BackgroundTracheobronchomalacia (TBM) and excessive dynamic airway collapse (EDAC) are two forms of expiratory large airway collapse which is a potential, often underdiagnosed cause for unexplained ...cough, breathlessness, inability to expectorate and frequent infections. They can vary in aetiology, morphology, extent and severity. Proper characterisation of patients may help to identify different phenotypes, potentially contributing to more personalised treatment.MethodsWe reviewed the database, bronchoscopy reports and video images of n=33 patients (27 female, age 54.5±12.9 years) who had been referred for treatment to a specialist respiratory physiotherapist for the diagnosis of expiratory large airway collapse. Patients were characterised according to the classification proposed by Murgu and Colt (Respirology, 2007). TBM and EDAC were scored in terms of extent (1=mild, <50% collapse, 2=focal, 3=multifocal, 4=diffuse), severity (1= <50% collapse, 2= 50–70% collapse, 3= 70–100%, 4= 100%), morphology (crescent, sabre-sheet, circumferential) and aetiology (idiopathic or secondary to lung disease).ResultsBronchoscopy had been performed in 32 subjects, and video available for review in 26 cases. Of these 26, the extent of collapse was mild in one, focal in nine, multifocal in seven, and diffuse in nine. The severity of collapse was <50% in one, 50–70% in seven, 70–100% in 15, and complete in three. There was a significant relationship between extent and severity (p=0.01, r=0.47). Two patients had circumferential collapse, the rest were crescent type. Associated diagnoses were: asthma in 23 patients; bronchiectasis in two; Ehlers-Danlos syndrome in one; and none of relevance in the six remaining.ConclusionsExpiratory large airway collapse is a multi-factorial disorder which can manifest in various extent and severity. Further observational studies are warranted to categorise patients and to see if these categories can predict treatment response.
ObjectivesDisorders with chronically elevated ICP have salient imaging findings associated with the sella turcica and optic nerves. We aim to quantify the degree of correlation between imaging ...features and ICP.DesignProspective case-cohort study.SubjectsOne-hundred and twenty-six patients (35M:91F) underwent ICPM with recent MR imaging.MethodsT1-saggital views for sella volume, optic nerve vertical tortuosity, then T2-axial views for optic nerve sheath distension were blindly reviewed against respective median ICP and pulse amplitudes (PA). Imaging was triple reviewed for discordant values.ResultsThe mean ICP of four sella morphologies (full/flat/concave/empty) were 1.2, 4.8, 8.4 and 16.7 mmHg respectively (p<0.01). AUROC for sella morphology predicting ICP was 0.81. This measurement was able to detect minimum ICP of 5.3 mmHg with 73.0% sensitivity and specificity, 73.0% PPV and 69.8% NPV. The mean PA values were 4.0, 5.2, 6.1 and 9.6 mmHg respectively (p<0.01). AUROC for sella morphology predicting PA was 0.78. This measurement was able to detect minimum PA of 5.47 mmHg with 76.3% sensitivity, 79.5% specificity, 63.5% PPV and 81.0% NPV. Mean PA values for vertical tortuosity (nil/uni/bi) were 5.2, 7.1 and 7.0 mmHg respectively (p<0.05). Mean ICP values for rail tracking (nil/uni/bi) were 4.5, 7.5 and 15.7 mmHg respectively (p<0.01). Mean PA values were 5.2, 5.8 and 8.0 mmHg respectively (p<0.0001).ConclusionsCombined radiological features of ICP are promising non-invasive markers for raised ICP.
Objectives:
To determine if acromial morphology is associated with posterior or anterior shoulder instability as measured on MRI.
Methods:
MRI measurements of posterior acromial coverage (PAC), ...posterior acromial height (PAH), posterior acromial tilt (PAT), and anterior acromial coverage (AAC) were completed for three separate matched groups who underwent surgical intervention: posterior instability, anterior instability, and a comparison group of patients with who underwent arthroscopic surgery for snapping scapula. Inclusion criteria were patients with recurrent instability younger than 40 years of age without multidirectional instability, glenoid bone loss greater than 13.5% or glenoid retroversion greater than 10%.
Results:
Thirty-seven patients were included in each group. PAC was significantly less in the posterior instability group when compared to anterior and the comparison groups (68.3° vs. 88.7° vs. 81.7°, p<.001). PAH was significantly greater in the posterior group than compared to the anterior instability patients (11.0 mm vs -0.1 mm, p<.001) as well as the comparison patients (0.7 mm, p<.001). There was no difference between the posterior and anterior groups in terms of PAT or AAC (p=0.45, p=0.05). PAT was significantly smaller in the posterior instability group than the comparison group (55.2 degrees vs 62.2 degrees, p=0.026). The anterior and comparison groups were not significantly different in PAH or PAT (p=8.74, p=0.067) but were significantly different with AAC (p=0.26).
Conclusions:
The posterior acromion is significantly higher and flatter in patients with posterior shoulder instability who require arthroscopic capsulolabral repair when measured on pre-operative MRI. This information may help clinicians to both diagnose and predict the need for operative intervention for patients with posterior labral tears.
Objectives:
Dual plate fixation has been proposed as a solution to the high rates of reoperation secondary to operative management of displaced midshaft clavicle fractures. Previous studies have ...recommended dual plating for patients specifically at higher risk of reoperation. Therefore, the purpose of this study was to compare reoperation rates among patients who underwent single superior, single anterior, and dual plating while adjusting for risk factors including age, smoking status, and high-risk fracture morphology. We hypothesized lower rates of reoperation among patients who underwent dual plate fixation.
Methods:
This was a retrospective cohort study of all patients who presented with a midshaft clavicle fracture and underwent ORIF between 2007 and 2021 to our trauma/sports divisions. Patient demographics, fracture pattern, plating technique, postoperative complications, date of surgery, reoperation status, date of last follow up, and date of reoperation were documented. We report hazard ratio (HR) estimates using a multivariate multilevel mixed-effects parametric survival model, which accounted for patients with multiple reoperations and adjusted for covariates.
Results:
A cohort of 395 patients (mean age 38.5±14.4 years, 81.7% male) were identified with average follow-up of 5.5±8.6 months. There were 77 z-type, 157 transverse, and 161 oblique fractures. With regards to plating technique, 152 underwent single superior plating, 149 experienced single anterior plating, and 94 had dual plating. After initial operation, there were 8 total instances of non-union (2.0%), 0 in the dual plating cohort (0%), 4 in the superior plating cohort (2.6%), and 4 in the anterior plating cohort (2.7%) (p=0.35). A total of 28 reoperations took place among 19 patients (4.8%), with 6 patients experiencing multiple reoperations.
Single plating with superior placement revealed the highest reoperation rate of 0.26 per person-years, followed by anterior placement with 0.17 per person-years, and finally dual plating with 0.02 per person-years (Figure 1). Patients who underwent single plating (either anterior or superior placement) revealed a greater rate of reoperation when compared to patients who underwent dual plating (HR: 8.3, p=0.045). Patients who underwent single plating with superior placement had a rate of reoperation ten- times greater than patients who underwent dual plating (HR:10.1, p=0.03). Patients who underwent single plating with anterior placement had a rate of reoperation six-times greater than patients who underwent dual plating (HR: 6.4, p=0.09), although not statistically significant.
Conclusions:
Dual plate fixation of displaced midshaft clavicle fractures has an eight-fold lower risk of reoperation compared to single plate fixation, while accounting for age, smoking, and high-risk fracture morphology. More specifically, dual plating had lower rates of reoperation than both single plating with anterior and superior placement. When operative management is indicated for a midshaft clavicle fracture, dual plating may be an excellent treatment alternative in patients at high risk for reoperation.
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