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Sample records for acetabular internal fracture

  1. FUNCTIONAL OUTCOME OF SURGICAL MANAGEMENT OF ACETABULAR FRACTURES BY INTERNAL FIXATION

    Sagar

    2015-06-01

    Full Text Available BACKGROUND: The treatment of acetabular fractures has seen major advances in the field of orthopaedic traumatology. Conservative treatment of acetabular fractures leads to poor results. Newer diagnostic tools like the Computed Tomography (CT scan help in analyzing the three dimensional disturbance in the normal anatomy and plan the surgical management accordingly. In recent years operative treatment has become the treat ment of choice in the management of acetabular fractures as precise anatomical reduction with adequate internal fixation can be attained. OBJECTIVES : To evaluate the functional outcome of operatively managed acetabular fractures , and assess the efficacy of operative fixation of acetabular fractures , and also study the complications of operative fixation of acetabular fractures. MATERIALS AND METHODS: Fifty five patients (49 male & six female admitted to Sanjay Gandhi Institute of Trauma and Orthopaedics wi th acetabular fractures underwent open reduction and internal fixation. All patients were evaluated with Matta et al score with a minimum of follow up of six months. RESULTS: There were 24 (43.6% patients with bicolumnar fractures , 15(27.3% had posterior column fractures , 10(18.1% had posterior wall fractures , five (9.1% had transverse fractures , and one (1.8% patient had an anterior column fracture. Full weight bearing was attained in thirty five (63.6% patients in 16 weeks and in twenty (36.4% pati ents after 16 weeks. Forty five (81.8% patients were free of complications. According to Matta et al score 27(49.1% had excellent , 15(27.3% had good , nine (16.4% had fair , and four (7.3% had poor results. CONCLUSION: Open reduction and internal fixati on of acetabular fractures is a reliable technique , minimizes healing time and provides congruent joint reduction. Operative treatment of acetabular fractures results in predictable union and good clinical results with a low rate of complications.

  2. An Unusual Combination of Acetabular and Pelvic Fracture: Is This a New Subtype of Acetabular Fracture?

    Reza Tavakoli Darestani

    2013-01-01

    Full Text Available Introduction: Acetabular fractures are a common problem among young males. An acetabular fracture with disruption of the joint surface, if untreated, will rapidly lead to post-traumatic osteoarthritis. Proper reduction and internal fixation depend on accurate classification and the quality of imaging.Case Presentation: We present an unusual form of acetabular fracture, which is not included in the conventional classification (Judet and Letournel ; this occurred in a middle-aged male who was operatively treated without any complications. In this case due to posterior extension of the fracture into the SI joint and concomitant anterior column fracture in the area above the acetabular dome, no portion of the acetabular anterior surface remained connected to the innominate bone.Conclusions: We recognized this type of fracture and treated it similarly to both column fractures. We recommend that the classification of acetabular fractures be modified to include this type of fracture.

  3. Open reduction and internal fixation aided by intraoperative 3-dimensional imaging improved the articular reduction in 72 displaced acetabular fractures

    Eckardt, Henrik; Lind, Dennis; Toendevold, Erik

    2015-01-01

    Background and purpose - During acetabular fracture surgery, the acetabular roof is difficult to visualize with 2-dimensional fluoroscopic views. We assessed whether intraoperative 3-dimensional (3D) imaging can aid the surgeon to achieve better articular reduction and improve implant fixation....... Patients and methods - We operated on 72 acetabular fractures using intraoperative 3D imaging and compared the operative results, duration of surgery, and complications with those for 42 consecutive acetabular fracture operations conducted using conventional fluoroscopic imaging. Postoperative reduction...... was evaluated on reconstructed coronal and sagittal images of the acetabulum. Results - The fracture severity and patient characteristics were similar in the 2 groups. In the 3D group, 46 of 72 patients (0.6) had a perfect result after open reduction and internal fixation, and in the control group, 17...

  4. Surgical treatment for complicated acetabular fractures

    Ning An; Yang Yanmin

    2004-01-01

    Objective: To sum up the surgical approaches and clinical outcome of complicated acetabular fractures. Methods: 17 patients with complicated acetabular fractures (including 4 cases of transverse with posterior wall fractures, 7 cases of posterior column and wall fractures, 4 cases of anterior and posterior columns fractures, 1 cases of T-type fracture and 1 cases of anterior column with posterior hemitransverse fractures) underwent open reduction and internal fixation with screws and plates by Kocher-Langenbeck (8 cases), ilio-inguinal (2 cases), extended iliofemoral (4 cases) or ilio-inguinal combined with K-L approaches (3 cases). Results: 12 patients with anatomical reduction, 4 patients with satisfactory reduction and 1 patient with non-satisfactory reduction. 15 out of 17 cases were followed up for 6 months to 5 years, and the excellent and good rate was 70.5%. Conclusion: Surgical treatment for complicated acetabular fractures can get a satisfactory reduction and a good clinical outcome.

  5. Management of acetabular fractures: challenging work

    CHEN Zheng-rong; YANG Yi

    2006-01-01

    @@ Acetabular fractures are complex and special intraarticular fractures. For most orthopaedic surgeons management of acetabular fractures is hard and challenging because the fractures are the results of high-energy trauma, and usually accompany with severe associated injuries. In addition, these fractures are uncommon except in a few trauma centers. The number of cases a surgeon can encounter is scarce.

  6. Surgical treatment for complex acetabular fractures

    LIU Qiang; WU Dou; LI Ping; HAN Shu-feng

    2006-01-01

    Objective: To explore the effect of surgical treatment on complex acetabular fractures.Methods: The data of 46 patients (38 males and 8 females, aged 16-75 years, mean = 38. 5 years ) with complex acetabular fractures, who were admitted to our hospital from January 1998 to December 2005, were analyzed retrospectively in this study. According to Letournel rules, posterior wall and posterior column fractures were found in 11 patients, transverse and posterior wall fractures in 13, T-type fracture in 4, both columns fracture in 10, and anterior column and posterior transverse fracture in 8. The choice of surgical approach was based on the individual fractures, which included ilioinguinal approach in 5 patients, Kocher-Langenbech approach in 7, combined approach in 26, and extended iliofemoral approach in 8.Results: All the patients were followed up for 3.5 years averagely. The clinical outcomes were analyzed with Harris hip score and radiography. In 36 patients (78.3%), the surgical procedure was successful (Harris hip score > 80 points). The rate of excellent and good was about 86 %.Conclusions: The keys to increase the effectiveness of surgical treatment on acetabular fractures are correct preoperative classification of factures and choices of appropriate surgical approach and time.

  7. Sciatic Nerve Injury Associated with Acetabular Fractures

    Issack, Paul S; Helfet, David L

    2008-01-01

    Sciatic nerve injuries associated with acetabular fractures may be a result of the initial trauma or injury at the time of surgical reconstruction. Patients may present with a broad range of symptoms ranging from radiculopathy to foot drop. There are several posttraumatic, perioperative, and postoperative causes for sciatic nerve palsy including fracture–dislocation of the hip joint, excessive tension or inappropriate placement of retractors, instrument- or implant-related complications, hete...

  8. A reduction clamp for an aiming component in associated acetabular fractures

    Zhang-Fu Wang

    2015-01-01

    Full Text Available Background: The treatment of acetabular fractures is complex and requires specialized equipment. However, all currently available instruments have some disadvantages. A new reduction clamp that can firmly enable reduction and not hinder subsequent fixation procedures for some special fracture types is needed. Materials and Methods: In this study, we introduce a new acetabular clamp and its preliminary clinical application in three T-shaped acetabular fractures. Results: This new clamp can successfully pull the posterior column back to the anterior column and firmly maintain the reduction. This clamp′s aiming plate can facilitate the insertion of long lag screws. The clamp is also easy to assemble and use. Conclusion: This reduction clamp is a useful instrument that can facilitate open reduction and internal fixation of acetabular fractures.

  9. Acetabular fractures following rugby tackles: a case series

    Morris Seamus

    2011-10-01

    Full Text Available Abstract Introduction Rugby is the third most popular team contact sport in the world and is increasing in popularity. In 1995, rugby in Europe turned professional, and with this has come an increased rate of injury. Case presentation In a six-month period from July to December, two open reduction and internal fixations of acetabular fractures were performed in young Caucasian men (16 and 24 years old who sustained their injuries after rugby tackles. Both of these cases are described as well as the biomechanical factors contributing to the fracture and the recovery. Acetabular fractures of the hip during sport are rare occurrences. Conclusion Our recent experience of two cases over a six-month period creates concern that these high-energy injuries may become more frequent as rugby continues to adopt advanced training regimens. Protective equipment is unlikely to reduce the forces imparted across the hip joint; however, limiting 'the tackle' to only two players may well reduce the likelihood of this life-altering injury.

  10. Acetabular fractures following rugby tackles: a case series

    Good, Daniel W

    2011-10-05

    Abstract Introduction Rugby is the third most popular team contact sport in the world and is increasing in popularity. In 1995, rugby in Europe turned professional, and with this has come an increased rate of injury. Case presentation In a six-month period from July to December, two open reduction and internal fixations of acetabular fractures were performed in young Caucasian men (16 and 24 years old) who sustained their injuries after rugby tackles. Both of these cases are described as well as the biomechanical factors contributing to the fracture and the recovery. Acetabular fractures of the hip during sport are rare occurrences. Conclusion Our recent experience of two cases over a six-month period creates concern that these high-energy injuries may become more frequent as rugby continues to adopt advanced training regimens. Protective equipment is unlikely to reduce the forces imparted across the hip joint; however, limiting \\'the tackle\\' to only two players may well reduce the likelihood of this life-altering injury.

  11. 骨盆并髋臼骨折内固定材料的生物相容性%Materials biocompatibility in the internal fixation of pelvic fracture combined with acetabular fracture

    高明杰; 陶杰; 周孜辉; 杜琳

    2015-01-01

    背景:骨盆骨折合并髋臼骨折多由高能量暴力伤所致,常伴严重并发症,往往需要外科内固定治疗。目的:探讨骨盆骨折合并髋臼骨折内固定治疗以及材料的生物相容性。方法:以“骨盆骨折,髋臼骨折,内固定,材料;pelvis fracture,acetabulum fracture,internal fixators, materials”为关键词,应用计算机检索2005至2014年万方数据库、清华知网数据库和PubMed数据库,选取有关骨盆骨折合并髋臼骨折内固定治疗以及材料生物相容性研究的文献,同一领域文献选择权威杂志或发表时间为近期的文章,依据纳入排除标准选取29篇文献进行归纳分析。结果与结论:对于骨盆骨折合并髋臼骨折临床多采用重建钢板或拉力螺钉内固定,常用于内固定的重建钢板材料是钛板,弹性模量接近骨的弹性模量,生物相容性好,可在置入前预先弯曲塑形,使之与骨折部位骨面相匹配。可吸收螺钉具有良好的组织相容性,无毒副反应,避免金属螺钉的电解与腐蚀,在内固定早期保持一定的强度,随着时间的推移骨折逐渐愈合,材料强度也缓慢降低,材料最终降解为水和二氧化碳,治疗效果满意。以三维重建技术定制钢板固定和微创内固定是目前骨折治疗的重大进展,临床应用前景广阔。%BACKGROUND:Pelvic fractures combined with acetabular fractures are mostly caused by high-energy violence, often accompanied by severe complications and high mortality, and surgical fixation is preferred in most cases. OBJECTIVE:To investigate the internal fixation of pelvic fracture combined with acetabular fracture and to analyze the material biocompatibility. METHODS:A computer-based search of Wanfang, CNKI and PubMed databases was performed for articles related to the internal fixation of pelvic fracture combined with acetabular fracture and material biocompatibility published

  12. Nonunion of acetabular fractures: evaluation with interactive multiplanar CT

    Nonunions involving fractures of the acetabulum are reportedly rare, with few citings and little discussion in the literature. It is possible that acetabular nonunions go undetected because imaging of the acetabulum is difficult by conventional radiography. We report two cases of fracture nonunion involving the weight-bearing surface of the acetabulum diagnosed with the aid of computed tomography (CT) and a newly developed interactive 2D/3D orthotool that uniquely processes and reformats routine CT data. The interactive 2D/3D orthotool is a sophisticated computer program that allows dynamic viewing of standard multiplanar reconstructions in the axial, coronal, and sagittal planes as well as multiple oblique projections. The 2D/3D orthotool provides on screen correlation of two-dimensional multiplanar images with three-dimensional reconstructions of the pelvis. The authors found this capability ideally suited for studying fractures with off-axis orientation such as those through the acetabular dome, greatly facilitating the diagnosis of nonunion

  13. An interactive surgical planning tool for acetabular fractures: initial results

    Marincek Borut

    2010-08-01

    Full Text Available Abstract Background Acetabular fractures still are among the most challenging fractures to treat because of complex anatomy, involved surgical access to fracture sites and the relatively low incidence of these lesions. Proper evaluation and surgical planning is necessary to achieve anatomic reduction of the articular surface and stable fixation of the pelvic ring. The goal of this study was to test the feasibility of preoperative surgical planning in acetabular fractures using a new prototype planning tool based on an interactive virtual reality-style environment. Methods 7 patients (5 male and 2 female; median age 53 y (25 to 92 y with an acetabular fracture were prospectively included. Exclusion criterions were simple wall fractures, cases with anticipated surgical dislocation of the femoral head for joint debridement and accurate fracture reduction. According to the Letournel classification 4 cases had two column fractures, 2 cases had anterior column fractures and 1 case had a T-shaped fracture including a posterior wall fracture. The workflow included following steps: (1 Formation of a patient-specific bone model from preoperative computed tomography scans, (2 interactive virtual fracture reduction with visuo-haptic feedback, (3 virtual fracture fixation using common osteosynthesis implants and (4 measurement of implant position relative to landmarks. The surgeon manually contoured osteosynthesis plates preoperatively according to the virtually defined deformation. Screenshots including all measurements for the OR were available. The tool was validated comparing the preoperative planning and postoperative results by 3D-superimposition. Results Preoperative planning was feasible in all cases. In 6 of 7 cases superimposition of preoperative planning and postoperative follow-up CT showed a good to excellent correlation. In one case part of the procedure had to be changed due to impossibility of fracture reduction from an ilioinguinal approach

  14. SeIectlng the incision In the surgical treatment of acetabular fractures

    Asik, Mehmet; Basturk, Sırrı; Akpinar, Sercan; Taser, Omer; Akalin, Yilmaz

    2004-01-01

    In acetabular fractures which may have totally differing three dimensional appearances selecting the incision directly influences the quality, directly influences the quality of the surgical reduction and, therefore, the postoperative clinical outcome of the patierit. Becauseof this, it is a subject that has to be meticulously done. According to the fracture types, we used 6 distinct incisions on the 35 acetabular fractures which were operated in our clinic between 1988 and 1992. We presente...

  15. Surgical Outcome of Acetabular Fracture Using Trochanteric Flip Osteotomy

    Espandar R

    2012-01-01

    Full Text Available Background: One of the difficulties in acetabulum surgery is appropriate exposure of the site of surgery. Trochanteric flip osteotomy is one of the surgical methods for superoposterior and posterior acetabulum exposure. However, due to possible complications some surgeons prefer to avoid this procedure. This study was undertaken to determine the outcome of surgical treatment of acetabular fracture using trochanteric flip osteotomy. Methods : In this prospective cohort study, 14 patients with acetabular fracture who had been admitted in Imam Khomeini Hospital in Tehran, Iran, during 2003-2006 underwent trochanteric flip osteotomy. The patients were followed for at least one year post-surgically. Demographics, radiologic findings, intensity of pain using visual analogue scale (VAS, Harris hip score (HHS, force of hip abductors and complications were noted. Data analysis was performed using SPSS ver. 13.Results : The mean HHS was 82.5 (55-95. Heterotopic ossification was observed in three patients. There were no cases of postoperative infection or nonunion. Only two patients showed displacement of osteotomized fragments. Reduction was anatomic in 10 patients. In one patient, the force of hip abductors was three-fifth. The mean hip pain was 3.4 based on VAS. There were no cases of femoral head osteonecrosis. With respect to HHS, the final hip status was excellent and good in four and six patients, respectively. Three patients had fair and only one patient had poor condition.Conclusion: It seems that trochanteric flip osteotomy has much fewer complications in comparison to other methods justifying its use in such cases.

  16. Simultaneous bilateral shoulder and bilateral central acetabular fracture dislocation: What to do?

    Hardik Sheth; Abhijeet Ashok Salunke; Ramesh Panchal; Jimmy Chokshi; G.I.Nambi; Saranjeet Singh; Amit Patel

    2016-01-01

    Musculoskeletal injuries following seizures have a high morbidity and mortality.These injuries are often missed and the diagnosis is delayed due to a lack of clinical suspicion and appropriate investigations.We report a case of 72 years old male with simultaneous bilateral central acetabular fracture dislocation and bilateral posterior shoulder fracture dislocation secondary to an epileptic seizure.Present study highlights the significance of clinical suspicion and clinico-radiological evaluation for diagnosis of a rare injury following episode of seizures.Simultaneous fracture dislocation of all four limbs treated with a holistic approach can lead to a good functional recovery.Surgical management with open reduction and internal fixation is preferred and replacement arthroplasty should be reserved for cases with implant failure and elderly patients.

  17. Acetabular stress fractures in military endurance athletes and recruits: incidence and MRI and scintigraphic findings

    Objective: To evaluate the incidence and the MRI and scintigraphic appearance of acetabular stress (fatigue) fractures in military endurance athletes and recruits. Design and patients: One hundred and seventy-eight active duty military endurance trainees with a history of activity-related hip pain were evaluated by both MRI and bone scan over a 2-year period. Patients in the study ranged in age from 17 to 45 years. They had hip pain related to activity and had plain radiographs of the hip and pelvis that were interpreted as normal or equivocal. The study was originally designed to evaluate the MRI and scintigraphic appearance of femoral neck stress fractures. Patients had scintigraphy and a limited MRI examination (coronal imaging only) within 48 h of the bone scan. Twelve patients demonstrated imaging findings compatible with acetabular stress fractures. Results: Stress fractures are common in endurance athletes and in military populations; however, stress fracture of the acetabulum is uncommon. Twelve of 178 patients (6.7%) in our study had imaging findings consistent with acetabular stress fractures. Two patterns were identified. Seven of the 12 (58%) patients had acetabular roof stress fractures. In this group, two cases of bilateral acetabular roof stress fractures were identified, one with a synchronous tensile sided femoral neck stress fracture. The remaining five of 12 (42%) patients had anterior column stress fractures, rarely occurring in isolation, and almost always occurring with inferior pubic ramus stress fracture (4 of 5, or 80%). One case of bilateral anterior column stress fractures was identified without additional sites of injury. Conclusions: Stress fractures are commonplace in military populations, especially endurance trainees. Acetabular stress fractures are rare and therefore unrecognized, but do occur and may be a cause for activity-related hip pain in a small percentage of military endurance athletes and recruits. (orig.)

  18. Subchondral Insufficiency Fracture of the Femoral Head Caused by Excessive Lateralization of the Acetabular Rim

    Kimura, Tetsuya; Goto, Tomohiro; Hamada, Daisuke; Tsutsui, Takahiko; Wada, Keizo; Fukuta, Shoji; Nagamachi, Akihiro; Sairyo, Koichi

    2016-01-01

    We present a case of a 53-year-old woman with subchondral insufficiency fracture (SIF) of the femoral head without history of severe osteoporosis or overexertion. Plain radiographs showed acetabular overcoverage with excessive lateralization of the acetabular rim. A diagnosis of SIF was made by typical MRI findings of SIF. The lesion occurred at the antipodes of the extended rim. Increased mechanical stress over the femoral head due to impingement against the excess bone was suspected as a cause of SIF. The distinct femoral head deformity is consistent with this hypothesis. This is the first report of SIF associated with acetabular overcoverage. PMID:27293935

  19. Outcome of operative treatment of acetabular fractures: short term follow-up

    Fractures of the acetabulum result from high energy accidents. The anatomic location of the acetabulum, as well as the three-dimensional structure of the bone, makes the treatment of these injuries extremely challenging. The objective of this study was to determine the outcome of operative treatment of acetabulum fractures with one year follow-up. Methods: In this descriptive case series, 31 patients with acetabular fracture were admitted in North West General Hospital, Peshawar, from July 2010 to Sept 2013. Patients were followed-up till one year. In follow-up, patients were assessed clinically with Merle Aubigne and Postel grading method. Radiological assessment was done using Matta criteria. Results: All patients were male. Twelve (38.7 %) were managed non-operatively, as they fulfilled criteria for non-operative treatment and 19 (61.3%) patients were operated after fulfilling the criteria for internal fixation; they were included for analysis. Ages ranged from 20-60 years with mean age of 37.21 ± 10.07 years. Fourteen (73.7%) patients had anatomic reduction and 5 (26.3 %) patients had imperfect reduction based on Matta radiographic criteria. At 1 year follow-up, we had 16 (84.2 %) excellent hips, 2 (10.5%) good hips and 1 (5.3%) poor hip , based on radiographs; and clinically we had 9 (47.4 %) hips with excellent function, 7 (36.8 %) hips with good outcome, 2 (10.5 %) had fair function and 1 (5.3 %) patient had poor function. Conclusion: Our results show that internal fixation of acetabular fractures lead to good outcome in majority of patients. (author)

  20. Minimum ten-year follow-up of acetabular fracture fixation from the Irish tertiary referral centre.

    Magill, Paul

    2012-04-01

    Successful outcome from acetabular fracture fixation is multi-factorial. Long-term results are not frequently reported. Pooling such data from high output centres will help progress acetabular fixation. This paper presents the first ten-year data from the Irish tertiary referral centre.

  1. The place of computerized axial tomography in the evaluation of acetabular fractures

    Asik, Mehmet; Akman, Senol; Taser, Omer; Aritamur, Ayhan

    2004-01-01

    Besides the importance of standard AP and Judet s 45° iliac and obturator pelvic views, CAT has proved to be very useful in the evaluation of the fractures of the acetabulum. Of 96 patients with acetabular fractures, who applied to the Orthopaedics and Traumatology Department, Istanbul Medical Faculty, Istanbul University between 1987 and 1991 in addition to conventional radiography, CAT investigation was done in 32 patients for whom it was considered necessary. The results of both convention...

  2. Massive heterotopic ossification associated with late deficits in posterior wall of acetabulum after failed acetabular fracture operation

    Zhang, Yuntong; Xie, Yang; Xu, Shuogui; Zhang, Chuncai

    2013-01-01

    Background Heterotopic ossification is a common postoperative complication of acetabular fracture. However, functionally significant heterotopic ossification with associated late bone defects in the posterior wall of the acetabulum is rare and challenging to treat. When heterotopic ossification is a late complication of failed acetabular fracture operation, it is disabling and may only be treated by THA. THA is highly susceptible to premature failure in young and active patients and may requi...

  3. Three-Dimensional CT Modeling Versus Traditional Radiology Techniques in Treatment of Acetabular Fractures

    Brown, George A.; Firoozbakhsh, Keikhosrow; Gehlert, Rick J

    2001-01-01

    Recently, the authors have used the computer generated three-dimensional (3-D) CT moving images for preoperative planning and screw/pin insertion in more than 28 cases involving plate and screw fixation of complex acetabular fractures. The authors also used stereolithography (wax or plastic 3-D model of bony anatomy) to develop a computer-generated "clip on" interpositioning template for accurate placement of plate and screws. Application of these new technologies gives the surgeon precise in...

  4. Custom-made locked plating for acetabular fracture: a pilot study in 24 consecutive cases.

    Xu, Meng; Zhang, Li-Hai; Zhang, Ying-Ze; Zhang, Li-Cheng; He, Chun-Qing; Wang, Yan; Tang, Pei-Fu

    2014-07-01

    Clinical implementation of site-specific locking plates for acetabular fracture remains untested. Custom-made locking plates were manufactured using computer-aided design and computer-aided manufacture techniques for acetabular fractures to test this procedure. The 3-dimensional images constructed from computed tomography data of pelvises in patients with acetabular fractures were used for preoperative planning and to design the plates. Data for each plate were input into software for programming, and the generated code was transferred into a computerized numerical control digital milling machine for manufacturing. These plates were clinically implemented, and the implementation parameters, reduction quality, and Postel Merle d'Aubigné score were evaluated. Forty-nine custom-made locking plates were manufactured for 24 unilateral acetabular fractures. The manufacturing process for the plates averaged 6.9±2.2 days. Processing the plates delayed operations by 2.6±1.3 days in one-third of the cases. Plate contouring was avoided in 48 plates. The plates had anatomical shapes, excellently matching reduced bone surface. The screws locked with the obtained plates avoided intra-articular penetration and provided secure fixation that allowed early out-of-bed rehabilitation. No indications of implant failures or observations of screw back-outs were observed during follow-up. The clinical application of such plates is associated with the avoidance of plate contouring, low risk of intra-articular penetration, early out-of-bed rehabilitation, and a low rate of implant failure. Implementing such plates in clinical practice is worthy of further investigation, with a focus on selecting patient population and minimizing the time required for and cost of plate manufacturing. PMID:24992064

  5. Surgical treatment of acetabular fractures: clinical and radiological results and its complications

    The objective of this work is to analyse a serie of consecutive cases of surigically treated acetabular fractures, evaluating middle-term clinical and radiological results. A retrospective analysis of clinical histories, surgical forms and X-rays was performed for 42 patients who underwent surgery in two centers (Instituto Nacional de Ortopedia y Traumatologia [INOT] and Banco de Protesis), from July 2001 through August 2007

  6. 髋臼双柱骨折四种固定方式的生物力学比较及临床意义%Biomechanical study of four kinds of internal fixation techniques in the treatment of acetabular both-column fractures

    朱李梅; 李明; 徐爱君; 张经纬; 何贤峰; 王虎

    2015-01-01

    目的 比较髋臼双柱骨折4种内固定方法在不同载荷下的生物力学特点.方法 利用CT图像,建立左侧髋臼双柱骨折三维有限元模型.比较四边区十字钢板、后路双重建钢板、髋臼三柱空心螺钉、新型解剖钢板固定,模拟上半身重量约60 kg坐位、向左转身、向右转身时的受力,施加600N的垂直载荷,向左旋转及向右旋转方向分别施加8 N/M的扭矩,时长1 s,Von Mises应力公式分析内固定的受力.结果 (1)垂直载荷及向左旋转工况下,应力峰值为:解剖板>十字板>后路双板>三柱钉,向右旋转工况为:十字板>解剖板>后路双板>三柱钉.(2)坐位向右转身,四边区十字板位于髂窝臼顶区域的位移最大,耻骨结节处的螺钉应力最大.(3)坐位向左转身,臼顶区域的后路双板内侧钢板近端应力及位移最大,臼顶内上方区域的髋臼后柱螺钉应力最大,髂后上嵴区域的横向双柱钉位移最大.位移峰值为:十字板>解剖板>后路双板>三柱钉.结论 三柱钉固定最稳定,解剖板应力分布较均匀,稳定性与后路双重建钢板相似.钢板固定时,应避免与拧人螺钉反方向的转身动作,减少内植物变形、松动滑脱、断裂、复位丢失等并发症.%Objective To compare the biomechanical properties of four kinds of internal fixation techniques for acetabular both columns fractures.Methods A three-dimensional finite element model of left acetabular both-column fracture was established according to pelvic computed tomography (CT) images and photo software.Four kinds of internal fixation techniques,including quadrilateral double plates,posterior double reconstruction plates,acetabular three-column canulated screws,new anatomical plate were performed separately by the three-dimensional finite element model.These four models were put into Abaqus finite element program,axial load 600 N on vertical compression,and 8 N/M (1 S) torque were loaded on left

  7. Inguinal Abnormalities in Male Patients with Acetabular Fractures Treated Using an Ilioinguinal Exposure

    Reza Firoozabadi

    2015-09-01

    Full Text Available Purpose: Surgeons performing an ilioinguinal exposure for acetabular fracture surgery need to be aware of aberrant findings such as inguinal hernias and spermatic cord lesions. The purpose of this study is to report these occurrences in a clinical series of adult males undergoing acetabular fracture fixation and a series of adult male cadavers. The secondary aim is to characterize these abnormalities to aid surgeons in detecting these abnormalities preoperatively and coordinating a surgical plan with a general surgeon.Methods: Clinical study- Retrospective review of treated acetabular fractures through an ilioinguinal approach. Incidence of inguinal canal and spermatic cord abnormalities requiring general surgery consultation were identified. Corresponding CT scans were reviewed and radiographic characteristics of the spermatic cord abnormalities and/or hernias were noted.Cadaveric study- 18 male cadavers dissected bilaterally using an ilioinguinal exposure. The inguinal canal and the contents of the spermatic cord were identified and characterized.Results: Clinical Study- 5.7% (5/87 of patients had spermatic cord lesion and/or inguinal hernia requiring general surgical intervention. Preoperative pelvic CT scan review identified abnormalities noted intraoperatively in four of the five patients. Cord lipomas visualized as enlargements of the spermatic cord with homogeneous density. Hernias visualized as enlarged spermatic cords with heterogeneous density. Cadaver Study- 31% (11/36 of cadavers studied had spermatic cord and/or inguinal canal abnormalities. Average cord diameter in those with abnormalities was 24.9 mm (15-28 compared to 16 mm (11-22 in normal cords, which was statistically significant.Conclusion: The clinical and cadaveric findings emphasize the importance of understanding inguinal abnormalities and the value of detecting them preoperatively. The preoperative pelvic CT scans were highly sensitive in detecting inguinal abnormalities.

  8. A Feasibility Study into the Use of Three-Dimensional Printer Modelling in Acetabular Fracture Surgery

    A. W. Yu

    2015-01-01

    Full Text Available There are a number of challenges associated with the operative treatment of acetabular fractures. The approach used is often extensive, while operative time and perioperative blood loss can also be significant. With the proliferation of 3D printer technology, we present a fast and economical way to aid the operative planning of complex fractures. We used augmented stereoscopic 3D CT reconstructions to allow for an appreciation of the normal 3D anatomy of the pelvis on the fractured side and to use the models for subsequent intraoperative contouring of pelvic reconstruction plates. This leads to a reduction in the associated soft tissue trauma, reduced intraoperative time and blood loss, minimal handling of the plate, and reduced fluoroscopic screening times. We feel that the use of this technology to customize implants, plates, and the operative procedure to a patient’s unique anatomy can only lead to improved outcomes.

  9. Delayed cementless total hip arthroplasty for neglected dislocation of hip combined with complex acetabular fracture and deficient bone stock

    Gavaskar Ashok S

    2012-12-01

    Full Text Available 【Abstract】Total hip arthroplasty (THA for an un-treated acetabular fracture is technically challenging and the long-term result is not so favorable. A 45-year-old fe-male patient with untreated column and comminuted poste-rior wall fracture of the acetabulum was treated in our insti-tution by reconstruction of the posterior wall using iliac strut autograft and plate stabilization of the posterior col-umn with cancellous grafting and cementless THA in a single stage. At 3 years’ follow-up, the patient was independently mobile without limb length discrepancy. Radiological evalu-ation showed well integrated components and bone grafts. No evidence of aseptic loosening or osteolysis was found. This report aims to emphasize that bony acetabular recon-struction allows the use of primary hip components, which improves prosthesis longevity and preserves bone stock for a future revision. Key words: Acetabulum; Fractures, bone; Hip dislocation; Arthroplasty, replacement, hip

  10. 复杂性髋臼骨析合并C型骨盆骨折的手术治疗探讨%Complexity of the acetabular fracture merger C pelvic fractures the surgical treatment of the discussion

    田素魁; 邓庭明; 王振强; 蒋华富; 张玉兴; 陈劲松

    2011-01-01

    Objective To study the complexity of the acetabular fracture merger C pelvic fractures the surgical treatment of the method. Methods Through Mar 2002 to Nov 2007 acetabular merger between fracture patients pelvic fractures are classified according to summarize, pelvic fractures Tile classification and the acetabular Judet-Letourol classification, improved 13 cases were complexity acetabular merger fracture C pelvic fractures, all through the positive before the operation after haing electie line, buried in joint incision open reduction steel plate, screw intemal fixation, average follow-up treatment 2.4 (0.5~4 years). Results 13 patients except 1 patient wound postponed to 20 days after the healing (fat lique-faction), the others are primary healing wound patient in 2 cases, the acetabular poor fracture restoration, follow-up of 0.5~4 years, have 1 patient traumatic hip osteoarthritis pain are more frequent, lame, and another in 2 cases only pain symptoms, without a limp, and analgesia symptoms after treatment, 5 patients feeling of the ache, can bear, not influence the work and life, 5 patients feel and no obvious difference between before the injury. Conclusion Positive preoperative preparation, do as early as possible fractures internal fixation (orif is for complex fracture acetabular merger C pelvic fractures the effective treatment means, in surgical approach and operation in the specific strategies should follow the principle of individual.%目的 探讨复杂性髋臼骨折合并C型骨盆骨折的手术治疗方法.方法 通过对2002年3月~2007年11月间髋臼骨折合并骨盆骨折的病人进行分类总结,按照骨盆骨折Tile分类法和髋臼改良Judet-Letourol分类法,共有13例复杂性髋臼骨折合并C型骨盆骨折,都通过积极手术前处埋后,择期行联合切口进行切开复位钢板、螺钉内固定,平均随访治疗2.4年(0.5~4年).结果 13例病人中除1例病人部分伤口延期至术后20天愈合外(脂

  11. Should money follow the patient: Financial implication for being the National Centre for the Treatment and Management of Pelvic and Acetabular Fractures in Ireland.

    Kelly, M E

    2013-03-13

    BACKGROUND: Pelvic and acetabular fractures are complex injuries requiring specialist treatment. Our institution is the National Centre for Treatment and Management of these injuries. AIM: To audit all referrals to our institution over a 6-month period and calculate the cost incurred by being the national referral centre. METHODS: Retrospective review of database, and subsequent allocation of Casemix points to assess total cost of treatment for each patient referred to our institution. RESULTS: 103 patients referred with pelvic or acetabular fracture for operative management. The furthest referral distance was 181miles. Over-all, the length of stay was 15.4 days. The average inclusive cost for a referral to our unit for operative management was €16,302. CONCLUSION: Pelvic and acetabular fractures are complex injuries that require specialist referral unit management. However for these units to remain sustainable money needs to "follow the patient".

  12. Femoral shaft and intertrochanteric fracture with ipsilateral acetabular fracture surgery%股骨干及股骨转子间骨折合并同侧髋臼骨折的手术治疗

    赵阳; 薛朝辉; 杨凯

    2013-01-01

    目的:探讨股骨干及股骨转子间骨折合并同侧髋臼骨折的治疗方法及临床疗效。方法股骨干及股骨转子间骨折合并同侧髋臼骨折10例,均为男性;年龄23~56岁,平均34.5岁。髋臼骨折按Letournel分型,后壁伴后柱骨折6例,单纯后壁骨折2例,髋关节中心性骨折脱位2例。均行重建钢板内固定。股骨骨折行加长髓内钉固定6例;股骨干行钢板内固定,股骨转子间骨折行动力髋螺钉固定4例。结果6例均获随访,随访时间12个月~3年,平均17.2个月。骨折均临床愈合,髋关节功能根据D’Aubigne疗效评定标准:优7例,良2例,可1例。10例中漏诊2例,漏诊率20%。结论股骨干及股骨转子间骨折合并同侧髋臼骨折受伤暴力大、机制复杂漏诊率较高,应早期明确诊断,合理内固定临床疗效尚好。%Objective: Explore the femoral shaft and intertrochanteric fracture with ipsilateral acetabular fracture treatment and the clinical efficacy .Methods: Femoral shaft and intertrochanteric fracture with ipsilateral acetabular fracture 10 cases, men; age 23- 56 years old, average 34.5 years old. Letournel acetabular fractures according to type, the posterior wal with 6 cases of posterior column fracture, 2 cases of posterior wal fractures alone are line Femoral shaft,Central fracture dislocation of the hip in 2 cases; with interlocking intramedul ary nailing Example,6; femur plate fixation line, intertrochanteric fracture of femur with dynamic hip screw fixation Example 4. Results: 10 patients were fol owed up for 12 months to 36 months, an average of 17.2 months. Clinical healing of fractures, hip function according to D’Aubigne efficacy criteria: excellent 7 cases, good in 2 cases, Example 1. Example 10 in two cases of missed diagnosis, missed diagnosis rate of 20%. Conclusion: Femoral shaft and intertrochanteric fracture with ipsilateral acetabular fracture were injured in the violence

  13. One stage treatment of acetabular fractures combined with ipsilateral femoral head or neck fractures with total hip arthroplasty%Ⅰ期全髋置换术治疗合并股骨头或股骨颈骨折的髋臼骨折

    唐孝明; 张耀明; 袁加斌; 庞健; 王跃

    2008-01-01

    目的 探讨全髋关节置换术(total hip arthroplasty,THA)治疗合并股骨头或股骨颈骨折的髋臼骨折方法、手术特点和疗效.方法 对7例合并股骨头或股骨颈骨折的髋臼骨折行Ⅰ期THA.髋臼骨折按AO分型:A型1例,B型3例,C型3例.股骨头骨折1例,股骨颈骨折6例.伤后7~21 d接受THA,5例行髋臼复位内固定后采用生物型髋臼,2例金属加强环配合骨水泥固定髋臼,股骨侧均采用生物型固定.结果 6例得到随访,平均随访时间3年9个月(2年3个月~6年5个月),出现脱位1例,经手法复位后未再脱位,1例出现异位骨化.所有随访患者髋关节功能均有明显改善,Harris评分术前平均48分,术后提高到91分.随访期内未发现假体松动.结论 THA是治疗合并同侧股骨头或股骨颈骨折髋臼骨折的有效方法,能显著改善关节功能,避免多次手术.%Objective To discuss method,operative characters and curative effect of total hip arthroplasty(THA)in treatment of acetabular fractures combined with ipsilateral femoral head or neck fractures.Methods One stage THA was done in seven patients with acetabular fractures combined with ipsilateral femoral head fracture(one patient)or femoral neck fractures(six patients)7-21 days after fractures.There were five males and two females,at age range of 41-65 years(average 50 years).According to AO classification,there were one patient with type A fracture,three with type B and three with type C.Of all,five patients received biological acetabular replacement after reduction and internal fixation of acetabular fracture and two received PMMA acetabular replacement with metal enforcement ring.All patients received biological femoral stem.Results Of all,six patients were followed up for from 2 years and 3 months to 6 years and 5 months(mean 3 years and 9 months),which showed heterotopic ossitlcation in one patient and dislocation in one who recovered after manipulative reduction.The Harris score was

  14. A Novel Fixation System for Acetabular Quadrilateral Plate Fracture: A Comparative Biomechanical Study

    Guo-Chun Zha

    2015-01-01

    Full Text Available This study aims to assess the biomechanical properties of a novel fixation system (named AFRIF and to compare it with other five different fixation techniques for quadrilateral plate fractures. This in vitro biomechanical experiment has shown that the multidirectional titanium fixation (MTF and pelvic brim long screws fixation (PBSF provided the strongest fixation for quadrilateral plate fracture; the better biomechanical performance of the AFRIF compared with the T-shaped plate fixation (TPF, L-shaped plate fixation (LPF, and H-shaped plate fixation (HPF; AFRIF gives reasonable stability of treatment for quadrilateral plate fracture and may offer a better solution for comminuted quadrilateral plate fractures or free floating medial wall fracture and be reliable in preventing protrusion of femoral head.

  15. One stage total hip arthroplasty for acetabular fractures%Ⅰ期全髋关节置换治疗髋臼骨折

    王子明; 孙红振; 王爱民; 杜全印; 吴思宇; 赵玉峰; 唐颖

    2008-01-01

    目的 探讨髋臼骨折后Ⅰ期全髋关节置换(total hip arthroplasty,THA)的手术适应证和手术方法,观察其临床疗效.方法 对11例髋臼骨折患者行Ⅰ期THA.其中前柱骨折3例,后壁骨折1例,后柱骨折2例,后柱合并后壁骨折2例,横形骨折1例,横形合并后壁骨折1例,两柱骨折1例.伤后8~37 d(平均24 d)接受THA.对新鲜髋臼骨折患者,先用重建钢板或螺钉固定骨折以恢复髋臼肇的形态,将切下的股骨头制成颗粒状或块状植于髋臼内后安置臼杯.陈旧性髋臼骨折有节段性髋臼骨缺损者,将切下的股骨头制成大块状进行髋臼内结构性植骨后再安置臼杯.结果 术后3个月完全负重,无人工关节脱位.随访时间6~45个月,平均28个月.Harris评分平均78分.髋关节屈伸平均活动度为95°.X线片示1例出现髋臼松动及骨溶解征象.结论 髋臼骨折移位明显,关节软骨面损伤严重,错过了手术复位时机,可以Ⅰ期行THA.如能创造稳定的髋臼杯结构,近期临床效果满意.%Objective To explore operative indications,methods and effect of one stage total hip arthroplasty(THA)in treatment of acetabular fractures.Methods One stage total hip arthroplasty (THA)was carried out in 11 patients with acetabular fractures including 10 males and one female(at mean age of 42.4 years)8-37 days(mean24 days)after injury.There were anterior column fractures in three patients,posterior wall fracture in one,posterior column fracture in two,posterior column fracture combined with posterior wall fracture in two,transverse fracture in one,transverse fracture combined with posterior wall fracture in one and two-column fracture in one.Fresh acetabular fractures were first fixed with reconstruction plate or screws to restore shape of acestbular wall;then,granule or bulk of resected femoral head were implanted into acetabulum posterior to placement of acetabular cup prosthesis.While for old acetabular fractures,the resected

  16. Fenestration operation for treatment of acetabular parastyle fracture combined with articular facet compression and collapse of acetabular top involving weight-bearing dome%开窗法复位植骨内固定治疗髋臼前柱骨折合并臼顶区关节面压缩塌陷的临床研究

    陈国富; 朱忠; 梁军波; 林列; 陈海啸

    2011-01-01

    Objective:To analyze the fenestration operation for treatment of acetabular parastyle fracture combined with articular facet compression and collapse of aeetabular top involving weight-bearing dome. Methods: From July 2005 to February 2007,52 cases of acetabular parastyle fracture combined with articular facet compression and collapse of acetabular top involving weight-bearing dome were treated by two methods. Among them, 24 cases were treated by fenestration operation for articular facet reduction,bone grafing,anatomical reconstruction of the acetabular papastyle with internal fixation,incuded 17 males and 7 females with an average age of(35.2±6.4) years old ;the other 28 cases were treated only anatomical reconstruction of the acetabular papastyle with internal fixation,included 19 males and 9 females with an average age of(36.4±4.8) years old.All the patients were evaluated with modified d'Aubigne-Postel clinical evaluation standard. Results:All patients gained bone healing. There were only 1 patient occurenced femoral nerve injury and recovered 2 months later. There were no other complications. All patients were followed up from 12 to 51 months (averaged in 31.5 months). According to modified d'Aubigne-Postel clinical evaluation standard, there were statistic difference between the two groups of patients in pain, walking, range of motion and total score. In fenestration operation group, the results were excellent in 13 patients, good in 9, fair in 1, poor in 1 ;in parastyle reduction group, the results were excellent in 9 patients, good in 11, fair in 6, poor in 2 (u=0.613, P<0.05 ). Conclusion: Fenestration operation for treatment of acetabular parastyle fracture combined with articular facet compression and collapse of acetabular top involving weight-bearing dome is a feasible methed for the recovery of hip joint function.%目的:探讨开窗法复位植骨内固定和单纯行前柱复位内固定治疗髋臼前柱骨折合并臼顶区关节面压

  17. Design of ABC damage variable and positioning system for acetabular fractures and 1122 cases of multi-center statistic analysis%髋臼骨折ABC损伤变数定位系统的设计与1122例多中心研究分析

    张春才; 苏佳灿; 曹烈虎; 徐永清; 阮墨; 陈庄洪; 黄继峰; 蔡贤华; 沈惠良; 刘利民; 王继芳; 许硕贵; 王岩; 唐佩福; 梁雨田; 王家让; 王愉思; 王振昊; 刘文德; 李文锐; 李文虎; 王序全; 禹宝庆; 周东生; 张鹏; 王仁; 王刚; 陈育岳; 丛永健; 纪方; 付青格; 刘欣伟; 章云童; 牛云飞; 王攀峰

    2011-01-01

    Objective:To design ABC damage variable and positioning system for acetabular fracture and explore the feasibility and clinical practical value of the system through the multi-center analysis of 1122 acetabular fractures. Methods: According to acetabular three-column conception, and pelvic ring lesions damage direction caused by acetabular fracture domino effect and injury degree of proximal femur joint,it defined class A as any column acetabular fracture; class B as any two-column acetabular fracture; class C as front,dome and posterior mixture acetabular fracture. Lower case English letters a,m,p represented front, dome, posterior fracture, respectively. Acetabular damage variables: 1 was simple displaced fractures; 2 was comminuted fractures; 3 was compression fractures. Pelvic ring lesions damage variables:α was sacroiliac joints or sacroiliac fracture horizontal separation deflection; β was sacroiliac joints or sacroiliac fracture vertical separation deflection; γwas pubic symphysis separation/superior and inferior ramus of pubis fracture deflection; αβγδ was compound floating damage. Proximal humerus joint damage variables: Ⅰ was femoral head fracture; Ⅱ was femoral neck fracture; Ⅲ was intertrochanteric fractures of femur; Ⅳ was Ⅰ to Ⅲ compound fracture. The ABC damage variable positioning system for acetabular fracture was made up by the above-mentioned variables. The statistics from March 1997 to February 2010 showed 1122 cases acetabular fractures with 18 cases of double side acetabular fracture and 1140 cases of acetabular fractures. The pelvics anterior-posterior view,ilium and obturator oblique view, and 2/3D-CT materials were analyzed and researched. Results: Each damage variables distribution situation in 1140 cases of acetabular fracture involved A in 237 cases (20.8%), B in 605 cases (53.1% ), C in 298 cases (26.1%);front column fracture in 808 cases (70.9%), dome fracture in 507 cases (44.5%), posterior fracture in

  18. 三维记忆内固定与髋臼重建钛板系统修复髋臼后壁骨折伴关节后脱位的比较%Three-dimensional memory fixationversusreconstruction titanium plate to repair posterior wall acetabular fracture with posterior dislocation

    梁云扬

    2015-01-01

    通过对髋臼三维记忆内固定系统在髋臼后壁骨折伴髋臼关节后脱位中临床应用效果的分析,了解其治疗髋臼后壁骨折伴髋臼关节后脱位的可行性与特点。研究发现,其在固定时间及术后功能恢复等方面较之重建钛板内固定都具有明显的应用优势。%BACKGROUND:Posterior wal fractures of the acetabulum with posterior dislocation of the acetabular joint mostly require the operation of open reduction and internal fixation. Different materials can be chosen for internal fixation operation. OBJECTIVE: To explore the effect of acetabular three-dimensional memory fixation system on acetabular posterior wal fractures accompanying the acetabulum joint dislocation. METHODS: A retrospective analysis was performed on clinical data of 92 cases of acetabular posterior wal fracture and dislocation at the Heze Municipal Hospital of Shandong Province from February 2010 to February 2014. Al patients received the operation of open reduction and internal fixation. They were divided into three-dimensional memory fixation group (45 cases) and reconstruction titanium plate group (47 cases) according to different fixators. Al patients were folowed up for 12 months after fixation. RESULTS AND CONCLUSION:The operation time and intraoperative blood loss were significantly longer or higher in the reconstruction titanium plate group than in the three-dimensional memory fixation group (P < 0.05). Harris score was significantly greater in the three-dimensional memory fixation group than in the reconstruction titanium plate group during final folow-up (P < 0.05). Thromboembolic complications or deep infection were not detected after fixation in both groups. These findings confirm that three-dimensional memory fixation system obtained good effects in the treatment of the posterior wal fractures of the acetabulum with posterior dislocation.

  19. Extremely high fracture rate of a modular acetabular component with a sandwich polyethylene ceramic insertion for THA: a preliminary report.

    Kircher, Jörn; Bader, Rainer; Schroeder, Bettina; Mittelmeier, Wolfram

    2009-09-01

    Improvements of ceramic components and design changes have reduced failure rates over the past 30 years in total hip arthroplasty. We present a series of n = 11 cases with ceramic failure out of n = 113 implantations, from which n = 66 were ceramic-on-ceramic (n = 50 with ceramic insert with sandwich in polyethylene and n = 16 with directly fixed ceramic inlay) and n = 47 ceramic on polyethylene bearings, between 1999 and 2001 after introduction of a new implantation system to the market. The overall fracture rate of ceramic for the whole series (n = 113) was 9.7%. For the combination ceramic head with UHMW-PE (n = 47) the fracture rate was 2.1%. For the combination ceramic with ceramic (n = 66) the fracture rate was 15.2%. For the combination ceramic with ceramic sandwich in PE (n = 50) the failure rate was 18%. Only three patients experienced a trauma. Demography of patients (age, gender, body weight and BMI) was not statistically different between patients with failed ceramics and the rest of the patients making patient-specific risk factors unlikely to be an explanation for the failures. Retrospective X-ray analysis of the cup positioning did not show significant difference between failed and non-failed implants in terms of mean cup inclination and version making also operation-specific factors unlikely to be the only reason of this high failure rate. Therefore, manufacturer-specific factors such as design features may have contributed to this high failure rate. Further analysis of the whole series with biomechanical testing of the retrieved material needs to be performed. PMID:18568354

  20. Osteopathic diagnosis of an acetabular injury.

    Morthland, Tim; Cote, Nicholas S; Humphrey, Jon; Fulk, Doug

    2010-05-01

    Physical findings demarking pathologic somatovisceral reflex activity and fascial strain patterns may lead the osteopathic physician to diagnoses that are masked within the initial presentation of a patient. The authors present a case report that demonstrates the use of osteopathic principles in the diagnosis of a chronic acetabular fracture and acetabular labral tear in a 19-year-old man. The injuries resulted from a posterior hip dislocation sustained during a basketball game more than 1 year before presentation. Osteopathic manipulative treatment and diagnostic techniques also relieved the patient's persistent thoracic pain, nausea, and vomiting. Subsequent orthopedic repair had the potential to avert or delay degenerative hip disease in the patient. PMID:20538751

  1. Loosening After Acetabular Revision

    Beckmann, Nicholas A.; Weiss, Stefan; Klotz, Matthias C.M.;

    2014-01-01

    The best method of revision acetabular arthroplasty remains unclear. Consequently, we reviewed the literature on the treatment of revision acetabular arthroplasty using revision rings (1541 cases; mean follow-up (FU) 5.7 years) and Trabecular Metal, or TM, implants (1959 cases; mean FU 3.7 years)...

  2. Classification to guide internal fixation for tibial fracture

    ZHANG Wen-xi; ZHENG Zhi-liang; JI Yue-ping; QIAO Zhi-jun

    2008-01-01

    Objective: To explore a classification method which can provide the clinical guidance for internal fixation of tibial fracture. Methods: The different fractures were fixed according to their mechanical classification. Totally, 71 cases of tibial plateau fracture, tibial proximal fracture, tibial distal fracture and Pilon fracture were analyzed to test this selective principle. Results: All 71 patients were followed up for 6-32 months. The displacement was seldomly observed in cases treated acccording to the classification principle, while some cases against the principle had postoperative displacement. The difference was statistically significant (P<0.05). It was proved that there was remarkable correlation between tibial fracture classification, internal fixator and fixation methods. Conclusion: Types IIIa3, IIIbl and IIIb2 fractures without eccentric moment should be fixed with double plates or anglestable materials combined with locking structure, otherwise displacement may occur.

  3. Measurements of the posterior acetabular surface and design of a new anatomical locking plate for acetabular fractures%髋臼后表面解剖形态测量及新型解剖锁定钢板的设计

    张里程; 张立海; 许猛; 尹鹏; 赵喆; 吕厚辰; 尹鹏滨; 唐佩福

    2014-01-01

    directions of screws preset completely avoided the acetabulum.Conclusion The new type of anatomical locking plate we designed provides a new choice for the treatment of acetabular fractures,because it perfectly fits the anatomic shape of the posterior acetabular wall and presets reasonable directions of the locking screws to ensure better stability and safety of the fixation.%目的 基于髋臼后表面的三维重建解剖形态数据库,自行设计符合髋臼后表面形态且具有成角稳定作用的新型解剖锁定钢板. 方法 共纳入171例全骨盆,男100例,女71例;年龄18 ~ 60岁,平均45.9岁;将所有骨盆.dicom格式的影像学资料导入Mimics 10.0版软件进行三维重建及编辑,并保存为.stl格式文件,再导入Imageware V12.1软件,设立髋臼表面标准点、标准平面后进行图像分割和测量,得到髋臼后表面的点云数据库,并通过该点云数据库拟合形成髋臼后表而曲面,以设计锁定钢板形态和角度锁定螺钉系统最后,将设计好的钢板和螺钉数据输入数码铣床获得实体钢板. 结果 男、女髋臼直径平均分别为(57.6±2.9) mm、(52.6 ±2.6)mm,髋臼后壁宽度平均分别为(40.7±2.9)mm、(38.4±2.4) mm,以上项目男女之间比较差异均有统计学意义(P<0.05);但采用1/10髋臼直径(d)作为度量单位标准化后,男、女髋臼后壁宽度平均分别为(7.10±0.52)个d/10单位、(7.16±0.47)个d/10单位,差异无统计学意义(P>0.05).设计的新型髋臼解剖锁定钢板与云数据库所拟合的髋臼后表面曲面吻合好,钢板偏离骨表面的平均距离为(3.2±1.0)mm.而且随机抽取髋臼样本三维图像与设计的钢板图像完全吻合.预设的螺钉打入方向可完全避让髋臼. 结论 设计的髋臼新型解剖锁定钢板解剖形态匹配性好,锁定螺钉成角稳定性强,可完全避开髋臼方向,安全性高,为复杂髋臼骨折的治疗提供了新的选择.

  4. 髋臼横行骨折采用前后柱拉力螺钉结合重建钢板固定疗效分析%Analysis of the Effect of the Acetabular Transverse Fracture Using the Lag Screw of the Acetabulum and the Reconstruction Plate With the Reconstruction Plate

    张立峰; 冯卫; 包道日娜; 冬梅; 佟雁翔

    2015-01-01

    Objective To investigate the clinical effect of the application of the acetabular transverse fracture in the treatment of the acetabular fracture and the reconstruction of the plate fixation with the lag screw of the acetabulum. Methods 50 cases of patients with transverse acetabular fracture were selected,and subject to acetabular posterior column lag screw combined with reconstruction plate fixation treatment,Bleeding volume,operation time, the acetabulum repositioning and hip joint function recovery after surgical of patients were observed. Results The average operation time was 3.5 hours, the average amount of bleeding was 950ml, according to Matta reduction, 25 cases of anatomic reduction, satisfactory reduction in 21 cases, 4 cases of unsatisfactory reduction, and the excellent and good rate of hip joint function was 86.0%. Conclusion The clinical effect of the acetabular transverse fracture patients with the acetabular anterior and posterior column lag screw combined with the reconstruction plate fixation is worthy of promotion.%目的:探讨对髋臼横行骨折患者应用髋臼前后柱拉力螺钉结合重建钢板固定治疗的临床疗效。方法选取髋臼横行骨折患者50例,对其进行髋臼前后柱拉力螺钉结合重建钢板固定手术治疗,观察患者手术时出血量、手术时间等,手术治疗后患者髋臼复位情况以及髋关节功能恢复情况。结果平均手术时间为3.5小时,平均出血量为950 ml,根据 matta 复位,25例解剖复位,21例满意复位,4例复位不满意,髋关节功能优良率为86.0%。结论对髋臼横行骨折患者采取髋臼前后柱拉力螺钉结合重建钢板固定手术治疗临床疗效突出。

  5. Internal fixation for stress fractures of the ankylosed spine.

    Marsh, C H

    1985-01-01

    Three cases of stress fractures affecting the rigid spine of ankylosing spondylitis are reported. Even without the typical destructive features of the Romanus lesion, symptoms may be very prolonged and disabling and the diagnosis difficult. Internal fixation produces immediate pain relief and rapid fracture union.

  6. 经髂腹股沟和Kocher-Langenbeck联合入路治疗复杂移位髋臼骨折%Treatment of complex acetabular fractures with combined ilio-inguinal and Kocher-Langenbeck approach

    连鸿凯; 李兴华; 王爱国; 白玉

    2011-01-01

    Objective To investigate the clinical effect and treatment experience of complicated acetabular fractures treated with open reduction with combined ilio-inguinal and Kocher-Langenbeck (K-L) approaches.Methods Sixty-six patients with complicated acetabular fractures were treated surgically with combined ilio-inguinal and K-L approaches from February 2004 to December 2009.Among them,45 cases were followed up for 8-45 months,with the average 26 months.Results Operation time was 1.4-5.7 h,with the average of 2.8 h.Intraoperative blood loss was 530-2300 ml,with the average of 1250 ml.According to Matta's score system,the excellent and good rate was 86.7%.According to modified Merle d' Aubigne and Postel score system,the excellent and good rate of function of hip was 86.7%.According to Brooker heterotopic ossification standard assessment system:Ⅰ degrees in 6,Ⅱ degrees in 3.According to Letournel and Judet clinical classification system,postoperative traumatic arthritis were 6 patients.Among them,3 patients with Ⅲ- Ⅴ period with symptoms of serious hip pain and joint activities obstacles were treated with total hip replacement secondly.Six cases of sciatic nerve injury and 9 cases of lateral femoral cutaneous nerve damage were recovered gradually after six months to a year.All incisions healed primarily.All got bony union,the healing time was 8 to 16 weeks,with the average of 10.4 weeks.None was complicated with femoral head necrosis.Conclusion For the patients with complicated acetabular fractures,open reduction with combined ilio-inguinal and K-L approaches can get clinical advantages of revealed fully,fracture restoration convenient,fixed tightly,fewer complications and satisfactory result.%目的 探讨采用经髂腹股沟和Kocher-Langenbeck(K-L)联合入路行切开复位内固定治疗复杂移位髋臼骨折的疗效.方法2004年2月至2009年12月,采用经髂腹股沟和K-L联合入路治疗66例复杂移位髋臼骨折,对其中获得随访的45

  7. Open reduction and internal fixation of radial head fractures.

    King, G J; Evans, D C; Kellam, J F

    1991-01-01

    Open reduction and internal fixation of displaced fractures of the radial head were reviewed in 14 elbows. Follow-up averaged 32 months. The average elbow score for Mason type II fractures was 96.8 points, corresponding to 100% good or excellent results. Average flexion was 142.5 degrees, and the mean fixed flexion deformity was 3.9 degrees. There was no loss in grip strength. An almost normal elbow was the expected result. Good or excellent results were achieved in only 33% of Mason type III fractures treated with open reduction and internal fixation. The average elbow score was 72.9 points, and this was statistically significantly different than the Mason type II fractures (p less than 0.05). An associated elbow dislocation did not affect the results significantly, but was associated with a slightly increased fixed flexion deformity. Fractures may be more comminuted than suggested by plain radiographs, and intraoperative decision making is required in deciding between reconstruction or excision of the radial head. Excellent results were obtained provided an anatomical reduction with stable fixation and early range of motion were achieved. If a stable anatomic reduction cannot be obtained, then alternative treatment methods should be considered. PMID:2023039

  8. Open reduction internal fixation of lateral humeral condyle fractures in children. A series of 105 fractures from a single institution

    Leonidou, Andreas; Chettiar, Krissen; Graham, Simon; Akhbari, Pouya; Antonis, Konstantinos; Tsiridis, Eleftherios; Leonidou, Omiros

    2014-01-01

    Lateral humeral condyle fractures account for 17 % of the distal humeral condyle fractures. Displaced and/or rotated fractures require appropriate reduction and stabilisation. There are, however, a number of controversies in the surgical management of these patients. The aim of the present study was to review the results of patients with a displaced lateral humeral condyle fracture treated with open reduction and internal fixation (ORIF). We retrospectively reviewed children treated with ORIF...

  9. Three-dimensional model of cementless acetabular cup migration

    Jíra, J.; Jiroušek, Ondřej; Jírová, Jitka; Micka, Michal

    Lisbon : CivilComp Press, 2004 - (Tooping, B.; Mota Soares, C.), s. 699 ISBN 0-948749-93-8. [The Seventh International Conference on Computational Structures Technology. Lisabon (PT), 07.09.2004-09.09.2004] Institutional research plan: CEZ:AV0Z2071913 Keywords : loosening and migration of cementless acetabular cup * pelvis * FE model Subject RIV: FI - Traumatology, Orthopedics

  10. Comparison of acetabular reamings during hip resurfacing versus uncemented total hip arthroplasty.

    Brennan, S A

    2009-04-01

    PURPOSE: To compare the quantity of bone removed from the acetabulum during resurfacing hip arthroplasty versus uncemented total hip arthroplasty (THA). METHODS: 62 consecutive patients with osteoarthritis of the hip were prospectively studied. 24 men and 7 women aged 40 to 86 (mean, 59) years underwent Birmingham hip resurfacing. 13 men and 18 women aged 34 to 88 (mean, 61) years underwent uncemented THA using the trident acetabular cup. Obese elderly women at risk of femoral neck fracture and patients with large subchondral pseudocysts or a history of avascular necrosis of the femoral head were assigned to uncemented THA. Acetabular reamings were collected; marginal osteophytes were not included. The reamings were dehydrated, defatted, and weighed. RESULTS: The mean weight of acetabular reamings was not significantly different between patients undergoing hip resurfacing and uncemented THA (p=0.57). CONCLUSION: In hip resurfacing, the use of an appropriately small femoral component avoids oversizing the acetabular component and removal of excessive bone stock.

  11. 3D visualization of the Letournel-Judet clssification of acetabular fractures based on a desktop virtual reality%基于桌面虚拟现实技术实现髋臼骨折Letournel-Judet分类的三维浏览

    苏秀云; 刘蜀彬; 裴国献

    2011-01-01

    目的 介绍使用HTML和虚拟现实建模语言(VRML)建立通过Web远程访问的髋臼骨折Letournel-Judet分类三维数字化浏览. 方法 首先,根据髋臼骨折Letounel-Judet分型,将重建的1例女性志愿者髋部骨骼模型通过Mimics软件的仿真模块切割模拟每一种骨折类型,将每一种骨折类型的骨折块以虚拟现实建模语言的格式.wrl导出.其次,编辑html网页,为每个骨折块建一个主菜单,每个主菜单设立调整透明度(透明、恢复、隐藏和显示)的子菜单.最后,编辑VRML文件,基于JavaScript语言建立 HTML与 VRML的通迅,实现各种骨折类型骨折块不同透明度的任意组合显示.结果 建立了髋臼骨折Letournel-Judet三维数字化分类系统(它分为5个部分),可以方便的通过远程网络访问.结论 该方法可以方便地应用于临床,提供对髋臼骨折的诊断与分析功能,使临床医生在极短的时间内可以对各类骨折的发生状况做出正确诊断.%Objective To establish a 3D atlas of Letournel-Judet classifications of acetabular fractures which provides remote access on the web through hypertext markup language (HTML) and virtual reality modeling language (VRML) for efficient remote diagnosis. Methods Firstly,different Letournel-Judet classifications of acetabular fracture were simulated based on 3D reconstruction models of healthy volunteers via Mimics software.The files of VRML format were exported after geometry modeling.Secondly,The.wrl files were edited by adding nodes of Sensor,Route,and Script to the files to make the static scene respond to users' interaction.Finally,the homepage of 3D atlas was established with the Dreamweaver software.Results The 3D atlas of Letournel-Judet classifications of acetabular fractures was established which can be accessed online.These virtual worlds can be browsed via the Internet and hyperlinked with the World Wide Web. Conclusion The 3D atlas of Letournel-Judet classifications of

  12. Options for acetabular fixation surfaces.

    Klika, Alison K; Murray, Trevor G; Darwiche, Hussein; Barsoum, Wael K

    2007-01-01

    Aseptic loosening is the most common cause for revision total hip arthroplasty (THA). Due to poor long-term results with cemented acetabular components, cementless implants that rely on biologic fixation became popular in the United States for both primary and revision procedures in the early 1980s. Cementless acetabular components used in THA have been reported to have superior radiographic performance compared with cemented fixation, although the optimal method of acetabular fixation remains controversial. Cementless acetabular components require initial implant stability to allow for bone ingrowth and remodeling into the acetabular shell, providing long-term durability of the prosthesis. Many improved implant materials are available to facilitate bone growth and remodeling, including the 3 most common surface treatments; fibermesh, sintered beads, and plasma spray coatings. Recently added to these are porous metal surfaces, which have increased porosity and optimal pore sizes when compared with titanium fibermesh. The most studied of these materials is the titanium fibermesh fixation surface, which has demonstrated a mechanical failure rate of 1% at 10 to 15 years. This technology utilizes the diffusion bonding process to attach fiber metal pads to a titanium substrate using heat and pressure. The sintered bead fixation surface offers a porous coating of various sizes of spherical beads, achieved by the sintering process, and has been shown to provide long-term fixation. While there are less long-term published data regarding the titanium plasma spray surface, its early results have provided evidence of its durability, even in the face of significant osteolysis. The most recently added alternative fixation surface is porous tantalum metal, which offers potentially greater bone ingrowth and bone graft incorporation due to its high porosity (80%) and low modulus of elasticity (3 MPa). Porous tantalum implants have shown early favorable clinical results and have

  13. Treatment of severe bone deficiency in acetabular revision surgery using a reinforcement device and bone grafting

    ZHAI Ji-liang; LIN Jin; JIN Jin; QIAN Wen-wei; WENG Xi-sheng

    2011-01-01

    Background Severe acetabular bone deficiency is a major challenge in acetabular revision surgery. Most cases require reconstruction of the acetabulum with bone grafting and a reinforcement device. The purpose of this study was to evaluate the results of this procedure for severe acetabular bone deficiency in acetabular revision surgery.Methods This study involved 12 patients (2 males and 10 females) with severe acetabular bone defects who underwent implantation of a reinforcement device (ring or cage) and bone grafting between February 2003 and October 2008. Using the Paprosky classification, 2 cases were Paprosky ⅡC, 6 were ⅢA, and 4 were ⅢB. The mean age at the time of surgery was 63.0 years (range, 46-78 years). During revision surgery, a reinforcement ring was implanted in 6patients, and a cage in 6 patients. The clinical and radiographic results were evaluated retrospectively. The mean duration of follow-up was 37 months (range, 9-71 months).Results The average Harris Hip Score improved from 35.2 preoperatively to 82.9 at the time of the final follow-up visit.The results were excellent in 8 hips (66.7%), good in 2 (16.7%), and fair in 2 (16.7%). Osteolysis was found in 1 case, but did not worsen. Three patients had yellow wound effusion, with healing after administration of dressing changes,debridement, and antibiotics. Dislocation occurred in a 62-year-old woman. Closed reduction was performed, and dislocation did not recur. There was no evidence of intraoperative acetabular fracture, nerve injury, ectopic ossification,aseptic loosening, or infection.Conclusion Reconstruction with a reinforcement device and bone grafting is an effective approach to the treatment of acetabular bone deficiency in acetabular revision surgery, given proper indications and technique.

  14. Common site of subchondral insufficiency fractures of the femoral head based on three-dimensional magnetic resonance imaging

    The objective of this study was to investigate the common sites of subchondral insufficiency fractures of the femoral head (SIF) based on three-dimensional (3-D) reconstruction of MR images. In 33 hips of 31 consecutive patients diagnosed with SIF, 3-D reconstruction of the bone, fracture, and acetabular edge was performed using MR images. These 3-D images were used to measure the fractured areas and clarify the positional relationship between the fracture and degree of acetabular coverage. The fractured area in the anterior portion was significantly larger than in the posterior area. In 11 cases, the fractures contacted the acetabular edge and were distributed on the lateral portion. The indices of acetabular coverage (center-edge angle and acetabular head index) in these cases were less than the normal range. In the remaining 22 cases, the fractures were apart from the acetabular edge and distributed on the mediolateral centerline of the femoral head. The majority of these cases had normal acetabular coverage. The common site of SIF is the anterior portion. In addition, two types of SIF are proposed: (1) Lateral type: the contact stress between the acetabular edge and lateral portion of the femoral head causes SIF based on the insufficient acetabular coverage, and (2) Central type: the contact stress between the acetabular surface and the mediolateral center of the femoral head causes SIF independent from the insufficiency of acetabular coverage. These findings may be useful for considering the treatment and prevention of SIF. (orig.)

  15. Common site of subchondral insufficiency fractures of the femoral head based on three-dimensional magnetic resonance imaging

    Iwasaki, Kenyu; Yamamoto, Takuaki; Motomura, Goro; Karasuyama, Kazuyuki; Sonoda, Kazuhiko; Kubo, Yusuke; Iwamoto, Yukihide [Kyushu University, Department of Orthopaedic Surgery Graduate School of Medical Sciences, Higashi-ku, Fukuoka (Japan)

    2016-01-15

    The objective of this study was to investigate the common sites of subchondral insufficiency fractures of the femoral head (SIF) based on three-dimensional (3-D) reconstruction of MR images. In 33 hips of 31 consecutive patients diagnosed with SIF, 3-D reconstruction of the bone, fracture, and acetabular edge was performed using MR images. These 3-D images were used to measure the fractured areas and clarify the positional relationship between the fracture and degree of acetabular coverage. The fractured area in the anterior portion was significantly larger than in the posterior area. In 11 cases, the fractures contacted the acetabular edge and were distributed on the lateral portion. The indices of acetabular coverage (center-edge angle and acetabular head index) in these cases were less than the normal range. In the remaining 22 cases, the fractures were apart from the acetabular edge and distributed on the mediolateral centerline of the femoral head. The majority of these cases had normal acetabular coverage. The common site of SIF is the anterior portion. In addition, two types of SIF are proposed: (1) Lateral type: the contact stress between the acetabular edge and lateral portion of the femoral head causes SIF based on the insufficient acetabular coverage, and (2) Central type: the contact stress between the acetabular surface and the mediolateral center of the femoral head causes SIF independent from the insufficiency of acetabular coverage. These findings may be useful for considering the treatment and prevention of SIF. (orig.)

  16. Placement of the acetabular component.

    Beverland, D E; O'Neill, C K J; Rutherford, M; Molloy, D; Hill, J C

    2016-01-01

    Ideal placement of the acetabular component remains elusive both in terms of defining and achieving a target. Our aim is to help restore original anatomy by using the transverse acetabular ligament (TAL) to control the height, depth and version of the component. In the normal hip the TAL and labrum extend beyond the equator of the femoral head and therefore, if the definitive acetabular component is positioned such that it is cradled by and just deep to the plane of the TAL and labrum and is no more than 4mm larger than the original femoral head, the centre of the hip should be restored. If the face of the component is positioned parallel to the TAL and psoas groove the patient specific version should be restored. We still use the TAL for controlling version in the dysplastic hip because we believe that the TAL and labrum compensate for any underlying bony abnormality. The TAL should not be used as an aid to inclination. Worldwide, > 75% of surgeons operate with the patient in the lateral decubitus position and we have shown that errors in post-operative radiographic inclination (RI) of > 50° are generally caused by errors in patient positioning. Consequently, great care needs to be taken when positioning the patient. We also recommend 35° of apparent operative inclination (AOI) during surgery, as opposed to the traditional 45°. PMID:26733639

  17. Persistent knee complaints after retrograde unreamed nailing of femoral shaft fractures

    El Moumni, Mostafa; Schraven, Pim; ten Duis, Henk Jan; Wendt, Klaus

    2010-01-01

    Retrograde nailing is an attractive method for stabilisation of femoral shaft fractures in cases of polytrauma, ipsilateral pelvic, acetabular, tibial and femoral neck fractures, bilateral femoral fractures, obese and pregnant patients. However, retrograde nailing may result in complaints about the

  18. Treatment of proximal humeral fractures with open reduction and internal fixation with Kirschner wires

    Esenyel, Cem Zeki; Yesiltepe, Ridvan; Bulbul, Murat; Bagriacik, Adnan; Kara, Ayhan Nedim

    2004-01-01

    Objectives: We evaluated the results of patients who were treated with open reduction and internal fixation for displaced proximal humeral fractures. Methods: Sixteen patients (mean age 49.31 years, range 22 to 78 years) with displaced proximal humeral fractures were treated by open reduction and internal fixation with Kirschner wires. According to the Neer classification, three patients had type II, 11 patients had type III, and two patients had type IV fractures. The mean duration betwee...

  19. Treatment of Edentulous Mandibular Fractures with Rigid Internal Fixation: Case Series and Literature Review

    Franciosi, Edgardo; Mazzaro, Eduardo; Larranaga, Juan; Rios, Alfredo; Picco, Pedro; Figari, Marcelo

    2014-01-01

    The aim of the study is to analyze the effectiveness of rigid internal fixation (RIF) for treating edentulous mandibular fractures. Because of the low incidence of fractures in edentulous mandible, there is no consensus of the optimal treatment for it. This study included all edentulous patients with mandibular fracture diagnosis, who were treated with internal fixation at the Hospital Italiano de Buenos Aires from November 1991 to July 2011. Data such as age, gender, etiology and location of...

  20. Evaluating the effect of internal aperture variability on transport in kilometer scale discrete fracture networks

    Makedonska, Nataliia; Hyman, Jeffrey D.; Karra, Satish; Painter, Scott L.; Gable, Carl W.; Viswanathan, Hari S.

    2016-08-01

    The apertures of natural fractures in fractured rock are highly heterogeneous. However, in-fracture aperture variability is often neglected in flow and transport modeling and individual fractures are assumed to have uniform aperture distribution. The relative importance of in-fracture variability in flow and transport modeling within kilometer-scale field-scale fracture networks has been under a matter of debate for a long time because the flow in each single fracture is controlled not only by in-fracture variability but also by boundary conditions. Computational limitations have previously prohibited researchers from investigating the relative importance of in-fracture variability in flow and transport modeling within large-scale fracture networks. We address this question by incorporating internal heterogeneity of individual fractures into flow simulations within kilometer scale three-dimensional fracture networks, where fracture intensity, P32 (ratio between total fracture area and domain volume) is between 0.027 and 0.031 [1/m]. A recently developed discrete fracture network (DFN) simulation capability, dfnWorks, is used to generate DFNs that include in-fracture aperture variability represented by a stationary log-normal stochastic field with various correlation lengths and variances. The Lagrangian transport parameters, non-reacting travel time and cumulative retention, are calculated along particles streamlines. It is observed that due to local flow channeling early particle travel times are more sensitive to in-fracture variability than the tails of travel time distributions, where no significant effect of the in-fracture transmissivity variations and spatial correlation length is observed.

  1. Relationship between Wiberg's lateral center edge angle, Lequesne's acetabular index, and medial acetabular bone stock

    Knowledge of acetabular anatomy is crucial for cup positioning in total hip replacement. Medial wall thickness of the acetabulum is known to correlate with the degree of developmental dysplasia of the hip (DDH). No data exist about the relationship of routinely used radiographic parameters such as Wiberg's lateral center edge angle (LCE-angle) or Lequesne's acetabular index (AI) with thickness of the medial acetabular wall in the general population. The aim of our study was to clarify the relationship between LCE, AI, and thickness of the medial acetabular wall. Measurements on plain radiographs (LCE and AI) and axial CT scans (quadrilateral plate acetabular distance QPAD) of 1,201 individuals (2,402 hips) were obtained using a PACS imaging program and statistical analyses were performed. The mean thickness of the medial acetabulum bone stock (QPAD) was 1.08 mm (95% CI: 1.05-1.10) with a range of 0.1 to 8.8 mm. For pathological values of either the LCE (12 ) the medial acetabular wall showed to be thicker than in radiological normal hips. The overall correlation between coxometric indices and medial acetabular was weak for LCE (r =-0.21. 95% CI [-0.25, -0.17]) and moderate for AI (r = 0.37, [0.33, 0.41]). We did not find a linear relationship between Wiberg's lateral center edge angle, Lequesne's acetabular index and medial acetabular bone stock in radiological normal hips but medial acetabular wall thickness increases with dysplastic indices. (orig.)

  2. Fractures of the radial head treated by internal fixation: late results in 26 cases.

    Esser, R D; Davis, S; Taavao, T

    1995-01-01

    Twenty-six patients, ranging in age from 14 to 57 years (average 29 years), were evaluated an average of 7 years and 4 months (range 1-14 years) after open reduction and internal fixation of a displaced radial head fracture. Using Mason's classification, there were 11 type II fractures, 9 type III fractures, and 6 type IV fractures with associated dislocation of the elbow. Seven patients had ipsilateral extremity injuries that included fractures of the coronoid process, capitellum, humerus, and distal radius. Using the Broberg and Morrey elbow score, good or excellent results were achieved in all Mason type II and type III fractures. Four of the six Mason type IV fractures were rated good or excellent. Fair results were obtained in two patients who had an associated dislocation of the elbow and multiple ipsilateral extremity injuries. In these two patients, secondary excision of the radial head relieved pain and yielded some improvement in flexion and forearm rotation. PMID:7562154

  3. Fracture union and complication following internal fixation of clavicle by plate and screw

    Bishnu Prasad Patro; Saroj Kumar Patra; Subrat Mohapatra

    2016-01-01

    Background: Among all long bones clavicle is the only bone placed horizontally and has membranous ossification. Clavicle fractures accounting for about 2.6% of total body fractures and 34% to 45% of total shoulder girdle injuries in adults. Most fractures occur in middle third of clavicle and common in young male patients. It has wide range of management from conservative to variant internal fixation. Each procedure has its own outcome and complications. We tried to find out the outcome and c...

  4. The Fifth International conference Deformation and fracture of materials and nanomaterials DFMN-2013. Conference proceedings

    The reports of the Fifth International Conference Deformation and fracture of materials and nanomaterials DFMN -2013, Moscow, 26-29 November 2013 are presented. The results of studies in the field of strength, deformation and fracture of materials and nanomaterials are discussed at the conference. Seminars and exhibition acquainting the participants and guests of the conference with the latest models of equipment for the study of the structure, the processes of deformation and fracture of materials and nanomaterials were conducted

  5. Bilateral traumatic proximal humerus fractures managed by open reduction and internal fixation with locked plates

    Atin Jaiswal; Naiman Deepak Kachchhap; Rupak Chaterjee; Yashwant Singh Tanwar; Masood Habib; Satya Prakash Singh

    2013-01-01

    Fractures of the proximal humerus are uncommon in young patients.Although bilateral fracture of proximal humerus itself is rare,association with epilepsy and electrocution is frequent.Only one case of traumatic bilateral proximal humerus fracture has been reported in the literature.We report a rare case of bilateral traumatic displaced proximal humerus fractures in a 40 years old male patient,which was treated by means of open reduction and internal fixation with proximal humerus locked pates on both sides and obtained a good functional outcome.

  6. Outcome of open reduction and internal fixation of intraarticular calcaneal fracture fixed with locking calcaneal plate

    Jain Saurabh; Jain Anil Kumar; Kumar Ish

    2013-01-01

    【Abstract】Objective: Debate continues regarding the management of calcaneal fractures, between open re- duction and internal fixation and closed treatment. Hence we aim at evaluating the radiological and functional out- comes of open reduction and internal fixation in displaced joint depression type of calcaneal fractures fixed with lock- ing calcaneal plate. Methods: In this series, 28 patients (26 unilateral and 2 bilateral) with joint depression type of calcaneal fr...

  7. 联合入路治疗复杂髋臼骨折的预后及影响因素分析%Prognosis of complex acetabular fractures treated by combined approaches

    王光林; 张晖; 吴刚; 杨天府; 池雷霆; 方跃; 王京生

    2009-01-01

    目的 回顾性研究采用前后联合入路治疗复杂髋臼骨折患者的预后及影响因素. 方法自2000年1月至2006年8月采用前后联合入路治疗且获得2年以上随访的复杂髋臼骨折患者共28例(28髋),对患者术后进行复位质量和远期影像学评价.根据改良的Merle d'Aubigné和Postel评分标准及SF-36简便型健康调查问卷(MOS SF-36)对患者的髋关节临床功能和生命质量进行评估.分析本组患者与一般人群的生命质量有无差异,预后因素与功能结果的相关性. 结果所有患者平均随访31个月(14~82个月),影像学评估显示术后初始影像显示解剖复位17例(60.7%),良好复位9例(32.2%),差复位2例(7.1%).远期影像学结果:优16例,良7例,可3例,差2例,优良率82.1%(23/28).发生异位骨化18例(64.3%),股骨头缺血坏死2例(7.1%).改良Merle d'Aubigné和Postel平均得分15.5分(10~18分).优4例,良18例,可4例,差2例,优良率78.6%(22/28).对于复杂髋臼骨折患者,生命质量在一般健埭状况、生命力、情感角色和心理健康等4个维度与一般人群差异无统计学意义(P>0.05),在躯体功能、躯体角色、机体疼痛和社会功能等4个维度较一般人群下降(P0.05); however, the domains of physical function, physical role, body pain and social function had significantly lower scores(P<0.05) . Conclusions Indications for the combined approaches are limited to complex fracture patterns involved both columns, such as both column fractures, transverse and posterior wall fractures and T-type fractures, for which anatomical (or good) reduction or rigid internal fixation cannot be achieved by a single approach. The quality of reduction is a crucial and controllable prognostic factor.

  8. Management of recurrent fracture of central incisor with internal resorption using light transmitting (luminex post

    Hariharan V

    2010-01-01

    Full Text Available The normal root canal anatomy may be altered in various pathological processes and making it very difficult and at times impossible to achieve ideal obturation by normal methods. Internal resorption is one among them. There are several treatment protocols advised for this pathological condition. A crown-root fracture is defined as a fracture involving enamel, dentin and cementum and accounts for 5% of all traumatic injuries to the permanent dentition. In anterior teeth, these fractures are usually caused by direct trauma and often complicated in fully erupted teeth. In cases where the fracture line extends down along the long axis of the root, extraction of the tooth is indicated. The purpose of this report is to present the use of light transmitting post system to reinforce the crown root fractured maxillary central incisor due to trauma and internal resorption.

  9. Importance of maintaining the basic stress pathway above the acetabular dome during acetabular reconstruction.

    Nie, Yong; Pei, Fuxing; Shen, Bin; Kang, Pengde; Li, Zongming

    2016-07-01

    The basic stress pathway above the acetabular dome is important for the maintenance of implant stability in press-fit acetabular reconstruction of total hip arthroplasty. However, information on the basic stress pathway and its impact factors remains unclear. The objective of this study was to investigate the effects of the orientations and positions of the acetabular component on the basic stress pathway. The basic stress pathway above the acetabular dome was defined as two parts: 3D basic trabecular bone stress distribution and quantified basic cortical bone stress level, using two subject-specific finite element normal hip models. The effects were then analysed by generating 32 reconstructed acetabular cases with different cup abduction and anteversion angles within a range of 35-50° and 10-25°, respectively, and 12 cases with different hip centre heights within a range of 0-15 mm above the acetabular dome. The 3D trabecular stress distribution decreased remarkably in all cases, while the 80% of the basic cortical bone stress level was maintained in cases when the acetabular component was positioned at 10° or 15° anteversion and 40° or 45° abduction angles. The basic stress pathway above the acetabular dome was disturbed when the superior displacement of the hip centre exceeded 5 mm above the anatomical hip centre. Positioning the acetabular component correctly contributes to maintain the stress balance between the acetabular cup and the bone during acetabular reconstruction, thus helping restore the normal hip biomechanics and preserve the stability of the implants. PMID:26469561

  10. Acute nursing care of the older adult with fragility hip fracture: An international perspective (Part 2)

    Maher, Ann Butler

    2012-10-23

    The second part of this paper provides those who care for orthopaedic patients with evidence-supported international perspectives about acute nursing care of the older adult with fragility hip fracture. Developed by an international group of nurse experts and guided by a range of information from research and clinical practice, it focuses on nurse sensitive quality indicators during the acute hospitalisation for fragility hip fracture. Optimal care for the patient who has experienced such a fracture is the focus. This includes (in the first, earlier, part):\\r\

  11. Osteoarthritis of the hip and acetabular dysplasia.

    Croft, P.; Cooper, C.; Wickham, C; Coggon, D

    1991-01-01

    The relation between acetabular dysplasia and osteoarthritis of the hip was examined in a series of 1516 pelvic radiographs taken for non-skeletal indications. Osteoarthritis was assessed by measuring joint space, and dysplasia by the centre-edge angle and acetabular depth. In contrast with previous studies of patients with symptomatic osteoarthritis of the hip, no evidence that dysplasia predisposes to osteoarthritis was found. Possible reasons for the discrepancy are discussed. It was concl...

  12. Wear of highly crosslinked polyethylene acetabular components

    Callary, Stuart A.; Solomon, Lucian B; Holubowycz, Oksana T; Campbell, David G; Munn, Zachary; Howie, Donald W.

    2015-01-01

    Background and purpose Wear rates of highly crosslinked polyethylene (XLPE) acetabular components have varied considerably between different published studies. This variation is in part due to the different techniques used to measure wear and to the errors inherent in measuring the relatively low amounts of wear in XLPE bearings. We undertook a scoping review of studies that have examined the in vivo wear of XLPE acetabular components using the most sensitive method available, radiostereometr...

  13. Proceedings of the International Symposium on Dynamics of Fluids in Fractured Rocks: Concepts and Recent Advances

    This publication contains extended abstracts of papers presented at the International Symposium ''Dynamics of Fluids in Fractured Rocks: Concepts and Recent Advances'' held at Ernest Orlando Lawrence Berkeley National Laboratory on February 10-12, 1999. This Symposium is organized in Honor of the 80th Birthday of Paul A. Witherspoon, who initiated some of the early investigations on flow and transport in fractured rocks at the University of California, Berkeley, and at Lawrence Berkeley National Laboratory. He is a key figure in the development of basic concepts, modeling, and field measurements of fluid flow and contaminant transport in fractured rock systems. The technical problems of assessing fluid flow, radionuclide transport, site characterization, modeling, and performance assessment in fractured rocks remain the most challenging aspects of subsurface flow and transport investigations. An understanding of these important aspects of hydrogeology is needed to assess disposal of nuclear wastes, development of geothermal resources, production of oil and gas resources, and remediation of contaminated sites. These Proceedings of more than 100 papers from 12 countries discuss recent scientific and practical developments and the status of our understanding of fluid flow and radionuclide transport in fractured rocks. The main topics of the papers are: Theoretical studies of fluid flow in fractured rocks; Multi-phase flow and reactive chemical transport in fractured rocks; Fracture/matrix interactions; Hydrogeological and transport testing; Fracture flow models; Vadose zone studies; Isotopic studies of flow in fractured systems; Fractures in geothermal systems; Remediation and colloid transport in fractured systems; and Nuclear waste disposal in fractured rocks

  14. Proceedings of the International Symposium on Dynamics of Fluids in Fractured Rocks: Concepts and Recent Advances

    Faybishenko, B. (ed.)

    1999-02-01

    This publication contains extended abstracts of papers presented at the International Symposium ''Dynamics of Fluids in Fractured Rocks: Concepts and Recent Advances'' held at Ernest Orlando Lawrence Berkeley National Laboratory on February 10-12, 1999. This Symposium is organized in Honor of the 80th Birthday of Paul A. Witherspoon, who initiated some of the early investigations on flow and transport in fractured rocks at the University of California, Berkeley, and at Lawrence Berkeley National Laboratory. He is a key figure in the development of basic concepts, modeling, and field measurements of fluid flow and contaminant transport in fractured rock systems. The technical problems of assessing fluid flow, radionuclide transport, site characterization, modeling, and performance assessment in fractured rocks remain the most challenging aspects of subsurface flow and transport investigations. An understanding of these important aspects of hydrogeology is needed to assess disposal of nu clear wastes, development of geothermal resources, production of oil and gas resources, and remediation of contaminated sites. These Proceedings of more than 100 papers from 12 countries discuss recent scientific and practical developments and the status of our understanding of fluid flow and radionuclide transport in fractured rocks. The main topics of the papers are: Theoretical studies of fluid flow in fractured rocks; Multi-phase flow and reactive chemical transport in fractured rocks; Fracture/matrix interactions; Hydrogeological and transport testing; Fracture flow models; Vadose zone studies; Isotopic studies of flow in fractured systems; Fractures in geothermal systems; Remediation and colloid transport in fractured systems; and Nuclear waste disposal in fractured rocks.

  15. Locking internal fixator with minimally invasive plate osteosynthesis for the proximal and distal tibial fractures

    TONG Da-ke

    2012-02-01

    Full Text Available 【Abstract】Objective: To investigate the efficacy of the locking internal fixator (LIF, which includes the locking compression plate (LCP and the less invasive stable system (LISS, in the proximal and distal tibial fractures. Methods: We did a retrospective study on a total of 98 patients with either proximal or distal tibial fractures from January 2003 to January 2007, who had received the opera- tion with LIF by the minimally invasive plate osteosynthesis (MIPO technique. The data consisted of 43 proximal tibial fractures (type AO41C3 and 55 distal tibial fractures (type AO43C3. Results: No complications were observed in all patients after operation. The mean healing time was 8.4 months (range 5-14 months. Only two cases of delayed union occurred at postoperative 10 months. No infections were reported after the definitive surgery even in the cases of open fractures. All patients reached a full range of motion at postoperative 6 to 9 months and regained the normal functions of knee and ankle joints. Conclusion: Using LIF in MIPO technique is a reliable approach towards the proximal and distal tibial fractures that are not suitable for intramedullary nailing. Key words: Internal fixator; Tibial fractures; Fracture fixation, intramedullary; Bone plates

  16. Internal fixation with headless compression screws and back buttress plate for treatment of old Hoffa fracture

    Min Li

    2014-04-01

    Full Text Available Objective: To analyze the early clinical and radiographic outcomes of Hoffa fractures treated by a standard protocol of open reduction and internal fixation using headless compression screws combined with back buttress plate in a consecutive series of 8 Chinese patients. Methods: Open reduction and internal fixation was performed on all patients. The fractures were anatomically reduced and held temporarily by K-wire. If the ends of fractures were atrophic, autologous bone graft from the ipsilateral iliac crest was packed between the ends. Then the fracture fragments were fixed with AO 6.5 mm headless compression cannulated screws. At least two screws were used to provide rotational stability. One pre-contoured reconstruction plate was placed on the nonarticular surface posteromedially or posterolaterally as back buttress plate. Results: All the patients were followed up for at least 12 months (range 12-25 months. All fractures achieved anatomical reduction and healed clinically and radiographically. At recent follow-up, the mean flexion degree was 120.6° (range 110°-135° and the mean extension degree was 2.5° (range 0°-5°. The average visual analogue scale score was 1.6 points (range 0-3. Six patients were assessed as excellent and 2 as good according to the hospital for special surgery knee score system. There were no superficial or deep infections, or hardware breakages. No patient had giving way or locking of the knee, though some had intermittent pain and swelling after strenuous exercise. Injury mechanism had significant influence on the functional outcome (P=0.046.Conclusion: Headless compression screws combined with back buttress plate and/or autologous bone grafting to treat old Hoffa fracture is one of effective measures. It would be conducive to not only fracture healing but also early exercise and functional recovery. Key words: Fractures, bone; Fracture fixation, internal; Intra-articular fractures

  17. The outcome of surgically treated traumatic unstable pelvic fractures by open reduction and internal fixation

    Keykhosro Mardanpour

    2013-07-01

    Full Text Available BACKGROUND: This study was performed to evaluate functional and radiological results of pelvic ring fractures treatment by open reduction and internal fixation. METHOD: Thirty eight patients with unstable pelvic fractures, treated from 2002 to 2008 were retrospectively reviewed. The mean patients’ age was 37 years (range 20 to 67. Twenty six patients were men (4patients with type B and 22 patients with type C fracture and 12 women (7 patients with type B and 5 patients with type C fracture. The commonest cause was a road traffic accident (N=37, about 97%. Internal fixation was done by plaque with ilioinguinal and kocher-langenbeek approaches for anterior, posterior pelvic wall and acetabulum fracture respectively. Quality of reduction was graded according to Majeed score system. RESULTS: There were 11 type-C and 27 type-B pelvic fractures according to Tile’s classification. Thirty six patients sustained additional injuries. the commonest additional injury was lower extremity fracture. The mean follow-up was 45.6 months (range 16 to 84 months.The functional outcome was excellent in 66%, good in 15%, fair in 11% and poor in 7% of the patients with type B pelvic fractures and functional outcome was excellent in 46%, good in 27%, fair in 27% and poor in 0% of the patients with type C pelvic fractures. There were four postoperative infections. No sexual functional problem was reported. Neurologic problem like Lateral cutaneous nerve of thigh injury recovered completely in 2 patients and partially in 2 patients. There was no significant relation between functional outcome and the site of fracture (P greater than 0.005. CONCLUSION: Unstable pelvic ring fracture injuries should be managed surgically by rigid stabilization. It must be carried out as soon as the general condition of the patient permits, and even up to two weeks

  18. Efficient radiologic diagnosis of pelvic and acetabular trauma

    In spite of the widespread availability of CT scanners, conventional X-ray radiographs remain the basic imaging modality in patients with pelvic and/or acetabular trauma. However, the extent of their use will depend on local utilities (e.g., availability of CT scanners) and on the patient's clinical condition. Regarding the inaccuracy of conventional radiography in the diagnosis of injuries of the dorsal pelvic ring and of the acetabulum, computed tomography represents the most important imaging modality in the clinically stable patient. CT provides an exact staging of the extent of trauma and allows for differentiation of pelvic instabilities. CT clearly demonstrates the severity of acetabular trauma and is superior in the detection of local complicating factors, i.e., impressions fractures and (sub-)luxations of the femoral head as well as free intraarticular fragments. CT findings provide the basis for definite treatment regimens of the injured patient. By extension of the examination, all relevant organs and systems (craniospinal, cardiovascular, gastrointestinal, respiratory, genitourinary) can be imaged during one session. The speed of spiral CT scanners and their diagnostic accuracy will play a major role in the management of, especially, polytraumatized patients. The indication for angiography with the option of therapeutic embolization exists if a pelvic bleeding persists even after reposition and operative fixation of the injury. (orig.)

  19. MR arthrography for evaluation of the acetabular labrum

    Petersilge, C.A. [Musculoskeletal and Emergency Radiology, Hillcrest Hospital, Mayfield Heights, OH (United States); Radiology and Orthopedic Surgery, Case Western Reserve Univ., Mayfield Heights, OH (United States)

    2001-08-01

    MR arthrography of the hip has provided new insights into the lesions underlying mechanical hip pain. Until now evaluation of these structures, especially the acetabular labrum, has been limited. With the joint distention provided by MR arthrography, labral detachments and intrasubstance tears can be identified and differentiated from the many varied appearances of the asymptomatic labrum. This article reviews the normal anatomy of the hip, the clinical presentation of internal derangement and the technique for performing MR arthrography. The variations in morphology and signal of the asymptomatic labrum are reviewed as well as the appearance of the abnormal labrum. (orig.)

  20. Free iliac crest grafts with periosteum for treatment of old acetabular defects

    ZHAO De-wei; SUN Qiang; WANG Ben-jie; CUI Da-ping

    2006-01-01

    Objective: To inquire into the therapeutic effectiveness of free iliac crest grafts with periosteum on old acetabular defects.Methods: From February 1996 to June 2005, 9 patients were treated with free iliac crest grafts with periosteum to reconstruct old acetabular defects. There were 7 males and 2 females and the average age was 41.3 years. The acetabular defects were caused by traffic accidents in 6 cases and fall injury in 3 cases. The time from injury to treatment was 4-13 months and averaged 8 months. Intraoperatively we firstly removed the acetabular fracture fragments of the posterior wall. The femoral head was then reducted. Bone graft was harvested from the iliac crest with periosteum, which was sculpted with a rongeur to conform to the defect. The concave (iliac fossa) side of the graft was placed toward the femoral head. The graft was securedly fixed by two to three leg screws.Results: Postoperative syndrome was not found in any of the cases. Harris' score system showed that the score raised from 32. 3 points preoperatively to 81 points postoperatively. The hip function was evaluated as excellent in 3 cases, good in 4 cases and fair in 2 cases.Conclusions: Although this procedure could not exactly reproduce the anatomy of the hip joint, it enables to restore the posterior stability, provide bone-stock for the hip joints and prevent dislocation of the femoral head.

  1. Evaluation in effects of poly (L-lactide) miniplates for internal fixation of mandibular fracture

    Objective: To investigate the internal fixation effects of poly (L-lactide) (PLLA) miniplates on the mandibular fracture in dogs. Methods: A total of 12 dogs were involved in the study. After mandibular fracture models were created on both sides, one side of the mandibular was fixed with PLLA miniplates and the other side was fixed with titanium plates as control. The dogs were sacrificed separately at 1, 3, 6, 12 months after operation, three animals at each time. Gross observation, radiography and histopathological examination were performed. Results: All of the dogs were alive and fracture fixation of both sides was excellent after the operation. Gross observation:in 1 month group, the fracture line and some bony callus could be seen on both sides; in 3 months group, both sides had become into bone union; in 6 months group, both sides had become into bone union completely; in 12 months group, the fracture lines on both sides were difficult to be seen. Radiography examination:in 1 month group, the fracture lines and the screw holes could be seen on both sides; in 3 months group, the fracture lines turned ambiguity; in 6 months group, the line on the experimental side was difficult to be seen but the line on the control side disappeared; in 12 months group, the fracture lines on both sides disappeared. Histopathology examination: in 1 month group, there were lots of collagen fibers and a little bone trabecula on both sides; in 3 months group, the trabecula on the experimental side were much more than the other side; in 6 months group, the bone trabecula on both sides looked like the normal bone tissue; in 12 months group, the bone trabecula became into nomal tissue. Conclusion: The effect of PLLA miniplates for internal fixation of mandibular fracture is safety, the PLLA miniplate can maintain the stability of the bone fracture during the healing process. (authors)

  2. The results of internal fixation of proximal humeral fractures with the PHILOS locking plate

    Korkmaz, Mehmet Fatih; Aksu, Neslihan; Gogus, Abdullah; Debre, Mursel; Kara, Ayhan Nedim; Isiklar, Zekeriya Ugur

    2004-01-01

    Objectives: Proximal and diaphyseal humeral fractures are common especially in the elderly, presenting as a challenging problem due to their high complication rates following surgical treatment. In this prospective study, we evaluated the results of patients treated with the PHILOS (Proximal Humeral Internal Locking System) locking plate, a new technique recently developed by the AO/ASIF. Methods: Forty-one patients who were treated with the PHILOS plate for proximal humeral fractures were...

  3. Experimental and Numerical Modeling of Screws Used for Rigid Internal Fixation of Mandibular Fractures

    Naresh Chaudhary; Lovald, Scott T.; Jon Wagner; Tariq Khraishi; Bret Baack

    2008-01-01

    Experimental and numerical methods are used to explore the stresses generated around bone screws used in rigid internal fixation of mandibular fractures. These results are intended to aid in decisions concerning both the design and the use of these bone screws. A finite element (FE) model of a human mandible is created with a fixated fracture in the parasymphyseal region. The mandibular model is anatomically loaded, and the forces exerted by the fixation plate onto the simplified screws are o...

  4. Open Reduction and Internal Fixation of a Fracture-dislocation of the Ankle

    Yaniel Truffin Rodriguez

    2015-12-01

    Full Text Available Open reduction and internal fixation of the fracture-dislocation of the ankle with plates, screws and Kirschner wires is a well-defined treatment method. This paper presents the management of a fracture-dislocation of the right ankle in a 33-year-old female patient stabilized by using a one-third tubular plate, screws, Kirschner wires with tension-band wires. Results were satisfactory.

  5. Experimental fracture studies on carbon steel elbows with and without internal pressure

    Pipe bends or elbows are commonly used components for nuclear power plant piping system. In service, these piping components are subjected to internal pressure in addition to bending loads and the internal pressure is known to have a significant effect on the load carrying capacity of these components. Hence, a systematic study was carried out to investigate and quantify the effect of internal pressure on the fracture behaviour of elbows used in nuclear power plant piping system. Fracture studies were conducted on five 219 mm diameter carbon steel elbows with and without internal pressure under in-plane opening moment. The investigations have shown that the presence of a circumferential notch at the intrados has a more detrimental effect on the fracture behaviour of the elbow, when compared with the presence of an axial notch at the intrados. It is also found that internal pressure plays a significant role in reducing the ovalization. -- Highlights: • Fracture studies were conducted on elbows with and without internal pressure. • Effect of internal pressure on load carrying capacity of the elbows was studied. • Various data acquired during the study include load, LLD, CMOD, ovality of the elbow. • Circumferential notch at intrados significantly affects elbow load carrying capacity

  6. Outcome after open reduction and internal fixation of intraarticular fractures of the calcaneum without the use of bone grafts

    Pendse Aniruddha; Daveshwar R; Bhatt Jay; Shivkumar

    2006-01-01

    Background: Intraarticular fractures of calcaneum are commenest type of calcaneal fractures. Lots of controversies exist about the ideal management for them. The focus is now shifting on operative management by open reduction and internal fixation for these fractures with or without the use of bone grafts. Method: Thirty intraarticular fractures classified by Essex Lopresti radiological classification, were treated by open reduction and fixation. The patients were followed over a mean peri...

  7. The effect of welding residual stresses on brittle fracture in an internal surface cracked pipe

    The change in brittle fracture properties due to the presence of welding residual stresses (RS) is studied in a pipe. Welding RS are simulated by using a 3-D finite element (FE) model and experimentally verified. An internal circumferential thumbnail crack is introduced at the weld line. The modified Beremin model is used as local approach method to predict toughness distributions in the presence of welding RS. The model is calibrated using experimental fracture tests at −150 °C consisting of low and high constraint specimens. The results indicate that, in the welded pipe, the fracture toughness will decrease dramatically in comparison with the as-received pipe. For the same fracture probability of 90%, fracture toughness will decrease from 65 to 40 MPa √m. This is due to the influence of tensile welding RS on the crack tip stress state, which result in a decrease in the opening mode stresses at the near crack tip up to 40%. - Highlights: • A Two-pass pipe welding process is simulated and obtained residual stresses (RS) are experimentally verified. • An internal semi-elliptical circumferential cracked pipe is considered and Modified Beremin model is used. • Two sets of specimens with high and low crack-tip constraint are used for model calibration. • Welding RS will cause to change crack-tip stress field and fracture probability, dramatically. • RS cause 40% increase in maximum opening stress and 38% decrease in fracture toughness, for a fracture probability of 90%

  8. FALSIRE phase 2: CSNI project for fracture analyses of large- scale international reference experiments

    A summary of Phase II of the Project for Fracture Analysis of Large-Scale International Reference Experiments (FALSIRE) is presented. FALSIRE I was initiated by the CSNI/FAG in 1988 to assess various fracture methodologies through interpretive analyses of six large-scale fracture experiments. Following the successful completion of FALSIRE I in 1992, several participating organizations indicated a desire to proceed with further evaluation of fracture analysis methods in a Phase II program. FALSIRE II included seven reference cleavage fracture experiments that focused primarily on behavior of relatively shallow cracks in the transition temperature region. Included were experiments for which cracks showed either unstable extension or two stages of extension (e.g., stable crack extension followed by unstable extension) under transient thermal and mechanical loadings. Also, crack initiation was investigated in connection with clad surfaces and with biaxial loading conditions. A comparative assessment and discussion of the analysis results are presented in the report. Generally, structural responses of the test specimens were predicted with tolerable scatter bands; these represent a marked improvement over the results achieved in the initial phase (FALSIRE I). The analyses revealed that the loss-of-constraint effects observed in specific cases require a second (or dual) fracture parameter to be introduced into the fracture model to characterize crack-tip conditions. Additional toughness data obtained from a range of specimen geometries and constraint conditions are required to validate these dual-parameter cleavage fracture methodologies. Finally, proposals for future work in the context of cooperative international analytical projects similar to FALSIRE are provided

  9. Outcome of open reduction and internal fixation of volar barton fracture treated with buttress plate

    Objective: To assess the outcome of volar Barton fracture treated with T-plate and locking plate. Methodology: From December 2011 to August 2014, prospective case series study was conducted at the Department of Orthopaedic Surgery, Dow University of Health Sciences/Civil Hospital, Karachi and included 45 patient of volar Barton fracture treated with buttress plate and locking plate. Colles fracture, dorsal barton and comminuted intraarticular fractures were excluded from the study. Results: Out of 45 patients, 33(73%) were male and 12(27%) female, Age ranged from 20 to 50 years. 17(38%) had fall and 28(62%) road traffic accident. 7(16%) patients were treated with locking plates and 38(84%) with T- buttress plate. Functional outcome was assessed on the basis of modified clinical staging system of Green and O'Brien, which showed excellent result in 20(44%) patient, good in 16(36%), fair in 7(16%), and poor in 2(4%) patients. Volar Barton fracture was associated with concomitant injuries, especially in trauma patients, 4(27%) had mid shaft femur fracture, 2(13%) scaphoid fracture, 4(27%) metacarpals and 5(33%) ulnar styloid fractures. With 9 months follow up, union was observed in all patients within 8 to 12 weeks. Conclusion: volar Barton fractures are unstable injuries; chances of displacement after closed reduction are high. So we recommend open reduction and internal fixation with T- buttress plate or locking plate to get the excellent functional outcome. (author)

  10. The influence of internal stresses on the fracture toughness of {alpha}/{beta} titanium alloys

    Helbert, A.L.; Feaugas, X.; Clavel, M.

    1999-11-01

    The influence of internal stresses on fracture toughness was investigated in {alpha}/{beta} titanium alloys. It was shown that the direct linkage of K{sub IC} to various microstructural parameters was not so conclusive, since the different parameters act simultaneously on fracture toughness. On the contrary, the metallurgical parameters change the plastic strain incompatibilities inside the material. Thus X, which is a macroscopic measurement of these incompatibilities, is the relevant parameter to account for the different metallurgical influences on toughness. The influence on X of the {alpha}-phase percentage, aspect ratio, and the secondary {alpha}-phase percentage was determined, and it was established that low internal stresses could provide high fracture toughness. The present work also showed the ability of a modified Gurson-Tvergaard (GT) model to calculate the experimental K{sub IC} value.

  11. Complications and functional outcome after internal fixation of dorsally displaced distal radial fractures

    Bove, Jeppe; Viberg, Bjarke; Greisen, Pernille;

    Background: Recently there has been an increasing interest in open reduction and internal fixation of distal radius fractures. Even so further studies are still needed. Purpose: To document the functional outcome and identify complica- tions among patients treated with a volar locking plate (DVR...

  12. CT evaluation of acetabular dysplasta in adults.

    2000-01-01

    Objective: To evaluate methods of measurement by CT and their clinical significance for acetabular dysplasia(AD) in adults. Methods: CT imaging was examined and measured in 33 adult patients with AD, compared with the normal control group of 210 adults. Results: This study showed the results of AD patients

  13. Deformation process and interaction of acetabular cup

    Jíra, J.; Jírová, Jitka; Micka, Michal

    Dusseldorf, Německo: VDI Verlag GmbH, 2001, s. 197-202. ISBN 3-18-091599-4. [GESA-Symposium 2001. Chemnitz (DE), 17.05.2001-18.05.2001] R&D Projects: GA ČR GA103/00/0831 Keywords : acetabular cup migration, computation modelling,straingauge measurement. Subject RIV: FI - Traumatology, Orthopedics

  14. Locking internal fixator with minimally invasive plate osteosynthesis for the proximal and distal tibial fractures

    TONG Da-ke; JI Fang; CAI Xiao-bing

    2011-01-01

    Objective: To investigate the efficacy of the locking internal fixator (LIF), which includes the locking compression plate (LCP) and the less invasive stable system (LISS), in the proximal and distal tibial fractures. Methods: We did a retrospective study on a total of 98 patients with either proximal or distal tibial fractures from January 2003 to January 2007, who had received the operation with LIF by the minimally invasive plate osteosynthesis (MIPO) technique. The data consisted of 43 proximal tibial fractures (type AO41C3) and 55 distal tibial fractures (type AO43C3). Results: No complications were observed in all patients after operation. The mean healing time was 8.4 months (range 5-14 months). Only two cases of delayed union occurred at postoperative 10 months. No infections were reported after the definitive surgery even in the cases of open fractures. All patients reached a full range of motion at postoperative 6 to 9 months and regained the normal functions of knee and ankle joints. Conclusion: Using LIF in MIPO technique is a reliable approach towards the proximal and distal tibial fractures that are not suitable for intramedullary nailing.

  15. Dyaphiseal open fractures of the forearm follows internal or external fixation

    The treatment of dyaphiseal open fractures of the forearm follows internal or external fixation. However, the effectivity of both approaches remains controversial. The aim of this descriptive, Wais study, to assess the osteosynthesis by limited approach (internal fixation) as treatment of this type of fractures. Between 1996 and 1999, 22 patients with open dyaphiseal forearm fractures caused by gunshot and treated with this technique were analyzed. The men age was 26.8 years. There were 13 patients with type lllA and 9 patients with type lllB fractures. The mean of comminution was 6.34 mm. Additionally; the mean of quirurgical rinses was 3.7. The complications were: superficial infections, insufficient osteosynthesis and pseudoarthrosis. According to a functional scale the outcomes were, excellent good acceptable and bad. Within parenthesis are the numbers of patients. On the other hand, there were nineteen successful bone consolidations. The observed relative success of the limited approach, with 17 excellent-good cases and 79 bone consolidating, can be explained by the avoiding of unnecessary manipulation of the fractures area which promotes consolidation and reduces infection risk. Moreover the acceptable functional recovery, the absence of complications due to the technique and the restrained use of bone grafts make this technique highly performable

  16. Internal fixation with headless compression screws and back buttress plate for treatment of old Hoffa fracture

    Min Li; Tu Chongqi; Wang Guanglin; Fang Yue; Duan Hong; Liu Lei; Zhang Hui

    2014-01-01

    Objective:To analyze the early clinical and radiographic outcomes of Hoffa fractures treated by a standard protocol of open reduction and internal fixation using headless compression screws combined with back buttress plate in a consecutive series of 8 Chinese patients.Methods:Open reduction and internal fixation was performed on all patients.The fractures were anatomically reduced and held temporarily by K-wire.If the ends of fractures were atrophic,autologous bone graft from the ipsilateral iliac crest was packed between the ends.Then the fracture fragments were fixed with AO 6.5 mm headless compression cannulated screws.At least two screws were used to provide rotational stability.One pre-contoured reconstruction plate was placed on the nonarticular surface posteromedially or posterolaterally as back buttress plate.Results:All the patients were followed up for at least 12 months (range 12-25 months).All fractures achieved anatomical reduction and healed clinically and radiographically.At recent follow-up,the mean flexion degree was 120.6° (range 110°-135°) and the mean extension degree was 2.5° (range 0°-5°).The average visual analogue scale score was 1.6 points (range 0-3).Six patients were assessed as excellent and 2 as good according to the hospital for special surgery knee score system.There were no superficial or deep infections,or hardware breakages.No patient had giving way or locking of the knee,though some had intermittent pain and swelling after strenuous exercise.Injury mechanism had significant influence on the functional outcome (P=0.046).Conclusion:Headless compression screws combined with back buttress plate and/or autologous bone grafting to treat old Hoffa fracture is one of effective measures.It would be conducive to not only fracture healing but also early exercise and functional recovery.

  17. Fractures

    ... commonly happen because of car accidents, falls, or sports injuries. Other causes are low bone density and osteoporosis, which cause weakening of the bones. Overuse can cause stress fractures, which are very small cracks in the ...

  18. Clinical effect of distal radius fracture treated with open reduction and internal plate fixation

    ZHANG Pei-xun; XUE Feng; DANG Yu; WANG Tian-bing; CHEN Jian-hai; XU Hai-lin; FU Zhong-guo; ZHANG Dian-ying; JIANG Bao-guo

    2012-01-01

    Background For some specific comminuted unstable intra-articular fracture,the plaster cast can not maintain the alignment of the articular surface effectively.The aim of this study was to evaluate the clinical effects of distal radius fracture treated with open reduction and internal plate fixation retrospectively.Methods From January 2002 to March 2010,539 cases of distal radius fracture were treated with open reduction and internal fixation,including 184 males and 355 females aging 21-72 years (mean 57 years).Fractures were caused by falling to the ground in 459 cases,by traffic accident in 62 cases and by athletic injuries in 18 cases.Of 539 cases,there were 523 cases of closed fracture and 16 cases of open fracture.According to Arbeitsgemeinschaft fur Osteosynthesefragen (AO) standards of classification,there were 14 cases of A2 type,22 of A3 type,18 of B1 type,24 of B2 type,62 of B3 type,91 of C1 type,162 of C2 type and 146 of C3 type.The time from injury to operation was 1-16 days (mean 5 days).All patitents received open reduction and internal plate screw fixation.Forty-seven patients with bone defect were given 6-15 g autologous ilium and 75 cases were given 5 ml calcium sulphate artificial aggregate after reduction.Results All incisions healed by first intention after operation.Patients were followed up for 15 to 32 months postoperatively (mean 22 months).The fractures healed within 10-18 weeks after operation (mean 12 weeks).During the last follow-up,the mean palmar tilt was (7.0±0.9)° and the mean ulnar variance was (21.0±4.2)°,showing significant difference when compared with preoperation ((-5.0±1.2)° and (8.0±3.8)°).The radial heights were not abbreviated.According to Gartland and Werley assessment system,the results were excellent in 314 cases,good in 163 cases,fair in 46 cases,and poor in 16 cases 12 weeks after operation,the excellent and good rate was 88.5%.Conclusions The clinical effect of distal radius fracture treated with open

  19. Treatment of displaced radial head fractures by internal fixation with absorbable pins

    HOU Zhen-hai; ZHOU Ji-hong; SHI Jian-guo; SHI Yi-bin; XIA Jun-jie; YAO Jun

    2006-01-01

    Objective: To study the effect of internal fixation with absorbable pins on treatment of displaced radial head fractures.Methods: From May 1999 to May 2004, 16 patients with displaced radial head fractures (Mason types Ⅱ and Ⅲ) were treated with internal fixation by absorbable pins.The duration of follow-up averaged 22.6 months (12-58 months). The outcome was assessed on the basis of elbow motion, radiographic findings and the functional rating score delineated by Broberg and Morrey.Results: All fractures healed within 10 months without avascular necrosis of radial head. The mean elbow flexion loss was 15°(0°-35°), and pronation and supination decreased by 10° (0°-30°) on average compared with those of the contralateral elbow. Five patients had an excellent result, 6 a good result, and 3 a fair result according to the criteria of Borberg and Morrey.Conclusions: Internal fixation with absorbable pins is an effective method in treating displaced radial head fractures. It can maintain the biomechanical stability of forearm, improve the elbow function and avoid second operation.

  20. FUNCTIONAL OUTCOME OF PATELLAR FRACTURES TREATED BY INTERNAL FIXATION: A RETROSPECTIVE STUDY

    Sudheendra

    2014-07-01

    Full Text Available BACKGROUND AND OBJECTIVES: Follow-up studies of displaced patellar fractures treated but various accepted contemporary internal fixation techniques have generally shown favorable results. However, reports of modest outcomes are not rare. The aims of this retrospective study were to review a series of patients with closed patellar fractures who a\\were treated by internal fixation, and to determine the final functional outcome. METHODS: In this study of retrospective design, the hospital records and radiographs of the 43 identified patients with 43 closed patellar fractures, treated by internal fixation between November 2000 and June 2005 were reviewed. These patients were called for a final follow-up evaluation, and the latest functional outcome assessed as per the modified Hospital for Special Surgery knee scores. Results were analyzed and statistical significance determined by Chi-square test. RESULTS: Younger patients showed significantly better outcomes. Modified tension band wiring was the most commonly associated with symptomatic hardware requiring removal. Different fixation techniques fared favorably against each other. The final functional outcome assessed using the modified Hospital for Special Surgery scores was encouraging with excellent or good results in 74%. Interpretations and conclusions: Operatively treated closed patellar fracture with accepted fixation techniques eventually result in a satisfactory return of knee function. Complications, particularly symptomatic hardware requiring removal, are not uncommon.

  1. Marginal-internal adaptation and fracture resistance of CAD/CAM crown restorations.

    Yildiz, Coşkun; Vanlioğlu, Burçin Akoglu; Evren, Buket; Uludamar, Altay; Ozkan, Yasemin Kulak

    2013-01-01

    This study evaluated the marginal adaptation and fracture resistance of CAD/CAM-fabricated zirconia crowns luted using different luting agents. Twenty crown restorations were produced using IPS ZirCAD zirconium oxide blocks (IZC), and another 20 using Lava zirconium oxide blocks (L). Ten teeth were used as control. Luting agents used were an etch-and-rinse adhesive (Variolink II) and a self-etch adhesive (Multilink Automix). Internal and marginal adaptation was evaluated using silicone replica technique. Fracture resistance was evaluated using a compression test. Marginal discrepancy was 89.26 μm for L crowns and 88.84 μm for IZC crowns, and difference was statistically insignificant. However, L crowns showed significantly larger axial and occlusal gaps than IZC crowns (pCAD/CAM-fabricated crowns showed acceptable in vitro marginal discrepancies and fracture strengths. PMID:23370869

  2. Use of the trochanteric flip osteotomy to facilitate internal fixation of a femoral head fracture.

    Gillespie, James A; Marsh, Andrew G; Patil, Sanjeev R

    2016-01-01

    We report the case of a 42-year-old male who suffered a fracture-dislocation of the femoral head. After a closed reduction of the hip, this proceeded to an open reduction with internal fixation of the fractured femoral head, in addition to labral repair and micro-fracture of an articular cartilage defect. After considering the risks to the femoral head blood supply, the trochanteric flip osteotomy was used. This provided ample and safe exposure. At 14 months follow-up, the patient-reported outcome measures are favourable: modified Harris Hip Score (81/100), the non-arthritic hip score (92.5/100) and SF-12 (41/48). PMID:27470013

  3. Use of gentamicin-loaded collagen sponge in internal fixation of open fractures

    Chaudhary Susheel

    2012-02-01

    and is a safe technique in the management of open bone injuries. These sponges can be used easily with any form of internal fixation and there is no need of second surgery for the removal of these antibiotic carriers since they are bioabsorbable. Local antibiotic-impregnated collagen sponges along with systemic antibiotics for 3 to 5 days offer promising results in open fracture management. Key words: Fractures, open; Debridement; Fracture fixation, internal; Collagen

  4. Outcome of total hip arthroplasty as a salvage procedure for failed infected internal fixation of hip fractures

    Shubhranshu S Mohanty; Agashe, Mandar V.; Sheth, Binoti A; Kumar K. Dash

    2013-01-01

    Background: Failed infected internal fixation produces significant pain and functional disability. In infected internal fixation of hip fractures with partial or complete head destruction, total hip arthroplasty (THA) can be technically challenging; however, it restores hip biomechanics. The present study is to evaluate the results and assess the complications of THA following failed infected internal fixation of these fractures. Materials and Methods: A retrospective review of prospectiv...

  5. Computed tomography analysis of acetabular anteversion and abduction

    Stem, Eric S. [Mayo Clinic, Department of Orthopedic Surgery, Jacksonville, FL (United States); South Carolina Sports Medicine and Orthopaedic Center, North Charleston, SC (United States); O' Connor, Mary I. [Mayo Clinic, Department of Orthopedic Surgery, Jacksonville, FL (United States); Kransdorf, Mark J. [Mayo Clinic, Department of Radiology, Jacksonville, FL (United States); Crook, Julia [Mayo Clinic, Biostatistic Unit, Jacksonville, FL (United States)

    2006-06-15

    The purpose of this study is to define the normal range of acetabular abduction and anteversion in relation to pelvic anatomy as depicted on conventional CT scan. We retrospectively reviewed 100 pelvic CT scans performed on patients presenting for evaluation of non-orthopaedic pathology. The study group consisted of 58 women and 42 men, aged between 18 and 88 years. Standard imaging protocol included an anteroposterior (AP) topogram with contiguous 5-mm thick axial images from the superior margin of the iliac crest to the lesser trochanter of the femur. The acetabular abduction was measured from the AP topogram by obtaining the angle between a line drawn from the acetabular teardrop to the lateral acetabular margin and a horizontal line between the ischial tuberosities. Acetabular anteversion was measured on axial images at the level of the mid-femoral head. We found the mean acetabular abduction to be 39 degrees (standard deviation 4 degrees, range 27 to 51 degrees) and the mean acetabular anteversion to be 23 degrees (standard deviation 5 degrees, range 12 to 39 degrees). Data suggests that acetabular anteversion may average 2.7 degrees lower in males than females and increase slightly with age, while abduction may tend to decrease with age. Ninety percent of patients had acetabular abduction between 31 and 46 degrees; the 90% central range for acetabular anteversion was estimated to be from 14 to 31 degrees. CT scanning is useful in accurately defining the normal range of acetabular abduction and antiversion. Knowledge of this normal anatomy will allow accurate assessment of acetabular component position as delineated on conventional CT scanning. (orig.)

  6. CSNI Project for Fracture Analyses of Large-Scale International Reference Experiments (Project FALSIRE)

    Bass, B.R.; Pugh, C.E.; Keeney-Walker, J. [Oak Ridge National Lab., TN (United States); Schulz, H.; Sievers, J. [Gesellschaft fuer Anlagen- und Reaktorsicherheit (GRS) mbH, Koeln (Gemany)

    1993-06-01

    This report summarizes the recently completed Phase I of the Project for Fracture Analysis of Large-Scale International Reference Experiments (Project FALSIRE). Project FALSIRE was created by the Fracture Assessment Group (FAG) of Principal Working Group No. 3 (PWG/3) of the Organization for Economic Cooperation and Development (OECD)/Nuclear Energy Agency`s (NEA`s) Committee on the Safety of Nuclear Installations (CSNI). Motivation for the project was derived from recognition by the CSNI-PWG/3 that inconsistencies were being revealed in predictive capabilities of a variety of fracture assessment methods, especially in ductile fracture applications. As a consequence, the CSNI/FAG was formed to evaluate fracture prediction capabilities currently used in safety assessments of nuclear components. Members are from laboratories and research organizations in Western Europe, Japan, and the United States of America (USA). On behalf of the CSNI/FAG, the US Nuclear Regulatory Commission`s (NRC`s) Heavy-Section Steel Technology (HSST) Program at the Oak Ridge National Laboratory (ORNL) and the Gesellschaft fuer Anlagen--und Reaktorsicherheit (GRS), Koeln, Federal Republic of Germany (FRG) had responsibility for organization arrangements related to Project FALSIRE. The group is chaired by H. Schulz from GRS, Koeln, FRG.

  7. Outcome after open reduction and internal fixation of intraarticular fractures of the calcaneum without the use of bone grafts

    Pendse Aniruddha

    2006-01-01

    Full Text Available Background: Intraarticular fractures of calcaneum are commenest type of calcaneal fractures. Lots of controversies exist about the ideal management for them. The focus is now shifting on operative management by open reduction and internal fixation for these fractures with or without the use of bone grafts. Method: Thirty intraarticular fractures classified by Essex Lopresti radiological classification, were treated by open reduction and fixation. The patients were followed over a mean period of 30 months (25-40 months. Results: All the fractures united at a mean duration of 14 weeks. 86% patients had excellent functional outcome with one patient having fair and one having poor functional outcome. Conclusion: Open reduction and internal fixation with plate is a good method for treatment of intraarticular fractures of calcaneum to achieve anatomical restoration of articular surface under vision, stable fixation, early mobilization and an option for primary subtalar arthrodesis if deemed necessary.

  8. Promising Effect Of Intraarticular Ropivacaine In Femoral Neck Fractures Treated With Internal Fixation (Best Poster Award)

    Bech, Rune Dueholm

    2008-01-01

     Promising Effect Of Intraarticular Ropivacaine In Femoral Neck Fractures Treated With Internal Fixation Rune Bech*, Jens Lauritsen*+,Tine Dimon*, Ole Ovesen*, Claus Emmeluth, Søren Overgaard*. *:Dept. Ortopaedic Surgery, Odense University Hospital, +:Institute of Public Health-dept. biostatistics......, Southern Denmark University.   INTRODUCTION Reducing pain is an essential factor for early mobilisation after internal fixation of femoral neck fractures. Systemic opioids have side effects that might obstruct mobilisation and induce deliria and nausea. We hypothesized that intraarticular local anaesthetic...... intraarticular catheter, which was removed after 48 hours. Control Group: 11 patients consecutively diagnosed in Sept. 2006, who received only standard pain treatment. The need for opioid rescue analgesia standardised to mg equivalent of oxycodon was compared between the two groups for the first two days after...

  9. INTERNAL FIXATION OF INTRA ARTICULAR CALCANEUM FRACTURES USING LOCKING COMPRESSION PLATE

    Neelakrishnan

    2014-10-01

    Full Text Available INTRODUCTION: Calcaneum is the most frequently fractured tarsal bone. Historically intra articular calcaneum fractures treated non-operatively which led to increased morbidity due to in congruency of articular surface resulting in subtalar arthritis. With advent of CT scan, better implants and improved methods of fixation. Operative treatment has now become a standard method. AIM OF THE STUDY: To study the functional and radiological outcome of intra articular calcaneum fractures treated by open reduction and internal fixation using locking compression plate. MATERIALS AND METHODS: Fifteen patients with intra articular calcaneum fractures treated by open reduction and internal fixation using locking compression plate from May 2012 to September 2014 at Rajah Muthiah Medical College Hospital with follow up of 6months. The fractures were classified on the basis of computer tomography (CT findings as Sanders type I to IV. The aim of our treatment is to achieve anatomical reconstruction of all articular surfaces, restore Bohler’s and Gissane angles, to carry out primary stable fixation and begin early mobilization. The patients were evaluated by Modified Maryland Foot Score, with excellent defined as90 - 100 points, good as 75 – 89 points, fair as 50 – 74 points and poor as <50 points. RESULTS: Fourteen patients were male and only one female. Twelve patients sustained fractures due to fall from height, three patients due to RTA. The mean pre-operative Bohler’s angle was 13 degree and mean post-operative angle was 26.2degree. The mean pre-operative Gissane angle was 147.6 degree and the mean post-operative angle was 121 degree. Excellent modified Maryland Foot score were achieved in 9 patients, good in 3, fair in 1patient.Only 2 had poor outcome. CONCLUSION: Surgical treatment of intra-articular calcaneum fractures using locking compression plate by lateral approach has good functional outcome. CT scan is required for understanding the

  10. Computerized tomography in evaluation of decreased acetabular and femoral anteversion

    Computerized tomography has received a new importance. It has been shown that decreased anteversion of femur and acetabulum, when both have decreased angles, are causing pain and osteoarthritis of the hip joint. Operative treatment should be performed before osteoarthritis develops. Exact measurements therefore are necessary. The investigation should be performed in prone position to have the pelvis lying in a defined and normal position. Femoral torsion is measured between the transverse axis of the knee and the femoral neck. The transverse axis for measurement of the femoral anteversion is defined by a rectangular line to the sagittal plane. For evaluation of the femoral anteversion in total the angle of the condyles has to be added to the femoral neck angle when the knee is found in internal rotation. Acetabular anteversion should be measured at the level where the femoral head is still in full contact and congruence with the anterior margin of the acetabulum. (orig.)

  11. Picturing internal fractures of historical statues using ground penetrating radar method

    S. Kadioglu; Y. K. Kadioglu

    2010-01-01

    The aim of the study is to formulate an approach to the monitoring of internal micro discontiniuties in a hybrid 2-D/3-D image of ground penetrating radar (GPR) data gathered on historical monument groups, and to indicate methodologically rearranging amplitude-color scale and its opacity functions to activate micro fractures in monument groups including three colossal women, three men, and 24 lion statues in Mustafa Kemal ATATÜRK's mausoleum (ANITKABIR) in Ankara, Turkey. Ad...

  12. Internal fixation and muscle pedicle bone grafting in femoral neck fractures

    Gupta A

    2008-01-01

    Full Text Available Background: The treatment of displaced intracapsular femoral neck fracture is still an unsolved problem. Non-union and avascular necrosis are the two main complications of this fracture, especially if patient presents late. Muscle pedicle bone grafting has been advocated to provide additional blood supply. We present analysis of our 32 cases of displaced femoral neck fracture treated by internal fixation and quadratus femoris based muscle pedicle bone grafting. Materials and Methods: Open reduction and internal fixation with muscle pedicle grafting was done in 32 patients. The age of patients varied from 14-62 years (average age 45 years with male to female ratio of 13:3. Twenty-nine fractures were more than three weeks old. All the cases were treated by Meyers′ procedure. The fracture was internally fixed after open reduction and then a muscle pedicle graft was applied. It was supplemented by cancellous bone graft in seven cases. Fixation was done by parallel cancellous lag screws ( n = 19, crossed Garden′s screws ( n = 7, parallel Asnis screws ( n = 5 and Moore′s pin ( n = 1.Quadratus femoris muscle pedicle graft was used in 32 cases. In the initial 12 cases the graft was fixed with circumferential proline sutures, but later, to provide a secure fixation, the graft was fixed with a cancellous screw ( n = 20. Postoperative full weight bearing was deferred to an average of 10 weeks. Results: Union was achieved in 26/29 (89.65% cases which could be followed for an average period of 3.4 years, (2-8.5 years with good functional results and had the ability to squat and sit cross-legged. Results were based on hip rating system given by Salvatti and Wilson. The results were excellent in 15 cases, good in four cases, fair in four cases and poor in six cases. Complications were avascular necrosis ( n = 2, transient foot drop ( n = 2, coxa-vara ( n = 1 and temporary loss of scrotal sensation ( n = 1. Conclusion: Muscle pedicle bone grafting with

  13. Osteonecrosis and femoro-acetabular impingement: sequelae of developmental dysplasia of the hip

    Cheung, Jason Pui Yin; Chow, Wang; To, Michael

    2012-01-01

    A 2-year-old girl with developmental dysplasia of the right hip underwent open reduction and capsulorrhaphy via the anterior approach with hip spica casting in an internally rotated position. During her 26 years of follow-up, she was found to have osteonecrosis and subsequently cam-type femoro-acetabular impingement at 28 years of age. She was treated with surgical dislocation of the hip and osteochondroplasty to recreate the normal contour of the head and neck offset.

  14. Fibular Strut Graft Augmentation for Open Reduction and Internal Fixation of Proximal Humerus Fractures

    Saltzman, Bryan M.; Erickson, Brandon J.; Harris, Joshua D.; Gupta, Anil K.; Mighell, Mark; Romeo, Anthony A.

    2016-01-01

    Background: Proximal humerus fractures are common problems plaguing the elderly population. Purpose: The purposes of this study were to determine the outcomes of fibular strut allografts in treatment of proximal humerus fractures with open reduction internal fixation (ORIF) and to present the authors’ preferred surgical technique. The hypothesis was that the use of fibular strut allografts in treating proximal humerus fractures with ORIF will provide low reoperation rates with acceptable outcomes. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was registered with PROSPERO and performed with PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines using 3 publicly available free databases. Therapeutic clinical outcome investigations reporting arthroscopic elbow outcomes with levels of evidence 1 through 4 were eligible for inclusion. All study, subject, and surgical technique demographics were analyzed and compared between continents and countries. Statistics were calculated using Student t tests, 1-way analysis of variance, chi-square tests, and 2-proportion Z tests. Results: Four studies met the inclusion criteria. While there is great heterogeneity existing in the literature surrounding use of a fibular strut allograft as an adjunct to ORIF of proximal humerus fractures, current evidence shows a humeral head screw penetration rate of 3.7% with acceptable functional outcome scores, with a reoperation rate of 4.4% at a weighted mean 80.78 weeks (1.55 years) of postoperative follow-up. Conclusion: There is great heterogeneity that exists in the literature surrounding the use of a fibular strut allograft as an adjunct to ORIF of proximal humerus fractures. Current evidence shows a screw penetration rate of 3.7% with acceptable functional outcome scores, demonstrating fibular strut allograft is a viable option for treating proximal humerus fractures. PMID:27504463

  15. Treatment of Humeral Shaft Fractures: Minimally Invasive Plate Osteosynthesis Versus Open Reduction and Internal Fixation

    Esmailiejah, Ali Akbar; Abbasian, Mohammad Reza; Safdari, Farshad; Ashoori, Keyqobad

    2015-01-01

    Background: The optimal technique for operative fixation of humeral shaft fractures remains controversial and warrants research. Objectives: The purpose of the current study was to compare the functional and clinical outcomes of conventional open reduction and internal fixation (ORIF) with minimally invasive plate osteosynthesis (MIPO) in patients with fractures in two-third distal humeral shaft. Patients and Methods: In the current prospective case-control study, 65 patients with humeral shaft fractures were treated using ORIF (33 patients) or MIPO (32 patients). Time of surgery, time of union, incidence of varus deformity and complications were compared between the two groups. Also, the university of California-Los Angeles (UCLA) shoulder rating scale and Mayo Elbow performance score (MEPS) were used to compare the functional outcomes between the two groups. Results: The median of union time was shorter in the MIPO group (4 months versus 5 months). The time of surgery and functional outcomes based on the UCLA and MEPS scores were the same. The incidence of varus deformity was more than 5° and was higher and the incidence of nonunion, infection and iatrogenic radial nerve injury were lower in the MIPO group; however, the differences were not significant. Conclusions: Due to the shorter union time, to some extent less complication rate and comparable functional and clinical results, the authors recommend to use the MIPO technique in treating the mid-distal humeral shaft fracture. PMID:26543844

  16. Treatment of Humeral Shaft Fractures: Minimally Invasive Plate Osteosynthesis Versus Open Reduction and Internal Fixation

    Esmailiejah

    2015-08-01

    Full Text Available Background The optimal technique for operative fixation of humeral shaft fractures remains controversial and warrants research. Objectives The purpose of the current study was to compare the functional and clinical outcomes of conventional open reduction and internal fixation (ORIF with minimally invasive plate osteosynthesis (MIPO in patients with fractures in two-third distal humeral shaft. Patients and Methods In the current prospective case-control study, 65 patients with humeral shaft fractures were treated using ORIF (33 patients or MIPO (32 patients. Time of surgery, time of union, incidence of varus deformity and complications were compared between the two groups. Also, the university of California-Los Angeles (UCLA shoulder rating scale and Mayo Elbow performance score (MEPS were used to compare the functional outcomes between the two groups. Results The median of union time was shorter in the MIPO group (4 months versus 5 months. The time of surgery and functional outcomes based on the UCLA and MEPS scores were the same. The incidence of varus deformity was more than 5° and was higher and the incidence of nonunion, infection and iatrogenic radial nerve injury were lower in the MIPO group; however, the differences were not significant. Conclusions Due to the shorter union time, to some extent less complication rate and comparable functional and clinical results, the authors recommend to use the MIPO technique in treating the mid-distal humeral shaft fracture.

  17. Outcome of open reduction and internal fixation of intraarticular calcaneal fracture fixed with locking calcaneal plate

    Jain Saurabh

    2013-12-01

    Full Text Available 【Abstract】Objective: Debate continues regarding the management of calcaneal fractures, between open re- duction and internal fixation and closed treatment. Hence we aim at evaluating the radiological and functional out- comes of open reduction and internal fixation in displaced joint depression type of calcaneal fractures fixed with lock- ing calcaneal plate. Methods: In this series, 28 patients (26 unilateral and 2 bilateral with joint depression type of calcaneal fractures as per Essex-Lopresti classification system were operated on with locking calcaneal plate within 3 weeks of injury. Patients were evaluated in terms of associated injuries and X-rays of anteroposterior, lateral and axial views of the calcaneum. CT scan was done to assess the amount of com- minution and articular depression. Patients were followed up clinically and radiologically at least for 1 year. Radiologi- cal assessment was done by Bohler’s angle and Gissane’s angle along with measurement of calcaneal height and width. Functional outcome was assessed using the American Or- thopaedics Foot and Ankle Society (AOFAS scale. Results: At average follow-up of 14.5 months, average AOFAS score was 86.3 (range 66 to 97, with 86% having excellent to good results and 2 (7.7% and 1 (3.7% having fair and poor results respectively. All patients had stable ankle joint with all having dorsiflexion and plantar flexion more than 30°. Average subtalar range of motion was 17°. The mean Bohler’s angle, mean Gissane’s angle, calcaneal height and width were 25.47°, 121.3°, 4.32 cm and 3.81cm respectively at final follow-up. Three patients had flap ne- crosis at incision site and one had superficial and deep infection. Subtalar arthritis was seen in 5 patients, whereas sural nerve hypoaesthesia in 1 patient. None of the patients had compartment syndrome, heel pad problems, peroneal tendinitis, reflex sympathetic dystropy or implant failure. Conclusion: Open reduction and

  18. Fracture resistance of cracked duplex stainless steel elbows under bending with or without internal pressure

    Electricite de France (EDF), in co-operation with Framatome, has conducted a large research programme on the fracture behaviour of aged cast duplex stainless steel elbows. One important task of this programme consisted of testing three large diameter (580 mm O.D.) thermally aged cast elbows containing either one or two semi-elliptical notches on the outer surface of the flank. The first two elbow tests (called SEM1 and SEM2) were conducted under in-plane closure bending at 320 C and the third one (called SEM3) under constant internal pressure and in-plane closure bending at 60 C. Those tests were carried out with 2/3-scale models of PWR primary loop elbows. This paper presents the results of the experiments and the results of the fracture mechanics analyses, based on finite element calculations. (orig.)

  19. Open reduction and internal fixation of displaced clavicle fractures in adolescents

    Harish S. Hosalkar

    2011-12-01

    Full Text Available The literature available on patient oriented outcomes of operative management for clavicle fractures in adolescents is fairly limited. The purpose of this study was to analyze the potential of open reduction and internal fixation for displaced mid-shaft clavicle fractures in adolescent patients. We reviewed our series of surgical cases performed in 19 adolescents (mean age: 14.6 years with displaced unilateral clavicle fractures. Baseline data acquisition included demographic and radiographic variables. A Synthes® LCP clavicular plate was utilized for fixation in all cases. Follow-up data included functional outcome assessment using the Quick Disability of Arm, Shoulder, and Hand Questionnaire (DASH, the simple shoulder test (SST and additional binary questions. At a mean follow-up of 16 months, quick DASH scores were 4.0 (range: 0-35.5 and mean number of positive yes responses on the SST for all operative patients was 11 (range: 9-12. All cases proved complete radiological union at the 3-month follow-up. All patients returned to full athletics at a mean time of 14 weeks (range: 12-17 weeks. Two patients had minimal hypertrophic scars while no patient was noted with keloid formation or neurovascular deficit. One patient complained of implant prominence and occasional symptoms of discomfort at the 15 month follow-up and opted for implant removal. This was successfully performed with uneventful full recovery. All patients were fully satisfied with their choice for surgical intervention. Anatomical reduction with internal fixation and early mobilization of adolescent displaced clavicle fractures remains a viable treatment option with predictable results and no major complications in reliable hands.

  20. Use of gentamicin-loaded collagen sponge in internal fixation of open fractures

    Chaudhary Susheel; Sen Ramesh; Saini Uttam Chand; Soni Ashwani; Gahlot Nitesh; Singh Daljit

    2011-01-01

    management of open bone injuries. These sponges can be used easily with any form of internal fixation and there is no need of second surgery for the removal of these antibiotic carriers since they are bioabsorbable. Local antibiotic-impregnated collagen sponges along with systemic antibiotics for 3 to 5 days offer promising results in open fracture management.

  1. Unusual Bilateral Rim Fracture in Femoroacetabular Impingement

    Claudio Rafols

    2015-01-01

    Full Text Available This is a report of one case of bilateral acetabular rim fracture in association with femoroacetabular impingement (FAI, which was treated with a hip arthroscopic procedure, performing a partial resection, a labral reinsertion, and a subsequential internal fixation with cannulated screws. Up to date, there are in the literature only two reports of rim fracture and “os acetabuli” in association with FAI. In the case we present, the pincer and cam resection were performed without complications; the technique used was published previously. With this technique the head of the screw lays hidden by the reattached labrum. We removed partially the fractured rim fragment and the internal fixation of the remaining portion was achieved with a screw. In the event of a complete resection of the fragment, it would have ended with a LCE angle of 18° and a high probability of hip instability. We believe that this bilateral case helps establish the efficacy and reproducibility of the technique described by Larson.

  2. Effect of Internal Stresses on Fracture Behaviour of Alumina and Zirconia Based Layered Composites

    Chlup, Zdeněk; Hadraba, Hynek; Slabáková, L.; Drdlík, D.; Dlouhý, Ivo

    Bratislava: VEDA, 2011 - (Pavol Šajgalík, Zoltán Lenčéš). s. 71 ISBN 978-80-970657-4-4. [Advanced Research Workshop Engineering Ceramics 2011 from Materials to Components. 08.05.2011-12.05.2011, Smolenice Castle] R&D Projects: GA ČR GD106/09/H035 Institutional research plan: CEZ:AV0Z20410507 Keywords : Ceramics * laminates * crack propagation * internal stresses * fracture behaviour Subject RIV: JL - Materials Fatigue, Friction Mechanics

  3. Combined fixation, intern and external, in proximal complex fractures of the tibia

    Between August of 1997 and December of 2001, they were treated in the orthopedics department and traumatology of the Hospital Clinica San Rafael, 16 patients with proximal complex fractures of the tibia, using internal fixation with plate in the lateral column and an unilateral external fixer, for the medial column. It carries out a clinical and radiological pursuit with average of 27 months (minimum 4.5, maximum 40 months). In 15 patients (93,7%) it was obtained a primary consolidation and 1 case (6,2%) it presented retard in the consolidation being necessary the placement of bony implants. in 2 cases (12,5%) there was superficial infection, one in the itinerary of the nails and another in area of superficial necrosis in soft fabrics in a closed fracture. single 1 case (6,2) it presented deep infection, which, it improve with bony curettage and antibiotics. In the final radiographic evaluation, 2 cases (12,5%) they presented depression of the lateral plate; according to the functional scale of Rasmussen excellent results were obtained (27 to 30 points) in 11 cases (68,7%) and good (20 to 26 points) in 5 cases (31,2%). The radiographic results and functional global they suggest that the combination of a technique less invasive in this area criticizes, it represents a good alternative for the treatment of the proximal complex fractures of the tibia

  4. Open reduction and internal fixation in treatment of pilon tibial fractures

    Yorgancigil, Ekmel; Baran, Ayhan; Yıldız, Muzaffer; Aksu, Sırrı; Gürbüz, Aydın

    2004-01-01

    Pilon fractures are the most serious fractures among the ankle fractures and generally occur after high energy trauma. The main goalfor the treatment of these fractures is to obtain a good functioned ankle joint as in all intraarticular fractures by achieving anatomicalreduction and fulljoint restoration. We evaluated 26 .cases with 28 pilon fractures hospitalized and treated at our Orthopaedie and Traumatology Clinic at Ministery of Health Kartal Training and Research Hospitalunder the light...

  5. Treatment of stress fracture of the olecranon in throwing athletes with internal fixation through a small incision

    Fujioka Hiroyuki

    2012-12-01

    Full Text Available Abstract The present study is a report of retrospective case series of stress fracture of the olecranon. Six patients presented posterior elbow pain in throwing in baseball and softball, but fracture was not diagnosed in radiographs. We detected stress fracture of the olecranon using computed tomographic (CT scan and treated the patient with internal fixation with a headless cannulated double threaded screw through a small skin incision. All patients returned to competitive level without elbow complaints after the operation. When throwing athletes present with unusual posterior elbow pain and no significant findings on radiographs, a CT scan examination should be performed. We recommend surgical treatment of internal fixation with a screw through a small skin incision, as a good option for stress fracture of the olecranon in order to allow early return to sports activity in competitive athletes.

  6. Falsire: CSNI project for fracture analyses of large-scale international reference experiments (Phase 1). Comparison report

    A summary of the recently completed Phase I of the Project for Fracture Analysis of Large-Scale International Reference Experiments (Project FALSIRE) is presented. Project FALSIRE was created by the Fracture Assessment Group (FAG) of Principal Working Group No. 3 (PWG/3) of the OECD/NEA Committee on the Safety of Nuclear Installations (CSNI), formed to evaluate fracture prediction capabilities currently used in safety assessments of nuclear vessel components. The aim of the Project FALSIRE was to assess various fracture methodologies through interpretive analyses of selected large-scale fracture experiments. The six experiments used in Project FALSIRE (performed in the Federal Republic of Germany, Japan, the United Kingdom, and the U.S.A.) were designed to examine various aspects of crack growth in reactor pressure vessel (RPV) steels under pressurized-thermal-shock (PTS) loading conditions. The analysis techniques employed by the participants included engineering and finite-element methods, which were combined with Jr fracture methodology and the French local approach. For each experiment, analysis results provided estimates of variables such as crack growth, crack-mouth-opening displacement, temperature, stress, strain, and applied J and K values. A comparative assessment and discussion of the analysis results are presented; also, the current status of the entire results data base is summarized. Some conclusions concerning predictive capabilities of selected ductile fracture methodologies, as applied to RPVs subjected to PTS loading, are given, and recommendations for future development of fracture methodologies are made

  7. Treatment of Gustilo grade Ⅲ leg fractures by external fixation associated with limited internal fixation

    ZHANG Chun-qiang; ZHENG Hong-yu; WANG Bing; HUANG He; HE Fei; ZHAO Xue-ling

    2010-01-01

    Objective: To explore the clinical ef-fects of external fixation associated with limited internal fixa-tion on treatment of Gustilo grade Ⅲ leg fractures.Methods: From July 2006 to December 2008, 40 cases of Gustilo grade Ⅲ leg fiactures were emergently treated in our unit with external fixation frames.Soft tissue injuries were grouped according to the Gustilo classification as ⅢA in 17 cases, ⅢB in 13 cases, and ⅢC in 10 cases.All the patients were debrided within 8 hours, and then fracture reposition was preformed to reestablish the leg alignment.Limited internal fixation with plates and screws were per-formed on all the Gustilo Ilia cases and 10 Gustilo ⅢB cases at the first operation.But all the Gustilo ⅢC cases and 3 Gustilo ⅢB cases who had severe soft tissue injuries and bone loss only received Vacuum-sealing drainage (VSD).Broad-spectrum antibiotics were regularly used and VSD must be especially maintained easy and smooth for one week or more after operation.Limited internal fixation and transplanted free skin flaps or adjacent musculocutaneous flaps were not used to close wounds until the conditions of the wounds had been improved.Results: The first operations were completed within 90-210 minutes (170 minutes on average).The blood trans-fusions were from 400 ml to 1500 ml (those used for anti-shock preoperatively not included).All the 40 patients in this study were followed up for 6-28 months, 20.5 months on average.The lower limb function was evaluated accord-ing to the comprehensive evaluation standards of leg func-tion one year after operation and the results of 28 cases were excellent, 9 were good and 3 were poor.Conclusion: External fixation associated with limited internal fixation to treat Gustilo grade Ⅲ leg fractures can get satisfactory early clinical therapeutic effects.

  8. Acetabular paralabral cyst: an uncommon cause of sciatica

    Sherman, P.M.; Sanders, T.G. [Department of Radiology, Wilford Hall Medical Center, 2200 Bergquist Drive, Ste. 1, Lackland AFB, TX 78236 (United States); Matchette, M.W. [University of Texas Medical School, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900 (United States); Parsons, T.W. [Department of Orthopedic Surgery, Wilford Hall Medical Center, 2200 Bergquist Drive, Ste. 1, Lackland AFB, TX 78236 (United States)

    2003-02-01

    The association between tears of the acetabular labrum and paralabral cysts has been well documented, and magnetic resonance imaging (MRI) has been shown to be the most accurate noninvasive method of depicting not only the normal anatomic structures of the hip, but also the common pathologic processes such as labral tears and paralabral cysts. We present the case of an acetabular paralabral cyst that resulted in clinically symptomatic compression of the sciatic nerve. (orig.)

  9. Outcome of open reduction and internal fixation of intraarticular calcaneal fracture fixed with locking calcaneal plate

    Saurabh Jain; Anil Kumar Jain; Ish Kumar

    2013-01-01

    Objective:Debate continues regarding the management of calcaneal fractures,between open reduction and internal fixation and closed treatment.Hence we aim at evaluating the radiological and functional outcomes of open reduction and internal fixation in displaced joint depression type of calcaneal fractures fixed with locking calcaneal plate.Methods:In this series,28 patients (26 unilateral and 2 bilateral) with joint depression type of calcaneal fractures as per Essex-Lopresti classification system were operated on with locking calcaneal plate within 3 weeks of injury.Patients were evaluated in terms of associated injuries and X-rays of anteroposterior,lateral and axial views of the calcaneum.CT scan was done to assess the amount ofcomminution and articular depression.Patients were followed up clinically and radiologically at least for 1 year.Radiological assessment was done by Bohler's angle and Gissane's angle along with measurement ofcalcaneal height and width.Functional outcome was assessed using the American Orthopaedics Foot and Ankle Society (AOFAS) scale.Results:At average follow-up of 14.5 months,average AOFAS score was 86.3 (range 66 to 97),with 86% having excellent to good results and 2 (7.7%) and 1 (3.7%) having fair and poor results respectively.All patients had stable ankle joint with all having dorsiflexion and plantar flexion more than 30°.Average subtalar range of motion was 17°.The mean Bohler's angle,mean Gissane's angle,calcaneal height and width were 25.47°,121.3°,4.32 cm and 3.81cm respectively at final follow-up.Three patients had flap necrosis at incision site and one had superficial and deep infection.Subtalar arthritis was seen in 5 patients,whereas sural nerve hypoaesthesia in 1 patient.None of the patients had compartment syndrome,heel pad problems,peroneal tendinitis,reflex sympathetic dystropy or implant failure.Conclusion:Open reduction and internal fixation with locking calcaneal plate gives sound functional outcome

  10. Relationship between sacral pelvic incidence and acetabular orientation.

    Legaye, Jean; Duval-Beaupere, Ginette; Barrau, Andre; Boulay, Christophe; Hecquet, Jerome; Montigny, Jean-Pierre; Tardieu, Christine

    2011-01-01

    The importance of the sacral pelvic incidence (SPI) in relation to individual variations of sagittal spinal curvature has become well-recognised. We attempted to determine the relationship between SPI and acetabular orientation. The three-dimensional coordinates of 47 homologous points were observed on 51 adult anatomical pelvises (26 female and 25 male). The reference vertical plane was Lewinnek's anterior pelvic plane. 10 angular parameters and 11 linear parameters were defined and calculated. These were expressed both in absolute value (in millimetres) and in "acetabular unit" (relative to the mean value of the right and left acetabular rays). Mean values of the parameters were calculated for all pelvises and according to gender. There were two dominant parameters: the "sacral slope" and the "V pubic angle". "Acetabular tilting" was primarily dependent on the "sacral slope" and its intermediary on the "SPI", while "acetabular anteversion" dependent on the "V pubic angle" via the "angle of prow". It is recommended that positioning of the acetabular cup in total hip arthroplasty relates to anatomical parameters, and to the global sagittal balance of the pelvi-spinal unit. PMID:21279971

  11. Experimental and Numerical Modeling of Screws Used for Rigid Internal Fixation of Mandibular Fractures

    Bret Baack

    2008-05-01

    Full Text Available Experimental and numerical methods are used to explore the stresses generated around bone screws used in rigid internal fixation of mandibular fractures. These results are intended to aid in decisions concerning both the design and the use of these bone screws. A finite element (FE model of a human mandible is created with a fixated fracture in the parasymphyseal region. The mandibular model is anatomically loaded, and the forces exerted by the fixation plate onto the simplified screws are obtained and transferred to another finite element submodel of a screw implant embedded in a trilaminate block with material properties of cortical and cancellous bone. The stress in the bone surrounding the screw implant is obtained and compared for different screw configurations. The submodel analyses are further compared to and validated with simple axial experimental and numerical screw pull-out models. Results of the screw FE analysis (FEA submodel show that a unicortical screw of 2.6 mm major diameter and 1.0 mm pitch will cause less bone damage than a bicortical screw of 2.3 mm major diameter and 1.0 mm pitch. The results of this study suggest that bicortical drilling can be avoided by using screws of a larger major diameter.

  12. Bioabsorbable fish scale for the internal fixation of fracture: a preliminary study.

    Chou, Cheng-Hung; Chen, Yong-Guei; Lin, Chien-Chen; Lin, Shang-Ming; Yang, Kai-Chiang; Chang, Shih-Hsin

    2014-09-01

    Fish scales, which consist of type I collagen and hydroxyapatite (HA), were used to fabricate a bioabsorbable bone pin in this study. Fresh fish scales were decellularized and characterized to provide higher biocompatibility. The mechanical properties of fish scales were tested, and the microstructure of an acellular fish scale was examined. The growth curve of a myoblastic cell line (C2C12), which was cultured on the acellular fish scales, implied biocompatibility in vitro, and the morphology of the cells cultured on the scales was observed using scanning electron microscopy (SEM). A bone pin made of decellularized fish scales was used for the internal fixation of femur fractures in New Zealand rabbits. Periodic X-ray evaluations were obtained, and histologic examinations were performed postoperatively. The present results show good cell growth on decellularized fish scales, implying great biocompatibility in vitro. Using SEM, the cell morphology revealed great adhesion on a native, layered collagen structure. The Young's modulus was 332 ± 50.4 MPa and the tensile strength was 34.4 ± 6.9 MPa for the decellularized fish scales. Animal studies revealed that a fish-scale-derived bone pin improved the healing of bone fractures and degraded with time. After an 8-week implantation, the bone pin integrated with the adjacent tissue, and new extracellular matrix was synthesized around the implant. Our results proved that fish-scale-derived bone pins are a promising implant material for bone healing and clinical applications. PMID:25211643

  13. Initial Results of an Acetabular Center Axis Registration Technique in Navigated Hip Arthroplasty with Deformed Acetabular Rims

    Wada, Hiroshi; Mishima, Hajime; Yoshizawa, Tomohiro; Sugaya, Hisashi; Nishino, Tomofumi; Yamazaki, Masashi

    2016-01-01

    Background In cementless total hip arthroplasty, imageless computer-assisted navigation is usually used to register the anterior pelvic plane (APP). The accuracy of this method is influenced by the subcutaneous tissues overlying the registration landmarks. On the other hand, the acetabular center axis (ACA) is determined from the acetabular rim. Precise registration of the ACA is possible because of direct palpation using a pointer. Imageless navigation using the ACA usually targets patients ...

  14. CT of pelvic fractures

    Falchi, Marco E-mail: marcofalchi@yahoo.it; Rollandi, Gian Andrea

    2004-04-01

    Although magnetic resonance imaging has become the dominant modality for cross-sectional musculo-skeletal imaging, the widespread availability, speed, and versatility of computed tomography (CT) continue to make it a mainstay of emergency room (ER) diagnostic imaging. Pelvic ring and acetabular fractures occur as the result of significant trauma secondary to either a motor vehicle accident or a high-velocity fall. These injuries are correlated with significant morbidity and mortality, both from the complications of pelvic ring fractures and from commonly associated injuries. The most commonly used classification of pelvic and acetabular fractures has been based on conventional radiographs that are, in the majority of cases, sufficient to determine the type of injury. However, because of the complexity of pelvic and acetabular fractures, precise pathological anatomy is not easily demonstrated by routine radiographs and in many cases details of fractures are not visible. Moreover, the insufficient co-operation of the patient or the difficulty of maintaining special positions can be overcome by using computed tomography. Spiral computed tomography provides information regarding the extent of the fractures and is complementary to radiography for ascertaining the spatial arrangement of fracture fragments. Spiral computed tomography is an effective tool for understanding complex fracture patterns, particularly when combined with multi-planar reconstruction two-dimensional (MPR 2D) reformatted images or three-dimensional images (3D) images. Including these techniques of reconstruction in routine pelvic imaging protocols can change management in a significant number of cases. Subtle fractures, particularly those oriented in the axial plane, are better seen on MPR images or 3D volume-rendered images. Complex injuries can be better demonstrated with 3D volume-rendered images, and complicated spatial information about the relative positions of fracture fragments can be easily

  15. CT of pelvic fractures

    Although magnetic resonance imaging has become the dominant modality for cross-sectional musculo-skeletal imaging, the widespread availability, speed, and versatility of computed tomography (CT) continue to make it a mainstay of emergency room (ER) diagnostic imaging. Pelvic ring and acetabular fractures occur as the result of significant trauma secondary to either a motor vehicle accident or a high-velocity fall. These injuries are correlated with significant morbidity and mortality, both from the complications of pelvic ring fractures and from commonly associated injuries. The most commonly used classification of pelvic and acetabular fractures has been based on conventional radiographs that are, in the majority of cases, sufficient to determine the type of injury. However, because of the complexity of pelvic and acetabular fractures, precise pathological anatomy is not easily demonstrated by routine radiographs and in many cases details of fractures are not visible. Moreover, the insufficient co-operation of the patient or the difficulty of maintaining special positions can be overcome by using computed tomography. Spiral computed tomography provides information regarding the extent of the fractures and is complementary to radiography for ascertaining the spatial arrangement of fracture fragments. Spiral computed tomography is an effective tool for understanding complex fracture patterns, particularly when combined with multi-planar reconstruction two-dimensional (MPR 2D) reformatted images or three-dimensional images (3D) images. Including these techniques of reconstruction in routine pelvic imaging protocols can change management in a significant number of cases. Subtle fractures, particularly those oriented in the axial plane, are better seen on MPR images or 3D volume-rendered images. Complex injuries can be better demonstrated with 3D volume-rendered images, and complicated spatial information about the relative positions of fracture fragments can be easily

  16. Three-fin acetabular prosthesis for superior acetabular bone defects: a three-dimensional finite element analysis

    LIU Yu-zeng; HAI Yong; ZHAO Hui

    2012-01-01

    Background Given that three-dimensional finite element models have been successfully used to analyze biomechanics in orthopedics-related research,this study aimed to establish a finite element model of the pelvic bone and three-fin acetabular component and evaluate biomechanical changes in this model after implantation of a three-fin acetabular prosthesis in a superior segmental bone defect of the acetabulum.Methods In this study,three-dimensional finite element models of the pelvic bone and three-fin acetabular component were first established.The prosthesis model was characterized by three different conformational fins to facilitate and optimize the prosthetic design.The spongy and cortical bones were evaluated using a different modulus of elasticity in this established model.Results The maximum and minimum von Mises stresses on the fins of the acetabular component were 15.2 and 0.74,respectively.The maximum and minimum micromotion between the three-fin acetabular component and the acetabulum bone interface were 27 and 13 μm,respectively.A high primary stability and implied better clinical outcome were revealed.Conclusion Finite element analysis may be an optimal strategy for biomechanics-related research of prosthetic design for segmental acetabular bone defects.

  17. A STUDY OF INTERNAL FIXATION OF INTRACAPSULAR FRACTURE NECK OF FEMUR IN ADULTS BY MULTIPLE CANNULATED CANCELLOUS LAG SCREEWS

    Sanjeevaiah

    2015-07-01

    Full Text Available INTRODUCTION: Fractures of neck of femur have always presented great challenges to the Orthopaedic surgeons. In many ways today the unsolved fracture as per as treatment and results are concerned. Fractures of neck of femur are usually entirely intracapsular results depend upon extent of injury and adequacy of reduction and fixation. Fixation with cannulated cancellous lagscrews is usually adequate for femoral neck fractures. Lateral cortex place a very important role in screw fixation. AIMS & OBJECTIVES : To evaluate the cannulated cancellous lagscrew fixation in case of intra capsular neck of femur. MATERIAL AND METHODS : The patients with intra capsular fracture neck of femur are evaluated with pre - operative X - Rays of the concerned hip joints both in anterio posterior and lateral views and their outcome post operatively after fixation with cancellous screws. The outcome was evaluated in terms of pain relief and ambulation after surgery. The patients followed upto one year to assess the outcome. RESULTS: The excellent results was obtained in 22.63% good result in 59.09% fair in 9.09% poor in 9.09%. Nonunion and loosening of screws in one case. Nonunion and extrusion of screws in one case. Cut through o f the screws in to the articular surface leading to painful joint in one case. Most of the cases are fracture neck of femur were in the age group of 20 to 40 with male preponderance. CONCLUSION: By the usage of cannulated cancellous lag screws compression of the fracture site is achieved, with also avoids rotations. Multiple cannulated cancellous lagscrews in intra capsular neck of femur is an easy procedure with encouraging results. AIM : An attempt has been made to evaluate the role of multiple cannulated cancellous lag Screws in internal fixation of intracapsular fracture neck of femur. Patients selected for this operation were between the age group of 15 to 55 years with intracapsular fracture neck of femur during the years 2011 to 2014.

  18. Phase II of the multinational project for fracture analysis of large-scale international reference experiments (FALSIRE II)

    This document describes the organization and plan for Phase II fo the Project for Fracture Analysis of Large-Scale International Reference Experiments (FALSIRE). The experiments employ a variety of test specimens, test materials, and loading conditions. The primary focus of the experiments was on the behaviour of relatively shallow cracks under conditions that relate to pressurized-thermal-shock loading in a reactor perssure vessel (RPV); the effects of biaxial loading and of cladding on cleavage fracture were separate topics of study in two experiments. A summary of each experiment is included in this report. Final versions of the problem statements will form the basis for FALSIRE II in which evaluations of the experiments will be performed by an international group of analysts using a variety of structural and fracture mechanis techniques. 7 refs, 7 figs, 5 tabs

  19. Primary internal fixation and soft-tissue reconstruction in the treatment for an open Lisfranc fracture-dislocation.

    Sanli, Ilknur; Hermus, Joris; Poeze, Martijn

    2012-06-01

    The importance of anatomical reduction for improved outcome has been recognised in the management of Lisfranc injuries. Operative fixation is indicated in case of dislocation or unstable ligamentous injury, because discongruity of the Lisfranc joint can lead to deleterious functional outcome. Screws are the recommended method of fixation of the medial en middle column, and K-wires are used for stabilisation of the unstable lateral column. Primary arthrodesis can provide advantages in pure ligamentous injury. In the management of complex open Lisfranc fractures, external fixation with K-wires can be used, but often results in a high percentage of arc deformities and functional limitations. In recent years, there is a progressive change from external to internal fixation in primary stabilisation of open fractures. This case report describes the treatment for a grade III open Lisfranc fracture-dislocation by use of primary internal fixation and soft-tissue reconstruction. PMID:21706153

  20. Radiographic prevalence of CAM-type femoroacetabular impingement after open reduction and internal fixation of femoral neck fractures

    Mathew, G.; Kowalczuk, M.; Hetaimish, B.; Bedi, A.; Philippon, M.J.; Bhandari, M.; Simunovic, N.; Crouch, S.; Ayeni, O.R.; Kampen, A. van

    2014-01-01

    PURPOSE: The purpose of this study was to estimate the radiographic prevalence of CAM-type femoroacetabular impingement (FAI) in elderly patients (>/= 50 years) who have undergone internal fixation for femoral neck fracture. METHODS: A total of 187 frog-leg lateral radiographs of elderly patients

  1. Fracturing of revision of a cobalt-chrome femoral head after fracturing of a ceramic femoral head, with diffuse metallosis. Case report

    Pedro Miguel Dantas Costa Marques

    2013-04-01

    Full Text Available We presente a case of a fracture of a cobalt-chrome femoral head after revision of a hip total prosthesis with ceramic femoral head fracture. During surgery we found the cobalt-chrome femoral head fracture, wear of the polyethylene and massive metallosis in muscular and cartilaginous tissue. Both femoral stem and acetabular cup were stable and without apparent wearing. After surgical debridement, we promoted the substitution of the femoral head and the acetabular polyethylene by similar ones. After 12 months of follow-up, the patient has no pain complaints, function limit or systemic signs associated with malign metallosis

  2. Accuracy of the modified Hardinge approach in acetabular positioning

    Goyal, Prateek; Lau, Adrian; McCalden, Richard; Teeter, Matthew G.; Howard, James L.; Lanting, Brent A.

    2016-01-01

    Background The surgical approach chosen for total hip arthroplasty (THA) may affect the positioning of the acetabular component. The purpose of this study was to examine the accuracy in orienting the acetabular component using the modified Hardinge approach. Methods We used our institutional arthroplasty database to identify patients with primary, press-fit, hemispherical acetabular components of a metal-on-polyethylene THA performed between 2003 and 2011. Patients with radiographs obtained 1–3 years after the index procedure were included for measurement of anteversion and inclination angles. Acceptable values of anteversion and abduction angles were defined as 15° ± 10° and 40° ± 10°, respectively. Results We identified 1241 patients from the database, and the modified Hardinge approach was used in 1010 of the patients included in our analysis. The acetabular component was anteverted in the acceptable zone in 54.1% of patients. The abduction angle was within the defined range in 79.2% of patients. Combined anteversion and abduction angles within the defined zone were present in 43.6% of patients. Conclusion Consistent with studies examining accuracy from other approaches, our study reveals that the modified Hardinge approach was only moderately accurate in positioning the acetabular component in the acceptable zone. PMID:27240130

  3. Management of intra-articular fracture of the fingers via mini external fixator combined with limited internal fixation

    LI Wen-jun; TIAN Wen; TIAN Guang-lei; CHEN Shan-lin; ZHANG Chang-qing; XUE Yun-hao; LI Zhong-zhe; ZHU Yin

    2009-01-01

    Background Intra-articular fractures of the fingers are common problems to emergency physicians and hand surgeons.Inappropriate management of these injuries may result in chronic pain,stiffness,deformity,or post traumatic arthritis.Ideal treatment necessitates the restoration of a stable and congruent joint that will allow early mobilization.The purpose of this study was to investigate the results of intra-articular fracture of the fingers by mini external fixator combined with limited internal fixation.Methods From May 2005 to May 2007,a total of 26 patients with intra-articular fracture of the fingers were treated by mini external fixator combined with limited internal fixation.Of the 26 cases,11 involved in metacarpophalangeal joint,and 15 interphalangeal joint in proximal interphalangeal.Kirschner wire,mini wire and absorbable suture were used for limited internal fixation.All patients were followed up and patients were accomplished with total active motion(TAM)of fingers.Results All patients were reviewed by an independent observer.The mean follow up was 13 months(range 9 to 24 months).Subjective,objective and radiographic results were evaluated.X-ray films revealed fracture union and the average radiographic union time was 7 weeks with a range of 5-12 weeks and the phalange shortening or rotation in 2 cases,joint incongruity(less than 1 mm)and joint space narrowing in 3 cases respectively.Phalangeal shortening or rotation was observed in 2 cases and joint incongruity or joint space narrowing was observed in 3 cases.An artificial implant was performed on one case for traumatic arthritis 1.5 years after surgery.Based on TAM the overall good-excellent rate of joint motion function was 80.8%.Conclusion Mini external fixator combined with limited internal fixation is a reliable and effective method for treatment of intra-articular fracture of the fingers.

  4. Internal fixation for coronal shear fracture of the capitellum with polylactide resorbable fixation

    Kraan, Gerald A; Krijnen, Matthijs R; Eerenberg, Jan Peter

    2013-01-01

    A 24-year-old woman with pain in the right elbow after a fall demonstrated a coronal shear fracture on radiographic studies. Perioperative a coronal shear fracture was seen and treated successfully with a polylactide Rigid fix resorbable pin. The operative correction resulted in normal function at 6 months follow-up. We state that a capitellum shear fracture can be fixated with a single resorbable pin, leading to successful fusion.

  5. MR imaging findings of acetabular dysplasia in adults

    James, Steven; Connell, David [The Royal National Orthopaedic Hospital, Radiology Department, London, Middlesex (United Kingdom); Miocevic, Miranda; Malara, Frank; Pike, Jonathan [Victoria House Hospital, Radiology Department, Melbourne (Australia); Young, David [Melbourne Orthopaedic Group, Orthopaedic Surgery, Melbourne (Australia)

    2006-06-15

    To evaluate the diagnostic accuracy of MR imaging in the identification of labral and articular cartilage lesions in patients with acetabular dysplasia. Pre-operative MR imaging was performed on 27 hips in 25 consecutive patients (16 males, 9 females, age range 19-52 years, mean age 31.2 years) with radiographic evidence of acetabular dysplasia (centre-edge angle of Wiberg <20 degrees). The average duration of symptoms was 16.2 months. Two musculoskeletal radiologists assessed MR images in consensus for the presence of abnormality involving the acetabular labrum and adjacent acetabular articular cartilage. A high resolution, non-arthrographic technique was used to assess the labrum and labral chondral transitional zone. Surgical correlation was obtained in all cases by a single surgeon experienced in hip arthroscopy and ten patients with normal hip MRI were included to provide a control group. The acetabular labra in the dysplastic hips demonstrated abnormal signal intensity, and had an elongated appearance when compared with the control group (mean length 10.9 mm vs 6.4 mm). Morphological appearances in the labra included surface irregularity, fissures and cleft formation. MR imaging correctly identified the severity of chondral abnormality in 24 of 27 hips (89%) when compared with arthroscopic findings. MR imaging demonstrates an elongated labrum, focal intra-substance signal change and irregularity and fissuring of the margins in patients with acetabular dysplasia. Abnormality is also identified at the labral chondral transitional zone, where fissuring, focal clefts, chondral deficiency and subchondral cyst formation may be apparent. A high-resolution, non-arthrographic technique can provide an accurate preoperative assessment and evaluate the presence of premature osteoarthritis. (orig.)

  6. Rate of Improvement following Volar Plate Open Reduction and Internal Fixation of Distal Radius Fractures

    Chris Dillingham

    2011-01-01

    Full Text Available Purpose. To determine recovery timeline of unstable distal radius fractures treated by open reduction and internal fixation with a locking volar plate. Methods. Data was collected prospectively on a consecutive series of twenty-seven patients during routine post-operative visits at 2 and 6 weeks, and 3, 6, 12 and 24 months. Range of motion measures and grip strength for both wrists were recorded. Results. Greatest gains were made within the first 3 months after surgery. Supination and pronation returned more quickly than flexion or extension, with supination and pronation both at 92% of the uninjured wrist at 3 months. Only flexion improved significantly between 3 and 6 months. All wrist motions showed some improvement until 1 year. Grip strength returned to 94% of the uninjured wrist by 12 months. Conclusions. Range of motion improvement will be greatest between 2 weeks and 3 months, with improvement continuing until 12 months. Grip strength should return to near normal by one year. Function and pain will improve, but not return to normal by the end of 12 months. Clinical Relevance. These results provide the surgeon with information that can be shared with patients on the anticipated timeline for normal recovery of function and strength.

  7. Peri-acetabular bone mineral density in total hip replacement

    Gauthier, L.(University of Illinois at Chicago (UIC), Chicago, USA); Dinh, L.; Beaulé, P. E.

    2013-01-01

    Objectives To quantify and compare peri-acetabular bone mineral density (BMD) between a monoblock acetabular component using a metal-on-metal (MoM) bearing and a modular titanium shell with a polyethylene (PE) insert. The secondary outcome was to measure patient-reported clinical function. Methods A total of 50 patients (25 per group) were randomised to MoM or metal-on-polyethlene (MoP). There were 27 women (11 MoM) and 23 men (14 MoM) with a mean age of 61.6 years (47.7 to 73.2). Measurement...

  8. Acetabular Dysplasia and Surgical Approaches Other Than Direct Anterior Increases Risk for Malpositioning of the Acetabular Component in Total Hip Arthroplasty

    Gromov, Kirill; Greene, Meridith E; Huddleston, James I;

    2016-01-01

    BACKGROUND: Persistent acetabular dysplasia (AD) after periacetabular osteotomy has been hypothesized to increase the risk for malpositioning of the acetabular component. In this study, we investigate whether AD is an independent risk factor for cup malpositioning during primary total hip...... arthroplasty (THA). METHODS: Patient demographics, surgical approach, presence of AD assessed using the lateral center-edge angle, and acetabular cup positioning determined using Martell Hip Analysis Suite were investigated in 836 primary THA patients enrolled in a prospective multicenter study. RESULTS: We...

  9. Development of a brittle fracture acceptance criterion for the International Atomic Energy Agency (IAEA)

    An effort has been undertaken to develop a brittle fracture acceptance criterion for structural components of nuclear material transportation casks. The need for such a criterion was twofold. First, new generation cask designs have proposed the use of ferritic steels and other materials to replace the austenitic stainless steel commonly used for structural components in transport casks. Unlike austenitic stainless steel which fails in a high-energy absorbing, ductile tearing mode, it is possible for these candidate materials to fail via brittle fracture when subjected to certain combinations of elevated loading rates and low temperatures. Second, there is no established brittle fracture criterion accepted by the regulatory community that covers a broad range of structural materials. Although the existing IAEA Safety Series number-sign 37 addressed brittle fracture, its the guidance was dated and pertained only to ferritic steels. Consultant's Services Meetings held under the auspices of the IAEA have resulted in a recommended brittle fracture criterion. The brittle fracture criterion is based on linear elastic fracture mechanics, and is the result of a consensus of experts from six participating IAEA-member countries. The brittle fracture criterion allows three approaches to determine the fracture toughness of the structural material. The three approaches present the opportunity to balance material testing requirements and the conservatism of the material's fracture toughness which must be used to demonstrate resistance to brittle fracture. This work has resulted in a revised Appendix IX to Safety Series number-sign 37 which will be released as an IAEA Technical Document within the coming year

  10. IPSILATERAL TRAUMATIC POSTERIOR DISLOCATION OF THE HIP ACCOMPANIED BY PRETROCHANTERC FRACTURE

    Taser, Omer; Cakmak, Mehmet; Cubuk, Mustafa Kemal; Domanic, Unsal; Karamehmetoglu, M.

    2004-01-01

    Attempts have been made to present a case with ipsilateral traumatic posterior dislocation of the hip and fracture of the trachanteric region without any acetabular fracture. In this unique case with no second in the literature, treatment of choice has been discussed and late results obtained from this case reported.

  11. Monteggia fracture dislocation equivalents - analysis of eighteen cases treated by open reduction and internal fixation

    Singh Ajay Pal

    2012-02-01

    Full Text Available 【Abstract】 Objective: Monteggia fracture dislocation equivalent, though already described by Bado, is still an unclassified entity. We aimed to retrospectively analyze 18 cases of Monteggia variants and discuss the injury mechanisms, management, and outcome along with a review of the literature. Methods: A retrospective record of Monteggia fracture dislocation (2003-2008 was reviewed from medical record department of our institute. Classic Monteggia fracture dislocation, children below 12 years or adults over 50 years, as well as open grade II & III cases were excluded from this study. Monteggia variant inclusion criteria included fracture of the proximal ulna together with a fracture of the radial head or neck and skeletal maturity. Totally 26 patients were identified with Monteggia variants and 18 were available for follow-up, including 11 males and 7 females with the mean age of 35 years. The ulna fracture was treated by compression plating along with tension band wiring. Radial head/neck was reconstructed in 12 patients while excised in 6 patients. Results: Follow-up ranged from 1-4 years, mean 2.6 years. Patients were assessed clinicoradiologically. Mayo Elbow Performance Score was employed to assess the outcomes. At final follow-up, the results were excellent in 10 patients, good in 4, fair in 2 and poor in 2. Mean range of motion of the elbow was 20°, 116°, 50° and 55° for extension, flexion, pronation and supination, respectively. Two patients had complications in the form of heterotopic ossification and stiffness of the elbow. One nonunion ulna, primarily treated by tension band wiring, was managed by refixation with locking reconstruction plate and bone grafting. Bone grafting was only required in this patient for nonunion. Another patient had implants removed on his request. The results in our series closely correlated with extent of intraarticular damage, coronoid fracture and comminuted fractures. Conclusions: Monteggia

  12. Supra-acetabular fixation and sacroiliac screws for treating unstable pelvic ring injuries: preliminary results from 20 patients☆

    Guimarães, Rodrigo Pereira; de Góes Ribeiro, Arthur; Ulson, Oliver; de Ávila, Ricardo Bertozzi; Ono, Nelson Keiske; Polesello, Giancarlo Cavalli

    2016-01-01

    Objective To analyze the treatment results from 20 patients who underwent an alternative osteosynthesis method as definitive treatment for pelvic ring fractures. Methods A retrospective analysis was conducted on a series of 20 patients with pelvic ring fractures (Tile type C) and a high risk of postoperative infection, who were treated at Santa Casa de Misericórdia de São Paulo between August 2004 and December 2012. The patients underwent percutaneous supra-acetabular external fixation in association with cannulated 7.0 mm iliosacral screws. Results The patients’ mean age was 40 years (range 22–77 years) and the mean length of follow-up was 18.5 months (range 3–69 months). At the end of the treatment, ten patients (50%) were classified as having good results, nine patients (45%) had fair results and one patient (5%) did not have any improvement. Six patients presented complications, and paresthesia of the lateral femoral cutaneous nerve was the most frequent of these (two patients). Conclusion Supra-acetabular external fixation in association with iliosacral percutaneous osteosynthesis is a good definitive treatment method for patients with a high risk of postoperative infection. PMID:27069879

  13. Distal tibial pilon fractures (AO/OTA type B, and C treated with the external skeletal and minimal internal fixation method

    Milenković Saša

    2013-01-01

    Full Text Available Background/Aim. Distal tibial pilon fractures include extra-articular fractures of the tibial metaphysis and the more severe intra-articular tibial pilon fractures. There is no universal method for treating distal tibial pilon fractures. These fractures are treated by means of open reduction, internal fixation (ORIF and external skeletal fixation. The high rate of soft-tissue complications associated with primary ORIF of pilon fractures led to the use of external skeletal fixation, with limited internal fixation as an alternative technique for definitive management. The aim of this study was to estimate efficacy of distal tibial pilon fratures treatment using the external skeletal and minimal internal fixation method. Methods. We presented a series of 31 operated patients with tibial pilon fractures. The patients were operated on using the method of external skeletal fixation with a minimal internal fixation. According to the AO/OTA classification, 17 patients had type B fracture and 14 patients type C fractures. The rigid external skeletal fixation was transformed into a dynamic external skeletal fixation 6 weeks post-surgery. Results. This retrospective study involved 31 patients with tibial pilon fractures, average age 41.81 (from 21 to 60 years. The average follow-up was 21.86 (from 12 to 48 months. The percentage of union was 90.32%, nonunion 3.22% and malunion 6.45%. The mean to fracture union was 14 (range 12-20 weeks. There were 4 (12.19% infections around the pins of the external skeletal fixator and one (3.22% deep infections. The ankle joint arthrosis as a late complication appeared in 4 (12.90% patients. All arthroses appeared in patients who had type C fractures. The final functional results based on the AOFAS score were excellent in 51.61%, good in 32.25%, average in 12.90% and bad in 3.22% of the patients. Conclusion. External skeletal fixation and minimal internal fixation of distal tibial pilon fractures is a good method for

  14. Second international conference on fundamentals of fracture. Program and abstract book. Summaries

    The approximately 95 papers and abstracts are grouped under the following headings: atomic theory, continuum theory, experimental studies, environmental effects, fatigue, ceramics, high-temperature phenomena, and interfacial fracture

  15. Combination of external and internal fixation in complex fractures of tibial plateau

    A case series observational study was performed at the Hospital Universitario del Valle. The main purpose was to evaluate the outcome of patients with complex tibial plateau fractures treated with a combined modality of medial external fixation and lateral plating. Thirteen patients with a median age of 41 years (range 27 70) were treated. Three fractures (20%) were classified as Schatzker V type and ten (80%) as Schatzker VI type. Six were open fractures, seven were close, and all of them had serious soft tissue injuries. Outcome was evaluated according to Rasmessen criteria, obtaining 23% excellent results, 54% good, 15% regular and 8% bad. We consider these type of treatment a good alternative for the management of complex tibial plateau fractures which normally would require medial fixation with plates (double plating), but which in the presence of important soft issue injury would nor be an adequate indication

  16. MRI morphometric hip comparison analysis of anterior acetabular labral tears

    Anterior (3 o'clock) acetabular labral tears (AALTs) have been reported to be associated with iliopsoas impingement (IPI). However, no study has examined the association between anatomical bony variables of the hip joint and AALTs. The purpose of this study was to evaluate the association between AALTs, femoroacetabular impingement (FAI) and other bony variables of the hip. Seventy-six out of 274 hip MRI records met the inclusion criteria. Two independent blinded investigators evaluated the location of acetabular labral tears (ALTs), edema at the musculotendinous junction of the iliopsoas insertion, femoral neck anteversion angle, femoral neck shaft angle, acetabular anteversion angle, alpha angle, lateral central edge angle (LCEA), acetabular index, and acetabular depth. Comparison analyses between groups were performed. Twenty-two patients had no ALTs (controls), 19 patients had AALTs, and 35 patients had ALTs not isolated at the 3 o'clock position (25 with cam-bony deformities [FAI-cam] and 10 with pincer-bony deformities [FAI-pincer]). The alpha angle mean was significantly higher (p < 0.001) in the FAI-cam group (62.7 , 95 % confidence interval [CI]: 56.2-69.2 ) compared with the AALTs group (46.9 , 95 % CI: 40.1-53.7 ). The LCEA mean was significantly higher (p < 0.001) in FAI-pincer group (41.9 , 95 % CI: 39.3 -44.5 ) compared to AALTs group (29.4 , 95 % CI: 24.2 -34.6 ). There was no statistically significant difference in any of the bony variables between the controls and the AALTs group. Our study demonstrated that AALTs are pathologically distinct and not associated with FAI or other bony abnormalities. This supports the previous studies, which proposed that AALTs are associated with IPI. (orig.)

  17. MRI morphometric hip comparison analysis of anterior acetabular labral tears

    Aly, Abdel Rahman [University of Saskatchewan, Department of Physical Medicine and Rehabilitation, Saskatoon, SK (Canada); Saskatoon City Hospital, Saskatoon, SK (Canada); Rajasekaran, Sathish [HealthPointe, Pain, Spine and Sport Medicine, Alberta (Canada); Obaid, Haron [Royal University Hospital, University of Saskatchewan, Department of Medical Imaging, Saskatoon, SK (Canada)

    2013-09-15

    Anterior (3 o'clock) acetabular labral tears (AALTs) have been reported to be associated with iliopsoas impingement (IPI). However, no study has examined the association between anatomical bony variables of the hip joint and AALTs. The purpose of this study was to evaluate the association between AALTs, femoroacetabular impingement (FAI) and other bony variables of the hip. Seventy-six out of 274 hip MRI records met the inclusion criteria. Two independent blinded investigators evaluated the location of acetabular labral tears (ALTs), edema at the musculotendinous junction of the iliopsoas insertion, femoral neck anteversion angle, femoral neck shaft angle, acetabular anteversion angle, alpha angle, lateral central edge angle (LCEA), acetabular index, and acetabular depth. Comparison analyses between groups were performed. Twenty-two patients had no ALTs (controls), 19 patients had AALTs, and 35 patients had ALTs not isolated at the 3 o'clock position (25 with cam-bony deformities [FAI-cam] and 10 with pincer-bony deformities [FAI-pincer]). The alpha angle mean was significantly higher (p < 0.001) in the FAI-cam group (62.7 , 95 % confidence interval [CI]: 56.2-69.2 ) compared with the AALTs group (46.9 , 95 % CI: 40.1-53.7 ). The LCEA mean was significantly higher (p < 0.001) in FAI-pincer group (41.9 , 95 % CI: 39.3 -44.5 ) compared to AALTs group (29.4 , 95 % CI: 24.2 -34.6 ). There was no statistically significant difference in any of the bony variables between the controls and the AALTs group. Our study demonstrated that AALTs are pathologically distinct and not associated with FAI or other bony abnormalities. This supports the previous studies, which proposed that AALTs are associated with IPI. (orig.)

  18. The Analysis of the Unstable Tibia Fracture Treatment Applying Internal Stabilization Method

    Lovrić, Ivan; Has, Borislav; Jovanović, Savo; Lekšan, Igor; Radić, Radivoje; Rapan, Saša; Rukavina, Milan

    2007-01-01

    The study included 51 patients with tibia fractures, who underwent percutaneous bone reposition and stabilization with unrimed tibial locking nail. The results obtained using this method were compared with those obtained by standard fracture treatment where flat and anatomic plates were applied (n=64). In patients who had osteosynthetic material implanted percutaneously (using unrimed tibial locking nail) there was no incidence of post surgical osteitis or any pseudarthrosis. The ...

  19. INTERNAL FIXATION OF INTRA ARTICULAR CALCANEUM FRACTURES USING LOCKING COMPRESSION PLATE

    Neelakrishnan; Balamurugavel; Barathiselvan; Viswanathan

    2014-01-01

    INTRODUCTION: Calcaneum is the most frequently fractured tarsal bone. Historically intra articular calcaneum fractures treated non-operatively which led to increased morbidity due to in congruency of articular surface resulting in subtalar arthritis. With advent of CT scan, better implants and improved methods of fixation. Operative treatment has now become a standard method. AIM OF THE STUDY: To study the functional and radiological outcome of intra articular calcaneum fr...

  20. Development, production and failure and fracture analysis of carbon fibre cylinders collapsed by internal pressure

    This work presents an experimental study carried out to evaluate the flaws caused in cylinders manufactured by filament winding using carbon fiber and epoxi resin that were collapsed by internal pressure by a fluid. Ten cylinders were manufactured by non symmetrical and unbalanced winding, in two production methods. The method proposed in this work, denominated overlapping, presents an innovation that may result in reduction of thickness of the structure and project optimization, as each covering of the mandrill contains only one reinforcement layer. The second method, denominated interweaving, produces cylinders in a way that each covering of the mandrill represents two reinforcement layers. Comparing the rupture tension between the cylinders manufactured by the two methods, obtained by the hydrostatic tests, it was shown that there were practically no difference between them, being just 3% smaller for the cylinders manufactured by the overlapping method. Statistical analysis of the averages of the samples was done applying statistical t of Student, and it showed the same average for the results of rupture tension for the whole population of cylinders. Observations of the material surface were using an optical microscope and a scanning electron microscope (SEM). These observations were made after the fracture of the cylinders, in order to study the mechanisms and the types and modes of failure of the composite and also to determine the failure sequence and cracks direction. Details of the failure process of the matrix, such as debonding, cracks, hacles and delamination were observed. In relation to the failure of the fibers for traverse tensile this occurred in the helical layers and for longitudinal tensile in the circumferential layers, resulting, in the last one, the formation of fracture blocks. Analysis by optical microscope and by scanning electron microscope, showed that the failure mechanisms and types and modes of failure in the cylinders manufactured by

  1. Clinical efficacy of open reduction and semirigid internal fixation in management of displaced pediatric mandibular fractures: A series of 10 cases and surgical guidelines

    Samir Joshi

    2015-01-01

    Full Text Available Aim: To evaluate the efficacy of open reduction and semirigid internal fixation in the management of displaced pediatric mandibular fractures. Method: Ten patients with displaced mandibular fractures treated with 1.5 mm four holed titanium mini-plate and 4 mm screws which were removed within four month after surgery. Results: All cases showed satisfactory bone healing without any growth disturbance. Conclusion: Open reduction and rigid internal fixation (ORIF with 1.5 mm titanium mini- plates and 4 mm screws is a reliable and safe method in treatment of displaced paediatric mandibular fractures.

  2. FALSIRE Phase II. CSNI project for Fracture Analyses of Large-Scale International Reference Experiments (Phase II). Comparison report

    A summary of Phase II of the Project for Fracture Analysis of Large-Scale International Reference Experiments (FALSIRE) is presented. A FALSIRE II Workshop focused on analyses of reference fracture experiments. More than 30 participants representing 22 organizations from 12 countries took part in the workshop. Final results for 45 analyses of the reference experiments were received from the participating analysts. For each experiment, analysis results provided estimates of variables that include temperature, crack-mouth-opening displacement, stress, strain, and applied K and J values. The data were sent electronically to the Organizing Committee, who assembled the results into a comparative data base using a special-purpose computer program. A comparative assessment and discussion of the analysis results are presented in the report. Generally, structural responses of the test specimens were predicted with tolerable scatter bands. (orig./DG)

  3. CSNI Project for Fracture Analyses of Large-Scale International Reference Experiments (FALSIRE II)

    A summary of Phase II of the Project for FALSIRE is presented. FALSIRE was created by the Fracture Assessment Group (FAG) of the OECD/NEA's Committee on the Safety of Nuclear Installations (CNSI) Principal Working Group No. 3. FALSIRE I in 1988 assessed fracture methods through interpretive analyses of 6 large-scale fracture experiments in reactor pressure vessel (RPV) steels under pressurized- thermal-shock (PTS) loading. In FALSIRE II, experiments examined cleavage fracture in RPV steels for a wide range of materials, crack geometries, and constraint and loading conditions. The cracks were relatively shallow, in the transition temperature region. Included were cracks showing either unstable extension or two stages of extensions under transient thermal and mechanical loads. Crack initiation was also investigated in connection with clad surfaces and with biaxial load. Within FALSIRE II, comparative assessments were performed for 7 reference fracture experiments based on 45 analyses received from 22 organizations representing 12 countries. Temperature distributions in thermal shock loaded samples were approximated with high accuracy and small scatter bands. Structural response was predicted reasonably well; discrepancies could usually be traced to the assumed material models and approximated material properties. Almost all participants elected to use the finite element method

  4. CSNI Project for Fracture Analyses of Large-Scale International Reference Experiments (FALSIRE II)

    Bass, B.R.; Pugh, C.E.; Keeney, J. [Oak Ridge National Lab., TN (United States); Schulz, H.; Sievers, J. [Gesellschaft fuer Anlagen- und Reaktorsicherheit (GRS) mbH, Koeln (Gemany)

    1996-11-01

    A summary of Phase II of the Project for FALSIRE is presented. FALSIRE was created by the Fracture Assessment Group (FAG) of the OECD/NEA`s Committee on the Safety of Nuclear Installations (CNSI) Principal Working Group No. 3. FALSIRE I in 1988 assessed fracture methods through interpretive analyses of 6 large-scale fracture experiments in reactor pressure vessel (RPV) steels under pressurized- thermal-shock (PTS) loading. In FALSIRE II, experiments examined cleavage fracture in RPV steels for a wide range of materials, crack geometries, and constraint and loading conditions. The cracks were relatively shallow, in the transition temperature region. Included were cracks showing either unstable extension or two stages of extensions under transient thermal and mechanical loads. Crack initiation was also investigated in connection with clad surfaces and with biaxial load. Within FALSIRE II, comparative assessments were performed for 7 reference fracture experiments based on 45 analyses received from 22 organizations representing 12 countries. Temperature distributions in thermal shock loaded samples were approximated with high accuracy and small scatter bands. Structural response was predicted reasonably well; discrepancies could usually be traced to the assumed material models and approximated material properties. Almost all participants elected to use the finite element method.

  5. Relationship between Wiberg's lateral center edge angle, Lequesne's acetabular index, and medial acetabular bone stock

    Werner, Clement M.L. [Balgrist University Hospital Zurich, Department of Orthopaedics, Zurich (Switzerland); University of Maryland Medical Systems, R. Adams Cowley Shock Trauma Center, Baltimore, MD (United States); Copeland, Carol E.; Stromberg, Jeff; Turen, Clifford H. [University of Maryland Medical Systems, R. Adams Cowley Shock Trauma Center, Baltimore, MD (United States); Ruckstuhl, Thomas; Bouaicha, Samy [Balgrist University Hospital Zurich, Department of Orthopaedics, Zurich (Switzerland)

    2011-11-15

    Knowledge of acetabular anatomy is crucial for cup positioning in total hip replacement. Medial wall thickness of the acetabulum is known to correlate with the degree of developmental dysplasia of the hip (DDH). No data exist about the relationship of routinely used radiographic parameters such as Wiberg's lateral center edge angle (LCE-angle) or Lequesne's acetabular index (AI) with thickness of the medial acetabular wall in the general population. The aim of our study was to clarify the relationship between LCE, AI, and thickness of the medial acetabular wall. Measurements on plain radiographs (LCE and AI) and axial CT scans (quadrilateral plate acetabular distance QPAD) of 1,201 individuals (2,402 hips) were obtained using a PACS imaging program and statistical analyses were performed. The mean thickness of the medial acetabulum bone stock (QPAD) was 1.08 mm (95% CI: 1.05-1.10) with a range of 0.1 to 8.8 mm. For pathological values of either the LCE (<20 ) or the AI (>12 ) the medial acetabular wall showed to be thicker than in radiological normal hips. The overall correlation between coxometric indices and medial acetabular was weak for LCE (r =-0.21. 95% CI [-0.25, -0.17]) and moderate for AI (r = 0.37, [0.33, 0.41]). We did not find a linear relationship between Wiberg's lateral center edge angle, Lequesne's acetabular index and medial acetabular bone stock in radiological normal hips but medial acetabular wall thickness increases with dysplastic indices. (orig.)

  6. Open Reduction Internal Fixation of a Bimalleolar Ankle Fracture With Syndesmotic Injury.

    Ostrum, Robert F; Avery, Matthew C

    2016-08-01

    Rotational ankle fractures are incredibly common, resulting in a wide spectrum of bony and ligamentous injury patterns. After open reduction of an ankle fracture, the treating surgeon must always evaluate syndesmotic stability. If the syndesmosis is determined to be unstable, a reduction of the distal tibiofibular joint should be performed. Failure to adequately identify and treat injuries to the syndesmosis may result in continued ankle instability and poor patient outcomes. Lateral fluoroscopic images are necessary to assess a closed reduction of the syndesmosis before stabilization, although the accuracy of this tool has been questioned in several studies. Significant controversy surrounds many aspects of this injury and its treatment, including methods of diagnosis, ideal reduction clamp positioning, diameter and number of syndesmotic screws, and number of tibial cortices to be engaged. In the accompanying video, we describe our approach for the treatment of a bimalleolar ankle fracture with syndesmotic injury, using a posterior fibular plate and single tricortical syndesmotic screw. PMID:27441940

  7. Mid-term functional outcome after the internal fixation of distal radius fractures

    Phadnis Joideep

    2012-01-01

    Full Text Available Abstract Background Distal radius fracture is a common injury with a variety of operative and non-operative management options. There remains debate as to the optimal treatment for a given patient and fracture. Despite the popularity of volar locking plate fixation, there are few large cohort or long term follow up studies to justify this modality. Our aim was to report the functional outcome of a large number of patients at a significant follow up time after fixation of their distal radius with a volar locking plate. Methods 180 patients with 183 fractures and a mean age of 62.4 years were followed up retrospectively at a mean of 30 months (Standard deviation = 10.4. Functional assessment was performed using the Disabilities of the Arm, Shoulder and Hand (DASH and modified MAYO wrist scores. Statistical analysis was performed to identify possible variables affecting outcome and radiographs were assessed to determine time to fracture union. Results The median DASH score was 2.3 and median MAYO score was 90 for the whole group. Overall, 133 patients (74% had a good or excellent DASH and MAYO score. Statistical analysis showed that no specific variable including gender, age, fracture type, post-operative immobilisation or surgeon grade significantly affected outcome. Complications occurred in 27 patients (15% and in 11 patients were major (6%. Conclusion This single centre large population series demonstrates good to excellent results in the majority of patients after volar locking plate fixation of the distal radius, with complication rates comparable to other non-operative and operative treatment modalities. On this basis we recommend this mode of fixation for distal radius fractures requiting operative intervention.

  8. Technical tips for (dry) arthroscopic reduction and internal fixation of distal radius fractures.

    Del Piñal, Francisco

    2011-10-01

    Contrary to general belief, arthroscopic assisted reduction in distal radius fractures can be done in an expeditious manner and with minimal consumption of operating room resources. This article presents the steps for a pleasant arthroscopic experience in detail. The technique proposed combines the benefits of rigid fixation with volar locking plates (for the extra-articular component) and arthroscopic control of the reduction (for the articular component). It is important that the operation be carried out using the dry arthroscopic technique. However, arthroscopy is just an addition to conventional methods. Thorough knowledge of and facility with classic techniques of distal radius fracture treatment is essential for a good result. PMID:21971058

  9. Treatment of acetabular dysplasia by triple pelvic osteotomy and its short-term results

    Dogan, Ahmet; Zorer, Gazi; Ozer, Utku Erdem

    2004-01-01

    Objectives: We evaluated the effect of triple pelvic osteotomy on acetabular coverage and its clinical implications by clinical and radiographic parameters in patients with acetabular dysplasia. Methods: Triple pelvic osteotomy was performed in 21 hips of 19 patients (13 females, 6 males; mean age during operation 16.3 years; range 8 to 32 years). Acetabular dysplasia was bilateral in two, and unilateral in 17 patients. Etiology was developmental dysplasia of the hip in 12 patients, Legg-C...

  10. Validation of a new radiographic measurement of acetabular version: the transverse axis distance (TAD)

    Nitschke, Ashley [University of Colorado School of Medicine, University of Colorado Denver, Division of Musculoskeletal Radiology, Department of Radiology, Aurora, CO (United States); Lambert, Jeffery R. [University of Colorado, Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO (United States); Glueck, Deborah H. [University of Colorado, Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO (United States); University of Colorado School of Medicine, University of Colorado Denver, Department of Radiology, Aurora, CO (United States); Jesse, Mary Kristen; Strickland, Colin [University of Colorado School of Medicine, University of Colorado Denver, Division of Musculoskeletal Radiology, Department of Radiology and Orthopaedics, Aurora, CO (United States); Mei-Dan, Omer [University of Colorado School of Medicine, University of Colorado Denver, Division of Sports Medicine and Hip Preservation, Department of Orthopaedics, Aurora, CO (United States); Petersen, Brian [University of Colorado School of Medicine, University of Colorado Denver, Division of Musculoskeletal Radiology, Department of Radiology and Orthopaedics, Aurora, CO (United States); Inland Imaging, Division of Musculoskeletal Radiology, Spokane, WA (United States)

    2015-11-15

    This study has three aims: (1) validate a new radiographic measure of acetabular version, the transverse axis distance (TAD) by showing equivalent TAD accuracy in predicting CT equatorial acetabular version when compared to a previously validated, but more cumbersome, radiographic measure, the p/a ratio; (2) establish predictive equations of CT acetabular version from TAD; (3) calculate a sensitive and specific cut point for predicting excessive CT acetabular anteversion using TAD. A 14-month retrospective review was performed of patients who had undergone a dedicated MSK CT pelvis study and who also had a technically adequate AP pelvis radiograph. Two trained observers measured the radiographic p/a ratio, TAD, and CT acetabular equatorial version for 110 hips on a PACS workstation. Mixed model analysis was used to find prediction equations, and ROC analysis was used to evaluate the diagnostic accuracy of p/a ratio and TAD. CT equatorial acetabular version can accurately be predicted from either p/a ratio (p < 0.001) or TAD (p < 0.001). The diagnostic accuracies of p/a ratio and TAD are comparable (p =0.46). Patients whose TAD is higher than 17 mm may have excessive acetabular anteversion. For that cutpoint, the sensitivity of TAD is 0.73, with specificity of 0.82. TAD is an accurate radiographic predictor of CT acetabular anteversion and provides an easy-to-use and intuitive point-of-care assessment of acetabular version in patients with hip pain. (orig.)

  11. Difference in the acetabular cup orientation in standing and supine radiographs.

    Khan, Munir; Beckingsale, Tom; Marsh, Martin; Holland, Jim

    2016-09-01

    Acetabular orientation changes with that of the pelvis during lying and standing. This study was designed to measure these changes. We assessed 17 BHR replacements using EBRA software. The mean acetabular anteversion was more (p = 0.02) on erect than supine radiographs. Linear regression analysis showed that anteversion and inclination increased in some while decreased in others, and Bland and Altman analysis showed wide limits of agreement. The changes in acetabular orientation are thus subject to significant variations between the patients. We suggest studying the factors affecting acetabular orientation in standing to help reduce joint reaction forces and improve outcomes. PMID:27408490

  12. Validation of a new radiographic measurement of acetabular version: the transverse axis distance (TAD)

    This study has three aims: (1) validate a new radiographic measure of acetabular version, the transverse axis distance (TAD) by showing equivalent TAD accuracy in predicting CT equatorial acetabular version when compared to a previously validated, but more cumbersome, radiographic measure, the p/a ratio; (2) establish predictive equations of CT acetabular version from TAD; (3) calculate a sensitive and specific cut point for predicting excessive CT acetabular anteversion using TAD. A 14-month retrospective review was performed of patients who had undergone a dedicated MSK CT pelvis study and who also had a technically adequate AP pelvis radiograph. Two trained observers measured the radiographic p/a ratio, TAD, and CT acetabular equatorial version for 110 hips on a PACS workstation. Mixed model analysis was used to find prediction equations, and ROC analysis was used to evaluate the diagnostic accuracy of p/a ratio and TAD. CT equatorial acetabular version can accurately be predicted from either p/a ratio (p < 0.001) or TAD (p < 0.001). The diagnostic accuracies of p/a ratio and TAD are comparable (p =0.46). Patients whose TAD is higher than 17 mm may have excessive acetabular anteversion. For that cutpoint, the sensitivity of TAD is 0.73, with specificity of 0.82. TAD is an accurate radiographic predictor of CT acetabular anteversion and provides an easy-to-use and intuitive point-of-care assessment of acetabular version in patients with hip pain. (orig.)

  13. Functional outcome of open reduction and internal fixation of clavicle fracture

    Manju G. Pillai

    2016-08-01

    Results: In 27 patients fracture were united at end of 12 weeks, in 2 patients fracture were united at end of 24 weeks and 1 patient went for non-union. One patient had superficial infection. None had deep infection. One patient had plate loosening at 4week but fracture was united at the end of 24 weeks. 2 patients had persistent pain which is controlled with occasional analgesic but not effecting ordinary work. One patient had gross restriction of shoulder movement. Functional outcome assessed according to near shoulder scoring system. 24 patients had excellent result, 4 patients had satisfactory result, 1 patient had unsatisfactory result and 1patients had failure. Conclusions: The study showed rigid fixation with plate and screw for fresh middle third clavicle fracture especially displaced and comminuted give immediate pain relief and prevent the development of shoulder stiffness and non-union and give good functional outcome. [Int J Res Med Sci 2016; 4(8.000: 3205-3210

  14. Comparison of Percutaneous Cementoplasty with and Without Interventional Internal Fixation for Impending Malignant Pathological Fracture of the Proximal Femur

    PurposeTo compare the efficacy of percutaneous cementoplasty (PCP) with and without interventional internal fixation (IIF) on malignant impending pathological fracture of proximal femur.MethodsA total of 40 patients with malignant impending pathological fracture of proximal femur were selected for PCP and IIF (n = 19, group A) or PCP alone (n = 21, group B) in this non-randomized prospective study. Bone puncture needles were inserted into the proximal femur, followed by sequential installation of the modified trocar inner needles through the puncture needle sheath. Then, 15–45 ml cement was injected into the femur lesion.ResultsThe overall excellent and good pain relief rate during follow-ups were significantly higher in group A than that in group B (89 vs. 57 %, P = 0.034). The average change of VAS, ODI, KPS, and EFES in group A were significantly higher than those in group B at 1-, 3-, 6-month, 1-year (P < 0.05). Meanwhile, The stability of the treated femur was significantly higher in group A than that in group B (P < 0.05).ConclusionPCP and IIF were not only a safe and effective procedure, but resulted in greater pain relief, bone consolidation, and also reduced the risk of fracture than the currently recommended approach of PCP done on malignant proximal femoral tumor

  15. Comparison of Percutaneous Cementoplasty with and Without Interventional Internal Fixation for Impending Malignant Pathological Fracture of the Proximal Femur

    Tian, Qing-Hua, E-mail: ddqinghua-tian@163.com; He, Cheng-Jian, E-mail: tianhechengjian@163.com; Wu, Chun-Gen, E-mail: 649514608@qq.com; Li, Yong-Dong, E-mail: tianliyongdong@163.com; Gu, Yi-Feng, E-mail: tianyifenggu@163.com; Wang, Tao, E-mail: tianandwangtao@163.com; Xiao, Quan-Ping, E-mail: tianxiaoquanping@163.com; Li, Ming-Hua, E-mail: tianminghuali@163.com [Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Department of Diagnostic and Interventional Radiology (China)

    2016-01-15

    PurposeTo compare the efficacy of percutaneous cementoplasty (PCP) with and without interventional internal fixation (IIF) on malignant impending pathological fracture of proximal femur.MethodsA total of 40 patients with malignant impending pathological fracture of proximal femur were selected for PCP and IIF (n = 19, group A) or PCP alone (n = 21, group B) in this non-randomized prospective study. Bone puncture needles were inserted into the proximal femur, followed by sequential installation of the modified trocar inner needles through the puncture needle sheath. Then, 15–45 ml cement was injected into the femur lesion.ResultsThe overall excellent and good pain relief rate during follow-ups were significantly higher in group A than that in group B (89 vs. 57 %, P = 0.034). The average change of VAS, ODI, KPS, and EFES in group A were significantly higher than those in group B at 1-, 3-, 6-month, 1-year (P < 0.05). Meanwhile, The stability of the treated femur was significantly higher in group A than that in group B (P < 0.05).ConclusionPCP and IIF were not only a safe and effective procedure, but resulted in greater pain relief, bone consolidation, and also reduced the risk of fracture than the currently recommended approach of PCP done on malignant proximal femoral tumor.

  16. Internal derangement of the knee after ipsilateral femoral shaft fracture: MR imaging findings

    Blacksin, M.F.; Zurlo, J.V. [Department of Radiology, University of Medicine and Dentistry of New Jersey, Newark, NJ (United States); Levy, A.S. [Department of Orthopedic Surgery, University of Medicine and Dentistry of New Jersey, University Hospital, Newark, NJ 07103-2426 (United States)

    1998-08-01

    Objective. This study uses magnetic resonance (MR) imaging to delineate the types and frequencies of injuries seen in the knee after ipsilateral femoral shaft fracture. We also compare the results of the orthopedic knee examination with the MR findings. Design and patients. MR imaging of the ipsilateral knee was performed on 34 patients with closed femoral shaft fractures. Indications for knee MR imaging included knee pain at the time of fracture, soft tissue swelling or an effusion of the knee, or a positive knee examination under anesthesia. The patients had a mean age of 27 years and all were stabilized with intramedullary nails. Imaging was performed a mean time of 2.5 days after surgery. All patients had knee examinations done under anesthesia, and the MR results were compiled and compared with the clinical examinations. Results. Ninety-seven percent of patients demonstrated knee effusions. Twenty-seven percent of patients demonstrated meniscal tears, with the posterior horn of the medial meniscus most frequently torn. The medial collateral ligament was the most frequent site of ligamentous injury (38%) followed by the posterior cruciate ligament (21%). Fifty percent of patients had injuries of the extensor mechanism. Bone bruises were noted in 32% of patients. Articular cartilage injuries were confined to the patella in four cases. One occult tibial plateau fracture and one meniscocapsular separation were seen. Conclusions. There is a common incidence of both ligamentous and meniscal injury to the knee after ipsilateral femoral shaft fracture. MR imaging can be useful in assessing the extent of injury, and may reveal findings unsuspected after clinical examination of the knee. (orig.) With 4 figs., 2 tabs., 13 refs.

  17. Internal derangement of the knee after ipsilateral femoral shaft fracture: MR imaging findings

    Objective. This study uses magnetic resonance (MR) imaging to delineate the types and frequencies of injuries seen in the knee after ipsilateral femoral shaft fracture. We also compare the results of the orthopedic knee examination with the MR findings. Design and patients. MR imaging of the ipsilateral knee was performed on 34 patients with closed femoral shaft fractures. Indications for knee MR imaging included knee pain at the time of fracture, soft tissue swelling or an effusion of the knee, or a positive knee examination under anesthesia. The patients had a mean age of 27 years and all were stabilized with intramedullary nails. Imaging was performed a mean time of 2.5 days after surgery. All patients had knee examinations done under anesthesia, and the MR results were compiled and compared with the clinical examinations. Results. Ninety-seven percent of patients demonstrated knee effusions. Twenty-seven percent of patients demonstrated meniscal tears, with the posterior horn of the medial meniscus most frequently torn. The medial collateral ligament was the most frequent site of ligamentous injury (38%) followed by the posterior cruciate ligament (21%). Fifty percent of patients had injuries of the extensor mechanism. Bone bruises were noted in 32% of patients. Articular cartilage injuries were confined to the patella in four cases. One occult tibial plateau fracture and one meniscocapsular separation were seen. Conclusions. There is a common incidence of both ligamentous and meniscal injury to the knee after ipsilateral femoral shaft fracture. MR imaging can be useful in assessing the extent of injury, and may reveal findings unsuspected after clinical examination of the knee. (orig.)

  18. PATHOLOGICAL AND MORPHOLOGICAL RESEARCH OF EXPERIMENTAL ACETABULAR DYSPLASIA

    张自明; 马瑞雪; 吉士俊; 牛之彬

    2004-01-01

    Objective To investigate the pathological mechanism of hip dysplasia. Methods The left knee joints of eighteen rabbits were fixed in extending position with plaster cylinder for four weeks, but their hip joints were flexed. The right side served as control. Roentgenogram was made in all animals. The changes of the xray films and the pathological findings between left and right hips were compared. Results Appearance of hip dysplasia was obvious at four weeks after plaster fixation. There were pathological changes, including shallow acetabulum and flat femoral head, increased acetabular index and decreased acetabular head index on the x-ray films.Conclusion The hip dysplasia is the result of prolonged extending position of the knee joint. Abnormal knee posture seems to be one of the important factors of hip dysplasia. This kind of deformation may be worsened with time.

  19. Acetabular prosthesis: Proff of migration with ruler and pencil?

    Conventional X-ray films were made with varying degrees of tilt of a pelvic phantom containing an acetabular prosthesis. The position of the prosthesis was then reconstructed graphically. The measurement errors were calculated and an estimate was made for the tilt. There is a linear correlation between the measurement error and the tilt of the prosthesis. Therefore a tilt dependent maximum error can be calculated. This error is very small for small degrees of tilt, so that acetabular migration can in this instance be evaluated with greater confidence than with other graphical methods. The error also correlates with the determination of the selected region of the acetabulum, but not with the position of the central focus spot or image magnification. (orig.)

  20. Contact Stress Analysis of Acetabular Component and Pelvic Bone

    Vyčichl, Jan; Jiroušek, Ondřej; Jírová, Jitka

    Wroclaw : Oficyna Wydawnicza Politechniki Wroclawskiej, 2006 - (Grygier, D.), s. 73-74 ISSN 1732-0240. [ Students ' Scientific Conference of Biomedical Engineeting /2/. Szklarska Poreba (PL), 20.04.2006-23.04.2006] R&D Projects: GA AV ČR(CZ) IAA200710504 Institutional research plan: CEZ:AV0Z20710524 Keywords : pelvic bone * acetabular component * stress analysis * finite element method Subject RIV: EI - Biotechnology ; Bionics

  1. Transosseous Acetabular Labral Repair as an Alternative to Anchors

    Pérez-Carro, Luis; Cabello, Andres Gonzalez; Rakha, Mohamed Ibrahim; Patnaik, Sarthak; Centeno, Elias; Miranda, Victor; Fernández, Ana Alfonso

    2015-01-01

    Labral tears are the most common pathology in patients undergoing hip arthroscopy and the most common cause of mechanical hip symptoms. Labral repair techniques have been described in the literature using suture anchors placed as close as possible to the acetabular rim without penetrating the articular surface. Optimal surgical technique for labral repair is very important, and an inappropriate entry point and guide angulation may lead to intra-articular penetration of the anchor, chondral da...

  2. Imaging diagnosis of acetabular dysplastic coxarthrosis in adult

    Objective: To investigate the imaging diagnosis of acetabular dysplastic coxarthrosis. Method: The imaging of the acetabular dysplasia was analyzed in 51 patients (87 hips). All but four patients were women. The age ranged from 22 to 78 years, and the mean age was 42.6 years. Pelvis radiographs were studied in all cases, and CT scan was performed in 18 cases and MRI in 10 cases. Results: The fundamental signs on the plain film included shallow acetabulum, increased obliquity and insufficient coverage of the femoral head by the acetabulum. The CE angles were determined in all the cases, ranging from -10 degree to 30 degree, mean 12.9 degree. The sharp angles ranged from 35 degree to 67 degree, mean 45.3 degree. The secondary osteoarthritis were revealed in 75 hips (84.2%). 54 hips (62.1%) had cyst-like lesions in weight-bear area of the acetabulum or femoral head. 19 hips had subluxation of femoral head. CT and MRI displayed small cyst-like lesions and forward shift of the femoral head, which could not be shown on plain film, respectively in 13 and 10 hips. Conclusion: The cyst-like lesion of subarticular region is a common sign in acetabular dysplastic coxarthrosis. CT or MRI can show the early osteolytic lesion and forward subluxations

  3. An in vivo evaluation of PLLA/PLLA-gHA nano-composite for internal fixation of mandibular bone fractures.

    Peng, Weihai; Zheng, Wei; Shi, Kai; Wang, Wangshu; Shao, Ying; Zhang, Duo

    2015-12-01

    Internal fixation of bone fractures using biodegradable poly(L-lactic-acid) (PLLA)-based materials has attracted the attention of many researchers. In the present study, 36 male beagle dogs were randomly assigned to two groups: PLLA/PLLA-gHA (PLLA-grafted hydroxyapatite) group and PLLA group. PLLA/PLLA-gHA and PLLA plates were embedded in the muscular bags of the erector spinae and also implanted to fix mandibular bone fractures in respective groups. At 1, 2, 3, 6, 9, and 12 months postoperatively, the PLLA/PLLA-gHA and PLLA plates were evaluated by adsorption and degradation tests, and the mandibles were examined through radiographic analysis, biomechanical testing, and histological analysis. The PLLA/PLLA-gHA plates were non-transparent and showed a creamy white color, and the PLLA plates were transparent and faint yellow in color. At all time points following surgery, adsorption and degradation of the PLLA/PLLA-gHA plates were significantly less than those of the PLLA plates, and the lateral and longitudinal bending strengths of the surgically treated mandibles of the beagle dogs in the PLLA/PLLA-gHA group were significantly greater than those of the PLLA group and reached almost the value of intact mandibles at 12 months postoperatively. Additionally, relatively rapid bone healing was observed in the PLLA/PLLA-gHA group with the formation of new lamellar bone tissues at 12 months after the surgery. The PLLA/PLLA-gHA nano-composite can be employed as a biodegradable material for internal fixation of mandibular bone fractures. PMID:26551378

  4. Histological evidence of successful internal fixation for traumatic chondral fracture of the femoral groove

    Kazuhisa Hatayama

    2014-07-01

    Full Text Available Isolated chondral fractures without cancellous bone have limited healing potential. We reattached a chondral fragment without cancellous bone using bone pegs for chondral fracture of the femoral groove in a 13-year-old boy. Five months after the surgery, we performed a biopsy to evaluate the histological findings for the healed osteochondral junction. Biopsy results showed that osteoblasts had proliferated in the subchondral layer, and some osteoblasts had invaded the calcified cartilage, suggesting active new bone formation. A tidemark was observed between the radial cartilage layer and the calcified cartilage, and it was evident that the osteochondral junction had been completely restored. Four years and 3 months after the surgery, magnetic resonance imaging revealed that the cartilage on the femoral groove was maintained and the patient can play basketball asymptomatically. This report shows that surgeons can attempt the reattachment of chondral fragments without cancellous bone in adolescent patients.

  5. Effect of different restorative procedures on the fracture resistance of teeth submitted to internal bleaching

    Andiara Ribeiro Roberto

    2012-02-01

    Full Text Available The aim of this study was to evaluate the influence of different restorative procedures on the fracture resistance of endodontically treated teeth submitted to intracoronal bleaching. Fifty upper central incisors were distributed into 5 groups: GI - healthy teeth; GII - endodontically treated teeth sealed with Coltosol; GIII - endodontically treated teeth bleached and sealed with Coltosol; GIV - endodontically treated teeth bleached and restored with composite resin; and GV - endodontically treated teeth bleached and restored with a fiberglass post and composite resin. In the bleached specimens, a cervical seal was made prior to bleaching with 38% hydrogen peroxide. The gel was applied on the buccal surface and in the pulp chamber, and was then light-activated for 45 s. This procedure was repeated three times per session for four sessions, and each group was submitted to the restorative procedures described above. The specimens were submitted to fracture resistance testing in a universal testing machine. There were statistically significant differences among the groups (p 0.05. The restorative procedures using composite resin were found to successfully restore the fracture resistance of endodontically treated and bleached teeth.

  6. FALSIRE. CSNI project for fracture analyses of large-scale international reference experiments. Phase 1

    The six experiments used in Project FALSIRE (performed in the Federal Republic of Germany, Japan, the United Kingdom, and the U.S.A.) were designed to examine various aspects of crack growth in reactor pressure vessel (RPV) steels under pressurized-thermal-shock (PTS) loading conditions. The CSNI/FAG established a common format for comprehensive statements of these experiments, including supporting information and available analysis results. For each experiment, analysis results provided estimates of variables such as crack growth, crack-mouth-opening displacement, temperature, stress, strain, and applied J and K values. A comparative assessment and discussion of the analysis results are presented; also, the current status of the entire results data base is summarized. Generally, these results highlight the importance of adequately modeling structural behavior of specimens before performing fracture mechanics evaluations. Applications of the various fracture methodologies were found to be partially successful in some cases but not in others. Based on these assessments, some conclusions concerning predictive capabilities of selected ductile fracture methodologies, as applied to RPVs subjected to PTS loading are given. (orig.)

  7. FUNCTIONAL OUTCOME OF SUPRACONDYLAR FRACTURES OF FEMUR MANAGED BY OPEN REDUCTION AND INTERNAL FIXATION WITH LOCKING COMPRESSION PLATE

    Madhusudhana

    2015-10-01

    Full Text Available INTRODUCTION : Incidence of distal femur fractures is approximately 37 per 1 , 00,000 person - years.¹Distal femoral fractures has two different injury mechanisms, high energy trauma and low energy trauma. In high - energy trauma, the problem of restoring the function in a destroyed knee joint persists. Complex knee ligament injuries frequently occur additionally to extensive cartilage injuries. In elderly patients, extreme osteoporosis represents a particular problem for anchoring the implant. 2 Supracondylar and inter condylar fractures often are unstable and comminuted and tend to occur in the elderly or those with multiple injuries. Treatment options are many with varied results. The final outcome would depend upon the type of fracture, stabilization of fixation and and perhaps patient general condition. 3 The options for operative treatment are traditional plating techniques that require compression of the implant to the femoral shaft (blade plate, Dynamic Condylar Screw, non - locking condylar buttress plate, antegrade nailing fixation, retrograde nailing, sub muscular locked internal fixation and external fixation. 4 However, as the complexity of fractures needing treatment has changed from simple extra - articular supra - condylar types to inter - condylar and metaphyseal comminuted types, these implants may not be ideal. Double plating, and more recently, locked plating techniques have been advocated 5 . However with double plating there is often extensive soft tissue stripping on both sides of the femur, resulting in reduced blood supply and potential non - union and failure of the implants 6 . The LCP is a single beam construct where the strength of its fixation is equal to the sum of all screw - bone interfaces rather than a single screw’s axial stiffness or pullout resistance as seen in unlocked plates 7,8 . Its unique biomechanical function is based on splinting rather than compression resulting in flexible stabilization

  8. 21 CFR 888.3370 - Hip joint (hemi-hip) acetabular metal cemented prosthesis.

    2010-04-01

    ... prosthesis. 888.3370 Section 888.3370 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND... (hemi-hip) acetabular metal cemented prosthesis. (a) Identification. A hip joint (hemi-hip) acetabular metal cemented prosthesis is a device intended to be implanted to replace a portion of the hip...

  9. Infiltration of soft tissue by myeloma after internal fixation of pathologic femoral fracture

    a 75-year-old man with multiple myeloma presented with a pathologic fracture of distal right femoral diaphysis, which was fixed with Ender nails. Two and a half months later, the patients was readmitted with rapidly progressive swelling of right thigh. Ultrasound computed tomography and magnetic resonance imaging revealed infiltration of anterior right thigh muscles, extending upward to the iliopsoas muscle and retroperitoneal space, above ipsilateral renal vein. Ultrasound-guided biopsy of the soft tissue of the thigh revealed diffuse myelomatous infiltration by plasma blasts. (Author) 9 refs

  10. [Influence of the pelvic trauma registry of the DGU on treatment of pelvic ring fractures].

    Holstein, J H; Stuby, F M; Herath, S C; Culemann, U; Aghayev, E; Pohlemann, T

    2016-06-01

    Fractures of the pelvic ring are comparatively rare with an incidence of 2-8 % of all fractures depending on the study in question. The severity of pelvic ring fractures can be very different ranging from simple and mostly "harmless" type A fractures up to life-threatening complex type C fractures. Although it was previously postulated that high-energy trauma was necessary to induce a pelvic ring fracture, over the past decades it became more and more evident, not least from data in the pelvic trauma registry of the German Society for Trauma Surgery (DGU), that low-energy minor trauma can also cause pelvic ring fractures of osteoporotic bone and in a rapidly increasing population of geriatric patients insufficiency fractures of the pelvic ring are nowadays observed with no preceding trauma.Even in large trauma centers the number of patients with pelvic ring fractures is mostly insufficient to perform valid and sufficiently powerful monocentric studies on epidemiological, diagnostic or therapeutic issues. For this reason, in 1991 the first and still the only registry worldwide for the documentation and evaluation of pelvic ring fractures was introduced by the Working Group Pelvis (AG Becken) of the DGU. Originally, the main objectives of the documentation were epidemiological and diagnostic issues; however, in the course of time it developed into an increasingly expanding dataset with comprehensive parameters on injury patterns, operative and conservative therapy regimens and short-term and long-term outcome of patients. Originally starting with 10 institutions, in the meantime more than 30 hospitals in Germany and other European countries participate in the documentation of data. In the third phase of the registry alone, which was started in 2004, data from approximately 15,000 patients with pelvic ring and acetabular fractures were documented. In addition to the scientific impact of the pelvic trauma registry, which is reflected in the numerous national and

  11. The biomechanical evaluation of polyester as a tension band for the internal fixation of patellar fractures.

    McGreal, G

    2012-02-03

    We use a braided polyester suture in place of cerclage wire in tension band fixations. The objective of this study was to test the biomechanical properties of this technique. Sixteen cadaveric patellae were fractured and repaired by modified tension band fixation. Eight were fixed using eighteen gauge stainless steel wire as a tension band and eight using braided polyester. All specimens were subjected to tensile testing. Polyester was 75.0% as strong as wire. For dynamic testing, the patellae of seven cadaveric knees were fractured and then fixed with polyester tension bands. These were mounted in a device capable of extending the knees from 90 degrees to neutral against an applied force. None of the fixations failed. Three of the specimens fixed using 18 gauge stainless steel wire were compared with three fixed using polyester over 2000 cycles of knee flexion and extension. Polyester performed as well as wire. We conclude that polyester is an acceptable alternative to wire in tension band fixation.

  12. Elastic-plastic fracture mechanics analyses of cracked steam generator tubes under internal pressure

    Kim, Hyeong Keun; Ahn, Min Yong; Moon, Seong In; Chang, Yoon Suk; Kim, Young Jin [Sungkyunkwan Univ., Suwon (Korea, Republic of); Hwang, Seong Sik; Kim, Joung Soo [KAERI, Taejon (Korea, Republic of)

    2005-07-01

    The structural and leakage integrity of steam generator tube should be maintained during operation even though a crack is existed on it. During the past three decades, several limit load solutions have been proposed to resolve the integrity issue. However, for exact load carrying capacity estimation of specific components under different conditions, these solutions have to be modified by using lots of experimental data. The purpose of this paper is to introduce a new burst pressure estimation scheme based on fracture mechanics analyses for steam generator tube with an axial or circumferential through-wall crack. To do this, closed-form engineering equations were derived to get relevant parameters from three dimensional elastic-plastic finite element analyses combined with reference stress method. Also, a series of structural integrity analyses were carried out using the calculated J-integral from engineering equations and fracture toughness data. Thereby, in comparison with the experimental data as well as corresponding estimation results from limit load solutions, it was proven that the proposed estimation scheme can be used as an efficient tool for integrity evaluation of cracked steam generator tubes.

  13. Micromotions and wear of acetabular cup

    Jíra, J.; Jírová, Jitka; Jiroušek, Ondřej; Micka, Michal

    Oxford : Elsevier, 2005 - (Ritchie, R.). s. 49-49 [International conference on mechanics of biomaterials and tissues /1./. 11.12.2005-15.12.2005, Waikoloa] R&D Projects: GA AV ČR(CZ) IAA200710504 Institutional research plan: CEZ:AV0Z20710524 Keywords : micromotions * UHMWPE wear * numerical analysis Subject RIV: FI - Traumatology, Orthopedics

  14. Comparison of acetabular version angle measurements between prone and reformatted supine computed tomography images

    Chong, Le Roy [Changi General Hospital, Department of Radiology, Singapore (Singapore); Too, Chow Wei [Singapore General Hospital, Department of Diagnostic Radiology, Singapore (Singapore)

    2014-03-15

    To compare acetabular version angle measurements of CT scans in the prone and reformatted supine positions. CT acetabular version angle measurements have previously been done in the prone position to correct for pelvic tilt. With the advent of multidetector CT, recent studies have evaluated acetabular version angles measured in the supine position. To our knowledge, a comparison between these two approaches has not been performed. Case series in which consecutive CT urography studies of 49 adult patients performed in both prone and supine positions were retrospectively reviewed, and acetabular version angles of both hips measured. Retrospective review of 49 consecutive CT urography studies performed in both prone and supine positions was done, and acetabular version angles of both hips were measured. Two radiologists measured the acetabular version angles independently. Multiplanar reformation of the supine CT images was performed to compensate for pelvic tilt and rotation prior to angle measurements. There was excellent interobserver agreement between the two readers (ICC = 0.90). Acetabular version angle measurements from the prone CT images were larger compared to reformatted supine images (24.0 and 21.3 , respectively, p < 0.0001), with greater angles found in women. There was strong correlation between supine and prone acetabular version angle measurements with a Pearson correlation coefficient of 0.743. Acetabular version angles measured from prone and reformatted supine CT images show strong correlation but are significantly different with larger angles obtained from the former and in women; clinical implications of these findings may require further study in other to determine the best method of version angle measurement. CT acetabular version angle measurement is also reliable with excellent interobserver correlation. (orig.)

  15. The computed tomographic evaluation of patellofemoral joint in patellar fractures treated with open reduction and internal fixation

    Benli, I.T.; Akalin, S.; Mumcu, E.F.; Citak, M.; Kilic, M.; Pasaoglu, E. (Ankara Social Security Hospital (Turkey))

    1992-08-01

    In this study, we examined 97 patella fractures in which open reduction and internal fixation had been performed at the 1st Orthopaedics and Trauma Clinic of Social Security Ankara Hospital between January 1983 and December 1988. After 24 to 96 months, on an average of 48.4 months follow-up period, the cases were evaluated clinically for knee function complaints and by CT and roentgenography for patellofemoral articulation. In 11 of the patients (11.5%) there was patellar displacement, 2 of the patients had patellar tilt (2.1%) and in 14 patients (14.5%) there was malalignment in which 1 patient (1.1%) had both patellar tilt and displacement. This data was obtained by measuring femoral trochlear angle (FTA) and patellar tilt angle (PTA) by CT at various degrees of knee flexion. Thirty three patients (34%) had slight and 19 patients (19.6%) had severe degenerative changes in the patellofemoral articulation. It is found that there is close relation between the variability of the pain complaints of the patients and the type of the fracture and the time of management and the postoperative rehabilitation. (author).

  16. The computed tomographic evaluation of patellofemoral joint in patellar fractures treated with open reduction and internal fixation

    In this study, we examined 97 patella fractures in which open reduction and internal fixation had been performed at the 1st Orthopaedics and Trauma Clinic of Social Security Ankara Hospital between January 1983 and December 1988. After 24 to 96 months, on an average of 48.4 months follow-up period, the cases were evaluated clinically for knee function complaints and by CT and roentgenography for patellofemoral articulation. In 11 of the patients (11.5%) there was patellar displacement, 2 of the patients had patellar tilt (2.1%) and in 14 patients (14.5%) there was malalignment in which 1 patient (1.1%) had both patellar tilt and displacement. This data was obtained by measuring femoral trochlear angle (FTA) and patellar tilt angle (PTA) by CT at various degrees of knee flexion. Thirty three patients (34%) had slight and 19 patients (19.6%) had severe degenerative changes in the patellofemoral articulation. It is found that there is close relation between the variability of the pain complaints of the patients and the type of the fracture and the time of management and the postoperative rehabilitation. (author)

  17. Displaced Intra-Articular Fractures of the Distal Radius: Open Reduction With Internal Fixation Versus Bridging External Fixation

    Fakoor

    2015-08-01

    Full Text Available Background Distal radius fracture is common in all ages. Mobility and wrist function is important. The choice of treatment should aim for optimal function with minimal complications. Objectives In this study we compared two surgical approaches, open reduction and internal fixation (ORIF and closed reduction with external fixation (CR + EF, for treatment of intra-articular distal radius fractures. Patients and Methods Ninety-four patients with distal radius fracture (type 3, 4 and 5 Fernandez classification were treated with two surgical methods (ORIF and CR + EF; 55 were treated with CR + EF and 39 were treated with ORIF by different surgeons. All patients were assessed at the end of the first, third and sixth week; and then after the third, sixth and 12th month. At the end of the follow-up, all patients completed the Michigan hand outcome questionnaire (MHOQ. We compared radiological parameters of distal radius, range of motion (ROM of the wrist, duration of rehabilitation, complication and patient satisfaction of the methods. Results In our study, radiological findings for the ORIF group were radial inclination (RI: 19.35, radial length (RL: 10.35, radial tilt (RT: 8.92, and ulnar variance (UV: 1.64, while for the CR + EF group these were RI: 15.13, RL: 8, RT: 4.78, and UV: 0.27. The ROM for ORIF were flexion/extension (F/E: 137, Radial/Ulnar deviation (R/U: 52, and Supination/Pronation (S/P: 141, while for the CR + EF group these were F/E: 117, R/U: 40 and S/P: 116. Michigan hand outcome score for ORIF was 75% and for Ext. fix was 60%. The rate of complication with the ORIF method was 58% and in Ext. fix this was 69%. The patients in CR + EF had more than the ORIF course of physiotherapy and rehabilitation. Conclusions In comparison of ORIF and CR + EF, all results including functional score, clinical and radiologic criteria were in favor of the ORIF method while there were less complications with this method. We believe that ORIF is a better

  18. Biomechanical Study Using the Finite Element Method of Internal Fixation in Pauwels Type III Vertical Femoral Neck Fractures

    Noda

    2015-08-01

    Full Text Available Background Several factors are known to influence osseous union of femoral neck fractures. Numerous clinical studies have reported different results, hence with different recommendations regarding treatment of Pauwels III fractures: femoral neck fractures with a more vertically oriented fracture line. The current study aimed to analyze biomechanically whether this fracture poses a higher risk of nonunion. Objectives To analyze the influence of one designated factor, authors believe that a computerized fracture model, using a finite element Finite Element Method (FEM, may be essential to negate the influence of other factors. The current study aimed to investigate a single factor, i.e. orientation of the fracture line toward a horizontal line, represented by Pauwels classification. It was hypothesized that a model with a vertically oriented fracture line maintaining parity of all other related factors has a higher stress at the fracture site, which would delay fracture healing. This result can be applicable to other types of pinning. Patients and Methods The finite element models were constructed from computed tomography data of the femur. Three fracture models, treated with pinning, were constructed based on Pauwels classification: Type I, 30° between the fracture line and a horizontal line; Type II, 50°; and Type III, 70°. All other factors were matched between the models. The Von Mises stress and principal stress distribution were examined along with the fracture line in each model. Results The peak Von Mises stresses at the medial femoral neck of the fracture site were 35, 50 and 130 MPa in Pauwels type I, II, and III fractures, respectively. Additionally, the peak Von Mises stresses along with the fracture site at the lateral femoral neck were 140, 16, and 8 MPa in Pauwels type I, II, and III fractures, respectively. The principal stress on the medial femoral neck in Pauwels type III fracture was identified as a traction stress, whereas

  19. Para-acetabular peritendinitis calcarea; its radiographic manifestations

    Peritendinitis calcarea and os acetabuli have long been confused during interpretations of hip-joint radiographs. Such confusion is reflected in the medical literature. The present study differentiated these two entities according to their interval radiographic progression and regression. There were 137 instances of para-acetabular calcifications among 110 subjects (59 men and 51 women), whose mean age was 46.8 years at the time of their initial detection. Twenty-six of the subjects had lumbago, which was probably unrelated. Other abnormalities including narrowed intervertebral spaces, scoliosis, and spondylolysis were observed in 21 of the subjects. These could have been responsible for any symptoms they had had, but none of the subjects complained of local hip-joint pain when the radiographs in question were made. Ninety-three of these instances of calcification were reviewed by means of serial radiographs. Interval changes in the sizes and shapes of the calcifications occurred among 90 of them, indicative of the latent type of peritendinitis calcarea. No interval changes were noted in the remaining three cases, indicating they were secondary ossification centers; namely, os acetabuli. This study showed that in asymptomatic adults, most para-acetabular calcifications were really not os acetabuli, but actually peritendinitis calcarea. (author)

  20. 髓内钉置入内固定治疗肱骨骨折☆%Intramedullary nail internal fixation for the treatment of humeral fracture

    王一民; 徐开明; 黄醒中; 黄爱军; 李中檀; 马树强

    2013-01-01

    BACKGROUND: At present, for the treatment of humeral fracture, there has not yet been formed uniform treatment mode which is fixed and accepted by most scholars, and there are disagreements on the indications and surgical timing of humeral fracture treated with intramedul ary nail internal fixation. OBJECTIVE: To analyze the pathological anatomy, healing process and injury typing of humeral fracture and to investigate the indications and surgical timing of humeral fracture treated with intramedul ary nail internal fixation. METHODS: The purpose of the treatment of complex humeral fractures was to restore the necessary functional or anatomical bits, achieve stable fixation and placement, thus get the early-stage functional exercise. The articles concerning the treatment of humeral fractures with intramedul ary nail internal fixation were summarized to find out the cases with the similar treatment objects and the same curative effect evaluation criteria for the comparative study, in order to provide basis for the clinical treatment of humeral fractures. RESULTS AND CONCLUSION: For the treatment of humeral fractures, it is important to critical y assess the type of fracture and bone quality and to select the suitable intramedul ary nail during the treatment of humeral fractures. Understanding the type of intramedul ary nail and the manner of internal fixation, recognizing the value of different types of intramedul ary nail placement for the treatment of humeral fractures as wel as taking the effective measures to prevent the related complications during the treatment of humeral fractures with intramedul ary nail internal fixation can help to obtain the satisfactory results during the treatment of humeral fractures.%  背景:肱骨骨折的治疗到目前仍未形成一个固定的、被大多数学者接受的统一的治疗模式,髓内钉置入内固定治疗肱骨骨折的适应证、手术时机等一直存在分歧。目的:分析肱骨骨折的病理

  1. CLINICAL AND FUNCTIONAL OUTCOME OF DISTAL RADIUS FRACTURES MANAGED BY LIGAMENTOTAXIS AND/OR PERCUTANEOUS PINNING VERSUS OPEN REDUCTION & INTERNAL FIXATION BY BUTTRESS PLATES

    Biju

    2015-05-01

    Full Text Available INTRODUCTI ON: We studied the clinical and functional outcome of distal radius fractures managed by ligamentotaxis and/or percutaneous pinning versus open reduction & internal fixation by buttress plates. METHODS : This prospective study was conducted during Aug 2012 to October 2014. All skeletally matured patients were having both Intra articular and extra articular Closed Distal Radius fractures were studied. Treatment was done either external fixator supplemented with k wires or internal fixation with plate and screws. The radiographic evaluation included radial length, palmar tilt, any evidence of jointincongruity and radio ulnar joint instability and arthritis. The assessments that were made includes Subjective assessment – pain, numbness, weakness of hand, stiffness, OBJECTIVE : R ange of motion measured by hand held goniometer, Measurement of grip strength done by commercially available hand dynamometer. Unaffected hand served as control. RESULTS : Male patients (85.46% outnumbered female patients (14.54% in incidence. The incidence of distal ra dius fractures was common between the ages of 20 to 40 years. Left sided fractures were more common (52.73%. Type III was most common type of fracture (Frykman’s Classification, accounting for 29% of all fractures.25 cases were treated by external fixati on and 30 cases were treated by open reduction and buttress plating. The results were evaluated by using STEWART ET AL anatomical and functional scoring system. The average range of movement at the knee joint was Dorsiflexion 70*, Palmar Flexion 65*, Ulnar Deviation 25*, Radial Deviation 15*, Supination 70*, Pronation 65*. Most common early complication was pin tract infection. Based on the stewar et al scoring, 4(7.27% had excellent, 43(78.18% had good, 7(12.72% had fair, 1(1.81% had poor results. CONC LUSION : We observed that both fixations were equally same, there is no superiority with over the other. The incidence of complications in

  2. Radiographic anatomy of the proximal femur: correlation with the occurrence of fractures

    Pires, Robinson Esteves Santos; Prata, Eric Fontes; Gibram, Athos Vilela; Santos, Leandro Emilio Nascimento; Lourenço, Paulo Roberto Barbosa de Toledo; Belloti, João Carlos

    2012-01-01

    Objective To evaluate the correlation between radiographic parameters of the proximal femur anatomy and fractures. Methods Three hundred and five digital x-rays of the pelvis were analyzed in the anteroposterior view. Of these x-rays, twenty-seven showed femoral neck or transtrochanteric fractures. The anatomical parameters analyzed were: femoral neck width (FNW), femoral neck length (FNL), femoral axis length (FAL), cervicodiaphyseal angle (CDA), acetabular tear-drop distance (ATD) and great...

  3. Fixation of femoral capital physeal fractures with 7.0 mm cannulated screws in five bulls

    Salter-Harris type I fractures of the femoral capital physis were repaired in five Holstein bulls with three 7.0 mm cannulated screws placed in lag fashion. Radiographically at months 7 to 10, the fractures were healed and there was periarticular bone production on the femoral necks and the dorsal acetabular rims. Four bulls had normal gaits, and one bull had muscle atrophy and barely detectable lameness

  4. High-precision measurements of cementless acetabular components using model-based RSA: an experimental study

    Baad-Hansen, Thomas; Kold, Søren; Kaptein, Bart L;

    2007-01-01

    BACKGROUND: In RSA, tantalum markers attached to metal-backed acetabular cups are often difficult to detect on stereo radiographs due to the high density of the metal shell. This results in occlusion of the prosthesis markers and may lead to inconclusive migration results. Within the last few years......, new software systems have been developed to solve this problem. We compared the precision of 3 RSA systems in migration analysis of the acetabular component. MATERIAL AND METHODS: A hemispherical and a non-hemispherical acetabular component were mounted in a phantom. Both acetabular components...... underwent migration analyses with 3 different RSA systems: conventional RSA using tantalum markers, an RSA system using a hemispherical cup algorithm, and a novel model-based RSA system. RESULTS: We found narrow confidence intervals, indicating high precision of the conventional marker system and model...

  5. Use of computer assisted orthopedic surgery in pelvic and acetabular trauma

    Amr Abdelgawad; Ralitsa Akins; Kanlic, Enes M

    2011-01-01

    Computer assisted orthopedic surgery (CAOS) is a recent concept inorthopedics. Its use in orthopedic trauma is becoming more popular.Pelvic and acetabular trauma is one of the applications where CAOScan play an important role to facilitate the surgery. In this review article, we provide an overview of the structure of CAOS with specialemphasis on its role in pelvic and acetabular trauma. Th e use of CAOShas many advantages in the field of orthopedic trauma, however, manyobstacles are still pr...

  6. A novel classification to guide total hip arthroplasty for adult acetabular dysplasia

    Zhu, Chen; CHENG, MENG-QI; Cheng, Tao; MA, RUI-XIANG; Kong, Rong; GUO, YONG-YUAN; Qin, Hui; SHI, SI FENG; Zhang, Xian-long

    2013-01-01

    In the field of hip arthroplasties, the secondary fixation of the implants depends directly on the quality of the primary stability. A good acetabular fit and metaphyseal filling between the prostheses and implants improve the initial stabilization, and optimize the transmission of forces to the bone. A precise knowledge of the three-dimensional acetabular or femoral shape is essential to the selection of adapted implants. A total of 63 patients diagnosed with developmental dysplasia were ana...

  7. Numerical modelling of the pelvis and acetabular construct following hip arthroplasty

    Phillips, Andrew T. M.

    2005-01-01

    The study presents finite element models of the acetabular construct and the pelvis. Particular attention is given to investigating the behaviour of the acetabular construct following revision hip arthroplasty, carried out using the Slooff-Ling impaction grafting technique. Mechanical tests are carried out on bone graft, and constitutive models are developed to describe its non-linear elasto-plastic behaviour, for inclusion in finite element analyses. Impaction of bone graft was found to have...

  8. Distal radius fracture arthroscopic intraarticular displacement measurement after open reduction and internal fixation from a volar approach

    The purpose of this study was to assess articular surface reduction arthroscopically after volar locked-plate fixation of distal radius fractures (DRFs) via fluoroscopy-guided open reduction/internal fixation. We also aimed to develop preoperative radiographic criteria to help assist in determining which DRFs may need arthroscopic evaluation. A total of 31 consecutive patients with DRF were prospectively enrolled. Posteroanterior (PA) and lateral radiographs as well as axial, coronal, and sagittal CT scans were obtained just after attempted reduction of the DRF. The widest articular displacement at the radiocarpal joint surface of the distal radius (preopD) was then measured using a digital radiography imaging system. The DRF was reduced under fluoroscopy, and a volar locked plate was applied. The degree of residual articular displacement was then measured arthroscopically, and the maximum displacement (postopD) was measured with a calibrated probe. Of the 31 patients, 7 had an arthroscopically assessed maximum postopD of ≥2 mm after internal fixation. The correlation coefficients between each preopD and postopD of all radiographs and CTs were statistically significant. The cutoff values were 0.5 mm for PA radiographs, 2.10 mm for lateral radiographs, 2.15 mm for axial CT scans, 3.15 mm for coronal CT scans, and 1.20 mm for sagittal CT scans. All cutoff values for PA and lateral radiographs and for axial, coronal, and sagittal CT scans were unsuitable as screening criteria for arthroscopic reduction of DRF because of their low sensitivities and specificities. The cutoff value of the new preopD (the sum of the preopDs determined by lateral radiography and coronal CT scan) was 5.80 mm, and its sensitivity and specificity were 100% and 83.3%, respectively. Because a new preopD cutoff value of 5.80 mm is a good indicator for residual articular displacement after internal fixation of >2 mm, it is also a good indicator for the need for arthroscopic evaluation after

  9. Custom acetabular component design with interactive two-dimensional CT

    This paper reports on a revision of failed acetabular components that must accommodate existing segmental and cavitary bone defects and global loss of bone stock. Two-dimensional CT can be used to determine which patients may benefit from a custom acetabulum and to design such a prosthesis. Ninety-one sequential failed hip arthroplasties were reviewed to find 12 potential custom cup candidates, of whom seven underwent CT assessment and subsequent cup design and placement. Coronal and sagittal CT was used to review existing bone stock and bone defects, to measure and map the contour of the defect into which the new cup must fit and to determine the precise placement, angulation, and depth of screw holes to provide purchase for the new cup. A template was produced for approval, followed by cup manufacture and placement

  10. Radiologic analysis of femoral acetabular impingement: from radiography to MRI

    Dwek, Jerry R. [University of California at San Diego, Department of Radiology, Rady Children' s Hospital and Health Center, San Diego, CA (United States); San Diego Imaging, San Diego, CA (United States); Monazzam, Shafagh [Rady Children' s Hospital and Health Center, Department of Orthopedics, San Diego, CA (United States); Chung, Christine B. [University of California at San Diego, Department of Radiology, San Diego, CA (United States)

    2013-03-15

    Femoral acetabular impingement is a set of morphologic abnormalities that are considered to be a major cause of degenerative disease in the hip joint. Early changes are already present in adolescence when it is the pediatric radiologist who must assess current damage with the aim of averting progression to more severe and debilitating osteoarthritis. A multimodality approach is used for diagnosis, that includes conventional radiography and CT to assess the osseous structures. MR arthrography is the primary advanced imaging modality for assessment of morphologic changes as well as injuries of the labrum and articular cartilage. Details of radiologic imaging are offered to guide the radiologist and provide an avenue for the accurate description of the osseous and articular alterations and injury. (orig.)

  11. Three-dimensional computed tomography analysis of non-osteoarthritic adult acetabular dysplasia

    Ito, Hiroshi; Matsuno, Takeo; Hirayama, Teruhisa; Tanino, Hiromasa; Yamanaka, Yasuhiro [Asahikawa Medical College, Department of Orthopaedic Surgery, Asahikawa (Japan); Minami, Akio [Hokkaido University School of Medicine, Department of Orthopaedic Surgery, Sapporo (Japan)

    2009-02-15

    Little data exists on the original morphology of acetabular dysplasia obtained from patients without radiographic advanced osteoarthritic changes. The aim of this study was to investigate the distribution and degree of acetabular dysplasia in a large number of patients showing no advanced degenerative changes using three-dimensional computed tomography (3DCT). Eighty-four dysplastic hips in 55 consecutive patients were studied. All 84 hips were in pre- or early osteoarthritis without radiographic evidence of joint space narrowing, formation of osteophytes or cysts, or deformity of femoral heads. The mean age at the time of CT scan was 35 years (range 15-64 years). 3D images were reconstructed and analyzed using recent computer imaging software (INTAGE Realia and Volume Player). Deficiency types and degrees of acetabular dysplasia were precisely evaluated using these computer software. The average Harris hip score at CT scans was 82 points. Twenty-two hips (26%) were classified as anterior deficiency, 17 hips (20%) as posterior deficiency, and 45 hips (54%) as lateral deficiency. No significant difference was found in the Harris hip score among these groups. The analysis of various measurements indicated wide variations. There was a significant correlation between the Harris hip score and the acetabular coverage (p < 0.001). Our results indicated wide variety of deficiency type and degree of acetabular dysplasia. Hips with greater acetabular coverage tended to have a higher Harris hip score. (orig.)

  12. Patient-specific acetabular shape modelling: comparison among sphere, ellipsoid and conchoid parameterisations.

    Cerveri, Pietro; Manzotti, Alfonso; Baroni, Guido

    2014-04-01

    The shape of the human acetabular cup was commonly represented as a hemisphere, but different geometries and patient-specific shapes have been recently proposed in the literature. Our aim was to test the limits of the sphericity assumption by comparing three different parameterisations, namely the sphere, the ellipsoid and the rotational conchoid. Models of hip surfaces, reconstructed from CT scans taken from Caucasian race cadavers and patients, were automatically processed to extract the acetabular surface. Two separate analyses were carried out on the overall acetabular shape, including both the acetabular fossa and the lunate surface (case A) and acetabular cup represented by the lunate surface only (case B). Nonlinear gradient-based and evolutionary computation approaches were implemented for the fitting process. Minor differences from the three idealised geometries were detected (median values of the fitting errors different from both the ellipsoid (p difference was detected between the ellipsoid and the conchoid for case A. Significance of the difference between ellipsoid and sphere (p difference was detected between the ellipsoid and the conchoid. In conclusion, we synthesise that the morphology of the overall acetabular cup can be parameterised both with an ellipsoid shape and with a conchoid shape as well with superior quality than the simple sphere. Differently, if one considers just the lunate surface, better fitting results are expected when using the ellipsoid. PMID:22789071

  13. The significance of evaluating the craniolateral acetabular rim for hip dysplasia

    The weight-bearing part of the canine hip is its dorsocraniolateral portion. On the radiograph the configuration of the craniolateral acetabular rim is important for evaluation of hip dysplasia. Changes in formation of this area should be differentiated from artefacts due to malpositioning. When the pelvis is tilted dorsally, the cranial acetabular rim is superimposed on the cranioventral acetabular contour and the acetabular roof. The craniolateral contour then seems to be missing. The contours of a ventrally tilted pelvis do not overlap, but it is difficult to discern the craniolateral rim. The reference points for Norberg-Olsson's measurements are difficult to choose in both cases and the angles may vary up to 10 degrees. A symmetrically positioned pelvis shows one point of reference for Norberg-Olsson's measurement where the cranial acetabular contour, the cranioventral margin and the acetabular roof intersect. Therefore poor positioning of the pelvis for radiographic evaluation of hip dysplasia should be avoided when using Norberg-Olsson's measurements

  14. Combined medial column primary arthrodesis, middle column open reduction internal fixation, and lateral column pinning for treatment of Lisfranc fracture-dislocation injuries.

    Boffeli, Troy J; Pfannenstein, Ryan R; Thompson, Jonathan C

    2014-01-01

    Lisfranc fracture-dislocation can be a devastating injury with significant long-term sequelae, including degenerative joint disease, progressive arch collapse, and chronic pain that can be potentiated if not effectively treated. We present a case to demonstrate our preferred surgical approach, consisting of combined medial column primary arthrodesis, middle column open reduction internal fixation, and lateral column pinning, with the primary goal of minimizing common long-term complications associated with Lisfranc injuries. We present the case of a typical patient treated according to this combined surgical approach to highlight our patient selection criteria, rationale, surgical technique, and operative pearls. A 36-year-old male who had sustained a homolateral Lisfranc fracture-dislocation injury after falling from a height initially underwent fasciotomy for foot compartment syndrome. The subsequent repair 16 days later involved primary first tarsometatarsal joint fusion, open reduction internal fixation of the second and third tarsometatarsal joints, and temporary pinning of the fourth and fifth tarsometatarsal joints. He progressed well postoperatively, exhibiting an American College of Foot and Ankle Surgeons forefoot score of 90 of 100 at 1 year after surgery with no need for subsequent treatment. Lisfranc fracture-dislocations often exhibit primary dislocation to the medial column and are conducive to arthrodesis to stabilize the tarsometatarsal complex. The middle column frequently involves comminuted intra-articular fractures and will often benefit from less dissection required for open reduction internal fixation instead of primary fusion. We propose that this surgical approach is a viable alternative technique for primary treatment of Lisfranc fracture-dislocation injuries. PMID:24846158

  15. Cranial acetabular retroversion is common in developmental dysplasia of the hip as assessed by the weight bearing position

    Troelsen, Anders; Mikkelsen, Lone Rømer; Jacobsen, Steffen;

    2010-01-01

    The appearance of acetabular version differs between the supine and weight bearing positions in developmental dysplasia of the hip. Weight bearing radiographic evaluation has been recommended to ensure the best coherence between symptoms, functional appearance, and hip deformities. Previous...... prevalence estimates of acetabular retroversion in dysplastic hips have been established in radiographs recorded with the patient supine and with inclusion only if pelvic tilt met standardized criteria. We assessed the prevalence and the extent of acetabular retroversion in dysplastic hip joints in weight...

  16. Massive haemorrhage from the internal iliac artery following a low energy superior pubic ramus fracture in a 73-year-old man.

    Wee, James; Lua, Wensheng; Louange, Danny Thomas

    2013-06-01

    We report a case of a 73-year-old man with a background of aspirin use who fell and sustained a minimally displaced right superior pubic ramus fracture. He subsequently developed hypotension that necessitated fluid resuscitation, associated with a significant drop in blood haemoglobin levels that required a packed red blood cell transfusion. CT scans revealed the presence of two pelvic haematomas, with ongoing bleeding. An angiogram demonstrated bleeding from the superior vesical branch of the anterior division of the right internal iliac artery, which was successfully embolised with gelfoam slurry. The patient recovered uneventfully thereafter. This is a unique case involving an unexpected injury to the superior vesical branch of the anterior division of the internal iliac artery following low energy trauma to an elderly man. We recommend that patients who develop hypotension following a seemingly-benign isolated pubic ramus fracture be evaluated for concomitant arterial injuries with the relevant CT imaging and angiography. PMID:26403633

  17. The Immediate Effects of Different Types of Ankle Support Introduced 6 Weeks After Surgical Internal Fixation for Ankle Fracture on Gait and Pain: A Randomized Crossover Trial.

    Keene, David J; Willett, Keith; Lamb, Sarah E

    2016-03-01

    Study Design Randomized 3-treatment, 3-period crossover trial. Background There is variation in clinical practice regarding the type of ankle support used to aid recovery after ankle fracture internal fixation surgery. Objective To determine the immediate effects of different ankle supports commonly issued to patients 6 weeks after surgery. Methods Participants were 18 adults, 6 weeks after internal fixation for transsyndesmotic/infrasyndesmotic fracture, in a major trauma center in the UK. Interventions were a stirrup brace and walker boot compared with Tubigrip. Outcomes were (1) step-length and single-limb support time asymmetry (percentage comparing injured and uninjured limbs), (2) step width, (3) gait velocity, and (4) pain during walking (visual analog scale, 0-100). Results Participants (mean ± SD age, 47 ± 14 years) included 8 women and 10 men, 6 weeks after surgical internal fixation for ankle fracture. Single-limb support time asymmetry reduced by 3% (95% confidence interval [CI]: 0%, 6%; P = .02) in the stirrup brace and by 5% (95% CI: 2%, 7%; P = .001) in the walker boot compared with Tubigrip. Step width was 1.2 cm (95% CI: 0.6, 1.7; PLevel of Evidence Therapy, level 2b. J Orthop Sports Phys Ther 2016;46(3):157-167. Epub 26 Jan 2016. doi:10.2519/jospt.2016.6212. PMID:26813753

  18. Rigid internal fixation of zygoma fractures: A comparison of two-point and three-point fixation

    Parashar Atul

    2007-01-01

    Full Text Available Background: Displaced fractures of the zygomatic bone can result in significant functional and aesthetic sequelae. Therefore the treatment must achieve adequate and stable reduction at fracture sites so as to restore the complex multidimensional relationship of the zygoma to the surrounding craniofacial skeleton. Many experimental biophysical studies have compared stability of zygoma after one, two and three-point fixation with mini plates. We conducted a prospective clinical study comparing functional and aesthetic results of two-point and three-point fixation with mini plates in patients with fractures of zygoma. Materials and Methods: Twenty-two patients with isolated zygomatic fractures over a period of one year were randomly assigned into two-point and three-point fixation groups. Results of fixation were analyzed after completion of three months. This included clinical, radiological and photographic evaluation. Results: The three-point fixation group maintained better stability at fracture sites resulting in decreased incidence of dystopia and enophthalmos. This group also had better malar projection and malar height as measured radiologically, when compared with the two-point fixation group. Conclusion: We recommend three-point rigid fixation of fractured zygoma after accurate reduction so as to maintain adequate stabilization against masticatory forces during fracture healing phase.

  19. Increasing thickness and fibrosis of the cartilage in acetabular dysplasia: a rabbit model research

    LI Tian-you; MA Rui-xue

    2010-01-01

    Background The order and mechanism of pathological changes in acetabular dysplasia are still unclear. This study investigated cartilage changes in rabbit acetabular dysplasia models at different ages.Methods Twenty-seven 1-month-old New Zealand rabbits underwent cast immobilization of the left hind limb in knee extension. Serial acetabular dysplasia models were established by assessment of the acetabular index and Sharp's angle on radiographs. The thickness of the acetabular cartilage was measured under a microscope, and fibrosis was observed. Ultrastructural changes were investigated with scanning electron microscopy and transmission electron microscopy. The messenger RNA expression of collagen Ⅰ and Ⅱ, β1 integrin, and caspase-9 were measured by real-time fluorescence quantitative polymerase chain reaction.Results In an immature group of rabbits, the acetabular index of the treated hip increased with animal growth. The cartilage on the brim of the left acetabulum was significantly thicker than that on the right side. The collagen fibrils on the surface of the cartilage became gross, and the chondrocytes in the enlargement layer underwent necrosis. In a mature group of rabbits, the left Sharp's angle increased in the rabbits with 6-week casting. The cartilage on the brim of the left acetabulum underwent fibrosis. The chondrocytes were weakly stained, and the number of lysosomes was much larger than normal. The messenger RNA expression of collagen Ⅰ and Ⅱ, β1 integrin, and caspase-9 in the cartilage differed significantly at different ages.Conclusions Increasing thickness followed by fibrosis may be the order of pathological cartilage changes in acetabular dysplasia, with changes in ultrastructure and collagen expression contributing to the process.

  20. A porous tantalum uncemented acetabular cup in acetabular revision arthroplasty%生物学固定骨小梁金属杯在髋臼翻修中的应用

    徐卫东; 陈刚; 张东华

    2009-01-01

    前后X射线平片显示无假体移位下沉等不稳迹象,骨小梁金属杯周围骨质向内长入.本组患者无置换后并发症发生,截至最后1次随访有14例行走时无疼痛,2例轻度疼痛伴轻度跛行.未出现症状性深静脉血栓或神经损伤.无需要再度翻修病例.结论:初次固定人工髋臼杯失败的病例,若无骨缺损,翻修时使用骨小梁金属杯可以获得良好的早期效果.%BACKGROUND: Biological fixation refers to the treatment of coarse or porous prosthetic surface. It is favorable to "bone ingrowth" prosthesis to achieve long-term stability. Porous tantalum is the latest scientific product that appears suitable to prosthetic surface owing to its porous feature and has been attracting a great deal attention.OBJECTIVE: To investigate the therapeutic efficacy of a porous tantalum uncemented acetabular cup in acetabular revision arthroplasty.DESIGN, TIME AND SETTING: A retrospective case analysis was performed at the Department of Orthopedics, Changhai Hospital, Second Military Medical University of Chinese PLA between April and November 2006.PARTICIPANTS/MATERIALS: Sixteen patients (16 hips), 7 males and 9 females, aged 54-81 years old, who received treatment at the Department of Orthopedics, Changhai Hospital, Second Military Medical University of Chinese PLA were included in this study. Of these patients, 2 suffered from femoral neck fracture, 6 from aseptic femoral head necrosis, and 8 from osteoarthritis. Trabecular metal cup (Zimmer, Warsaw, Indiana) provided a titanium alloy bottom layer and porous tantalum-coated surface, which was realized by technical combination of bone trabecular tantalum and titanium alloy. The prosthesis contained an ultrahigh modulus polyethylene lining.METHODS: All patients underwent acetabular revision with modular porous tantalum uncemented acetabular cup. Prior to replacement, acetabular defects and femoral prosthesis were evaluated. A posterolateral approach of hip joint was made. Following

  1. 髌骨骨折关节镜下闭合复位内固定术后的康复训练%Rehabilitation exercises after closed reduction internal fixation of fracture of patella under arthroscope

    朴成哲; 李培; 阿良; 王敏

    2003-01-01

    @@ INTRODUCTION Closed reduction internal fixation under arthroscope is performed from August, 2000 to April, 2001 and advanced domestic and foreign rehabilitation programs are combined to treat fracture of patella comprehensively, satisfying effects are achieved.

  2. Chinese traditional medicine rehabilitative treatment of femoral neck fracture after screw thread needle internal fixation%螺纹针内固定术后中药康复治疗股骨颈骨折

    高广升; 李凤辉

    2001-01-01

    @@ Background:Femoral neck fracture is one of common and severe injury in old people. We utilize transcutaneous Screw thread needle internal fixation treat it, cooperated with Chinese medicine treatment, and gained good effects.

  3. 股骨颈骨折内固定手术的研究历程与展望%History and prospect of internal fixation operation of femoral neck fracture

    梅炯

    2015-01-01

    Femoral neck fracture is one of the major damages to health and life in the elderly population. But man has had his own understanding of that damage for only 600 years. The following research efforts had their milepost signiifcance in the development of the internal ifxation operation on femoral neck fracture. In 1858, a German surgeon, Von Langenbeck, did the ifrst internal ifxation of femoral neck fracture. But the patient unfortunately died of septicemia. In 1875, Franz König succeeded in the same operation with metal screws on disinfection. In 1883, Nicholass Senn, an American Surgeon, suggested that all femoral neck fractures should be treated with operation based on his animal experiments, but his proposal was not widely accepted. In 1931, Smith-Petersen etc. from the USA ifrst published the results of open reduction and internal ifxation of femoral neck fracture with the use of triifn nail. In 1938, an American doctor, Henderson, publisized his results of the treatment of femoral neck fracture with cannulated screws in Mayo Clinic. In 1941, American Academy of Orthopaedic Surgeons ( AAOS ) advocated the technique of triifn nail, which was pointed out to be unsuitable for the displaced femoral neck fracture by British Medical Research Council in 1976. Asnis cannulated screws appeared in 1980, which is still in use today. Fairly good effects have been achieved in the treatment of femoral neck fracture with internal ifxation, but in some patients it still results in the necrosis of the femoral head. Thus, people are still making different choices between arthroplasty or internal ifxation for the femoral neck fracture, depending largely on the surgeon’s judgment on the degree of the impairment on blood supply to femoral head after the fracture and the influence of the impairment on its healing. The individualized choice of operation method, the maximal retainability of the femoral head blood supply, and the retaining of the residual blood supply from the

  4. Functional outcome after open reduction and internal fixation for symptomatic delayed union and nonunion after fracture clavicle: A series of 31 cases

    Mukhopadhaya John

    2007-01-01

    Full Text Available Background: Non-union after clavicular fractures can cause significant disability due to pain, impaired function of the shoulder joint and limitations of certain activities, especially in high-demand patients. Materials and Methods: 31 patients (21 males and 10 females of symptomatic delayed union or nonunion were treated operatively using plate osteosynthesis with bone grafting where required between January 1994 to September 2005. Out of the 31 patients, 14 cases were of delayed union (no evidence of union > six wks and 17 cases were of nonunion (no union > three months. Fracture of the lateral one-third and open fractures of the clavicle were not included in the study. Bone grafting was done in 23 patients. The outcome was assessed with the American Academy of Orthopedic Surgeons (AAOS disabilities of the arm, shoulder and hand (DASH questionnaire. Results: The patients were followed-up for an average of 13 months (range six months to four years. All fractures united with in three months Most of the patients had their DASH scores in the range of 10 to 20, the average being 14.7 in our series. Functionally, this was very much acceptable. Conclusion: Open reduction and internal fixation with a plate in conjunction with an autogenous bone graft where required is a successful procedure with good outcome and most of the patients can return to a near normal level of function.

  5. Combined circular external fixation and open reduction internal fixation with pro-syndesmotic screws for repair of a diabetic ankle fracture

    Zacharia Facaros

    2010-10-01

    Full Text Available The surgical management of ankle fractures among the diabetic population is associated with higher complication rates compared to the general population. Efforts toward development of better methods in prevention and treatment are continuously evolving for these injuries. The presence of peripheral neuropathy and the possible development of Charcot neuroarthropathy in this high risk patient population have stimulated much surgical interest to create more stable osseous constructs when open reduction of an ankle fracture/dislocation is required. The utilization of multiple syndesmotic screws (pro-syndesmotic screws to further stabilize the ankle mortise has been reported by many foot and ankle surgeons. In addition, transarticular Steinmann pins have been described as an adjunct to traditional open reduction with internal fixation (ORIF of the ankle to better stabilize the talus, thus minimizing risk of further displacement, malunion, and Charcot neuroarthropathy. The authors present a unique technique of ORIF with pro-syndesmotic screws and the application of a multi-plane circular external fixator for management of a neglected diabetic ankle fracture that prevented further deformity while allowing a weight-bearing status. This technique may be utilized for the management of complex diabetic ankle fractures that are prone to future complications and possible limb loss.

  6. Monteggia fracture dislocation equivalents——analysis of eighteen cases treated by open reduction and internal fixation

    Ajay Pal Singh; Ish Kumar Dhammi; Anil Kumar Jain; Rajeev Raman; Prashant Modi

    2011-01-01

    Objective: Monteggia fracture dislocation equivalent, though already described by Bado, is still an unclassified entity. We aimed to retrospectively analyze 18 cases of Monteggia variants and discuss the injury mechanisms, management, and outcome along with a re view of the literature. Methods: A retrospective record of Monteggia fracture dislocation (2003-2008) was reviewed from medical record department of our institute. Classic Monteggia fracture dislocation, children below 12 years or adults over 50 years, as well as open grade Ⅱ & Ⅲ cases were excluded from this study. Monteggia variant inclusion criteria included fracture of the proximal ulna together with a fracture of the radial head or neck and skeletal maturity. Totally 26 patients were identified with Monteggia variants and 18 were available for follow-up, including 11 males and 7 females with the mean age of 35 years. The ulna fracture was treated by compression plating along with tension band wiring. Radial head/neck was reconstructed in 12 patients while excised in 6 patients. Results: Follow-up ranged from 1 -4 years, mean 2.6 years. Patients were assessed clinicoradiologically. Mayo Elbow Performance Score was employed to assess the outcomes. At final follow-up, the results were excellent in 10 patients, good in 4, fair in 2 and poor in 2. Mean range of motion of the elbow was 20°, 116°, 50° and 55° for extension, flexion, pronation and supination, respectively. Two patients had complications in the form of heterotopic ossification and stiffness of the elbow. One nonunion ulna, primarily treated by tension band wiring, was managed by refixation with locking reconstruction plate and bone grafting. Bone grafting was only required in this patient for nonunion. Another patient had implants removed on his request. The results in our series closely correlated with extent of intraarticular damage, coronoid fracture and comminuted fractures. Conclusions: Monteggia fracture dislocation equivalents

  7. Warwick Hip Trauma Study: a randomised clinical trial comparing interventions to improve outcomes in internally fixed intracapsular fractures of the proximal femur. Protocol for The WHiT Study

    Griffin Xavier; Parsons Nick; Achten Juul; Costa Matthew L

    2010-01-01

    Abstract Background Controversy exists regarding the optimal treatment for patients with displaced intracapsular fractures of the proximal femur. The recognised treatment alternatives are arthroplasty and internal fixation. The principal criticism of internal fixation is the high rate of non-union; up to 30% of patients will have a failure of the fixation leading to revision surgery. We believe that improved fracture healing may lead to a decreased rate of failure of fixation. We therefore pr...

  8. Acetabular rim and surface segmentation for hip surgery planning and dysplasia evaluation

    Tan, Sovira; Yao, Jianhua; Yao, Lawrence; Summers, Ronald M.; Ward, Michael M.

    2008-03-01

    Knowledge of the acetabular rim and surface can be invaluable for hip surgery planning and dysplasia evaluation. The acetabular rim can also be used as a landmark for registration purposes. At the present time acetabular features are mostly extracted manually at great cost of time and human labor. Using a recent level set algorithm that can evolve on the surface of a 3D object represented by a triangular mesh we automatically extracted rims and surfaces of acetabulae. The level set is guided by curvature features on the mesh. It can segment portions of a surface that are bounded by a line of extremal curvature (ridgeline or crestline). The rim of the acetabulum is such an extremal curvature line. Our material consists of eight hemi-pelvis surfaces. The algorithm is initiated by putting a small circle (level set seed) at the center of the acetabular surface. Because this surface distinctively has the form of a cup we were able to use the Shape Index feature to automatically extract an approximate center. The circle then expands and deforms so as to take the shape of the acetabular rim. The results were visually inspected. Only minor errors were detected. The algorithm also proved to be robust. Seed placement was satisfactory for the eight hemi-pelvis surfaces without changing any parameters. For the level set evolution we were able to use a single set of parameters for seven out of eight surfaces.

  9. Acetabular component migration in total hip arthroplasty using CT and a semiautomated program for volume merging

    Purpose: To develop a non-invasive method for detection of acetabular cup migration after total hip arthroplasty (THA) with a higher degree of accuracy than routine plain radiography. Material and Methods: Two CT examinations, 10 min apart, were obtained from each of 10 patients that had undergone THA. Using an in-house developed semiautomated program for volume merging, the pelves in the two examinations were fused and the acetabular cup was visually and numerically evaluated to test the method's accuracy in detecting migration. Results: In the visual evaluation of the best match a 1-mm translation of the cup was detectable. The numerical evaluation, comparing landmarks placed in the images of the acetabular cup and the head of the femur component in the two examinations, showed the mean difference in orientation of acetabular axes to be 2.5 deg, the mean distance between centre of cup face to be 2.5 mm and the mean distance between centre of the head of the prosthetic femoral component to be 1 mm. Conclusion: This method has a significantly higher accuracy than routine plain radiography in detecting acetabular cup migration and could be used in clinical practice. It gives both a visual and a numerical correlate to migration

  10. Cemented total hip arthroplasty with impacted morcellized bone-grafts to restore acetabular bone defects in congenital hip dysplasia.

    Bolder, S.B.T.; Melenhorst, J.; Gardeniers, J.W.M.; Slooff, T.J.J.H.; Veth, R.P.H.; Schreurs, B.W.

    2001-01-01

    We evaluated the results of 27 acetabular reconstructions in 21 patients with secondary osteoarthritis resulting from congenital dysplasia of the hip in which the acetabular bone defects were restored with impacted morcellized bone-grafts in combination with a cemented cup. At an average follow-up o

  11. 21 CFR 888.3320 - Hip joint metal/metal semi-constrained, with a cemented acetabular component, prosthesis.

    2010-04-01

    ... cemented acetabular component, prosthesis. 888.3320 Section 888.3320 Food and Drugs FOOD AND DRUG..., prosthesis. (a) Identification. A hip joint metal/metal semi-constrained, with a cemented acetabular component, prosthesis is a two-part device intended to be implanted to replace a hip joint. The...

  12. 21 CFR 888.3330 - Hip joint metal/metal semi-constrained, with an uncemented acetabular component, prosthesis.

    2010-04-01

    ... uncemented acetabular component, prosthesis. 888.3330 Section 888.3330 Food and Drugs FOOD AND DRUG..., prosthesis. (a) Identification. A hip joint metal/metal semi-constrained, with an uncemented acetabular component, prosthesis is a two-part device intended to be implanted to replace a hip joint. The...

  13. First TRUE Stage - Transport of solutes in an interpreted single fracture. Proceedings from the 4th international seminar

    . The outcome of the 4th International Aespoe seminar focused on the TRUE-1 experiments can be summarised in the following main points: There is a general consensus that the observed retardation observed in the TRUE-1 experiments requires diffusion into geological material to be an active process. This supported by the -3/2 slope noted in log-log BTCs. Whether this is due to diffusion (and subsequent sorption) in the altered matrix rock, or in possible fault gouge cannot be differentiated with available data; Some researchers claim that the observed enhanced retardation may be explained by diffusion into stagnant water pools, pure surface sorption, or may be due to an underestimation in the flow-wetted surface area. The latter effect may be attributed to a more complex flow path (multi-layered structure) or three-dimensional effects; A clear differentiation between the principal active process can only assessed by resin injection and subsequent excavation and analysis; It was identified that experiments of TRUE type are important for improving the understanding of retention processes. However, this type of experiment will not be part of a site characterisation programme; It was recommended to broaden the data base from the TRUE-1 site before characterising pore space with resin techniques. This includes tracer dilution tests using sinks in other features than Feature A. The seminar was divided into four sessions: 1. Detailed characterisation of transport-related properties (Three contributions separately indexed). 2. Alternative evaluation of TRUE-1 results (Five contributions separately indexed). 3. Related studies (Three contributions separately indexed). 4. Understanding of retention processes in a single fracture (Two contributions separately indexed)

  14. First TRUE Stage - Transport of solutes in an interpreted single fracture. Proceedings from the 4th international seminar

    NONE

    2001-08-01

    . The outcome of the 4th International Aespoe seminar focused on the TRUE-1 experiments can be summarised in the following main points: There is a general consensus that the observed retardation observed in the TRUE-1 experiments requires diffusion into geological material to be an active process. This supported by the -3/2 slope noted in log-log BTCs. Whether this is due to diffusion (and subsequent sorption) in the altered matrix rock, or in possible fault gouge cannot be differentiated with available data; Some researchers claim that the observed enhanced retardation may be explained by diffusion into stagnant water pools, pure surface sorption, or may be due to an underestimation in the flow-wetted surface area. The latter effect may be attributed to a more complex flow path (multi-layered structure) or three-dimensional effects; A clear differentiation between the principal active process can only assessed by resin injection and subsequent excavation and analysis; It was identified that experiments of TRUE type are important for improving the understanding of retention processes. However, this type of experiment will not be part of a site characterisation programme; It was recommended to broaden the data base from the TRUE-1 site before characterising pore space with resin techniques. This includes tracer dilution tests using sinks in other features than Feature A. The seminar was divided into four sessions: 1. Detailed characterisation of transport-related properties (Three contributions separately indexed). 2. Alternative evaluation of TRUE-1 results (Five contributions separately indexed). 3. Related studies (Three contributions separately indexed). 4. Understanding of retention processes in a single fracture (Two contributions separately indexed)

  15. Smallness kerf pedicle screw internal fixation cure thoracolumbar fracture%小切口椎弓根钉棒内固定治疗胸腰椎骨折

    胡红耘

    2009-01-01

    Objective Smallness kerr rout of retreat pedicle screw posting restoration fixing cure thoracolum-bar fracture. Methods Versus 12 example thoracolumbar fracture adopt smallness keff micro-wound rout of retreat pedicle screw posting restoration fixing technology. Results 12 example fracture patient follow-up survey 8 loaf months to 2 year, average long dozen month, fracture restoration satisfaction, pedicle screw position all right, without height lost, without looseness,lapse sever natl. Conclusion Thoracolumbar fracture met pedicle screw push off resto-ration internal fixation, reestablish physiologic protrusion, operation kerf smallness, esthetic appearance, hemorrhage fewness wound reaction smallness, in favor of skill post-recovery.%目的 探讨椎弓根钉棒置入复位固定治疗胸腰椎骨折的手术入路方法.方法 对12例胸腰椎骨折的病例采用小切口微创后路椎弓根钉棒置入复位固定技术.结果 12例骨折患者随访8个月至2年,平均13个月,骨折复位满意,椎弓根钉棒位置良好,无高度丢失、无松动、失效、断钉.结论 胸腰椎骨折可选择后路小切口术式行椎弓根钉棒撑开复位内固定,重建生理前突,手术切口小、美观、出血少、创伤反应小,有利于术后恢复.

  16. The early influence of hip traction or internal rotating on blood circulation of femoral head with neck fracture: study by superselective digital subtraction arteriography

    Objective: To investigate the early influence of hip traction or internal rotating on the femur head blood circulation with femur neck fracture. Methods: Using digital subtraction angiography (DSA), nine patients underwent selective arteriography of the medial and lateral femoral circumflex artery from 2 to 23 days after the femoral neck fracture in a neutral position. Seven of them were done in the presence of 3 kg hip traction, and six were in 5 kg hip traction (4 cases after 3 kg traction). Angiography was also performed in a intorted position without traction in 5 patients. In 3 cases, retinacular artery angiography was done simultaneously using the micro catheter. The femoral circumflex arteriography of the normal leg was done in 8 patients, and three of them were simultaneously done in a postion of internal rotating of straight leg. Results: Comparison with the arteriographic findings in absence of traction, all retinacular arteries but inferior arteries were depicted few branches and less femoral head perfusion in all 9 patients, especially in that of medial femoral circumflex arteriography, as hip joint was tractating in neutral position with the same speed and volume of injecting contrast medium and, the veins were demonstrated poorly or delayed. Those changes became notable as traction weight increased from 3 kg to 5 kg in all four cases. While hip joint was internally rotating with the sick leg straightened in 5 patients, all retinacular arteries especially their branches and femoral head perfusion were hardly shown, which were also seen in normal leg in 2 cases, and those changes were more marked than that of in traction. Conclusion: Traction and internally rotating of hip joint decrease blood perfusion of major areas of the femoral head while blood flow of major retinacular arteries are reduced or even failed to be displayed with the vein drainage being impeded. Traction may be one of the important causes of avascular osteonecrosis of the femoral head

  17. Quantification of clearance and creep in acetabular wear measurements

    Gregory, Thomas; Vandenbussche, Eric

    2016-01-01

    Background This study aimed to measure femoral head penetration before occurrence of real wear, and to quantify the portions attributable respectively to clearance and plastic deformations in various acetabular designs. Methods We analyzed CT scans from 15 patients at ‘day five’ after total hip arthroplasty (THA). All patients received Exafit® femoral stems and 28 mm heads: 5 patients had cemented Durasul® all-PE cups, 5 patients had un-cemented Allofit® metal-backed cups, and 5 patients had un-cemented Stafit® dual-mobility cups. We also analyzed CT scans of samples of the three head-cup combinations to compare in vivo and in vitro measurements. Results The mean femoral head penetration measured on ‘day five’ was lower for all-PE cups (0.196 mm) than for metal-backed cups (0.551 mm) and dual-mobility cups (0.634 mm). Conclusions The present study indicates that isolated measurements of femoral head penetration include 0.15–0.46 mm of radial clearance and 0.05–0.27 mm of creep, and confirms that the majority of so-called bedding-in observed in the first post-operative months is not entirely due to wear. PMID:27162781

  18. Results of Chiari pelvic osteotomy for acetabular dysplasia in adults

    In an attempt to determine indications of Chiari pelvic osteotomy in acetabular dysplasia, postoperative outcome of hip joint (64 joints) was examined on the basis of findings of bone scintigraphy. The subjects were 61 patients with osteoarthrosis of hip joint who underwent preoperative bone scintigraphy. The follow-up period ranged from 2 years to 9 years and 7 months with a mean of 4 years and 9 months. According to X-ray findings, 37 osteoarthrosis joints were staged as early and 27 as progressive. Preoperative bone scintigraphic findings fell into three: (I) normal or slight hot type (33 joints), (II) hot type at the weighting part (16 joints), and (III) double hot type in the weighting part and inside part (15 joints). None of the patients had severe surgical complications such as deep-seated infection, neuroparalysis and pseudojoint. According to the clinical staging for hip joint function, 7 (47%) of 64 joints were judged as poor after osteotomy, belonging to type III. Deterioration of osteoarthrosis was seen in 11 joints (41%) on X-ray films. Of these, 9 had type III. In conclusion, Chiari pelvic osteotomy should not be indicated when type III is shown on bone scintigrams. (N.K.)

  19. Magnetic resonance arthrography of the acetabular labral lesion

    Magnetic resonance arthrography (MRA) is a reliable diagnostic method with high sensitivity and accuracy for acetabular labral lesion in the hip joint. This paper describes the present state and task of the method mainly based on authors' experience. Subjects are 18 patients with the lesion, whose 10 joints have dysplastic shelf (Sharp angle >45 degrees). Enhanced T1-weighted, and 3D T2 as well, MRA is conducted with the machine Signa Excite 3.0 T (GE), rapidly after injection in the joint cavity of 10-20 mL of gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA) 100 times-diluted by iopamidol. Abnormal MRA findings involve the labral morphology of circular edge, flatness, irregular contour and shrink/disappearance, and the image of high brightness in parenchyma, invasion of the contrast medium there, and discontinuousness between the shelf edge and labrum. The lesion predominantly exists at anterior and superior portion on the labrum and the images of ganglion and synovial cyst suggest the existence of labral tear. Normal variants can give a part of the abnormal MRA findings above, and thus who require the differential diagnosis for the lesion. Education of MRA is a task for general orthopedists. (R.T.)

  20. Ultrasound versus Magnetic Resonance Arthrography in Acetabular Labral Tear Diagnostics: A Prospective Comparison in 20 Dysplastic Hips

    Troelsen, A.; Jacobsen, S.; Bolvig, L.; Gelineck, J.; Roemer, L.; Soeballe, K. [Orthopedic Research Unit and Dept. of Radiology, Univ. Hospital of Aarhus, A arhus (Denmark)

    2007-11-15

    Background: Acetabular labral tears are highly associated with hip dysplasia. Magnetic resonance arthrography (MR arthrography) is the expensive and time-consuming contemporary gold-standard method in the radiological assessment of acetabular labral tears. Purpose: To assess the diagnostic ability of noninvasive ultrasound (US) examination compared to MR arthrography in diagnosing acetabular labral tears in dysplastic hip joints. Material and Methods: The study compared US examination and MR arthrography diagnosis of labral tears in 20 consecutively referred dysplastic hip joints. Results: The ability to diagnose acetabular labral tears upon US examination was calculated: sensitivity 44%, specificity 75%, positive predictive value 88%, and negative predictive value 25%. Conclusion: The ability of US examination in diagnosing acetabular labral tears is not yet good enough. The technique is still to be developed, and more experience, especially with the interpretation of US examinations, is needed.

  1. Management of parasymphyseal fractures of the mandible.

    McClurg, F L

    1978-02-01

    Fractures of the parasymphyseal mandible occur in 15% of all cases of mandibular fracture. The experience obtained from 32 consecutive parasymphyseal fractures is outlined. Open reduction and internal fixation was required in patients having severe comminution, a mobile central fragment, or bilateral subcondylar fractures. These circumstances constituted 15% of all parasymphyseal fractures. The techniques utilized have been outlined. PMID:621994

  2. Utilization of the less-invasive stabilization system internal fixator for open fractures of the proximal tibia: A multi-center evaluation

    Stannard James

    2008-01-01

    Full Text Available Background: Locked plating has become popular and has clear biomechanical advantages when compared with conventional plating. When combined with minimally invasive surgical techniques, locked plating may cause substantially less iatrogenic tissue damage when compared with conventional plating. These characteristics may make locked plating an attractive option for treating open fractures of the tibial plateau and proximal tibia for which coverage over the plate can be obtained. The purpose of this study was to evaluate the use of the Less-Invasive Stabilization System (LISS for high-energy open fractures involving either the tibial plateau or proximal tibia. Materials and Methods: This study is a retrospective evaluation of a consecutive multicenter series of 52 consecutive patients operated by seven surgeons, who used LISS plating in open proximal tibia or tibial plateau fractures seen at one of four Level I Trauma Centers. All patients were treated using a locked plating system that was implanted using minimally invasive submuscular surgical techniques. The primary outcome measure was the incidence of deep and superficial infection. Results: Fifty-two patients with open fractures have been evaluated, with a mean follow-up of 16.8 (12-36 months. Three patients (5.8% developed deep infections. Two patients (6.3% with tibial plateau and one (4.3% of patients with a tibial shaft fracture developed deep infections. Fifteen patients required flap coverage of their open wounds. The incidence of deep infection as per Gustilo and Anderson classification was Type I and II - 0 (0%; Type IIIA - 2 (7.7%; Type IIIB - 1 (7.1%; and Type IIIC - 0 (0%. Conclusions: Biomechanically, the LISS functions as an "internal-external fixator" rather than a plate. Traditional plate osteosynthesis has yielded rates of infection between 18% and 35%. Our data indicate that locked plating using minimally invasive techniques yield deep infections rates that are no worse than

  3. 锁定接骨板治疗肱骨近端骨折%Internal Fixation of Proximal Humeral Fractures with Locking Plate

    王振堂; 申海波; 吴艳刚; 董军政; 刘艳梅; 焦顺成

    2011-01-01

    Objective: To evaluate the clinical results of proximal humeral fractures treated by locking plate. Methods: From March 200S to March 2010,43 cases of proximal humeral fractures were treated with open reduction and internal fixation with Locking plate. According to Neer classification, 20 cases were two-part fractures, 19 cases three-part fractures and 4 cases four-part fractures. The clinical results were evaluated by using Neer'S evaluation system and X-ray films. Results: 43 cases were followed up for average 14.2 months(9~21 months). All fractures got complete healing, the mean time for bony union was 10.4 (8~1 2)weeks. According to Neer'S evaluation system: 19 patients were graded as excellent, 19 as good, 5 as fair. The excellent and good rate was 88.4%. Conclusions: Inter fixation of proximal humeral fractures with locking plate has the advantages of less invasive, easy operation, stable fixation, which permit early functional rehabilitation and lead to satisfactory clinical results.%目的:探讨锁定钢板治疗肱骨近端骨折的临床疗效.方法:2005年3月~2010年3月应用锁定钢板(包括肱骨近端锁定钢板或肱骨近端锁定内固定系统)治疗肱骨近端骨折43例,按Neer分型2部分骨折20例,3部分骨折19例,4部分骨折4例.随访评定包括X线片、Neer肩关节功能评分标准.结果:43例患者获得平均14.2个月(9~21个月)临床随访,骨折全部愈合,愈合平均时间10.4周(8~12周).根据Neer肩关节功能评分标准:优19例,良19例,可5例,优良率88.4%.结论:锁定钢板治疗肱骨近端骨折具有手术创伤小、操作方便、固定可靠的优点,允许早期功能锻炼,疗效满意.

  4. Oxidation and other property changes of retrieved sequentially annealed UHMWPE acetabular and tibial bearings.

    Reinitz, Steven D; Currier, Barbara H; Van Citters, Douglas W; Levine, Rayna A; Collier, John P

    2015-04-01

    This investigation analyzed retrieved sequentially crosslinked and annealed (SXL) ultra-high molecular weight polyethylene bearings to determine whether the material is chemically stable in vivo. A series of retrieved tibial and acetabular components were analyzed for changes in ketone oxidation, crosslink density, and free radical concentration. Oxidation was observed to increase with in vivo duration, and the rate of oxidation in tibial inserts was significantly greater than in acetabular liners. SXL acetabular bearings oxidized at a rate comparable to gamma-sterilized liners, while SXL tibial inserts oxidized at a significantly faster rate than their gamma-sterilized counterparts. A significant decrease in crosslink density with increased mean ketone oxidation index was observed, suggesting that in vivo oxidation may be causing material degradation. Furthermore, a subsurface whitened damage region was also found in a subset of the bearings, indicating the possibility of a clinically relevant decrease in mechanical properties of these components. PMID:24956572

  5. Low bone mineral density is not related to failure in femoral neck fracture patients treated with internal fixation

    Viberg, Bjarke; Ryg, Jesper; Overgaard, Søren;

    2014-01-01

    new hip fracture). A stratified Cox regression model on fracture displacement was applied and adjusted for age, sex, quality of reduction, implant positioning, comorbidity, and walking disability. Results - 49 patients had a T-score below -2.5 (standard deviation from the young normal reference mean......, implant positioning, and quality of reduction. From a questionnaire completed during admission, 2 variables for comorbidity and walking disability were chosen. Primary outcome was low hip BMD (amount of mineral matter per square centimeter of hip bone) compared to hip failure (resection, arthroplasty, or...

  6. Combining of small fragment screws and large fragment plates for open reduction and internal fixation of periprosthetic humeral fractures

    Dominik Seybold

    2011-01-01

    Full Text Available Operative treatment of periprosthetic humeral fractures in elderly patients with osteoporotic bone requires a stable fixations technique. The combination of 3.5 cortical screws with washers in a 4.5 Arbeitsgemeinschaft fόr Osteosynthesefragen, Limited-contact dynamic compression plate or Locking plate, allows a stable periprosthetic fixation with the small 3.5 screws and 4.5 screws above and below the prosthesis, respectively. This combination is a cost-effective technique to treat periprosthetic humeral fractures.

  7. Quantifying the contribution of pincer deformity to femoro-acetabular impingement using 3D computerised tomography

    Dandachli, Wael; Najefi, Ali; Iranpour, Farhad; Lenihan, Jonathan; Hart, Alister; Cobb, Justin [Imperial College London, Charing Cross Hospital, Department of Orthopaedic Surgery, London (United Kingdom)

    2012-10-15

    To provide a simple, reliable method for the three-dimensional quantification of pincer-type hip deformity. Computerised tomography scans of 16 normal female hips and 15 female hips with clinical femoro-acetabular impingement (FAI) and radiographic signs of pincer secondary to acetabular protrusio were analysed. After orientating the pelvis in the anterior pelvic plane, the acetabular centre was determined, and the ratios of its coordinates to the corresponding pelvic dimensions were calculated. Acetabular coverage of the femoral head and centre-edge angles were also measured for the two groups. In hips with a pincer, the hip was medialised by 37 % (p = 0.03), more proximal by 5 % (p = 0.05) and more posterior by 9 % (p = 0.03) compared with the normal hips. Coverage of the femoral head in protrusio hips was significantly greater than normal (average 71 % vs 82 %, p = 0.0001). Both the lateral centre-edge angle and the combined anterior-posterior centre-edge angle were greater in protrusio hips than in the normal ones (48 vs 37 , p < 0.001; and 216 vs 176 , p < 0.0001 respectively). Displacement in acetabular protrusio occurs in all planes. This CT-based method allows for the accurate and standardised quantification of the extent of displacement, as well as 3D measurement of femoral head coverage. In the adult female population, a combined centre-edge angle of over 190 suggests an acetabulum that is too deep and a potential cause of symptoms of femoro-acetabular impingement. Conversely, an acetabulum that has a combined centre-edge angle of less than 190 may be considered to be of normal depth, and therefore not contributing a pincer to FAI should it occur. (orig.)

  8. Quantifying the contribution of pincer deformity to femoro-acetabular impingement using 3D computerised tomography

    To provide a simple, reliable method for the three-dimensional quantification of pincer-type hip deformity. Computerised tomography scans of 16 normal female hips and 15 female hips with clinical femoro-acetabular impingement (FAI) and radiographic signs of pincer secondary to acetabular protrusio were analysed. After orientating the pelvis in the anterior pelvic plane, the acetabular centre was determined, and the ratios of its coordinates to the corresponding pelvic dimensions were calculated. Acetabular coverage of the femoral head and centre-edge angles were also measured for the two groups. In hips with a pincer, the hip was medialised by 37 % (p = 0.03), more proximal by 5 % (p = 0.05) and more posterior by 9 % (p = 0.03) compared with the normal hips. Coverage of the femoral head in protrusio hips was significantly greater than normal (average 71 % vs 82 %, p = 0.0001). Both the lateral centre-edge angle and the combined anterior-posterior centre-edge angle were greater in protrusio hips than in the normal ones (48 vs 37 , p < 0.001; and 216 vs 176 , p < 0.0001 respectively). Displacement in acetabular protrusio occurs in all planes. This CT-based method allows for the accurate and standardised quantification of the extent of displacement, as well as 3D measurement of femoral head coverage. In the adult female population, a combined centre-edge angle of over 190 suggests an acetabulum that is too deep and a potential cause of symptoms of femoro-acetabular impingement. Conversely, an acetabulum that has a combined centre-edge angle of less than 190 may be considered to be of normal depth, and therefore not contributing a pincer to FAI should it occur. (orig.)

  9. Entrapment of the acetabular labrum following reduction of traumatic hip dislocation in a child

    In traumatic hip dislocation, concentric reduction can be prevented by various causes. Soft-tissue interposition, such as entrapment of the acetabular labrum, is a rare but important cause of failed reduction of a hip. Early diagnosis of incomplete reduction due to interposition of soft tissue is important, because delayed treatment is associated with a greater incidence of avascular necrosis of the femoral head and early onset of osteoarthritis. This report describes a case of acetabular labral entrapment following reduction of traumatic hip dislocation in a child. The importance of CT and MRI in arriving at an early diagnosis is emphasized. (orig.)

  10. Mechanics of Hydraulic Fractures

    Detournay, Emmanuel

    2016-01-01

    Hydraulic fractures represent a particular class of tensile fractures that propagate in solid media under pre-existing compressive stresses as a result of internal pressurization by an injected viscous fluid. The main application of engineered hydraulic fractures is the stimulation of oil and gas wells to increase production. Several physical processes affect the propagation of these fractures, including the flow of viscous fluid, creation of solid surfaces, and leak-off of fracturing fluid. The interplay and the competition between these processes lead to multiple length scales and timescales in the system, which reveal the shifting influence of the far-field stress, viscous dissipation, fracture energy, and leak-off as the fracture propagates.

  11. Internal fixation for intra-articular distal radius fracture (AO type C3) using condylar stabilizing technique

    Authors' fixation procedure involving their unique technique for the fracture in the title is precisely presented. In the technique, subchondral support of fragments of ventral palmar lunate bone and anatomical reintegration are thought to be important. The fixation for the AO type C3 fracture is conducted with Acu-Loc Distal Radius Plate System (Kobayashi Medical Co.) by condylar stabilizing technique for 20 patients (M 9/F 11, 60.8 years old in average). Fractures involve the comminuted Colles and Smith types of 18 and 2 cases, respectively (C3-1/7 case, C3-2/12, C3-3/1). Before and 2 weeks after surgery, multi-slice CT is performed to construct images of multiplanar inclination to calculate the radial inclination (RI) and ulnar variance (UV) from frontal images, and the palmar tilt (PT), and gap/step-off of articular surface from sagittal images with Synapse (FUJI FILM Medical Co., Ltd). Average angles or distances at the injury/after operation are respectively; RI, 16.7/22.6 degrees; PT (Colles type), -14.6/5.8 degrees; or UV; 4.3/1.0 mm; gap, 2.3/1.2 mm; step-off, 1.3/0.5 mm; which are all statistically significant improvement. Thus the procedure is thought useful for reintegrating fixation of highly depressed intra-articular fracture surface. (K.I.)

  12. Percutaneous screw fixation of a vertebral pedicle fracture under CT-guidance: A new technique

    We report on a new minimally invasive technique for the vertebral pedicle fracture after placement of a prosthetic disc. This intervention is an adaptation of CT-guided sacroiliac and acetabular fracture screw fixation. This type of procedure enables the perfect placement and measurement of the screw, as well as an extremely small incision under local anesthesia. CT guided Transpedicular fixation could be a useful strategy in the treatment of future cases involving poorly healing pedicle fractures causing persistent symptoms. This intervention confirms the range of capacities of CT scan-controlled interventions in terms of precision, safety, speed, minimal invasiveness, rapid return to everyday activity and consequently, economical management.

  13. Acetabular anteversion is associated with gluteal tendinopathy at MRI

    Moulton, Kyle M. [University of Saskatchewan, Department of Medical Imaging, Saskatoon, SK (Canada); Royal University Hospital, Department of Medical Imaging, Saskatoon, SK (Canada); Aly, Abdel-Rahman [University of Saskatchewan, Department of Physical Medicine and Rehabilitation, Saskatoon, SK (Canada); Rajasekaran, Sathish [Health Pointe - Pain, Spine and Sport Medicine, Edmonton, AB (Canada); Shepel, Michael; Obaid, Haron [University of Saskatchewan, Department of Medical Imaging, Saskatoon, SK (Canada)

    2015-01-15

    Gluteal tendinopathy and greater trochanteric pain syndrome (GTPS) remain incompletely understood despite their pervasiveness in clinical practice. To date, no study has analyzed the morphometric characteristics of the hip on magnetic resonance imaging (MRI) that may predispose to gluteal tendinopathy. This study aimed to evaluate whether acetabular anteversion (AA), femoral neck anteversion (FNA), and femoral neck-shaft angle (FNSA) are associated with MRI features of gluteal tendinopathy. A total of 203 MRI examinations of the hip met our inclusion and exclusion criteria. A single blinded investigator measured AA, FNA, and FNSA according to validated MRI techniques. Two blinded subspecialty-trained musculoskeletal radiologists then independently evaluated the presence of gluteal tendinosis, trochanteric bursitis, and subgluteal bursitis. Statistical analysis was performed using a one-way analysis of variance (ANOVA; post-hoc Tukey's range test). At MRI, 57 patients had gluteal tendinosis with or without bursitis, 26 had isolated trochanteric bursitis, and 11 had isolated subgluteal bursitis. AA was significantly (p = 0.01) increased in patients with MRI evidence of gluteal tendinosis with or without bursitis [mean: 18.4 , 95 % confidence interval (CI): 17.2 -19.6 ] compared with normal controls (mean: 15.7 , 95 % CI: 14.7 -16.8 ). Similarly, AA was significantly (p = 0.04) increased in patients with isolated trochanteric bursitis (mean: 18.8 , 95 % CI: 16.2 -21.6 ). No association was found between FNA or FNSA and the presence of gluteal tendinopathy. Interobserver agreement for the presence and categorization of gluteal tendinopathy was very good (kappa = 0.859, 95 % CI: 0.815-0.903). Our MRI study suggests that there is an association between increased AA and gluteal tendinopathy, which supports a growing body of evidence implicating abnormal biomechanics in the development of this condition. (orig.)

  14. Stress fractures in athletes.

    Hulkko, A; Orava, S

    1987-06-01

    During the 14-year period of 1971-1985, 368 stress fractures in 324 athletes were treated. The series contained 268 fractures in males and 100 fractures in females; 32 fractures occurred in children (less than 16 years), 117 in adolescents (16-19 years), and 219 in adults. Forty-six fractures were incurred by athletes at an international level, 274 by athletes at a national or district level and 48 by recreational athletes. Of the total cases, 72% occurred to runners and a further 12% to athletes in other sports after running exercises. The distribution of the stress fractures by site was: tibia 182, metatarsal bones 73, fibula 44, big toe sesamoid bones 15, femoral shaft 14, femoral neck 9, tarsal navicular 9, pelvis 7, olecranon 5 and other bones 10. Of the total fractures, 342 were treated conservatively and 26 fractures required surgical treatment. The operative indication was dislocation in 5 cases and delayed union/nonunion in 21 cases. The sites most often affected by delayed union were: anterior midtibia, sesamoid bones of the big toe, base of the fifth metatarsal, olecranon, and tarsal navicular. The athletes at an international level experienced the greatest risk of multiple separate fractures, protracted healing, or fractures requiring surgery. PMID:3623785

  15. Heterotopic Ossification around the Knee after Internal Fixation of a Complex Tibial Plateau Fracture Combined with the Use of Demineralized Bone Matrix (DBM: A Case Report

    1.\tSjoerd P.F.T. Nota

    2014-10-01

    Full Text Available Demineralized bone matrix has been successfully commercialized as an alternative bone graft material that not only can function as filler but also as an osteoinductive graft. Numerous studies have confirmed its beneficial use in clinical practice. Heterotopic ossification after internal fixation combined with the use of demineralized bone matrix has not been widely reported. In this paper we describe a 39 year old male who sustained a complex articular fracture that developed clinically significant heterotopic ossification after internal fixation with added demineralized bone matrix. Although we cannot be sure that there is a cause-and-effect relation between demineralized bone matrix and the excessive heterotopic ossification seen in our patient, it seems that some caution in using demineralised bone matrix in similar cases is warranted. Also, given the known inter- and intraproduct variability, the risks and benefits of these products should be carefully weighed.

  16. Determinación del desgaste del componente acetabular en prótesis totales de cadera. // Wear determination of acetabular component in total hip prosthesis.

    G. García del Pino

    2002-01-01

    Full Text Available En este trabajo se realiza un estudio a través del Método de los Elementos Finitos “MEF” sobre el desgaste del componenteacetabular durante el ciclo de marcha y considerando algunos casos extremos de cargas como subir y bajar escaleras,levantarse de una silla, etc. Utilizando el MEF fueron modelados independientemente los componentes acetabular yfemoral de la prótesis total de cadera y puestos en contacto posteriormente. Fueron estudiadas varias posiciones delacetábulo así como diferentes casos de carga simulando pacientes con diferente peso corporal y actividades físicas. Paraevaluar los resultados se crearon rutinas en lenguaje C que organizaron los mismos para un tratamiento estadísticoposterior.Palabras claves: biomecánica, ortopedia, elementos finitos, modelación, desgaste, prótesis de cadera.___________________________________________________________________________Abstract.A wear study of acetabular component during the marching cycle, considering some extreme loads cases as: ascend anddescend stairways, get up from a seat, etc , by means of Finite Elements Method ( FEM , is carried out. The acetabular andfemoral component of the total hip prosthesis were independently modeled and placed in contact lastly. Several acetabulpositions were studied as well as different load cases, simulating patients with different body weight and different physicalactivities. To evaluate the results routines in C language were created in order to organized the same ones for a laterstatistical treatment.Key words. biomechanics, ortophedy, finite elements, modelation, wear, hip bone prosthesis.

  17. 3.0 T conventional hip MR and hip MR arthrography for the acetabular labral tears confirmed by arthroscopy

    Tian, Chun-Yan [Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191 (China); Wang, Jian-Quan [Department of Sports Medicine, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191,PR China (China); Zheng, Zhuo-Zhao, E-mail: zzhuozhao@aliyun.com [Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191 (China); Ren, A.-Hong [Department of Radiology, Beijing Daxing Hospital, 26 West Huangcun Road, Daxing District, Beijing 102600 (China)

    2014-10-15

    Highlights: • MR is the preferred imaging modality for diagnosing acetabular labral tears. • The diagnostic performance of MR arthrography are superior than conventional hip MR. • The hip MR arthrography is recommended for diagnosing acetabular labral lesions. - Abstract: Objective: To evaluate the value of hip MR for diagnosing acetabular labrum tears, and to further compare the diagnostic performances of conventional MR with MR arthrography in acetabular labrum tears. Methods: 90 patients undergoing both hip MR examination and subsequent hip arthroscopy were retrospectively evaluated. Of these patients, 34 accepted both conventional MR and MR arthrography; while the other 56 only underwent conventional MR examination. All hip MR images were independently reviewed by two radiologists, and further compared with the results of hip arthroscopy. Results: 59 of 90 patients were confirmed with acetabular labral tears by hip arthroscopy and 31 without tears. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of conventional MR for evaluating the acetabular labral tears were 61.0%, 77.4%, 83.7% and 51.1% (radiologist A), and 66.1%, 74.2%, 82.9% and 53.4% (radiologist B), respectively, with good consistency between the two observers (K = 0.645). The sensitivity, specificity, PPV and NPV of MR arthrography for assessing the acetabular labral tears were 90.5%, 84.6%, 90.5% and 84.6% (radiologist A), and 95.2%, 84.6%, 90.9% and 91.7% (radiologist B), respectively, with excellent good consistency between the two observers (K = 0.810). The sensitivity and NPV of MR arthrography for diagnosing the acetabular labral tears were significantly higher than those of conventional MR (both P < 0.05). Conclusion: Hip MR arthrography is a reliable evaluation modality for diagnosing the acetabular labral tears, and its diagnostic performance is superior to that of conventional MR at 3.0 T.

  18. Percutaneous screw placement in acetabular posterior column surgery: gender differences in implant positioning.

    Dienstknecht, Thomas; Müller, Michael; Sellei, Richard; Nerlich, Michael; Pfeifer, Christian; Krutsch, Werner; Fuechtmeier, Bernd; Berner, Arne

    2014-04-01

    Percutaneous reduction and periarticular screw implantation techniques have been successfully introduced in acetabular surgery. Image guided navigation techniques might be beneficial in increasing accuracy. However, a thorough understanding of standard values is needed to oversee pitfalls. This cadaver study was designed to identify reliable angulation values for screw implantation in the posterior acetabular column and to provide knowledge of the bony thickness for the periarticular corridor. Gender differences were specifically addressed. 27 embalmed cadaveric hemipelvic specimens (13 male, 14 female) were used. After soft-tissue removal posterior column acetabular screw placement was conducted by one experienced orthopaedic trauma surgeon under visibility. Radiographic verification of ideal screw placement was followed by radiographic assessment in three standard views and angulation values were assessed. Through bony dissection the maximal periarticular canal width was assessed. Various angulation values with regard to anatomical landmarks could be determined in the anteroposterior radiograph, as well as in the iliac oblique and the obturator oblique view. Gender differences were significant for all reference points with the pubic rami involved. The minimal canal width was 1.1cm in female and 1.6 cm in male specimen. The findings provide standard values for safe passages in percutaneous posterior column acetabular surgery. Gender differences have to be taken in consideration when planning the drill corridor. By adherence to standard values, screw placement can be performed safely. PMID:24182644

  19. An unusual mode of failure of a tripolar constrained acetabular liner: a case report.

    Banks, Louisa N

    2012-02-01

    Dislocation after primary total hip arthroplasty (THA) is the most commonly encountered complication and is unpleasant for both the patient and the surgeon. Constrained acetabular components can be used to treat or prevent instability after primary total hip arthroplasty. We present the case of a 42-year-old female with a BMI of 41. At 18 months post-primary THA the patient underwent further revision hip surgery after numerous (more than 20) dislocations. She had a tripolar Trident acetabular cup (Stryker-Howmedica-Osteonics, Rutherford, New Jersey) inserted. Shortly afterwards the unusual mode of failure of the constrained acetabular liner was noted from radiographs in that the inner liner had dissociated from the outer. The reinforcing ring remained intact and in place. We believe that the patient\\'s weight, combined with poor abductor musculature caused excessive demand on the device leading to failure at this interface when the patient flexed forward. Constrained acetabular components are useful implants to treat instability but have been shown to have up to 42% long-term failure rates with problems such as dissociated inserts, dissociated constraining rings and dissociated femoral rings being sited. Sometimes they may be the only option left in difficult cases such as illustrated here, but still unfortunately have the capacity to fail in unusual ways.

  20. Relationship between developmental dislocation of the hip in infant and acetabular dysplasia at skeletal maturity.

    Okano, Kunihiko; Yamaguchi, Kazumasa; Ninomiya, Yoshikazu; Matsubayashi, Shohei; Aoyagi, Kiyoshi; Osaki, Makoto; Enomoto, Hiroshi; Takahashi, Katsuro

    2015-01-01

    Previous reports demonstrated 8-60% patients treated for developmental dislocation of hip (DDH) in infancy have residual acetabular dysplasia (AD) at skeletal maturity. AD patients reportedly exhibit abnormal morphology of the pelvis, high rates of comorbid spinal congenital anomalies and high bone mineral density. These physical findings suggest that AD patients have genetic background. We examined the percentage of AD patients with hip pain at skeletal maturity having a history of DDH in infancy and the correlation between the severity of AD at skeletal maturity and history of DDH treatment to investigate the relationship between AD and DDH.A total of 245 patients were radiographically examined for any history of DDH treatment in infancy. The study included 226 women and 19 men with a mean age at examination of 40.7 years (range 17-59 years).Eighty-eight patients (36%) had a history of DDH treatment (DDH group) and the remaining 157 patients (64%) had no history of DDH treatment (non-DDH group). The average age was lower and acetabular angle was larger in the DDH group. There was a significant increasing trend of the percentage of DDH patients associated with the severity of AD classified with CE, acetabular angle, and acetabular roof angle.Our data suggest that there are several AD patients without a history of DDH in Japan, and AD in patients without a history of DDH has different characteristics from AD in patients with a history of DDH. PMID:25569642

  1. Transstyloid, transscaphoid, transcapitate fracture: a variant of scaphocapitate fractures.

    Burke, Neil G

    2014-01-01

    Transstyloid, transscaphoid, transcapitate fractures are uncommon. We report the case of a 28-year-old man who sustained this fracture following direct trauma. The patient was successfully treated by open reduction internal fixation of the scaphoid and proximal capitate fragment, with a good clinical outcome at 1-year follow-up. This pattern is a new variant of scaphocapitate fracture as involves a fracture of the radial styloid as well.

  2. Thin-Walled Cross-Linked Acetabular Liners Need Not Exhibit Reduced Locking Strength.

    Murtha, Andrew S; Roy, Marcel E; Whiteside, Leo A; Tilden, David S; Schmitt, Krystal L

    2015-08-01

    Use of larger diameter femoral heads has emerged as a promising strategy to reduce the risk of dislocation after total hip arthroplasty, but thinning the walls of cross-linked ultra-high-molecular-weight polyethylene (UHMWPE) acetabular liners to accommodate these larger heads may compromise the locking mechanism of the liner. The purpose of this study was to test the mechanical integrity of the locking mechanism in cross-linked and re-melted UHMWPE acetabular components with reduced wall thickness. The locking mechanism of cross-linked (100 kGy/re-melted) acetabular liners in sizes 50/28, 50/36, and 52/36 mm of 1 design was evaluated by lever-out tests and torsion tests. Torsion tests were performed at 2 angles to isolate the liner's locking tabs independent of the contribution of its central post. Lever-out testing demonstrated nominally reduced failure strength in 50/36-mm liners (13.3 N · m) compared with 50/28-mm liners (12.3 N · m; P=.0502), whereas the lever-out strength of 52/36-mm liners was 12.2±0.94 N · m. Failure torques were similar between 50/28- and 50/36-mm liners at 45° and 90°, but the failure torque of size 52/36-mm liners was significantly higher at each angle. The use of larger diameter femoral heads does not compromise the locking mechanism of thinned MicroSeal (Signal Medical Corp, Marysville, Michigan) acetabular liners. Use of a cross-linked UHMWPE acetabular liner, with a locking mechanism that is not compromised when the liner is thinned to a thickness of at least 2.86 mm, appears to be a biomechanically sound construct when articulated with large diameter femoral heads. PMID:26270761

  3. Biological internal fixation of the fracture and performance analysis of the internal fixation materials%骨折的生物学内固定及内固定材料性能分析

    成翔宇; 纪斌; 庞金辉

    2012-01-01

    BACKGROUND: In recent years, the focus of internal fixation for the fracture has developed from rigidity, stability and anatomic reduction to biological fixation which can preserve soft tissue blood supply, relatively stable and had anatomical axis arrangement.OBJECTIVE: To summarize the clinical characteristics of various materials for fracture fixation, and to analyze the biocompatibility after fixation device implantation.METHODS: A computer-based online retrieval of CNKI database and VIP database from January 1990 to November 2011 was conducted for articles addressing fracture internal fixation materials, by screening the key words of "fracture, internal fixation, plates, screws" in title and "loose, breakage, compatibility" in abstract. Documents related with fracture fixation treatment were involved, and those published in recent years or in authorized journals were preferred in the same field. After preliminary retrieval, 178 literatures were screened out and 24 of them were involved in the retrospective analysis according to inclusion criteria. RESULTS AND CONCLUSION: With the advanced progress on raw materials industry and biomedicine, internal fixation devices are rapidly developing. The vast majority of current orthopedic internal fixation plates and screws used in medical institutions show very good biocompatibility and stiffness. However, fixation materials in different parts and different types of fracture alter, thus resulting in different bending resistance, axial, lateral and anti-rotational stability, as well as complications and compatibility after fixation. Biological fixation for the fracture can greatly reduce the injury at soft tissue and rate of bone graft, thereby shortening fracture healing time and significantly reducing the incidence of fracture non-union, second fracture and infection.%背景:近年来,骨折内固定已经从强调坚强内固定、绝对稳定和解剖复位,转向强调保留软组织血运、相对稳定和解剖

  4. Clinical analysis of the removal of internal fixation device after the internal fixation of limb fracture healing%四肢骨折内固定术愈合后内固定装置取出临床分析

    戈光群

    2015-01-01

    Objective: To investigate the specific performance and reason of the removal difficult of internal fixation device after the internal fixation of limb fracture healing,in order to put forward specific strategies.Methods:We retrospective analyzed 20 cases of limb fixation healing after internal fixation device removal difficult patients as the observation group,and other 209 cases who were removed relatively easy were selected as the control group.Results:The device does not match was 25% ,the callus growth around the embedded screw was 25%,screw groove damage was 55%,bone cement embedding implants was 5%;the age of the control group was higher than that of the observation group,the total complication cases of the observation group was higher than that of the control group(P<0.05).Conclusion:The internal fixation device is difficult to take out after internal fixation of limb fracture healing,which is related to the fracture injury,bone cement embedding quality,physician removal preparations and other causes.%目的:探讨四肢骨折内固定术愈合后内固定装置取出困难具体表现与原因,提出针对性的解决策略。方法:20例四肢内固定术愈合后内固定装置取出困难患者作为观察组,将209例取出相对容易者作为对照组。结果:器械不匹配25.00%,周围骨痂生长包埋螺钉25.00%,螺钉凹槽损坏55.00%,骨水泥包埋内固定物5.00%;对照组年龄高于观察组,观察组并发症合计例次率高于对照组(P<0.05)。结论:四肢骨折内固定术愈合后内固定装置取出困难,与骨折伤情、骨水泥包埋质量、医师取出术准备工作等原因有关。

  5. Tantalum acetabular augments in one-stage exchange of infected total hip arthroplasty: a case-control study.

    Klatte, Till Orla; Kendoff, Daniel; Sabihi, Reza; Kamath, Atul F; Rueger, Johannes M; Gehrke, Thorsten

    2014-07-01

    During the one-stage exchange procedure for periprosthetic joint infection (PJI) after total hip arthroplasty (THA), acetabular defects challenge reconstructive options. Porous tantalum augments are an established tool for addressing acetabular destruction in aseptic cases, but their utility in septic exchange is unknown. This retrospective case-control study presents the initial results of tantalum augmentation during one-stage exchange for PJI. Primary endpoints were rates of re-infection and short-term complications associated with this technique. Study patients had no higher risk of re-infection with equivalent durability at early follow-up with a re-infection rate in both groups of 4%. In conclusion, tantalum augments are a viable option for addressing acetabular defects in one-stage exchange for septic THA. Further study is necessary to assess long-term durability when compared to traditional techniques for acetabular reconstruction. PMID:24559522

  6. Shoulder Fractures

    ... a Hand Therapist? Media Find a Hand Surgeon Shoulder Fractures Email to a friend * required fields From * ... can create difficulty with its function. Types of Shoulder Fractures The type of fracture varies by age. ...

  7. The 10-year international development trends of intertrochanteric fracture of femur%股骨转子间骨折10年国际发展趋势

    贺建军; 葛建忠

    2012-01-01

    背景:随着社会逐渐老龄化和骨质疏松人数的增加,股骨转子间骨折发生率呈逐渐上升趋势.目的:检索股骨转子间骨折的研究文献资料,利用SCI数据库文献检索和深度分析功能对其发病及其治疗趋势进行多层次探讨分析.设计:文献计量学研究.资料提取:以"股骨转子间骨折(intertrochanteric fracture of femur or intertrochanteric fracture or femoral intertrochanteric fracture);髓内钉(intramedullary nail or nail);动力髋螺钉(dynamic hip screws);股骨头置换(femoral head replacement or femoral head arthroplasty or femur head prosthesis replacement)"为关键词,检索SCI数据库2001-01/2010-12的相关文献,以文字和图表的形式进行统计和结果分析,描述其特征.入选标准:纳入标准:股骨转子间骨折相关的文献:①研究原著.②会议文章.③快报.④会议摘要.⑤综述.⑥编辑素材.⑦勘误.排除标准:校对、随笔、短讯及未发表的文章.主要数据判定指标:分析文献出版时间、国家地区分布、研究机构、文献类型、来源期刊、文献被引情况以及学科类别.结果:检索到SCI数据库2001/2010收录的584篇股骨转子间骨折相关文献,研究原著以500篇位居首位,其中有5篇可以确定为经典文献.文献数量在2001/2010呈总体上升趋势,Injury -International Journal of the Care of the Injured杂志发表文献量最多,59篇,占全部文献的10.10%.结论:以文献计量学方法研究来源于SCI数据库关于股骨转子间骨折的文献,可提供该领域的现状和趋势,可为研究者进一步确定研究热点提供有价值的量化数据参考.%BACKGROUND: With the gradual aging of the society and the number of osteoporosis increasing, the rate of intertrochantericfracture of femur is also on the rise.OBJECTIVE: To multivariately analyze the literature on the intertrochanteric fracture of femur through Science Citation Index(SCI) database and its analysis tool

  8. A novel method of removal of a broken drill bit in the femoral medullary canal during internal fixation of a type C distal femoral fracture: a case report

    Varatharaj Mounasamy; Pingal Desai; Satya Mallu; Senthil Sambandam

    2012-01-01

    Breakage of surgical instruments and implants during operative procedures is not uncommon in any surgical discipline.The need for removal and the outcome of leaving the broken instruments and implants in the surgical area have not been described in detail.Few studies have suggested removal if they are lying loosely in the tissues or joint,close to neurovascular structures.Challenges and the amount of time spent in the retrieval of broken instruments and implants are well known among surgeons,so most choose to leave them in situ.We reported a novel method of retrieval of a broken drill bit in the femoral medullary canal during internal fixation of a type C distal femoral fracture.

  9. Fracture Toughness, Mechanical Property, And Chemical Characterization Of A Critical Modification To The NASA SLS Solid Booster Internal Material System

    Pancoast, Justin; Garrett, William; Moe, Gulia

    2015-01-01

    A modified propellant-liner-insulation (PLI) bondline in the Space Launch System (SLS) solid rocket booster required characterization for flight certification. The chemical changes to the PLI bondline and the required additional processing have been correlated to mechanical responses of the materials across the bondline. Mechanical properties testing and analyses included fracture toughness, tensile, and shear tests. Chemical properties testing and analyses included Fourier transform infrared (FTIR) spectroscopy, cross-link density, high-performance liquid chromatography (HPLC), gas chromatography (GC), gel permeation chromatography (GPC), and wave dispersion X-ray fluorescence (WDXRF). The testing identified the presence of the expected new materials and found the functional bondline performance of the new PLI system was not significantly changed from the old system.

  10. SACRAL FRACTURES

    2000-01-01

    Objective. To delineate the clinical spectrum and treatment choice of sacral fractures.Methods. In this series, 39 sacral fractures were retrospectively reviewed and classified utilizing Denis′ classification. There were 21 Zone Ⅰ fractures, 6 Zone Ⅱ fractures and 12 Zone Ⅲ fractures. Neurological deficits were present in seven patients. Thirty seven patients were treated conservatively and two underwent surgical management.Results.Thirty eight patients were followed up for three months to 19 years. Thirty three have recovered, four improved, and one remained disabled.Conclusion.The treatment of sacral fractures requires assessment of pelvic stability and existing nerve injury. The patients with pelvic ring instability and neurological deficits should be treated with fracture reduction and stability reconstruction. When the patients with pelvic fracture are complicated with neurological deficits, sacral fracture should be first suspected. Once the diagnosis of sacral fracture is made, fracture reduction should be indicated. Conservative treatment usually permits satisfactory results.

  11. “钢筋混凝土”在髋臼重建中的应用★%Application of “reinforced concrete” in acetabular reconstruction

    王子富; 尚希福

    2013-01-01

    -up. RESULTS AND CONCLUSION: Al the patients were fol owed-up for 1-3 years and average in 24 months without losing. The Harris score at 3 months after operation was higher than that before operation, and the hip activity at 2 years after operation was higher than that before operation, and the difference was significant (P <0.05). Two patients stil had leg length discrepancy, one patient with dislocation after squatting, and recovered after conservative treatment. The last fol ow-up showed there were no early infection, dislocation and pelvic discomfort. Radiographic results showed that there was no aseptic loosening and displacement of the acetabular cap and there was no fracture on titanium mesh. Screw fixed titanium mesh combined with a cemented cup is satisfactory process in the treatment of hip revision in over 65 years old patients, and the long-term effects are needed to be further fol owed-up and observed.

  12. Determinación del desgaste del componente acetabular en prótesis totales de cadera. // Wear determination of acetabular component in total hip prosthesis.

    G. García del Pino; Gonçalves, E; R. Gonzáles Lima; R. Dantas Queiroz; J. L. Valín Rivera

    2002-01-01

    En este trabajo se realiza un estudio a través del Método de los Elementos Finitos “MEF” sobre el desgaste del componenteacetabular durante el ciclo de marcha y considerando algunos casos extremos de cargas como subir y bajar escaleras,levantarse de una silla, etc. Utilizando el MEF fueron modelados independientemente los componentes acetabular yfemoral de la prótesis total de cadera y puestos en contacto posteriormente. Fueron estudiadas varias posiciones delacetábulo así como diferentes cas...

  13. Femoro-acetabular impingement and hip pain with conventionally normal x-rays.

    Baker, J F

    2010-06-01

    There has in recent years been a fundamental change in the understanding of hip pain in the young adult and hip pain without plain radiographic findings of arthritis. Pain in these groups has long represented a diagnostic and therapeutic challenge. With new appreciation of hip biomechanics, pathological processes and the arrival of modern imaging modalities we now have a greater understanding of non-arthritic hip pathology. One of the commonest yet least well recognized \\'new\\' diagnoses around the hip is femoro-acetabular impingement (FAI). FAI is a developmental condition of the hip joint that is associated with abnormal anatomical configuration and thus joint mechanics on either the femoral or acetabular sides or both. It is hypothesized to have a variety of precipitants and may ultimately lead to labral and chondral injury and what has previously been referred to as \\'primary\\' or \\'idiopathic\\' hip osteoarthritis.

  14. Progressive Fracture of Composite Structures

    Chamis, Christos C.; Minnetyan, Levon

    2008-01-01

    A new approach is described for evaluating fracture in composite structures. This approach is independent of classical fracture mechanics parameters like fracture toughness. It relies on computational simulation and is programmed in a stand-alone integrated computer code. It is multiscale, multifunctional because it includes composite mechanics for the composite behavior and finite element analysis for predicting the structural response. It contains seven modules; layered composite mechanics (micro, macro, laminate), finite element, updating scheme, local fracture, global fracture, stress based failure modes, and fracture progression. The computer code is called CODSTRAN (Composite Durability Structural ANalysis). It is used in the present paper to evaluate the global fracture of four composite shell problems and one composite built-up structure. Results show that the composite shells and the built-up composite structure global fracture are enhanced when internal pressure is combined with shear loads.

  15. Apparent capitellar fractures.

    Ring, David

    2007-11-01

    Isolated capitellar fractures are rare but are identified as such, even when they are more complex, because the displaced capitellar fracture is usually the most obvious and identifiable radiographic finding and because teaching has traditionally underemphasized the involvement of the trochlea in such fractures. The author prefers the term 'apparent capitellar fractures' and draws on his experience to explain why he favors three-dimensional CT for depicting fracture detail. This article discusses treatment options, emphasizing open reduction and internal fixation to restore the native elbow. Operative techniques, including extensile lateral exposure and olecranon osteotomy; fixation techniques; and elbow arthroplasty, are described. Complications, such as ulnar neuropathy and infection, are also covered. PMID:18054674

  16. Open reduction and internal fixation of extracapsular mandibular condyle fractures: a long-term clinical and radiological follow-up of 25 patients

    Spinzia, Alessia; Patrone, Renato; Belli, Evaristo; Dell'Aversana Orabona, Giovanni; Ungari, Claudio; Filiaci, Fabio; Agrillo, Alessandro; De Riu, Giacomo; Meloni, Silvio Mario; Liberatore, Gianmauro; Piombino, Pasquale

    2014-01-01

    Background: During the last 2 decades, many studies on the treatment of mandibular condyle fracture have been published. The incidence of mandibular condyle fractures is variable, ranging from 17.5% to 52% of all mandibular fractures. This retrospective study evaluated the long-term clinical and radiological outcomes after surgical treatment of 25 patients with a total of 26 extracapsular condyle fractures. Methods: We used 2 types of surgical approaches, the retromandibular retroparotid o...

  17. The preliminary application of magnetic resonance arthrography in the diagnosis of acetabular labrale tears

    Objective: To investigate the application value of MR arthrography (MRA) in the diagnosis of acetabular lab ral tears. Methods: Fifteen patients with a high degree of suspected acetabular lab ral tears received fluoroscope-guided injection of the contrast media into the hip joint (hip arthrography) and fat-saturated spin-echo T1-weighted images were obtained in the coronal, sagittal, oblique-axial and radial planes. Hip arthroscopy was performed on 12 of them. Results: Lab ral tears which were diagnosed in 11 patients by hip MRA were confirmed at hip arthroscopy. One patient showed no MRA indication of lab ral tear, also showed normal on arthroscopy. Tear in the anterior-superior quadrant 10 cases of 12 joints (12/13), posterior-superior quadrant 1 case of a joint (1/13). In 11 patients who underwent arthroscopy, hip MRA diagnosed 3 (3/13) joints labrale tears in coronal planes, 10 (10/13) joints in sagittal planes and 13 (13/13) labrale tears in axial-oblique and radial planes. In 15 patients with 20 hip joints, 5 cases 6 joints (6/20) with normal acetabular sublabral sulcus were performed. Conclusions: MR arthrography of hip is a reliable method in the diagnosis of acetabular labrale tears. Scanning method should be included fat-saturated spin-echo T1-weighted images in sagittal and oblique-axial planes or sagittal plus radial planes. The diagnosis of torn posterior-inferior quadrant should pay attention to the existence of a normal variation. (authors)

  18. The role of experience level in radiographic evaluation of femoroacetabular impingement and acetabular dysplasia

    Schottel, Patrick C.; Park, Caroline; Chang, Anthony; Knutson, Zakary; Ranawat, Anil S.

    2014-01-01

    Accurate radiographic interpretation is essential for properly diagnosing the etiology of pre-arthritic hip pain such as femoroacetabular impingement (FAI) and acetabular dysplasia (AD); however, radiographic interpretation can be significantly influenced by the observer’s experience level. This study assesses the accuracy and inter- and intraobserver reliability in the radiographic evaluation of FAI and AD based on experience level. Fifty-five patients diagnosed with FAI, AD or normal hip mo...

  19. The Effect of an Acetabular Labral Tear, Repair, Resection, and Reconstruction on the Hip Fluid Seal

    Nepple, Jeffrey J.; Campbell, Kevin J.; Wijdicks, Coen A.; Jansson, Kyle; Dornan, Grant; LaPrade, Robert F.; Philippon, Marc J.

    2014-01-01

    Objectives: The acetabular labrum is theorized to have an important role in the normal function of the hip through the hip fluid seal. The hip fluid seal functions to create intra-articular fluid pressurization and stability to distractive forces. Yet, the effect of a labral tear or partial labral resection, and interventions including labral repair and labral reconstruction, on the hip fluid seal remain to be defined. The purpose of the current study was to characterize the hip fluid seal, i...

  20. The effect of femoro-acetabular impingement on the kinematics and kinetics of the hip joint

    Alshameeri, Zeiad; Khanduja, Vikas

    2014-01-01

    Gait analysis is an objective tool that has been used to assess and monitor treatment for many musculoskeletal conditions. Recently, it has been used to assess the impact of femoro-acetabular impingement (FAI) on the hip and lower limb movements. There have been a fairly limited number of studies published so far reporting unexpected and inconsistent results, which calls for more research to be conducted in this arena. In the light of the limited data available, it has been challenging to rec...

  1. Rapid Hip Osteoarthritis Development in a Patient with Anterior Acetabular Cyst with Sagittal Alignment Change

    Yasuhiro Homma

    2014-01-01

    Full Text Available Rapidly destructive coxarthrosis (RDC is rare and develops unusual clinical course. Recent studies suggest multiple possible mechanisms of the development of RDC. However the exact mechanism of RDC is still not clear. The difficulty of the study on RDC is attributed to its rareness and the fact that the data before the onset of RDC is normally unavailable. In this report, we presented the patient having the radiographic data before the onset who had rapid osteoarthritis (OA development after contralateral THA, which meets the current criteria of RDC. We thought that the increased posterior tilt of the pelvis after THA reinforced the stress concentration at pre-existed anterior acetabular cyst, thereby the destruction of the cyst was occurred. As a result the rapid OA was developed. We think that there is the case of rapid osteoarthritis developing due to alternating load concentration by posterior pelvic tilt on preexisting anterior acetabular cyst such as our patient among the cases diagnosed as RDC without any identifiable etiology. The recognition of sagittal alignment changes and anterior acetabular cyst may play important role in prediction and prevention of the rapid hip osteoarthritis development similar to RDC.

  2. Iliac redirectional osteotomy of the acetabular without use of bony implant

    The objective is to value the results of an original redirectional acetabular osteotomy, devised by its senior author. We describe 20 patients with hip developmental dysplasia (14 females and 6 males). The surgical approach is similar to the original description for Salter's osteotomy. The ilium cut buy a gigli saw, is performed in a curved fashion along the bone's coronal plane starting in the greater sciatic notch directed toward the anterior inferior iliac spine. The acetabolum is displaced anterior, lateral and caudally and the osteotomy is fixed with k-wires or screws, according to bone volume and quality, without graft interposition. The patient is immobilized in a spica cast for four to six weeks. Solid bone union was documented in all patients at the six-week follow up. The mean acetabular index correction obtained was measured at six weeks (16 degrades) and at six months (13 degrades). Initial femoral epiphysis extrusion was 25% and there was none at the six-month follow up. At two year later developmental displasia was not documented. This iliac redirectional osteotomy appears as a safe procedure, providing stability and contact for bone union and assures an adequate correction of the pre operative acetabular index and femoral head extrusion. Besides, this technique avoids the risk of graft collapse as in the original Salter's osteotomy

  3. Mini-plate internal fixation for the treatment of metacarpal and phalangeal fractures:Biomechanical evaluation%微型钢板内固定掌指骨骨折的生物力学评价

    石海林; 罗轶

    2013-01-01

    BACKGROUND:Metacarpal and phalangeal fractures is one of the common fracture, and usual y treated with internal fixation in clinic. OBJECTIVE:To evaluate the biomechanical performance as wel as the corresponding clinical effect of different internal fixation implants for the treatment of metacarpal and phalangeal fractures. METHODS:The changes of biomechanical performance, such as the axial compressive strain, the axial displacement and bending strain of mini-plate internal fixation, screw internal fixation, Kirschner wire internal fixation and wire internal fixation in the treatment of metacarpal and phalangeal fractures were measured to determine the ideal internal fixator for the treatment of metacarpal and phalangeal fractures, and to identify the clinical effect. RESUTLS AND CONCLUSION:Biomechanical test showed that under the same physiological loads, the mini-plate internal fixation showed the lowest axial compressive strain, axial displacement and bending strain, fol owed by Kirschner wire internal fixation, while the wire internal fixation showed the highest axial compressive strain, axial displacement and bending strain. The test results indicate that mini-plate internal fixation is the preferred internal fixation implant for the treatment of metacarpal and phalangeal fractures. The clinical results suggest that the excel ent and good rate of mini-plate internal fixation for the treatment of metacarpal and phalangeal fractures can reach 87%, and the mini-plate internal fixation can achieve the good fixation effect without complications of loosening of implants, fracture and loss of reduction.%  背景:掌指骨骨折是常见的骨折之一,临床多应用内固定物置入治疗。  目的:评价不同内固定物置入固定掌指骨骨折的生物力学性能以及相应的临床应用效果。  方法:通过测定掌指骨骨折微型钢板内固定、螺钉内固定、克氏针内固定以及钢丝内固定的轴向压缩应变

  4. 全髋关节置换术治疗成人髋臼发育不良继发骨性关节炎疗效分析%Analysis Curative Effect of Total Hip Arthroplasty in Treatment of Adult Acetabular Dysplasia With Bad Osteoarthritis Secondary

    时梦猇

    2015-01-01

    Objective To observe curative effect of total hip arthroplasty in treatment of adult acetabular dysplasia with bad osteoarthritis secondary. Methods Retrospective analyzed the clinical data of total hip arthroplasty of adult acetabular dysplasia with bad osteoarthritis secondary. Results The symptoms of pain disappeared, and the body was short and the case was correct. The acetabular angle was located at 35 to 40 angle, and the CE angle of the prosthesis was more than 20 angle. No prosthesis loosening, fracture of acetabulum, handle, neurovascular injury and so on. The excellent and good rate of postoperative Harris hip score was 94.6%. Conclusion The effect of total hip arthroplasty on adult acetabular dysplasia with bad osteoarthritis secondary os obvious.%目的 观察全髋关节置换术治疗成人髋臼发育不良继发骨性关节炎疗效.方法 回顾性分析在我院接受全髋关节置换术治疗的成人髋臼发育不良继发骨性关节炎患者临床资料.结果 疼痛症状基本消失,肢体短缩情况矫正良好.髋臼角位于35°~40°,假体CE角>20°,无假体臼、柄松动、骨折、神经血管损伤等发生.患者术后Harris髋关节功能评分优良率94.6%.结论 全髋关节置换术治疗成人髋臼发育不良继发骨性关节炎疗效明显.

  5. Internal fixation of femoral neck fractures in the elderly%老年股骨颈骨折的内固定治疗

    危杰; 吴晓亮; 王满宜

    2009-01-01

    目的 探讨内固定治疗老年股骨颈骨折的疗效. 方法回顾研究2000年1月至2007年12月采用内固定治疗且获得随访的139例老年股骨颈骨折患者资料,其中男52例,女87例;年龄65~93岁,平均71.6岁;受伤至入院时间为1 h~30 d,平均56.7 h.骨折按Garden分型:Ⅰ型17例,Ⅱ型43例,Ⅲ型62例,Ⅳ型17例.移位骨折79例,非移位骨折60例.内固定材料:空心钉131例,动力髋螺钉5例,动力髋螺钉加空心钉3例.对患者住院时间、骨折愈合率、术后并发症、股骨头缺血坏死率、内固定失效率及患者功能恢复情况进行总结分析. 结果 139例患者住院时间为5~59 d,平均15.4 d.术后获7~77个月(平均35个月)随访.骨折愈合126例,占90.6%(126/139);愈合时间2~12个月,平均6.2个月.其中22例患者术后出现并发症.骨折不愈合内固定失效13例,占9.4%(13/139);股骨头缺血性坏死9例,占6.5%(9/139).正常行走者81例,占58.3%(81/139),需要助行器械者50例,占36.0%(50/139),不能行走者8例,占5.7%(8/139).结论 老年股骨颈骨折内固定治疗骨折愈合率高,股骨头缺血坏死率较低,内固定治疗老年股骨颈骨折具有积极意义.术前病情评估和合并症的积极治疗非常重要,条件允许时应尽早手术.%Objective To evaluate the outcome of the old patients who were treated for femoral neck fractures in our hospital during 2000-2007. Methods A retrospective study was conducted to evaluate outcomes of the 139 old patients who had received internal fixation for femoral neck fractures in our department during 2000-2007. The mechanism of injury, duration between injury and hospitalization, severity of fracture, anamnesis, time of hospital stay, anaesthesia, operation, postoperative complications, fracture healing, in-cidence of avascular necrosis of femoral head, failure of fixation, and functional restoration of the patients were documented. Results Fracture healing was found in 126 cases (90

  6. Assessment of the influence of Laser phototherapy on the bone repair process of complete fractures in tibiae of rabbits stabilized with semi-rigid internal fixation treated with or without MTA graft: a histological study

    Soares, Luiz G. P.; Silva, Aline C. P.; Silva, Anna Paula L. T.; Neves, Bruno Luiz R. C.; Santos, Nicole R. S.; dos Santos, Jean N.; Pinheiro, Antonio L. B.

    2016-03-01

    Beside biomaterials, Laser phototherapy has shown positive effects as auxiliary therapy in bone repair process, especially when involving large bone losses. The aim of this histological study was to evaluate, by light microscopy, the influence of laser phototherapy on the repair of complete tibial fractures in rabbits treated or not with semi-rigid internal fixation and Mineral Trioxide Aggregate - MTA graft. Twelve Rabbits were randomly divided into four groups with three animals each. After general anesthesia, complete fractures were created in one tibia with a carborundum disk. All animals (groups I-IV) had the fracture stabilized with semi-rigid fixation (wire osteosynthesis - WO). Group I was routinely fixed with WO; groups II and IV fracture was filled by blood clot and MTA implant. In Groups III and IV fracture was filled by blood clot and further irradiated with laser (λ780 nm, 70 mW, CW, Φ = 0.04 cm2, 20.4 J/cm2, per session, t = 300s, 142.8 J/cm2 per treatment). The phototherapy protocol was applied immediately after the surgery and repeated each 48 hours during 15 days. Animal death occurred on the 30th postoperative day. After removal of the specimens, the samples were routinely processed, stained with HE and evaluated by light microscopy. Histologically, the group treated with MTA graft and irradiated with laser showed the fracture filled by a more organized and mature trabecular bone, when compared with all other groups. From the results of the present study, it may be concluded that the association of Laser phototherapy + MTA graft in fractures treated with WO improved bone repair when compared with fractures treated only with WO.

  7. Bipolar hip arthroplasty as salvage treatment for loosening of the acetabular cup with significant bone defects

    Ghanem, Mohamed; Glase, Almuth; Zajonz, Dirk; Roth, Andreas; Heyde, Christoph-E.; Josten, Christoph; von Salis-Soglio, Georg

    2016-01-01

    Introduction: Revision arthroplasty of the hip is becoming increasingly important in recent years. Early primary arthroplasty and longer life expectancy of the patients increases the number of revision surgery. Revision surgery of hip arthroplasty is major surgery for the patients, especially the elderly, with significant risks concerning the general condition of the patient. The aim of this work is to evaluate the outcome of bipolar hip arthroplasty as a salvage procedure for treatment of loosening of the acetabular cup with significant acetabular bone defects after total hip replacement (THR) in multi-morbid patients. Patients and methods: During the period from January 1st 2007 to December 31st 2011 19 revision hip surgeries were performed in 19 patients, in which the loosened acetabular cup was replaced by a bipolar head. The examined patient group consisted exclusively of female patients with an average of 75 years. The predominant diagnosis was “aseptic loosening” (84.2%). All patients in our study were multi-morbid. We decided to resort to bipolar hip arthroplasty due to the compromised general condition of patients and the major acetabular bone defects, which were confirmed intraoperatively. The postoperative follow-up ranged from 0.5 to 67 months (average 19.1 months). Results: Evaluation of the modified Harris Hip Score showed an overall improvement of the function of the hip joint after surgery of approximately 45%. Surgery was less time consuming and thus adequate for patients with significantly poor general health condition. We noticed different complications in a significant amount of patients (68.4%). The most common complication encountered was the proximal migration of the bipolar head. The rate of revision following the use of bipolar hip arthroplasty in revision surgery of the hip in our patients was high (21%). Despite the high number of complications reported in our study, we have noticed significant improvement of hip joint function as

  8. Bipolar hip arthroplasty as salvage treatment for loosening of the acetabular cup with significant bone defects

    Ghanem, Mohamed

    2016-04-01

    Full Text Available Introduction: Revision arthroplasty of the hip is becoming increasingly important in recent years. Early primary arthroplasty and longer life expectancy of the patients increases the number of revision surgery. Revision surgery of hip arthroplasty is major surgery for the patients, especially the elderly, with significant risks concerning the general condition of the patient. The aim of this work is to evaluate the outcome of bipolar hip arthroplasty as a salvage procedure for treatment of loosening of the acetabular cup with significant acetabular bone defects after total hip replacement (THR in multi-morbid patients.Patients and methods: During the period from January 1 2007 to December 31 2011 19 revision hip surgeries were performed in , in which the loosened acetabular cup was replaced by a bipolar head. The examined patient group consisted exclusively of female patients with an average of 75 years. The predominant diagnosis was “aseptic loosening” (84.2%. All patients in our study were multi-morbid. We decided to resort to bipolar hip arthroplasty due to the compromised general condition of patients and the major acetabular bone defects, which were confirmed intraoperatively. The postoperative follow-up ranged from 0.5 to 67 months (average 19.1 months. Results: Evaluation of the modified Harris Hip Score showed an overall improvement of the function of the hip joint after surgery of approximately 45%.Surgery was less time consuming and thus adequate for patients with significantly poor general health condition. We noticed different complications in a significant amount of patients (68.4%. The most common complication encountered was the proximal migration of the bipolar head.The rate of revision following the use of bipolar hip arthroplasty in revision surgery of the hip in our patients was high (21%. Despite the high number of complications reported in our study, we have noticed significant improvement of hip joint function as well

  9. Warwick Hip Trauma Study: a randomised clinical trial comparing interventions to improve outcomes in internally fixed intracapsular fractures of the proximal femur. Protocol for The WHiT Study

    Griffin Xavier

    2010-08-01

    Full Text Available Abstract Background Controversy exists regarding the optimal treatment for patients with displaced intracapsular fractures of the proximal femur. The recognised treatment alternatives are arthroplasty and internal fixation. The principal criticism of internal fixation is the high rate of non-union; up to 30% of patients will have a failure of the fixation leading to revision surgery. We believe that improved fracture healing may lead to a decreased rate of failure of fixation. We therefore propose to investigate strategies to both accelerate fracture healing and improve fixation that may significantly improve outcomes after internal fixation of intracapsular femoral fractures. We aim to test the clinical effectiveness of the osteoinductive agent platelet rich plasma and conduct a pilot study of a novel fixed-angle fixation system. Design We have planned a three arm, single centre, standard-of-care controlled, double blinded, pragmatic, randomised clinical trial. The trial will include a standard two-way comparison between platelet-rich plasma and standard-of-care fixation versus standard-of-care fixation alone. In addition there will be a subsidiary pilot arm testing a fixed-angle screw and plate fixation system. Trial Registration Current Controlled Trials ISRCTN49197425

  10. Acetabular bone density and metal ions after metal-on-metal versus metal-on-polyethylene total hip arthroplasty; short-term results

    Zijlstra, Wierd P.; van der Veen, Hugo C.; van den Akker-Scheek, Inge; Zee, Mark J. M.; Bulstra, Sjoerd K.; van Raay, Jos J. A. M.

    2014-01-01

    Information on periprosthetic acetabular bone density is lacking for metal-on-metal total hip arthroplasties. These bearings use cobalt-chromium instead of titanium acetabular components, which could lead to stress shielding and hence periprosthetic bone loss. Cobalt and chromium ions have detriment

  11. Rib Fractures

    ... 2 Diabetes, Heart Disease a Dangerous Combo Are 'Workaholics' Prone to OCD, Anxiety? ALL NEWS > Resources First ... Rib Fractures Traumatic Pneumothorax Tension Pneumothorax Rib fractures cause severe pain, particularly when a person breathes deeply. ...

  12. Root fractures

    Andreasen, Jens Ove; Christensen, Søren Steno Ahrensburg; Tsilingaridis, Georgios

    2012-01-01

    The purpose of this study was to analyze tooth loss after root fractures and to assess the influence of the type of healing and the location of the root fracture. Furthermore, the actual cause of tooth loss was analyzed.......The purpose of this study was to analyze tooth loss after root fractures and to assess the influence of the type of healing and the location of the root fracture. Furthermore, the actual cause of tooth loss was analyzed....

  13. Exposure of the superior gluteal neurovascular bundle for the safe application of acetabular reinforcement cages in complex revisions.

    Smitham, Peter J; Kosuge, Dennis; Howie, Donald W; Solomon, Lucian B

    2016-05-16

    The posterior approach to the hip is the most common extensile approach used, however exposure is limited superiorly by the superior gluteal neurovascular bundle (SGNB). The extra-pelvic course of the SGNB demonstrates variability between individuals, occasionally located only 1 cm from the acetabular rim. In complex acetabular reconstructions where the application of a reinforcement cage maybe required protecting the SGNB is challenging. The flanges of these cages are designed to sit on the ilium superior to the acetabular rim and to receive screws for fixation. The application of such cages may result in iatrogenic injury to the SGNB by way of forceful retraction or entrapment. We describe a technique that involves exposure and release of the SGNB such that the flanges of cage constructs may be safely applied. PMID:27079287

  14. Femoral anteversion is correlated with acetabular version and coverage in Asian women with anterior and global deficient subgroups of hip dysplasia: a CT study

    Akiyama, Mio; Nakashima, Yasuharu; Fujii, Masanori; Sato, Taishi; Yamamoto, Takuaki; Mawatari, Taro; Motomura, Goro; Matsuda, Shuichi; Iwamoto, Yukihide [Kyushu University, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, 3-1-1 Maidashi, Higashi-ku, Fukuoka (Japan)

    2012-11-15

    Morphological correlation between the acetabulum and femur at the hip joint is still controversial. We tested the hypothesis that femoral anteversion correlates with acetabular version and coverage in patients with developmental dysplasia of the hip (DDH). Using pelvic computed tomography (CT) images of 79 hips in 49 Asian women with DDH and 49 normal hips, we measured femoral anteversion, the axial and vertical acetabular version and the acetabular sector angle (ASA) to demarcate femoral head coverage. Depending on the location of the acetabular bone defect, dysplastic hips were divided into three subgroups: the anterior, global and posterior deficiency groups. We performed a comparative analysis between dysplastic and normal hips using the Wilcoxon rank sum test, and a relative analysis between femoral anteversion and acetabular measurements in dysplastic hips using Pearson's correlation coefficient. The amount of femoral anteversion in dysplastic hips was greater and more variable than in normal hips (p < 0.0001, p = 0.0277 respectively). Femoral anteversion in dysplastic hips correlated significantly with acetabular anteversion in the groups with anterior and global deficiency subgroups (p < 0.05, r = 0.2990, p < 0.05, r = 0.451 respectively), but not with the posterior deficiency subgroup. Femoral anteversion also correlated with vertical acetabular version. When acetabular coverage was examined, significant correlations were noted between femoral anteversion and anterior and superior coverage, but not with posterior coverage. These correlations were not observed in normal hips. Our results showed significantly greater and more variable femoral anteversion in DDH, and a significant correlation between femoral anteversion and acetabular version and coverage in DDH with anterior and global acetabular bone deficiency. (orig.)

  15. Femoral anteversion is correlated with acetabular version and coverage in Asian women with anterior and global deficient subgroups of hip dysplasia: a CT study

    Morphological correlation between the acetabulum and femur at the hip joint is still controversial. We tested the hypothesis that femoral anteversion correlates with acetabular version and coverage in patients with developmental dysplasia of the hip (DDH). Using pelvic computed tomography (CT) images of 79 hips in 49 Asian women with DDH and 49 normal hips, we measured femoral anteversion, the axial and vertical acetabular version and the acetabular sector angle (ASA) to demarcate femoral head coverage. Depending on the location of the acetabular bone defect, dysplastic hips were divided into three subgroups: the anterior, global and posterior deficiency groups. We performed a comparative analysis between dysplastic and normal hips using the Wilcoxon rank sum test, and a relative analysis between femoral anteversion and acetabular measurements in dysplastic hips using Pearson's correlation coefficient. The amount of femoral anteversion in dysplastic hips was greater and more variable than in normal hips (p < 0.0001, p = 0.0277 respectively). Femoral anteversion in dysplastic hips correlated significantly with acetabular anteversion in the groups with anterior and global deficiency subgroups (p < 0.05, r = 0.2990, p < 0.05, r = 0.451 respectively), but not with the posterior deficiency subgroup. Femoral anteversion also correlated with vertical acetabular version. When acetabular coverage was examined, significant correlations were noted between femoral anteversion and anterior and superior coverage, but not with posterior coverage. These correlations were not observed in normal hips. Our results showed significantly greater and more variable femoral anteversion in DDH, and a significant correlation between femoral anteversion and acetabular version and coverage in DDH with anterior and global acetabular bone deficiency. (orig.)

  16. Ankle Injury Management (AIM): design of a pragmatic multi-centre equivalence randomised controlled trial comparing Close Contact Casting (CCC) to Open surgical Reduction and Internal Fixation (ORIF) in the treatment of unstable ankle fractures in patients over 60 years

    Willett, K; Keene, DJ; Morgan, L.; Gray, B.; Handley, R; Chesser, T; Pallister, I; Tutton, E; Knox, C; Lall, R; A. Briggs; Lamb, SE

    2014-01-01

    BACKGROUND: Ankle fractures account for 9% of all fractures with a quarter of these occurring in adults over 60 years. The short term disability and long-term consequences of this injury can be considerable. Current opinion favours open reduction and internal fixation (ORIF) over non-operative treatment (fracture manipulation and the application of a standard moulded cast) for older people. Both techniques are associated with complications but the limited published research indicates higher c...

  17. Examination and treatment of a professional ballet dancer with a suspected acetabular labral tear: A case report.

    Khoo-Summers, Lynnette; Bloom, Nancy J

    2015-08-01

    Dancers are at risk for developing groin pain that is due to acetabular labral tears. Although surgical management of labral tears has been reported extensively, conservative management has been poorly described. This case report describes the examination, diagnosis, and treatment of groin pain in a professional ballet dancer with a suspected acetabular labral tear. Treatment focused on decreasing anterior hip joint stresses and improving the precision of hip motion through correction of alignment and movement impairments noted during functional activities and dance. Successful outcomes included a reduction in pain and return to professional ballet dancing. PMID:25725589

  18. Acetabular morphometry and prevalence of hip dysplasia in the South Asian population

    Masood Umer

    2009-07-01

    Full Text Available We carried out a cross-sectional study to measure the association of the seven acetabular parameters with pelvic morphometry and prevalence of hip dysplasia in our population. Convenience sampling was carried out and 250 consecutive patients who came to AKUH for intravenous pyelogram and had no complaints in the region of the hip joint were enrolled in the study. Post-micturition standardized plain antero-posterior pelvic radiographs of 250 asymptomatic adults (500 hip joints was studied. There were 136 males (54.4% and 114 females (45.6%. Mean age of our study population was 38 years (15-78 years. The average center edge angle was 35.5±6.6° standard deviation (SD, acetabular angle was 37.76±4.37°, depth to width ratio was 0.31±4.6°, roof obliquity was 10.6±6.2°, extrusion index was 0.1±5.8, lateral subluxation 8.9±2.7 mm, and peak to edge distance 17±3.98 mm. There was significant influence (p lower than  0.05 of age in all angles except depth to width ratio. A total of seven hip joints (1.4% were dysplastic with CE angle lower than 25° while four of the seven hips were severely dysplastic with CE angle  lower than 20°. In the dysplastic group there was significant correlation (p lower than 0.05 of CE angle with acetabular angle, depth to width ratio, extrusion index and peak to edge distance. Prevalence of hip dysplasia was found to be very low in our population. These results are consistent with the findings of studies carried out in other Asian countries.

  19. A new measurement for posterior tilt predicts reoperation in undisplaced femoral neck fractures: 113 consecutive patients treated by internal fixation and followed for 1 year

    Palm, Henrik; Gosvig, Kasper; Krasheninnikoff, Michael;

    2009-01-01

    posterior tilt was an accurate predictor of failure (p = 0.002). 14/25 of posteriorly tilted fractures > or = 20 degrees were reoperated, as compared to 12/88 of fractures with less tilt (p < 0.001). In multiple logistic regression analysis including sex, age, ASA score, cognitive function, new mobility...

  20. Fracture Union in Closed Interlocking Nail in Humeral Shaft Fractures

    Ramji Lal Sahu

    2015-01-01

    Conclusions: The results of the present study indicates that in the presence of proper indications, reamed antegrade intramedullary interlocked nailing appears to be a method of choice for internal fixation of osteoporotic and pathologic fractures.

  1. Microarchitecture and Peripheral BMD are Impaired in Postmenopausal White Women With Fracture Independently of Total Hip T-Score: An International Multicenter Study.

    Boutroy, Stephanie; Khosla, Sundeep; Sornay-Rendu, Elisabeth; Zanchetta, Maria Belen; McMahon, Donald J; Zhang, Chiyuan A; Chapurlat, Roland D; Zanchetta, Jose; Stein, Emily M; Bogado, Cesar; Majumdar, Sharmila; Burghardt, Andrew J; Shane, Elizabeth

    2016-06-01

    Because single-center studies have reported conflicting associations between microarchitecture and fracture prevalence, we included high-resolution peripheral quantitative computed tomography (HR-pQCT) data from five centers worldwide into a large multicenter analysis of postmenopausal women with and without fracture. Volumetric BMD (vBMD) and microarchitecture were assessed at the distal radius and tibia in 1379 white postmenopausal women (age 67 ± 8 years); 470 (34%) had at least one fracture including 349 with a major fragility fracture. Age, height, weight, and total hip T-score differed across centers and were employed as covariates in analyses. Women with fracture had higher BMI, were older, and had lower total hip T-score, but lumbar spine T-score was similar between groups. At the radius, total and trabecular vBMD and cortical thickness were significantly lower in fractured women in three out of five centers, and trabecular number in two centers. Similar results were found at the tibia. When data from five centers were combined, however, women with fracture had significantly lower total, trabecular, and cortical vBMD (2% to 7%), lower trabecular number (4% to 5%), and thinner cortices (5% to 6%) than women without fracture after adjustment for covariates. Results were similar at the radius and tibia. Similar results were observed with analysis restricted to major fragility fracture, vertebral and hip fractures, and peripheral fracture (at the radius). When focusing on osteopenic women, each SD decrease of total and trabecular vBMD was associated with a significantly increased risk of major fragility fracture (OR = 1.55 to 1.88, p data were pooled across centers and the sample size increased, we observed significant and consistent deficits in vBMD and microarchitecture independent of total hip T-score in all postmenopausal white women with fracture and in the subgroup of osteopenic women, compared to women who never had a fracture. © 2016 American

  2. What is the role of clinical tests and ultrasound in acetabular labral tear diagnostics?

    Troelsen, Anders; Mechlenburg, Inger; Gelineck, John;

    2009-01-01

    . PATIENTS AND METHODS: We examined 18 patients (18 hips, 2 men, median age 43 (32-56) years) with impingement test, FABER test, resisted straight leg raise test, ultrasound, and MR arthrography. They had had previous periacetabular osteotomies due to symptomatic, acetabular dysplasia. All hips showed no or...... only slight signs of osteoarthritis (Tönnis grade 0-1). RESULTS: MR arthrography identified labral tears in 17 of the 18 hips. Ultrasound had a sensitivity of 94%, a positive predictive value of 94%, and was false negative in only 1 case compared to MR arthrography. The impingement test had the best...

  3. DSA-guided percutaneous acetabuloplasty for the treatment of acetabular metastases: a clinical study

    Objective: To discuss the technical points, safety and clinical effectiveness of DSA-guided percutaneous acetabuloplasty (PA) for the treatment of acetabular metastases. Methods: Fifteen patients, including 6 males and 9 females, with acetabular malignant metastases were enrolled in this study. A total of 19 lesions were detected. The lesions were 13-25 mm in size (mean 19 ± 4 mm), the dose of PMMA used for per lesion was 5-13 ml (mean 8.2 ± 2.3 ml). All patients complained of greater or less degree of pain in their hips, 8 patients had to use walking stick, 4 patients showed limping although they could walk independently and three patients could not walk alone. DSA-guided percutaneous acetabuloplasty was performed in all patients and follow-up after the procedure was conducted for 1-12 months. Visual analogue score (VAS), walking state score and analgesic dosage taken by the patients were used for the evaluation of the clinical effectiveness. The complications were analyzed. All the data obtained were statistically analyzed with paired samples t test and analysis of variance by using SPSS12.0 statistical software. Results: The procedure was technically successful in all patients. Pain rating evaluated by the VAS decreased from a mean of 7.8 before surgery to a mean of 4.2 in 24 hours after surgery (P<0.01), which further decreased to 2.5 in one month (P<0.01), while walking state score increased from a mean of 1.5 before surgery to a mean of 2.5 in 24 hours after surgery (P<0.01). The analgesic dosage taken by the patient was reduced in 14 patients and remained the same in one patient. The bone cement leakage into para-acetabular soft tissues occurred in three cases and peripheral vascular exudation of acetabulum was observed in three cases with no obvious clinical symptoms. Conclusion: As a safe, reliable and minimally-invasive technique, DSA-guided percutaneous acetabuloplasty has excellent anti-pain effect in treating acetabular metastases. This therapy can

  4. Experimental and analytical validation of a modular acetabular prosthesis in total hip arthroplasty

    Aram Luke

    2007-05-01

    Full Text Available Abstract A finite element model has been developed to predict in vivo micro motion between a modular acetabular cup and liner after cement less total hip arthroplasty. The purpose of this study is to experimentally validate the model. Six LVDT sensors were used to monitor the micromotion of the liner when subjected to loading conditions ranging from 250 N to 5000 N. Deformations at points of interest for both the experiment and FEM were compared. Results of the FEM with different coefficient of friction between the liner and the cup were investigated to correlate with the experimental results.

  5. Migration measurement of acetabular components in cementless total hip arthroplasty; Messung der Pfannenwanderung bei zementfreien Hueftimplantaten

    Eckardt, A.; Karbowski, A.; Schwitalle, M.; Vogel, J.; Boden, F.; Seeleitner, C. [Mainz Univ. (Germany). Orthopaedische Klinik und Poliklinik; Schunk, K. [Mainz Univ. (Germany). Klinik und Poliklinik fuer Radiologie; Mayrhofer, P. [Innsbruck Univ. (Austria). Inst. fuer Mathematik und Geometrie

    1998-08-01

    Migration measurements of acetabular components using a special computer aided method (EBRA = abbrevation for the German term ``Ein-Bild-Roentgenanalyse``) were performed to evaluate early results of the implants and predict aseptic loosening. Methods: Standard ap-radiographs of the pelvis were marked, specific points were digitised. Simulating the spatial situation the programme computes lengitudinal and vertical migration of the cup. 74 acetabular components in 71 patients could be studied by migration measurements. Results: 14 patients showed migration of more than 1 mm, which is the confidence limit of this method. Each of these patients showed diverse reasons for the migration, i.e. osteoporosis of the acetabular bone stock or problems concerning the surgical technique which means malposition of the cup or insufficient reaming of the bone. There were some patients with severe congenital dysplasia of the hip and in some cases the inclination angle of the cup was too great. Conclusion: The technique applied for measuring migration of acetabular components can be useful for evaluating early instability of the implant and can be helpful in detecting problems concerning the surgical technique. (orig.) [Deutsch] Mittels der Ein-Bild-Roentgenanalyse wurden Pfannenwanderungen nach Implantation von zementfreien, sphaerischen Hueftgelenkspfannen erfasst, um Praediktoren fuer die langfristige Prognose der Implantate zu evaluieren. Methoden: Nach Markierung von Referenzpunkten in den Beckenuebersichtsaufnahmen wurden diese digitalisiert, vom Programm verrechnet und die Wanderung des Implantats im Verlauf angegeben. Bei 71 Patienten wurden von 74 Pfannen ueber einen Mindestnachuntersuchungszeitraum von 12 Monaten Migrationsmessungen durchgefuehrt. Das Konfidenzintervall der Methode liegt bei <1 mm. Bei jedem dieser Patienten fanden sich Hinweise entweder auf ein schlechtes Knochenlager, auf operationsbedingte Probleme, wenn keine ausreichende Primaerstabilitaet der Pfanne

  6. Management of subtrochanteric femur fractures with internal fixation and recombinant human bone morphogenetic protein-7 in a patient with osteopetrosis: a case report

    Golden Robert D

    2010-05-01

    Full Text Available Abstract Introduction Osteopetrosis is a group of conditions characterized by defects in the osteoclastic function of the bone resulting in defective bone resorption. Clinically, the condition is characterized by a dense, sclerotic, deformed bone which, despite an increased density observable by radiography, often results in an increased propensity to fracture and delayed union. Case Presentation We report the case of a 27-year-old Asian man presenting with bilateral subtrochanteric femur fractures. He had a displaced right subtrochanteric femur fracture after a low-energy fall, which was treated surgically. The second fracture that our patient endured was diagnosed as a stress fracture ten weeks later when he complained of pain in the contralateral left thigh. By that time, the right-sided fracture exhibited no radiographic evidence of healing, and when the left-sided stress fracture was being treated surgically, bone grafting with recombinant human bone morphogenetic protein-7 was also performed on the right side. Conclusion While there are no data supporting the use of bone morphogenic proteins in the management of delayed healing in patients with osteopetrosis, no other reliable osteoinductive grafting options are available to treat this condition. Both fractures in our patient healed, but based on the serial radiographic assessment it is uncertain to what degree the recombinant human bone morphogenetic protein-7 may have contributed to the successful outcome. It may have also contributed to the formation of heterotopic bone around the fracture site. Further investigation of the effectiveness and indications of bone morphogenic protein use for the management of delayed fracture healing in patients with osteopetrosis is warranted.

  7. Fractures in the growing foal. Part 1: Epiphyseal fractures

    This paper discusses general considerations for epiphyseal fractures and the anatomical differences which led to the Salter-Harris-classification are explained. The various locations and fracture configurations in the different bones are mentioned, and suggestions for their treatment are made. Epiphyseal fractures in growing foals have generally a favourable prognosis for healing, if treated properly. However, the prognosis for future use as an athlete has to be judged as guarded. The limb with an epiphyseal fracture should under any circumstances be splinted or cast for the transport to hospital. Epiphyseal fractures of the distal portions of the limb may be treated by cast application in some cases. More frequently, however, surgical reduction followed by some form of internal fixation is preferred. It is important to follow the basic principles of internal fixation. The implants should be removed at the earliest convenience, to prevent undue growth disturbances. Epiphyseal fractures should be treated as soon as possible to avoid further destruction of the growth plate through continuous movement at the fracture site. Growth disturbances are the most frequently encountered complications with epiphyseal fractures. Other complications include infection, osteomyelitis, degenerative joint disease and breakdown of the fracture fixation

  8. Open reduction and internal fixation versus casting for highly comminuted and intra-articular fractures of the distal radius (ORCHID: protocol for a randomized clinical multi-center trial

    Seiler Christoph

    2011-03-01

    Full Text Available Abstract Background Fractures of the distal radius represent the most common fracture in elderly patients, and often indicate the onset of symptomatic osteoporosis. A variety of treatment options is available, including closed reduction and plaster casting, K-wire-stabilization, external fixation and open reduction and internal fixation (ORIF with volar locked plating. The latter is widely promoted by clinicians and hardware manufacturers. Closed reduction and cast stabilization for six weeks is a simple, convenient, and ubiquitously available intervention. In contrast, ORIF requires hospitalization, but allows for functional rehabilitation. Given the lack of randomized controlled trials, it remains unclear whether ORIF leads to better functional outcomes one year after injury than closed reduction and casting. Methods/Design ORCHID (Open reduction and internal fixation versus casting for highly comminuted intra-articular fractures of the distal radius is a pragmatic, randomized, multi-center, clinical trial with two parallel treatment arms. It is planned to include 504 patients in 15 participating centers throughout Germany over a three-year period. Patients are allocated by a central web-based randomization tool. The primary objective is to determine differences in the Short Form 36 (SF-36 Physical Component Score (PCS between volar locked plating and closed reduction and casting of intraarticular, comminuted distal radius fractures in patients > 65 years of age one year after the fracture. Secondary outcomes include differences in other SF-36 dimensions, the EuroQol-5D questionnaire, the Disability of the Arm, Shoulder, and Hand (DASH instrument. Also, the range of motion in the affected wrist, activities of daily living, complications (including secondary ORIF and revision surgery, as well as serious adverse events will be assessed. Data obtained during the trial will be used for later health-economic evaluations. The trial architecture

  9. Computerized tomography in evaluation of decreased acetabular and femoral anteversion; Besonderheiten bei der Bestimmung der Hueftpfannenanteversion und Schenkelhalsantetorsion durch Computertomographie

    Toennis, D.; Skamel, H.J. [Institut fuer Strahlendiagnostik, Klinikum Dortmund GmbH (Germany)

    2003-09-01

    Computerized tomography has received a new importance. It has been shown that decreased anteversion of femur and acetabulum, when both have decreased angles, are causing pain and osteoarthritis of the hip joint. Operative treatment should be performed before osteoarthritis develops. Exact measurements therefore are necessary. The investigation should be performed in prone position to have the pelvis lying in a defined and normal position. Femoral torsion is measured between the transverse axis of the knee and the femoral neck. The transverse axis for measurement of the femoral anteversion is defined by a rectangular line to the sagittal plane. For evaluation of the femoral anteversion in total the angle of the condyles has to be added to the femoral neck angle when the knee is found in internal rotation. Acetabular anteversion should be measured at the level where the femoral head is still in full contact and congruence with the anterior margin of the acetabulum. (orig.) [German] Fuer die Computertomographie hat sich eine neue Aufgabe ergeben. Es hat sich gezeigt, dass verringerte Pfannenanteversion und Schenkelhalsantetorsion haeufige Ursachen von Hueftschmerz und -arthrose sind, v. a. wenn beide gegen 0 gehen. Da operative Massnahmen vor Eintreten der Arthrose ergriffen werden sollten, sind genaue Messwerte erforderlich. Die Untersuchung sollte in Bauchlage durchgefuehrt werden, um eine einheitliche und weitgehend normale Beckenkippung zu gewaehrleisten. Die Schenkelhalstorsion wird zwischen der Kniegelenk- und der Schenkelhalsachse gemessen. Zur Festlegung der Sagittalebene legt man am besten eine Mittellinie zwischen die Beckenschaufeln. Die Messung der Pfannenanteversion sollte in der Schnitthoehe erfolgen, wo die Bewegungseinschraenkung der Innenrotation auftritt. (orig.)

  10. Hip fracture - discharge

    Inter-trochanteric fracture repair - discharge; Subtrochanteric fracture repair - discharge; Femoral neck fracture repair - discharge; Trochanteric fracture repair - discharge; Hip pinning surgery - discharge

  11. Sonographic anatomy of the newborn hip and high-resolution US equipments: internal capsular stripe and perichondral gap

    The use of high-resolution US equipments in the examination of the newborn hip allowed the evaluation of a thin echogenic stripe (the internal capsule stripe), which defines laterally the acetabular hyaline cartilage. By means of an anatomo-histological preparation the echogenic stripe can be related to either the capsular circular fibres or the interface between the latter and the hyaline cartilage. The internal capsular stripe, together with the echogenic synovial stripe, precisely delimit the whole acetabular hyaline cartilage. Further-more, in many babies high-resolution US sometimes fails to demonstrate Graft's 'perichondral gap', so that an accurate anatomic knowledge of the hip becomes necessary in the evaluation of acetabular labrum

  12. Segond Fractures

    Arneja, Shalinder S.; Furey, Matthew J.; Alvarez, Christine M.; Reilly, Christopher W.

    2010-01-01

    Initially described following cadaveric studies in the late 19th century by Dr. Paul Segond, the Segond fracture is now widely accepted as a pathognemonic radiographic marker of anterior cruciate ligament injury. This fracture in a skeletally immature 16-year-old was not seen with an anterior cruciate ligament injury, but with a Salter-Harris type IV fracture of the tibial plateau. A nonweightbearing knee immobilizer with the leg in full extension was used for 6 weeks. Recovery was uncomplica...

  13. Evaluation of Medial Acetabular Wall Bone Stock in Patients with Developmental Dysplasia of the Hip Using a Helical Computed Tomography Multiplanar Reconstruction Technique

    Rui Yu Liu; Kun Zheng Wang; Chun Sheng Wang; Xiao Qian Dang; Zhi Qin Tong (Second Hospital Affiliated to the Medical College of Xi' an Jiaotong Univ., Xi' an Shaanxi (China))

    2009-08-15

    Background: The technique of medialization has been used to reconstruct acetabula at the level of true acetabula in total hip arthroplasty (THA) in patients with developmental dysplasia of the hip (DDH). Appreciation of the bone stock in the medial acetabular wall is significant for making an optimal acetabular reconstruction plan and avoiding complications. Purpose: To evaluate the bone stock of the medial acetabular wall and its relation to the degree of subluxation in patients with DDH using computed tomography (CT). Material and Methods: Helical CT scans of 27 hips were obtained from 21 patients with osteoarthritis secondary to DDH who were scheduled for total hip arthroplasty. Eleven hips belonged to Crowe class I, while 16 hips belonged to Crowe class II/III. The raw CT data were reprocessed in various planes by scrolling multiplanar reformation (MPR). Acetabular opening, depth, and medial bone stock, as indicated by the minimum thickness of the medial acetabular wall, were measured in the transverse reformed MPR plane. Results: The minimum thicknesses of the medial acetabular wall in Crowe-I and Crowe-II/III hips were 3.8+-2.1 mm and 7.1+-3.1 mm, respectively, with statistically significant differences between the groups (P<0.05). Furthermore, the bone stock in the medial acetabular wall correlated with the degree of subluxation (R=0.69) and the acetabular depth (R= ;- ;0.71). Conclusion: There was significantly more bone stock in the medial acetabular wall in patients with higher-degree subluxation than there was in the less-severe class. This difference should be taken into consideration when reconstructing acetabula in THA in patients with DDH using the technique of medialization

  14. Acetabular labral tears: contrast-enhanced MR imaging under continuous leg traction

    Nishii, T. [Div. of Functional Diagnostic Imaging, Biomedical Research Center, Osaka Univ. Medical School, Suita (Japan); Nakanishi, K. [Dept. of Radiology, Osaka Univ. Medical School, Suita (Japan); Sugano, N. [Dept. of Orthopaedic Surgery, Osaka Univ. Medical School, Suita (Japan); Naito, H. [Div. of Functional Diagnostic Imaging, Biomedical Research Center, Osaka Univ. Medical School, Suita (Japan); Tamura, S. [Div. of Functional Diagnostic Imaging, Biomedical Research Center, Osaka Univ. Medical School, Suita (Japan); Ochi, T. [Dept. of Orthopaedic Surgery, Osaka Univ. Medical School, Suita (Japan)

    1996-05-01

    The objective of this study was to evaluate the effects of continuous leg traction on contrast-enhanced MR imaging of the hip joint and to determine whether MR imaging under these conditions is useful for demonstrating acetabular labral tears. Nineteen hips underwent MR imaging with a T1-weighted spin-echo sequence, followed by MR imaging under continuous leg traction after intravenous injection of gadolinium-DTPA. Joint fluid enhancement and labral contour detection were evaluated. Eleven hips had labral tears shown by conventional arthrography, arthroscopy and macroscopic surgical findings. Assessment of labral tears by MR imaging was correlated with the diagnosis based on these standard techniques. Joint fluid enhancement was obtained in all hips at 30 min after injection. Superior and inferior labral surfaces were completely delineated in 1 hip on the unenhanced MR images, and in 7 and 13 hips, respectively, on the enhanced images under traction. The enhanced images under traction depicted 9 of the 11 labral tears. Comparison between the unenhanced image and the enhanced image under traction avoided mistaking undercutting of the labrum for a tear in 4 hips. Contrast-enhanced MR imaging under traction was valuable for detecting labral tears non-invasively and without radiation. Follow-up examinations using this method in patients with acetabular dysplasia can help to clarify the natural course of labral disorders and enable better treatment planning. (orig./MG)

  15. Acetabular reconstruction with human and bovine freeze-dried bone grafts and a reinforcement device

    Ricardo Rosito

    2008-01-01

    Full Text Available BACKGROUND: This is a cohort trial (1997-2005 of 49 patients submitted to an acetabular component revision of a total hip arthroplasty, using impacted human and bovine freeze-dried cancellous bone grafts (H&FDBG and a reinforcement device. OBJECTIVE: To compare clinical/radiographic graft incorporation capability between cancellous bone grafts. PATIENTS/METHODS: There were two groups: I (n=26 receiving human grafts and II (n=25 receiving bovine grafts. The average follow-up times were 55 and 49 months, respectively. Clinical analysis was based on the Merle d'Aubigné and Postel score, and the radiographic analysis involved an established score based on Conn's et al. criteria for radiographic bone incorporation. RESULTS: No clinical/radiographic differences were found between the groups and both showed an overall rate of 88.5% and 76% of graft incorporation (p=0.424. CONCLUSION: The results presented here are comparable to those in the literature with the use of deep-FG. Therefore, cancellous bone grafts can be safely and adequately used in acetabular component revision in total hip arthroplasty.

  16. Acetabular Reconstruction with Human and Bovine Freeze- Dried Bone Grafts and a Reinforcement Device

    Rosito, Ricardo; Galia, Carlos Roberto; Macedo, Carlos Alberto Souza; Moreira, Luis Fernando; Quaresma, Lourdes Maria Araújo C.; Palma, Humberto Moreira

    2008-01-01

    BACKGROUND This is a cohort trial (1997–2005) of 49 patients submitted to an acetabular component revision of a total hip arthroplasty, using impacted human and bovine freeze-dried cancellous bone grafts (H&FDBG) and a reinforcement device. OBJECTIVE To compare clinical/radiographic graft incorporation capability between cancellous bone grafts. PATIENTS/METHODS There were two groups: I (n=26) receiving human grafts and II (n=25) receiving bovine grafts. The average follow-up times were 55 and 49 months, respectively. Clinical analysis was based on the Merle d’Aubigné and Postel score, and the radiographic analysis involved an established score based on Conn’s et al. criteria for radiographic bone incorporation. RESULTS No clinical/radiographic differences were found between the groups and both showed an overall rate of 88.5% and 76% of graft incorporation (p=0.424). CONCLUSION The results presented here are comparable to those in the literature with the use of deep-FG. Therefore, cancellous bone grafts can be safely and adequately used in acetabular component revision in total hip arthroplasty. PMID:18719763

  17. Towards the optimal design of an uncemented acetabular component using genetic algorithms

    Ghosh, Rajesh; Pratihar, Dilip Kumar; Gupta, Sanjay

    2015-12-01

    Aseptic loosening of the acetabular component (hemispherical socket of the pelvic bone) has been mainly attributed to bone resorption and excessive generation of wear particle debris. The aim of this study was to determine optimal design parameters for the acetabular component that would minimize bone resorption and volumetric wear. Three-dimensional finite element models of intact and implanted pelvises were developed using data from computed tomography scans. A multi-objective optimization problem was formulated and solved using a genetic algorithm. A combination of suitable implant material and corresponding set of optimal thicknesses of the component was obtained from the Pareto-optimal front of solutions. The ultra-high-molecular-weight polyethylene (UHMWPE) component generated considerably greater volumetric wear but lower bone density loss compared to carbon-fibre reinforced polyetheretherketone (CFR-PEEK) and ceramic. CFR-PEEK was located in the range between ceramic and UHMWPE. Although ceramic appeared to be a viable alternative to cobalt-chromium-molybdenum alloy, CFR-PEEK seems to be the most promising alternative material.

  18. Assessing Wear of the Acetabular Cup Using Computed Tomography: an ex vivo Study

    Purpose: To validate a clinically useful method for measuring acetabular cup wear using computed tomography (CT). Material and Methods: Eight uncemented acetabular cups were scanned twice ex vivo using CT. The linear penetration depth of the femoral component head into the cup and the thickness of the remaining polyethylene liner were measured in the CT volumes using dedicated software. Two independent examiners twice assessed each volume. The CT measurements were compared to direct measurements using a coordinate measuring device and micrometer measurements. Results: Accuracy of wear measurements expressed as penetration depth was ±0.6 and ±1.0 mm for the two examiners, respectively, with no significant differences between examiners, trials, and CT scans. Accuracy of measurements of remaining polyethylene was ±1.3 and ±1.0 mm, respectively, for the two examiners. Systematic differences between examiners were found, but no significant differences between trials and CT scans. These differences were due to different interpretations of metal artifacts in the volumes. Conclusion: The proposed CT method for evaluating wear as head penetration depth allows for reliable wear detection at a clinically relevant level. Measurements of remaining polyethylene on CT volumes are not as reliable as wear measurements owing to metal artifacts

  19. Facial nerve palsy after mandibular fracture.

    Weinberg, M J; Merx, P; Antonyshyn, O; Farb, R

    1995-05-01

    A 19-year-old man sustained a right parasymphyseal fracture and bilateral condylar neck fractures in a motor vehicle accident. The parasymphyseal fracture was treated by open reduction and internal fixation, and the subcondylar fractures were treated with closed reduction and maxillomandibular fixation. Three days postoperatively, a near-complete left facial nerve palsy developed. Facial nerve recovery was not full. The literature is reviewed, and possible mechanisms of this rare and devastating complication are discussed. PMID:7639495

  20. Reliability of ultrasonographic measurements in suspected patients of developmental dysplasia of the hip and correlation with the acetabular index

    Cem Copuroglu

    2011-01-01

    Full Text Available Background: Ultrasonography is accepted as a useful imaging modality in the early detection of developmental dysplasia of the hip (DDH. Early detection and early treatment of DDH prevents hip dislocation and related physical, social, economic, and psychological problems. The purpose of this study was to evaluate the reliability of ultrasonographic and roentgenographic measurements measured by seven different observers. Materials and Methods: The alpha angles of 66 hips in 33 patients were measured using the Graf method by seven different observers. Acetabular index degrees on plane roentgenograms were measured in order to assess the correlation between the ultrasonographic alpha angle and the radiographic acetabular index, which both show the bony acetabular depth, retrospectively. Results: The interclass correlation coefficient, measuring the interobserver reliability, was high and statistically significant for the ultrasonographic measurements. There was a negative correlation between the alpha angle and the acetabular index. Conclusions: Ultrasonography, when applied properly, is a reliable technique between different observers, in the diagnosis and follow up of DDH. When assessed concomitantly with the roentgenographic measurements, the results are reliable and statistically meaningful.

  1. The crescent sign: dissociation of the polyethylene liner from a modular acetabular component in total hip arthroplasty

    To study whether there was a common pattern of clinical symptoms, signs and radiographic features for the dissociation of the polyethylene liner from an acetabular component and to postulate reasons for these features. Retrospective study of notes and radiographs of cases of revision hip arthroplasty for polyethylene liner dissociation of the cementless Harris-Galante I porous-coated acetabular component (Zimmer Inc, Warsaw, IN) at the Avon Orthopaedic Centre, Bristol, UK and St. Mary's Hospital, Bristol, UK between 1995 and 2004. Patients were contacted to confirm preoperative symptoms. Nine cases of late polyethylene liner dissociation of this prosthesis have been revised in these institutions. All patients presented with a reduction in mobility, groin pain and limp. Eight patients reported an audible noise on hip movement. In all cases, radiographs showed radiolucency medial to the femoral neck in association with an eccentrically placed femoral head showing contact with the acetabular metal shell, which we have termed the ''crescent sign.'' There is a typical clinical presentation in this study. The diagnosis can be made from a single anteroposterior pelvic radiograph without the need for previous films for comparison, or the need for arthrography. Clinicians should look specifically for the crescent sign when an eccentrically placed femoral head has been noted, in order to differentiate the more unusual diagnosis of dissociation from that of polyethylene wear. Early revision surgery can prevent damage to the femoral head and metal acetabular shell, thus reducing the complexity of revision surgery. (orig.)

  2. 微型钛板植入体可坚强内固定修复下颌骨骨折%Mini-titanium plate implant can enhance internal fixation for mandibular fracture

    姚红磊; 纳应坤; 陈涌; 刘华

    2012-01-01

    背景:下颌骨折越来越多的采用口内切开小型钛板张力带内固定治疗,那么微小型钛板在颌骨骨折中起怎样的作用?目的:评价下颌骨骨折骨缺损重建微型钛板坚固内固定的重要性.方法:以 "钛板,下颌骨,骨折,坚固内固定"为关键词.采用计算机检索1995-01/2011-10 PubMed数据库,维普数据库有关坚固内固定技术在下颌骨骨折中的临床应用的文章.排除重复研究,以20篇为重点进行探讨.结果与结论:采用钛板在下颌角上缘张力带内固定辅以颌间固定治疗下颌角骨折,临床操作简单,易掌握,缩短颌间固定的时间,固定稳固性有了可靠的保证,创伤较小,患者能早期张口训练,避免关节强直.有利于内固定后骨折愈合及恢复正常咬合关系.%BACKGROUND: Intraoral incision and mini-plate fixation as tension band have been used to treat for mandibular fracture. The effect of mini-plate has not been fully investigated. OBJECTIVE: To assess the importance of mini-plate fixation during bone defect reconstruction following mandibular fracture. METHODS: With “titanium plate, mandible, fracture, and rigid internal fixation” as key words, a computer-based online search of PubMed and VIP database was performed for articles published between January 1995 and October 2011 related to clinical application of rigid internal fixation in mandibular fracture. Repetitive articles were excluded, and 20 were included and further discussed. RESULTS AND CONCLUSION: Titanium plate has been used as tension band in the superior margin of the mandibular angle, assisted with intermaxillary fixation to treat mandibular angle fracture. This method is simple, convenient, and can shorten duration for intermaxillary fixation, ensuring stability of the fixation. In addition, the incision is minimal, allowing early mouth open training and preventing ankylosis. This method benefits fracture healing and recovery of normal occluding relation

  3. Outcomes of total hip arthroplasty, as a salvage procedure, following failed internal fixation of intracapsular fractures of the femoral neck:a systematic review and meta-analysis

    Mahmoud, Samer; Pearse, Eyiyemi; Smith, Toby; Hing, Caroline

    2016-01-01

    The management of intracapsular femoral neck fractures in independently mobile patients remains controversial. Successful fixation obviates the limitations of arthroplasty for this group of patients, however with fixation failure rates as high as 30%, the outcome of revision surgery to salvage total hip replacement (THR) must be considered. We carried out this review to determine the outcome of salvage THR and how this compares to primary THR for fracture. We performed a PRISMA compliant syst...

  4. Fracture Mechanics

    Zehnder, Alan T

    2012-01-01

    Fracture mechanics is a vast and growing field. This book develops the basic elements needed for both fracture research and engineering practice. The emphasis is on continuum mechanics models for energy flows and crack-tip stress- and deformation fields in elastic and elastic-plastic materials. In addition to a brief discussion of computational fracture methods, the text includes practical sections on fracture criteria, fracture toughness testing, and methods for measuring stress intensity factors and energy release rates. Class-tested at Cornell, this book is designed for students, researchers and practitioners interested in understanding and contributing to a diverse and vital field of knowledge. Alan Zehnder joined the faculty at Cornell University in 1988. Since then he has served in a number of leadership roles including Chair of the Department of Theoretical and Applied Mechanics, and Director of the Sibley School of Mechanical and Aerospace Engineering.  He teaches applied mechanics and his research t...

  5. International

    This rubric reports on 10 short notes about international economical facts about nuclear power: Electricite de France (EdF) and its assistance and management contracts with Eastern Europe countries (Poland, Hungary, Bulgaria); Transnuclear Inc. company (a 100% Cogema daughter company) acquired the US Vectra Technologies company; the construction of the Khumo nuclear power plant in Northern Korea plays in favour of the reconciliation between Northern and Southern Korea; the delivery of two VVER 1000 Russian reactors to China; the enforcement of the cooperation agreement between Euratom and Argentina; Japan requested for the financing of a Russian fast breeder reactor; Russia has planned to sell a floating barge-type nuclear power plant to Indonesia; the control of the Swedish reactor vessels of Sydkraft AB company committed to Tractebel (Belgium); the renewal of the nuclear cooperation agreement between Swiss and USA; the call for bids from the Turkish TEAS electric power company for the building of the Akkuyu nuclear power plant answered by three candidates: Atomic Energy of Canada Limited (AECL), Westinghouse (US) and the French-German NPI company. (J.S.)

  6. Analysis and prevention of the failure reason of internal fixation in peritrochanteric fractures%股骨转子间骨折内固定失败原因与预防

    林奋强; 蔡东岭

    2013-01-01

    Objective To summarize and analyze the failure reason of internal fixation operation in peritrochanteric fractures and propose appropriate prevention measures.Methods The clinical data of 229 patients with peritrochanteric fractures were retrospectively analyzed,the failure reason of internal fixation was analyzed by the univariate and multivariate Logistic regression analysis.Results The univariate analysis showed that the patients' age,gender composition,types of internal fixation had no significantly correlated with the failure of internal fixation (P > 0.05) ; the Garden reset index,bone quality,fracture type and load time had significantly correlated with the failure of internal fixation (P < 0.05).The multivariate Logistic analysis showed that load time was the independent risk factors for fixation failure (OR =13.515).Conclusion The weight-bearing time points should be selected according to the bone quality,fracture type,and degree of intraoperative reset,thereby reducing the risk of surgery failure.%目的 总结分析股骨转子间骨折行手术内固定后失败发生的原因,并提出相应预防措施.方法 回顾性分析229例股骨转子间骨折患者的临床资料,采用单因素和多因素Logistic回归分析内固定失败的原因.结果 单因素分析结果显示,患者年龄、性别构成、内固定种类与内固定失败无相关性(P>0.05);Garden复位指数、骨骼质量、骨折类型、负重时间与内固定失败有相关性(P<0.05).多因素分析结果显示,负重时间为骨折内固定失败的独立危险因素(OR=13.515).结论 负重时间点的选择应根据骨骼质量、骨折类型以及术中复位程度制定,从而降低手术失败的风险.

  7. 双钢板内固定急诊手术治疗复杂肱骨远端骨折%Dual plating internal fixation for the emergency surgery of complex distal humeral fractures

    薛锦标; 陈丹华; 汤春平; 葛许峰; 潘刚; 姚长海

    2008-01-01

    目的 探讨复杂肱骨远端骨折(肱骨髁间加髁上骨折)应用经尺骨鹰嘴截骨入路,行双钢板内固定急诊手术的疗效.方法 急诊手术治疗复杂肱骨远端骨折47例患者,取鹰嘴旁肘后轻度弧形正中切口,经尺骨鹰嘴截骨入路,行切开复位双钢板内同定急诊手术,术后早期功能锻炼.结果 全部患者随访5~50个月,平均18个月,骨折在3~6个月全部愈合.采用Cassebaum评分系统评定肘关节功能,优36例,良4例,可5例,差2例,优良率85.1%.结论 复杂肱骨远端骨折,应用经尺骨鹰嘴截骨入路,双钢板坚强内固定急诊手术,可以早期进行肘关节功能锻炼,最大限度恢复肘关节功能,在临床可取得满意疗效.%Objective To investigate the efficacy of dual plating internal fixation with olecranon osteotomy approach for the emergency surgery of complex distal humeral fractures (intereondylar and supracondylar fracture).Methods Forty-seven cases of complex distal humeral fractures were treated with emergency surgery from May 2002 to May 2007.The dual plating internal fLxation was implemented with olecranon osteotomy approach in a posteubital slight arc shaped median incision.Early postoperative rehabilitation was necessary.Results The follow-up period differed from 5 to 50 months,averaged 18 months.All fractures healed in 3-6 months after surgery.The Cassebaum scoring system was used for the assessment of cubital joint function,36 cases were excellent,4 cases were good,5 cases were common,and 2 cases were bad.The excellent and good rate was 85.1%.Conclusions For complex distal humeral fractures,dual plating internal fixation emergency surgery with olecranon osteotomy approach ensures the early postoperative rehabilitation of the cubital joint and the maximum possible functional recovery.It shows the efficacy is satisfactory.

  8. 微创内固定系统治疗膝关节周围骨折临床疗效分析%Clinical Efficacy Analysis of Minimally Invasive Internal Fixation System Treating Fracture Around Knees

    崔志民; 张国峰; 周天宝; 冷雪; 陈韶丽

    2013-01-01

      目的:研究微创内固定系统治疗膝关节周围骨折的治疗效果,为治疗膝关节周围骨折提供临床参考。方法:60例膝关节周围骨折患者分为采用微创内固定系统治疗的微创组和常规治疗的传统组,观察两组的治疗效果及恢复状况。结果:微创组在平均手术所需时间、手术中的出血量、骨折愈合时间、肢体缩短长度、关节功能外形及患者痛感等各项指标上均较优于传统组。结论:微创内固定系统治疗膝关节周围骨折治疗效果及关节功能恢复较好,值得在临床实践中推广应用。%Objective:To study the therapeutic effects of minimally invasive internal fixation system treating fractures around knees, and provide clini-cal reference for the treatment of fractures around knees. Methods:60 cases of patients with fractures around knees were divided into minimally inva-sive group treated with minimally invasive internal fixation system and traditional group with conventional therapy, to observe the efficacy and recov-ery of two groups. Results:The average required operation time, amount of bleeding, fracture healing time, limbs shortening length, joint function shape, pain perception of patients and other indicators of minimally invasive group were all better than the those of traditional group. Conclusion:The therapeutic effects of minimally invasive internal fixation system treating fractures around the knees, and its recovery of joint function are better, being worthy of popularization and application in clinical practice.

  9. Making the first fracture the last fracture: ASBMR task force report on secondary fracture prevention.

    Eisman, John A; Bogoch, Earl R; Dell, Rick; Harrington, J Timothy; McKinney, Ross E; McLellan, Alastair; Mitchell, Paul J; Silverman, Stuart; Singleton, Rick; Siris, Ethel

    2012-10-01

    Fragility fractures are common, affecting almost one in two older women and one in three older men. Every fragility fracture signals increased risk of future fractures as well as risk of premature mortality. Despite the major health care impact worldwide, currently there are few systems in place to identify and "capture" individuals after a fragility fracture to ensure appropriate assessment and treatment (according to national guidelines) to reduce future fracture risk and adverse health outcomes. The Task Force reviewed the current evidence about different systematic interventional approaches, their logical background, as well as the medical and ethical rationale. This included reviewing the evidence supporting cost-effective interventions and developing a toolkit for reducing secondary fracture incidence. This report presents this evidence for cost-effective interventions versus the human and health care costs associated with the failure to address further fractures. In particular, it summarizes the evidence for various forms of Fracture Liaison Service as the most effective intervention for secondary fracture prevention. It also summarizes the evidence that certain interventions, particularly those based on patient and/or community-focused educational approaches, are consistently, if unexpectedly, ineffective. As an international group, representing 36 countries throughout Asia-Pacific, South America, Europe, and North America, the Task Force reviewed and summarized the international data on barriers encountered in implementing risk-reduction strategies. It presents the ethical imperatives for providing quality of care in osteoporosis management. As part of an implementation strategy, it describes both the quality improvement methods best suited to transforming care and the research questions that remain outstanding. The overarching outcome of the Task Force's work has been the provision of a rational background and the scientific evidence underpinning

  10. 内、外固定与保守方法治疗不稳定型骨盆骨折:骨痂生长及骨折愈合率比较%Internal fixation, external fixation and conservative treatment for unstable pelvic fractures:callus growth and fracture healing rate

    刘国雄; 肖柳斌; 李鹏飞; 马翰斐; 连银川; 汪清华; 吴元成

    2015-01-01

    背景:对于骨盆骨折的治疗临床上有很多方法,其中以保守治疗、内固定治疗和外固定治疗3种方法为主。传统的保守治疗常因骨折的不良复位而造成相关并发症。固定治疗对于一般不稳定型骨折有着良好的修复效果,但对于骨盆骨折报道甚少。  目的:观察内固定治疗对不稳定型骨盆骨折的修复效果,并与外固定及保守治疗进行对比。  方法:将深圳市龙华新区人民医院2008年1月至2014年6月收治的126例不稳定型骨盆骨折患者,根据修复方式分为保守治疗组、外固定组和内固定组,每组42例。治疗后行X射线片检查,以Lindahl影像学标准为依据,对骨折复位的质量进行评估。治疗后定期随访,依据Majeed标准对患者肢体功能恢复情况进行评价。末次随访时评估患者修复效果、骨折愈合优良率及骨痂生长优良率。  结果与结论:末次随访时,内固定组患者的治疗总有效率为81%,保守治疗组为69%,外固定组为71%,内固定组明显优于其余两组,差异有显著性意义(P OBJECTIVE:To observe the effects of internal fixation on unstable pelvic fractures, and compare with conservative treatment and external fixation. METHODS:126 cases of unstable pelvic fractures from Longhua District People’s Hospital of Shenzhen City from January 2008 to June 2014 were divided into three groups:conservative treatment group, external fixation group and internal fixation group (n=42). After treatment, patients received X-ray examination. Lindahl imaging criteria were used as evidence. The quality of fracture reduction was evaluated. Patients were regularly fol owed up after treatment. The recovery of limb function was evaluated according to Majeed standard. Repair effects, the excel ent and good rates of fracture healing and cal us growth were evaluated in the last fol ow-up. RESULTS AND CONCLUSION:During the last fol ow

  11. Acetabular deepening in the treatment of severe canine hip dysplasia Aprofundamento do acetábulo no tratamento de displasia coxofemoral grave em cães

    Paulo Iamaguti; Luciana S. Iamaguti; Raquel Sartor

    2009-01-01

    A technique to restore acetabular anatomy by deepening the acetabular cavity and reconstructing the femoral head ligament and the joint capsule was tested on nine large breed dogs with severe hip dysplasia and acute subdislocation or dislocation. The technique consisted of two phases. First, all dogs were submitted to bilateral pectinotomy. In a second surgical intervention on the same dogs the acetabulum was approached and deepened, and the femoral head ligament and the joint capsule were re...

  12. Precooling an acetabular liner makes its insertion into a metal shell easier.

    Kyle, Richard F; Bourgeault, Craig A; Lew, William D; Bechtold, Joan E

    2006-02-01

    Temporary shrinkage of an acetabular polyethylene liner due to precooling could reduce the force required to snap the liner into its metal shell. This study documented cooling and heating rates of liners with a particular locking mechanism design, determined forces required to seat liners in their shells as a function of temperature, and quantified the force surgeons can exert with their thumbs when seating a liner. It took up to 8 minutes to cool 58- and 70-mm liners in an ice-water bath from room temperature to near 0 degrees C, and up to 24 minutes to subsequently warm these liners to near body temperature. Forces required to seat liners were greater at room and body temperatures than at 0 degrees C. Liners precooled to 0 degrees C required insertion forces that could be generated manually by surgeons. PMID:16520215

  13. Multiscale Multifunctional Progressive Fracture of Composite Structures

    Chamis, C. C.; Minnetyan, L.

    2012-01-01

    A new approach is described for evaluating fracture in composite structures. This approach is independent of classical fracture mechanics parameters like fracture toughness. It relies on computational simulation and is programmed in a stand-alone integrated computer code. It is multiscale, multifunctional because it includes composite mechanics for the composite behavior and finite element analysis for predicting the structural response. It contains seven modules; layered composite mechanics (micro, macro, laminate), finite element, updating scheme, local fracture, global fracture, stress based failure modes, and fracture progression. The computer code is called CODSTRAN (Composite Durability Structural ANalysis). It is used in the present paper to evaluate the global fracture of four composite shell problems and one composite built-up structure. Results show that the composite shells. Global fracture is enhanced when internal pressure is combined with shear loads. The old reference denotes that nothing has been added to this comprehensive report since then.

  14. Outcome of periacetabular osteotomy for the management of acetabular dysplasia: experience in an academic centre.

    Burke, Neil G

    2011-02-01

    Periacetabular osteotomy (PAO) is a very effective reconstructive procedure for treatment of acetabular dysplasia. An orthopaedic paediatric surgeon and a reconstructive hip arthroplasty surgeon performed this procedure together in the early phase of their learning curve and then performed it individually. The early clinical and radiographic results of 85 consecutive PAOs performed in this academic orthopaedic unit were reviewed. The mean Merle-d\\'Aubigné score increased from 12.4 preoperatively to 16 at follow-up. Pre-operatively 73 hips were anteverted and 12 were neutral or retroverted. The mean angle of Wiberg improved from 5 degrees to 21 degrees (p < 0.0001) in anteverted hips, and from 9 degrees to 30 degrees in neutral or retroverted hips. The mean angle of Lequesne and de Sèze improved from 6 degrees to 35 degrees (p < 0.0001) in anteverted hips, and in neutral or retroverted hips from 9 degrees to 30 degrees (p < 0.0001). The acetabular index improved from 26 degrees to 8 degrees (p < 0.0001) in anteverted hips, and from 21 degrees to 7 degrees (p < 0.0001) in neutral or retroverted hips. Over the 7 year period the blood loss and operative time improved from 2000 ml to 900 ml and 4 hours to 2 hours respectively. Four hips (four patients) required conversion to total hip replacement. The radiographic correction and improved clinical scores are similar to those in previous studies. This study shows a survival rate of 94% at 58 months following periacetabular osteotomy. The learning curve and the early results of this procedure performed in our academic unit are encouraging.

  15. Supra-Acetabular Brown Tumor due to Primary Hyperparathyroidism Associated with Chronic Renal Failure

    Rosaria M. Ruggeri

    2010-01-01

    Full Text Available A 63-year-old woman presented to the Orthopedic Unit of our hospital complaining of right hip pain of 6 months'duration associated with a worsening limp. Her past medical history included chronic renal insufficiency. Physical examination revealed deep pain in the iliac region and severe restriction of the right hip's articular function in the maximum degrees of range of motion. X-rays and CT scan detected an osteolytic and expansive lesion of the right supra-acetabular region with structural reabsorption of the right iliac wing. 99mTc-MDP whole-body bone scan showed an abnormal uptake in the right iliac region. Bone biopsy revealed an osteolytic lesion with multinucleated giant cells, indicating a brown tumor. Serum intact PTH was elevated (1020 pg/ml; normal values, 12 62 pg/ml, but her serum calcium was normal (total = 9.4 mg/dl, nv 8.5–10.5; ionized = 5.0 mg/dl, nv 4.2–5.4 due to the coexistence of chronic renal failure. 99mTc-MIBI scintigraphy revealed a single focus of sestamibi accumulation in the left retrosternal location, which turned out to be an intrathoracic parathyroid adenoma at surgical exploration. After surgical removal of the parathyroid adenoma, PTH levels decreased to 212 pg/ml. Three months after parathyroidectomy, the imaging studies showed complete recovery of the osteolytic lesion, thus avoiding any orthopedic surgery. This case is noteworthy because (1 primary hyperparathyroidism was not suspected due to the normocalcemia, likely attributable to the coexistence of chronic renal failure; and (2 it was associated with a brown tumor of unusual location (right supra-acetabular region.

  16. Stress fractures

    The diagnosis of a stress fracture should be considered in patients presented with pain after a change in activity, especially if the activity is strenuous and the pain is in the lower extremities. Since evidence of the stress fracture may not be apparent for weeks on routine radiographs, proper use of other imaging techniques will allow an earlier diagnosis. Prompt diagnosis is especially important in the femur, where displacement may occur

  17. Toddler's fracture.

    Shravat, B P; Harrop, S N; Kane, T P

    1996-01-01

    "Toddler's fracture" can be difficult to diagnose but should be suspected whenever a child presents to the accident and emergency department with a limp or fails to bear weight on the leg. Irritable hip and subacute osteomyelitis must feature in the differential diagnosis. The history may or may not include an obvious traumatic episode. Rather than fracture, elastic bowing of the bone and consequent periosteal stripping may explain symptoms in some cases.

  18. Current Concepts in the Mandibular Condyle Fracture Management Part I: Overview of Condylar Fracture

    Kang-Young Choi; Jung-Dug Yang; Ho-Yun Chung; Byung-Chae Cho

    2012-01-01

    The incidence of condylar fractures is high, but the management of fractures of the mandibular condyle continues to be controversial. Historically, maxillomandibular fixation, external fixation, and surgical splints with internal fixation systems were the techniques commonly used in the treatment of the fractured mandible. Condylar fractures can be extracapsular or intracapsular, undisplaced, deviated, displaced, or dislocated. Treatment depends on the age of the patient, the co-existence of ...

  19. Hoffa fracture associated with ipsilateral femoral shaft fracture: clinical feature and treatment

    GONG Yu-bao; LI Qing-song; YANG Chen; LI Shu-qiang; LIU Jian-guo; QI Xin

    2011-01-01

    Hoffa fracture associated with ipsilateral femoral shaft fracture is very rare.Three cases of this rare type of injury were retrospectively reviewed.The sites of femoral shaft fractures and Hoffa fractures were documented.All femoral shaft fractures were managed with internal fixation.The rate of misdiagnosis for the Hoffa fractures was documented.Functions of the affected knees were evaluated according to the modified Hospital for Special Surgery (HSS) scores at two years follow-up.Femoral fractures were either transverse or composite in all three cases.Ipsilateral Hoffa fractures occurred at medial condyle in two cases,and lateral condyle in one case.Only one Hoffa fracture was identified preoperatively.All the femoral shaft fractures healed uneventfully.In the patient whose Hoffa fracture was correctly diagnosed,the modified HSS score was 94.In another patient,whose Hoffa fracture was treated by a second operation,the modified HSS score was 93.And in the third case,who refused additional operation for the Hoffa fracture,the modified HSS score was only 70.Conclusively femoral shaft fracture can be associated with ipsilateral Hoffa fracture,especially in motorcycle accident.This type of injury is very rare and misdiagnosis is common.

  20. A randomized controlled trial of nonoperative treatment versus open reduction and internal fixation for stable, displaced, partial articular fractures of the radial head: The RAMBO trial

    W. Bruinsma (Wendy); I.F. Kodde (Izaäk Frederik); R.-J. De Muinck Keizer (Robert-Jan); P. Kloen (Peter); A. Lindenhovius (Anneluuk); J.P.A.M. Vroemen (Jos); R. Haverlag (Robert); M.P.J. van den Bekerom (Michel); H.W. Bolhuis (Hugo); P. Bullens (Pieter); S.A.G. Meylaerts (Sven); P. van der Zwaal (Peer); E.P. Steller; G.S. Hageman (Gregory); D. Ring (David); D. den Hartog (Dennis); E.R. Hammacher (Eric); G. King (Graham); G. Athwal (George); K. Faber (Ken); D. Drosdowech (Darren); R. Grewal (Ruby); J.C. Goslings (Carel); N.W.L. Schep (Niels); D. Eygendaal (Denise)

    2014-01-01

    textabstractBackground: The choice between operative or nonoperative treatment is questioned for partial articular fractures of the radial head that have at least 2 millimeters of articular step-off on at least one radiograph (defined as displaced), but less than 2 millimeter of gap between the frag

  1. Getting Active After Knee Replacement Might Raise Hip Fracture Risk

    ... exact reason for the increase in hip and spine fractures isn't clear, it's most likely due "to ... Osteoporosis International . "The increasing risk for hip and vertebral fracture in the 10 years after knee replacement may ...

  2. Roles of radiograph, magnetic resonance imaging, threedimensional computed tomography in early diagnosis of femoro-acetabular impingement in 17 cases

    GU Gui-shan; ZHU Dong; WANG Gang; WANG Cheng-xue

    2009-01-01

    Objective: To evaluate the roles of radiograph, magnetic resonance imaging (MRI), three-dimensional computed tomography (3-D CT) in early diagnosis of femoro-acetabular impingement (FAI) in 17 cases. Methods: Plain radiographs of the pelvis, 3-D CT, and MRI of the hip were made on 17 patients with groin pain, which was worse with prolonged sitting (i.e. hip flexion). There was no history of trauma or childhood hip disorders in the patients who did not complain of any other joint problems or neurologic symptoms. All patients had positive anterior or posterior impingement test. Plain radiographs included an antero-posterior (AP) view of the hip and a cross table lateral view with slight internal rotation of the hip. CT scan was performed with the Lightspeed 16 row spiral (General Electric Company, USA) at 1.25 mm slice reconstruction. MRI scan was performed on the Siemens Avanto (Siemens Company, Germany)1.5T supraconducfion magnetic resonance meter. The CT and MRI scans were taken from 1 cm above the acetabulum to the lesser trochanter in 5 series. Results: The plain radiographs of the pelvis showed that among the 17 patients, 12 (70.59%) had "Cam" change of the femoral head, 6 (35.29%) had positive "cross-over" sign, and 17 (100%) had positive "Pincer" change of the acetabulum. The 16 row spiral CT noncontrast enhanced scan and 3-D reconstruction could discover minus femoral offset and ossification and osteophyte of the acetabulum labrum in all the 17 cases (100%). The MRI noncontrast enhanced scan could discover more fluid in the hip joint in 15 cases (88.33%), subchondral ossification in 3 cases (17.6%), and labium tears in 3 cases (17.6%). Conclusions: Plain radiographs can provide the initial mainstay for the diagnosis of FAI, 3-D CT can tell us the femoral offset, while MRI can show labrum tears in the very early stage of FAI. Basically, X-ray examination is enough for the early diagnosis of FAI, but 3-D CT and MRI may be useful for the treatment.

  3. Initial stability of cementless acetabular cups: press-fit and screw fixation interaction—an in vitro biomechanical study

    Tabata, Tomonori; Kaku, Nobuhiro; Hara, Katsutoshi; Tsumura, Hiroshi

    2014-01-01

    Background Press-fit and screw fixation are important technical factors to achieve initial stability of a cementless acetabular cup for good clinical results of total hip arthroplasty. However, how these factors affect one another in initial cup fixation remains unclear. Therefore, this study aimed to evaluate the mutual influence between press-fit and screw fixation on initial cup stability. Methods Foam bone was subjected to exact hemispherical-shape machining to diameters of 48, 48.5 and 4...

  4. Analysis of acetabular version in the native hip: comparison between 2D axial CT and 3D CT measurements

    Dandachli, Wael [Department of Orthopaedic Surgery, Imperial College London Hospitals, London (United Kingdom); Ul Islam, Saif; Tippett, Richard; Hall-Craggs, Margaret A.; Witt, Johan D. [University College London Hospitals, London (United Kingdom)

    2011-07-15

    To compare two-dimensional (2D) axial with three-dimensional (3D) computerized tomography (CT) measurements of acetabular version in native hips. CT scans of 34 hips in 17 consecutive patients being investigated for femoroacetabular impingement were analyzed. Acetabular version was measured using 2D CT at two different axial levels, one cranial (slice 2) and the other at the equator (slice 3). The measurements were repeated after correction for pelvic tilt. The results were compared to the measurements of anatomical version obtained using a 3D CT method that automatically corrects for pelvic tilt. The mean acetabular version using the 3D CT method was 15.7 (SD 6.9 ). The mean version using slice 2 was 9.3 (SD 6.5 ) before correction for pelvic tilt and 15.7 (SD 8.0 ) after the correction. The mean version using slice 3 was 16.4 (SD 4.2 ) before tilt correction and 19.0 (SD 5.0 ) after the correction. In relation to the 3D method, the intraclass correlation coefficient (ICC) was 0.58 for the uncorrected and 0.93 for the corrected slice 2 method. For the uncorrected and corrected slice 3 methods, the ICC was 0.64 and 0.89, respectively. The 2D axial methods produced variable results. The results that correlated best with the 3D method were those of the cranial slice (slice 2) after correction for pelvic tilt. Interpretation of 2D axial CT measurements of acetabular version should be done with caution. The level at which the measurement is done and the presence of pelvic tilt appear to be significant factors. (orig.)

  5. Study of the three-dimensional orientation of the labrum: its relations with the osseous acetabular rim

    Bonneau, Noémie; Bouhallier, July; Baylac, Michel; Tardieu, Christine; Gagey, Olivier

    2012-01-01

    Understanding the three-dimensional orientation of the coxo-femoral joint remains a challenge as an accurate three-dimensional orientation ensure an efficient bipedal gait and posture. The quantification of the orientation of the acetabulum can be performed using the three-dimensional axis perpendicular to the plane that passes along the edge of the acetabular rim. However, the acetabular rim is not regular as an important indentation in the anterior rim was observed. An innovative cadaver study of the labrum was developed to shed light on the proper quantification of the three-dimensional orientation of the acetabulum. Dissections on 17 non-embalmed corpses were performed. Our results suggest that the acetabular rim is better represented by an anterior plane and a posterior plane rather than a single plane along the entire rim as it is currently assumed. The development of the socket from the Y-shaped cartilage was suggested to explain the different orientations in these anterior and posterior planes. The labrum forms a plane that takes an orientation in between the anterior and posterior parts of the acetabular rim, filling up inequalities of the bony rim. The vectors VL, VA2 and VP, representing the three-dimensional orientation of the labrum, the anterior rim and the posterior rim, are situated in a unique plane that appears biomechanically dependent. The three-dimensional orientation of the acetabulum is a fundamental parameter to understand the hip joint mechanism. Important applications for hip surgery and rehabilitation, as well as for physical anthropology, were discussed. PMID:22360458

  6. A NUMERICAL STUDY OF THE CONTACT PRESSURE BETWEEN A FEMORAL HEAD AND ACETABULAR CUP OF A TOTAL HIP REPLACEMENT

    Koukal, M.; Florian, Z.; Fuis, Vladimír

    Brno : Brno University of Technology, 2006 - (Burša, J.; Fuis, V.), s. 126-127 ISBN 80-214-3232-2. [Human Biomechanics 2006. Hrotovice (CZ), 13.11.2006-16.11.2006] R&D Projects: GA ČR(CZ) GA101/05/0136 Institutional research plan: CEZ:AV0Z20760514 Keywords : FEM * ceramic head * contact pressure * acetabular cup Subject RIV: BO - Biophysics

  7. Model Studies on Acetabular Component Migration in Total Hip Arthroplasty using CT and a Semiautomated Program for Volume Merging

    Purpose: Validation of a non-invasive CT method for detection of acetabular cup migration after total hip arthroplasty in a phantom study. Material and Methods: 26 CT examinations were obtained of a pelvic model while altering the position of the acetabular cup. Using a previously described program for volume merging, the pelvi in different examinations were fused and the 3D alterations of the position of the acetabular cup were evaluated visually and numerically and correlated to direct measurements on the model. Results: Visually, two independent examiners differentiated between 0, 1 and 2 to 3 mm migration with 100% specificity and sensitivity. Numerically, the mean error over all cases between model and CT measurements was 0.04 mm (SD ± 0.33). The mean absolute error between model and CT data was 0.26 mm (SD ± 0.19). Intra- and interobserver 95% accuracy and repeatability limits were below 0.5/0.7 mm, respectively. No significant interobserver difference occurred. The data were normally distributed and not dependent on observer. Conclusion: The accuracy of this non-invasive method out-performs routine plain radiography. The method gives both visual and numerical correlates to migration and can be used in clinical practice

  8. Burnei’s “double X" internal fixation technique for supracondylar humerus fractures in children: indications, technique, advantages and alternative interventions

    Georgescu, I.; Gavriliu, S; Pârvan, A; Martiniuc, A; Japie, E; Ghiță, R; Drăghici, I; Hamei, S; Ţiripa, I; El Nayef, T; Dan, D

    2013-01-01

    Background. The Study and Research Group in Pediatric Orthopedics-2012 initated this retrospective study due to the fact that in Romania and in other countries, the numerous procedures do not ensure the physicians a definite point of view related to the therapeutic criteria in the treatment of supracondylar fractures. That is why the number of complications and their severity brought into notice these existent deficiencies. In order to correct some of these complications, cubitus varus or val...

  9. The industrial application of fracture mechanics concepts discussed at the background of international standards and guidelines; Die industrielle Anwendung bruchmechanischer Konzepte vor dem Hintergrund internationaler Bewertungsvorschriften und Regelwerke

    Zerbst, U. [GKSS-Forschungszentrum Geesthacht GmbH (Germany). Inst. fuer Werkstofforschung; Langenberg, P. [Ingenieurbuero fuer Werkstofftechnik, Aachen (Germany)

    2000-07-01

    Many features from the background for an intensified application of fracture mechanics concepts in many industries world-wide. These include requirements for a permanent increase of the level of performance of technical components and structures by the introduction of new materials, joining technologies and design principles, the problem of ageing components and life extension, an increased emphasis on non-destructive in-service inspection combined with improved NDT techniques, and also a number of failure events caused by fatigue and fracture The aim of the present paper is to give a brief state-of-the-art review on how fracture mechanics is applied in different industrial branches today. This is based on standards and guidelines in the aerospace industry, in the nuclear and fossil power generation, in the chemical and petrochemical and the pipeline industry, in civil engineering, offshore technique and other fields. Based on the review an outlook is given on a future development that would be reasonable and desirable from the point of view of a basically unified philosophy of fracture mechanics application. (orig.) [German] Die Erhoehung der Leistungsparameter vieler Maschinen und Anlagen verbunden mit dem Einsatz neuer Werkstoffe, Fuegeverfahren und Konstruktionsprinzipien, der Betrieb vieler Strukturen ueber ihre projektierte Lebensdauer hinaus, technische Verbesserungen und ein durchgaengigerer Einsatz zerstoerungsfreier Defektpruefverfahren, aber auch immer wieder einmal auftretende Schadensfaelle bilden den Hintergrund fuer die zunehmende Nutzung bruchmechanischer Bewertungsvorschriften in der industriellen Praxis. Die vorliegende Studie zieht eine momentane Bilanz dieser Entwicklung am Beispiel von Fachbereichsstandards der Luft- und Raumfahrtindustrie, der konventionellen und Kernkrafttechnik, der Chemie und Petrochemie, der Pipelineindustrie, des Stahlbaus, der Offshore-Technik und anderer Bereiche. Ausgehend von dieser Bestandsaufnahme wird ein Ausblick

  10. Evaluation of soft tissue asymmetry using cone-beam computed tomography after open reduction and internal fixation of zygomaticomaxillary complex fracture

    Kim, Dong Hyuck; Kim, Rae Hyong; Lee, Jun; Chee, Young Deok; Kwon, Kyoung-Hwan

    2014-01-01

    Objectives In this study, we assessed soft tissue asymmetry that occurred after open reduction of unilateral zygomaticomaxillary complex (ZMC) fractures. We proposed a simple method to assess soft tissue asymmetry after reduction surgery by evaluating the symmetry between the affected and the unaffected sides. The factors affecting soft tissue contour after surgery were also analyzed. Materials and Methods Subjects included patients admitted to Wonkwang University Dental Hospital from 2008 to...

  11. Single-incision technique for the internal fixation of distal fractures of the tibia and fibula: a combined anatomic and clinical study

    Yu, Baoqing; Huang, Gan; George, Josiah T.; Li, Wenrui; Pan, Sihua; Zhou, Haiyan

    2013-01-01

    Objectives To present a novel single anterior-lateral approach for the treatment of distal tibia and fibula fracture via anatomical study and primary clinical application in order to minimize soft tissue complications. Design Both a gross anatomic cadaver and retrospective studies of the single-incision technique in patients recruited between June 2004 and January 2010. Setting Level I trauma center. Patients/participants Twenty-six legs of 14 adult human cadavers and clinical recruitment of ...

  12. 经皮克氏针内固定结合术后康复训练治疗Bennett骨折对关节功能恢复的观察%Internal fixation with Kirschner pins in combination of postoperative trainig recovering joint function following Bennett fracture

    查天文; 聂梅

    2002-01-01

    Background:Bennett fracture belongs to intraarticular injury.Conventionally,external fixation with splint or plaster failures to maintain postrepair position,leading to fracture and translocation.On the other hand,longer term outer fixation will result in joint stiffness.Internal fixation with Kirschner pins in combination of postoperative training was characterized by stable fixation,less injury,allow early functional exercise and is beneficial to recovery of joint function.

  13. DESIGNING DRUG TRIALS FOR SARCOPENIA IN OLDER ADULTS WITH HIP FRACTURE - A TASK FORCE FROM THE INTERNATIONAL CONFERENCE ONFRAILTY AND SARCOPENIA RESEARCH (ICFSR).

    Vellas, B; Fielding, R; Miller, R; Rolland, Y; Bhasin, S; Magaziner, J; Bischoff-Ferrari, H

    2014-01-01

    In May 2012, a Sarcopenia Consensus Summit was convened by the Foundation of the National Institutes of Health (FNIH), National Institute of Aging (NIA), and the U.S. Food and Drug Administration (FDA); and co-sponsored by five pharmaceutical companies. At this summit, sarcopenia experts from around the world worked to develop agreement on a working definition of sarcopenia, building on the work of previous efforts to generate a consensus. With the ultimate goal of improving function and independence in individuals with sarcopenia, the Task Force focused its attention on people at greatly increased risk of muscle atrophy as a consequence of hip fracture. The rationale for looking at this population is that since hip fracture is a recognized condition, there is a clear regulatory path forward for developing interventions. Moreover, patients with hip fracture may provide an appropriate population to advance understanding of sarcopenia, for example helping to define diagnostic criteria, develop biomarkers, understand the mechanisms that underlie the age-related loss of muscle mass and strength, and identify endpoints for clinical trials that are reliable, objective, and clinically meaningful. Task Force members agreed that progress in treating sarcopenia will require strengthening of partnerships between academia, industry, and government agencies, and across continents to reach consensus on diagnostic criteria, optimization of clinical trials design, and identification of improved treatment and preventive strategies. In this report, the main results of the Task Force discussion are presented. PMID:26380231

  14. Close reduction and percutaneous internal fixation with hollow screw in treatment of posterior malleolus fractures%闭合复位经皮空心螺钉内固定治疗后踝骨折

    冯青; 许效坤; 苏海涛

    2011-01-01

    目的探讨闭合复位经皮空心螺钉内固定选择性治疗后踝骨折的手术方法、适应证及临床效果.方法回顾性分析2004年7月至2010年4月期间采用闭合复位经皮空心拉力螺钉内固定治疗42例成人后踝骨折的临床资料,其中旋后-外旋型28例,旋前-外旋型6例,旋前-外展型8例.采用X线片评估骨折愈合率,采用美国足踝骨科协会(AOFAS)推荐的足踝评分系统评估踝关节功能.结果平均随访22个月(6~75个月),骨折愈合时间为6~12周.按AOFAS足踝评分系统评分,平均为96分(78~100分),优41例,可1例,优良率为97.6%.结论闭合复位经皮空心螺钉内固定是一种可用于治疗后踝骨折的微创术式,具有骨折愈合快,骨折愈合率高,踝关节功能好的优点.%Objective To investigate the indication and efficacy of close reduction and percutaneous internal fixation with hollow screws in the treatment of posterior malleolus fractures. Methods The clinical data of 42 cases of posterior malleolus fracture treated by this method from July,2004 to April ,2010 were retrospectively analyzed,including 28 cases of supination-eversion fractures,6 cases of pronation-eversion fractures and 8 cases of pronation-abduction fractures. The fracture healing rate was assessed by X-ray film and the function of the ankle joint was evaluated by foot and ankle scoring system recommended by American Orthopedic Foot & Ankle Society ( AOFAS). Results The followup averaged for 22 months (6 ~75 months). The fracture healing time ranged form 6 to 12 weeks. According to the results of foot and ankle function scores, the average score was 96 points (78 ~ 100 points), including 41 cases of excellence and 1 case of fairness, the rate of excellent and good amounting to 97.6%. Conclusion With the advantage of quick recovery, high healing rate and better healing effect, close reduction and percutaneous internal fixation with hollow screws is feasible in the treatment of

  15. A comparative study of "plasmacup" and "porous-coated" acetabular components: survival after 10 to 12 years of follow-up

    José Ricardo Negreiros Vicente

    2010-01-01

    Full Text Available OBJECTIVES: Our primary aim was to compare the long-term survivorship rates and the rates of successful osseointegration between two different types of uncemented acetabular components. INTRODUCTION: Two types of alloys have primarily been used for the manufacture of the uncemented acetabular components: titanium-based and cobalt-based alloys. A titanium-based alloy appears to be more effective with regard to interface stress transfer to the host bone because of its lower elastic modulus relative to a cobalt-based alloy. This supposed mechanical advantage of a titanium-based alloy component motivated this comparative study. METHODS: Two uncemented acetabular components, a porous-coated acetabulum and a Plasmacup®, were compared with a focus on long-term prosthesis survivorship and the development of acetabular osseointegration. Five radiographic signs of osseointegration were evaluated at the last follow-up appointment: (1 absence of radiolucent lines, (2 presence of a superolateral buttress, (3 medial stress-shielding, (4 radial trabeculae, and (5 an inferomedial buttress. We considered the presence of any three of these radiographic signs, in the absence of acetabular dislocation or symptoms, to be indicative of successful acetabular osseointegration. RESULTS: Among 70 patients implanted with the porous-coated acetabulum, 80% achieved osseointegration over a mean follow-up time of 11.9 years versus 75.3% of the 73 patients who received a Plasmacup insert over a mean of 10.7 years. Prosthesis survivorship rates were not different between the two groups. Revision surgery due to mild or severe acetabular osteolysis, polyethylene wear, and aseptic loosening occurred in eight patients (11.4% with a PCA versus nine (12.3% with a Plasmacup. CONCLUSIONS: We conclude that, during the first ten years after surgery, there is no significant difference between these two types of uncemented cups with regard to either prosthesis survivorship or successful

  16. 拉力螺钉辅加抗滑钢板内固定治疗Hoffa骨折%Internal fixation with lag screws plus an auxiliary anti-sliding plate for the treatment of Hoffa fractures

    徐培; 孙杰; 袁天祥; 马宝通

    2012-01-01

    Objective To investigate the clinical efficacy of internal fixation with lag screws plus an auxiliary sliding plate for the treatment of Hoffa fractures.Methods A retrospective analysis was made for 12 patients (14 condyles) with Hoffa fracture who had been treated in our hospital from December 2007 through November 2011.They were 8 males (10 condyles) and 4 females (4 condyles),with an average age of 36.2 years (range,from 20 to 61 years).By the Hoffa classification,6 cases were medial condylar fractures,4 lateral condylar fractures and 2 bicondylar fractures.By the AO/OTA classification,10 cases were type 33B32 and 2 type 33B33.By Letenneur's classification,7 condyles were type Ⅰ,one condyle was type Ⅱ and 6 condyles were type Ⅲ.There were 2 open fractures and 10 closed ones.Femoral shaft fracture was complicated in one case,proximal tibia fracture in 3 cases,ankle fracture in one,injury to the knee extensor mechanism in 2,cruciate ligament injury in 4,medial collateral ligament injury in one,and meniscus injury in 3.The time from injury to surgery averaged 3.2 days (from 2 hours to 7 days).All fractures were reduced under direct vision and fixated with cancellous lag screws plus an additional anti-sliding plate.Results All the patients were followed for 6 to 54 months (average,20.3 months).Union was achieved in all patients after an average time of 16.6 weeks (from 11 to 23 weeks).No implant failure or fracture displacement occurred.Incision infection and incision disunion occurred in one case each,but both were cured after intensive care.According to Letenneur's functional assessment,11 cases were excellent or good and one case was fair,giving a good to excellent rate of 91.7%.Conclusions Open reduction and internal fixation with lag screws and an additional anti-sliding plate may result in excellent results for Hoffa fractures.The key to a successful surgery is an appropriate approach,anatomic reduction and rigid fixation.%目的 探讨拉力螺钉辅

  17. Effect of proximal humeral internal locking system in treating complex proximal humeral fractures in elderly patients%应用PHILOS接骨板治疗复杂老年肱骨近端骨折

    苑娜; 郑继会; 胡思斌; 孙宏辉; 赵爱军

    2011-01-01

    目的 探讨肱骨近端内固定锁定系统(PHILOS)接骨板治疗复杂老年肱骨近端骨折的疗效.方法 回顾性分析我院2005年6月~2008年12月应用PHILOS接骨板手术治疗复杂老年肱骨近端骨折27例临床资料,其中男性15例,女性12例;平均年龄74岁(59~83岁).按Neer分型:三部分骨折19例,四部分骨折8例,均有原发性骨质疏松.复位后PHILOS接骨板固定.结果 术后随访8~36个月,平均13个月.骨折全部愈合,2例出现肱骨头坏死.按照Neer肩关节功能评分标准:优6例,良14例,可4例,差3例;优良率74%.结论 应用PHILOS接骨板治疗复杂老年肱骨近端骨折固定可靠,可以早期功能锻炼,术后功能恢复满意,对复杂老年肱骨近端骨折是一种有效的治疗方法.%Objective To summarize the treatment effect of proximal humeral internal locking system( PHILOS ) for complex proximal humeral fractures in old patients. Methods A retrospective study was done on 27 cases of complex proximal humeral fracture treated with PHILOS plate from Jun. 2005 to Dec. 2008, including 15 males and 12 females aged 59-83 years ( average 74 years). According to the Neer classification, 19 cases were three-part fractures, 8 cases were four-part fractures, and all cases were observed primary osteoporosis. A deltoid-pectoral approach was used in all patients and fixed the fracture with PHILOS plate after reduction, the tubercle fragments were sutured with non-absorbable ethibond. Results The follow-up time ranged from 8 to 36 months,with mean of 13 months. All fractures got bone union and humeral head necrosis was observed in 2 cases. By Neer shoulder scoring system, 6 cases were excellent,14 cases were good,4 cases were fair and 3 cases were poor. Conclusion Applying PHILOS plate in treatment of the complex proximal humeral fractures in old patients provides a stable fixation and earlier rehabilitation. It is an effective method for complex proximal humeral fractures in old patients.

  18. Comparison of biomechanical properties of different internal fixation methods for the treatment of posterior ankle fractures%后踝关节骨折不同内固定方式的生物力学性能对比

    万全会

    2015-01-01

    BACKGROUND:Different fixtures can be used for the internal fixation treatment of patients with posterior ankle fractures in clinic, however, different internal fixation methods wil produce different biomechanical effect. OBJECTIVE:To compare and analyze the biomechanical properties of mini steel plate internal fixation and tension screw internal fixation in the treatment of posterior ankle fracture. METHODS:The clinical data of 95 patients with posterior ankle fractures were retrospectively analyzed. Al patients were treated with internal fixation. Mini steel plate group (n=48 cases) and tension screw group (n=47 cases) were divided according to the internal fixation methods. RESULTS AND CONCLUSION:The fixation effect of these two groups was simulated and analyzed using three-dimensional finite element model. The results showed that when the posterior ankle joint fracture block spreaded to the distal tibial articular surface of more than 25%, the mean pressure of internal fixation failure of tension screw group was significantly less than that of the mini steel plate group (P  目的:比较分析后踝关节骨折行微型钢板内固定以及拉力螺钉内固定治疗的生物力学性能。  方法:回顾性分析95例后踝关节骨折患者的临床资料,均接受内固定治疗,按照内固定方法分为微型钢板组48例和拉力螺钉组47例。  结果与结论:对两组的固定效果进行三维有限元模型模拟和分析,经分析发现,在后踝关节骨折块波及到胫骨远端关节面25%以上的情况下,在内固定失效平均压力方面,拉力螺钉组显著小于微型钢板组(P<0.05);而当后踝关节骨折块波及到胫骨远端关节面25%以下的情况下,在内固定失效平均压力方面,拉力螺钉组显著大于微型钢板组(P <0.05)。拉力螺钉组的踝关节内固定优良率显著高于微型钢板组(P <0.05)。两组治疗过程中均未出现任何内固定材料相关不

  19. Recent trends in fracture and damage mechanics

    Zybell, Lutz

    2016-01-01

    This book covers a wide range of topics in fracture and damage mechanics. It presents historical perspectives as well as recent innovative developments, presented by peer reviewed contributions from internationally acknowledged authors.  The volume deals with the modeling of fracture and damage in smart materials, current industrial applications of fracture mechanics, and it explores advances in fracture testing methods. In addition, readers will discover trends in the field of local approach to fracture and approaches using analytical mechanics. Scholars in the fields of materials science, engineering and computational science will value this volume which is dedicated to Meinhard Kuna on the occasion of his 65th birthday in 2015. This book incorporates the proceedings of an international symposium that was organized to honor Meinhard Kuna’s contributions to the field of theoretical and applied fracture and damage mechanics.

  20. External fixation combined with limited internal flxation and bone grafting for Pilon fracture%有限内固定结合外固定架治疗胫骨远端 Pilon骨折临床观察

    刘建; 刘俊宾; 王文珠; 郑卫东

    2014-01-01

    目的:观察有限内固定结合外固定架治疗胫骨Pilon骨折的临床效果。方法采用三维单侧多功能外固定支架结合有限切开内固定治疗Ruedi和Allgower分型中Ⅱ、Ⅲ型有移位骨折57例。结果根据Pi-lon骨折复位的Burwell-Charnley放射学标准及踝关节主观评分结果示,优45例,良10例,差2例。术后并发症:4例感染,3例皮肤坏死,2例发生骨筋膜综合征,5例踝关节功能障碍但未见骨不连或畸形愈合。结论根据Pilon骨折的类型和软组织损伤程度选择合适的手术方式和手术时机,合理使用外固定支架结合有限内固定维持骨折复位和下肢力线,干骺端缺损区充分植骨,整复关节面,适当功能锻炼,晚负重,术后可达到良好的临床效果。%Objective To investigate the clinical efficacy of external fixation combined with limited internal fixation and bone graft for the treatment of Pilon fractures .Methods Fifty-seven patients of Ruedi and AllgowerⅡ ,Ⅲ type of displaced fracture from March 2008 to October 2013 had treated with external fixation combined with limited internal flxation and bone grafting .Results According to Mazur function assessment system ,the curative effect was excellent in 45 patients ,good in 10 patients and poor in 2 patients .The complications included wound in-fection in 4 cases ,skin necrosis in 3 cases ,fascia syndrome in 2 cases and functional disturbance of ankle in 5 cases . Conclusion Accurate assess local soft tissue conditions for Pilon fractures is essential .According to Pilon fracture type and degree of soft tissue injury ,appropriate surgical method and surgical opportunity can be selected .External fixation combined with limited internal fixation and bone grafting maintains fracture reduction and mechanical axis of lower limb .Metaphyseal bone defect area can be filled with autogenous bone or artificial bone to prompt restora-tion of articular surface .Appropriate

  1. Geostatistical Evaluation of Fracture Frequency and Crushing

    Séguret, Serge Antoine; Guajardo Moreno, Cristian; Freire Rivera, Ramon

    2014-01-01

    International audience This work details how to estimate the Fracture Frequency (FF), ratio of a number of fractures divided by a sample length. The difficulty is that often, a part of the sample cannot be analyzed by the geologist because it is crushed, a characteristics of the rock strength that must also be considered for the Rock Mass Rating. After analyzing the usual practices, the paper describes the (geo)statistical link between fracturing and crushing and the resulting method to ob...

  2. Implementing a Greener Hydraulic Fracturing in Scotland

    Cano, Michele; Matthew, Anietie; Quinn, Brian

    2015-01-01

    International audience Abstract - The drive to implement unconventional gas drilling by means of hydraulic fracturing in United Kingdom (UK) has been a major issue of concern due to the potential environmental and health impacts. This paper is aimed at examining the following: what triggers the need for the unconventional gas; the process of unconventional gas through hydraulic fracturing method; the potential risks of hydraulic fracturing to the environment and to human health; key succes...

  3. Fractures of distal radius: an overview.

    Meena, Sanjay; Sharma, Pankaj; Sambharia, Abhishek Kumar; Dawar, Ashok

    2014-01-01

    Fractures of distal radius account for up to 20% of all fractures treated in emergency department. Initial assessment includes a history of mechanism of injury, associated injury and appropriate radiological evaluation. Treatment options include conservative management, internal fixation with pins, bridging and non-bridging external fixation, dorsal or volar plating with/without arthroscopy assistance. However, many questions regarding these fractures remain unanswered and good prospective randomized trials are needed. PMID:25657938

  4. Contemporary Management of Infected Mandibular Fractures

    Alpert, Brian; Kushner, George M.; Tiwana, Paul S.

    2008-01-01

    The treatment of infected mandibular fractures has advanced rather dramatically over the past 50 years. Immobilization with maxillomandibular fixation and/or splints, removal of diseased teeth in the fracture line, external fixation, use of antibiotics, debridement, and rigid internal fixation has played a role in management. Perhaps the most important advance was the realization that infected fractures also result from moving fragments and nonvital bone, not just bacteria. Controlling moveme...

  5. 平行双钢板内固定治疗成人肱骨远端复杂骨折疗效观察%Internal fixation for complex distal humeral fractures in adults with parallel-plating

    李明

    2011-01-01

    Objective To study the efficacy of complex distal humeral fractures in adults with the parallel-plate technique. Methods 16 patients with complex distal humeral fractures were treated by open reduction and internal fixation using parallel plating. The function of elbow was assessed according to Mayo elbow performance score (MEPS) and plain X-ray films. Results 16 patients had been followed up for 3~18 months (mean, 9.5 months). The mean fracture healing time was 6~16 weeks (mean, 10.5 weeks), with no nonunion, delayed union, displacement, avascular necrosis of implant failure. The range of motion of the elbow joint averaged 113.2°and the mean MEPS was 83.9. The overall excellent to good rate was 87.5%. Conclusion The parallel-plate technique can obtain stable internal fixation, early postoperative rehabilitation and satisfactory clinical effect in the treatment of complex distal humeral fractures in adults.%目的 观察平板双钢板内固定治疗成人肱骨远端复杂骨折的临床效果.方法 采用平板双钢板内固定方法治疗16例成人肱骨远端复杂骨折患者,按照Mayo肘关节功能评分(MEPS)标准及X线平片结果评估疗效.结果 本组16例患者骨折均一期愈合,时间为6~16周,平均10.5周,无一例内固定松动及骨折移位发生.术后均随访3~18个月,平均10个月,患侧肘关节MEPS评分为46~100分(平均83.9分),疗效评定:优8例(50%),良6例(37.5%),可2例(12.5%),差0例,优良率为87.5%.结论 平板双钢板内固定治疗成人肱骨远端复杂骨折,固定强度和抗疲劳作用强,利于肘关节早期功能锻炼,效果满意.

  6. The treatment of distal radius fractures of by LCP internal fixation implanted under pronator quadratus%经旋前方肌下置入LCP内固定治疗桡骨远端骨折

    刘红军; 明立功; 明立德; 明立山; 明朝戈

    2014-01-01

    Objective To evaluate the clinical effect and method of LCP internal fixation for the treatment of fractures of the distal radius under the pronator quadratus. Methods From April 2008 to January 2001, by the volar approach with reservation of pronator, the unstable distal radius fractures were treated by LCP internal fixation inserted under the pronator quadratus in 17 cases, according to AO classification: type B1 2 cases, type B2 7 cases, type B3 2 cases, type C1 in 4 cases, 2 cases of C2 type. All the cases were taken by volar approach, pronator quadratus were reserved, or only to cut off partly and LCP internal fixation were inserted under pronator to treat distal radius fractures. Results The patients were followed up for 9~44 months, with the average of 13 months. All fracture healed, the average healing time was 7 weeks. No infection, nonunion, carpal tunnel syndrome and other complications occurred. According to the improved Mcbride wrist joint function evaluation standard: excellent in 15 cases, good in 1 case, moderate in 1 case, the excellent and good rate was 94.1%. Conclusion The LCP internal fixation inserted under the pronator quadratus for treatment of distal fractures is completely feasible, in line with the point of view of modern minimally invasive operation. Pronator can cover the plate, reduces interference of wrist tendon, reduce tissue injury, to maximize the retention of forearm rotation function, is advantageous to the recovery of wrist function.%目的:探讨经旋前方肌下置入LCP内固定治疗桡骨远端骨折的方法及临床效果。方法2008年4月-2011年1月,采用掌侧入路保留旋前方肌的方法,于旋前方肌下置入LCP内固定治疗桡骨远端不稳定骨折17例,按AO分类标准:B1型2例,B2型7例,B3型2例,C1型4例,C2型2例。所有病例均采取掌侧入路,术中不切断旋前方肌,或仅切断部分旋前方肌行旋前方肌下置入LCP内固定治疗桡骨远端骨折。结

  7. Fracture source

    2003-07-01

    Full Text Available The fracture properties of many different types of fibers are covered in a timely new book that will prove to be a tremendous source of information and references for researchers in the wide and diverse field of fibers and composites, says Bill Clegg.

  8. Internal fixation of the unstable pelvic fracture based on the anatomic features of the pelvis%骨盆的形态特点与不稳定型骨折内固定治疗评价

    翁阳华; 吴显奎; 彭扬国; 欧耀芬

    2011-01-01

    目的 探讨根据骨盆的形态特点选择不同的内固定手术治疗不稳定型骨盆骨折的临床应用价值。方法65例不稳定型骨盆骨折,31例Tile B型骨折经前入路,将耻骨联合或耻骨支复位用重建钢板固定,其中8例合并髂骨骨折经髂窝入路将之复位用重建钢板固定;34例Tile C型骨折的前环损伤均采用与Tile B型骨盆骨折相同的方法处理,后环损伤的固定方法:17例骶骨骨折或骶髂关节脱位之中,复位后在透视引导下从后方经皮骶髂螺钉固定11例,经髂骨的螺栓固定4例,经后路在双侧髂骨后嵴之间用张力带钢板固定2例;9例骶髂关节骨折-脱位之中,经皮骶髂螺钉固定6例,钢板固定3例;8例合并髋臼骨折行重建钢板内固定。结果通过对术后骨盆X线测量骨折分离移位的最大距离,根据Matta评分标准:小于4 mm为优,占86.1%(56例);4~10mm为良,占7.7%(5例);10~20 mm为可,占6.2%(4例);大于20 mm为差(0例)。本组骨盆X线测量结果总优良率为93.8%。结论不稳定型骨盆骨折应在血流动力学稳定时尽早根据骨折的类型及骨盆的解剖形态特点选择合理的内固定手术方案。%Objective To explore clinical efficiency of different surgical internal fixations on treating the unstable pelvic fracture according to the anatomic features of the pelvis. Methods 65 cases suffering from the unstable pelvic fractures, were included in this study. Anterior approach, with the replacement and plate fixation of symphysis pubis or ramus of pubis, was performed for 31 cases of Tile B type fracture. 8 cases combined with ilium fracture among them were replaced and fixed through iliac fossa approach. As well, anterior approach also was used for fixing damaged anterior girdle of 34 cases of Tile C type fracture. However, the damaged posterior girdles were treated with the replacement and the posterior sacroiliac screw fixation

  9. Early history of scapular fractures.

    Bartoníček, Jan; Kozánek, Michal; Jupiter, Jesse B

    2016-01-01

    The first to use the term Scapula was Vesalius (1514-1564) and thus it has remained ever since. Probably the oldest injured scapula, from 250 million years ago, was described by Chinese authors of a skeletal examination of a fossilised remains of a dinosaur Yangchuanosaurus hepingensis. In humans, the oldest known scapular fractures date back to the prehistoric and early historic times. In ancient times, a fracture of acromion was described in the treatises of Hippocrates. Early modern history of the treatment of scapular fractures is closely interlinked with the history of the French surgery. The first to point out the existence of these fractures were Petit, Du Verney and Desault in the 18th century. The first study devoted solely to scapular fractures was published by Traugott Karl August Vogt in 1799. Thomas Callaway published in 1849 an extensive dissertation on injuries to the shoulder girdle, in which he discussed a number of cases known at that time. The first radiograph of a scapular fracture was published by Petty in 1907. Mayo Robson (1884), Lambotte (1913) and Lane (1914) were pioneers in the surgical treatment of these fractures, followed in 1923 by the French surgeons Lenormat, Dujarrier and Basset. The first internal fixation of the glenoid fossa, including a radiograph, was published by Fischer in 1939. PMID:26133287

  10. Infiltration of soft tissue by myeloma after internal fixation of pathologic femoral fracture; Infiltracion de partes blandas por mieloma, tras la fijacion interna de una fractura patologica femoral

    Martinez, J.; Escape, I.; Bastart, F.; Solduga, C. [Hospital de Barcelona. Barcelona (Spain)

    2002-07-01

    a 75-year-old man with multiple myeloma presented with a pathologic fracture of distal right femoral diaphysis, which was fixed with Ender nails. Two and a half months later, the patients was readmitted with rapidly progressive swelling of right thigh. Ultrasound computed tomography and magnetic resonance imaging revealed infiltration of anterior right thigh muscles, extending upward to the iliopsoas muscle and retroperitoneal space, above ipsilateral renal vein. Ultrasound-guided biopsy of the soft tissue of the thigh revealed diffuse myelomatous infiltration by plasma blasts. (Author) 9 refs.

  11. Acetabular retroversion as a rare cause of chronic hip pain: recognition of the ''figure-eight'' sign

    Banks, Kevin P. [Brooke Army Medical Center, Department of Radiology, Fort Sam Houston, TX (United States); Grayson, David E. [Wilford Hall Medical Center, Department of Radiology, Lackland Air Force Base, TX (United States)

    2007-06-15

    While well-recognized in the orthopedic literature as a cause of chronic hip pain, acetabular retroversion has not been specifically described in the radiologic literature. Acetabular retroversion represents a particular form of hip dysplasia characterized by abnormal posterolateral orientation of the acetabulum. This pathophysiology predisposes the individual to subsequent anterior impingement of the femoral neck upon the anterior acetabular margin and fibrous labrum. Without treatment, cases may progress to damage of the anterior labrum and cartilage, with eventual early onset of osteoarthritic disease. This impinging condition has been described as occurring in isolation or as part of a complex dysplasia. We describe two cases of acetabular retroversion diagnosed by conventional radiographic evaluation of the pelvis, one in isolation and one occurring in the setting of a larger congenital syndrome. These cases illustrate the utility of the ''figure-eight'' sign in identifying abnormalities of acetabular version and thus assisting clinicians in properly identifying these individuals so that appropriate therapy may be instituted. (orig.)

  12. Effect of Posterior Surgery Internal Fixation in Treatment of Spinal Fractures%后路手术内固定治疗脊柱骨折的效果探析

    邢龙

    2015-01-01

    目的:探析脊柱骨折采用后路手术内固定治疗的效果。方法研究对象取本院2014年4月~2015年4月脊柱骨折42例,依据不同治疗方式将其分两组。对照组21例,接受传统手术;研究组21例,治疗方式为后路手术内固定,观察比较两组效果。结果组间对比,研究组伤椎前缘高度、伤椎后缘高度及Cobb角改善程度较大(P<0.05),治疗有效率高(P<0.05),差异有统计学意义。结论脊柱骨折后路手术内固定治疗效果佳。%Objective Posterior surgery internal fixation effect in treatment of spinal fractures is to be studied.Methods Chose 42 patients with spinal fracture who were treated in hospital from April 2014 to April 2015 and separated them into two groups according to different treatment methods,21 patients in control group were given conventional surgery treatment,while 21 patients in study group were given posterior surgery internal fixation treatment and then observed and compared patients’ treatment effects between two groups. Results Patients’ height of fronting injured vertebral as wel as height of posterior injured vertebral and Cobb angle improvement in study group were much better than counterparts in control group(P< 0.05),and in addition,treatment efficacy in study group was much higher,there was a differential between two groups.ConclusionPosterior surgery internal fixation is of efficacy in treatment of spinal fractures. patients with diabetes,strengthening the management of the diet to improve the treatment effect.

  13. 切开复位双重建钛板内固定治疗青壮年肱骨远端粉碎性骨折%Double plates internal fixation for comminuted distal humeral fracture in young adults

    韩芳; 魏世隽; 蔡贤华

    2011-01-01

    Objective To evaluate the clinical efficacy of double plates internal fixation for comminuted distal humeral fracture in young adults. Methods From June 2003 to June 2009,41 patients( 18 females and 23males)with distal humeral fracture underwent open reduction and internal fixation with double plates in our hospital. Thirty - seven patients were followed up for 14 to 35 mon( average 25 mon).Clinical outcomes were evaluated according to the Cassebaum criteria. Results Bone union was achieved in all the 37 patients. The efficacy was excellent in 14 patients, good in 9 patients, fair in 3 patients, poor in 1 patient. The overall satisfactory rate was 87.2%. Conclusion Early internal fixations with double narrow plates in combination with rehabilitation program is the key for the successful treatment of humeral shaft fractures.%目的 探讨青壮年肱骨远端粉碎性骨折的手术治疗方法及疗效.方法 回顾性总结2003年6月至2009年6月期间采用手术切开复位双侧重建钛板90度成角内固定治疗肱骨远端双柱骨折41例,其中37例患者获得术后随访(15~35个月),平均随访25个月,应用Cassebaum方法评定术后疗效.结果 以上病例骨折均获得愈合,其中优14例,良19例,可3例,差1例,优良率达87.2%.结论 早期行切开复位双侧重建钛板90度成角固定配合术后无痛状态下早期活动是成功治疗青壮年肱骨远端粉碎性骨折的关键点.

  14. Explicit finite element modelling of the impaction of metal press-fit acetabular components.

    Hothi, H S; Busfield, J J C; Shelton, J C

    2011-03-01

    Metal press-fit cups and shells are widely used in hip resurfacing and total hip replacement procedures. These acetabular components are inserted into a reamed acetabula cavity by either impacting their inner polar surface (shells) or outer rim (cups). Two-dimensional explicit dynamics axisymmetric finite element models were developed to simulate these impaction methods. Greater impact velocities were needed to insert the components when the interference fit was increased; a minimum velocity of 2 m/s was required to fully seat a component with a 2 mm interference between the bone and outer diameter. Changing the component material from cobalt-chromium to titanium alloy resulted in a reduction in the number of impacts on the pole to seat it from 14 to nine. Of greatest significance, it was found that locking a rigid cap to the cup or shell rim resulted in up to nine fewer impactions being necessary to seat it than impacting directly on the polar surface or using a cap free from the rim of the component, as is the case with many commercial resurfacing cup impaction devices currently used. This is important to impactor design and could make insertion easier and also reduce acetabula bone damage. PMID:21485331

  15. Retrieval analysis of a failed TriboFit polycarbonate urethane acetabular buffer.

    Biant, Leela C; Gascoyne, Trevor C; Bohm, Eric R; Moran, Matthew

    2016-03-01

    The purpose of this research was to determine the failure mechanisms and damage features of a TriboFit acetabular buffer implanted directly against a native, prepared acetabulum which was revised after 11months. Retrieval analyses were carried out via light microscopy, gravimetric wear assessment, and observer scoring of visible damage features on the buffer. The volume of material abraded from the backside of the buffer was estimated via three-dimensional reconstruction using a laser scanner. Scanning electron microscopy was used to confirm damage features and mechanisms. Severe abrasion to the backside of the buffer was the primary damage feature, while stippling damage was seen on the articular surface of the buffer. Material loss due to backside abrasion was approximated to be between 0.13360.085 g (gravimetric analyses) and 0.19360.053 g (three-dimensional reconstruction). Implantation of the TriboFit buffer against the patient's native acetabulum without a metal backing allowed for significant movement of the buffer against the bone, resulting in the abrasion seen on this implant. The stippling damage on the articular surface indicates an adhesive wear mechanism which exacerbates movement of the buffer against the acetabulum, thereby increasing backside abrasion. PMID:26833696

  16. Radiographic evaluation of HDPE cemented and cementless Lord and An.C.A. screwed acetabular models.

    Toni, A; Sudanese, A; Viceconti, M; Montina, P P; Ciaroni, D; Calista, F; Terzi, S; Giunti, A

    1992-01-01

    A total of 187 alumina screwed porous-ceramic coated sockets (An.C.A.), 48 screwed smooth-surfaced Lord sockets, and 251 cemented polyethylene sockets were radiographically evaluated at an average follow-up of 30, 51 and 96 months respectively. After 6 years the Lord prostheses revealed a 38% incidence of loosening, similar to that observed for cemented sockets 10-12 years after surgery. The An.C.A. prostheses revealed radiographic loosening equal to 12% (6 cases) in the first 50 implants, and only 0.7% in the remaining 137 cases: overall, the An.C.A. acetabular prosthesis revealed an index of radiographic loosening equal to 3.3% (7/187). To guarantee "osteointegration" of the porous coating of An.C.A. sockets optimal stability must be obtained when the prosthesis is screwed in. Because the mid-term follow-up for this clinical experience is relatively short (30 months), an opinion on the reliability of the screwed "porous" sockets must await confirmation. PMID:1297574

  17. The effect of femoro-acetabular impingement on the kinematics and kinetics of the hip joint.

    Alshameeri, Zeiad; Khanduja, Vikas

    2014-08-01

    Gait analysis is an objective tool that has been used to assess and monitor treatment for many musculoskeletal conditions. Recently, it has been used to assess the impact of femoro-acetabular impingement (FAI) on the hip and lower limb movements. There have been a fairly limited number of studies published so far reporting unexpected and inconsistent results, which calls for more research to be conducted in this arena. In the light of the limited data available, it has been challenging to reconcile the contradictions in some of these results, and therefore no coherent conclusions could be drawn. In this short article, we attempt to explain some of the abnormal kinematic and kinetic patterns associated with FAI by highlighting similarities between the gait seen in early osteoarthritis (OA) and that of FAI. We also propose an approach for future research in this field and emphasise the importance of quantifying early OA in FAI based on magnetic resonance imaging (MRI) scans and the amount of chondral damage seen during open or arthroscopic surgery. PMID:24687267

  18. Open reduction and internal fixation for treatment of severely impacted valgus proximal humeral fractures%切开复位内固定治疗严重嵌插外展型肱骨近端骨折

    曹毅; 刘璠; 王洪; 周振宇; 陶然; 王友华

    2009-01-01

    目的 评价切开复位内固定治疗严重嵌插外展型肱骨近端骨折的临床效果.方法 004年4月-2008年2月,手术治疗严重嵌插外展型肱骨近端骨折23例,采用改良的Thompson切口切开复位,用肱骨近端锁定钢板固定,其中20例行一期自体骨移植,8例术中发现有明显的肩袖撕裂而行修补术.术后进行系统的肩关节功能锻炼.结果 23例获得1年以上的随访,平均随访时间为17个月(12~33个月).所有骨折均于术后2个月内愈合,最近一次X线片检查未出现内固定失效和肱骨头坏死.采用肩关节Neer评分系统评分:优9例,良10例,可3例,差1例;优良率为82.6%.患者主观满意率为91.3%.5例出现供骨区髂部疼痛.结论 采用切开复位LPHP内固定治疗严重嵌插外展型肱骨近端骨折有利于早期功能锻炼,疗效满意.%Objective To assess the clinical results of open reduction and internal fixation(ORIF) for treatment of severely impacted valgus proximal humeral fractures. Methods From April 2004 to February 2008,twenty-three patients with a severely impacted valgus fractures of the proximal part of the humerus were treated with ORIF.The modified Thompson approach was employed to facilitate open reduction of the fractures and fixation with LPHP.Autologous bone graft was filled in the metaphyseal defect created behind the humeral head following its reduction in 20 cases.The rotator cuff tear was identified in 8 cases and was repaired with nonabsorbable sutures during the surgery.Systematic rehabilitation of the shoulder joint was performed postoperatively. Results All patients were followed up for at least one year,with an averaged of 17 months (ranged from 12 to 33 months).All fractures united within two years postoperatively.No patient had signs of internal fixation failure and avascular necrosis on the latest radiographys.The clinical outcomes were rated using Neer score system.Nine cases were graded as excellent,10 cases as good,3

  19. Absorbable internal fixation materials in the repair of patellar transverse fractures%可吸收内固定材料修复髌骨横断性骨折

    王峰; 贾金领

    2016-01-01

    BACKGROUND: In recent years, al kinds of absorbable internal fixation materials have been used in the clinical treatment of patel ar transverse fractures. OBJECTIVE: To investigate the repairing effect of absorbable internal fixation materials on patel ar transverse fractures. METHODS: Total y 102 cases of fresh patel ar transverse fractures were included 62 males and 40 females cases, with a mean age of (41.85±11.15) years, and according to treatment methods, they were divided into two groups: observation group (n=52) using absorbable screws for reconstruction and control group (n=50) using Kirschner wire repair. At 12 months after repair, Lysholm knee function score were measured and evaluated, and the occurrence of adverse events was recorded. RESULTS AND CONCLUSION: The knee function score and excel ent rate of the observation group were significantly higher than those of the control group (both P < 0.05). In the observation group, there were four cases of fracture displacement, but no skin irritation and other adverse events occurred; in the control group, there were two cases of nonunion and five cases of skin irritation or internal fixation loosening and slippage. Therefore, there was a higher incidence of adverse events in the control group compared with the observation group (P < 0.05). These experimental results show that the use of absorbable screws in the repair of patel ar transverse fracture can promote the functional recovery of the knee joint, with good biocompatibility.%背景:近几年来,各种可吸收内固定材料开始被积极应用于各种髌骨横断性骨折的临床治疗中。目的:探讨可吸收内固定材料修复髌骨横断性骨折的效果。方法:纳入102例新鲜髌骨横断性骨折患者,其中男62例,女40例,年龄(41.85±11.15)岁,按治疗方法分为2组,观察组(n=52)采用可吸收螺钉修复,对照组(n=50)采用改良张力带钢丝内固定修复。修复后12个月,进行 Lysholm

  20. Different fixation methods for transverse acetabular fracture:a finite element analysis%有限元分析髋臼横行骨折不同植入物的内固定方式

    周坚锋; 李建涛; 张浩; 李辰; 尹鹏; 李志锐; 陈宇翔; 唐佩福; 张立海

    2016-01-01

    BACKGROUND:Transverse acetabular fracture often involves the damage of anterior and posterior columns of acetabulum. The most popular fixation of the anterior and posterior columns needs the combined anterior and posterior approach. Big trauma is not conducive to patient’s recovery after surgery. Limited incision or percutaneous minimaly invasive lag screw placement can reduce soft tissue injuries, but the strength of the fixation lacks of biomechanical verification. OBJECTIVE: To compare different types of fixations for transverse acetabular fracture, explore the appropriate fixation options that can achieve effective fixation and reduce tissue injury by combing with repair approach and the condition of soft tissue. METHODS: The fourth generation of synthetic semi-pelvic sawbones was set as a template to establish a model of acetabular transverse fracture using finite element analysis. Five different fixation options were used to fix the transverse acetabular fracture. The magnitudes of anterior and posterior displacement of transverse fracture were compared to assess the stability of different options under a simulated condition of incomplete weight bearing stand. RESULTS AND CONCLUSION:The motion at anterior column was minimal when fixed by anterior column locking plate + posterior column screw and the minimum displacement at posterior column was the fixation of anterior column screw + posterior column locking plate. Both of the motions of these two fixations were less than the reconstruction plate fixation respectively. The worst fixation was the anterior column and posterior column lag screw fixation with the largest displacement. The anterior column locking plate + posterior column screw, accomplished by single approach, could not only reduce surgical trauma, but also has a stronger stability. Moreover, this fixation option is effective method to place posterior column lag screw under direct vision and reduce the difficulty of screw implantation.%背景:

  1. Fracture mechanics

    This book entitle ''Fracture Mechanics'', the first one of the monograph ''Materiologie'' is geared to design engineers, material engineers, non destructive inspectors and safety experts. This book covers fracture mechanics in isotropic homogeneous continuum. Only the monotonic static loading is considered. This book intended to be a reference with the current state of the art gives the fundamental of the issues under concern and avoids the developments too complicated or not yet mastered for not making reading cumbersome. The subject matter is organized as going from an easy to a more complicated level and thus follows the chronological evolution in the field. Similarly the microscopic scale is considered before the macroscopic scale, the physical understanding of phenomena linked to the experimental observation of the material preceded the understanding of the macroscopic behaviour of structures. In this latter field the relatively recent contribution of finite element computations with some analogy with the experimental observation is determining. However more sensitive analysis is not skipped

  2. Phalangeal bone mineral density predicts incident fractures

    Friis-Holmberg, Teresa; Brixen, Kim; Rubin, Katrine Hass;

    2012-01-01

    This prospective study investigates the use of phalangeal bone mineral density (BMD) in predicting fractures in a cohort (15,542) who underwent a BMD scan. In both women and men, a decrease in BMD was associated with an increased risk of fracture when adjusted for age and prevalent fractures...... Examination Survey 2007-2008. BMD at the middle phalanges of the second, third and fourth digits of the non-dominant hand was measured using RA (Alara MetriScan®). These data were merged with information on incident fractures retrieved from the Danish National Patient Registry comprising the International...

  3. Fracture and crack growth in orthotropic laminates. Part 2: Experimental determination of internal damage growth in unidirectional boron/aluminum composite laminates

    Goree, J. G.

    1982-01-01

    The fracture behavior of unidirectional boron/aluminum composite laminates is investigated in order to verify the results of mathematical models. These models predict the stresses and displacements of fibers and the amount of damage growth in a center-notched lamina as a function of the applied remote stress and the matrix and fiber material properties. The damage may take the form of longitudinal yielding and splitting in the matrix as well as stable transverse damage consisting of broken fibers and matrix yielding ahead of the notch. A brittle lacquer coating is used to detect the yielding in the matrix while X-ray techniques are used to detemine the number of broken fibers in the laminate. The notched strengths and the amounts of damage found in the experimental specimens agree well with those predicted by the mathematical model.

  4. Achados em ressonância magnética artrográfica de indivíduos com lesão do labrum acetabular Magnetic resonance arthrographic findings in subjects with acetabular labral tears

    André Luiz Almeida Pizzolatti; Alessandro Haupenthal; Adriano Marostika; Richard Prazeres Canella; Ademar José de Oliveira Paes Junior; Sérgio Marcondes Brincas

    2011-01-01

    OBJETIVO: Descrever os achados em artro RM de sujeitos com suspeita de lesão do labrum acetabular. MÉTODO: Foram analisadas 108 artro RM de quadris em 2007/2008. Dois radiologistas independentemente analisaram as imagens e foi considerada a resposta comum entre eles. Com base em seus pareceres observou-se o local e estadiamento das lesões labrais e condrais, as alterações anatômicas, e a presença de tendinite e bursite trocantérica. RESULTADO: As lesões labrais grau I ocorreram em 41% dos cas...

  5. Fixation of displaced proximal humeral fractures with proximal humeral internal locking plate in the elderly%肱骨近端锁定型钉板治疗老年人移位的肱骨近端骨折

    纪泉; 文良元; 薛庆云; 赵立连; 黄公怡

    2011-01-01

    Objective To investigate the treatment effect of the proximal humeral internal locking system (PHIL()S) on the elderly patients with displaced proximal humeral fractures.Methods From Feb 2004 to Mar 2007, 36 patients (mean age: 72.2 years) with proximal humeral fractures were treated with PHILOS plate fixation which included 14 cases with 2-part, 17 cases with three-part and 5 cases with four-part fractures according to Neer classification. Operation time,intraoperative blood loss, blood transfusion, perioperative complications and function evaluation of the operated shoulder joint were calculated with 14.5 months follow-up at average.Results The average operation time and blood loss were (61.5± 11.6) min and ( 165.2±91.2) ml, respectively. 1 case with accidents of blood vessel and 1 case with pneumonia were found without neurovascular injuries. All fractures were radiographically healed in an average of 3-5 months. No necrosis of humeral head appeared and 30 (83.3%) cases were excellent or good according to Neer scoring system. Two part fracture and early operation ( within 3 days after operation) might improve the postoperative function of shoulder joint, but the patient's age, gender and ASA score were not statistically with Neer score.Conclusions PHILOS plate fixation is a suitable procedure for displaced proximal humeral fractures via stable fixation and early rehabilitation, especially for elderly patients combined with osteoporosis.%目的 探讨肱骨近端锁定型钉(PHILOS)板治疗老年人移位的肱骨近端骨折的疗效。方法 回顾性分析2004年2月至2007年3月用PHILOS板治疗的36例肱骨近端骨折患者,Neer分型二部分骨折14例,三部分骨折17例,四部分骨折5例。统计手术时间、输血量和手术并发症,评价肩关节功能。 结果 患者平均年龄72.2岁,平均随访14.5个月。术中平均输血165.2 ml,术后X线显示骨折复位满意,无神经、血管损

  6. Amputated Lower Limb Fixation to the Fracture Table.

    Gamulin, Axel; Farshad, Mazda

    2015-11-01

    Fractures of the proximal and diaphyseal femur are frequently internally fixed using a fracture table with fracture reduction obtained by traction and adequate rotation exerted on the slightly abducted extremity. Although rare, these fractures may occur on an amputated limb. If so, standard use of a fracture table is not possible. To address this situation, the authors describe a simple novel technique allowing rigid fixation of the amputated limb to the traction device of the fracture table that provides accurate control of reduction in all planes. PMID:26558660

  7. The acetabular fossa hot spot on {sup 18}F-FDG PET/CT: epidemiology, natural history, and proposed etiology

    Kubicki, Shelby L. [Trinity University, San Antonio, TX (United States); Richardson, Michael L. [University of Washington, Department of Radiology, Seattle, WA (United States); Martin, Thomas [X-Ray Associates of New Mexico, Department of Radiology, Albuquerque, NM (United States); Rohren, Eric [The University of Texas M.D. Anderson Cancer Center, Department of Diagnostic Radiology, Division of Nuclear Medicine, Houston, TX (United States); Wei, Wei [The University of Texas M.D. Anderson Cancer Center, Department of Biostatistics, Houston, TX (United States); Amini, Behrang [The University of Texas M.D. Anderson Cancer Center, Department of Diagnostic Radiology, Division of Musculoskeletal Radiology, Houston, TX (United States)

    2015-01-15

    To describe a benign focus of increased activity in the acetabular fossa (the acetabular fossa hot spot, AFHS) on {sup 18}F-FDG PET/CT that can mimic a neoplasm. {sup 18}F-FDG PET/CT images from four patient populations were examined. Group 1 (n = 13) was collected from a search of radiology reports and used to define the AFHS and for hypothesis generation. Group 2 (n = 1,150) was used for prevalence of AFHS. Group 3 (n = 1,213) had PET/CT and MRI pelvis within a week of each other and was used to correlate metabolic and anatomic findings. Group 4 (n = 100) was used to generate the control group. Data were collected on demographics, common comorbidities, underlying cancer diagnosis and status, and hip symptoms. Prevalence of AFHS was 0.36 % (95 % CI 0.10-0.91 %). None progressed to malignancy or was associated with cancer status. The majority (71 %) were on the left, and 6 % were bilateral. Mean SUV{sub max} of the AFHS was 4.8 (range, 2.7-7.8). Male patients were more likely to have the AFHS (OR = 8.69, 95 % CI 1.88-40.13). There was no difference with respect to other collected data, including hip symptoms. Average minimum duration of AFHS was 346 days (range, 50-1,010 days). Readers did not detect corresponding hip abnormalities on MRIs. AFHS is a benign finding that may be caused by subclinical ligamentum teres injury, focal synovitis, or degeneration of acetabular fossa fat. Despite uncertainty regarding its etiology, recognition of AFHS as a benign finding can prevent morbidity associated with unnecessary biopsy or initiation of therapy. (orig.)

  8. The acetabular fossa hot spot on 18F-FDG PET/CT: epidemiology, natural history, and proposed etiology

    To describe a benign focus of increased activity in the acetabular fossa (the acetabular fossa hot spot, AFHS) on 18F-FDG PET/CT that can mimic a neoplasm. 18F-FDG PET/CT images from four patient populations were examined. Group 1 (n = 13) was collected from a search of radiology reports and used to define the AFHS and for hypothesis generation. Group 2 (n = 1,150) was used for prevalence of AFHS. Group 3 (n = 1,213) had PET/CT and MRI pelvis within a week of each other and was used to correlate metabolic and anatomic findings. Group 4 (n = 100) was used to generate the control group. Data were collected on demographics, common comorbidities, underlying cancer diagnosis and status, and hip symptoms. Prevalence of AFHS was 0.36 % (95 % CI 0.10-0.91 %). None progressed to malignancy or was associated with cancer status. The majority (71 %) were on the left, and 6 % were bilateral. Mean SUVmax of the AFHS was 4.8 (range, 2.7-7.8). Male patients were more likely to have the AFHS (OR = 8.69, 95 % CI 1.88-40.13). There was no difference with respect to other collected data, including hip symptoms. Average minimum duration of AFHS was 346 days (range, 50-1,010 days). Readers did not detect corresponding hip abnormalities on MRIs. AFHS is a benign finding that may be caused by subclinical ligamentum teres injury, focal synovitis, or degeneration of acetabular fossa fat. Despite uncertainty regarding its etiology, recognition of AFHS as a benign finding can prevent morbidity associated with unnecessary biopsy or initiation of therapy. (orig.)

  9. Distal radius triplane fracture

    Parkar, AAH; Marya, S.; Auplish, S

    2014-01-01

    A triplane fracture is so named because of the three planes traversed by the fracture line. These are physeal fractures that result from injury during the final phase of maturation and cessation of growth. This fracture pattern typically involves the distal tibia. We present a rare case of a triplane fracture involving the distal radius.

  10. Precision of radiostereometric analysis (RSA) of acetabular cup stability and polyethylene wear improved by adding tantalum beads to the liner

    Nebergall, Audrey K; Rader, Kevin; Palm, Henrik;

    2015-01-01

    Background and purpose - In traditional radiostereometric analysis (RSA), 1 segment defines both the acetabular shell and the polyethylene liner. However, inserting beads into the polyethylene liner permits employment of the shell and liner as 2 separate segments, enabling distinct analysis of the...... precision of 3 measurement methods in determining femoral head penetration and shell migration. Patients and methods - The UmRSA program was used to analyze the double examinations of 51 hips to determine if there was a difference in using the shell-only segment, the liner-only segment, or the shell + liner...

  11. 平行双钢板双柱固定技术治疗成人肱骨远端粉碎骨折%Parallel-double-plate internal fixation technique in the treatment of distal humeral comminuted fracture in adults

    陈广辉; 王洪伟; 阮美树

    2013-01-01

    目的 评价平行双钢板双柱固定技术重建成人肱骨远端粉碎性骨折的手术效果.方法 2006年10月至2009年10月,采用切开复位平行双钢板双柱固定技术治疗成人肱骨远端粉碎性骨折20例,受伤至手术时间平均2d,手术采用肘后正中切口,术后3d开始保护性功能锻炼.所有患者按照Mayo肘关节功能评分(MEPS)评价,影像学检查评价内固定及骨折愈合情况.结果 20例患者均获随访,时间(18.4±2)个月.X线证实骨折均一期愈合,无伤口感染及神经损伤并发症,无短缩和旋转畸形,无内固定失败.术后1年随访MEPS中位分数86分,优良率85.3%.结论 平行双钢板双柱内固定治疗肱骨远端复杂骨折可实现骨折早期稳定固定,有助于患肢早期功能锻炼及关节功能的恢复.%Objective To assess the effects of parallel-double-plate internal fixation on distal humeral comminuted fracture in adults.Methods Twenty consecutive adults with distal humeral comminuted fracture who received open reduction and internal fixation with parallel-double-plating at day 2 following bone facture between October 2006 and October 2009 were enrolled.Posterior elbow median incision was adopted for surgery.The functional exercise program commenced at day 3 postoperatively.The function of elbow was assessed by Mayo elbow performance score (MEPS),and the internal fixation and fracture healing by plain X-ray films.Results The 20 patients were followed up for 12 to 36 months [mean (18.4±2.0) months].Neither infection of incisions,nor nerve injury,or deformity of shortening,rotation,or implantation failure were found.The median MEPS was 86 points and the overall excellence rate was 85.3% in the first year of follow-up.Conclusion The parallel-double-plate technique may facilitate early-stage solid fixation of distal humeral comminuted fracture and promote postoperative functional exercise of the affected extremity and joint rehabilitation.

  12. Is Fibular Fracture Displacement Consistent with Tibiotalar Displacement?

    van den Bekerom, Michel P. J.; van Dijk, C. Niek

    2009-01-01

    We believed open reduction with internal fixation is required for supination-external rotation ankle fractures located at the level of the distal tibiofibular syndesmosis (Lauge-Hanssen SER II and Weber B) with 2 mm or more fibular fracture displacement. The rationale for surgery for these ankle fractures is based on the notion of elevated intraarticular contact pressures with lateral displacement. To diagnose these injuries, we presumed that in patients with a fibular fracture with at least ...

  13. Distal humerus fractures: a review of current therapy concepts

    Amir, Steinitz; Jannis, Sailer; Daniel, Rikli

    2016-01-01

    Fractures of the distal humerus in the adult comprise approximately one third of all humeral fractures. Successful management of distal humerus fractures depends on correct reduction of the fracture, reconstruction of the articular surface if needed, stability and rigidity of the fixation, and appropriate rehabilitation. In this review, we evaluated the available literature and highlighted current therapy concepts. We assessed the evolution of internal fixation and elbow arthroplasty focusing...

  14. Press fit shape femoral heads for acetabular reconstruction - 5 to 8 years results

    Filling of acetabular defects with allograft bone is a favourable method in revision-THR provided that primary stability and load bearing capability can be achieved. Since 1990 we perform structural allografting in the acetabular area using a special technique. Defects are prepared with hemispherical reamers (male) in order to obtain a smooth concave surface. Deep-frozen femoral heads are then prepared using female shapers of a diameter 0-4mm larger, thus obtaining a convex surface fitting precisely into the prepared bed. In ideal cases a press-fit can be obtained granting primary stability without additional implants, otherwise we secure the grafts against rotation with one or two traction screws in loading-direction. Implantation of the cup is performed like in primary THR, care is taken to place the implant exactly at the anatomically correct position. Weight bearing is performed as soon as after primary THR; due to the technique loads are distributed evenly over the entire contact area to host bone, pressing the graft firmly into its bed. From 1990 to 1993 this method has been used in 179 cases. 104 cases could be followed between 60 and 95 months (average 71,5 months). Mean age at operation was 66,5 years (39-87 vears). Defects were classified according to Gross as cavitary in 15, minor column in 50 and major column in 39 cases. 85x the cup has been cemented, 19x cementless. One uncemented and 7 cemented cups loosened, all within the first 2 years. 6 meanwhile have been revised a second time. Those usually were cases, where the cup was placed in a non-anatomical position and / or the graft was not secured against rotatory forces. In 17 cases we observed slight condensation of the grafts with consequent migration of the implants. Migration usually did not exceed 5mm and no other signs of implant loosening have been associated. Radiographs indicated a unifon-n pattern of rapid graft-incorporation. Remodelling seemed to be completed after the second year, from

  15. 后内侧入路切开复位内固定治疗后 Pilon 骨折的疗效分析%Clinical outcome of open reduction and internal fixation through posteromedial approach for posterior Pilon fracture

    黄晓楠; 郝磊; 沈明杰; 范猛

    2015-01-01

    Objective To evaluate the clinical outcome of open reduction and internal fixation through pos -teromedial approach for the treatment of posterior Pilon fracture .Methods Data of 139 patients with posterior mal-leolar fractures from Apr .2008 to Apr.2013 in our hospital were retrospectively analyzed .Among them,29 patients whose X ray and CT scan showed posterior Pilon fracture were involved in this study .There were 19 males and 10 females with the mean age of 46.3 years(ranged from 21 to 74 years).The mechanism of injury included falling in 12 patients,strain in 10 patients,and motor vehicle accidents in 7 patients.All patients were accompanied with lat-eral malleolus fracture and articular cartilage collapse .All patients had foot and ankle swelling ,deformity and re-stricted movement .Open reduction and internal fixation through posteromedial approach was applied .The period from injury to surgery was 1 to 11 days,with an average of 5.3 days.The condition of wound and fracture healing was regularly recorded after operation .Function was evaluated according to the AOFAS Ankle Hindfoot Scale .Re-sults All 29 patients were followed up for 15 to 47 months(mean,24.6 months).The incisions in all patients re-ceived primary healing .Postoperative X ray showed anatomical reduction in 26 patients with no articular collapse and normal ankle mortise and 1 mm of collapse and 1mm widening of the medial ankle mortise in 3 patients.The rate of anatomical reduction was 89.7%(26/29).All patients achieved fracture union and the healing time ranged from 12 to 21 weeks(mean,15.2 weeks).The AOFAS Ankle Hindfoot Scale were 81 to 100 points(mean,89.5 points).There were excellent outcomes in 21 patients and good in 8 patients,and the excellent and good rate was 100%.Conclusion Treatment of posterior Pilon fracture through posteromedial approach can achieve a good sur -gical field and easy anatomical reduction with satisfactory clinical outcome .Therefore,the posteromedial approach

  16. The Use of Iliac Stem Prosthesis for Acetabular Defects following Resections for Periacetabular Tumors

    De Paolis, Massimiliano; Romagnoli, Carlo; Alì, Nikolin; Giannini, Sandro; Donati, Davide Maria

    2013-01-01

    Introduction. The management of pelvic tumors is a challenge for orthopaedic oncologists due to the complex anatomy of the pelvis and the need to have extensive exposure. Various reconstructive techniques have been proposed with poor functional results and a high percentage of complications. Our purpose is to determine the functional results and the rate of complications of iliac stem prosthesis for acetabular defects following resections for periacetabular tumors. Materials and Methods. Between 1999 and 2012, 45 patients underwent pelvic resections for periacetabular bone tumors followed by reconstruction with stem cup prosthesis. The most common diagnosis was CS (chondrosarcoma, 29 cases), followed by OS (osteosarcoma, 9 cases) and metastasis (3 cases). In 33 cases, this implant was associated with massive bone allografts. Minimum follow-up required to evaluate functional outcome was 2 years. We classified pelvic resections according to Enneking and Dunham's classification and we used MSTS (musculoskeletal tumor system) score to evaluate functional outcomes. Results and Discussion. Sixteen patients died of their disease, three were lost to follow-up, four are alive with disease, and twenty-two are alive with no evidence of disease. Fifteen patients had local recurrence. Sixteen patients had bone or lung metastasis. We have had 6 infections, 2 aseptic loosening, and 2 cases of hip dislocation. Iliac sovracetabular osteotomy was fused in all cases at 10 months from surgery. Functional results were good or excellent in 25 of 31 patients with long-term follow-up (77%), with a percentage similar to that reported in the literature. Conclusion. The use of iliac stem prosthesis is a simple reconstructive technique that reduces operative times and risk of infection. It allows having good results and low rate of complications, but it should be performed in selected cases and centres of reference. PMID:24250275

  17. 小针刀结合手法对髌骨骨折内固定术后膝关节创伤性关节炎的治疗效果观察%Curative Effect Observation on Needle Knife Combined With Manipulation on Patella Fracture After Internal Fixation of Knee Joint Traumatic Arthritis

    乔正华

    2015-01-01

    ObjectiveTo observe the summary with needle knife combined with surgery for patelar fracture by internal fixation after traumatic arthritis of knee joint treatment effect.Methods Study from 32 cases of patelar fracture by internal fixation after knee joint traumatic arthritis patients with smal needle knife combined with surgical treatment.Results32 cases of patelar fracture internal fixation after the treatment of traumatic arthritis of the knee joint was 93.8%.Conclusion Patelar fracture after internal fixation of knee joint traumatic arthritis patients with needle knife combined with operation therapy significantly.%目的:观察总结小针刀结合手法对髌骨骨折内固定术后膝关节创伤性关节炎的治疗效果。方法研究收治的32例髌骨骨折内固定术后膝关节创伤性关节炎患者用小针刀联合手法治疗效果。结果32例髌骨骨折内固定术后膝关节创伤性关节炎治疗后优良率为93.8%。结论髌骨骨折内固定术后膝关节创伤性关节炎患者实施小针刀结合手法治疗疗效显著。

  18. 内外侧切口入路植入物内固定治疗肱骨中下段骨折%Internal fixation via medial and lateral approaches for the middle and inferior humeral fracture

    王伟; 艾尔肯•玉麦尔; 张青春; 艾合买提江•玉素甫

    2014-01-01

    BACKGROUND:The open reduction and internal fixation in treatment of middle and inferior humeral fractures often choose anterolateral approach. As the rapid development of microsurgical technique in recent years, some domestic hospitals try to adopt the medial approach, but the operation safety and efficacy are rarely reported. OBJECTIVE:To evaluate the clinical efficacy of two different approaches of open reduction and internal fixation for treating the middle and inferior humeral fractures. METHODS:A total of 68 patients with the middle and inferior humeral fractures were selected from Orthopedic Center of Xinjiang Medical University from January 2010 to January 2012, and were retrospectively analyzed. According to the approach of incision, the involved patients were divided into anterolateral approach group (n=33) and medial approach group (n=35). The blood loss in two groups was analyzed using Gross equation. The postoperative complications and functional recovery were compared. RESULTS AND CONCLUSION:During the fol ow-up at 12-18 months, X-ray results showed that the fractures achieved bone healing, fracture healing time was 16.9±3.9 weeks in anterolateral approach group and 15.5±2.2 weeks in the medial approach group. Shoulder Neer system score was 86±5 points in anterolateral approach group and 84±4 points in the medial approach group;elbow Mayo system score was 78±7 points in anterolateral approach group and 81±8 points in the medial approach group. Three cases in anterolateral approach group and one case in medial approach group presented postoperative radial nerve numbness and wrist dorsiflexion weakness, which were self-healed after 3 months. There was no nonunion, chronic osteomyelitis for other complications. The fracture healing time, the incidence of complications and the functional recovery between the two groups showed no significant difference (P>0.05). The medial approach is a feasible and safe surgical approach of internal fixation for

  19. Open Calcaneus Fractures and Associated Injuries.

    Worsham, Jacob R; Elliott, Mark R; Harris, Anthony M

    2016-01-01

    Open calcaneus fractures are usually the result of high-energy mechanisms and are associated with other orthopedic and whole body system injures. Understanding the difference between open versus closed fractures is essential for the provider, and they must be vigilant for the associated injuries that present with this condition. We performed a retrospective medical record review of 62 patients (64 calcaneus fractures) with open calcaneus fractures from January 2003 to January 2013 presenting at a level 1 trauma center. Sex, age, laterality, mechanism of injury, wound appearance, initial management, and associated injures were recorded. The most common mechanisms were motor vehicle accidents (35 [56.4%]) and falls from >6 ft (15 [24.1%]). Four (6.4%) patients had a posterior tibial artery transection. Eight (12.9%) patients had a femoral shaft fracture, 14 (22.5%) an ipsilateral ankle fracture, 16 (25.8%) a metatarsal fracture, and 11 (17.7%) had associated midfoot fractures. Of the midfoot fractures, 12 (19.3%) patients had a talus fracture and 5 (8.0%) a cuboid fracture. Spinal fractures were present in 9 (14.5%) of the patients, with lumbar fractures occurring in 6 (9.6%) patients. Fifteen (24.1%) patients had associated upper extremity fractures. Thirteen (20.9%) patients had an associated pulmonary injury, including 8 pneumothoraces. Ten (16.1%) patients had a closed head injury and 6 (9.6%) had an abdominal injury. Fifteen (23.4%) patients were treated with percutaneous wire fixation and 7 (10.9%) with open reduction internal fixation. A total of 44 (68.7%) fractures were treated without internal fixation. Overall, 5 (8.0%) patients with an open calcaneus fracture eventually underwent a below-the-knee amputation. Open calcaneus fractures are severe, high-energy injuries with the potential for considerable morbidity to the patient, given the high rate of concomitant orthopedic and whole body system injuries. Type III open injuries have an increased risk of

  20. Probabilistic application of fracture mechanics

    The different methods used to evaluate the rupture probability of a pressure vessel are reviewed. Data collection and processing of all parameters necessary for fracture mechanics evaluation are presented with particular attention to the size distribution of defects in actual vessels. Physical process is followed during crack growth and unstable propagation, using LEFM (Linear Elastic Fracture Mechanism) and plastic instability. Results show that the final failure probability for a PWR pressure vessel is 3.5 10-8, and is due essentially to LOCAs for any break size. The weakest point is the internal side of the belt line

  1. Trapezoid fracture caused by assault

    Malshikare V

    2007-01-01

    Full Text Available In this report we describe an open fracture of trapezoid and break in anterior cortex of capitate due to assault in a young adult male. Direct impact force of a sharp object to the first web space caused the above fractures. Open reduction and internal fixation of the trapezoid was carried out using Kirschner wires. Cut extensor tendons, extensor retaniculum, capsule, adductor pollicis muscle, first dorsal interosseous muscle, soft tissue and overlying skin were sutured primarily. Three months after the operation the patient has made a complete recovery. There is no similar case reported in the literature.

  2. Comparative study of open reduction and internal fixation versus external fixation combined with limited internal fixation in the treatment of Pilon fractures%切开复位内固定与有限内固定结合外固定治疗胫骨Pilon骨折的对比研究

    张小兵

    2012-01-01

    目的 比较切开复位内固定与有限内固定结合外固定治疗胫骨Pilon骨折的疗效.方法 将76例经X线或CT证实的胫骨Pilon骨折患者随机分为研究组(n = 38,接受有限内固定结合外固定架治疗)和对照组(n = 38,接受切开复位内固定术),比较两组骨折愈合时间、患者术后踝关节功能恢复情况及并发症发生情况.结果 研究组平均骨折愈合时间[(5.9±0.6)个月]较对照组[(5.2±0.4)个月]稍长,但差异无统计学意义(P > 0.05);两组患者术后踝关节功能均得到恢复,但研究组疗效优良率(84.21%)显著高于对照组(68.42%)(P < 0.05);研究组并发症发生率为15.79%(6/38),显著低于对照组的28.95%(11/38)(P < 0.05),其中软组织感染发生率较对照组高(P < 0.05),骨髓炎及骨折畸形愈合发生率较对照组低(P < 0.05),关节融合发生率差异无统计学意义(P > 0.05).结论 有限内固定结合外固定治疗胫骨Pilon骨折操作简单、安全,并发症少,可获得较好的踝关节功能和预后,值得临床推广应用.%Objective To compare the efficacy of open reduction and internal fixation versus external fixation combined with limited internal fixation in the treatment of Pilon fractures. Methods 76 patients with Pilon fractures confirmed by X-ray or CT were divided into study group (n = 38, received external fixation combined with limited internal fixation) and control group (n = 38, received open reduction and internal fixation) at random, the fracture healing time, postoperative ankle joint function recovery and complications of the two groups were compared. Results The mean fracture healing time of study group was (5.9 ±0.6) months, slightly longer than control group of (5.2±0.4) months, but no statistical difference was observed (P > 0.05). The ankle joint function of both groups was well recovered, but the good rate of study group (84.21%) was significantly higher than control group (68.42%) (P 0

  3. Three-dimensional magnetic resonance imaging analysis of hip morphology in the assessment of femoral acetabular impingement

    Kavanagh, E.C. [Department of Radiology, Mater Misericordiae Hospital, Dublin (Ireland); Read, P.; Carty, F.; Zoga, A.C. [Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA (United States); Parvizi, J. [The Rothman Institute of Orthopedics, Philadelphia, PA (United States); Morrison, W.B., E-mail: William.Morrison@Jefferson.edu [Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA (United States)

    2011-08-15

    Aim: To determine a possible association between femoral-acetabular impingement (FAI) volume and the development of labral tear using a three-dimensional (3D) model reconstruction of the acetabulum and the femoral head. Materials and methods: Magnetic resonance arthrography images of the hip in 42 patients with pain and suspected labral tear were acquired using a 1.5 T MRI machine. Using 3D analysis software, outlines of the acetabular cup and femoral head were drawn and 3D reconstruction obtained. To control for differences in patient size, ratios of acetabulum : femoral head volume (AFV) and acetabulum : femoral head surface area (AFA) were used for analysis. The association between volume of acetabulum : femoral head and FAI was investigated using ANOVA analysis. Results: There were 19 men and 23 women with a mean age of 39 years (range 18-78 years). The average AFV was 0.64 (range 0.37-1.05, SD 0.16) and AFA was 0.73 (range 0.36-1.26, SD 0.23). Herniation pit was significantly associated with a small AFV. Conclusion: Femoral neck herniation pits are associated with a low AFV. Gross volume and surface area ratios do not appear to correlate with labral tears or cartilage loss. This technique will enable more advanced analysis of morphological variations associated with FAI.

  4. Distal tibia fractures: management and complications of 101 cases

    Joveniaux, Pierre; Ohl, Xavier; Harisboure, Alain; Berrichi, Aboubekr; Labatut, Ludovic; Simon, Patrick; Mainard, Didier; Vix, Nicolas; Dehoux, Emile

    2009-01-01

    Distal tibia fractures are complex injuries with a high complication rate. In this retrospective and multicentre study we attempted to detail complications and outcomes of this type of injury in order to determine predictive factors of poor results. Between 2002 and 2004, 104 patients were admitted for 105 distal tibia fractures. One hundred patients (101 fractures) were reviewed with an average follow-up of 19 months (range, 12–46). Internal fixation, external fixation, limited internal fixa...

  5. Management of distal humerus fractures.

    McCarty, L Pearce; Ring, David; Jupiter, Jesse B

    2005-09-01

    Fractures of the distal humerus are complex injuries that can be effectively treated with open reduction and internal fixation (ORiF). Exposure of a complex intra-articular fracture may best be achieved through a posterior approach with osteotomy of the olecranon process. The ulnar nerve must be identified and protected, the articular surface must be reduced anatomically, and rigid fixation must be applied to both the medial and lateral columns of the distal humerus. Range of motion should be initiated as soon as possible postoperatively. Complications such as ulnar neuropathy, elbow stiffness, heterotopic ossification, and nonunion should be treated aggressively. Total elbow arthroplasty represents an effective option for fractures that cannot be treated with ORIF. PMID:16250484

  6. Dislocation of a dual mobility total hip replacement following fracture of the polyethylene liner.

    Vedrine, Bertrand; Guillaumot, Pierre; Chancrin, Jean-Luc

    2016-05-18

    An eight-year-old male English Setter was referred for management of a dislocation of a cemented dual mobility canine total hip prosthesis that occurred four months after the initial surgery. Revision surgery showed that the dislocation was associated with fracture of the ultra-high molecular weight polyethylene liner. The dislocation was successfully reduced after replacing the liner. A dual mobility acetabular component is composed of a mobile polyethylene liner inside a metallic cemented cup. Chronic wear of the components of a canine dual mobility total hip replacement has not been described previously. The use of this type of implant is fairly recent and limited long term follow-up of the implanted cases may be the explanation. Acute rupture of a polyethylene liner has never been described in humans, the only case of rupture of a polyethylene liner occurred 10 years after implantation. The case presented here of rupture of the polyethylene liner of a dual mobility total hip replacement is a hitherto unreported failure mode in this model of acetabular cup in the dog. PMID:26991949

  7. Bilateral femoral neck fractures following pelvic irradiation

    Over 300 cases of femoral neck fractures following radiotherapy for intrapelvic malignant tumor have been reported in various countries since Baensch reported this disease in 1927. In Japan, 40 cases or so have been reported, and cases of bilateral femoral neck fractures have not reached to ten cases. The authors experienced a case of 75 year-old female who received radiotherapy for cancer of the uterus, and suffered from right femoral neck fracture 3 months after and left femoral neck fracture one year and half after. As clinical symptoms, she had not previous history of trauma in bilateral femurs, but she complained of a pain in a hip joint and of gait disturbance. The pain in left femoral neck continued for about one month before fracture was recognized with roentgenogram. As histopathological findings, increase of fat marrow, decrease of bone trabeculae, and its marked degeneration were recognized. Proliferation of some blood vessels was found out, but thickness of the internal membrane and thrombogenesis were not recognized. Treatment should be performed according to degree of displacement of fractures. In this case, artificial joint replacement surgery was performed to the side of fracture of this time, because this case was bilateral femoral neck fractures and the patient had received artificial head replacement surgery in the other side of fracture formerly. (Tsunoda, M.)

  8. Application of internal fixation and external fixator for unstable pelvic fracture%内固定加外固定架在不稳定型骨盆骨折治疗中的应用

    张军; 郭克斌; 熊元波; 魏君虎; 张炼; 翟剑亭

    2011-01-01

    目的 探讨内固定加外固定支架手术在不稳定型骨盆骨折治疗中的临床应用及疗效.方法 对我院自2001年3月至2009年6月收治的137例不稳定型骨盆骨折患者的临床资料进行回顾性分析,本组患者均采用内固定加外固定支架手术治疗.其中车祸交通伤81例,高处坠落伤34例,塌方挤压伤22例.根据Tile's分型,本组中B型89例,C型48例.所有患者术后均获随访,随访时间1~6年.结果 本组中125例术后关节功能明显改善,疼痛缓解,各种并发症发生率低.采用Matta评定标准进行评估,术后优良率达91.3%.结论 内固定加外固定支架手术治疗不稳定型骨盆骨折的临床疗效良好,能够重建骨盆稳定性,是治疗此类骨折的有效方法.%Objective To evaluate the clinical application and effect of internal fixation and external fixator for treatment of unstable pelvic fracture.Methods From March 2001 to June 2009,137 patients with unstable pelvic fractures were treated by internal fixation and external fixator,a retrospective study was conducted. The injuries were caused by the traffic accident in 81 patients,following falling from high places in 34 patients,crush injury by collapse in 22 patients. According to Tile classification, 89 cases were Tile B,48 cases were Tile C. All the patients were followed up for 1 to 6 years. Results Among the 137 patients,excellent results were achieved in 125 cases with the improvement in joint function and easement of pain,with lower complications. All the patients were reviewed using the Matta evaluation system,the result showed that the clinical effective rate exceeded 91.3%.Conclusions Internal fixation combined with external fixator is a very good method,which was effective for the treatment of unstable pelvic fracture,it may be the most effective way to rebuild the stability of pelvic.

  9. 经皮撬拨复位空心钉内固定治疗跟骨关节内骨折%Percutaneous Reduction and Internal Fixation in the Treatment of Intra-articular Calcaneal Fractures

    王先辉; 陈舰; 胡孙君; 应正然

    2013-01-01

    Objective:To sum up the experience of percutaneous and internal fixation of intra-articular calcaneal fracture.Methods:Fom June 2007 to June 2010,Percutaneous reduction and internal fixtion was performed on 24 cases with intra-articular calcaneal fractures.According to Sanders classification,there were 19 feet of type Ⅱ (3 type Ⅱ a,5 type Ⅱ b and 11 type Ⅱ c) and 5 feet of type Ⅲac.Results:All patients were followed up for an average of 16 months (ranged from12 to 24 months).No complications such as wound infection,screw breakage and calcaneum varus were found postoperatively.The average time for bone healing was 14.5weeks.The results were excellent in 17 cases,good in 5 cases,average in 2 cases according to the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score.The rate of excellent and good clinical results was 91.6%.Radiography showed basic restoration of B(o)hler' s angle,Gissane' s angle and calcaneal shape.Conclusions:Percutaneous reduction and internal fixation is suitable for surgical treatment of Sanders Ⅱ and Ⅲ type calcaneal fractures,with advantages of simple operation,fewer complications and good clinical results.%目的:总结经皮撬拨复位空心钉内固定治疗跟骨关节内骨折的手术经验.方法:2007年6月~2010年6月,采用经皮撬拨复位空心钉内固定治疗跟骨骨折24例,其中SandersⅡ型19例(Ⅱ a型3例,Ⅱ b型5例,Ⅱ c11例),Sanders Ⅲ ac型5例.结果:所有患者术后随访12 ~24个月(平均16个月).术后均未发生切口感染、螺钉断裂及跟骨内翻等并发症.术后平均骨折愈合时间为14.5周.按美国足踝外科协会(AOFAS)后足评分系统评价疗效,优17例,良5例,一般2例,优良率91.6%.X线片检查示B(o)hler角、Gissane角、跟骨外形基本恢复正常.结论:经皮撬拨复位空心钉内固定适用于治疗Sanders Ⅱ,Ⅲ型跟骨骨折,具有操作简单、并发症少和临床疗效好等优点.

  10. MR findings in cases of suspected impacted fracture of the femoral neck

    Purpose: To evaluate MR imaging of the hip in patients with a clinically suspected impacted fracture of the femoral neck in cases where conventional plain films show negative or equivocal findings. Material and Methods: Twenty-seven such patients were prospectively examined by MR imaging with a 1.0 T unit, within 24 hours of admittance to hospital. A coronal T1-weighted turbo spin-echo sequence (n=27), and a coronal STIR sequence (n=25) or a coronal T2-weighted turbo spin-echo fast saturation sequence (n=2) were used. The evaluations were made by 2 radiologists with experience in musculoskeletal radiology. Results: There were 6 patients with a petrochanteric fracture, 2 without and 4 with slight displacement. Five patients had an impacted fracture of the femoral neck, and 3 had a fracture of the superior pubic bone. Of 2 patients with advanced arthrosis, i had an impacted femoral neck fracture and the other a nondisplaced intertrochanteric fracture. There was 1 patient who had sustained a nondisplaced acetabular fracture with increased joint fluid and muscle contusions. Three patients had muscle contusions only. Two patients had bone marrow contusions only, while 2 others with advanced coxarthrosis had increased joint fluid only. Three patients showed normal findings. Our findings led to emergency surgery in 13 cases, and conservative measures directed to the specific MR findings in 14 patients. Conclusion: MR imaging should be the first modality of choice in examining patients with a clinically suspected impacted fracture of the femoral neck where conventional films show negative or equivocal findings. (orig.)

  11. MR findings in cases of suspected impacted fracture of the femoral neck

    Stiris, M.G.; Lilleaas, F.G. [Aker Hospital, Oslo (Norway). Dept. of Diagnostic Radiology

    1997-09-01

    Purpose: To evaluate MR imaging of the hip in patients with a clinically suspected impacted fracture of the femoral neck in cases where conventional plain films show negative or equivocal findings. Material and Methods: Twenty-seven such patients were prospectively examined by MR imaging with a 1.0 T unit, within 24 hours of admittance to hospital. A coronal T1-weighted turbo spin-echo sequence (n=27), and a coronal STIR sequence (n=25) or a coronal T2-weighted turbo spin-echo fast saturation sequence (n=2) were used. The evaluations were made by 2 radiologists with experience in musculoskeletal radiology. Results: There were 6 patients with a petrochanteric fracture, 2 without and 4 with slight displacement. Five patients had an impacted fracture of the femoral neck, and 3 had a fracture of the superior pubic bone. Of 2 patients with advanced arthrosis, i had an impacted femoral neck fracture and the other a nondisplaced intertrochanteric fracture. There was 1 patient who had sustained a nondisplaced acetabular fracture with increased joint fluid and muscle contusions. Three patients had muscle contusions only. Two patients had bone marrow contusions only, while 2 others with advanced coxarthrosis had increased joint fluid only. Three patients showed normal findings. Our findings led to emergency surgery in 13 cases, and conservative measures directed to the specific MR findings in 14 patients. Conclusion: MR imaging should be the first modality of choice in examining patients with a clinically suspected impacted fracture of the femoral neck where conventional films show negative or equivocal findings. (orig.).

  12. Computer assisted determination of acetabular cup orientation using 2D-3D image registration

    2D-3D image-based registration methods have been developed to measure acetabular cup orientation after total hip arthroplasty (THA). These methods require registration of both the prosthesis and the CT images to 2D radiographs and compute implant position with respect to a reference. The application of these methods is limited in clinical practice due to two limitations: (1) the requirement of a computer-aided design (CAD) model of the prosthesis, which may be unavailable due to the proprietary concerns of the manufacturer, and (2) the requirement of either multiple radiographs or radiograph-specific calibration, usually unavailable for retrospective studies. In this paper, we propose a new method to address these limitations. A new formulation for determination of post-operative cup orientation, which couples a radiographic measurement with 2D-3D image matching, was developed. In our formulation, the radiographic measurement can be obtained with known methods so that the challenge lies in the 2D-3D image matching. To solve this problem, a hybrid 2D-3D registration scheme combining a landmark-to-ray 2D-3D alignment with a robust intensity-based 2D-3D registration was used. The hybrid 2D-3D registration scheme allows computing both the post-operative cup orientation with respect to an anatomical reference and the pelvic tilt and rotation with respect to the X-ray imaging table/plate. The method was validated using 2D adult cadaver hips. Using the hybrid 2D-3D registration scheme, our method showed a mean accuracy of 1.0 ± 0.7 (range from 0.1 to 2.0 ) for inclination and 1.7 ± 1.2 (range from 0.0 to 3.9 ) for anteversion, taking the measurements from post-operative CT images as ground truths. Our new solution formulation and the hybrid 2D-3D registration scheme facilitate estimation of post-operative cup orientation and measurement of pelvic tilt and rotation. (orig.)

  13. Computer assisted determination of acetabular cup orientation using 2D-3D image registration

    Zheng, Guoyan; Zhang, Xuan [University of Bern, Institute for Surgical Technology and Biomechanics, Bern (Switzerland)

    2010-09-15

    2D-3D image-based registration methods have been developed to measure acetabular cup orientation after total hip arthroplasty (THA). These methods require registration of both the prosthesis and the CT images to 2D radiographs and compute implant position with respect to a reference. The application of these methods is limited in clinical practice due to two limitations: (1) the requirement of a computer-aided design (CAD) model of the prosthesis, which may be unavailable due to the proprietary concerns of the manufacturer, and (2) the requirement of either multiple radiographs or radiograph-specific calibration, usually unavailable for retrospective studies. In this paper, we propose a new method to address these limitations. A new formulation for determination of post-operative cup orientation, which couples a radiographic measurement with 2D-3D image matching, was developed. In our formulation, the radiographic measurement can be obtained with known methods so that the challenge lies in the 2D-3D image matching. To solve this problem, a hybrid 2D-3D registration scheme combining a landmark-to-ray 2D-3D alignment with a robust intensity-based 2D-3D registration was used. The hybrid 2D-3D registration scheme allows computing both the post-operative cup orientation with respect to an anatomical reference and the pelvic tilt and rotation with respect to the X-ray imaging table/plate. The method was validated using 2D adult cadaver hips. Using the hybrid 2D-3D registration scheme, our method showed a mean accuracy of 1.0 {+-} 0.7 (range from 0.1 to 2.0 ) for inclination and 1.7 {+-} 1.2 (range from 0.0 to 3.9 ) for anteversion, taking the measurements from post-operative CT images as ground truths. Our new solution formulation and the hybrid 2D-3D registration scheme facilitate estimation of post-operative cup orientation and measurement of pelvic tilt and rotation. (orig.)

  14. Periacetabular osteotomy for acetabular dysplasia%髋臼周围截骨术治疗髋臼发育不良

    李华; 王云清; 魏东

    2011-01-01

    目的 探讨髋臼周围截骨术治疗髋臼发育不良的方法 及疗效.方法 对36例髋臼发育不良患者(43髋)行手术治疗,通过髋臼周围截骨、旋转髋臼向前外侧移位恢复髋臼的正确位置,并增加髋臼覆盖面.结果 36例均获随访,时间 6个月~3年.术后髋痛、跛行完全消失或有明显改善,髋关节活动范围基本正常.CE角和Sharp角均基本恢复正常.结论 髋臼周围截骨术可有效改善临床症状,恢复髋关节的生物力学特点,是治疗髋臼发育不良的有效方法.%Objective To discuss the method and effect of the treatment of acetabular dysplasia by periacetabular acetabular osteotomy. Methods Periacetabular osteotomy was performed to correct 36 patients( 43 hips )with dysplastic acetabulum through rotating the acetabulum anterolaterally, by which the position and acetabular coverage of the femoral head was restored to nearly normal. Results 36 patients with acetabular dysplasia were all followed up for six months to three years. After operation, in the majority, the hip limp or pain with exertion disappeared, and a satisfactory range of motion had been restored. CE angle and Sharp angle were restored to nearly normal value. Conclusions Periacetabular osteotomy is effectively to improve the clinical symptoms, and restore the hip biomechanics characteristics,which is ideal for the treatment of developmental acetabular dysplasia.

  15. The effect of geometry and abduction angle on the stresses in cemented UHMWPE acetabular cups – finite element simulations and experimental tests

    Santavirta Seppo S

    2005-05-01

    Full Text Available Abstract Background Contact pressure of UHMWPE acetabular cup has been shown to correlate with wear in total hip replacement (THR. The aim of the present study was to test the hypotheses that the cup geometry, abduction angle, thickness and clearance can modify the stresses in cemented polyethylene cups. Methods Acetabular cups with different geometries (Link®: IP and Lubinus eccentric were tested cyclically in a simulator at 45° and 60° abduction angles. Finite element (FE meshes were generated and two additional designs were reconstructed to test the effects of the cup clearance and thickness. Contact pressures at cup-head and cup-cement interfaces were calculated as a function of loading force at 45°, 60° and 80° abduction angles. Results At the cup-head interface, IP experienced lower contact pressures than the Lubinus eccentric at low loading forces. However, at higher loading forces, much higher contact pressures were produced on the surface of IP cup. An increase in the abduction angle increased contact pressure in the IP model, but this did not occur to any major extent with the Lubinus eccentric model. At the cup-cement interface, IP experienced lower contact pressures. Increased clearance between cup and head increased contact pressure both at cup-head and cup-cement interfaces, whereas a decreased thickness of polyethylene layer increased contact pressure only at the cup-cement interface. FE results were consistent with experimental tests and acetabular cup deformations. Conclusion FE analyses showed that geometrical design, thickness and abduction angle of the acetabular cup, as well as the clearance between the cup and head do change significantly the mechanical stresses experienced by a cemented UHMWPE acetabular cup. These factors should be taken into account in future development of THR prostheses. FE technique is a useful tool with which to address these issues.

  16. Biomechanical Study of Rigid Internal Fixation for Mandibular Angle Fracture Through 3-D FEM Simulation%三维有限元法对下颌角骨折内固定的生物力学分析

    代燕; 张超; 赵华强

    2011-01-01

    目的 应用三维有限元方法,对不同固定方式的下颌角骨折进行生物力学分析,为临床选择下颌角骨折固定方式提供理论依据.方法 应用螺旋CT扫描及相关软件,建立下颌角骨折内固定系统三维有限元模型,并利用MSC.Marc软件对模型进行应力分析.结果 张力带固定时应力集中分布于钛板中部,而双列小型板固定时最大应力位于上缘钛板中部.张力带固定时骨折断端的最大相对位移大于双列小型板固定.在健侧后牙咬(牙合)和前牙咬(牙合)情况下,张力带固定的安全咬(牙合)力范围分别在102.7 N和40.3 N以下.结论 下颌角骨折时,双列小型板固定的稳定性优于张力带固定.选取适当的咬(牙合)方式,张力带固定也可以达到下颌骨骨折固定的安全范围.%Objective To observe the stress distribution of mandibular angle fracture under different rigid internal fixation (RIF) methods by developing a three-dimensional finite-element method (3-D FEM). Methods CT scan technology and related software were used to develop a 3 -D FEM of mandibular angle fracture under different RIF. On this basis, the mandibular stress distributions were analyzed by MSC.Marc software. Results The von Mises stress mainly concentrated on the middle of the titanium plate in tension band fixation, while in two mini-plate fixation, it concentrated on the middle of the superior titanium plate. In the tension band fixation, the max-values of displacement was more than that in the two mini-plate fixation. When the biting force dropped to 102.7 N (LMOL) and 40.3 N (ICP), the furthest fracture mobility got into margin of safety under the tension band fixation. Conclusion The two mini-plate fixation was more stable than the tension band fixation. Choosing the suitable occlusion, tension band fixation could also provide sufficient stability for the mandibular angle fracture.

  17. Assessment of fracture risk

    Kanis, John A. [WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield S10 2RX (United Kingdom)], E-mail: w.j.pontefract@sheffield.ac.uk; Johansson, Helena; Oden, Anders [WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield S10 2RX (United Kingdom); McCloskey, Eugene V. [WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield S10 2RX (United Kingdom); Osteoporosis Centre, Northern General Hospital, Sheffield (United Kingdom)

    2009-09-15

    Fractures are a common complication of osteoporosis. Although osteoporosis is defined by bone mineral density at the femoral neck, other sites and validated techniques can be used for fracture prediction. Several clinical risk factors contribute to fracture risk independently of BMD. These include age, prior fragility fracture, smoking, excess alcohol, family history of hip fracture, rheumatoid arthritis and the use of oral glucocorticoids. These risk factors in conjunction with BMD can be integrated to provide estimates of fracture probability using the FRAX tool. Fracture probability rather than BMD alone can be used to fashion strategies for the assessment and treatment of osteoporosis.

  18. Assessment of fracture risk

    Fractures are a common complication of osteoporosis. Although osteoporosis is defined by bone mineral density at the femoral neck, other sites and validated techniques can be used for fracture prediction. Several clinical risk factors contribute to fracture risk independently of BMD. These include age, prior fragility fracture, smoking, excess alcohol, family history of hip fracture, rheumatoid arthritis and the use of oral glucocorticoids. These risk factors in conjunction with BMD can be integrated to provide estimates of fracture probability using the FRAX tool. Fracture probability rather than BMD alone can be used to fashion strategies for the assessment and treatment of osteoporosis.

  19. 有限切开内固定结合外固定器治疗Tile C型骨盆骨折%Treatment of Tile C pelvic fractures with external fixator and limited internal fixation

    辛景义; 马宝通; 曹红彬; 鲁杰; 魏万福; 申琳

    2008-01-01

    目的 探讨有限切开内固定结合外固定器治疗Tile C型骨盆骨折的临床价值.方法 采用有限切开内固定结合外固定器治疗Tile C型骨盆骨折28例,男17例,女11例;年龄21~52岁,平均34岁;合并神经损伤4例,失血性休克16例,其他部位骨折15例.按照Tile分型均为C型骨折,C1型15例,C2型9例,C3型4例.结果 28例中,23例复位满意,5例未完全复位,其中3例纵向移位≥1cm,2例横向分离移位(耻骨联合分离≥2cm,耻骨支分离≥1cm).骨折愈合时间2~5个月,平均3.2个月.2例切开复位后骶髂部皮肤发生浅层感染,培养为表皮葡萄球菌,选用敏感抗生素治疗后感染得到控制.3例外固定针孔感染.1例骶髂螺钉固定术后CT证实螺钉穿出S1A椎体前皮质.1例外固定支架固定螺钉穿出髂嵴外侧皮质.1例术后股外侧皮神经损伤.26例获得随访,随访时间18~58个月,平均48个月.根据Majeed制定评估标准,优17例,良7例,可2例,优良率92.3%.4例术前有神经损伤症状者,2例在术后4个月时完全恢复,2例未恢复.4例患者主诉腰骶部疼痛.结论 有限切开内固定可纠正不稳定骨盆骨折纵向移位,而横向移位可以使用外固定器复位固定.%Objective To assess the clinical significance of limited internal fixation and external fixator for the treatment of unstable pelvic fractures. Methods 28 patients (17 males and 11 females) with unstable pelvic fractures were treated with external fixator and limited internal fixation. The average age of patients was 34 years (range from 21 to 52 years). All fractures were rotationally and vertically unstable. According to the classification of Tile, 15 fractures were classified as type C1,9 as type C2,4 as type C3. The anterior ring was fixed with external fixator and posterior ring was fixed with cannulated lag screws, sacral bar or reconstruction plate. Results The posterior ring reduction was not satisfied in 5 patients, among these patients

  20. SURGICAL FIXATIION OF TALAR FRACTURES - OUR EXPERIENCE

    Sreenivasa Reddy

    2015-09-01

    Full Text Available BACKGROUND: Fractures and dislocations of the talus are challenging injuries. The frequent incidence of serious complications, such as osteonecrosis, associated with talus fractures leads to a substantial risk of unsatisfactory results. The results of surgical interv ention in these cases have improved over the years, thanks to the usage newer implants and superior surgical skills. MATERIALS AND METHODS: The present study was undertaken in the department of Orthopedics and Traumatology, Osmania General Hospital, during the period September 12 to September 14, and comprises 30 patients who underwent surgical management of displaced talar fractures . CONCLUSIONS : Most of the fractures of the talus should be treated with reduction and internal fixation to reduce the complic ations. Once the fractures are fixed the joints can be mobilized early so that Post trauamatic stiffness can be prevented. However development of Aseptic necrosis and pain the joint are independent of method of treatment and are dependent on the initial di splacement of the fragments.

  1. 人工关节置换治疗内固定失败的股骨转子间骨折%Effect of hip joint replacement on the femoral intertrochanteric fracture with failed internal fixation

    朱裕昌; 孙业青; 孙健; 蔡新宇; 蔡郑东

    2011-01-01

    Objective To evaluate the surgical procedures and clinical efficacy of endoprosthetic replacement as a salvage procedure for intertrochanteric fracture suffered failure of internal fixation.Methods The study involved 18 intertrochanteric fracture patients that suffered failed internal fixation from 2001 to 2009,including 16 patients with failed dynamic hip screw (DHS) fixation and two with failed proximal femoral nail anti-rotation (PFNA).The patients were at mean age of 76.5 years (range,58-92 years).The treatment methods included total hip arthroplasty in five patients and the bipolar hemiarthroplasty in 13.Harris score was used to evaluate the function outcome during the follow-up.Results The mean operation time lasted for 115 minutes,with intraoperative blood loss of 500 ml.Two patients presented with intraoperative complications.Of all the patients,three patients died within three months after operation and three patients were lost to follow-up.The remaining 12 patients received complete follow-up for a mean of 2.3 years ( range,1-7 years).One patient with hip joint dislocation was treated with closed reduction and distraction for three weeks.At the latest follow-up,the pain disappeared or was reduced in all the patients,including two patients with moderate pain and four with mild pain after some movements.The average Harris score was increased from preoperative 34 points to 83 points at one year after operation.Conclusions Endoprosthetic replacement is an effective salvage procedure for the failed treatment of the intertrochanteric fracture,as it can attain satisfactory pain relief and functional improvement.%目的 分析人工关节置换治疗内固定失败的股骨转子间骨折的临床效果及手术技术. 方法 选择2001年- 2009年内固定治疗失败的股骨转子间骨折18例,动力髋螺钉(DHS)固定失败16例,股骨近端防旋螺钉(PFNA)固定失败2例.失败后对13例行人工双极股骨头置换,5例行全髋关节

  2. Computed tomography arthrography with traction in the human hip for three-dimensional reconstruction of cartilage and the acetabular labrum

    Aim: To develop and demonstrate the efficacy of a computed tomography arthrography (CTA) protocol for the hip that enables accurate three-dimensional reconstructions of cartilage and excellent visualization of the acetabular labrum. Materials and methods: Ninety-three subjects were imaged (104 scans); 68 subjects with abnormal anatomy, 11 patients after periacetabular osteotomy surgery, and 25 subjects with normal anatomy. Fifteen to 25 ml of contrast agent diluted with lidocaine was injected using a lateral oblique approach. A Hare traction splint applied traction during CT. The association between traction force and intra-articular joint space was assessed qualitatively under fluoroscopy. Cartilage geometry was reconstructed from the CTA images for 30 subjects; the maximum joint space under traction was measured. Results: Using the Hare traction splint, the intra-articular space and boundaries of cartilage could be clearly delineated throughout the joint; the acetabular labrum was also visible. Dysplastic hips required less traction (∼5 kg) than normal and retroverted hips required (>10 kg) to separate the cartilage. An increase in traction force produced a corresponding widening of the intra-articular joint space. Under traction, the maximum width of the intra-articular joint space during CT ranged from 0.98–6.7 mm (2.46 ± 1.16 mm). Conclusions: When applied to subjects with normal and abnormal hip anatomy, the CTA protocol presented yields clear delineation of the cartilage and the acetabular labrum. Use of a Hare traction splint provides a simple, cost-effective method to widen the intra-articular joint space during CT, and provides flexibility to vary the traction as required. - Highlights: • We present a hip CTA protocol to clearly delineate the intra-articular space. • A Hare traction splint provides a simple, cost-effective way to apply traction. • The required traction force depends on individual hip morphology. • The traction force

  3. Fractures and Dislocations of the Tarsal Navicular.

    Ramadorai, Maj Uma E; Beuchel, Matthew W; Sangeorzan, Bruce J

    2016-06-01

    Fractures of the tarsal navicular are commonly the result of trauma or chronic overload. Because of its complex anatomy and blood supply, the tarsal navicular is susceptible to osteonecrosis, and injury to this bone can lead to posttraumatic arthrosis of the surrounding joints. Diagnosis of the injury, especially in patients with stress fractures, can require a high index of suspicion and the use of advanced imaging. The treatment of stress fracture is controversial and ranges from immobilization in a non-weight-bearing cast or boot to internal fixation with or without bone grafting. Traumatic fractures are treated with open reduction and internal fixation with or without external fixation for medial and lateral column stabilization. To avoid a poor outcome, concomitant injuries must be recognized and treated. Despite appropriate treatment, patients may ultimately require fusion procedures to address ongoing pain and disability. PMID:27213621

  4. Contemporary Management of Infected Mandibular Fractures

    Alpert, Brian; Kushner, George M.; Tiwana, Paul S.

    2008-01-01

    The treatment of infected mandibular fractures has advanced rather dramatically over the past 50 years. Immobilization with maxillomandibular fixation and/or splints, removal of diseased teeth in the fracture line, external fixation, use of antibiotics, debridement, and rigid internal fixation has played a role in management. Perhaps the most important advance was the realization that infected fractures also result from moving fragments and nonvital bone, not just bacteria. Controlling movement and eliminating the dead bone allowed body defenses to also eliminate bacteria. The next logical step in the evolution of treatment was primary bone grafting of the resulting defect following application of rigid internal fixation and debridement of the dead bone. We offer our results with this treatment in 21 infected fractures, 20 of which achieved primary union. PMID:22110786

  5. Biological plating of comminuted fractures of femur and tibia

    Mohammad Javdan

    2007-08-01

    Full Text Available

    BACKGROUND: The treatment of comminuted fractures in long bones has continued to be a problem in orthopedic surgery. Recently, fixation without exploration of the fracture site, known as "biologic fixation”, has been introduced. This study was performed to assess the results and complications of this method for the treatment of comminuted fractures of the tibia and femur.
    METHODS: The study included 41 patients with comminuted fractures of the tibia and femur treated with biologic plating from 2003 to 2006 (25 femur fractures and 16 tibial fractures. After biological fixation joint motion was started but weight bearing was avoided until radiographic evidence of union was shown.
    RESULTS: The mean time of union in the tibial fractures was 19 ± 2 weeks and 17 ± 2 weeks for the femur fractures. All patients had fracture union without any infection, non-union or implant failure. In one patient with a femur fracture there was a 10° internal rotation deformity. Two of the femoral fractures had shortening of 1 cm, and one patient had shortening of about 2 cm. Compared to similar studies, all results were statistically significant (P<0.05.
    CONCLUSIONS: The biologic plating method is a safe, simple and effective method of fixation for comminuted fractures of long bones. It has a high rate of union with minimal complications.
    KEY WORDS: Biological fixation, plate, comminuted fracture.

  6. Distal humerus fractures: a review of current therapy concepts.

    Amir, Steinitz; Jannis, Sailer; Daniel, Rikli

    2016-06-01

    Fractures of the distal humerus in the adult comprise approximately one third of all humeral fractures. Successful management of distal humerus fractures depends on correct reduction of the fracture, reconstruction of the articular surface if needed, stability and rigidity of the fixation, and appropriate rehabilitation. In this review, we evaluated the available literature and highlighted current therapy concepts. We assessed the evolution of internal fixation and elbow arthroplasty focusing on the established surgical approaches against the background of a growing incidence of distal humeral fractures in an aging patient population. Therefore evaluating the aspect and influence of age-dependent comorbidities like osteoporosis on successful treatment. PMID:27039395

  7. Abordagem cirúrgica inédita para denervação acetabular em cães A new surgical approach to acetabular denervation in dogs

    Cássio R.A. Ferrigno; Alexandre Schmaedecke; Vanessa C.M. Ferraz

    2007-01-01

    Este artigo tem por objetivo demonstrar nova abordagem cirúrgica para denervação seletiva das fibras sensitivas do periósteo acetabular, para tratamento da displasia coxo femoral em cães, conduzidas em 189 articulações. Para tanto, é descrita abordagem da região cranial e dorso-lateral do acetábulo de cães por incisão em forma de meia lua de aproximadamente de três centímetros de extensão, iniciando trocânter maior do fêmur e em direção ao corpo do ílio. Após rebatimento dorsal do músculo glú...

  8. External fixation in contemporary fracture management

    McCoy, G. F.; Orr, J. F.; Templeton, J.

    1987-01-01

    Important advances have been made within the last two decades in the field of fracture management. The development of the AO internal fixation system and the advances in cast bracing techniques are but two of the improvements worthy of mention. It is, however, in the field of external fixation of fractures that the greatest advances have been made. This paper traces the history of external fixation up to the present day and discusses, with examples, the application of external fixation in the...

  9. Soluble CD14 and fracture risk

    Bethel, M; Bůžková, P; Fink, HA; Robbins, JA; Cauley, JA; Lee, J.; Barzilay, JI; Jalal, DI; Carbone, LD

    2016-01-01

    © 2015 International Osteoporosis Foundation and National Osteoporosis Foundation Summary: Soluble CD14 (sCD14) is an inflammatory marker associated with osteoclasts. Using Cox proportional hazards models, we found a positive association between plasma levels of sCD14 and risk of incident fracture among participants in the Cardiovascular Health Study. sCD14 may be useful in identifying those at risk for fracture. Introduction: Soluble CD14, a proinflammatory cytokine, is primarily derived fro...

  10. COMPARATIVE STUDY OF FRACTURE NECK OF FEM UR TREATED WITH UNIPOLAR AND BIPOLAR HEMIARTHROPLASTY

    Nava Krishna Prasad

    2015-03-01

    Full Text Available OBJECTIVES: This study has been carried out to compare the functional outcome of intracapsular fracture neck of femur treated with unipolar (Austin Moore prosthesis and bipolar prosthesis. METHODS: Fifteen out of thirty patients with displaced fracture of femoral nec k treated with unipolar prosthesis and other fifteen of patients treated with bipolar prosthesis from August 2012 to January 2015 in the Department of Orthopedics, Governmen t medical college, Ananthapuram . Functional outcome was assessed and compared using Modified Harris hip score and radiological assessment with a follow up of one year. RESULTS: Two group s of patients with mean age 72. 2years in AMP and 65.3 years in bipolar were evaluated and the mean hi p score of unipolar was 82.6±8.72and bipolar was 86.17±8.12 respectively. CONCLUSION: Functional outcome with mean Modified Harris hip score is better in Bipolar group than unipolar (Austin Moore prosthesis. Complications like painful hip, acetabular eros ion, periprosthetic fractures are more in unipolar group. Hence bipolar prosthesis is better in elderly patients with fracture neck of femur.

  11. Minimal Invasive Percutaneous Plate Osteosynthesis for Distal Tibial Fractures: A Prospective Study

    Nitin Samal; Sanjay Deshpande; Vasant Gawande; Romil Rathi

    2014-01-01

    Background: Fractures of distal tibia and pilon fractures are one of the most common fractures and are difficult to treat on account of, absence of muscle tissue attachment on lower ¼ tibia and metaphyseal cancellous comminution. Most of them are compound fractures and result in poor blood supply to the distal tibia. The conventional technique of Open Reduction and Internal Fixation (ORIF) with plating of distal tibia fracture requires wide exposure, extensive soft tis...

  12. Imaging of vertebral fractures

    Ananya Panda

    2014-01-01

    Full Text Available Vertebral fracture is a common clinical problem. Osteoporosis is the leading cause of non-traumatic vertebral fracture. Often, vertebral fractures are not clinically suspected due to nonspecific presentation and are overlooked during routine interpretation of radiologic investigations. Moreover, once detected, many a times the radiologist fails to convey to the clinician in a meaningful way. Hence, vertebral fractures are a constant cause of morbidity and mortality. Presence of vertebral fracture increases the chance of fracture in another vertebra and also increases the risk of subsequent hip fracture. Early detection can lead to immediate therapeutic intervention improving further the quality of life. So, in this review, we wish to present a comprehensive overview of vertebral fracture imaging along with an algorithm of evaluation of vertebral fractures.

  13. CT false-profile view of the hip: a reproducible method of measuring anterior acetabular coverage using volume CT data

    Needell, Steven D.; Borzykowski, Ross M. [Boca Radiology Group, Boca Raton, FL (United States); Carreira, Dominic S.; Kozy, John [Broward Health Orthopedics and Sports Medicine, Fort Lauderdale, FL (United States)

    2014-11-15

    To devise a simple, reproducible method of using CT data to measure anterior acetabular coverage that results in values analogous to metrics derived from false-profile radiographs. Volume CT images were used to generate simulated false-profile radiographs and cross-sectional false-profile views by angling a multiplanar reformat 115 through the affected acetabulum relative to a line tangential to the posterior margin of the ischial tuberosities. The anterolateral margin of the acetabulum was localized on the CT false-profile view corresponding with the cranial opening of the acetabular roof. Anterior center edge angle (CEA) was measured between a vertical line passing through the center of the femoral head and a line connecting the center of the femoral head with the anterior edge of the condensed line of the acetabulum (sourcil). Anterior CEA values measured on CT false-profile views of 38 symptomatic hips were compared with values obtained on simulated and projection false-profile radiographs. The CT false-profile view produces a cross-sectional image in the same obliquity as false-profile radiographs. Anterior CEA measured on CT false-profile views were statistically similar to values obtained with false-profile radiographs. CT technologists quickly mastered the technique of generating this view. Inter-rater reliability indicated this method to be highly reproducible. The CT false-profile view is simple to generate and anterior CEA measurements derived from it are similar to those obtained using well-positioned false-profile radiographs. Utilization of CT to assess hip geometry enables precise control of pelvic inclination, eliminates projectional errors, and minimizes limitations of image quality inherent to radiography. (orig.)

  14. CT false-profile view of the hip: a reproducible method of measuring anterior acetabular coverage using volume CT data

    To devise a simple, reproducible method of using CT data to measure anterior acetabular coverage that results in values analogous to metrics derived from false-profile radiographs. Volume CT images were used to generate simulated false-profile radiographs and cross-sectional false-profile views by angling a multiplanar reformat 115 through the affected acetabulum relative to a line tangential to the posterior margin of the ischial tuberosities. The anterolateral margin of the acetabulum was localized on the CT false-profile view corresponding with the cranial opening of the acetabular roof. Anterior center edge angle (CEA) was measured between a vertical line passing through the center of the femoral head and a line connecting the center of the femoral head with the anterior edge of the condensed line of the acetabulum (sourcil). Anterior CEA values measured on CT false-profile views of 38 symptomatic hips were compared with values obtained on simulated and projection false-profile radiographs. The CT false-profile view produces a cross-sectional image in the same obliquity as false-profile radiographs. Anterior CEA measured on CT false-profile views were statistically similar to values obtained with false-profile radiographs. CT technologists quickly mastered the technique of generating this view. Inter-rater reliability indicated this method to be highly reproducible. The CT false-profile view is simple to generate and anterior CEA measurements derived from it are similar to those obtained using well-positioned false-profile radiographs. Utilization of CT to assess hip geometry enables precise control of pelvic inclination, eliminates projectional errors, and minimizes limitations of image quality inherent to radiography. (orig.)

  15. The diagnostic value of direct CT arthrography using MDCT in the evaluation of acetabular labral tear: with arthroscopic correlation

    Ha, Yong-Chan; Kim, Jae Yoon [Chung-Ang University College of Medicine, Department of Orthopaedic Surgery, Seoul (Korea, Republic of); Choi, Jung-Ah; Lee, Guen Young; Kang, Heung Sik [Seoul National University Bundang Hospital, Departments of Radiology, Seoul National University College of Medicine, 166 Gumi-ro, Bundang-gu, Seongnam (Korea, Republic of); Lee, Young-Kyun; Koo, Kyung-Hoi [Seoul National University Bundang Hospital, Orthopaedic Surgery, Seoul National University College of Medicine, Seongnam (Korea, Republic of)

    2013-05-15

    The purpose of this study was first, to determine the sensitivity, specificity, and accuracy of MDCT arthrography (CTA) for the diagnosis of acetabular labral tear and sulcus; second, to correlate tear types using the Lage classification system on CTA compared with the arthroscopic classification; and third, to correlate CTA localization with arthroscopic localization. Direct CTA was performed using 16- or 64-slice MDCT in 126 hips (124 patients) who had chronic groin pain and positive impingement test. Images were reviewed and evaluated by two experienced musculoskeletal radiologists preoperatively. CTA findings were compared with arthroscopic findings in 58 hips (56 patients) under consensus by two orthopedic surgeons. Forty-one of the 58 hips were diagnosed as labral tears on CT arthrography. Forty-three of the 58 hips were shown to have a labral tear on arthroscopy. Sensitivity, specificity, and accuracy for detecting labral tear and sulcus by CTA were 90.7%, 86.7%, and 89.7%, and 93.8%, 97.6% and 96.6% respectively for observer 1, and 90.7% and 80.0%, 87.9% and 87.5%, 95.2%, and 93.1 % respectively for observer 2. Thirty-five out of 41 hips (85%) that were diagnosed with labral tear on CTA correlated substantially with arthroscopic Lage classification (kappa coefficient = 0.65). CTA and arthroscopic findings showed similar distribution patterns of the tears with most lesions located in antero- and postero-superior areas (p = 0.013). Direct CT arthrography using MDCT may be a useful diagnostic technique in the detection of acetabular labral tear. (orig.)

  16. Assessment of Accuracy and Reliability in Acetabular Cup Placement Using an iPhone/iPad System.

    Kurosaka, Kenji; Fukunishi, Shigeo; Fukui, Tomokazu; Nishio, Shoji; Fujihara, Yuki; Okahisa, Shohei; Takeda, Yu; Daimon, Takashi; Yoshiya, Shinichi

    2016-07-01

    Implant positioning is one of the critical factors that influences postoperative outcome of total hip arthroplasty (THA). Malpositioning of the implant may lead to an increased risk of postoperative complications such as prosthetic impingement, dislocation, restricted range of motion, polyethylene wear, and loosening. In 2012, the intraoperative use of smartphone technology in THA for improved accuracy of acetabular cup placement was reported. The purpose of this study was to examine the accuracy of an iPhone/iPad-guided technique in positioning the acetabular cup in THA compared with the reference values obtained from the image-free navigation system in a cadaveric experiment. Five hips of 5 embalmed whole-body cadavers were used in the study. Seven orthopedic surgeons (4 residents and 3 senior hip surgeons) participated in the study. All of the surgeons examined each of the 5 hips 3 times. The target angle was 38°/19° for operative inclination/anteversion angles, which corresponded to radiographic inclination/anteversion angles of 40°/15°. The simultaneous assessment using the navigation system showed mean±SD radiographic alignment angles of 39.4°±2.6° and 16.4°±2.6° for inclination and anteversion, respectively. Assessment of cup positioning based on Lewinnek's safe zone criteria showed all of the procedures (n=105) achieved acceptable alignment within the safe zone. A comparison of the performances by resident and senior hip surgeons showed no significant difference between the groups (P=.74 for inclination and P=.81 for anteversion). The iPhone/iPad technique examined in this study could achieve acceptable performance in determining cup alignment in THA regardless of the surgeon's expertise. [Orthopedics. 2016; 39(4):e621-e626.]. PMID:27322169

  17. Deformation of the Durom acetabular component and its impact on tribology in a cadaveric model--a simulator study.

    Feng Liu

    Full Text Available BACKGROUND: Recent studies have shown that the acetabular component frequently becomes deformed during press-fit insertion. The aim of this study was to explore the deformation of the Durom cup after implantation and to clarify the impact of deformation on wear and ion release of the Durom large head metal-on-metal (MOM total hips in simulators. METHODS: Six Durom cups impacted into reamed acetabula of fresh cadavers were used as the experimental group and another 6 size-paired intact Durom cups constituted the control group. All 12 Durom MOM total hips were put through a 3 million cycle (MC wear test in simulators. RESULTS: The 6 cups in the experimental group were all deformed, with a mean deformation of 41.78 ± 8.86 µm. The average volumetric wear rate in the experimental group and in the control group in the first million cycle was 6.65 ± 0.29 mm(3/MC and 0.89 ± 0.04 mm(3/MC (t = 48.43, p = 0.000. The ion levels of Cr and Co in the experimental group were also higher than those in the control group before 2.0 MC. However there was no difference in the ion levels between 2.0 and 3.0 MC. CONCLUSIONS: This finding implies that the non-modular acetabular component of Durom total hip prosthesis is likely to become deformed during press-fit insertion, and that the deformation will result in increased volumetric wear and increased ion release. CLINICAL RELEVANCE: This study was determined to explore the deformation of the Durom cup after implantation and to clarify the impact of deformation on wear and ion release of the prosthesis. Deformation of the cup after implantation increases the wear of MOM bearings and the resulting ion levels. The clinical use of the Durom large head prosthesis should be with great care.

  18. Fracture Criterion for Fracture Mechanics of Magnets

    潘灏; 杨文涛

    2003-01-01

    The applicability and limitation of some fracture criteria in the fracture mechanics of magnets are studied.It is shown that the magnetic field intensity factor can be used as a fracture criterion when the crack in a magnet is only affected by a magnetic field. For some magnetostrictive materials in which the components of magnetostriction strain do not satisfy the compatibility equation of deformation, the stress intensity factor can no longer be effectively applicable as a fracture criterion when the crack in a magnet is affected by a magnetic field and mechanical loads simultaneously.

  19. Introduction into fracture mechanics

    The present report gives an introduction to the basic principles of fracture mechanics. First the behaviour of a linear elastic body containing a crack is described. This is followed by a survey of experimental methods for the determination of fracture mechanics properties, like R-curve and fatigue crack growth. Two chapters deal with the most important parameters affecting stable crack growth and fracture toughness. The knowledge of the limits of applicability of linear eleastic fracture mechanics and of the concepts of elastic-plastic fracture mechanics is of particular importance. The last chapter deals with some basic procedures for the practical application of fracture mechanics. (orig.)

  20. Association of cognitive status with mobility and functioning after femoral neck fracture surgery in elderly patients: differences between hemiarthroplasty and internal fixation: Povezanost kognitivnega stanja z gibljivostjo in funkcijskim stanjem po operacijskem zdravljenju zloma vratu stegnenice pri starejših poškodovancih: razlike med uporabo delne cementne endoproteze in notranje fiksacije:

    Burger, Helena; Kos, Nataša; Vidmar, Gaj

    2013-01-01

    Background: Comparison of outcomes between two different operative treatments of femoral neck fracture hemiarthroplasty (HA) and internal fixation (IF) remains an open issue. We performed new analyses of data from a previously published study with the aim of investigating the influence of cognitive problems on mobility and functioning after such surgery and comparing it between groups treated with HA and IF. Methods: Sixty-six elderly patients were consecutively enrolled in a prospective non-...

  1. Current concepts in the mandibular condyle fracture management part I: overview of condylar fracture.

    Choi, Kang-Young; Yang, Jung-Dug; Chung, Ho-Yun; Cho, Byung-Chae

    2012-07-01

    The incidence of condylar fractures is high, but the management of fractures of the mandibular condyle continues to be controversial. Historically, maxillomandibular fixation, external fixation, and surgical splints with internal fixation systems were the techniques commonly used in the treatment of the fractured mandible. Condylar fractures can be extracapsular or intracapsular, undisplaced, deviated, displaced, or dislocated. Treatment depends on the age of the patient, the co-existence of other mandibular or maxillary fractures, whether the condylar fracture is unilateral or bilateral, the level and displacement of the fracture, the state of dentition and dental occlusion, and the surgeonnds on the age of the patient, the co-existence of othefrom which it is difficult to recover aesthetically and functionally;an appropriate treatment is required to reconstruct the shape and achieve the function ofthe uninjured status. To do this, accurate diagnosis, appropriate reduction and rigid fixation, and complication prevention are required. In particular, as mandibular condyle fracture may cause long-term complications such as malocclusion, particularly open bite, reduced posterior facial height, and facial asymmetry in addition to chronic pain and mobility limitation, great caution should be taken. Accordingly, the authors review a general overview of condyle fracture. PMID:22872830

  2. Current Concepts in the Mandibular Condyle Fracture Management Part I: Overview of Condylar Fracture

    Kang-Young Choi

    2012-07-01

    Full Text Available The incidence of condylar fractures is high,but the management of fractures of the mandibularcondyle continues to be controversial. Historically, maxillomandibular fixation, externalfixation, and surgical splints with internal fixation systems were the techniques commonlyused in the treatment of the fractured mandible. Condylar fractures can be extracapsularor intracapsular, undisplaced, deviated, displaced, or dislocated. Treatment depends on theage of the patient, the co-existence of other mandibular or maxillary fractures, whether thecondylar fracture is unilateral or bilateral, the level and displacement of the fracture, thestate of dentition and dental occlusion, and the surgeonnds on the age of the patient, theco-existence of othefrom which it is difficult to recover aesthetically and functionally;anappropriate treatment is required to reconstruct the shape and achieve the function oftheuninjured status. To do this, accurate diagnosis, appropriate reduction and rigid fixation, andcomplication prevention are required. In particular, as mandibular condyle fracture may causelong-term complications such as malocclusion, particularly open bite, reduced posterior facialheight, and facial asymmetry in addition to chronic pain and mobility limitation, great cautionshould be taken. Accordingly, the authors review a general overview of condyle fracture.

  3. INCIDENCE, AETIOLOGY AND PATTERN OF MANDIBULAR FRACTURES IN PONDICHERRY

    Karthik

    2015-12-01

    Full Text Available BACKGROUND The mandible is the second most commonly fractured part of the maxillofacial region after nasal bones. The incidence, etiology and pattern of mandibular fractures vary considerably among the different study population, there is a need to evaluate aspects of mandibular trauma in Pondicherry. This study was undertaken to evaluate the results of mandibular fractures treated in a population of Pondicherry. PATIENT AND METHOD A total of sixty nine patients treated for mandibular fractures at the Department Of Dentistry, Sri Manakula Vinayagar Medical College and Hospital, Pondicherry from January 2011 to December 2014 were retrospectively evaluated. The variables analyzed in the study were gender, age, aetiology, fracture site, method of treatment and complications. RESULTS This study included 106 fractures in 69 patients. The ratio of male to female was 16:1. The highest prevalence of fracture occurred in 21 to 30 years (37.7% and the minimum in patients over 61 years old. The most common cause of fractures were road traffic accident (RTA, 56.5% followed by fall. In our study most commonly reported fracture site was parasymphysis (37.7%, followed by angle (19.8% and condyle (19.8%. Mandibular fractures were generally treated by Open Reduction and Internal Fixation (ORIF in 76.4% of the patients. CONCLUSION The retrospective study of mandibular fractures has shown, road traffic accidents are main cause of fracture and young men in their 20s are predominantly affected.

  4. Analysis of the Effect of Artificial Hip Replacement in the Treatment of Acetabular Defect%髋臼缺损畸形的人工髋关节置换手术疗效分析

    武豪杰

    2015-01-01

    Objective To study the acetabulum defect deformity treatment methods of artificial total hip replacement. Methods 30 cases of acetabular defects were selected in our hospital, including 13 cases of acetabulum hypoplasia, acetabulum fracture malunion after trauma in 5 cases, 6 patients with rheumatoid arthritis, ankylosing spondylitis hip lesions, 6 cases were performed total hip replacement, take the acetabulum deepening, double cone spiral acetabulum, autologous bone graft and structural methods such as titanium mesh and bone graft line true acetabular reconstruction, all patients preoperative CT three-dimensional reconstruction, with Harris scoring criteria. Results Followed up for 6~36 months, has not occurred during the follow-up period of artificial hip prosthesis loosening and fracture around, etc. Harris scoring (36±6.5) preoperatively, postoperative (93±5.2). Conclusion Deformity of total hip replacement for defects of acetabulum, through the acetabulum, Zweymulle double cone spiral acetabulum, grain pressure distribution, structural bone graft autologous bone graft and titanium mesh and bone graft and so on the many kinds of methods can be a very good reconstruction of acetabulum, restore good stability and the Harris score, can achieve very good effect.%目的探讨髋臼缺损畸形的人工全髋关节置换术的处理方法。方法选取我院收治存在髋臼缺损畸形患者30例,包括髋臼发育不良13例、髋臼创伤骨折后畸形愈合5例、类风湿性关节炎6例,强直性脊柱炎髋关节病变6例,均行全髋关节置换术,采取髋臼加深、双锥  面螺旋型髋臼、自体结构性植骨及钛网加植骨等多种方法行真臼重建,全部病例术前行 CT 三维重建,评分标准采用 Harris 评分。结果随访6~36个月,随访期间未发生人工髋关节假体松动、周围骨折等。Harris 评分术前(36±6.5),术后(93±5.2)。结论对于髋臼缺损畸形的全髋关节置

  5. 钢板与克氏针内固定修复跟骨骨折:Gissane角及Bohler角与跟骨高度比较%Internal fixation with plate and Kirschner wire to repair calcaneal fractures:comparison of Gissane angle, Bohler angle and calcaneus height

    马东弟; 杨振建; 宋锦旭; 高志峰; 孙立恒; 潘学文

    2015-01-01

      结果与结论:切开复位重建钢板内固定组治疗后的Gissane角、Bohler角及跟骨高度显著大于经皮撬拨复位克氏针固定组(P 0.05);切开复位重建钢板内固定组治疗后1年随访的足踝功能AOFAS评分显著高于经皮撬拨复位克氏针固定组(P OBJECTIVE:To compare and analyze the prognosis effect of open reduction and internal fixation and percutaneous poking fixation with Kirschner wire for calcaneal fractures. METHODS:A total of 62 patients with calcaneal fractures, who were treated in Tangshan Fengnan District Hospital from March 2012 to September 2013, were selected for this study. The patients were divided into two groups according to the therapy strategy:open reduction and internal fixation group (n=29) and percutaneous poking fixation with Kirschner wire group (n=33). Gissane angle, Bohler angle, calcaneus height, incidence of postoperative complication and AOFAS score (1-year fol ow-up) were compared between the two groups. RESULTS AND CONCLUSION:The Gissane angle, Bohler angle and calcaneus height in open reduction and internal fixation group were higher than percutaneous poking fixation with Kirschner wire group (P0.05). The AOFAS score during 1-year fol ow-up was significantly higher in open reduction and internal fixation group than in the percutaneous poking fixation with Kirschner wire group (P<0.05). Results indicated that open reduction and internal fixation could recover the regular structure of calcaneus and subtalar joint. Surgeon with skil ed operation skil s could ensure the safety of surgery. Open reduction and internal fixation can promote the prognosis of calcaneal fractures, and is better than percutaneous poking fixation with Kirschner wire.

  6. Hip fracture surgery

    ... repair; Femoral neck fracture repair; Trochanteric fracture repair; Hip pinning surgery; Osteoarthritis-hip ... top of the bone) you may have a hip pinning procedure. During this surgery: You lie on ...

  7. Fractures in anisotropic media

    Shao, Siyi

    Rocks may be composed of layers and contain fracture sets that cause the hydraulic, mechanical and seismic properties of a rock to be anisotropic. Coexisting fractures and layers in rock give rise to competing mechanisms of anisotropy. For example: (1) at low fracture stiffness, apparent shear-wave anisotropy induced by matrix layering can be masked or enhanced by the presence of a fracture, depending on the fracture orientation with respect to layering, and (2) compressional-wave guided modes generated by parallel fractures can also mask the presence of matrix layerings for particular fracture orientations and fracture specific stiffness. This report focuses on two anisotropic sources that are widely encountered in rock engineering: fractures (mechanical discontinuity) and matrix layering (impedance discontinuity), by investigating: (1) matrix property characterization, i.e., to determine elastic constants in anisotropic solids, (2) interface wave behavior in single-fractured anisotropic media, (3) compressional wave guided modes in parallel-fractured anisotropic media (single fracture orientation) and (4) the elastic response of orthogonal fracture networks. Elastic constants of a medium are required to understand and quantify wave propagation in anisotropic media but are affected by fractures and matrix properties. Experimental observations and analytical analysis demonstrate that behaviors of both fracture interface waves and compressional-wave guided modes for fractures in anisotropic media, are affected by fracture specific stiffness (controlled by external stresses), signal frequency and relative orientation between layerings in the matrix and fractures. A fractured layered medium exhibits: (1) fracture-dominated anisotropy when the fractures are weakly coupled; (2) isotropic behavior when fractures delay waves that are usually fast in a layered medium; and (3) matrix-dominated anisotropy when the fractures are closed and no longer delay the signal. The

  8. Fracture toughness correlations

    In this study existing fracture parameter correlations are reviewed. Their applicability and reliability are discussed in detail. A new KIC-CVN-correlation, based on a theoretical brittle fracture model, is presented

  9. Metatarsal stress fractures - aftercare

    ... page: //medlineplus.gov/ency/patientinstructions/000553.htm Metatarsal stress fractures - aftercare To use the sharing features on ... that connect your ankle to your toes. A stress fracture is a break in the bone that ...

  10. Revision Arthroplasty Using a MUTARS® Prosthesis in Comminuted Periprosthetic Fracture of the Distal Femur.

    Choi, Hyung Suk; Nho, Jae Hwi; Kim, Chung Hyun; Kwon, Sai Won; Park, Jong Seok; Suh, You Sung

    2016-11-01

    Periprosthetic fractures after total knee arthroplasty (TKA) are gradually increasing, reflecting extended lifespan, osteoporosis, and the increasing proportion of the elderly during the past decade. Supracondylar periprosthetic femoral fracture is a potential complication after TKA. Generally, open reduction and internal fixation are the conventional option for periprosthetic fracture after TKA. However, the presence of severe comminution with component loosening can cause failure of internal fixation. Although the current concept for periprosthetic fracture is open reduction and internal fixation, we introduce an unusual case of revision arthroplasty using a MUTARS® prosthesis for a comminuted periprosthetic fracture in the distal femur after TKA, with technical tips. PMID:27593884

  11. Two-stage total hip arthroplasty for complex pelvic abnormalities: Example of hip arthrodesis conversion with concomitant treatment of pelvic and acetabular non-union.

    Jacquot, A; Goetzmann, T; Jullion, S; Sirveaux, F; Molé, D; Roche, O

    2016-06-01

    Hip prosthesis implantation requires a stable pelvic foundation, which may be lacking in patients with complex pelvic abnormalities (e.g., arthrodesis conversion, tumour excision, or revision with large bony defects). Many reconstructive options exist for these situations, but their outcomes vary with the initial amount of bone loss and with the technique used. We describe a two-stage arthroplasty technique (acetabular cup first, then femoral stem) and report its use in a case of arthrodesis conversion with concomitant treatment of pelvic and acetabular non-union. Clinical and radiological outcomes after 5 years are reported. This procedure can be adapted to the most complex cases of pelvic reconstruction. PMID:27052938

  12. Fractures in childhood

    Clinical diagnosis of fractures in childhood can be very difficult. Therefore imaging, not only x-rays but also ultrasound, computed tomography and magnetic resonance imaging are of special importance. There are typical pediatric types of fractures due to epiphyseal plates and high flexibility of the bone. Fractures heal faster and dislocations can be spontaneously corrected better but also growth disturbance can occur. The second part of the article describes the special types of fractures with special attention to the characteristics in childhood.

  13. Individualizing fracture risk prediction

    van Geel, Tineke A. C. M.; van den Bergh, Joop P. W.; Dinant, Geert Jan; Geusens, Piet

    2010-01-01

    Low bone mineral density (BMD) and clinical factors (CRF) have been identified as factors associated with an increased relative risk of fractures. From this observation and for clinical decision making, the concept of prediction of the individual absolute risk of fractures has emerged. It refers to the individual's risk for fractures over a certain time period, e.g. the next 5 and 10 years. Two individualized fracture risk calculation tools that are increasingly used and are available on the ...

  14. Abordagem cirúrgica inédita para denervação acetabular em cães A new surgical approach to acetabular denervation in dogs

    Cássio R.A. Ferrigno

    2007-02-01

    Full Text Available Este artigo tem por objetivo demonstrar nova abordagem cirúrgica para denervação seletiva das fibras sensitivas do periósteo acetabular, para tratamento da displasia coxo femoral em cães, conduzidas em 189 articulações. Para tanto, é descrita abordagem da região cranial e dorso-lateral do acetábulo de cães por incisão em forma de meia lua de aproximadamente de três centímetros de extensão, iniciando trocânter maior do fêmur e em direção ao corpo do ílio. Após rebatimento dorsal do músculo glúteo médio, secciona-se parcialmente a inserção do m. glúteo profundo para acesso às regiões citadas. Com auxílio de cureta foi removido, em todos os pacientes, periósteo na margem acetabular cranial e dorso lateral, até a exposição da cortical óssea. Em todos os animais foi possível a abordagem, tanto da face cranial como também acesso para a curetagem da face dorsal do acetábulo, com a técnica descrita, com incisão de pele de aproximadamente 3,2cm. A curetagem da porção cranial do acetábulo foi, em todos os casos realizados, sem visualização do osso, mas de fácil confecção e sem intercorrências de lesão de nervos ou músculos. Em todas as abordagens foi possível visualizar a cápsula articular da articulação coxo femoral, e em nenhum dos animais esta estrutura foi incisada por erro de técnica. Conclui-se que a abordagem cirúrgica descrita no presente trabalho é factível para este tipo de procedimento cirúrgico em cães, promovendo acesso adequado, com mínima invasão e sem complicações de qualquer natureza.The purpose of this study is to demonstrate a new surgical approach for the selective denervation of the sensitive fibers of the acetabular periosteum, for the treatment of hip dysplasia in dogs, conducted in 189 joints.The surgical approach of the cranial and dorso-lateral regions of the acetabular joint in dogs, by moon-shaped incision of approximately 3cm in extension, starting from the

  15. A Case of Fracture of Multiple Ribs Cut Nursing Experience Afterreduction and Internal Fixation%一例多根肋骨骨折切开复位内固定术后的护理体会

    周汝智

    2014-01-01

    Multiple fractures of multiple ribs can appear "paradoxical respiratory movement", because of the intense pain after injury, the injury to the action of thethoracic stability has been destroyed, so breathing will gradually becomes shallow andspeed, reduce the causes of patients with alveolar ventilation, dare not to cough, then caused the sputum retention in the body, causing lower respiratory tract secretionobstruction, pulmonary infection, pulmonary contusion, resulting in respiratory and circulatory insufficiency, endanger life, the need for closed thoracic drainage and open reduction and internal fixation, care should be mastered strictly standardized sputum suction, closed thoracic drainage.%多根多处肋骨骨折可出现“反常呼吸运动”,因伤后的激烈疼痛、外伤的作用使胸廓稳定性受到了破坏,因而呼吸会逐步变浅且加快,肺泡通气减少,患者不敢咳嗽,继而引起痰液潴留在体内,引起下呼吸道分泌梗阻,肺部感染,肺挫伤,造成呼吸循环功能不全,危及生命,需进行胸腔闭式引流和切开复位内固定术,护理需严格掌握规范吸痰,胸腔闭式引流等…。

  16. On the correlation of fracture quantities in small punch test

    Dobeš, Ferdinand; Dymáček, Petr

    Zurich : Trans Tech Publications, 2014 - (Šandera, P.), s. 275-278 ISBN 978-3-03785-934-6. ISSN 1013-9826. - (Key Engineering Materials . 592-593). [MSMF 7 - International Conference on Materials Structure & Micromechanics of Fracture /7./. Brno (CZ), 01.07.2013-03.07.2013] R&D Projects: GA ČR(CZ) GAP108/12/1452 Institutional support: RVO:68081723 Keywords : small punch test * fracture strain * fracture energy * iron aluminides Subject RIV: JG - Metallurgy

  17. Mandibular Ramus Fracture: An Overview of Rare Anatomical Subsite

    Anendd Jadhav; Bhushan Mundada; Rahul Deshmukh; Umesh Bhutekar; Atul Kala; Kapil Waghwani; Apoorva Mishra

    2015-01-01

    Aim. The present study aims at exemplifying the incidence, and aetiology and analyses the outcomes of open reduction internal fixation (ORIF) over closed treatment of mandibular ramus fractures. Patients and Method. In the present retrospective analysis of mandibular fracture patients, variables analysed were age, sex, cause of injury, pretreatment occlusion, treatment given, period of maxillo-mandibular fixation (MMF), and posttreatment occlusion. Results. Out of 388 mandibular fractures tre...

  18. SURGICAL MANAGEMENT OF PROXIMAL HUMERUS FRACTURES BY PHILOS PLATTING

    Anand; Kamareddy; Hanu Tej

    2015-01-01

    Proximal humerus fractures are common and debilitating injuries and incidence of them are increasing especially in elderly. Treatment of unstable, displaced, and comminuted fractures of the proximal humerus remains challenging. Various operative procedures are carried out, recent trend in internal fixation has moved on to locking plates. The goal of the study is to test the efficacy and functional outcome of PHILOS plating in proximal humerus fractures.To evaluate the inc...

  19. The Effects of Delayed Stabilization on Fracture Healing

    Miclau, Theodore; Lu, Chuanyong; Thompson, Zachary; Choi, Paul; Puttlitz, Christian; Marcucio, Ralph; Helms, Jill A.

    2007-01-01

    Previous studies have revealed that delayed internal fixation can stimulate fracture callus formation and decrease the rate of non-union. However, the effect of delayed stabilization on stem cell differentiation is unknown. To address this, we created fractures in mouse tibiae and applied external fixation immediately, at 24, 48, 72, or 96 hours after injury. Fracture healing was analyzed at 10 days by histological methods for callus, bone, and cartilage formation, and the mechanical properti...

  20. Simultaneous ipsilateral humerus and forearm fractures in children

    Kayali, Cemil; Agus, Haluk; Sanli, Coskun

    2004-01-01

    Objectives: To evaluate the results of treatment with early reduction and internal fixation for simultaneous ipsilateral distal humeral and forearm fractures in children. Methods: The study included six patients (1 girl, 5 boys; mean age 11.5 years; range 9 to 13 years) who underwent treatment for ipsilateral humerus distal and forearm fractures. Reduction and fixation of fractures were performed percutaneously or by mini-open incisions. At the end of the follow-up period, patients were e...

  1. Revision arthroplasty using an anti-protrusio cage for Paprosky type Ⅲ acetabular bone deficiency:a middle-term follow-up%髋臼PaproskyⅢ型骨缺损髋臼加强杯翻修的中期疗效

    黄强; 杨静; 沈彬; 周宗科; 康鹏德; 裴福兴

    2013-01-01

    -up time was (5.8±2.4) years.Hip function of patients was judged by Harris hip scores pre-and post-operation.The outcome of acetabular prostheses and bone grafts were assessed by radiologic evaluation.The five-year cage failure-free survival rate was assessed by Kaplan-Meier survivorship analysis.Results The Harris hip scores improved from preoperative 14.6±4.3 to 83.5±7.9 at the final follow-up.Lower limb discrepancy improved from preoperative (26.3±9.1) mm to postoperative (1.2±3.4) mm.The hip rotation center was reconstructed from preoperative(23.6±7.4) mm up-toward and (4.4±14.7) mm lateral-toward dislocation to inside Ranawat triangle.All the allograft bone was incorporated with host bone.None of cage displacement,screw fracture,progressive radiolucency and cement fracture was observed.Mild allograft bone resorption was observed in 3 hips (15%).There was no moderate or severe bone resorption found at the final follow-up.The five-year cage failure-free survival rate was 100% (95% CI,0.95-1.00).Conclusion The revision using anti-protrusio cage combined with allograft bone graft shows satisfying middle-term clinical and radiological results in the treatment of Paprosky type Ⅲ acetabular bone defect.

  2. A safe zone for acetabular component position in metal-on-metal hip resurfacing arthroplasty: winner of the 2012 HAP PAUL award.

    Liu, Fei; Gross, Thomas P

    2013-08-01

    A safe zone for acetabular component positioning in hip resurfacing (RAIL: Relative Acetabular Inclination Limit) was calculated based on implant size and acetabular inclination angle (AIA). For AIA below the RAIL, there were no adverse wear failures or dislocations, and only 1% of cases with ion levels above 10 μg/L. Other than high inclination angle and small bearing size, female gender was the only other factor that correlated with high ion levels in the multivariate analysis. Seven hundred sixty-one hip resurfacing cases are included in this study. The UCLA activity score, femoral shaft angle, body mass index, weight, American Society of Anesthesiologists score, combined range of motion, diagnosis, age, gender, implant brand, AIA, bearing size, and duration of implantation were analyzed to determine the potential risk factors for elevated metal ion levels. These findings apply to sub hemispheric metal-on-metal bearings with similar coverage arcs as the Biomet and Corin hip resurfacing brands. Additional problems may occur when these bearings are connected with trunions on stems for total hip arthroplasty. PMID:23540536

  3. No red cell alloimmunization or change of clinical outcome after using fresh frozen cancellous allograft bone for acetabular reconstruction in revision hip arthroplasty: a follow up study

    Mittag Falk

    2012-09-01

    Full Text Available Abstract Background Possible immunization to blood group or other antigens and subsequent inhibition of remodeling or incorporation after use of untreated human bone allograft was described previously. This study presents the immunological, clinical and radiological results of 30 patients with acetabular revisions using fresh frozen non-irradiated bone allograft. Methods AB0-incompatible (donor-recipient bone transplantation was performed in 22 cases, Rh(D incompatible transplantation in 6 cases. The mean follow up of 23 months included measuring Harris hip score and radiological examination with evaluation of remodeling of the bone graft, implant migration and heterotopic ossification. In addition, all patients were screened for alloimmunization to Rh blood group antigens. Results Compared to the whole study group, there were no differences in clinical or radiological measurements for the groups with AB0- or Rh(D-incompatible bone transplantation. The mean Harris Hip Score was 80.6. X-rays confirmed total remodeling of all allografts with no acetabular loosening. At follow up, blood tests revealed no alloimmunization to Rh blood group donor antigens. Conclusions The use of fresh frozen non-irradiated bone allograft in acetabular revision is a reliable supplement to reconstruction. The risk of alloimmunization to donor-blood group antigens after AB0- or Rh-incompatible allograft transplantation with a negative long-term influence on bone-remodeling or the clinical outcome is negligible.

  4. An extended posterior approach to the hip and pelvis for complex acetabular reconstruction that preserves the gluteal muscles and their neurovascular supply.

    Solomon, L B; Hofstaetter, J G; Bolt, M J; Howie, D W

    2014-01-01

    We investigated the detailed anatomy of the gluteus maximus, gluteus medius and gluteus minimus and their neurovascular supply in 22 hips in 11 embalmed adult Caucasian human cadavers. This led to the development of a surgical technique for an extended posterior approach to the hip and pelvis that exposes the supra-acetabular ilium and preserves the glutei during revision hip surgery. Proximal to distal mobilisation of the gluteus medius from the posterior gluteal line permits exposure and mobilisation of the superior gluteal neurovascular bundle between the sciatic notch and the entrance to the gluteus medius, enabling a wider exposure of the supra-acetabular ilium. This technique was subsequently used in nine patients undergoing revision total hip replacement involving the reconstruction of nine Paprosky 3B acetabular defects, five of which had pelvic discontinuity. Intra-operative electromyography showed that the innervation of the gluteal muscles was not affected by surgery. Clinical follow-up demonstrated good hip abduction function in all patients. These results were compared with those of a matched cohort treated through a Kocher-Langenbeck approach. Our modified approach maximises the exposure of the ilium above the sciatic notch while protecting the gluteal muscles and their neurovascular bundle. PMID:24395310

  5. Role of MRI in hip fractures, including stress fractures, occult fractures, avulsion fractures

    Nachtrab, O. [Department of Radiology, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Gobowen, Oswestry Shropshire SY10 7AG (United Kingdom); Cassar-Pullicino, V.N., E-mail: Victor.Pullicino@rjah.nhs.uk [Department of Radiology, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Gobowen, Oswestry Shropshire SY10 7AG (United Kingdom); Lalam, R.; Tins, B.; Tyrrell, P.N.M.; Singh, J. [Department of Radiology, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Gobowen, Oswestry Shropshire SY10 7AG (United Kingdom)

    2012-12-15

    MR imaging plays a vital role in the diagnosis and management of hip fractures in all age groups, in a large spectrum of patient groups spanning the elderly and sporting population. It allows a confident exclusion of fracture, differentiation of bony from soft tissue injury and an early confident detection of fractures. There is a spectrum of MR findings which in part is dictated by the type and cause of the fracture which the radiologist needs to be familiar with. Judicious but prompt utilisation of MR in patients with suspected hip fractures has a positive therapeutic impact with healthcare cost benefits as well as social care benefits.

  6. Role of MRI in hip fractures, including stress fractures, occult fractures, avulsion fractures

    MR imaging plays a vital role in the diagnosis and management of hip fractures in all age groups, in a large spectrum of patient groups spanning the elderly and sporting population. It allows a confident exclusion of fracture, differentiation of bony from soft tissue injury and an early confident detection of fractures. There is a spectrum of MR findings which in part is dictated by the type and cause of the fracture which the radiologist needs to be familiar with. Judicious but prompt utilisation of MR in patients with suspected hip fractures has a positive therapeutic impact with healthcare cost benefits as well as social care benefits.

  7. Comparison of diagnostic accuracy of Magnetic Resonance Imaging and Multidetector Computed Tomography in the detection of pelvic fractures

    Henes, F.O., E-mail: fhenes@uke.de [Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg (Germany); Nüchtern, J.V. [Department of Trauma-, Hand- and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg (Germany); Groth, M.; Habermann, C.R.; Regier, M. [Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg (Germany); Rueger, J.M. [Department of Trauma-, Hand- and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg (Germany); Adam, G. [Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg (Germany); Großterlinden, L.G. [Department of Trauma-, Hand- and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg (Germany)

    2012-09-15

    Objective: To compare diagnostic accuracy and interobserver reliability of Magnetic Resonance Imaging (MRI) and Multidetector Computed Tomography (MDCT) in the detection of acute pelvic fractures. Materials and methods: In 38 consecutive patients (mean age 74.7 years) with a positive finding of anterior pelvis fracture in the conventional X-rays, pelvic MRI and MDCT were performed for further evaluation of pelvic ring fractures. Two radiologists independently read all data sets. Sensitivity and specificity were calculated based on mean scores for each method. Sensitivities of CT and MRI were compared using a paired proportion test (McNemar). Diagnostic validity of both methods was assessed by the interobserver variability using kappa statistics. Combined clinical data and findings from all imaging studies served as the reference standard. Results: 122 fractures were identified in the reference standard (37 sacral, 58 pubic, 22 acetabular, 1 ischial, 4 ilial). On average, MRI detected 96.3% whereas CT detected 77% of all fractures. With regard to sensitivity, MRI proved to be significantly better compared to MDCT (observer 1, p = 0.0009; observer 2, p = 0.0003 by observer 2). In particular, MRI performed better in the depiction of sacral fractures, reaching a sensitivity of 98.6% compared to 66.1% at CT. The interobserver variability was determined to be very good (k = 0.955 for MRI and 0.902 for MDCT). Conclusion: MRI reaches a significantly higher sensitivity than CT in the detection of acute pelvic fractures, particularly of the sacrum. Especially in elderly patients with suspicion of a sacral fracture and negative results at MDCT, MRI may be considered as the next step in diagnostic workup.

  8. Fracture of advanced building materials: aspects of modelling

    Veselý, V.; Keršner, Z.; Knésl, Zdeněk

    Roterdam: Millpress, 2007 - (Zingoni, A.), s. 643-649 [International Conference on Structural Engineering, Mechanics and Computation /3./ (SEMC 2007). Cape Town (ZA), 10.09.2007-12.09.2007] Institutional research plan: CEZ:AV0Z20410507 Keywords : cementitious composites * numerical modelling * fracture experiment * fracture energy Subject RIV: JL - Materials Fatigue, Friction Mechanics

  9. Orbital fractures: a review

    Jeffrey M Joseph

    2011-01-01

    Full Text Available Jeffrey M Joseph, Ioannis P GlavasDivision of Ophthalmic Plastic and Reconstructive Surgery, Department of Ophthalmology, School of Medicine, New York University, New York, NY, USA; Manhattan Eye, Ear, and Throat Hospital, New York, NY, USAAbstract: This review of orbital fractures has three goals: 1 to understand the clinically relevant orbital anatomy with regard to periorbital trauma and orbital fractures, 2 to explain how to assess and examine a patient after periorbital trauma, and 3 to understand the medical and surgical management of orbital fractures. The article aims to summarize the evaluation and management of commonly encountered orbital fractures from the ophthalmologic perspective and to provide an overview for all practicing ophthalmologists and ophthalmologists in training.Keywords: orbit, trauma, fracture, orbital floor, medial wall, zygomatic, zygomatic complex, zmc fracture, zygomaticomaxillary complex fractures 

  10. Results of cemented bipolar hemiarthroplasty for fracture of the femoral neck - 10 year study

    Maini P

    2006-01-01

    Full Text Available Background : One of the most common treatments of displaced fracture of femoral neck in elderly is bipolar hemiarthroplasty. Method : Two hundred and seventy patients of displaced fracture of femoral neck were treated by bipolar hemiarthroplasty. The Mean age of the patients at the time of surgery was 69.80 years. Results : Follow up ranged between 12 months and 120 months. There were 8 cases each of acetabular erosion and protrusion with 10 cases of femoral stem loosening. Eight cases had post operative dislocation requiring open reduction. Eighteen patients got revision surgery to total hip replacement. The overall incidence of DVT/PE was 9.9% which declined after regular use of low molecular weight heparin. Eleven patients had post operative infection. There were 54.2 % excellent results, 21.0 % good results, 10.7 % fair and 3.7% poor results. Conclusion : Elderly patients with displaced fracture of neck femur are able to ambulate early after Cemented bipolar hemi arthroplasty. The complication rate is low, the component survival long and pre injury functional status is restored in majority of patients.

  11. Bilateral rapidly destructive arthrosis of the hip joint resulting from subchondral fracture with superimposed secondary osteonecrosis

    Yamamoto, Takuaki; Iwamoto, Yukihide [Kyushu University, Department of Orthopaedic Surgery, Fukuoka (Japan); Schneider, Robert [Hospital for Special Surgery, Department of Radiology, New York (United States); Bullough, Peter G. [Hospital for Special Surgery, Department of Laboratory Medicine, New York, NY (United States)

    2010-02-15

    A 57-year-old woman suffered rapid destruction of both hip joints over a 10 months period. At the first visit, her radiographs demonstrated slight joint space narrowing and acetabular cyst formation in both hips. Five months later, joint space narrowing had further progressed, and intra-articular injection of steroid was given in both hips. However, the hip pain gradually became worse. Five months later, both joint spaces had totally disappeared and both femoral heads had undergone massive collapse. At gross examination, both resected femoral heads showed extensive opaque yellow areas consistent with osteonecrosis. Microscopic examination of these areas revealed evidence of both extensive fracture and callus formation, as well as necrosis throughout, indicating that the osteonecrosis observed in this case was a secondary phenomenon superimposed on pre-existing osteoarthritis and subchondral fracture. There were many pseudogranulomatous lesions in the marrow space and necrotic area, where tiny fragments of bone and articular cartilage, surrounded by histiocytes and giant cells, were embedded, such as are typically seen in rapidly destructive arthrosis. No radiologic or morphologic evidence of primary osteonecrosis was noted. This case indicates that at least some cases of rapidly destructive arthritis are the result of subchondral fracture with superimposed secondary osteonecrosis. (orig.)

  12. Bilateral rapidly destructive arthrosis of the hip joint resulting from subchondral fracture with superimposed secondary osteonecrosis

    A 57-year-old woman suffered rapid destruction of both hip joints over a 10 months period. At the first visit, her radiographs demonstrated slight joint space narrowing and acetabular cyst formation in both hips. Five months later, joint space narrowing had further progressed, and intra-articular injection of steroid was given in both hips. However, the hip pain gradually became worse. Five months later, both joint spaces had totally disappeared and both femoral heads had undergone massive collapse. At gross examination, both resected femoral heads showed extensive opaque yellow areas consistent with osteonecrosis. Microscopic examination of these areas revealed evidence of both extensive fracture and callus formation, as well as necrosis throughout, indicating that the osteonecrosis observed in this case was a secondary phenomenon superimposed on pre-existing osteoarthritis and subchondral fracture. There were many pseudogranulomatous lesions in the marrow space and necrotic area, where tiny fragments of bone and articular cartilage, surrounded by histiocytes and giant cells, were embedded, such as are typically seen in rapidly destructive arthrosis. No radiologic or morphologic evidence of primary osteonecrosis was noted. This case indicates that at least some cases of rapidly destructive arthritis are the result of subchondral fracture with superimposed secondary osteonecrosis. (orig.)

  13. 小针刀结合手法对髌骨骨折内固定术后膝关节创伤性关节炎的治疗价值分析%The Analysis of Needle knife Combined With Manipulation on Patella Fracture After Internal Fixation Treatment of Traumatic Arthritis of Knee Joint

    毛灵

    2015-01-01

    目的:分析小针刀结合手法对髌骨骨折内固定术后膝关节创伤性关节炎的治疗价值。方法选取2014年1月~12月我院收治的髌骨骨折内固定术后膝关节创伤性关节炎患者32例,均给予小针刀结合手法治疗。结果2周治疗结束后,患者膝关节功能恢复率为93.75%。结论小针刀结合手法可以有效治疗髌骨骨折内固定术后膝关节创伤性关节炎。%Objective Analysis of therapeutic value about smal needle knife combined with manipulation of patelar fracture by internal fixation of traumatic arthritis of knee joint.MethodsSelected 32 cases in our hospital of patela fracture by internal fixation after knee traumatic arthritis from January to December 2014 and treated with smal needle knife combined treatment approach.ResultsThe recovery of the knee joint function was 93.75% after 2 weeks.Conclusion Acupotomy combined with manipulation in the treatment of patelar fracture in fixation after traumatic arthritis of knee joint is significant.

  14. Study on imaging analysis using three-dimensional CT system for mandibular condylar fracture. Establishing quantitative classification

    We examined 13 patients with fractures of the condylar process (7 men, 6 women) by using 3-dimensional images. A break-down of 15 examined joints revealed 11 patients with unilateral and 2 patients with bilateral fractures of the condylar process. Eight joints of healthy control individual (2 men and 2 women) were used as controls. Fractures of the condylar process and healthy controls were compared, which comparison led to the following conclusions: Bone fragments of deviated fractures may move slightly within the joint, preferentially internally and medially; following displaced fractures, internal and downward movement of bone fragments within the joint is observed; after the occurrence of deviated dislocation fractures, bone fragments protrude from the joint and clearly move internally and inferiorly, showing a rotation of the bone fragments; after the occurrence of displaced dislocation fractures, bone fragments also protrude from the joint and clearly move anteriorly and inferiorly; sometimes an internal rotation of the bone fragments is observed; and with linear fractures there is only minimal overall increase in, and characteristic changes are not observed. Regarding diagnosis, the classical classification of fractures of the condylar process does not provide a classification for linear fractures. Thus, this type has to be newly added to the common classification: Fissure fractures (type I), Deviated fractures (type II), Displaced fractures (type III), Deviated dislocation fractures (type IV), Displaced dislocation fractures (type V), Longitudinal (type VI). (author)

  15. Operative results of closed tibial plateau fractures

    Mathur Hitin

    2005-01-01

    Full Text Available Background: Management of tibial plateau fractures remains challenging because of their number, variety and associated soft tissue injuries that further augment their complexity. Comparison of operative results in recent reports has been difficult due to a lack of standard fracture classification scheme and uniform standardized objective criteria for evaluating results. Methods: Between August 1998 to December 2002, 27 closed tibial plateau fractures were treated operatively using methods and principles advocated by AO/ASIF and followed up for an average of 35.74 months (range 24-68 months. Fractures were classified according to Schatzker′s staging system and results evaluated using Rasmussen′s 30-point clinical grading system and Rasmussen′s radiological evaluation of the knee at a minimum follow up of 2 years. Results: Type II was the most common fracture type (9 cases followed by type I (6 cases. There were 37% excellent and 51.85% good functional results with only 3 patients having unacceptable results. The mean Rasmussen′s functional score was 25.062 (range 15-30. Minimal fixation in comminuted or depressed fractures as compared to rigid fixation was the cause of unacceptable results. Loss of knee range of motion in a few cases was attributed to delayed knee mobilization in these cases. Using Rasmussen′s radiological grading, 2 patients had excellent results and 81.48 % patients had good results. Only 3 patients had poor radiological results. The mean Rasmussen′s radiological score was 15.33 (range 10-18. Moreover, clinical evaluation did not correlate with the follow up radiograph. Conclusion: Anatomic reduction and rigid internal fixation followed by early knee motion and partial weight bearing during bone healing are the cornerstones in the treatment of tibial plateau fractures. Standard fracture classification, uniform reporting and evaluating criteria, along with detailed analysis of uniform treatment methods, has helped us

  16. Fracture Toughness Determination of Cracked Chevron Notched Brazilian Disc Rock Specimen via Griffith Energy Criterion Incorporating Realistic Fracture Profiles

    Xu, Yuan; Dai, Feng; Zhao, Tao; Xu, Nu-wen; Liu, Yi

    2016-08-01

    The cracked chevron notched Brazilian disc (CCNBD) specimen has been suggested by the International Society for Rock Mechanics to measure the mode I fracture toughness of rocks, and has been widely adopted in laboratory tests. Nevertheless, a certain discrepancy has been observed in results when compared with those derived from methods using straight through cracked specimens, which might be due to the fact that the fracture profiles of rock specimens cannot match the straight through crack front as assumed in the measuring principle. In this study, the progressive fracturing of the CCNBD specimen is numerically investigated using the discrete element method (DEM), aiming to evaluate the impact of the realistic cracking profiles on the mode I fracture toughness measurements. The obtained results validate the curved fracture fronts throughout the fracture process, as reported in the literature. The fracture toughness is subsequently determined via the proposed G-method originated from Griffith's energy theory, in which the evolution of the realistic fracture profile as well as the accumulated fracture energy is quantified by DEM simulation. A comparison between the numerical tests and the experimental results derived from both the CCNBD and the semi-circular bend (SCB) specimens verifies that the G-method incorporating realistic fracture profiles can contribute to narrowing down the gap between the fracture toughness values measured via the CCNBD and the SCB method.

  17. Modeling of Interaction of Hydraulic Fractures in Complex Fracture Networks

    Kresse, O. 2; Wu, R.; Weng, X.; Gu, H.; Cohen, C.

    2011-12-01

    A recently developed unconventional fracture model (UFM) is able to simulate complex fracture network propagation in a formation with pre-existing natural fractures. Multiple fracture branches can propagate at the same time and intersect/cross each other. Each open fracture exerts additional stresses on the surrounding rock and adjacent fractures, which is often referred to as "stress shadow" effect. The stress shadow can cause significant restriction of fracture width, leading to greater risk of proppant screenout. It can also alter the fracture propagation path and drastically affect fracture network patterns. It is hence critical to properly model the fracture interaction in a complex fracture model. A method for computing the stress shadow in a complex hydraulic fracture network is presented. The method is based on an enhanced 2D Displacement Discontinuity Method (DDM) with correction for finite fracture height. The computed stress field is compared to 3D numerical simulation in a few simple examples and shows the method provides a good approximation for the 3D fracture problem. This stress shadow calculation is incorporated in the UFM. The results for simple cases of two fractures are presented that show the fractures can either attract or expel each other depending on their initial relative positions, and compares favorably with an independent 2D non-planar hydraulic fracture model. Additional examples of both planar and complex fractures propagating from multiple perforation clusters are presented, showing that fracture interaction controls the fracture dimension and propagation pattern. In a formation with no or small stress anisotropy, fracture interaction can lead to dramatic divergence of the fractures as they tend to repel each other. However, when stress anisotropy is large, the fracture propagation direction is dominated by the stress field and fracture turning due to fracture interaction is limited. However, stress shadowing still has a strong effect

  18. Indication Mistakes in the Treatment of Childhood Bones Fractures

    Unsaldi, Tansel; Inanoglu, Yusuf; Salman, Unal

    2004-01-01

    4 cases of fracture of the shaft of the femur and 1 case of tibia were treated before by open reduction and internal fixation in another hospital with malunion complication were discussed in this paper.

  19. SURGICAL MANAGEMENT OF FRACTURE SHAFT HUMERUS WITH INTERLOCKING NAIL - A PROSPECTIVE STUDY

    Muralidhar,; Mahendranath Reddy

    2013-01-01

    ABSTRACT : INTRODUCTION : Conservative treatment of fracture humerus has resulted in malunion , nonunion , and ultimately poor functional outcome. Internal fixation of fracture shaft of humerus allows ready access for nursing care in patients with multiple injuries and associated co morbid conditions. And also restrictive bandages and splints are avoided , early mobilization o f the patients and his limbs helps to prevent fracture disease....

  20. Modified endaural approach for the treatment of condylar fractures: A review of 75 cases

    S M Balaji

    2016-01-01

    Conclusion: Surgery for mandibular condyle fractures with modified approach allows direct vision of the fracture and reduces surgical trauma to the site while avoiding permanent facial nerve injury. Hence, the author's modified Al-Kayat Bramley incision via endaural approach could be considered as the best approach for open reduction and internal fixation of condylar neck and subcondylar mandibular fractures.

  1. Fracture of Fe-3 Si Single Crystals

    Prahl, J.; Machová, Anna; Landa, Michal; Haušild, P.; Karlík, M.; Clavel, M.; Haghi-Ashtiani, P.

    Praha : MFF UK, 2005. s. 33-33. [International symposium on physics of materials /10./. 30.08.2005-02.09.2005, Praha] R&D Projects: GA AV ČR(CZ) IAA2076201 Institutional research plan: CEZ:AV0Z20760514 Keywords : fracture * twins * bcc iron Subject RIV: JG - Metallurgy

  2. Treatment of the humeral shaft fractures - minimally invasive osteosynthesis with bridge plate versus conservative treatment with functional brace: study protocol for a randomised controlled trial

    Matsunaga, Fabio T; Tamaoki, Marcel J S; Matsumoto, Marcelo H; dos Santos, João B G; Faloppa, Flavio; Belloti, João C

    2013-01-01

    Background Humeral shaft fractures account for 1 to 3% of all fractures in adults and for 20% of all humeral fractures. Non-operative treatment is still the standard treatment of isolated humeral shaft fractures, although this method can present unsatisfactory results. Surgical treatment is reserved for specific conditions. Modern concepts of internal fixation of long bone shaft fractures advocate relative stabilisation techniques with no harm to fracture zone. Recently described, minimally i...

  3. Extra-articular triplane fracture of the distal tibia: a case report

    The triplane fracture of the distal tibia is anatomically complex. It typically consists of a coronal fracture of the metaphysis, a transverse fracture of the physis, and a sagittal, intra-articular fracture of the epiphysis. We report an unusual variation of the triplane fracture which includes an extra-articular epiphyseal component involving the medial malleolus. This is an important variant to recognize because it does not disrupt the distal tibial articular surface. This lack of articular involvement allows for non-surgical management in contrast to the usual triplane fracture which often requires open reduction and internal fixation. (orig.)

  4. Multiple growing fractures and cerebral venous anomaly after penetrating injuries: delayed diagnosis in a battered child

    A growing fracture usually results from a skull fracture with dural tear after blunt head trauma during infancy. We present a case of child abuse with multiple growing fractures resulting from penetrating head trauma by scissors. MR imaging confirmed the presence of growing fractures and revealed a presumably post-traumatic venous anomaly (occluded left cavernous sinus and aberrant posterior venous drainage via the internal cerebral veins). Diagnosis of the growing fractures and venous anomaly was delayed until the age of 15 years. Medical expertise should be more readily available to battered children, and MR imaging is advocated in growing skull fracture to exclude associated post-traumatic brain lesions. (orig.)

  5. STUDY OF FUNCTIONAL OUTCOME OF SURGICAL MANAGEMENT OF UNSTABLE MALLEOLAR FRACTURES IN ADULTS : A CASE REPORT

    Sankara Rao

    2015-09-01

    Full Text Available Malleolar fractures are one of the most common lower extremity fractures in orthopaedic traumatology. Ankle injuries gain importance because body weight is transmitted through it and locomotion depends upon the stability of this joint. Malleolar fractures have varied presentations which have given rise to a wide variety of classification systems, of which two ar e in vogue Lauge - Hansens and Danis - Weber classification. As with all intra articular fractures, malleolar fractures necessitate accurate reduction and stable internal fixation. When malleolar fractures are not reduced accurately they may lead to post tra umatic painful restriction of motion or osteoarthritis or both .

  6. Geostatistics for fracture characterization

    As the critical role of fractures has become more apparent in fluid flow and contaminant transport studies, the characterization of fracture networks has received considerable attention in a wide variety of applications such as nuclear waste repository design. The application of geostatistics to fracture characterization has traditionally involved modelling fractures as thin disks; assumptions about the frequency, orientation, length and width of these disks allow the construction of a 3D model of the fracture network. This paper examines alternatives whose statistical parameters are more relevant for contaminant transport studies and are also easier to infer and validate. A new algorithm for conditional simulation is presented, one that is able to honor multipoint statistics through annealing. By honoring statistics that capture with two-point spatial convariances, this algorithm offers an important new tool not only for the specific problem of fracture characterization but also for the more general problem of spatial simulation

  7. Prevalence of the acetabular sublabral sulcus at MR arthrography in patients under 17 years of age: does it exist?

    Magerkurth, Olaf [University of Michigan, Department of Radiology, Ann Arbor, MI (United States); Hospital Baden, Department of Radiology, Baden (Switzerland); Jacobson, Jon A.; Morag, Yoav; Fessell, David [University of Michigan, Department of Radiology, Ann Arbor, MI (United States); Bedi, Asheesh; Sekiya, Jon K. [University of Michigan, Department of Orthopedic Surgery, Ann Arbor, MI (United States)

    2015-04-18

    To retrospectively determine characteristics of contrast-filled acetabular labral clefts in patients under the age of 17 years at MR arthrography (Mra) correlated with arthroscopy, which may impact the thinking regarding the existence of a sublabral sulcus. After IRB approval, 41 patients under the age of 17 who had MRa were identified. The following observations of contrast-filled clefts were assessed: (1) presence/absence, (2) location, (3) depth, (4) abnormal signal within the labrum and (5) shape (linear, gaping, complex). Fisher's exact and the Wilcoxon matched-pairs signed-rank test were performed. Interreader agreement was calculated with Cohen's k. Reader 1 found clefts in 41 %. Depth was less than half in 6 %, more than half in 65 % and full thickness in 29 %. Shape was linear in 53 %, gaping in 18 % and complex in 29 %. Signal changes occurred in 88 %. Reader 2 found clefts in 29 %. Depth was less than half in 17 %, more than half in 58 % and full thickness in 25 %. Shape was linear in 50 %, gaping in 42 % and complex in 17 %. Signal changes occurred in 50 %. None of the clefts fulfilled the criteria for a sublabral sulcus at MRa and arthroscopy. None of the clefts found in our subjects under the age of 17 years met the MRa and arthroscopy criteria for a sublabral sulcus, which supports the theory that such clefts represent labral tears. (orig.)

  8. Palliative surgery for acetabular metastasis with pathological central dislocation of the hip joint after radiation therapy. A case report

    Orthopedic surgery for bone metastases is mainly a palliative treatment. Pathological central dislocation of the hip joint secondary to osteonecrosis of acetabular metastasis after radiation therapy brings severe suffering to cancer patients. We performed minimally invasive palliative surgery for an elderly woman, and excellent pain relief was achieved. An 80-year-old female suffering from right hip pain was referred to our hospital. She had undergone surgery for lung cancer 5 years previously and her right acetabulum was subsequently affected by metastasis. With the aim of controlling the metastasis, radiation therapy was performed. Two years later, pathological central dislocation of the hip joint occurred with sudden onset of severe pain, and she was unable to maintain a sitting position and became bedridden. After she was referred to our hospital, we created an intentional pseudarthrosis in the femoral neck for palliation. After the surgery, excellent pain relief and remarkably improved mobility were achieved during her limited remaining lifetime. In this report, we introduce a novel method of producing a pseudarthrosis in the femoral neck for pathological dislocation. This procedure is a minimally invasive treatment and an alternative option for palliative surgery for pathological dislocation of the hip joint due to osteonecrosis after radiation therapy. (author)

  9. Pediatric stress fractures

    de la Cuadra, P.; Albiñana, J.

    2000-01-01

    Stress fractures in children are uncommon. This report describes the findings of 8 cases in 6 children. One patient had 3 stress fractures: 2 consecutive midshaft stress fractures of the same tibia associated with one of the fibula. Signs and symptoms may be misdiagnosed as malignant tumors or osteomyelitis. Serial radiographs and computed tomography scans are the key to the diagnosis, although bone scan and magnetic resonance imaging can be helpful. Biopsy is unnecessary and might even be mi...

  10. Bone fractures after menopause

    Barlow, David H.; Bouchard, Philippe; Brandi, Maria Luisa; Evers, J.L.H.; Glasier, A.; Negri, Eva; Papapoulos, Socrates E; Ralston, Stuart H; Rizzoli, Rene; Baird, D T; Collins, J.; G. Benagiano; P.G. Crosignani; La Vecchia, C.; Volpe, A

    2010-01-01

    Every year 30% of individuals above age 65 fall, and falls are the principal cause of bone fractures. To reduce fracture incidence requires both prevention of falls and maintenance of bone strength.PubMed searches were performed, for studies of the epidemiology of fractures, bone physiology, endocrine effects, osteoporosis measurement, genetics, prevention and effectiveness. Topic summaries were presented to the Workshop Group and omissions or disagreements were resolved by discussion.Ageing ...

  11. Pelvic Insufficiency Fractures

    O’Connor, Timothy J.; Cole, Peter A.

    2014-01-01

    Pelvic insufficiency fractures may occur in the absence of trauma or as a result of low-energy trauma in osteoporotic bone. With a growing geriatric population, the incidence of pelvic insufficiency fracture has increased over the last 3 decades and will continue to do so. These fractures can cause considerable pain, loss of independence, and economic burden to both the patient and the health care system. While many of these injuries are identified and treated based on plain radiographs, some...

  12. Fracture Nasal Bone

    Balasubramanian, Thiagarajan; Venkatesan, Ulaganathan

    2013-01-01

    Nose is the most prominent part of the face, hence it is likely to be the most common structure to be injured in the face. Although fractures involving the nasal bones are very common, it is often ignored by the patient. Patients with fractures of nasal bone will have deformity, tenderness, haemorrhage, edema, ecchymosis, instability, and crepitation. These features may be present in varying combinations. This article discusses the pathophysiology of these fractures, role of radiography and u...

  13. FRACTURE NASAL BONES

    Balasubramanian Thaigarajan; Venkatesan Ulaganathan

    2013-01-01

    Nose is the most prominent part of the face, hence it is likely to be the most common structure to be injured in the face. Although fractures involving the nasal bones are very common, it is often ignored by the patient. Patients with fractures of nasal bone will have deformity, tenderness, haemorrhage, edema, ecchymosis, instability, and crepitation. These features may be present in varying combinations. This article discusses the pathophysiology of these fractures, role of radiography a...

  14. Fracture mechanics safety approaches

    Component integrity assessments require the knowledge of reliable fracture toughness parameters characterising the initiation of the failure process in the whole relevant temperature range. From a large number of fracture mechanics tests a statistically based procedure was derived allowing to quantify the initiation of fracture toughness as a function of temperature as a closed function as well as the temperature dependence of the cleavage instability parameters. Alternatively to the direct experimental determination one also can use a correlation between fracture toughness and notch impact energy. (orig.)

  15. Fracture mechanics safety approaches

    Roos, E.; Schuler, X.; Eisele, U. [Materials Testing Inst. (MPA), Univ. of Stuttgart (Germany)

    2004-07-01

    Component integrity assessments require the knowledge of reliable fracture toughness parameters characterising the initiation of the failure process in the whole relevant temperature range. From a large number of fracture mechanics tests a statistically based procedure was derived allowing to quantify the initiation of fracture toughness as a function of temperature as a closed function as well as the temperature dependence of the cleavage instability parameters. Alternatively to the direct experimental determination one also can use a correlation between fracture toughness and notch impact energy. (orig.)

  16. Increasing fracture during childhood

    Although calvarial fractures usually heal well in children, it may occur that interposition of dura and arachnoidea leads to an enlargement of the fracture line, and to formation of a leptomeningeal cyst accompanied by an arrosion of the bone. This defect of the skull cap is the so-called 'growing fracture of the vault of the cranium'. Clinical manifestation of this growing fracture is a swelling that occurs after some weeks on the skull. Diagnostic evaluation can be done by CT and X-ray radiography. (orig./GDG)

  17. 纤维根管桩根管内固定联合复合树脂粘接修复儿童前牙冠根联合折%Fibrous root canal dowel internal fixation combined with composite resin adhesion in treatment of crown-root fracture of anterior teeth in children

    汪隼; 曹慧珍

    2012-01-01

    Objective To investigate the clinical effect of fibrous root canal dowel internal fixation combined with composite resin adhesion in treatment of crown-root fracture of anterior teeth in children. Methods Eleven children (11 teeth) aged 11 to 14 with crown-root fracture caused by trauma of upper mandible medial incisor were selected. All were horizontal fracture or oblique fracture, and there was no longitudinal fracture and alveolar bone fracture. Patients received one-visit endodontics treatment after external fixation of the injured teeth, and were follow up for one week. The crown-root broken ends were restored with fibrous root canal dowel internal fixation combined with composite resin adhesion. Results Nine teeth were successfully restored, and were cosmetically and functionally resumed in short term. One patient failed due to lower palatal fracture line, with more wound hemorrhage and exudation. And the other patient failed due to consumption of hard food, which led to the loose broken ends. Conclusion Fibrous root canal dowel internal fixation combined with composite resin adhesion may be an ideal temporary restoration method in treatment of crown-root fracture of anterior teeth in children, which can resume cosmetics and function in short term and decrease loss in dental and periodontal tissues to the full extent.%目的 观察纤维根管桩根管内固定联合复合树脂粘接对儿童前牙冠根联合折的修复效果.方法 上颌中切牙外伤致冠根联合折断的患者11例(患牙11颗),年龄11 ~ 14岁,均为横折或斜折,无纵折,无牙槽骨骨折;就诊予以断牙外固定后即刻行一次性根管治疗,观察1周;采用纤维根管桩根管内固定加冠根断端复合树脂粘接的方法进行断端自体牙修复.结果 11颗患牙中,9例治疗成功,短期内恢复美观和功能,效果满意;失败2例,其中1例为腭侧折断,折断线较低,出血、渗出较多;另1例患儿未遵医嘱食用硬物

  18. Two-dimensional finite element simulation of fracture and fatigue behaviours of alumina microstructures for hip prosthesis

    Kim, Kyungmok; Géringer, Jean; 10.1177/0954411911422843

    2012-01-01

    This paper describes a two-dimensional (2D) finite element simulation for fracture and fatigue behaviours of pure alumina microstructures such as those found at hip prostheses. Finite element models are developed using actual Al2O3 microstructures and a bilinear cohesive zone law. Simulation conditions are similar to those found at a slip zone in a dry contact between a femoral head and an acetabular cup of hip prosthesis. Contact stresses are imposed to generate cracks in the models. Magnitudes of imposed stresses are higher than those found at the microscopic scale. Effects of microstructures and contact stresses are investigated in terms of crack formation. In addition, fatigue behaviour of the microstructure is determined by performing simulations under cyclic loading conditions. It is shown that crack density observed in a microstructure increases with increasing magnitude of applied contact stress. Moreover, crack density increases linearly with respect to the number of fatigue cycles within a given con...

  19. Long-bone fractures in llamas and alpacas: 28 cases (1998–2008)

    Knafo, S. Emmanuelle; Getman, Liberty M.; Richardson, Dean W.; Fecteau, Marie-Eve

    2012-01-01

    Treatment and outcome of camelids with long-bone fractures are described. Medical records (1998–2008) of camelids (n = 28) with long-bone fractures were reviewed for signalment, time to presentation, fracture type, method of repair, duration of hospitalization, and post-operative complications. Follow-up information was obtained via telephone interviews with owners. Mean age and weight at presentation were 3.4 years and 56.3 kg, respectively. Twenty-six fractures were treated with internal fi...

  20. The need for rigid fixation of combined parasymphyseal and bilateral subcondylar fractures.

    Wheatley, M J; Meltzer, T R

    1997-01-01

    Both miniplate and larger fracture plate fixation techniques have been utilized successfully in the treatment of mandibular fractures. Parasymphyseal fractures which occur in conjunction with bilateral subcondylar fractures, however, represent a special fracture pattern that is not well managed with miniplate fixation. Miniplates do not have the tensile strength to resist the strong, muscular-deforming forces that act on these fractures. This fracture pattern is best managed with anatomic symphyseal reduction and internal fixation with a 2.7 mm mandibular fracture plate and a 2.0 mm tension band plate. The subcondylar fractures can then be managed with either intermaxillary fixation or open reduction. This approach provides good functional results and can prevent late complications. PMID:11951271