I think recently something has changed. I'm sure there used to be a 'default vault' option (I might be wrong though). Now EVERYTHING I create is defaulted to my personal vault not the shared vault. This is really annoying as i keep having to manually move things between the vaults. I know I can change this when creating the new record, but it is annoying and I shouldn't have to. Good customer design is to reduce the number of interactions a customer has to make but this is not the case as every new record would require an extra click to change the vault.
It isn't a massive issue, as i can change the suggested vault, it is just that I don't always remember and I have to occasionally do a sweep to move things from my private vault into the shared vault.
My basic vault is a folder (titled main K) within a folder (titled Obsidian) within Documents within my user folder. My basic vault folder only has .md files within folders, an obsidian file with config and such in it, and a DS_Store file.
Deleting the Application Support folder helped. Got to the dialog box for choosing vault folder. Made a new vault folder rather than using the existing folder and then that worked. When I try to switch back to my previous vault folder, it crashes. I suppose I can just move the contents of the previous vault into a new vault folder.
The conventional measuring method for glenoid version is greatly influenced by the scapular body shape that varies widely between patients. We postulated that the glenoid vault version could be more useful than the conventional glenoid version in clinical cases.
The purposes of this study were to compare the values of glenoid version measured with the conventional method to those with the vault method and to investigate the feasibility of the glenoid vault version.
Computed tomography scans of 150 normal shoulders and 150 arthritic shoulders were analyzed. Three-dimensionally corrected slices were reconstructed from the Digital Imaging and Communications in Medicine (DICOM) data, and glenoid version was measured with both the conventional and vault methods. After determining intra- and interrater reliabilities, differences in glenoid version values between the conventional and vault methods were assessed. In the normal shoulder group, side-to-side differences of glenoid version values were also evaluated in both methods.
The glenoid vault version could be used as an alternative measuring method for glenoid version with high reliability. In clinical use, the glenoid vault version appears to be more useful than the conventional glenoid version to assess the severity of arthritis and difficulty of glenoid replacement. The glenoid vault is not symmetric, but usually retroverted in both normal and arthritic shoulders.
We hypothesized that the conventional measuring method and the glenoid vault method would give different values of glenoid version and that the glenoid vault would have larger retroversion than had previously been thought. The purposes of this study were to compare the values of glenoid version measured with the two methods and to assess the feasibility of the glenoid vault version.
The obtained Digital Imaging and Communication in Medicine (DICOM) data were analyzed using the Osirix MD 1.4.1 software (Pixmeo, Geneva, Switzerland). In order to exclude the effect of scapular inclination, three-dimensionally corrected slices were reconstructed on the software[1, 11]. We determined the scapular plane as the plane including the inferior tip of the scapular body, the center of the glenoid surface, and the medial pole of the scapula[12]. The three-dimensionally corrected slice was reconstructed as the plane including the center of the glenoid surface and the medial pole of the scapula, and perpendicular to the scapular plane[13] (Figure 1). We examined glenoid version with the conventional measuring method described by Friedman et al.[4] (conventional method) and the glenoid vault method (vault method). Both methods defined the glenoid line as the line connecting the anterior rim with the posterior rim of the glenoid. The intermediate line was selected as the glenoid line[8] in the Walch classification[10] type B2 glenoid of the arthritic shoulders. The scapular axis was defined as the line connecting the tip of the medial border of the scapula and the center of the glenoid line in the conventional method. Glenoid version measured with the conventional method was calculated as the angle between the glenoid line and the line perpendicular to the scapular axis (Figure 2A,B,C). In the vault method, we defined the glenoid vault axis as the line connecting the tip of the scapular vault and the center of the glenoid line. Glenoid version with the vault method was calculated as the angle between the glenoid line and the line perpendicular to the glenoid vault axis (Figure 3A,B,C). Three evaluators independently reviewed all measurements twice with a minimum of a 1-month interval between measurements. Each measurement started from slice reconstruction.
The vault method as an alternative glenoid version measurement. The same cases as Figure 2 are measured with the vault method. The glenoid line is the same as that of the conventional method (blue line). The glenoid vault axis is defined as the line connecting the tip of the scapular vault and the center of the glenoid line (red solid line). Glenoid version measured with the vault method (β) is calculated as the angle between the glenoid line and the line perpendicular to the glenoid vault axis (red dashed line). (A) The vault method for measuring a normal shoulder. Glenoid vault retroversion is 9.7. The difference between conventional glenoid version and glenoid vault version is only 3.5. (B) The glenoid has 5.0 retroversion when measured with the vault method. The difference between conventional glenoid version and glenoid vault version amounts to 13.9. (C) The vault method for measuring an arthritic shoulder. The glenoid vault has 34.8 retroversion. The difference between conventional glenoid version and glenoid vault version is 6.5.
Statistical analyses were performed using IBM SPSS Statistics 20.0.0 software (IBM, Armonk, NY, USA). Intra- and interrater reliabilities were evaluated with intraclass correlation coefficients (ICCs) first. Glenoid version measurement reliability was examined in the normal and arthritic shoulder groups for both the conventional and vault methods. Intrarater reliability for each of three observers was calculated by repeated measurements with a 1-month interval (ICC model 1.1). Interrater reliability was calculated by blinded measurements of three observers (ICC model 2.1). After reliability was assessed, the glenoid version values were averaged across the three observers and their two measurements. The glenoid version values measured with the two methods were compared with the Wilcoxon signed-rank tests, and their distributions were compared using F-tests in both normal and arthritic shoulders. In the normal shoulders, differences of glenoid version values between the dominant and nondominant shoulders were compared using Wilcoxon signed-rank tests in both the conventional method and the vault method. The significance level was set at 0.05 for all analyses.
Scapular morphology appears to be modular[14]. The scapular body is congruent with the thorax, and together they form the scapulothoracic joint. The glenoid vault is congruent with the humeral head, and together they form the glenohumeral joint. During shoulder arthroplasty, it is important to recognize the respective glenoid version for proper placement of the glenoid component within the vault[1, 15, 16]. Severe glenoid version is one of the risk factors for postoperative loosening[2, 3], and surgical strategy will change with glenoid version[17, 18]. However, the conventional method for measuring glenoid version is greatly influenced by the scapular body shape, which widely varies from straight to round and wavy[19]. In the normal shoulder group of this study, the vault method showed a lower standard deviation and different distribution of the values of version compared to the conventional method, and this may be the result of elimination of the variable scapular body effects. Although the arthritic glenoid also showed a lower standard deviation of glenoid vault version than the conventional glenoid version, their distributions were not different. The wide variations in version were supposed to lead the result. As the rotator cuff muscles originate from the medial border of the scapula, conventional glenoid version might represent the force balance of the rotator cuff. Nevertheless, the glenoid vault version, which eliminates the scapular body effect, is likely to be more important for clinical use than the conventional glenoid version. The vault method showed significantly larger retroversion than the conventional method in both normal shoulders and arthritis shoulders. The conventional glenoid version could possibly underestimate the severity of arthritis.
We can eliminate the scapular body angulation in measuring glenoid version with the glenoid vault method. We can also check the respective glenoid vault shape by inspecting the anterior wall of the vault during arthroplasty, but it will be impossible to assess the conventional version that utilizes the medial border of the scapula. Finally, the glenoid vault version can be evaluated even if the CT scan does not include the entire scapula, which unfortunately happens quite frequently. The vault method showed high intra- and interrater reliabilities in both normal and arthritic shoulders as well as the conventional method. Thus, glenoid vault version can be used as an alternative measuring method for glenoid version. Poon and Ting also focused on the glenoid vault in version measurement, and they reported their original measuring method using an isosceles triangle pictured within the medial end of the glenoid endosteal vault[19]. However, it is important for proper placement of the glenoid component to understand the location of the glenoid vault with respect to the glenoid center. During glenoid replacement, we face the glenoid surface and not the glenoid endosteal vault. In clinical use, we believe that our glenoid vault version could be more useful than their measuring method to assess the severity of arthritis and difficulty of shoulder arthroplasty.
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