popular methods used for skeletal age assessment is Greulich and Pyle method which was based on a study done in the 1940s on growth and development in Caucasian North American children. Objective: This study aimed to determine the applicability of Greulich and Pyle standards in assessment of skeletal age in black African children living in Kenya. Materials and Methods: 110 participants referred for hand and wrist radiographs for evaluation of trauma at Kenyatta National Hospital from January 2017 to December 2017 study period, were included in the study. Chronological age was calculated using the participants’ date of birth. Skeletal age was determined according to the Greulich and Pyle method by three independent investigators who were blinded to the chronological age. Statistical analyses were performed to determine mean differences between chronological age and skeletal age in boys and girls and inter-rater variability. Results: No statistically significant difference was found between skeletal ages estimated by the 3 observers. (p =0.409) Overall in girls, skeletal age was underestimated compared to chronological age with differences from 2 to 16 months (mean difference =12months) found between estimated skeletal age and chronological age. In boys, skeletal age was underestimated by 4 to 14 months (mean difference =11months) overall compared to chronological age. Conclusion: The results suggest black African children may have different skeletal development compared to American children from who the Greulich and Pyle atlas was derived and thus it should be used cautiously in age assessment in black African children. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to determine the diagnostic performance of artificial intelligence with the use of convolutional neural networks (CNN) for detecting scaphoid fractures on anteroposterior wrist radiographs. The performance of the deep learning algorithm was also compared with that of the emergency department (ED) physician and two orthopaedic specialists (less experienced and experienced in the hand surgery). Methods: A total 390 patients with AP wrist radiographs were included in the study. The presence/absence of the fracture on radiographs was confirmed via CT. The diagnostic performance of the CNN, ED physician and two orthopaedic specialists (less experienced and experienced) as measured by AUC, sensitivity, specificity, F-Score and Youden index, to detect scaphoid fractures was evaluated and compared between the groups. Results: The CNN had 76% sensitivity and 92% specificity, 0.840 AUC, 0.680 Youden index and 0.826 F score values in identifying scaphoid fractures. The experienced orthopaedic specialist had the best diagnostic performance according to AUC. While CNN's performance was similar to a less experienced orthopaedic specialist, it was better than the ED physician. Conclusion: The deep learning algorithm has the potential to be used for diagnosing scaphoid fractures on radiographs. Artificial intelligence can be useful for scaphoid fracture diagnosis particularly in the absence of an experienced orthopedist or hand surgeon. [ABSTRACT FROM AUTHOR]

In recent years, fracture image diagnosis using a convolutional neural network (CNN) has been reported. The purpose of the present study was to evaluate the ability of CNN to diagnose distal radius fractures (DRFs) using frontal and lateral wrist radiographs. We included 503 cases of DRF diagnosed by plain radiographs and 289 cases without fracture. We implemented the CNN model using Keras and Tensorflow. Frontal and lateral views of wrist radiographs were manually cropped and trained separately. Fine-tuning was performed using EfficientNets. The diagnostic ability of CNN was evaluated using 150 images with and without fractures from anteroposterior and lateral radiographs. The CNN model diagnosed DRF based on three views: frontal view, lateral view, and both frontal and lateral view. We determined the sensitivity, specificity, and accuracy of the CNN model, plotted a receiver operating characteristic (ROC) curve, and calculated the area under the ROC curve (AUC). We further compared performances between the CNN and three hand orthopedic surgeons. EfficientNet-B2 in the frontal view and EfficientNet-B4 in the lateral view showed highest accuracy on the validation dataset, and these models were used for combined views. The accuracy, sensitivity, and specificity of the CNN based on both anteroposterior and lateral radiographs were 99.3, 98.7, and 100, respectively. The accuracy of the CNN was equal to or better than that of three orthopedic surgeons. The AUC of the CNN on the combined views was 0.993. The CNN model exhibited high accuracy in the diagnosis of distal radius fracture with a plain radiograph. [ABSTRACT FROM AUTHOR]

The article focuses on a 19-year-old nonverbal female with autism and anxiety disorder presenting with right wrist pain, affecting her ability to perform daily tasks and hold a pencil, where diagnostic ultrasound revealed a persistent median artery near the median nerve.

Background/Aim: Wrist parameters measured on direct radiography are essential in diagnosing distal radius fractures and many specific wrist disorders and determining prognosis after treatment. Previous studies have shown the intercommunity variability of these parameters in the literature. To our knowledge, no study in the literature reflects the normal values in the Turkish population. This study aimed to determine the distribution and normal limits of parameters measured in posteroanterior (PA) and direct lateral radiographs of the wrist in our population between age and gender groups. Methods: In this retrospective cohort study, patients who presented to 2 centers in our clinic between 2014-2020 and had PA and lateral wrist radiographs were retrospectively reviewed. Images from patients who had no significant osseous pathology and had not undergone wrist surgery were randomly selected, and 320 (201 female, 119 male) digital images were retrospectively analyzed. The mean age was 40.45 (13.71). The sample was divided into three groups (18-30, 31-50, over 51) according to age and into two groups according to gender. Radial inclination (RI), lunate fossa inclination (LFA), cord of radiocarpal arch (cord RC), radial shift (Radsh), radial height (RadH), ulnar variance (UV), third metacarpal height (3rd MH), carpal height (CH), capitate height (CapH), lunate transverse length (LL), lunate uncovering length (LUL), scapholunate joint distance (SLD), distal radioulnar joint distance (RUD), volar tilt on lateral radiographs (VT), scapholunate angle (SLA) were measured. The lunate uncovering ratio (LUR) was measured in proportion to the lunate uncovering length (LUL) / lunate transverse length (LL); carpal height ratio (CHR) by proportioning carpal height (CH) / third metacarpal height (3rd MH); revised carpal height ratio (rCHR) was calculated by proportioning the carpal height (CH) / capitate height (CapH). Results: Although the RI and SL values of angular parameters were similar between the gender groups, the LFI and VT values were significantly higher in the female group (P=0.014 and P=0.004, respectively). All metric parameters were significantly superior in the male group (P<0.001). CHR and rCHR values were similar for proportional parameters, while LUR -values were significantly higher in the male group (P<0.001). All angular measurement parameters, Cord RC, RadH, RadS, LL, LUL, SLD of metric parameters, and CHR and rCHR values of proportional parameters were similar between age groups (P>0.05). While UV values of metric parameters increased in parallel with age, RUD values decreased significantly (P<0.001). The values of the metric parameters CH 3rd MH, CapH, and proportional parameters LUR values also differed between the groups without being correlated with age (P=0.011, P=0.003, P=0.009, P=0.019, respectively). Conclusion: In our study, we have given the measurement parameters that can be used as a reference for the Turkish population, the relationships between gender and age groups, and the variability. These parameters can be helpful in the diagnosis and treatment of wrist pathologies, the design and development of implants for the treatment of wrist pathologies for our population. [ABSTRACT FROM AUTHOR]

Background/Aim: Bone age (BA) is important in the diagnosis and follow-up of pediatric growth disorders. Skeletal maturation can vary according to the geographical region and climate. The goal of this study is to investigate whether Greulich-Pyle (GP) method is suitable for detecting BA for Turkish children for all age groups and both genders. Methods: In our retrospective cohort study, the roentgenograms of all pediatric patients who visited the pediatrics or pediatric endocrinology outpatient clinics and underwent left hand and wrist radiographs for suspicious trauma or BA determination were examined with reference to the GP atlas. Patients without evidence of chronic disease or growth disorders with body size and weight values between the 25th-75th percentile were included. Poor quality roentgenograms were excluded. Results: Radiographs of 665 patients were analyzed and 310 (161 boys and 149 girls, age range 13-203 months) patients were included. The rate of concordant BA with CA was significantly higher in the children above 120 months of age and low BA was significantly higher among the children aged 120 months or below (P<0.001). The rate of concordant BA with CA was significantly higher among girls and low BA was significantly higher among boys (P=0.014). Among patients aged 120 months or below, low BA was significantly higher in the boys (P<0.001). There were no significant differences between the boys and girls aged 120 months and above (P=1.000). Conclusion: Although widely used in the determination BA, local studies on the accuracy and reliability of the GP method are insufficient in less developed countries. The accuracy of this method in Turkish children, especially boys under the age of 10 years, is controversial, and correct standards should be developed. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Medical Imaging & Radiation Sciences is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Although the automatic diagnosis of fractures using artificial intelligence (AI) has recently been reported to be more accurate than those by orthopedics specialists, big data with at least 1000 images or more are required for deep learning of the convolutional neural network (CNN) to improve diagnostic accuracy. The aim of this study was to develop an AI system capable of diagnosing distal radius fractures with high accuracy even when learning with relatively small data by learning to use bi-planar X-rays images. Methods: VGG16, a learned image recognition model, was used as the CNN. It was modified into a network with two output layers to identify the fractures in plain X-ray images. We augmented 369 plain X-ray anteroposterior images and 360 lateral images of distal radius fractures, as well as 129 anteroposterior images and 125 lateral images of normal wrists to conduct training and diagnostic tests. Similarly, diagnostic tests for fractures of the styloid process of the ulna were conducted using 189 plain X-ray anteroposterior images of fractures and 302 images of the normal styloid process. The distal radius fracture is determined by entering an anteroposterior image of the wrist for testing into the trained AI. If it identifies a fracture, it is diagnosed as the same. However, if the anteroposterior image is determined as normal, the lateral image of the same patient is entered. If a fracture is identified, the final diagnosis is fracture; if the lateral image is identified as normal, the final diagnosis is normal. Results: The diagnostic accuracy of distal radius fractures and fractures of the styloid process of the ulna were 98.0 ± 1.6% and 91.1 ± 2.5%, respectively. The areas under the receiver operating characteristic curve were 0.991 {n = 540; 95% confidence interval (CI), 0.984–0.999} and 0.956 (n = 450; 95% CI 0.938–0.973). Conclusions: Our method resulted in a good diagnostic rate, even when using a relatively small amount of data. [ABSTRACT FROM AUTHOR]

To investigate the relationship between handgrip strength (HGs) features, evaluated with an innovative cylindrical-shaped grip device, and demographic, anthropometric and clinical variables, in patients with rheumatoid arthritis (RA). Consecutive RA patients were prospectively enrolled for this cross-sectional study. For each patient were collected demographic, anthropometric, clinical data related to disease activity. HGs was assessed in terms of area under the force–time curve (AUC-FeT), peak grip force and time to reach the curve plateau. The correlations between the variables were studied with the Spearman's rho correlation coefficient. The receiver operating characteristic (ROC) curve analysis was used to test the discriminant accuracy of HGs features in identifying patients in moderate/high disease activity. A multivariate analysis was performed to estimate the contribution of covariates on the AUC-FeT. A significant correlation was found among AUC-FeT, age, Simplified Disease Activity Index (SDAI), Ultrasound-Clinical Arthritis Activity (US-CLARA) (all at p < 0.0001), and body mass index (BMI) (p = 0.0001). Any correlation was found between HGs and radiographic damage. The discriminatory power of AUC-FeT was good [area under-ROC curve = 0.810 (95% CI 0.746–0.864)]. Variables significantly associated with AUC-FeT in multivariate analysis were age (p = 0.0006), BMI (p = 0.012), gender (p = 0.004), SDAI (p = 0.047) and US-CLARA (p = 0.023). HGs is negatively influenced by demographic (gender and age), anthropometric (BMI), and disease activity variables (SDAI and US-CLARA). These findings highlight the role of HGs in RA patients' functional impairment and disability. [ABSTRACT FROM AUTHOR]

Purpose: 1. To determine the effect of vitamin D supplementation on bone age (BA), a marker of skeletal maturity, and Bone Health Index (BHI), a surrogate marker of bone density. 2. To characterise the differences in nutritional intake and anthropometry between children with advanced vs. delayed BA. Methods: The current study is a post hoc analysis of radiographs obtained as part of a randomised controlled trial. In this double-blind, placebo-controlled trial, deprived Afghan children (n = 3046) aged 1–11 months were randomised to receive six doses of oral placebo or vitamin D3 (100,000 IU) every 3 months for 18 months. Dietary intake was assessed through semi-quantitative food frequency questionnaires at two time points. Anthropometric measurements were undertaken at baseline and 18 months. Serum 25OHD was measured at five time points on a random subset of 632 children. Knee and wrist radiographs were obtained from a random subset (n = 641), of which 565 wrist radiographs were digitised for post-hoc analysis of BA and BHI using BoneXpert version 3.1. Results: Nearly 93% (522, male = 291) of the images were analysable. The placebo (n = 258) and vitamin D (n = 264) groups were comparable at baseline. The mean (± SD) age of the cohort was 2 (± 0.3) years. At study completion, there was no difference in mean 25-hydroxy vitamin D concentrations [47 (95% CI 41, 56) vs. 55 (95% CI 45, 57) nmol/L, p = 0.2], mean (± SD) BA SDS [− 1.04 (1.36) vs. − 1.14 (1.26) years, p = 0.3] or mean (± SD) BHI SDS [− 0.30 (0.86) vs. − 0.31 (0.80), p = 0.8] between the placebo and vitamin D groups, respectively. Children with advanced skeletal maturity (BA SDS ≥ 0) when compared to children with delayed skeletal maturity (BA SDS < 0), had consumed more calories [mean (± SD) calories 805 (± 346) vs 723 (± 327) kcal/day, respectively, p < 0.05], were significantly less stunted (height SDS − 1.43 vs. − 2.32, p < 0.001) and underweight (weight SDS − 0.82 vs. − 1.45, p < 0.001), with greater growth velocity (11.57 vs 10.47 cm/ year, p < 0.05). Conclusion: Deprived children have significant delay in skeletal maturation but no substantial impairment in bone health as assessed by BHI. BA delay was influenced by total calorie intake, but not bolus vitamin D supplementation. [ABSTRACT FROM AUTHOR]

Bone age is one of biological indicators of maturity used in clinical practice and it is a very important parameter of a child's assessment, especially in paediatric endocrinology. The most widely used method of bone age assessment is by performing a hand and wrist radiograph and its analysis with Greulich-Pyle or Tanner-Whitehouse atlases, although it has been about 60 years since they were published. Due to the progress in the area of Computer-Aided Diagnosis and application of artificial intelligence in medicine, lately, numerous programs for automatic bone age assessment have been created. Most of them have been verified in clinical studies in comparison to traditional methods, showing good precision while eliminating inter- and intra-rater variability and significantly reducing the time of assessment. Additionally, there are available methods for assessment of bone age which avoid X-ray exposure, using modalities such as ultrasound or magnetic resonance imaging. [ABSTRACT FROM AUTHOR]

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Background: Anterior cruciate ligament (ACL) injuries demand individualized treatments based on an accurate estimation of the child's skeletal age. Wrist radiographs, which have traditionally been used to determine skeletal age, have a number of limitations, including cost, radiation exposure, and inconvenience. Purpose: To evaluate the reliability and validity of a radiographic staging system using tibial apophyseal landmarks as hypothetical proxies for skeletal age to use in the preoperative management of pediatric ACL tears. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: The study included children younger than 16 years of age who underwent ACL reconstruction between July 2008 and July 2018 and received both skeletal age radiography and knee radiography within 3 months of each other. Skeletal age was calculated from hand and wrist radiographs using the Greulich and Pyle atlas. Tibial apophyseal staging was categorized into 4 stages: cartilaginous stage (stage 1), apophyseal stage (stage 2), epiphyseal stage (stage 3), and bony/fused stage (stage 4). Data were collected by 2 independent assessors. The analysis was repeated 1 month later with the same assessors. We calculated descriptive statistics, measures of agreement, and the correlation between skeletal age and apophyseal stage. Results: The mean chronological age of the 287 patients included in the analysis was 12.9 ± 1.9 years; 164 (57%) of the patients were male. The overall Spearman r between skeletal age and tibial apophyseal staging was 0.69 (0.77 in males; 0.60 in females). The interrater reliability for the tibial apophyseal staging was substantial (Cohen κ = 0.66), and the intrarater reliability was excellent (Cohen κ = 0.82). The interrater reliability for skeletal age was excellent (intraclass correlation coefficient [ICC] = 0.93), as was the intrarater reliability (ICC = 0.97). Conclusion: The observed correlation between skeletal age and tibial apophyseal staging as well as observed intra- and interrater reliabilities demonstrated that tibial apophyseal landmarks on knee radiographs may be used to estimate skeletal age. This study supports the validity of knee radiographs in determining skeletal age and provides early evidence in certain clinical presentations to simplify the diagnostic workup and operative management of pediatric knee injuries, including ACL tears. [ABSTRACT FROM AUTHOR]

Injuries to the triangular fibrocartilage complex (TFCC) and distal radioulnar joint (DRUJ) require careful consideration and management to ensure an optimal outcome. These complex injuries can be effectively managed by having a fundamental understanding of the anatomy of the structures involved in addition to an appreciation of the biomechanical modes of failure in the context of wrist trauma. The principles of managing these injuries are addressed in this article by focusing on the relevant anatomy and highlighting the key features of clinical and radiological assessment. An outline of the surgical treatment options is included to help the clinician select the most appropriate treatment ranging from soft tissue repair to salvage measures. [ABSTRACT FROM AUTHOR]

Background: The accurate assessment of distal radioulnar joint (DRUJ) instability is still challenging as there is no established objective evaluation method. This study aimed to develop a noninvasive measurement method using a three-dimensional electromagnetic sensor system (EMS) to quantitatively assess and characterize the normal DRUJ movement in healthy volunteers. Methods: The DRUJ movement was mimicked using both a block model and saw bone. Movement of the models was measured by EMS, and the accuracy and reproducibility of the measurements were assessed. In vivo measurement was performed in a sitting position with the elbow flexed and the forearm pronated. One sensor each was attached to the distal radial shaft and the ulnar head. The examiners fixed the distal radius and the carpal bones, moved the ulnar head from the dorsal to the volar side and measured the dorsovolar translation. The volar translation was measured by EMS and ultrasonography, and the correlation coefficient was calculated. The dorsovolar translation was evaluated in 14 healthy volunteers (7 men and 7 women) by three hand surgeons. The intraclass and inter-rater correlation coefficients (ICCs), the differences between the dominant and non-dominant sides and between men and women were assessed. Results: The accuracy and reproducibility assessment results of the EMS showed high accuracy and reproducibility. In the comparison between EMS and ultrasonography, the correlation coefficient was 0.920 (p = 0.16 × 10-3). The ICC (1,5) for the intra-rater reliability was 0.856, and the ICC (2,5) for inter-rater reliability was 0.868. The mean ulnar head translation and difference between dominant and non-dominant sides were 6.00 ± 1.16 mm (mean ± SD) and − 0.12 ± 0.40 mm, respectively. There were no significant differences between any of the parameters. Conclusions: A new measurement method using EMS could evaluate DRUJ movement with high accuracy, reproducibility, and intra- and inter-rater reliability. In healthy volunteers, the dorsovolar ulnar head translation was 6.00 mm. The difference between the dominant and non-dominant sides was < 1.0 mm with no significant difference. EMS provided an objective, non-invasive, real-time assessment of dynamic changes in the DRUJ. These findings could be useful in the treatment of patients with DRUJ instability. [ABSTRACT FROM AUTHOR]

Background: The American Society for Surgery of the Hand advises patients that symptoms after wrist sprains resolve in 6 weeks and that recovery is usually excellent; however, there is scant supporting evidence for this reassurance. Purpose: To describe the epidemiology and report long-term outcomes of wrist sprains. Study Design: Descriptive epidemiology study. Methods: The US Department of Defense Military Health System Management Analysis and Reporting Tool was queried for wrist sprain International Classification of Diseases, Ninth Revision, codes between 2005 and 2008 among US Military Academy cadets. The electronic medical records were reviewed to obtain demographic information, mechanism of injury, and patient characteristics. A telephone survey was conducted to collect Single Assessment Numeric Evaluation (SANE) score, the shortened version of Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, and ability to return to full military duty. Results: Of the 90 patients identified, 49 patients (50 wrists) met the final inclusion criteria. The mean patient age was 21 years, the majority were male (86%), and most sprains occurred during athletics (65%) and military activities (20%). Most patients (61%) had radiographs taken after index wrist sprain, and few (14%) underwent magnetic resonance imaging (MRI). After a mean follow-up of 10.4 years, most patients (78%) had no further wrist injury. The average SANE and QuickDASH scores were 88 and 7.5, respectively. Two patients (4%) ultimately were treated with surgical repair. Most patients (96%) were on an upper extremity profile, limiting military duty for a median of 14 days. All patients ultimately returned to full military duty. Conclusion: Patients with a wrist sprain diagnosis were followed for an average of 10 years. Although the majority (96%) of patients required a median of 14 days with limited upper extremity function, MRI is rarely indicated in the acute setting and most patients will never have another wrist injury and can expect excellent wrist recovery outcomes. [ABSTRACT FROM AUTHOR]

Background: Although dorsal/palmar tilt, radial inclination (RI), and ulnar variance (UV) are measurements commonly performed in wrist radiographs, the impact of forearm rotation on those measurements during the radiographic procedure is uncertain. Our aim was to determine the impact of supination and pronation on the reliability of measurements of tilt, RI, and UV. Methods: Tantalum markers were inserted into the distal radius of 21 unfractured cadaver forearms. The forearms were radiographed in different degrees of supination and pronation. The exact degree of rotation was calculated with radiostereometric analyses. Tilt, RI, and UV were measured by two independent readers in a random and anonymised fashion. Association between forearm rotation and radiographic measurements was examined using linear regression. Results: Forearm rotation significantly impacted the radiographically measured tilt. One degree of supination and pronation respectively increased and decreased palmar tilt with 0.68° and 0.44°, observers 1 and 2, respectively. As opposed to observer 1, observer 2 found that RI was significantly impacted by rotation with a slope of 0.08. Ulnar variance was not significantly impacted by rotation with linear regression slopes of 0.01° (95% confidence interval [CI] − 0.02–0.05, p = 0.490) and 0.02° (95% CI − 0.02–0.07; p = 0.288), observer 1 and observer 2, respectively. Conclusion: In unfractured forearms, the radiographically measured tilt was significantly affected by rotation. Palmar tilt increased with supination and decreased with pronation. Rotation significantly affected radial inclination, although of a magnitude that is probably not clinically relevant. No significant impact on UV was found. [ABSTRACT FROM AUTHOR]