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CT Confirms Scaphoid Fracture Union Quicker than X-Ray

CT assessment of patients casted for a non-displaced scaphoid fracture shows union occurring at approximately 7.5 weeks, with a majority of fractures healing in less than 6 weeks, according to  a 2016 study by Ruby Grewal et al. Similar studies using plain X-Ray demonstrated union time to be anywhere between 10 – 24 weeks. The authors noted the union time on CT may even be overestimated because the majority of patients’ first CT scan after casting was not until 6 weeks.

The CurveBeam InReach provides 0.2mm high resolution slices of the distal limbs.
The CurveBeam InReach provides 0.2mm high resolution slices of the distal limbs.

In a previous study, Professor Timothy Davis wrote CT studies demonstrate healing of a non-displaced fracture treated with a plaster cast can occur in as little as 4 weeks. If a fracture is displaced less than 2 mm, Davis said those CT studies suggest a plaster cast for 8 – 12 weeks.

CT is ideally performed for all scaphoid waist fractures in the first week after injury to classify whether they are displaced or non-displaced, said Professor Davis, an orthopedic surgeon at Woodthorpe Hospital in Nottingham, UK said in his research paper.

 

 

Professor Tim Davis proposes this workflow , which calls for a CT scan for every suspected scaphoid waist fracture, for management of scaphoid waist fractures.
Professor Timothy Davis proposes the above workflow , which calls for a CT scan for every suspected scaphoid waist fracture.

By using CT as a baseline, researchers at the Roth/McFarlane Hand and Upper Limb Center in London said they were able to identify fractures which may have appeared non-displaced on X-Ray, but were actually minimally displaced.

“We feel that the added visualization of CT over plain radiography enables the surgeon to properly select which fractures are appropriate for non-operative cast treatment with an expected high degree of union,” the researchers said in a study published in The Open Orthopaedics Journal.

Out of the research setting, routine CT scans of scaphoid fractures may not be practically feasible, Professor Davis wrote.

“I appreciate that [routine CT assessment of scaphoid fractures] is impossible in many centers at the present time but it should become increasingly possible in the future,” Professor Davis wrote in the medical journal “Annals of the Royal College of Surgeons of England” in 2013.

The CurveBeam InReach plugs into a standard wall outlet and is self-shielded.
The CurveBeam InReach plugs into a standard wall outlet and is self-shielded.

The InReach is a compact CT imaging system dedicated to the hand, wrist and elbow. The system received FDA and CE approval in 2017. Since then, it has been installed in leading orthopedic centers and hospitals in the United States. The InReach allows orthopedic practices to offer CT imaging at the point-of-care.

“InReach has been an excellent asset allowing in-office imaging and rapid CT evaluation of the hands with complex diagnostic dilemmas,” said Dr. Lloyd Champagne, an orthopedic surgeon at the Arizona Center for Hand to Shoulder Surgery in Phoenix.

Fifteen percent of acute fractures of the scaphoid waist fail to unite if treated non-operatively in plaster, resulting in a persistent loss of function, according to the 2013 article. Plain X-Rays do not clearly show fracture features such as displacement and communition. Previous inter-observer studies have shown radiographs of scaphoid fractures are neither sensitive nor specific.

Podcast: Interview with James Kraft, Founder of Standing CT Company

Weight-bearing CT scans have many benefits when compared to a weight-bearing X-ray. The problem is that the United Kingdom’s hospitals often don’t have the immediate capital to invest in the 3D technology.

On today’s episode of Curvebeam Connect, host Vinti Singh, Director of Marketing at CurveBeam talks to James Kraft, founder and CEO of The Standing CT Company, a provider of weight-bearing CT services to hospitals throughout the UK and Europe via mobile imaging vans.

“The question was how to get more of these into hospital in a way that was financially feasible,” Mr. Kraft said. “So, we came up with a mobile solution that could go from hospital to hospital.”

 

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The mobile scanning unit has so far taken off with flying colors, and hospitals are beginning to adopt this structure. “Right now, we are doing a lot of one-off scanning days with our first unit. And the surgeons are very motivated to get it into their hospitals. They know the advantages,” Dr. Kraft said. “We plan to have our second mobile unit by end of the year and two to three more by 2020.”

The company is very focused on educating surgeons, radiologists, and clinicians about the units, the workflow of getting scans back to hospitals, and why mobile units are more cost-effective. To bring together all stakeholders, The Standing CT Company is hosting a full day conference in London on July 12.

“The event came from the idea of looking at what the industry needed to know, and our advisory board was very influential. The conference will have lots of sessions from experts about CT scanning, orthopedics, and more,” Mr. Kraft said.

WEBINAR: “Role of WBCT in the Assessment of Pes Cavovarus”

CurveBeam’s next FOOTInnovate webinar  “Role of WBCT in the Assessment of Pes Cavovarus” will  be delivered by Dr. Alessio Bernasconi, MD,  on May 22nd at 12 pm CDT.

Register for the webinar today. A FOOTInnovate membership is required, but is complimentary for foot & ankle surgeons and related professions.

Dr. Bernasconi is currently a Foot and Ankle Clinical Fellow at the Royal National Orthopaedic Hospital of Stanmore, UK. He has served as a Clinical Fellow in Orthopaedics and Traumatology at St. George’s University Hospital in Tooting, UK, and participated in a Foot and Ankle Research Fellowship & Clinical Observership at the Hospital for Special Surgery in New York City.

To view this webinar, you must sign up for a FOOTInnovate account, then register in advance here. Once registered, you will receive an email with instructions on how to join the session.

Conference Will Feature Full Day Agenda on Weight Bearing CT

An upcoming conference at the Royal Society of Medicine – London will feature a day-long program on weight bearing CT Imaging. “Bipedalism: Defining Humanity and Foot & Ankle Surgery” is aimed at surgeons, podiatrists and radiologists. CurveBeam is proud to be the primary sponsor of this prestigious event.

The conference will be held on July 12. Sponsored registration is available for attendees who register prior to May 30th.

The conference is organized by Standing CT Company, which provides weight bearing CT services via mobile imaging centers to hospitals and orthopedic practices in the United Kingdom and Europe. Standing CT Company exclusively utilizes CurveBeam’s weight bearing CT systems.

Several members of Standing CT’s medical advisory board will be lecturing at the conference. Advisory board member Dr. Sajid Butt, MB BS, FCPS, FCPR, a respected radiologist at Royal National Orthopedic Hospitals in London and Stanmore, will present imaging best practices in the morning session.

Another member of the advisory board, Mr. Stephen Bendall, MBBS, FRCS, FRCS (Orth), an orthopedic foot & ankle surgeon at Princess Royal Hospital in Haywards Heath will present on Lisfranc injuries during the section “Trauma: Better Imaging, Better Outcomes.”

If you are interested in attending, call 0800 047 1010 or email kirsty.collins@standingct.com.

Recap: WBCT Society Scientific Meeting

The Weight-Bearing CT Society held its latest Scientific Meeting in Las Vegas this past March during the AAOS 2019 conference. Co-sponsored by CurveBeam, the Scientific Meeting featured an education-packed agenda to discuss the revolutionary transformation weight-bearing technology is having on the imaging industry.

First to present was Dr. Alexej Barg, MD, a University of Utah orthopedic surgeon who also served as the moderator for this event. In his presentation discussing imaging of patients with syndesmosis instability, Dr. Barg explained that conventional non-weight-bearing radiograph imaging cannot predict syndesmotic injuries reliably. And while MRI’s demonstrate sensitivity and specificity of nearly 100%, correlating patient complaints with MRI findings can be difficult. Further, although CT technology surpasses conventional imaging methods when 3D MRI or CT imaging is transferred to 2D, there is a substantial loss of information. However, the torque applied in the natural standing position offered higher contrast and spatial resolution of alignment and degeneration, providing a significant advantage in the accuracy of diagnosing syndesmotic injuries.

Dr. Pablo Wagner, MD, of Clinica Alemana in Chile then took the stage for a presentation titled “WBCT for Assessment of Metatarsal Rotation”. Crediting his brother, Emilio Wagner, MD, for his work with hallux valgus patients, Dr. Wagner explained that metatarsal condyles are visible laterally if pronated, of which 87 percent of hallux valgus cases are. If not corrected, metatarsal pronation will result in worse clinical outcomes and higher deformity relapse rates due to the soft tissue balance lateral to the medical ray axis. However, when compared to challenging, unreliable weight-bearing axial sesamoid views and more useful AP foot weight-bearing views on plan X-Ray, weight-bearing CT scans are the gold standard in quantifying metatarsal rotations.

Following Dr. Wagner, Dr. Cesar de Cesar Netto, MD, Ph.D., discussed “WBCT in Patients with AAFD”. While some symptoms or pain are experienced in patients with Adult-Acquired Flatfoot Deformity, it can be difficult knowing when to be more aggressive in treatment to prevent foot collapse. In a study of 55 male and female patients with stage II AAFD, multiple weight bearing CBCT and MRI variables related to the severity of the deformity were evaluated. Weight-bearing CBCT was found to provide more reliability in predicting patients at high risk for foot collapse.

Dr. Arne Burssens, MD, of the Univesity Hospital of Ghent then deliberated on the “Hidden Aspects of a Medializing Calcaneus Osteotomy Revealed by a WBCT”. Difficult to assess via 2D plain radiographic technology, there is a significant difference when assessing MCO in AAFD using weight-bearing imaging versus non-weight-bearing, offering substantial detail to improve understanding with a higher rate of reliability.

WBCT Research On Display at OARSI 2019

Osteoarthritis Research Society International (OARSI) 2019  World  Congress, the pre-eminent multidisciplinary global forum for all those interested in cutting edge OA research from academia and industry around the world, kicks off May 2 in Toronto, Canada.

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Make sure to visit poster #512 titled, “The Relationship of Three-Dimensional Joint Space Width Measured on Standing Computed Tomography with Concurrent Pain and Physical Function in the MOST Study” (Dr. Neil Segal, M.D. et al).

If you are unable to attend this year and would like to view the poster on display at OARSI 2019  click here to download it now.

Study: Weight Bearing CT leads to better injury identification in NBA players

For professional athletes, injuries mean reduced playing time, impacted performance, and, in rare cases, an end to their careers. These injuries often affect the lower extremities, primarily because their sports require high-risk activities like jumping, cutting movements, and collision with other players. While traditional scanning techniques have mainly been used to identify injuries, a recent study found that weight-bearing cone beam computed tomography (CBCT) may be crucial to not only identify anatomic risks but also to help develop treatments explicitly tailored to the needs of professional athletes.

Incorporating new tech

In The Orthopaedic Journal of Sports Medicine, Dr. Cesar de Cesar Netto, et al. examined the morphology of foot injuries in 45 active NBA players. The doctors used weight-bearing CBCT scans to obtain 3D imaging of each foot. These scans provide more accurate alignment measurements than traditional scans and offer views of the foot while the player’s natural weight is being placed on it.

The study sought to discern whether the morphology of NBA players differed from that of the population at large, and whether the morphology changed based on position played. Foot and ankle injuries account for 27 percent of professional sports injuries, and 85 percent of basketball players experience at least one ankle sprain in their career.

Getting a better look

The players who participated in the study ranged from 20 to 31 years of age, and in total 29 right feet and 25 left feet were studied. All images were taken using a state-of-the-art pedCAT CurveBeam pedCAT system to obtain reliable and accurate images of each subject, and measurements were taken both manually and using the automatic TALAS measurement tool included with CurveBeam’s CubeVue software. TALAS is a research tool and is not available for clinical use. This is significant as it is the first time that a study of the foot morphotypes of NBA players has been conducted.

The study found that, for the most part, NBA players have standard alignment in their lower extremities, although they do tend to have high arches and varus hindfoot alignment. These trends were slight, but they are related to foot injuries and should still be noted. Building up a database of weight-bearing CBCT scans of professional athletes could also allow specialists to have a new control group to compare scans to, which would be enormously beneficial., the study authors said.

Better analysis means better results

Incorporating weight-bearing CBCT scans like those of CurveBeam’s pedCAT can save players, and the league as a whole, both time and money in the long term. Not only will they be able to watch for warning signs, but they will have a complete view of available injuries and will could develop more specific training regimens geared towards returning athletes to the court as quickly as possible.

You can read the full study by Dr. de Cesar Netto, et al. here.

CURVEBEAM CONNECT: THE FUTURE OF SYNDESMOSIS EVALUATION

On this month’s edition of CurveBeam ConnectVinti Singh, Director of Marketing at CurveBeam interviews Alexej Barg, M.D., an orthopedic surgeon at the University of Utah.

Dr. Barg specializes in the care of the foot and ankle, as well as reconstruction of traumatic injuries to the foot, ankle replacement, and joint preserving procedures.

Prior to coming to the University of Utah, he was the head of the Orthopedic Department at the University of Basel in Switzerland.

Dr. Barg currently serves as a reviewer for numerous medical journals including Foot & Ankle International, Journal of Biomechanics, Clinical Anatomy, and BMC Musculoskeletal Disorders, and is well published in foot and ankle replacement.

Currently, Dr. Barg is working with a variety of other researchers on a series of weight-bearing CT projects, including two cadaver research studies. On working with Dr. Arne Burssens on a templating method, Dr. Barg said, “we’re able to compare the healthy side versus the injury side and can detect very small differences in imaging using weight-bearing, which we’re not able to do using conventional radiographs and MRI.”

Give this podcast a listen to hear Singh and Dr. Barg break down his recent presentation on evaluating syndesmosis, his discoveries on the effect that torque plays in syndesmosis measurement, and whether these findings could translate to imaging in the clinical setting.

CurveBeam Heads to Nashville for AAOE 2019

 

CurveBeam will be on hand at AAOE 2019, exhibiting our innovative imaging solutions for orthopedic specialties and subspecialties in Booth #629.

AAOE provides advocacy, networking and business development for the orthopedic and musculoskeletal healthcare professions. To further promote quality healthcare practice management in the industry, each year the AAOE hosts a conference, gathering orthopedic practice professionals from around the country in one venue to learn new practice management techniques and policies, compare new products and services, discuss changes in healthcare and other issues affecting them each day, and more.

Proud to be a field pioneer, CurveBeam’s design and manufacture of advanced 3D imaging technologies have been setting new standards in orthopedic and podiatric 3D imaging since the company’s founding in 2009. Industry-leading innovation, CurveBeam’s imaging systems utilize progressive Cone Beam CT capabilities to provide cutting-edge imaging at a fraction of the cost of traditional CT equipment.

While at AAOE 2019, stop by Booth #629 and let the CurveBeam team guide you through the benefits of our trailblazing solutions that can positively support the imaging needs of your practice and patients.