The radiographic relationship between the cortical overlap view (COV) and the tip of the greater trochanter

Abstract For proximal femoral nailing, choosing the proper entry point with the aid of C-arm imaging is crucial. Therefore, obtaining accurate radiological views that facilitate sound identification of the tip of the greater trochanter (GT) is of utmost importance. The aim of this study was to defin...

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Autores principales:	Bjorn-Christian Link, Nicole M. van Veelen, Katja Boernert, Piyabuth Kittithamvongs, Frank J.P. Beeres, Hans H. de Boer, Filippo Migliorini, Sven Nebelung, Matthias Knobe, Steffen Ruchholtz, Reto Babst, Chittawee Jiamton
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/ff6a9a84c9554475bc70a674f4d625c6
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spelling	oai:doaj.org-article:ff6a9a84c9554475bc70a674f4d625c62021-12-02T15:15:35ZThe radiographic relationship between the cortical overlap view (COV) and the tip of the greater trochanter10.1038/s41598-021-97951-82045-2322https://doaj.org/article/ff6a9a84c9554475bc70a674f4d625c62021-09-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-97951-8https://doaj.org/toc/2045-2322Abstract For proximal femoral nailing, choosing the proper entry point with the aid of C-arm imaging is crucial. Therefore, obtaining accurate radiological views that facilitate sound identification of the tip of the greater trochanter (GT) is of utmost importance. The aim of this study was to define a radiological view characterised by reproducible radiographic landmarks which will allow the reliable identification of the tip of the GT in the anteroposterior view. Anatomical and radiographic features of 16 cadaveric femurs were analysed. The cortical overlap view (COV), characterised by the radiological overlap of the density line of the piriform fossa and the intertrochanteric crest, was identified. It marks the rotation of the proximal femur at which the GT can be accurately identified and used to determine the desired entry point for a proximal femoral nail. Trainees and fully qualified orthopedic trauma surgeons were asked to identify the correct COV in radiological imaging series. Mean internal rotation of the femur to achieve a COV was 17.5° (range 12.8°–21.8°). In the COV the tip of the GT is the highest visible point and the mean distance from the cortical overlap line to the tip of the GT is 4.45 mm. Intra- and inter-rater reliability was high with ICC(2,k) = 0.932 and ICC(2,k) = 0.987 respectively. Trainees achieved higher rates of correct COV identification than specialists. There was no significant correlation between the internal rotation of the femur to achieve the COV and femoral antetorsion. In conclusion, the COV is a highly reproducible radiological view that is characterised by radiographic landmarks easy to recognise. It allows for accurate identification of the tip of the GT, which can be used by the surgeon as a reference to determine the desired entry point for an intramedullary nail.Bjorn-Christian LinkNicole M. van VeelenKatja BoernertPiyabuth KittithamvongsFrank J.P. BeeresHans H. de BoerFilippo MiglioriniSven NebelungMatthias KnobeSteffen RuchholtzReto BabstChittawee JiamtonNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-7 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Bjorn-Christian Link Nicole M. van Veelen Katja Boernert Piyabuth Kittithamvongs Frank J.P. Beeres Hans H. de Boer Filippo Migliorini Sven Nebelung Matthias Knobe Steffen Ruchholtz Reto Babst Chittawee Jiamton The radiographic relationship between the cortical overlap view (COV) and the tip of the greater trochanter
description	Abstract For proximal femoral nailing, choosing the proper entry point with the aid of C-arm imaging is crucial. Therefore, obtaining accurate radiological views that facilitate sound identification of the tip of the greater trochanter (GT) is of utmost importance. The aim of this study was to define a radiological view characterised by reproducible radiographic landmarks which will allow the reliable identification of the tip of the GT in the anteroposterior view. Anatomical and radiographic features of 16 cadaveric femurs were analysed. The cortical overlap view (COV), characterised by the radiological overlap of the density line of the piriform fossa and the intertrochanteric crest, was identified. It marks the rotation of the proximal femur at which the GT can be accurately identified and used to determine the desired entry point for a proximal femoral nail. Trainees and fully qualified orthopedic trauma surgeons were asked to identify the correct COV in radiological imaging series. Mean internal rotation of the femur to achieve a COV was 17.5° (range 12.8°–21.8°). In the COV the tip of the GT is the highest visible point and the mean distance from the cortical overlap line to the tip of the GT is 4.45 mm. Intra- and inter-rater reliability was high with ICC(2,k) = 0.932 and ICC(2,k) = 0.987 respectively. Trainees achieved higher rates of correct COV identification than specialists. There was no significant correlation between the internal rotation of the femur to achieve the COV and femoral antetorsion. In conclusion, the COV is a highly reproducible radiological view that is characterised by radiographic landmarks easy to recognise. It allows for accurate identification of the tip of the GT, which can be used by the surgeon as a reference to determine the desired entry point for an intramedullary nail.
format	article
author	Bjorn-Christian Link Nicole M. van Veelen Katja Boernert Piyabuth Kittithamvongs Frank J.P. Beeres Hans H. de Boer Filippo Migliorini Sven Nebelung Matthias Knobe Steffen Ruchholtz Reto Babst Chittawee Jiamton
author_facet	Bjorn-Christian Link Nicole M. van Veelen Katja Boernert Piyabuth Kittithamvongs Frank J.P. Beeres Hans H. de Boer Filippo Migliorini Sven Nebelung Matthias Knobe Steffen Ruchholtz Reto Babst Chittawee Jiamton
author_sort	Bjorn-Christian Link
title	The radiographic relationship between the cortical overlap view (COV) and the tip of the greater trochanter
title_short	The radiographic relationship between the cortical overlap view (COV) and the tip of the greater trochanter
title_full	The radiographic relationship between the cortical overlap view (COV) and the tip of the greater trochanter
title_fullStr	The radiographic relationship between the cortical overlap view (COV) and the tip of the greater trochanter
title_full_unstemmed	The radiographic relationship between the cortical overlap view (COV) and the tip of the greater trochanter
title_sort	radiographic relationship between the cortical overlap view (cov) and the tip of the greater trochanter
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/ff6a9a84c9554475bc70a674f4d625c6
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The radiographic relationship between the cortical overlap view (COV) and the tip of the greater trochanter

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