Physeal Location on the Distal Femoral Cortical Surface Is Consistently Proximal to Apparent Location on the Perfect Lateral Radiograph: A 3-Dimensional Digitally Reconstructed Radiograph Study.

J Am Acad Orthop Surg

From the Department of Orthopaedics, University of Utah, Salt Lake City, UT (Rosenthal, Metz, Khalil, Featherall, Maak, Ernat, and Aoki), and the School of Medicine, University of Utah, Salt Lake City, Utah (Froerer).

Published: August 2024

AI Article Synopsis

  • The study focuses on how accurately a perfect lateral knee X-ray represents the anatomical features of the femoral physis, given that X-rays are 2D images of a 3D structure.
  • By analyzing pediatric CT scans, researchers created digitally reconstructed radiographs (DRRs) and measured the differences between the actual physis and its projection on these X-rays.
  • Results showed that the actual position of the physis on the medial cortex was significantly higher than what was seen in the X-ray, indicating a consistent discrepancy in visualization across all measured areas.

Article Abstract

Introduction: The perfect knee lateral radiograph visualizes anatomic landmarks on the distal femur for clinical and scientific purposes. However, radiographic imaging is a two-dimensional (2D) representation of a three-dimensional (3D) physis. The aim of this study was to characterize the perceived radiographic projection of the femoral physis using perfect lateral digitally reconstructed radiographs (DRRs) and to evaluate discrepancies from this projection to the physis at the lateral and medial cortices.

Methods: Pediatric patients from a cohort of CT scans were analyzed. Inclusion criteria were an open physis; exclusion criteria were any implant or pathology affecting the physis. CT scans were imported into 3D imaging software and transformed into lateral DRRs and 3D renderings of the femur. The physis was divided into four equal segments, with fiducial markers placed at the "anterior," "midpoint," and "posterior" points. Lines extended from these points in the lateral and medial direction. The vertical distance from these lines, representing the radiographic projection of the physis, was measured relative to the physis at the lateral and medial cortex of the femur on coronal CT slices.

Results: Thirty-one patients were included. On the perfect lateral radiograph DRR, the physis on the medial cortex was located proximal to the visualized physis by 6.64 ± 1.74 mm, 11.95 ± 1.67 mm, and 14.30 ± 1.75 mm at the anterior (25%), midpoint (50%), and posterior (75%) locations, respectively. On the lateral side, the physis on the lateral cortex was proximal to the visualized physis by 2.19 ± 1.13 mm, 3.71 ± 1.19 mm, and 6.74 ± 1.25 mm at the anterior, midpoint, and posterior locations, respectively.

Discussion: In this cohort of pediatric patients, the location of the cortical physis was, in all areas measured, proximal to the projection of the visualized physis as seen on the perfect knee lateral DRR. The distance from radiographic physis to cortical physis was greater at the medial cortex compared with the lateral cortex.

Study Design: Descriptive laboratory study.

Level Of Evidence: III, observational radiographic anatomic study.

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Source
http://dx.doi.org/10.5435/JAAOS-D-23-00983DOI Listing

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