3-D Ultrasound Imaging Reliability of Measuring Dysplasia Metrics in Infants

Developmental dysplasia of the hip is a hip abnormality that ranges from mild acetabular dysplasia to irreducible femoral head dislocations. While 2-D B-mode ultrasound (US)-based dysplasia metrics or disease metrics are currently used clinically to diagnose developmental dysplasia of the hip, such estimates suffer from high inter-exam variability. In this work, we propose and evaluate 3-D US-derived dysplasia metrics that are automatically computed and demonstrate that these automatically derived dysplasia metrics are considerably more reproducible. The key features of our automatic method are (i) a random forest-based learning technique to remove regions across the coronal axis that do not contain bone structures necessary for dysplasia-metric extraction, thereby reducing outliers; (ii) a bone segmentation method that uses rotation-invariant and intensity-invariant filters, thus remaining robust to signal dropout and varying bone morphology; (iii) a novel slice-based learning and 3-D reconstruction strategy to estimate a probability map of the hypoechoic femoral head in the US volume; and (iv) formulae for calculating the 3-D US-derived dysplasia metrics. We validate our proposed method on real clinical data acquired from 40 infant hip examinations. Results show a considerable (around 70%) reduction in variability in two key 3-D US-derived dysplasia metrics compared with their 2-D counterparts.     

Epidemiology of inpatient tibia fractures in Singapore - A single centre experience

Purpose: There are no previous epidemiological studies to represent the trends of tibia fractures in the urban setting. The purpose of our study was to provide unique epidemiological information on the incidence of tibia fractures requiring admission in the urban population of Singapore. Methods: This is a retrospective review of clinical and radiological records encompassing three years period from 2012 to 2014 in a tertiary hospital in Northern Singapore, which covers an adult population of 550,000. Clinical information included demographics, mechanism of injury, and Gustillo-Anderson classification. Radiological records were evaluated by two of the authors and fractures were classified using the AO classification after consensus was reached. Results: There were 214 cases of tibia fractures with a population incidence of 13 in 100,000. Among the tibia fractures, 47% were diaphyseal, 43% proximal and 10% distal. Majority of patients were males with a male to female ratio of 3 to 1. The mean age of females was 64 years while that of males was 40 years. The commonest mechanism of injury was road traffic accident, which contributed to 42% of cases, with motorcyclists making up 78% of all road traffic accidents. Compound fractures made up 23% of all fractures, most of which were Gustillo-Anderson type III; 69% of patients underwent surgical intervention. Conclusion: The incidence of tibia fractures is 13/100,000 with a male-to-female ratio of 3:1. This incidence is lower than other studies, but the proportion of open fractures were surprisingly high at 23%. Distribution of fractures was unimodal with a peak in younger men and older women. This may signify a component of fragility among tibia fractures, especially proximal and distal fractures, which peaks above the age of 80 years old.     

Anatomical Study on the Variations in the Branching Pattern of Internal Iliac Artery

The internal iliac artery (IIA) arises from the common iliac artery at the level of the sacroiliac joint. It descends as trunk, divides into anterior and posterior divisions. From the anterior division it gives superior vesical, obturator, middle rectal, inferior vesical, inferior gluteal, and internal pudendal arteries. In females, inferior vesical artery is replaced by vaginal artery and gives an additional branch, uterine artery. The branches from the posterior division are ilio lumbar, lateral sacral, and superior gluteal arteries. An accidental hemorrhage and neurovascular injuries are common due to erroneous interpretation of variant arteries during surgical procedures. Hence the present study has been undertaken with reference to highlight its clinical and surgical significances. The study included 50 human bisected pelvises irrespective of their side and sex. Formalin-fixed specimens were selected and the branching patterns of IIA were studied. The level of origin, length, and the branching pattern of the IIA were examined and tabulated. The present study highlighted the variation seen in the origin, division branches of the IIA. The detailed knowledge of morphology is essential for successful ligation of the IIA during acute hemorrhage. This will guide the interventional radiologist in intra-arterial procedures during arterial embolization for hemorrhage, control of pelvic fractures, during selective catheterization of the intra-arterial chemotherapy, and embolization of the pelvic tumors.