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42 and

= 0.53, respectively). In the 4- to 6-year age range, there was a significant difference between bony and cartilaginous aLDFA (

= 0.02) but not MPTA (

= 0.88).

In children 6 years of age and younger, intraoperative arthrogram should be considered while treating knee deformity, as plain films may not fully represent the true deformity of the distal femur in particular.

Supports the need for advanced imaging or intraoperative arthrogram for joint corrective surgery in young patients.

Level 3 diagnostic.

Bigach SD, Carender CN, Liu RW. Is Bony Knee Alignment Representative of the True Joint Surface in Skeletally Immature Patients? A Magnetic Resonance Imaging Study. Strategies Trauma Limb Reconstr 2020;15(2)79-83.

Bigach SD, Carender CN, Liu RW. Is Bony Knee Alignment Representative of the True Joint Surface in Skeletally Immature Patients? A Magnetic Resonance Imaging Study. Strategies Trauma Limb Reconstr 2020;15(2)79-83.

Limb lengthening using intramedullary nails is an increasingly popular method of achieving limb length equalisation. Currently, the decision regarding when to commence full weight-bearing (FWB) remains largely subjective. Objective criteria for determining the proper timing of FWB would be helpful to limb lengthening surgeons. This study examines using the pixel value ratio (PVR) as an objective method to determine the time to FWB for patients being lengthened with an intramedullary nail.

A retrospective chart review of 42 patients who underwent unilateral lengthening of the femur was undertaken. The PVR of all four cortices of the regenerate bone was monitored throughout the distraction and consolidation stages to determine the ratio at the time of FWB.

Clinically and radiologically determined FWB was achieved at a mean time of 125.7 ± 30.1 days from surgery. The mean PVR at the time of FWB was 0.94. The medial cortex healed fastest with a mean PVR of 0.96, while the posterior cortex healed slowest with a mean PVR of 0.92.

The PVR is a quick and reliable method to objectively assess the state of healing of the regenerate bone during distraction osteogenesis. Selleck PRT062607 We observed that there were no adverse effects when subjects commenced FWB when three out of the four cortices had a PVR of at least 0.93.

Bafor A, Duncan ME, Iobst CA. Evaluating the Utility of the Pixel Value Ratio in the Determination of Time to Full Weight-bearing in Patients Undergoing Intramedullary Limb Lengthening. Strategies Trauma Limb Reconstr 2020;15(2)74-78.

Bafor A, Duncan ME, Iobst CA. Evaluating the Utility of the Pixel Value Ratio in the Determination of Time to Full Weight-bearing in Patients Undergoing Intramedullary Limb Lengthening. Strategies Trauma Limb Reconstr 2020;15(2)74-78.

Humeral retroversion (RV) is important to the study of shoulder function and reconstruction. This study tests the hypothesis that clinically obtained computer tomography (CT) measurements for humeral RV (off-axis measurements) differ from those obtained after reformatting the image slice orientation so that the humeral shaft is perpendicular to the gantry (coaxial measurements) and explores deviations from true RV.

A custom-built application created in Mathematica was used to explore the effect of altering the humeral orientation on slice angle acquisition by 3D imaging technologies, on the perceived angle of RV from the 2D-projection of the reference axes. The application allows for control of humeral axis orientation relative to image slice (3D) or plain of projection (2D) and humeral rotation. The effect of rotating a virtual model of one humerus around its own axis and in discrete anatomical directions on the measured RV angle was assessed.

The coaxial measurement of humeral RV (31.2°) differed from off-axis measurement, with a maximum difference in measured RV of 50° in 45° of extension. The typical position of the humerus in a CT scan resulted in a difference in RV measurement up to 22°. Explorations of deviation led to the following outcomes, as divided by anatomic direction. Extension and abduction led to an underestimation, and flexion and adduction led to an overestimation of the RV-angle.

Measurements must be done consistently about the position and orientation of the humerus. Deviation in the humeral alignment of as little as 10° can distort the measurement of version up to 15°.

van de Bunt F, Pearl ML, van Noort A. Humeral Retroversion (Complexity of Assigning Reference Axes in 3D and Its Influence on Measurement) A Technical Note. Strategies Trauma Limb Reconstr 2020;15(2)69-73.

van de Bunt F, Pearl ML, van Noort A. Humeral Retroversion (Complexity of Assigning Reference Axes in 3D and Its Influence on Measurement) A Technical Note. Strategies Trauma Limb Reconstr 2020;15(2)69-73.

Treatment of proximal humeral fractures with plate osteosynthesis or intramedullary nail fixation in humeral shaft fractures with a proximal locking bolt carries the risk of iatrogenic injury of the axillary nerve. The purpose of this anatomical study is to define a more reliable safe zone to prevent iatrogenic axillary nerve injury using the humeral head instead of the acromion as a (radiographic) reference point during operative treatment.

Anatomical dissection and labeling of the axillary nerve and branches was performed on 10 specially embalmed human specimens. Standard AP and straight lateral radiographs were made. The distances were measured indirectly from the cranial tip of the humerus to the axillary nerve on radiographs.

The median distance from the cranial tip of the humerus to the axillary nerve was 52 mm. The mean number of axillary nerve branches was 3. The distances from the cranial tip of the humerus to the nerve (branch) varied from 23 to 78 mm. The median distance from the proximal (ance Point to Prevent Axillary Nerve Damage during Proximal Fixation of Humeral Fractures An Anatomical and Radiographic Study. Strategies Trauma Limb Reconstr 2020;15(2)63-68.

Long-term data on inflammatory bowel disease (IBD) patients switched from originator to biosimilar infliximab SB2 are lacking. The aim of the conducted study was to investigate the effectiveness, immunogenicity and safety of a large prospectively followed-up IBD patient cohort that was entirely switched from originator infliximab to biosimilar SB2 treatment.

This was a prospective, single-center, longitudinal, observational study describing clinical outcomes in IBD patients, over an 80-week period following switch from originator infliximab to SB2. Primary outcome measures were change of disease activity [Harvey-Bradshaw Index for Crohn's disease (CD), partial Mayo Score for ulcerative colitis (UC)], C-reactive protein (CRP), infliximab trough levels (TLs), anti-drug antibodies (ADAs) and adverse events.

One hundred and forty-four IBD patients (94 CD, 50 UC), with median duration of 30.5 months' (range 2-110) treatment with originator infliximab were evaluated. Mean change of disease activity compared with baseline was -0.