In human genetics and orthopedics quite different answers have been given to the question of hereditary transmission and frequency of hip dysplasia in families of children with congenital hip dislocation. We therefore have made roentgenometric measurements of 110 parents of children with congenital hip dislocation. In 25% we found abnormal flat acetabulae, whereas 12% had pathologic deep hips. This may propose a new concept of morphology of congenital hip dysplasia.

When Pavlik introduced his method of treating congenital dislocation of the hip, he emphasized reducing the rate of osteonecrosis. Graf?s method of sonographic evaluation afforded earlier accurate diagnosis and subsequent treatment of developmental dysplasia of the hip. To ascertain whether treatment duration, gender, age at diagnosis, clinical stability, and/or treatment onset correlate with the risk of osteonecrosis in Graf Type III or IV hips, we clinically and sonographically screened 18,067 neonates (36,134 hips) for developmental dysplasia of the hip over a 4-year period; 151 had Graf Type III or IV hips, and 78 of these were treated by us and had known outcomes. Of these 78 hips, 65 (0.18%) had Graf Type III and 13 (0.036%) had Graf Type IV hips. Sixteen of the 65 Type III hips (25%...

A case is presented of a 33-year-old woman who presented with pain in the right hip and groin. An osteotomy at the age of 15 months had been performed for congenital dislocation of the right hip. Radiological studies, including CT, showed the lesser trochanter posterior to its usual position and illustrated an abnormal course of the ipsilateral iliopsoas tendon. With contrast under fluoroscopy an abrupt jump of the iliopsoas tendon over the ileopectineal line was elicited, resulting in pain. (orig./GDG).

Purpose Magnetic resonance imaging (MRI) has been successfully used in the determination of the adequacy of the surgical reduction of congenitally dislocated hips in children. We present the results of a prospective series of patients treated conservatively. MRI was performed in all hips after positioning was deemed adequate on radiographs after spica cast application. The goal of this study was to evaluate the usefulness of MRI in this indication. Methods After the study was approved by our local ethics committee, 31 patients for a total of 36 dislocated hips were included. After the traction period, hip testing was performed and a hip spica cast was applied under general anaesthesia. All children had MRI within 1 week of reduction, without the need for contention or general anaesthesia....

Congenital knee dislocation is a rare anomaly associated with a variety of neuromuscular diseases and deformities. The etiology of this condition remains unclear, but it is usually associated with a variety of disorders, such as Larsen's syndrome, arthrogryposis, spondyloepiphyseal dysplasia, Ehlers-Danlos syndrome, Down syndrome, and Streeter's dysplasia. It is rarely an isolated entity, and 60% of patients with congenital knee dislocation had additional congenital anomalies, most commonly hip dysplasia. The ideal method of treatment is debated. No current treatment algorithms address anterior cruciate ligament (ACL) elongation and its role in recurrent deformity or hyperextension. This article describes 2 patients who underwent open reduction of the knee for recurrent and neglected congenital knee dislocations. An ACL shortening and reinforcement technique is described. Both patients' treatment consisted of V-Y advancement of the extensor mechanism, soft tissue release, anterior capsulotomy, and posterior capsulorrhaphy. Anterior cruciate ligament shortening and reinforcement using an iliotibial band physeal-sparing technique was performed. The technique improved maintenance of reduction and prevented hyperextension of the knee. Anterior cruciate ligament elongation is an underemphasized anatomical feature associated with congenital knee dislocation. Due to its role in the prevention of anterior subluxation of the tibia and its effect on knee stability, incompetence should be addressed at the time of open reduction. The presence of an intact ACL with a congenital knee dislocation does not preclude management of anterior instability. Competence of the intact ACL should be addressed following reduction. PMID:22784907

Congenital torticollis is a very common postural deformity, characterized by a more or less severe retraction of sternocleidomastoid muscle. Any treatment, else that ''good sense'' counsels given to the parents, is indicated. The evolution is spontaneously favorable in the majority of cases before the age of one year old. The elimination of differential diagnosis (vertebral and/or neurological malformations, ocular, tumor) is the key-point. Screening of congenital hip dislocation is mandatory because the physiopathology is the same in both diseases. A remaining torticolis after 18 months of age may be an indication to sternocleidomastoid muscle lengthening.

Congenital dislocation of the hip represents a spectrum of disease from transient neonatal hip instability to established dislocation. Established risk factors include breech presentation and a positive family history. Emphasis should be placed on early diagnosis and treatment to minimize the need for surgical intervention. Clinical assessment has limited accuracy which further diminishes soon after birth. Ultrasound based screening is more sensitive, but controversy remains as to which method to use and its effect on outcome. When initiated early, treatment using a simple abduction device such as a Pavlik harness has an excellent success rate. Resistant cases and late presentations usually require surgical management, which are largely age dependent. We discuss the condition, detail the s...

The Israeli national neonatal screening program for congenital hypothyroidism (CH) was initiated in May 1978. The overall incidence of persistent primary congenital hypothyroidism (PPCH) during the first 10 years of screening was 1:2,950 live births. The purpose of this study was to ascertain the incidence of congenital extrathyroid anomalies (ETAs) among the infants with PPCH and to compare it with the Israeli Birth Defect Monitoring System data. Among 243 PPCH infants on whom adequate data were available, 38 infants (15.6%) had associated congenital anomalies. Fourteen infants had congenital cardiac anomalies (5.8%): VSD (n = 7), PDA (n = 3), PS (n = 2), one mitral insufficiency, and one congenital atrial flutter. Eight children (3.3%) had congenital dislocation of the hip; their M:F ratio was 3:5 similar to the M:F ratio in CH (unlike the ratio in the general population). Some additional anomalies were considerably more common than in the general population. It is reasonable to assume that teratogenic effects active during organogenesis may affect simultaneously many organs, including the developing thyroid, causing a relatively high percentage of CH infants with congenital ETA. PMID:1519652

Dosimetry studies, employing a model, were conducted under the technical conditions established by one of the authors for exploration of the infant and child pelvis during diagnosis and treatment of congenital dislocation of the hip. Based on this data, it was confirmed that the dose applied to the various organs of a patient can be evaluated by using a relation identical to that employed for calculating the dose during radiotherapy. The results measured experimentally or calculated from the proposed formula, were comparable to those in the published literature. This method of dose assessment is valid not only in pediatric radiology, and whatever the region explored, but also for radiodiagnosis in adults.

Chromosome analysis in two young patients with multiple congenital anomalies revealed a de novo interstitial deletion of 8q that has not been reported before. The deletions were overlapping by 8.35 Mb (8q24.21q24.23). The clinical features shared by our patients were coloboma, VSD, digital abnormalities, congenital dislocation of a hip, feeding problems, psychomotor delay and convulsions. The deletion included the region for Langer-Giedion syndrome (TRPS1 and EXT1) in the girl only. However, she is too young to present features of this syndrome, apart from dysmorphic features like a bulbous nose and notched alae nasi. Several genes are present in the commonly deleted region, including genes with unknown function, and genes for which haploinsufficiency is known to have no phenotypic effect in mice (Wnt1). A gene that might play a role in the convulsions of our patients is KCNQ3. PMID:19464398

Rheumatoid Arthritis; Osteoarthritis; Post-traumatic Arthritis; Collagen Disorders; Avascular Necrosis; Traumatic Femoral Fractures; Nonunion of Femoral Fractures; Congenital Hip Dysplasia; Slipped Capital Femoral Epiphysis.

Osteoarthritis; Post-traumatic Arthritis; Collagen Disorders; Avascular Necrosis; Traumatic Femoral Fractures; Nonunion of Femoral Fractures; Congenital Hip Dysplasia; Slipped Capital Femoral Epiphysis; Perthes Disease

Background Hip deformity secondary to Legg-Calv? Perthes disease (LCPD) may result in femoroacetabular impingement (FAI) and ultimately osteoarthritis. Observations made with the surgical hip dislocation approach have improved our understanding of the pathologic mechanics of FAI. However, owing to concerns about complications related to the vascularity, the role of surgical hip dislocation in the treatment of healed LCPD remains controversial. Questions/purposes We present an algorithm to treat deformities associated with healed LCPD and asked (1) whether femoral head-neck osteochondroplasty and other procedures performed with the surgical hip dislocation approach provide short-term clinical improvement; and (2) is the complication rate low enough to be acceptable. Methods We retrospective...

Pauwels’ method of hip biomechanics can explain a negative influence of the lateral shift of the femoral head on the load of dislocated hip joint, but, the influence of the cranial shift of femoral head can not be explained. A calculation of hip balance which takes into consideration both lateral an...

Occasionally, heterotopic splenic tissue can occur in the renal fossa secondary to splenosis following splenic trauma or splenectomy. Rarely, it can represent a developmental anomaly secondary to fusion of splenic and renal tissues. Splenorenal fusion can present as a renal mass, mimicking primary or secondary renal neoplasm on imaging studies, or with symptoms of hypersplenism (anaemia). To our knowledge, only seven cases of splenorenal fusion have been previously reported and the present case is only the second presentation in a young child. We report a case of splenorenal fusion in a 26-month-old girl with symptoms of hypersplenism and an abdominal mass associated with a ventricular septal defect, an umbilical hernia and a previous congenital dislocation of the hip. (orig.)

Objective of this study was to present the spectrum of early magnetic resonance imaging (MRI) findings following traumatic dislocation of the femoral head, and to identify any associated injuries. Prospective MRI of both hips was performed on 18 patients within 5 weeks of a traumatic femoral head dislocation. The interval between the time of injury and the imaging studies ranged from 2 to 35 days. Posterior dislocation was present in 14 patients and anterior dislocation in 4 patients. In the majority of cases, we performed axial T1, coronal T1, and coronal T2{sup *} (MPGR) sequences. MRI can effectively identify and quantify the muscle injury and joint effusion that invariably accompany traumatic hip dislocations. It is also useful for demonstrating trabecular bone contusion (trabecular injury) and iliofemoral ligament injury, which occur commonly with acute hip dislocation. (orig./VHE)

Congenital dislocation of the radial head is rare, although it is the most common congenital anomaly of the elbow. A concomitant progressive cubitus valgus of the elbow has not previously been described in literature. We describe a case of an 8-year-old girl with an unilateral congenital radial head...

... known as TMARCS. It is with great pleasure that I moderate tonight's surgical demonstration performed by my ... possibly a fracture dislocation of her hip. At that time, or a year or two later, she ...

We reviewed 16 patients with spina bifida and unilateral dislocation of the hip at an average age of 17 years. Nine had a high neurological level (thoracic to L3) and seven a low lesion (L4 to sacral). We assessed the influence of unilateral dislocation of the hip on leg-length discrepancy, hip pain, hip stiffness and pressure sores of the ischial tuberosity. In non-walking patients with high-level lesions, unilateral dislocation gave little functional disability and did not appear to require reduction. In walking patients with low-level lesions, leg-length discrepancy led to a poor gait and functional problems which could be prevented by reduction of the dislocation. In all patients with low lesions, surgery was successful in maintaining reduction; in two of five patients with high lesions it was unsuccessful. PMID:7615608

A case of recurrent post-traumatic anterior dislocation of the hip in a 27-year-old woman is presented. Radiographs document this rare abnormality in the acute stage. Post-reduction arthrography demonstrates an anterior pseudobursa resulting from capsular tear.

The limbus and the neolimbus are both pathological lesions that form in response to a developmentally dislocated hip. An understanding of these structures is integral to treatment of developmental dysplasia of the hip (DDH). Yet, we believe the current peer-reviewed orthopaedic literature and orthop...

The Pembersal operation combines features of the Pemberton and Salter osteotomies. Results have usually been reported in patients with dysplasia but without frank dislocation. We asked if the following factors influence the outcome of the Pembersal operation in patients with dislocated hips: triradi...

We report a case of a 27-year-old man who was involved in a high-speed car accident. He sustained multiple organ damage including multiple brain petechiae suggesting diffuse axonal damage, aortic dissection, retroperitoneal haematoma and a fracture-dislocation of the right hip with a femoral head fracture and an ipsilateral intertrochanteric fracture. Due to the general condition of the patient, physiological stabilisation was prioritized, and at 2?weeks the fracture-dislocation of the hip was treated with a proximal femoral nail for the intertrochanteric fracture and Herbert screws for the femoral head fracture. Postoperatively, two episodes of recurrent hip dislocation occurred, and this was stabilized eventually with a Steinman pin inserted across the hip joint and taken out 1?month lat...

Slipped capital femoral epiphysis (SCFE) results in posterior and inferior displacement of the epiphysis on the femoral neck. In most centers, the recommended initial management of stable SCFE is in situ pinning. Minimal reduction with in situ pinning is recommended for unstable SCFE. This approach does not restore the normal anatomy of the hip joint, and the resulting proximal femoral deformity may cause femoroacetabular impingement. Patients with femoroacetabular impingement experience reduced hip range of motion as well as hip pain, and they are at risk of early-onset hip osteoarthritis. Techniques for managing this deformity include arthroscopic femoral neck osteochondroplasty, a limited anterior hip approach or surgical hip dislocation, and flexion intertrochanteric osteotomy. These surgical techniques should be considered for patients with healed SCFE deformity who present with hip pain at an early age. PMID:22052643

Purpose This study reviews the dynamic patellofemoral CT results of 39 patients with untreated developmental dislocation of the hip who are suffering from knee pain. Method The mean age of the patients with unilateral developmental dislocation of the hip was 33.3 (?7.9), for bilateral patients 36.2 (?11.3), and for the control group, it was 31.5 (?8.5). While 14 of them were bilateral, 25 were unilateral. The CT results of 24 asymptomatic adult knees served as the control group. The patellofemoral parameters of patients with unilateral and bilateral developmental dislocation of the hip, the control group?s parameters and the effect of femoral anteversion, limb length discrepancy, severity of dislocation, the mechanical axis deviation on patellofemoral parameters were analyzed. Results In p...

Total hip arthroplasty (THA) with ceramic-on-ceramic bearings and an uncemented design is considered an effective treatment of developmental dysplasia of the hip, especially for young, active patients. The new generation of hip resurfacing with large femoral heads offers more stability, better range of motion (ROM), and more bone preservation than conventional THA. Twenty-one consecutive patients (26 hips) with osteoarthritis secondary to developmental dysplasia of the hip underwent metal-on-metal hip resurfacing. Average patient age at the time of surgery was 46.5 years (range, 37-59 years). Six patients (28.6%) were men and 15 (71.4%) were women. During the same period, another 21 patients (26 hips) with developmental dysplasia of the hip secondary to osteoarthritis were treated with ceramic-on-ceramic THA. Average patient age at the time of surgery was 48.2 years (range, 38-64 years). At follow-up, no complications (eg, dislocation, infection, or symptomatic deep venous thrombosis) occurred in the 2 groups. No significant difference was noted in Harris Hip Score between the 2 groups, but the average ROM of the hip resurfacing group was significantly better than the THA group (Pmetal-on-metal hip resurfacing have been encouraging in the treatment of developmental dysplasia of the hip, with better ROM recovery than conventional THA. PMID:19226067

Congenital dislocation of the radial head is rare, although it is the most common congenital anomaly of the elbow. A concomitant progressive cubitus valgus of the elbow has not previously been described in literature. We describe a case of an 8-year-old girl with an unilateral congenital radial head dislocation with a progressive cubitus valgus of 35°, caused by a prematurely closing physis of the lateral humeral condyle. This might be caused by an increased pressure on the lateral physis by the anteriorly dislocated radial head. As no complaints or limitations were present, treatment was non-operative with clinical observation, with satisfactory results after a follow-up of 18 months. A concomitant progressive cubitus valgus can be present in patients with a congenital radial head disloca...

Hip dislocations are relatively uncommon in children, they may occur before five years of age as a result of seemingly trivial trauma. A 5-year-old boy was admitted with knee pain six weeks after a fall from bed. Physical examination showed obturator dislocation of the left hip. Owing to the late presentation and without attempting closed reduction, the patient was treated with open reduction and capsulorrhaphy. At the end of a year follow-up, the patient had no complaints and no functional restriction. PMID:16905902

We have contrasted 161 patients with Down's syndrome admitted to three acute care centers with 107 patients in an institutional setting, outlining their major orthopedic problems and suggesting methods of management based on acute care experience. Severe hallux valgus, metatarsus primus varus, subluxation an dislocation of the patella, severe pes planus, atlantoaxial subluxation, femoral head epiphysiolysis, and dislocation or subluxation of the hips remain the most critical problems against a background of other less common orthopedic abnormalities. PMID:6451852

Objective: The BICON-PLUS cup is an uncemented, threaded acetabular component. We evaluated the clinical results of the cup in revision surgery after failed bipolar hip arthroplasty.Methods: In our institute, 71 hips underwent revision surgery for failed bipolar hip arthroplasty. A total of 30 hips in 25 patients were revised using the BICON-PLUS cup. Among them, we evaluated 24 hips in 21 patients with 2 or more years’ follow-up. All patients were women, and the average age at revision was 57 years. The average period of follow-up was 6 years. During the surgery, morselized allograft bone was filled and impacted into the bone defect, and then the cup was twisted into the bony acetabulum.Results: The average hip score was 64 points before revision surgery and 84 points 2 years postoperatively. At the final follow-up, seven cups were unstable radiologically. Six hips required repeat revision among the unstable hips. Five hips were revised because of the varus migration of the cup and one hip because of recurrent dislocation. The score had improved to 84 points at 2 years after the repeat revision.Conclusion: The varus and the repeat revision cases had a severe thinning in the anterior or posterior column, a huge bone defect, or an intraoperative fracture in the acetabulum. Most patients with failed bipolar hip arthroplasty had a severe bone defect in the acetabulum due to outer head migration and/or osteolysis. In addition, the quality of the acetabulum was poor. We suspected that the initial fixation was not adequate as the fins of the cup did not bite into the bony acetabulum. Moreover, the allograft bone could not provide adequate bearing against the load. In conclusion, the indication of the cup for use in failed bipolar hip arthroplasty should be limited to hips with minimum damage in the acetabulum.   

BACKGROUND: Hip dysplasia is considered pre-osteoarthritic, causing degeneration in young individuals. OBJECTIVE: To determine the pattern of degenerative change in moderate to severely dysplastic hips in young patients. DESIGN AND PATIENTS: One hundred and ninety-three consecutively-referred younger patients with hip pain believed to be caused by hip dysplasia constituted the study cohort. The average age was 35.5 years (range, 15-61 years). They were examined by close-cut transverse pelvic and knee computed tomography and antero-posterior radiographs (CT). We identified 197 hips with moderate to severe dysplasia, and 78 hips with normal morphology in the study cohort, whilst 111 hip joints were borderline dysplastic according to preset definitions. Comparative analyses of anatomy and distribution of degeneration between dysplastic and normal hips in the study cohort were performed. RESULTS: In dysplastic hips the anterior acetabular sector angle was significantly and inversely associated to femoral anteversion (p < 0.001). The center-edge (CE) angle, the acetabular angle (AA), and the acetabular depth ratio (ADR) were significantly interrelated (p < 0.001; correlation coefficients ranging from -0.8 to 0.7). Fifty-one hips were subluxated (24R/27L). There were no cases of complete dislocation. The formation of subchondral cysts or osteophytes in dysplastic hips was significantly associated with reduced minimum joint space width (p ranging from 0.005 to 0.02). However, in 67 hips with acetabular cysts, only 6 hips had minimum joint space widths = 2.0 mm (8.9%) in the coronal plane. In 96 cases with acetabular cysts found in the sagittal plane, 43 cases had minimum joint space widths = 2.0 mm (44.7%). Bony rim detachment at the site of labral insertion was recorded in 30 hips. Twenty-three of these were dysplastic (p = 0.01). CONCLUSIONS: Degeneration was most often found in the anterolateral part of the dysplastic hip joints. Most cysts were located above the transition zone between the bony and the fibrocartilaginous acetabulum, and we found a significantly- increased number of cases with avulsed bony fragments at the antero-lateral labral insertion in dysplastic hips compared to normal hips. It seems likely that the early degenerative process in dysplastic hips originates at the watershed zone between the acetabular labrum and the acetabular cartilage in response to subluxation and femoroacetabular impingement.

Congenital muscle disease, including congenital myopathies (CM) and congenital muscular dystrophies (CMD) may develop hip dysplasia, progressive joint contractures, and scoliosis, sometimes leading to surgical intervention. Both the incidence of orthopedic problems and cardiopulmonary abnormalities that may impact surgical management and patient outcomes in certain CM/CMD subtypes are unknown. Defining the incidence and outcome of orthopedic and cardiopulmonary involvement per CM/CMD subtype will direct pre and post-surgical management to improve patient care. The objective was to determine the incidence of orthopedic, pulmonary and cardiac problems in CM/CMD subtypes. A PubMed search of peer-reviewed literature limited to human case reports, series, and multicenter studies was performed w...

Dislocation after total hip replacement is more common in the early, postoperative period. Postoperative intraarticular haematoma and remaining seroma fluid and/or weakened posterior soft tissue wall may be contributing factors. Our purpose was to compare and follow with sonography the resorption o...

Background Despite advances in primary THA, dislocation remains a common complication. In New Zealand (NZ), dislocations are reported to the National Joint Registry (NJR) only when prosthetic components are revised in the treatment of a dislocation. Closed reductions of dislocated hips are not recorded by the NJR. Questions/purposes We compared the true dislocation rate for patients receiving primary THA in the Wellington region with the rate reported by the NZ NJR for the same group of patients. Methods The NZ NJR identified 570 patients undergoing primary THA from January 1, 2008, to December 31, 2009, with addresses in the Wellington region. The mean age was 67.5?years (range, 27?96?years). The minimum followup was 2?years (mean, 3?years; range, 2?4?years). Results Six patients required...

This is the first case report of an iatrogenic anterior hip dislocation after arthroscopic surgery for femoroacetabular impingement with over 1 year of follow-up. This case report describes the clinical course of a patient with symptomatic cam-pincer femoroacetabular impingement. She underwent arthroscopic rim trimming, labral debridement after a failed attempt at labral refixation from suture cut-through, and femoral head-neck resection osteoplasty. The procedure involved supranormal hip distraction for extraction of an iatrogenic loose body (detached metallic radiofrequency probe tip). The patient had an anterior hip dislocation in the recovery room. Immediate closed reduction under general anesthesia and bracing were performed but failed despite the ability to obtain a concentric but gr...

Autosomal dominant congenital spinal muscular atrophy is characterized by predominantly lower limb weakness and wasting, and congenital or early-onset contractures of the hip, knee and ankle. Mutations in TRPV4, encoding a cation channel, have recently been identified in one large dominant congenital spinal muscular atrophy kindred, but the genetic basis of dominant congenital spinal muscular atrophy in many families remains unknown. It has been hypothesized that differences in the timing and site of anterior horn cell loss in the central nervous system account for the variations in clinical phenotype between different forms of spinal muscular atrophy, but there has been a lack of neuropathological data to support this concept in dominant congenital spinal muscular atrophy. We report clini...

Abstract in portuguese OBJETIVO: Avaliar a evolução clínica e comparar a eficácia do tratamento fisioterapêutico intensivo ou mínimo, em neonatos e lactentes com torcicolo congênito. MÉTODOS: Foram atendidas no Ambulatório de Fisioterapia e Cirurgia Pediátrica do Hospital de Clínicas da Universidade Estadual de Campinas 47 crianças com torcicolo congênito. Analisaram-se, retrospectivamente, antecedentes maternos, neonatais, apresentação clínica e tratamento fisioterapêutico, cl (more) assificado de acordo com a freqüência das sessões. O tratamento intensivo foi definido como sessões de fisioterapia realizadas pelo fisioterapeuta no ambulatório, acrescidas de exercícios diários realizados pelos pais em domicílio. O tratamento mínimo foi considerado quando apenas o fisioterapeuta realizava as sessões semanalmente no ambulatório, sem a participação dos pais. RESULTADOS: Quanto às características demográficas da população, observou-se: idade média materna=26 anos; parto normal=40 (85%); mães primigestas=35 (75%); idade média ao diagnóstico=50 dias. A presença de nódulo intramuscular foi notada em 46 (98%) pacientes. As seguintes doenças estiveram associadas: luxação congênita de quadril igual=4 (8%); fratura de clavícula=2 (4%); pé torto congênito=1 (2%). O tratamento intensivo foi realizado em 34 (72%) pacientes e a cura observada em 100%, após 74 dias, em média. O tratamento mínimo foi aplicado em 13 (28%) pacientes e a cura observada em dez (77%), tratados em média por 130 dias. CONCLUSÕES: O torcicolo congênito apresentou evolução clínica favorável em ambos os grupos. O tratamento intensivo propiciou maior índice de cura em menor tempo de tratamento. Abstract in english OBJECTIVE: To evaluate the clinical course and to compare the effectiveness of physiotherapeutic treatment performed daily or once a week in newborns and infants with congenital torticollis. METHODS: 47 patients with congenital torticollis were assisted at the Physiotherapy and Pediatric Surgery Services of the Clinical Hospital of Campinas University. The following data were retrospectively collected: maternal and neonatal history, clinical presentation and physiotherape (more) utic treatment classified according to the frequency of the exercises. Intensive treatment was defined as sessions performed at the daycare clinic by the physiotherapist plus daily sessions performed by parents at home. Minimal treatment was defined as weekly sessions performed only by the physiotherapist at the daycare clinic, without participation of the parents. RESULTS: The demographic characteristics of the studied patients were: mean maternal age=26 years; first gestation=35 (75%); vaginal delivery=40 (85%); mean age at diagnosis =50 days. A sternomastoid nodule was felt seen in 46 (98%) patients. Diseases associated with congenital torticollis were: congenital hip dislocation=4 (8%); fracture of clavicles=2 (4%); and club feet=1 (2%). Intensive treatment was performed in 34 (72%) patients for an average of 74 days and the cure was achieved in 100%. Minimal treatment was performed in 13 (28%) for an average of 130 days and ten (77%) patients achieved cure. CONCLUSIONS: Congenital torticollis had favorable outcome in both groups. The intensive treatment was followed by higher rates of cure in smaller period of time.

Background Compared to knees, hips have more bony constraint and soft tissue coverage. Thus, repair of focal cartilage defects in hips requires more invasive and technically complex surgeries than simple arthroscopy or arthrotomy. Autologous matrix-induced chondrogenesis (AMIC) is a second-generation bone marrow stimulation technique. Improvement in Tegner, Lysholm, International Cartilage Repair Society (ICRS), and Cincinnati scores has been reported at 1 and 2 years after AMIC in knees. AMIC is potentially useful to repair defects in hips, but it is unknown whether it relieves symptoms or results in a durable construct. Description of Technique A surgical hip dislocation is used to access the defect. This is débrided to stable cartilage shoulders, necrotic bone is removed, and the lesi...

Hip problems in children are relatively rare but usually serious, potentially causing lifelong disability. Early diagnosis and treatment is, therefore, mandatory. The aim of this review is to discuss the most frequent diseases of the hip from birth to adolescence. The different affections are relatively closely related to age periods. After birth and in infancy, developmental dislocation of the hip (DDH) and septic arthritis are more prominent. DDH is not always present at birth and should regularly be checked for in the first 6?months of life. Septic arthritis is an emergency and should be adequately treated within 4?days of the beginning of the infection with open drainage of the hip. Transient synovitis and Legg?Calv??Perthes disease (LCPD) are mostly found between 4 and 10?years of age...

Abstract in english Background: The ECLAMC (Estudio Colaborativo Latinoamericano de Malformaciones Congénitas) is an epidemiological surveillance program for congenital defects that operates in Chile since 1969. Aim: To communicate the frequency of disabling congenital defects in Chile in the period 1982-1997. Material and methods: A review of the ECLAMC registry, choosing 12 congenital defects: amelia, limb amputations, limb reductions, arthrogryposis, hip luxation and subluxation, spina b (more) ifida, hydrocephaly, microcephaly, cephalocele, talipes equinovarus, Down syndrome and multiple abnormalities. Results: In the study period, 283,403 births occurred and 7,917 newborns were malformed (7,654 born alive and 263 stillbirths). The congenital defects prevalence rates appeared higher in Chile than in other Latin American countries, specially among stillbirths. Among the studied maternity hospitals, the Clinical Hospital of the University of Chile, showed the higher prevalence of congenital defects. Rancagua and the Navy Hospital in Valparaiso have a high frequency of Down syndrome. Global rates in Chile and in the rest of ECLAMC for specific defects, do not have significant differences, except for hip subluxation, that has a lower incidence in Chile. Conclusions: The ECLAMC allows to have a good knowledge of the prevalence of congenital malformations in Latin America (Rev Méd Chile 2001; 129: 67-74).

One potential strategy to decrease the risk of dislocation after revision total hip arthroplasty (THA) is the use of an abduction brace to limit flexion and adduction. The purpose of this study was to compare the dislocation rate after revision THA between patients treated with or without an abduction brace. Data were obtained from 1211 revision THAs performed in 610 women and 518 men who had a mean age of 64.7 years (range, 22-95 years) and were followed up for a minimum of 90 days. Five hundred two patients were braced, whereas 650 were not. The 90-day dislocation rate among patients who wore a brace was 5.2% compared with 5.7% in the nonbrace group (P = .70). Multivariate regression found no benefit to bracing (P = .37), while controlling for factors found to significantly affect disloc...

Background and purpose The effects of patient-related and technical factors on the risk of revision due to dislocation after primary total hip arthroplasty (THA) are only partly understood. We hypothesized that increasing the femoral head size can reduce this risk, that the lateral surgical approach is associated with a lower risk than the posterior and minimally invasive approaches, and that gender and diagnosis influence the risk of revision due to dislocation. Patients and methods Data on 78,098 THAs in 61,743 patients performed between 2005 and 2010 were extracted from the Swedish Hip Arthroplasty Register. Inclusion criteria were a head size of 22, 28, 32, or 36 mm, or the use of a dual-mobility cup. The covariates age, sex, primary diagnosis, type of surgical approach, and head size ...

Background Dual mobility (DM) cups of mobile polyethylene were introduced to prevent total hip arthroplasty (THA) dislocation, but no large series with this design to treat recurrent instability have been reported. Purpose Our retrospective investigation ascertained the efficiency of DM cups in correction of recurrent dislocation and assessed any adverse effects. Methods One hundred eighty THAs with recurrent instability were revised to DM cups in 180 patients (mean age, 67.4???11.7?years; range, 19 to 92?years). Thirty-one patients (17.2%) underwent at least one earlier THA revision, and 15 (10.3%) incurred non-union of the greater trochanter. Of the initial group in 2009, 145 patients had completed evaluations which included assessment of the Harris Hip Score and a radiographic assessmen...

The Marshall Smith Syndrome (MSS) is a rare congenital disorder, displaying a constellation of unique symptoms, including orofacial dysmorphisms, accelerated osseous maturation and dysplasias, mental retardation, and respiratory maladies. Few individuals with MSS survive past early childhood. In this case report, we describe a unique treatment for a 30 year-old patient with MSS who presented to our pain medicine clinic for management of pain secondary to uncontrolled bilateral hip dysplasias. PMID:20731866

Background and purpose Different methods have been used to classify osteoarthritis (OA) of the hip. We evaluated the reliability of different classifications in order to find which grading system is most appropriate for use in clinical practice. Patients and methods 49 patients (61 affected hips) with late-detected developmental dislocation of the hip (DDH) were studied. The mean age at follow-up was 45 (32-49) years. 3 classifications of OA were compared. The gradings by Kellgren and Lawrence (1957) (K&L) and Croft et al. (1990) are global visual assessments based on osteophytes, cysts, subchondral sclerosis, and narrowing of the joint space. The third classification is based on narrowing in the upper, weight-bearing part of the joint and defines as OA a minimum joint space width (JSW) of...

This is the first case report of an iatrogenic anterior hip dislocation after arthroscopic surgery for femoroacetabular impingement with over 1 year of follow-up. This case report describes the clinical course of a patient with symptomatic cam-pincer femoroacetabular impingement. She underwent arthroscopic rim trimming, labral debridement after a failed attempt at labral refixation from suture cut-through, and femoral head-neck resection osteoplasty. The procedure involved supranormal hip distraction for extraction of an iatrogenic loose body (detached metallic radiofrequency probe tip). The patient had an anterior hip dislocation in the recovery room. Immediate closed reduction under general anesthesia and bracing were performed but failed despite the ability to obtain a concentric but grossly unstable reduction. After 3 failed attempts, a mini-open capsulorrhaphy was performed that successfully restored stability. Her postoperative management and outcome are presented. All of the major static stabilizers of the hip (osseous, labral, and capsuloligamentous) were surgically altered, and a multifactorial causation is proposed. Lessons learned are discussed in hopes of minimizing the occurrence of this rare but dramatic complication. PMID:19341927

Summary: Congenital radial head dislocation is a rare condition which is, however, the most common of all congenital pathologies of the elbow joint. This paper is a case report on a patient presenting with moderate pain and discomfort in one of his elbow joints, both of which were found to be affected by this condition. He was treated by surgery which consisted of resection of the proximal radius and partial anterior capsulectomy of the elbow joint. This treatment led to a significant improvement in pain and elbow function compared to the preoperative status. PMID:23043061

Dislocation is one of the most common complications after total hip arthroplasty (THA). Risk factors include neuromuscular and cognitive disorders, patient non-compliance, and previous hip surgery. Surgical considerations that must be addressed include approach, soft-tissue tension, component positioning, impingement, head size, acetabular liner profile, and surgeon experience. Recent improvements in posterior soft-tissue repair after primary THA have shown a reduced incidence of dislocation. When dislocation occurs, a thorough history, physical examination, and radiographic assessment help in choosing the proper intervention. Closed reduction usually is possible, and nonsurgical management frequently succeeds in preventing recurrence. When these measures fail, first-line revision options should target the underlying etiology. This most often involves tensioning or augmentation of soft tissues, as in capsulorrhaphy or trochanteric advancement; correction of malpositioned components; or improving the head-to-neck ratio. If instability persists, or if a primary THA repeatedly dislocates without a clear cause, a constrained cup or bipolar femoral prosthesis may be as effective as a salvage procedure. PMID:15469226

It is important to be aware of the various complications related to resurfacing arthroplasty of the hip (RSA) and the spectrum of findings that may be encountered on imaging. The bone conserving metal-on-metal (MOM) hip resurfacing has become increasingly popular over the last ten years, especially in young and active patients. Initial reports have been encouraging, but long-term outcome is still unknown. Early post operative complications are rare and have been well documented in the literature. Medium and long term complications are less well understood. A rare but important problem seen at this stage is the appearance of a cystic or solid periarticular reactive mass, which occurs predominately in women and usually affects both hips when seen in patients with bilateral RSAs. The following imaging findings are illustrated and their significance discussed; Uncomplicated hip resurfacing arthroplasty, radiolucency around the femoral peg, femoral neck fracture, loosening and infection, suboptimal component position, femoral notching, dislocation, heterotopic ossification, femoral neck thinning and reactive masses. The radiologist should be aware of the normal radiographic appearances and the variety of complications that may occur following RSA and should recommend ultrasound or MRI in patients with an unexplained symptomatic hip and normal radiographs. PMID:20842366

Nail-patella syndrome is a rare disease inherited in an autosomal dominant fashion with multiple skeletal anomalies, including absent or hypoplastic patellae, absent or hypoplastic nails, dislocation of the radial heads and the pathognomonic sign of posterior iliac horns. The most clinically significant anomaly associated with this syndrome is a disorder of the renal basement membrane causing proteinuria and sometimes chronic renal failure. Congenital absence of the fibulae is believed to be a spontaneous mutation. (orig./GDG).

Between April 1993 and July 1994, the senior author (R.C.J.) performed 151 consecutive primary total hip arthroplasties using a Harris-Galante II acetabular component and a polished Iowa femoral component. In 105 hips, 22-mm head components were used, and in 46 hips, 28-mm head components were used. Femoral head penetration into the acetabular shell was measured using digital edge detection techniques. The group average penetration for the initial 2-year bedding-in period was 0.35 mm/y for the 22-mm and 0.31 mm/y for the 28-mm head components. The long-term rate of penetration into the shell was 0.11 mm/y for the 22-mm heads and 0.17 mm/y for the 28-mm heads, a significant difference (P=.029). The dislocation rate was significantly higher, however, with the 22-mm heads (P=.001). The 22-mm components showed significantly less wear but at the expense of an increase in the prevalence of dislocation. PMID:11742461

The walking pattern in a group of nine adult male subjects who had received early intensive treatment for congenital clubfoot was evaluated and compared to the walking pattern in a control group of 15 adult healthy male subjects. All subjects were filmed with a five-camera video system as they walked across two force plates. A three-dimensional inverse dynamics approach was used to calculate average joint angles, moments, power, and work. The results showed that there were no differences in the joint angles between the two groups. The overall patterns of the joint moments were very similar in the two groups. However, analysis revealed a smaller ankle joint moment and larger knee and hip joint moments in those with clubfoot. It was concluded that the larger knee and hip joint moments served as compensation for the smaller ankle moment. The reduced ankle moment and work developed about the ankle joint in the clubfeet could possibly be owing to weaker plantar flexors. In conclusion, gait analysis can be an important tool when evaluating treatment for clubfoot. However, further investigation is needed to determine whether the higher hip and knee joint moments observed in subjects with clubfoot may lead to the development of knee or hip joint pathologies.

Metal implants corrode and release metal ions, cobalt and chromium, which, in turn, may cause systemic toxicity, mostly in the first few months from implantation of metal-on-metal hip arthroplasty. At the time of delivery, the placenta reduces the passage of cobalt and chromium ions released from metal-on-metal prosthesis. From a biomechanical view point, hip replacement should not be considered a contraindication for pregnancy or for spontaneous delivery, and does not seem to have any negative effects in terms of risk of dislocation, loosening, fracture, or revision surgery, neither negative effects on clinical and functional outcomes. The long-term biological consequences of exposure to Co-Cr particles and ions remain largely unknown.

In this report, we discuss a case of a 14-month-old male presenting in the emergency department with refusal to bear weight on his left leg. Plain radiographic studies revealed no evidence of effusion, fracture, or dislocation. Laboratory studies were significant for an elevated white blood cell count, erythrocyte sedimentation rate, and C-reactive protein. Further studies included unremarkable ultrasound of the left hip and normal magnetic resonance imaging (MRI) of both hips. An incidental finding on MRI was a left inguinal mass concerning an incarcerated hernia. Ultrasound of this mass demonstrated a left undescended testis within the inguinal canal and possible incarcerated paratesticular inguinal hernia. The final pathologic diagnosis of a torsed gangrenous left testicle within the inguinal canal was confirmed during surgery. PMID:22224149

Purpose Malposition of the acetabular cup is the most common cause of total hip arthroplasty (THA) dislocation. The position of a total hip implant is usually analysed on computed tomography (CT) scan. We aim to prove it is possible to measure, with good accuracy, the position of an acetabular cup using the low-dose irradiation (EOS) imaging. Material and methods We implanted an acetabular cup in a pelvic dry bone and measured cup anteversion and inclination with scanography. We performed 14 series of EOS acquisitions with different inclination, rotation and pelvic tilt, which were analysed by five observers. Two observers repeated angle measurements. We then calculated measurement inter- and intrareproducibility and accuracy. Results Using a confidence interval (CI) of 95?%, inter- and in...

The paper presents the microstructure and mechanical properties of an oxide dispersion strengthened (ODS), reduced activation, ferritic steel, namely the Fe-14Cr-2W-0.3Ti-0.3Y2O3 alloy, which was fabricated by hot isostatic pressing followed by high speed hydrostatic extrusion (HSHE) and heat treatment HT at 1050 degreeC. Transmission electron microscopy (TEM) observations revealed significant differences in the grain size and dislocation density between the as-HIPped and as-HSHE materials. It was also found that the microstructure of the steel is stable after HT. The HSHE process improves significantly the tensile and Charpy impact properties of the as-HIPped steel. The ultimate tensile strength at room temperature increases from 950 up to 1350 MPa, while the upper shelf energy increases ...

We performed a series of 16 anatomical dissections on Caucasian cadaver material to determine the surgical anatomy of the medial femoral circumflex artery (MFCA) and its anastomoses. These confirmed that the femoral head receives its blood supply primarily from the MFCA via a group of posterior superior nutrient arteries and the posterior inferior nutrient artery. In terms of anastomoses that may also contribute to the blood supply, the anastomosis with the inferior gluteal artery, via the piriformis branch, is the most important. These dissections provide a base of knowledge for further radiological studies on the vascularity of the normal femoral head and its vascularity after dislocation of the hip. PMID:22058296

Simultaneous bilateral femoral neck fracture following an epileptic seizure attack are rare. Open reduction and internal fixation remains the most used therapeutic option. Arthroplasty, carrying a high risk of dislocation is less often recommended. We report the favourable evolution of a 49-year-old man who benefited from a single stage bilateral total hip arthroplasty operation for his simultaneous bilateral, femoral neck fractures secondary to a generalized seizure. This nonconsensual choice, in this case, was justified on multiple grounds: surgical care delay longer than 48 hours, substantial bone displacement, borderline bone quality, adequate antiepileptic treatment efficacy and tolerance. A ceramic-on-ceramic bearing surfaces couple, a large-diameter head and a cementless implantatio...

Abstract in spanish Se realizó un estudio retrospectivo en 20 pacientes con tratamiento quirpurgico por presentar coxa vara congénita o del desarrollo. Se mostró el diferente comportamiento de ambas entidades en el grado de deformidad de la cadera, la respuesta al tratamiento, su evolución y pronóstico. Abstract in english A retrospective study of 20 patients surgically treated because of their congenital or developmental coxa vara was performed. The different behaviors of both entities were shown in the extent of hip deformity, the response to treatment, the development and the prognosis.

Background Failure rates of constrained cups for treating recurrent dislocation in revision THA range from 40% to 100%. Although constrained liners are intended to stabilize the hip by mechanically preventing dislocation, the resulting loss of range of motion may lead to impingement and, ultimately, implant failure. Questions/purposes We therefore documented the mechanisms of failure of constrained acetabular cups in revision THA and determined the type and severity of damage (wear, fracture, and impingement) that occurs in situ. Methods We retrieved 57 constrained components of four different designs at revision THA and examined for the presence of rim impingement, oxidation, cracks within the liner, backside wear, pitting, scratching, abrasion, burnishing, and the presence of embedded pa...

Instability of artificial joints is still one of the most prevalent reasons for revision surgery caused by various influencing factors. In order to investigate instability mechanisms such as dislocation under reproducible, physiologically realistic boundary conditions, a novel test approach is introduced by means of a hardware-in-the-loop (HiL) simulation involving a highly flexible mechatronic test system. In this work, the underlying concept and implementation of all required units is presented enabling comparable investigations of different total hip and knee replacements, respectively. The HiL joint simulator consists of two units: a physical setup composed of a six-axes industrial robot and a numerical multibody model running in real-time. Within the multibody model, the anatomical environment of the considered joint is represented such that the soft tissue response is accounted for during an instability event. Hence, the robot loads and moves the real implant components according to the information provided by the multibody model while transferring back the position and resisting moment recorded. Functionality of the simulator is proved by testing the underlying control principles, and verified by reproducing the dislocation process of a standard total hip replacement. HiL simulations provide a new biomechanical testing tool for analyzing different joint replacement systems with respect to their instability behavior under realistic movements and physiological load conditions. PMID:21852016

Congenital dysplasia of the humerus is very rare. It is characteristically seen in omodysplasia and has also been reported as one of the associated features of Larsen's syndrome. We report a 4-year-old girl with bilateral humero-ulnar dysplasia, with dislocation of the elbows, facial dysmorphism, ball-and-socket ankles and foot deformities. Although the elbow dysplasia is similar to that seen in Larsen's syndrome, other pathognomic features of Larsen's syndrome were absent. The changes seen in the elbows in this patient are also different from those encountered in omodysplasia. We believe that this condition may be a distinct form of skeletal dysplasia hitherto undescribed. (orig.)

Femoral stems with reduced stiffness have the potential of decreasing stress shielding and could be an alternative in revision surgery when restoration of bone stock is required. We retrospectively reviewed 38 patients (40 stems) with a central core of cobalt-chromium surrounded by a polymer and an outer titanium mesh layer containing a proximal coating of hydroxyapatite/tricalcium phosphate; 30 of the 38 patients (32 hips) had a minimum 2-year followup. We impacted morselized allograft around the stem in 28 of 32 revisions. Repeated radiostereometric examinations showed medial, distal, and posterior migration (median, 0.21 mm, 0.17 mm, and 0.96 mm, respectively) of the femoral head center for up to 6 months followed by stabilization. Measurements of bone mineral density in the seven Gruen zones at 6 months revealed either a decrease (down to a median of 3%), no change, or a slight increase (up to 5%) followed by a further increase up to 2 years in three of the regions (2, 3, and 5). Conventional radiography at 2 years demonstrated graft remodeling and incomplete radiolucent lines in 19 hips, mainly in Regions 1 and 7. Two hips were reoperated on as a result of dislocation, but none of the stems had been revised. LEVEL OF EVIDENCE: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. PMID:18196421

Background The treatment of femoral neck fracture with internal fixation (IF) is recommended in younger patients and has compared to arthroplasty the advantage of retaining the femoral head. A big problem with osteosynthesis is though failure. Finding predictors for fixation failure is still an ongoing process and osteoporosis has been suggested as a predictor. Aim To correlate bone mineral density (BMD) in regard to failure of IF in osteosynthesized femoral neck fractures. Material and method In a health technology assessment study from 2005-2006 at Odense University Hospital, Department of Orthopaedic Surgery and Traumatology, 175 patients with femoral neck fractures accepted DEXA –scanning of the hip and lumbar spine assessing BMD. Final follow-up were 01.08.2010 and 141 patients with IF comprised the final cohort. The cohort consisted of 105 females and 36 males with a mean (CI) age of 77,2 (75,4-79,0). Failure is defined as revision surgery or new fracture. Results 69 patients had a t-score (total hip) below -2,5 SD as defined for osteoporosis. At 1 year the overall (dislocated) failure rate was 34,5 % (44,7 %), at 2 years 45,4 % (60,0 %) and at end of follow-up 49,6 % (62,8 %). In the cox regression analysis the following factors for failure were significant: dislocated fracture, osteosynthesis placement and prior fracture. There were no associations for total hip BMD, neck BMD, age, sex, quality of fracture reduction, walking disability, independent living, alcohol or smoking. A cox regression sub analysis of the undisplaced fractures showed significant result only for osteosynthesis placement. Conclusion There is no association between BMD and failure of internal fixation in osteosynthesized femoral neck fractures.

Leg length discrepancy following total hip replacement (THR) can contribute to poor hip function. Abnormal gait, pain, neurological disturbance and patient dissatisfaction have all been described as a result of leg length inequality after THR. The purpose of this study was to determine whether the use of computer navigation in THR can improve limb length restoration and early clinical outcomes. We performed a matched-pair study comparing 48 computer-assisted THR with 48 THRs performed using a traditional freehand alignment method. The same implant with a straight non-modular femoral stem was used in all cases. The navigation system used allowed the surgeon to monitor both acetabular cup placement and all the phases of femoral stem implantation including rasping. Patients were matched for age, sex, arthritis level, pre-operative diagnosis and pre-operative leg length discrepancy. At a minimum follow-up of six months, limb length discrepancy was measured using digital radiographs and a standardised protocol. The number of patients with a residual discrepancy of 10 mm or more and/or a post-operative over-lengthening were measured. The clinical outcome was evaluated using both the Harris Hip Score and the normalised Western Ontario and McMaster Universities (WOMAC) Arthritis Index. Restoration of limb length was significantly better in the computer-assisted THR group. The number of patients with a residual limb length discrepancy greater than 10 mm and/or a post-operative over-lengthening was significantly lower. No significant difference in the Harris Hip Score or normalised WOMAC Arthritis Index was seen between the two groups. The surgical time was significantly longer in the computer-assisted THR group. No post-operative dislocations were seen. PMID:19904533

... Hip Replacement Anterior Approach to Total Hip Replacement (St. John's Health Center, Santa Monica, CA, 8/24/2011) ... Hip Replacement Anterior Approach to Total Hip Replacement (St. John's Health Center, Santa Monica, CA, 8/24/2011) ...

Instability of artificial joints is still one of the most prevalent reasons for revision surgery caused by various influencing factors. In order to investigate instability mechanisms such as dislocation under reproducible, physiologically realistic boundary conditions, a novel test approach is introduced by means of a hardware-in-the-loop (HiL) simulation involving a highly flexible mechatronic test system. In this work, the underlying concept and implementation of all required units is presented enabling comparable investigations of different total hip and knee replacements, respectively. The HiL joint simulator consists of two units: a physical setup composed of a six-axes industrial robot and a numerical multibody model running in real-time. Within the multibody model, the anatomical en...

The purpose of this study was to compare results of patients with Paprosky type I and II femoral defects vs type IIIA, IIIB, and IV defects in patients undergoing revision hip arthroplasty. There were 64 patients in the group with type I and II defects with an average age of 68 years. There were 52 patients with Paprosky type IIIA, IIIB, and IV defects with an average age of 67 years. There were 8 intraoperative fractures in the type III and IV group, whereas there were 9 in the type I and II group. There were no differences between the 2 groups with respect to subsidence, loosening, dislocation, infection, and medical complications. Survivorship for the whole group was 96.9% at 5 years. Modular femoral implants provide several intraoperative options to restore leg length, offset, and stab...

Abstract Heterotopic ossification or calcification follows any type of musculoskeletal trauma and is known to occur after arthroplasties of hip, knee, shoulder, or elbow; fractures; joint dislocations; or tendon ruptures. Histamine receptor H2 (Hrh2) has been shown to be effective for reducing pain and decreasing calcification in patients with calcifying tendinitis, which suggested that H2 blockers were effective for the treatment of tendon ossification or calcification. However, the detailed mechanisms of its action on tendon remain to be clarified. We investigated the mechanisms underlying H2 blocker-mediated suppression of tendon calcification, with a focus on the direct action of the drug on tendon cells. Famotidine treatment suppressed the mRNA expressions of Col10a1 and osteocalcin, ...

Objective: To evaluate the proportion of ''successes'' after surgery for femoroacetabular impingement (FAI) using different external criteria, ''feeling better'' and ''feeling good'', and to determine the corresponding cut-off scores indicating ''success'' for the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) (0-10-point response scale), Oxford Hip Score (OHS) and EuroQoL-5D (EQ-5D and EQ-VAS). Design: Prospective, observational study based in an orthopaedic hospital. Ninety-nine consecutive patients with FAI completed the questionnaires before and 6 months after surgery (arthroscopy or mini-open surgical dislocation). Patient-ratings of change in state (''feeling better'') were assessed using a global treatment outcome (GTO) item. Acceptability of the current heal...

Chronic intoxication with cobalt in a male implanted with an uncemented total hip arthroplasty (THA) with a ceramic-on-ceramic bearing. Three years postoperatively the acetabular ceramic liner fractured necessitating revision. The bearing couple was revised to a metal-on-polyethylene articulation. 20 months postoperatively, the patient represented with a dislocated THA. The patient presented with symptoms and signs of chronic intoxication with heavy metals, including quadriparesis, hypothyreosis, cardiomyopathy and perceptive amblyacousia. Severe metallosis was discovered at revision. High concentrations of cobalt, chromium and titanium were found in the serum, blood, pericardial exudate, urine and hair. On the basis of this experience the authors recommend always using a ceramic-on-ceramic pairing when revising fractured ceramic bearings. PMID:23112074

The chromosome 22q11.2 region is commonly involved in non-allelic homologous recombination (NAHR) events. Microduplications of 22q11.2, usually involving a 3 Mb or 1.5 Mb region constitute the 22q11 microduplication syndrome. Both microdeletions and microduplications of 22q11.21 are reported to share several phenotypic characteristics, including dysmorphic facial features, velopharyngeal insufficiency, congenital heart disease, urogenital abnormalities, and immunologic defects. We report a child who presented at 8 months of age for evaluation of microcephaly and mild motor delay. Head circumference at birth, at 8 months, and at 19 months of age was below the 3rd centile. Other findings included left-sided cryptorchidism and developmental dysplasia of the left hip. In addition, echocardiogr...

Aim To evaluate the use of ultrasonography (US) in the diagnosis of gluteal muscle contracture (GMC) by analysis of its imaging characteristics. Materials and Methods Thirty-nine patients suspected of having GMC due to abnormal gait underwent pre-operative US. Results The diagnosis of GMC was confirmed by surgery in 27 patients. Six patients were diagnosed with congenital hip dysplasia, and the remaining six patients were diagnosed with sciatic nerve damage, post-poliomyelitis sequelae, and myasthenia gravis. For the patients with GMC, US showed muscle thinning and hyperechoic strips (specific for muscular contracture) in the muscles involved. In three patients with GMC, the strips were integrated into muscle bundles, demonstrating both strong and weak sonographic echoes. The sensitivity a...

Abstract in spanish La displasia de cadera es una enfermedad que se presenta en niños menores de dos años, pero puede tener consecuencias importantes en edad adulta, incluso, puede llevar a osteoartrosis de cadera, y por tanto, desembocar en invalidez en adultos jóvenes. La displasia de cadera es una afección ósea que puede tener su raíz en defectos congénitos, hereditarios, o degenerativos que llevan a una formación inadecuada de la articulación de la cadera (coxofemoral) que puede (more) provocar, a mediano plazo, una deficiente formación de la articulación y cojera y a largo plazo, desgaste excesivo de la articulación e invalidez. Por tanto, se requieren estudios actualizados que relaten los avances más importantes en la comprensión, desarrollo, pronóstico y tratamiento de esta importante enfermedad que afecta de 15 a 20 por cada 1 000 niños y tiene como principal víctima a las niñas recién nacidas. Desde este punto de vista el objetivo de este artículo es presentar el estado del arte, los antecedentes, historia y pronóstico de la displasia del desarrollo de la cadera. Por tanto, este trabajo puede ser de especial importancia para los médicos, ortopedistas y fisioterapeutas que requieran de una actualización en el tema de la displasia de la cadera. Abstract in english Hip dysplasia is a disease present in children under two years, but may to have significant consequences in adulthood; even it may leads to a hip osteoarthrosis and thus, to provoke disability in young adults. The his dysplasia is a bone affection that may to have its origin in congenital, hereditary or degenerative disorders that a medium term may to cause of an inappropriate formation in hip joint (coxofemoral) and claudication, and at long term, an excessive corrosion (more) and disability. Thus, updated studies are necessary relating the more significant advances in understanding, development, prognosis and treatment of this important entity affecting 15-20 by each 1 000 children and its major victims are the newborn girls. From this point of view, the aim of present paper is to present the backgrounds, history and prognosis of hip dysplasia development. Therefore, present paper may to be very important for physicians, orthopedists, and physiotherapists updating on hip dysplasia.

Progress in implant design and surface properties have improved long-term survival of total hip prosthesis and lowered the incidence of dislocation. New materials, particularly ceramics and metals, decrease the risk for implant loosening because they induce less particle disease than polyethylene debris. These new materials have been submitted to simulator studies before being released for clinical use. They have been used since a sufficient amount of time in clinical practice to consider them as being part of our current armamentarium. They enable the orthopaedic surgeon to tailor the optimal hip prosthesis to each patient's need, depending on his/her bone stock, activity level and life expectancy. Disk prostheses and the general concept of non fusion surgery in spine surgery seems attractive, since intervertebral fusion carries a number of drawbacks, particularly at the level of adjacent segments. However, the documented follow-up of non-fusion spine surgery is at present insufficient to consider a widespread use of these new technologies. Their own possible complications are largely unknown and they do not replace bone fusion in the most clear-cut accepted indications for spine surgery. The use of disk prostheses should therefore be strictly limited according to present knowledge. PMID:17725204

Background: Minimally invasive (MI) total hip arthroplasty (THA) is an alternative to standard THA, but has created much controversy among orthopedic surgeons. The authors modified the original minimally invasive two-incision THA technique and used large-diameter (32 mm, 36 mm) ceramic-on-ceramic articulation. Materials and Methods: One hundred and seventy patients that underwent unilateral MI two-incision THA were retrospectively reviewed, and surgical morbidity, functional recovery, radiological properties, and complications were assessed. Results: Mean Harris hip score (HHS) improved from 41.8 to 96.1 at last followup, and mean Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score from 66.2 to 26.9. The mean lateral opening angle of the acetabular component was 38.2° and the mean stem position was valgus 1.9°. There was an intraoperative femur fracture and one revision surgery due to stem subsidence. No patient had dislocation. Conclusions: Our data suggest that this modified technique combined with large ceramic femoral head is safe and reproducible in terms of achieving proper implant positioning and early functional recovery. PMID:7488273

Objective To investigate the coexistence rate and related factors of developmental dysplasia of the hip (DDH) and congenital muscular torticollis (CMT), and to determine whether ultrasonography (US) gives good value for screening of DDH in CMT. Method We prospectively examined 121 infants (73 males and 48 females) diagnosed with CMT to determine the incidence of DDH by US. We also assessed the relationship between neck US findings and DDH occurrence, and investigated the clinical features of CMT related to DDH. Results 18 patients (14.9%) were diagnosed as having DDH by US. However, most DDH was subclinical and spontaneously resolved. Only 2 patients (1.7%) needed to be treated with a harness. The positive predictive value of clinical examinations for DDH was 52.6% and patients treated by harness were all clinically positive. DDH was more common in the left side (13 left, 4 right, 1 both), but 6 out of 18 DDH (33.3%) cases presented on the contralateral side of CMT. Sex difference was not observed. Breech presentation and oligohydramnios were not related to DDH occurrence. Neck US findings did not correlate with DDH occurrence. Conclusion The coexistence rate of CMT and DDH was concluded to be 14.9%. If only DDH cases that required treatment were included, the coexistence rate of these two disorders would be lowered to 1.7%. All of these patients showed positive findings in clinical examination. Therefore, hip US should not be recommended routinely for patients with CMT.

The aim of this study was to quantify the gait patterns of adults with joint hypermobility syndrome/Ehlers-Danlos syndrome (JHS/EDS-HT) hypermobility type, using Gait Analysis. We quantified the gait strategy in 12 JHS/EDS-HT adults individuals (age: 43.08 + 6.78 years) compared to 20 healthy controls (age: 37.23 plus or minus 8.91 years), in terms of kinematics and kinetics. JHS/EDS-HT individuals were characterized by a non-physiological gait pattern. In particular, spatio-temporal parameters evidenced lower anterior step length and higher stance phase duration in JHS/EDS-HT than controls. In term of kinematics, in JHS/EDS-HT patients the main gait limitations involved pelvis, distal joints and ankle joint. Conversely, hip and knee joint showed physiological values. Ankle moment and power revealed reduced peak values during terminal stance. Differences in stiffness at hip and ankle joints were found between JHS/EDS-HT and controls. JHS/EDS-HT patients showed significant decreased of Kh and Ka parameters very probably due to congenital hypotonia and ligament laxity. These findings help to elucidate the complex biomechanical changes in JHS/EDS-HT and may have a major role in the multidimensional evaluation and tailored management of these patients. (Contains 2 figures and 2 tables.)

Replacement of the hip joint has become an exceptionally successful procedure since the inauguration of the low friction principle by Charnley. Aseptic osteolysis and joint dislocation have been addressed by the development of wear-optimized materials and the introduction of larger heads. As an increase in head diameter against polyethylene causes wear increase, larger hard-on-hard bearings were introduced, which exhibit reduced wear and reduced dislocation risk with increasing head diameter. These findings were derived from standard simulator testing, not sufficiently considering the risk of fluid film breakdown under adverse conditions, which can cause a dramatic increase in wear and friction proportional to the head diameter. Such adverse conditions can occur clinically in patients due to several factors and have caused the presently observed unexpected problems with these new designs. Standardized preclinical testing has to be viewed as a minimum requirement but certainly not as a guarantee for the clinical success of new materials and designs even if the testing is adapted to the current patient requirements, which is presently not the case. The future of tribology lies in the prevention of adverse conditions in patients, the improvement and optimized use of proven existing materials and not in the use of new materials. PMID:22083422

Purpose Adolescent patients with congenital radial head dislocation presenting with pain and limitation in motion might benefit from radial head excision. We report objective and patient-rated data for patients treated with radial head excision and those followed nonsurgically. We hypothesized that surgery would improve pain and motion and that outcomes and the need for additional surgery would be similar between the 2 groups. Methods We reviewed our surgical logs and identified 16 patients (10 treated surgically and 6 treated nonsurgically) for participation. At a mean of 10 years for the surgical group and 16 years after initial office visit for the nonsurgical group, we collected patient-rated and objective data, including range of motion, strength, and pain at the wrist or elbow. Resul...

... 2010 7 It is important to remember that your hip surgery may cause decreased sensation in the hip; therefore, check the temperature of anything you put on your hip with your hand first. You should also ...

... on this page, please enable JavaScript. Hip Resurfacing More Likely to Fail Than Hip Replacement: Study Women ... metal or plastic. Researchers looked at data from more than 434,000 hip operations conducted in England ...

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... the left, is in the patients under the age of 55. Anybody over that age, the hip replacement -- the standard type -- has better ... standard hip replacement. If you’re over the age of 60, I think a standard hip replacement, ...

We reviewed 27 patients with developmental anomalies in craniovertebral junction, and special attention was paid to CT findings in congenital atlantoaxial dislocation (AAD), basilar invagination and Chiari malformations. In AAD, CT clearly demonstrated the relationships of the atlas to the axis in axial plane. Four major types were distinguished; anteroposterior (6 cases), transverse (0 case), anteroposterior-transverse (4 cases) and rotatory (5 cases) dislocations. Soft tissue was was shown on the posterior aspect of the odontoid in 7 out of 15 patients with AAD. Those two features, pathomechanics of AAD and intraspinal soft tissue wad, were felt to be important for patient's symptomatology. Basilar invagination might be suggested of its existence in such a case as CT showing; (1) the odontoid at or above the level of the foramen magnum, (2) distinctive margin of the foramen magnum above the bottom of the posterior fossa, and (3) the posterior arch of the atlas at the same level as foramen magnum. Nevertheless, it is essential to confirm occipital hypoplasia by using either reformatting CT images in coronal and sagittal plane or conventional tomography; whereas high resolutional CT machine provides new dimension for demonstration of bony details. In Chiari malformations, plain CT scanned by high resolutional machine often makes it possible to delineate caudal migration of the cerebellar tonsils, so that it may be a choice of examination as a screening of the anomaly. In addition, metrizamide CT clearly demonstrated caudal migration both of cerebellar tonsils and medulla oblongata.

Background Microdeletions on chromosome 17q12 cause of diverse spectrum of disorders and have only recently been identified as a rare cause of Mayer-Rokitansky-Kuester-Hauser-Syndrome (MRKH), which is characterized by uterus aplasia ± partial/complete vaginal aplasia in females with a regular karyotype. For the first time we report about a patient with a 17q12 microdeletion who is affected by MRKH in combination with a vascular and soft tissue disorder. Repeatedly she suffered from kidney transplant failure caused by consuming membranous nephropathy. Case presentation A 38-year-old female patient had been diagnosed with right kidney aplasia, left kidney dysplasia and significantly impaired renal function during infancy. Aged 16 she had to start hemodialysis. Three years later she received her first kidney transplant. Only then she was diagnosed with MRKH. The kidney transplant was lost due to consuming nephrotic syndrome caused by de novo membranous nephropathy, as was a second kidney transplant years later. In addition, a hyperelasticity syndrome affects the patient with congenital joint laxity, kyphoscoliosis, bilateral hip dysplasia, persistent hypermobility of both elbows, knees and hips. Her clinical picture resembles a combination of traits of a hypermobile and a vascular form of Ehlers-Danlos-Syndrome, but no mutations in the COL3A1 gene was underlying. Instead, array-based comparative genomic hybridisation (CGH) detected a heterozygous 1.43 Mb deletion on chromosome 17q12 encompassing the two renal developmental genes HNF1? and LHX1. Conclusions Deletions of HNF1? have recently drawn significant attention in pediatric nephrology as an important cause of prenatally hyperechogenic kidneys, renal aplasia and renal hypodysplasia. In contrast, membranous nephropathy represents an often-unaccounted cause of nephrotic syndrome in the adult population. A causative connection between theses two conditions has never been postulated, but is suggestive enough in this case to hypothesize it. PMID:11910053

The effect of a high hydrostatic pressure on the dislocation dipole vibration frequency and the forces of dynamic drag of dislocations by dislocation dipoles and of dislocation pairs by pinned dislocations is studied. Analytical expressions are obtained for the force of dynamic drag of mobile dislocation pairs by pinned dislocations and for the force of drag of isolated dislocations by dislocation dipoles in hydrostatically compressed crystals. Hydrostatic compression leads to a significant increase in these forces. This effect is most pronounced in alkali-halide crystals, where the drag force increases by a factor of 1.5-2.0.

Unexplained pain after hip arthroplasty is frustrating for patients and surgeons. We describe the use of hip arthroscopy in management of the painful hip arthroplasty, critically evaluate the outcomes of these patients, and refine indications for hip arthroscopy in this setting. We retrospectively r...

...eligible for dislocated worker activities under WIA? 663.120...ADMINISTRATION, DEPARTMENT OF LABOR (CONTINUED) ADULT AND DISLOCATED WORKER ACTIVITIES UNDER TITLE I OF THE WORKFORCE...eligible for dislocated worker activities under WIA? (a)...

...eligibility requirements for dislocated workers to receive needs-related payments...CONTINUED) ADULT AND DISLOCATED WORKER ACTIVITIES UNDER TITLE I OF THE WORKFORCE...eligibility requirements for dislocated workers to receive needs-related...

...CONTINUED) ADULT AND DISLOCATED WORKER ACTIVITIES UNDER TITLE I OF THE WORKFORCE...categories of adults and dislocated workers who may receive intensive services: (a) Adults and dislocated workers who are unemployed, have...

...ADULT AND DISLOCATED WORKER ACTIVITIES UNDER TITLE I OF THE...adults and dislocated workers? Supportive services...as referral to such activities, is one of the core...adults and dislocated workers through the...

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High-angle annular dark-field scanning transmission electron microscopy and molecular dynamic simulation are applied to study the misfit dislocations at the GaSb/GaAs interface. In the investigated samples, three types of misfit dislocations have been observed: shuffle and glide set Lomer dislocations and 60° dislocation pairs. The dislocation density tensor analysis is next used to quantify the Burgers vector of misfit dislocations and investigate the misfit dislocation formation mechanism. This work demonstrates that, in these hetero-structures, the dominant mechanism underlying the formation of misfit dislocations is the glide and reaction of 60° dislocations. It is shown that the final structure of each misfit dislocation depends on the Burgers vectors of the initial 60° dislocations. Finally, this analysis points out an approach to determine the local rotation at interface due to mixed type dislocations.

The present review summarizes the pathogenic mechanisms leading to hip fracture based on epidemiological, experimental, and controlled studies. The estimated lifetime risk of hip fracture is about 14% in postmenopausal women and 6% in men. The incidence of hip fractures increases exponentially with aging, but the time-trend in increasing age-specific incidence may not be a universal phenomenon. Postmenopausal women suffering earlier non-hip fractures have an increased risk of later hip fracture. The relative risk being highest within the first years following the fracture. Nursing home residents have a high risk of hip fracture (annual rate of 5-6%), and the incidence of falls is about 1,500 falls/1,000 persons/year. Most hip fractures are a result of a direct trauma against the hip. The incidence of falls on the hip among nursing home residents is about 290 falls/1,000 persons/year and about 24% of these impacts lead to hip fracture. The force acting on the hip may reach 3.7 kN in falls on the hip from standing height, which means that only susceptible subjects will sustain a hip fracture in such falls. The effective load acting on the hip is 35% of the body weight in unprotected falls on the hip. Women with hip fractures have a lower body weight compared with controls, and they may also have less soft tissue covering the hip even when adjusted for body mass index, indicating a more android body habitus. Experimental studies show that the passive energy absorption in soft tissue covering the hip may influence the risk of hip fracture, and being an important determinant for the development of hip fracture, maybe more important than bone strength. External hip protectors were developed and tested in an open randomised nursing home study. The rate of hip fractures was reduced by 50%, corresponding to 9 out of 247 residents saved from sustaining a hip fracture. The review points to the essentials of the development of hip fracture, which constitutes; risk of fall, type of fall, type of impact, energy absorption, and lastly bone strength, which is the ultimate and last permissive factor in the cascade leading to hip fracture. Risk estimation and prevention of hip fractures may prove realistic when these issues are taken into consideration.

The interaction of dislocations with low-angle grain boundaries (LAGBs) is considered one important contribution to the mechanical strength of metals. Although LAGBs have been frequently observed in metals, little is known about how they interact with free dislocations that mainly carry the plastic deformation. Using discrete dislocation dynamics simulations, we are able to quantify the resistance of a LAGB-idealized as three sets of dislocations that form a hexagonal dislocation network-against lattice dislocation penetration, and examine the associated dislocation processes. Our results reveal that such a coherent internal boundary can massively obstruct and even terminate dislocation transmission and thus make a substantial contribution to material strength.

Abstract in spanish La avulsión traumática de una raíz lumbo-sacra es una lesión poco frecuente que se presenta en asociación con fracturas lumbares y pélvicas o luxaciones de cadera. Se describe un caso clínico de avulsión traumática de la raíz lumbar L1 derecha, en un paciente de 63 años, víctima de un accidente de alta energía, quien no presentó lesiones asociadas. La resonancia magnética mostró un pseudomeningocele traumático de Ll y el estudio con gadolinio intratecal p (more) ermitió confirmar el diagnóstico y evaluar la extensión. Luego de 7 meses de evolución, el paciente retornó a sus actividades laborales con mínimas molestias Abstract in english Traumatic lumbosacral nerve root avulsion it's an infrequent injury that appears in association with pelvic and lumbar fractures or hip dislocations. We describe a clinical case of traumatic avulsion at the LI lumbar root in a patient victim of an accident of high energy, without associate injuries. Magnetic resonance demonstrated traumatic pseudomenin-gocele at the LI lumbar root. The use of intrathecal gadolinium allowed us to confirm diagnosis and evaluate extension. Seven months later, patient returns to its labour activities with minimum pain

Papers are presented on the development and characteristics of rapidly solidified Ti alloys and powders; the solidification characteristics of laser surface melts in advanced Ti alloys; secondary cooling effects in rapidly solidified Ti alloys; the characteristics of oxide dispersions in rapidly solidified Ti alloys; the solidification structure and dispersoids in rapidly solidified Ti-Al-Sn-Zr-Er-B alloys; and the mechanical evaluation of rapidly solidified Ti alloys containing fine dispersoids. Consideration is given to laser surface melting of Ti alloys containing Er or La; the effect of Er, Si, and W additions on powder metallurgy high temperature Ti alloys; the production of high strength beta Ti alloys using powder metallurgy; the coarsening of Y-Sn particles in the beta phase of Ti-5Sn-3Y; eutectoid forming Ti alloys; and the aging response of rapidly solidified Ti-W alloys. Topics discussed include the dislocation in Nb-containing Ti/sub 3/Al; the effects of heat treatment on the fatigue crack growth behavior of Ti/sub 3/ Al + Nb; the powder metallurgy of titanium aluminide components, HIP compaction of Ti alloy powder at high pressure and low temperature; and the production of metal matrix composites from rapidly solidified Ti alloy foils.

VATER association represents a cluster of Vertebral, Anal, Tracheo-Esophageal, Radial and Renal malformations, and caudal regression syndrome is an entity consisting of a spectrum of congenital anomalies of lower spine and hips associated with genitourinary and lower limb defects. The concurrence of various malformations may be explained by a common defect in blastogenesis, but direct evidence is yet to be accumulated. Here, by the use of autofluorescence and the teratogenic effect of adriamycin, we demonstrated that adriamycin administered to eggs of White Leghorns distributes to the caudal portion of the embryo and foregut epithelium and induces caudal regression and tracheal and pulmonary agenesis. The induction of caudal regression syndrome-like anomaly was developmental stage and dose dependent. Embryos with caudal regression demonstrated tracheoesophageal anomalies, one of the defects included in VATER association. The stages at which anomalies were produced corresponded to that of human embryos between days 22 and 26 (Carnegie stages 10-11). In view of the antitumor activity of adriamycin by intercalating to double-stranded DNA of undifferentiated cells undergoing rapid cell division, it is possible that adriamycin had preferentially attacked cells in the caudal end where pronounced proliferation takes place during this narrow period of greatest susceptibility. PMID:19218883

Background: Os odontoideum (OO) with C1-2 anterolisthesis and retrolisthesis may cause cervicomedullary injury both from anterior and posterior aspects. We analyzed fourteen such patients for biomechanical issues, radiological features and management of OO with free-floating atlantal arch and review pertinent literature. Materials and Methods: Fourteen patients having nonsyndromic, reducible atlantoaxial dislocation (AAD) with orthotopic OO were analyzed. During neck flexion, their C1 anterior arch-os complex displaced anteriorly relative to remnant odontoid-C2 body. The posteriorly directed hypoplastic remnant odontoid sliding below the atlas and forward translation of the C1 posterior arch caused concomitant cervicomedullary compression. During neck extension, there was retrolisthesis of the “free-floating” C1 arch-os complex into spinal canal. Spinal stenosis and lateral C1-2 facet dislocation; Klippel-Feil anomaly; and posterior circulation infarcts were also present in one patient each, respectively. Posterior C1-2 (n=10) or occipitocervical fusion (n=3) was performed in neutral position to stabilize atlantoaxial movements. Results: Follow-up (mean, 3.9 years) assessment revealed improvement in spasticity and weakness in 13 patients. One patient had neurological deterioration following C1-2 posterior sublaminar fusion, requiring its conversion to occipitocervical contoured rod fusion. One patient with posterior circulation stroke died prior to any operative intervention. Follow-up lateral view radiographs showed a bony union or a stable construct in these 13 patients. Conclusions: OO with free-floating atlantal arch may precipitate cord injury both during neck flexion and extension. This condition may be overlooked unless lateral radiographs of craniovertebral junction are undertaken in neck extension, along with the usual ones in neutral and flexed positions. Etiological factors include C1 ring-OO unrestrained movements above the hypoplastic odontoid; upward pull on OO by alar and apical ligaments; lax C1-2 facet joint ligaments; and congenital presence of horizontal facet joint surfaces that facilitates C1-2 translation.

The interactions between dislocations and twin boundaries (TBs) are significantly affected by both intrinsic material properties and extrinsic factors, including stacking fault energy, the energy barriers for dislocation reactions at TBs, twin thickness and applied stress. In this study, dislocation-TB interactions in grains with different dislocation densities were investigated and we conclude that the dislocation density also affects the dislocation-TB interactions. In a twinned grain with a low dislocation density, a dislocation may react with a TB to fully or partially penetrate the TB or to be absorbed by the TB via different dislocation reactions. Alternatively, in a twinned grain with a high dislocation density, dislocations tangle with each other and are pinned at the TBs, thereby ...

Abstract in portuguese Introdução: o programa de fisioterapia da Universidad del Rosario, em sua responsabilidade social de gerar um impacto positivo na comunidade e em seu propósito de formar profissionais, conta com os Programas Acadêmicos de Campo (PAC) que se consideram uma forte estratégia de extensão da universidade. Os PAC contribuem à aquisição de competências para o desenvolvimento de processos de ação - atuação - criação nos estudantes para que resolvam problemas em um (more) espaço real de exercício profissional. Sob esta perspectiva os PAC do programa de Fisioterapia mostram seu comportamento através da medição de indicadores de processos e resultados propostos desde o Programa com o fim de prover informação útil para a reorientação e permanente atualização dos conteúdos programáticos nas disciplinas e nos mesmos PAC. Materiais e métodos: No seguinte artigo se apresenta uma análise dos indicadores de demanda por gênero, regime de Segurança Social em Saúde, procedimento e morbidade dos Programas Acadêmicos de Campo Integral Pediátrico, Integral de Adultos e Reabilitação cardíaca e/ou pulmonar, com o fim de estabelecer as características da povoação objeto da apresentação dos serviços e procurar informação verificável que dê suporte para a construção de processos de mudança dentro da dinâmica de melhoramento contínuo que deve ter qualquer instituição. Este seguimento é útil para a tomada de decisões de planejamento acadêmico que contribuem a melhorar os procesos de planejamento e a facilitar o cumprimento dos propósitos de formação para cada prática, e desta forma ajuda a ser elemento de análise para diretivas, instrutores e estudantes na orientação do processo de gestão acadêmico-administrativo, e a retroalimentar os processos de planejamento e programação acadêmica. Resultados: Os resultados produzidos na análise dos dados da morbidade nos programas acadêmicos de campo mostram o seguinte comportamento durante os anos 2004, 2005, 2006 e 2007. Conclusões: No PAC pediátrico a maior incidência é de asma com um 37,2% e a mais baixa incidência é para luxação congênita de quadril e enfermidade mental de origem central com um 0,1%. O 58% dos usuários é de gênero masculino, e o 81% do total pertence ao regime contributivo. Na morbidade do PAC de adultos, a maior incidência é de EPOC, com um 23,2%, e a menor incidência é de lombalgia, com um 2,4%. A maioria de usuários atendidos (58%) são homens, e o 58% dos usuários pertencem ao regime contributivo. No PAC de reabilitação cardíaca e/ou pulmonar a maior incidência foi de EPOC, com um 40%; seguido de pneumonia, com 17%; e com uma menor incidência para asma, com um 2%. O 54% dos usuários são homens e o 91% do total pertencem ao regime subsidiado. Abstract in spanish Introducción: El programa de Fisioterapia de la Universidad del Rosario, en su responsabilidad social de generar un impacto positivo en la comunidad y en su propósito de formar profesionales, cuenta con los Programas Académicos de Campo (PAC) que se consideran una fuerte estrategia de extensión de la Universidad. Los PAC contribuyen a la adquisición de competencias para el desarrollo de procesos de acción-actuación-creación en los estudiantes para que resuelvan pr (more) oblemas en un espacio real de ejercicio profesional. Bajo esta perspectiva los PAC del programa de Fisioterapia muestran su comportamiento a través de la medición de indicadores de proceso y resultados propuestos desde el Programa con el fin de proveer información útil para la reorientación y permanente actualización de los contenidos programáticos en las asignaturas y en los mismos PAC. Materiales y métodos: En el siguiente artículo se presenta un análisis de los indicadores de demanda por género, régimen de Seguridad Social en Salud, procedimiento y morbilidad de los Programas Académicos de Campo Integral Pediátrico, Integral de Adultos y Rehabilitación cardíaca y/o pulmonar, con el fin de establecer las características de la población objeto de la prestación de los servicios y procurar información verificable que dé soporte para la construcción de procesos de cambio dentro de la dinámica de mejoramiento continuo que debe tener cualquier institución. Este seguimiento es útil para la toma de decisiones de planeación académica que contribuye a mejorar los procesos de planeación y a facilitar el cumplimiento de los propósitos de formación para cada práctica, y de esta manera ayuda a ser elemento de análisis para directivas, instructores y estudiantes en la orientación del proceso de gestión académico-administrativo, y a retroalimentar los procesos de planeación y programación académica. Resultados: Los resultados arrojados en el análisis de los datos de la morbilidad en los programas académicos de campo muestran el siguiente comportamiento durante los años 2004, 2005, 2006 y 2007. Conclusiones: En el PAC pediátrico la mayor incidencia es de asma con un 37,2% y la más baja incidencia es para luxación congénita de cadera y enfermedad mental de origen central con un 0,1%. El 58% de los usuarios es de género masculino, y el 81% del total pertenece al régimen contributivo. En la morbilidad del PAC de adultos la mayor incidencia es de EPOC, con un 23,2%, y la menor incidencia es de lumbalgia, con un 2,4%. La mayoría de usuarios atendidos (58%) son hombres, y el 58% de los usuarios pertenece al régimen contributivo. En el PAC de rehabilitación cardíaca y/o pulmonar la mayor incidencia fue de EPOC, con un 40%; seguido de neumonía, con 17%; y con una menor incidencia para asma, con un 2%. El 54% de los usuarios son hombres y el 91% del total pertenece al régimen subsidiado. Abstract in english Introduction: The Physical Therapy program at Rosario University in its social responsibility to create a positive impact on the community and its aim of training professionals, counts on Field Academic Programs (FAP), which are considered a strong strategy of extending the University. FAPs contribute to the acquisition of skills for the development of processes in students including acting-doing-creating in order to solve problems in a real area of practice. From this pe (more) rspective, the FAP of Physical Therapy show their ongoing, through the measurement of process and outcome indicators proposed in the Program to provide useful information to the reorientation and continuous updating of program contents in the subject matters and the FAP itself. Method and materials: The following article presents an analysis of demand indicators by gender, Social Security Regimen for Health, procedure and morbidity of Integral Pediatric Field Academic Programs, Integral Adult and Cardiac/Pulmonary Rehabilitation with the purpose of establishing the characteristics of the target population, which is under the provision of services and seek verifiable information to support the construction of change processes within the continuous improvement dynamic every institution must possess. Objective: Such monitoring is useful for making decisions about of planning academic, which contribute to improve planning processes, to facilitate compliance of the training purposes of each practice. Therefore, become an element of analysis to directives, instructors and students in guidind the process of academic and administrative management and feedback processes of academic planning and programming. Conclusions: The results obtained in the analysis of morbidity data in the field's academic programs show the following behavior during the years 2004, 2005, 2006 and 2007: In the pediatric FAP, the highest incidence of asthma corresponds to 37.2% and the lowest incidence covers congenital hip dislocation and mental disease of central origin with 0.1%; 58% of users are male and 81% of users belong to the contributory regimen. In adults FAP morbidity, the highest incidence of COPD is 23.2%, and the lowest incidence correspond to lower back pain with 2.4%; most treated users are men with 58%, and 58% of users belong to the contributory regimen. In the cardiac/pulmonary rehabilitation FAP, the highest incidence of COPD was 40%, followed by pneumonia with 17% and with a lower incidence to asthma with 2%; 54% of users are male, and 91% of users belong to the subsidized regimen.

A modified version of the Dregia-Hirth rebound mechanism for misfit dislocation creation is observed in atomistic models of CuNi nanolayered structures. Under applied compression glide dislocations in Cu layers undergo a reaction at the CuNi interface to produce another glide dislocation and a misfit dislocation.

Congenital vertical talus (CVT) is a primary dislocation of the talonavicular joint that often occurs in neuromusculoskeletal syndromes, but may also be seen as an isolated abnormality. Six families with isolated CVT were ascertained. DNA was isolated from 21 affected individuals and 17 unaffected individuals from these families, as well as from five sporadic patients with CVT. Variable expressivity was noted in three families, manifesting as clubfoot in three individuals. Genome-wide linkage analysis generated a maximum two-point logarithm of odds score on chromosome 2q with D2S1353 (Zmax = 1.43 at theta(max) = 0.1), 17 Mb from the HOXD gene cluster. DNA from one affected individual of each family was subjected to mutational analysis of the HOXD10 gene. A single missense mutation was identified (M319K, 956T > A) in the homeodomain recognition helix of the HOXD10 gene that segregated with disease in one large British family. This mutation was recently described in a family of Italian descent with CVT and Charcot-Marie-Tooth deformity HOXD10 gene mutations were not identified in any of the other families or sporadic patients with CVT, suggesting that genetic heterogeneity underlies this disorder. PMID:16450407

Background. ``Metatropic dysplasia variants`` are a group of bone dysplasias whose skeletal abnormalities are similar to, but milder than, those of classical metatropic dysplasia. The genetic and phenotypic heterogeneity has not been thoroughly elucidated. Objective. The objective was to designate a distinct subtype of these metatropic dysplasia variants. Materials and methods. The subjects were four Japanese patients, two sporadic cases and two siblings, who all had identical skeletal changes. The radiological features in these patients were compared with those of previously reported metatropic dysplasia variants. Results. Moderate platyspondyly with pear-shaped and/or anterior-tongued vertebral bodies, halberd pelvis, and dumbbell deformity of the tubular bones were regarded as hallmarks of metatropic dysplasia variants. The peculiar skeletal change in our patients was advanced carpal skeletal age in childhood, unlike most patients reported as metatropic dysplasia variants who manifest delayed carpal ossification. Another hallmark was congenital dislocation of the radial heads. A description of a patient with similar skeletal changes was found in the literature. Conclusion. These patients are considered to represent a distinct subgroup of metatropic dysplasia variants. It remains unknown whether the present siblings represent an autosomal recessive trait or an autosomal dominant trait with germinal mosaicism related to increased paternal age. (orig.) With 3 figs., 10 refs.

Structure and configuration of boundary dislocations on various low angle tilt grain boundaries in alumina were considered based on the ideas that the boundary is composed of regularly arrayed edge dislocations and that the dislocations could dissociate into partial dislocations with maintaining the hcp-like oxygen sublattice. Moreover, the separation distance between the partial dislocations formed by the dissociation was evaluated by the calculations based on an elastic theory. The calculations indicated that the width of the stacking fault region between partial dislocations decreases with increasing tilt angles. As a consequence, the hypothesis and calculations used here would enable us to predict the structures of various low angle boundaries with dissociated boundary dislocations.   

Dislocation formation in Czochralski (CZ) Si crystal growth using an annealed heavily B-doped Si seed has been investigated. Many dislocations were observed in the crystals grown from the annealed heavily B-doped Si seeds although no dislocations due to thermal shock were formed in the annealed seeds. No misfit dislocations should have been introduced in the grown crystal because there was no difference between the B concentration of the seeds and that of the grown crystals. However, many dislocation loops were observed in the annealed Si seeds. Therefore, the dislocations generated in the grown crystals were probably induced by the dislocation loops in the annealed seed.   

... them. Traditional total hip arthroplasty, in some people’s minds, does not provide enough for the patient; patients ... patients qualify for hip resurfacing, and would you mind recapping on again, who is a candidate for ...

... Aneurysms (Shawnee Mission Medical Center, Merriam, KS, 7/30/2009) Silent Killer -- Aortic Aneurysms -- Resolved Without Open ... Total Hip Arthoplasty (Mercy Hospital, Miami, FL, 8/30/2011) Hip Replacement with Acetabular System and Modular ...

... to decrease the inflammation in the hip joint. Physical therapy may also help keep the joint as ... of movement under the strict supervision of a physical therapist. As you gradually strengthen your hip muscles, ...

... socket device. Artificial hips allow a very wide range of motion, even though it is a little ... physical therapy, strengthen your leg and improve the range of motion in your new hip. The surgeon, ...

Intrinsic magnetic coercivities of samarium cobalt magnets made to approach theoretical limit of 350 kA/m by carefully eliminating oxygen from finished magnet by hot isostatic pressing (HIP). HIP process viable alternative to currently used sintering process.

STUDY OBJECTIVE: To assess the most appropriate postoperative analgesic technique after hip surgery. DESIGN: Prospective, nonrandomized study. SETTING: University hospital. PATIENTS: 1,338 ASA physical status I, II, and III patients scheduled for elective unilateral total hip arthroplasty (THA). INT...

The topics covered include the theory and modeling of hot isostatic pressing (HIP), the metals and alloys, advanced composites, composite materials, coatings and superconductors, and HIP technology and instrumentation. Papers are presented on the rapid computerized modeling of the final shape of HIPed axisymmetric containers, a finite-element simulation of HIPing of ceramic powders, densification during HIP, comparative studies on post-HIP and sinter-HIP treatments of transformation toughened ceramics, the effects of oxygen on the HIPing of laser-synthesized Si3N4 powders, and HIPing of SiN4-SiC composite powders prepared by the nitriding combustion reaction. Other papers are on the microstructure, mechanical properties and oxidation behavior of HIPed tantalum nitride, HIP sintering of beta-sialon powder derived from silicon diimide, vacuum sintering and HIPing of a plasma-sprayed WC-Co coating, recent trends in HIP process technology in Japan, and the development and use of a HIP dilatometer.

... Gastroesophageal Reflux Disease (GERD) Glaucoma Gout Hearing Loss Heart Attack Hepatitis B Hepatitis C HIV and AIDS Hypertension (High Blood Pressure) Hypoglycemia Incisional Hernia Influenza Inguinal ... Valve Replacement Hemorrhoid Surgery Hip Replacement Hip Replacement - ...

The microstructure and mechanical properties of a specimen HIPped at 1100 degrees C under 60 ksi were examined. The examinations indicated that the proper HIPping temperature for this material should be higher than 1100 degrees C. New recipe of monolithic...

Hip fracture Basics In-Depth Multimedia Expert Answers Resources Definition Symptoms Causes Risk factors Complications Preparing for your appointment ... Book Definition By Mayo Clinic staff A hip fracture is a serious injury, particularly if you're ...

[Purpose] The aim of this study was to determine relationship between hip muscle strength and kinematics of the knee joint during single leg squatting and dropping. [Subjects] Twelve healthy subjects participated in this study. [Methods] The knee medial displacement was measured during single leg squatting and dropping using a high-speed camera. Peak isometric muscle strengths of the following muscles were measured hip abductors, hip adductors, hip external rotators, hip internal rotators, knee extensors and knee flexors. [Results] Muscle strength of hip external rotators was associated with knee medial displacement during both single leg squatting (r=-0.69) and dropping (r=-0.59), and muscle strength of knee flexors was associated with knee medial displacement during dropping (r=-0.58). [Conclusion] The present results suggest that hip muscles' strength, particularly hip external rotators' strength are closely associated with knee medial displacement.   

... Jefferson University Hospital specializing in hip and knee joint replacement. And today with me I have Dr. ... bandaged up. The yellow material covers the hip joint. I’m standing there to the right on ...

The success of hip resurfacing in younger patients with primary osteoarthritis has paved the way for the trial of the procedure in patients with secondary osteoarthritis of the hip. We retrospectively reviewed the clinical and radiologic results in a cohort of 23 patients (32 hips) with inflammatory arthritis who were chosen for hip resurfacing after normalizing vitamin D levels and ruling out proximal femoral osteopenia using dual-energy x-ray absorptiometry. At a minimum follow-up of 3 years, there was failure in only 1 hip due to fracture of the femoral neck attributable to osteonecrosis of the remnant head. The clinical outcome was evaluated using Harris hip score and was found to be good to excellent in 30 of 31 hips. Hip resurfacing is a promising alternative in carefully chosen patients with inflammatory arthritis. PMID:21414743

Founded in Barcelona in 1985, the Spanish Hip Society (SECCA) now has over 200 members and organizes annual meetings. Papers read in the SECCA meeting are published in Hip International, since our society is affiliated with this journal. The late Sixties and early Seventies coincided with the beginning and development of total hip replacement. At present, over 30,000 hip prostheses are implanted in our country. A great deal of research and development has been made at the various universities and hospitals in Spain. This special supplement issue of Hip International is intended to provide an update on a variety of hip pathologies by experienced Spanish hip surgeons, all SECCA members. The contributions consider different areas in hip surgery: several aspects of acetabular fracture treatment, age as a cause of nosocomial infection after hip fracture and how to avoid injuries to the superior gluteal nerve are addressed. Epiphyseal femoral tumor resection under intraosseous endoscopic control, clinical results after an anterior mini-open approach for femoroacetabular impingement and computer navigation guided alignment of the femoral component in hip resurfacing are also presented. The accuracy of Ranawat's and Pierchon's methods to determine the center of hip rotation, CFP short stem results and home hospitalization for elective total hip arthroplasty are considered. The clinical results of total hip replacement are analyzed. A new cementless stem is considered in a multicentric study and the long-term results of the Spotorno and Furlong implants are also analysed. The bedding-in and true wear in two different generations of porous-coated acetabular cups and the clinical results of the alumina-on-alumina hip replacement in developmental dysplasia of the hip are both assessed. Revision surgery is analyzed in four interesting papers, the first presents basic research into osteoprogenitor cell adhesiveness on titanium mesh, one paper assesses the use of hemispherical HA-coated cups with impacted graft in acetabular reconstruction for severe bone defects, and other articles address the use of the Burch-Schneider antiprotrusio cages for acetabular revision and the use of the Trabecular Metal Buttress Augment and Trabecular Metal Cup-Cage construct for severe acetabular bone loss and pelvic discontinuity. Finally, two-stage revision of infected hip prostheses using a hip spacer with stabilizing proximal cementation is also reported. I express my gratitude to all contributors. This short supplement cannot expect to cover all hip problems, but it does aim to show the current trends of hip surgery in our country as is an opportunity to share common experiences with hip surgeons in all parts of the world. Finally, SECCA thanks Hip International for giving us the opportunity to show the international orthopaedic community a schematic overview of the current developments in hip surgery in Spain. PMID:20512764

The nanoscale deformation field of twin boundary dislocations in nanocrystalline aluminum was experimentally investigated using a combination of high-resolution transmission electron microscopy and geometric phase analysis. The entire strain field of the twin boundary dislocations was mapped and then compared with those of the Peierls-Nabarro and elastic theory dislocation models. The comparison results demonstrated that the Peierls-Nabarro dislocation model best describes the strain field of the twin boundary dislocations in nanocrystalline aluminum.

A six-year-old, female, spayed Labrador Retriever was evaluated for progressive lameness of one year duration, ending in non-weight-bearing of the right hindlimb. The dog had a history of severe coxarthrosis of both hip joints, and had a HELICA hip prosthesis implanted in the right hip 18 months bef...

OBJECTIVE: To study the prevalence of ultrasonic hip joint effusion and its relation with clinical, radiological and laboratory (ESR) findings in adults with hip pain. METHODS: Patients (n = 224) aged 50 years or older with hip pain, referred by the general practitioner...

Osteoporotic hip fracture (HF) is a serious global public health problem associated with high morbidity and mortality. Hip bone size (BS) has been identified as one of key measurable risk factors for HF, independent of bone mineral density (BMD). Hip BS is highly genetically determined, but genetic ...

Purpose To describe an arthroscopic technique for decompression of a prominent anterior inferior iliac spine (AIIS) leading to extra-articular hip impingement and to provide short-term outcome after this procedure. Methods We retrospectively reviewed office charts, imaging studies, operative reports, arthroscopic images, preoperative and postoperative hip flexion range of motion, and preoperative and postoperative modified Harris Hip Scores in a consecutive series of 10 male patients who had arthroscopic decompression of symptomatic AIIS deformities leading to extra-articular hip impingement. The procedure was performed through standard anterolateral and mid-anterior hip arthroscopy portals that were also used to explore the joint and address concomitant intra-articular pathologies. Result...

Background Developmental hip disorders (DHDs), eg, developmental dysplasia of the hip, slipped capitis femoris epiphysis, and femoroacetabular impingement, can be considered morphology variants of the normal hip. The femoroacetabular morphology of DHD is believed to induce osteoarthritis (OA) through local cumulative mechanical overload acting on genetically controlled patterning systems and subsequent damage of joint structures. However, it is unclear why hip morphology differs between individuals with seemingly comparable load histories and why certain hips with DHD progress to symptomatic OA whereas others do not. Questions/Purposes We asked (1) which mechanical factors influence growth and development of the proximal femur; and (2) which genes or genetic mechanisms are associated with ...

We outline a method to study the spatial and orientation statistics of dynamical dislocation systems by modeling the dislocations as a stochastic fiber process. Statistical measures have been introduced for the density, velocity, and flux of dislocations, and the connection between these measures and the dislocation state and plastic distortion rate in the crystal is explained. A dislocation dynamics simulation model has been used to extract numerical data to study the evolution of these statistical measures numerically in a body-centered cubic crystal under deformation. The orientation distribution of the dislocation density, velocity and dislocation flux, as well as the dislocation correlations have been computed. The importance of the statistical measures introduced here in building continuum models of dislocation systems is highlighted.

The molecular dynamics method is used to simulate dislocation intersection in aluminum containing 1.6x10{sup 6} atoms using embedded atom method (EAM) potential. The results show that after intersection between two right-hand screw dislocations of opposite sign there are an extended jog corresponding to a row of 1/3 vacancies in the intersected dislocation, and a trail of vacancies behind the moving dislocation. After intersection between screw dislocations of same sign, there are an extended jog corresponding to a row of 1/3 interstitials in the intersected dislocation, and a trail of interstitials behind the moving dislocation. After intersection between screw and edge dislocations with different Burgers vector, there are a constriction corresponding to one 1/3 vacancy in the edge dislocation, and no point-defects behind the screw dislocation. When a moving screw dislocation intersects an edge dislocation with the same Burgers vector, the point of intersection will split into two constrictions corresponding to one 1/3 vacancy and 1/3 interstitial, respectively. The moving screw dislocation can pass the edge dislocation only after the two constrictions, which can move along the line of intersection of the two slip planes, meet and annihilate.

Ti-6Al-4V powders have been hot-isostatically-pressed (“HIPped”) using a range of hot-isostatic-pressing (“HIPping”) conditions, and the effects on microstructure and mechanical properties have been assessed. The properties were measured on test samples machined from HIPped powder billets and on samples that contained the as-HIPped surface. The fatigue limit of samples that contained the as-HIPped surface was improved by using a new HIPping procedure. The machined samples that had been HIPped at 1203 K (930 °C) exhibited a better balance of properties than those HIPped at 1153 K (880 °C) or 1293 K (1020 °C). The fine microstructure, formed from the martensitic structure of the atomized powder, coarsens with the increase of temperature or time during HIPping. These changes have been correlated with the corresponding changes in properties and with the fracture surfaces. The significance of these observations, especially the fatigue properties of samples that contain the as-HIPped surface, is discussed in terms of the properties of net-shape HIPped components.

Primary total hip arthroplasties were performed in 70 hips for the treatment of Crowe type IV developmental dysplasia of the hip. The patients were subdivided into 2 groups with or without iliofemoral osteoarthritis. Leg length change was measured radiographically. Preoperative hip motion was reviewed from medical records and defined as either higher or lower motion groups. The leg length change in patients without iliofemoral osteoarthritis was significantly greater than that in patients with iliofemoral osteoarthritis, and the higher hip motion group had greater leg length change in total hip arthroplasty than the lower motion group. The current study identifies several features that might help predict leg length change during the preoperative planning of total hip arthroplasty for Crowe...

Background Legg-Calvé-Perthes disease (LCPD) often results in a deformity that can be considered as a complex form of femoroacetabular impingement (FAI). Improved preoperative characterization of the FAI problem based on a noninvasive three-dimensional computer analysis may help to plan the appropriate operative treatment. Questions/purposes We asked whether the location of impingement zones, the presence of additional extraarticular impingement, and the resulting ROM differ between hips with LCPD and normal hips or hips with FAI. Methods We used a CT-based virtual dynamic motion analysis based on a motion algorithm to simulate the individual motion for 13 hips with LCPD, 22 hips with FAI, and 27 normal hips. We then determined the motion and impingement pattern of each hip for the anterio...

Background Total hip arthroplasty (THA) is a commonly performed procedure with increasing frequency in the young adult. While most available outcome measures can document postoperative improvement in pain and function, they do not measure the ability to perform high-demand activities. Questions/Purposes We present and validate a user-friendly discriminating hip scoring system (the functional hip score) for use in younger, ?high-demand? patients undergoing hip arthroplasty surgery. Methods We studied 38 subjects without any hip symptoms and 72 patients undergoing THA for osteoarthritis of the hip. Preprocedure and postprocedure scores were collected in the latter cohort of patients. SF-36 and WOMAC scores were used to validate our functional scoring system. The functional hip score was test...

Abstract in spanish Este trabajo analiza una casuística de 200 niños con signos clínicos y/o radiológicos de displasia congénita de cadera, lo que supone el 2,20 % de los recién nacidos. En los resultados se evidencia una mayor frecuencia entre los hijos de madres jóvenes, un predominio entre las de origen rural, un porcentaje alto de presentaciones de nalgas, una incidencia elevada entre las de edades gestacionales superiores a 39 sem., predominante en el sexo femenino, mayor afectac (more) ión unilateral con predominio evidente de lesión en el lado izquierdo y un número relativamente bajo de malformaciones asociadas. Las formas anatomorradiológicas halladas por orden de frecuencia fueron, displasia subluxaciones y luxaciones con una proporción alta de asociación unilateral de anomalías. El tratamiento fundamentado en Harnes de Pavlick para la displasia cefálica y acetabulares sin subluxaciones y con ellas y yeso en posición de centraje en la luxación, así como tenotomías en casos de abducción limitada dio resultados francamente favorables. Abstract in english A casuistics of 200 children with clinical and/or radiological signs of congenital hip dysplasia, accounting for 2.20 % of the newborn infants, is analyzed in this paper. Among the results we found a higher frequency among the children from young mothers, mainly in those of rural origin, a high percentage of breech presentations, an elevated incidence in gestational ages over 39 weeks, a predominance of the female sex, higher unilateral affectation with an evident prevail (more) ing of injury on the left side and a relatively low number of associated malformations. The most frequent anatomoradiological forms observed were dysplasia, subluxations and luxations with a high proportion of unilateral association of abnormalities. The treatment was based on Pavlick Harness for cephalic dysplasia and acetabular dysplasias with or without subluxations and cast in physiological position of the articulation in the luxation, as well as on tenotomies in those cases of limited abduction. The results were favorable.

Dislocation continuity is derived from the Bilby--Kondo theory of dislocations using exterior calculus. Dislocation density is represented by the torsion vector-valued two-form. Burgers vectors are associated with the vector part of the torsion while dislocation lines are associated with the two-form part. The exterior derivative of the torsion is shown to vanish when the crystal curvature vanishes. This implies two simultaneous continuity conditions: Burgers vector conservation and continuity of dislocation lines. On the other hand, dislocation continuity is violated when the curvature does not vanish. Since this can occur on grain boundaries it is inferred that grain boundaries are regions where crystal curvature is concentrated.

A new method is proposed to quantify the local dislocation spacings on sections displaying the intersections of dislocation lines. The method was applied to dislocation structures in single crystals of CaF2 introduced by deformation at elevated temperature and made visible by etch pits. The method yields the frequency distributions and the spatial distributions of dislocation spacings. For cellular dislocation structures the method provides a quantitative and objective characterization in terms of frequency distribution of dislocation spacings in cell boundaries and cell interiors and of cell size.

We present a strain analysis of an edge dislocation core in gold. The strain fields around an edge dislocation were mapped with a geometric phase analysis of high-resolution transmission electron microscopy images. The strain measurement results were compared with the gradient elasticity dislocation model, the field theory of elastoplasticity dislocation model and the Peierls-Nabarro dislocation model. We then concluded that for the field theory of elastoplasticity, the non-dimensional constant e{sub 0} is more suitable when chosen as 0.25 than with 0.399. However, the Peierls-Nabarro model is the most appropriate theoretical model to describe the deformation fields of the dislocation core.

A multi-scale approach is used to construct a continuum strength model for vanadium. The model is formulated assuming plastic deformation by dislocation motion and strain hardening due to dislocation interactions. Dislocation density is adopted as the state variable in the model. Information from molecular statics, molecular dynamics and dislocation dynamics simulations is combined to create kinetic relations for dislocation motion, strain hardening relations and evolution equations for the dislocation density. Implicit time integration of the constitutive equations is described in the context of implementation in a finite element code. Results are provided illustrating the strain, strain rate, temperature and pressure dependence of the constitutive model.

We investigated the propagation of the threading dislocations in the GaN layer grown by facet-controlled epitaxial lateral overgrowth (FACELO). The mixed-type dislocations were bent toward the mask areas and they were terminated at the voids on the SiO2 masks. On the other hand, the pure edge dislocations were bent in the direction of the mask stripe. No dislocations originating from the GaN/sapphire interface propagated to the surface. As a result, it was confirmed that a large reduction of dislocation density was achieved. Therefore, FACELO seems to be a promising technique for the realization of a GaN wafer of low dislocation density.   

Crystal plasticity is the result of the motion and interaction of dislocations. There is, however, still a major gap between microscopic and mesoscopic simulations and continuum crystal plasticity models. Only recently a higher dimensional dislocation density tensor was defined which overcomes some drawbacks of earlier dislocation density measures. The evolution equation for this tensor can be considered as a continuum version of dislocation dynamics. We use this evolution equation to develop evolution equations for the total dislocation density and an average curvature which together govern a faithful representation of the dislocation kinematics without having to use extra dimensions.

An asymptotic methodology for analysing pile-ups of large numbers of dislocations is proposed. We provide robust proof of the interconnection between continuum and discrete approaches to dislocation description. The practical usefulness of the technique is tested on a pile-up of screw or edge dislocations in a uniform material stressed against a lock. The approach is extended to the case of a pile-up of screw dislocations stressed against an interface in a bimetallic solid. The dislocations are located with sufficient accuracy to predict the large but finite stress distribution close the interface. Such a prediction is impossible using a conventional continuum dislocation theory.

Cylindrical specimens of bainitic pressure vessel steel 16MND5 were strained in uniaxial tension at a temperature of -196 C. Dislocation structure and surface relief were studied at 2.5 and 8% of plastic deformation and their evolution with increasing plastic strain is documented. Great heterogeneities were observed in the dislocation arrangements of individual laths. The dislocation substructure is dominated by short straight dislocation segments of the screw type and by dislocation debris. Dislocation clusters and walls can be seen with increasing deformation. Slip markings are wavy, and some of them become pronounced with increasing plastic strain. (orig.)

We use massively parallel molecular dynamics simulations of polycrystal plasticity to elucidate the intricate dislocation dynamics that evolves during the process of deformation of columnar nanocrystalline Al microstructures of grain size between 30 and 100 nm. We analyze in detail the mechanisms of dislocation-dislocation and dislocation-twin boundary reactions that take place under sufficiently high stress. These reactions are shown to lead to the formation of complex twin networks, i.e. structures of coherent twin boundaries connected by stair-rod dislocations. Consistent with recent experimental observations, these twin networks may cause dislocation pile-ups and thus give rise to strain hardening.

Dislocations produced by 1300{degree}C indentation of the silicon-terminated (111) face of 3{ital C}-SiC were investigated by transmission electron microscopy. They were all found to be either widely separated partial dislocation pairs, or else, arrays of single partial dislocation half-loops on neighboring parallel slip planes and having the same Burgers vector. It was concluded that in the latter case, each array consisted of {ital leading} partial dislocations which had nucleated without accompanying trailing partial dislocations. The core nature of both dissociated dislocations and arrays of single partial dislocations has been determined by the technique of large angle convergent beam electron diffraction. The results indicate that the core of all single partial dislocation half-loops constituting an array consists of silicon atoms. It is concluded that, with the present deformation geometry, the Si-core partial dislocations are preferentially nucleated before the C-core partial dislocations. In the case of a dissociated dislocation, when a pair of partials was present, electron microscopy observations showed that the morphology of the two partial dislocations was very different; while the Si-core partials were smooth, the C-core partial dislocations had a zig-zag morphology. {copyright} {ital 1996 Materials Research Society.}

The purpose of this study was to consider the discrepancy between the trunk-based and the pelvis-based hip joint angles, and the difference between the MTC lengths estimated on the basis of the two types of hip joint angles during dynamic movement. Ten male athletes performed CMJ. Joint kinematics and the MTC length of long head of biceps femoris were compared between the trunk-based hip angle and the pelvis-based hip angle. In the CMJ, the angular displacements of the trunk-based were significantly higher than that of pelvis-based hip joints. There were no significant correlations between the two types of hip joint angles except at initial position. As for long head of biceps femoris, in contrast with the trunk-based-hip joint angle derived MTC length, which shows stretching in the descending phase and shortening in the ascending phase, the pelvis-based hip joint angle derived MTC length shows little changes. These results suggest that the trunk-based and pelvis-based hip joint angles have similar patterns of fluctuation; however, the angular displacement of each type is not equivalent. These results also suggest that we may misinterpret the type of muscle contraction because the definitions of hip joint angle are different even for the same muscle type.   

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.)

PURPOSE: A possible cause of hip pain is the presence of radiating pain from the higher lumbar spine. Identification of factors associated with hip pain arising from the lumbar spine would aid the physician. The first step in identifying possible factors is to look at the association between hip pain and osteoarthritis of the lumbar spine. METHODS: In an open population based study of people 55 years and older (Rotterdam study), 2,819 lumbar radiographs were scored for the presence and severity of individual radiographic features of disk degeneration. Hip osteoarthritis was scored on anteroposterior pelvic radiographs, and questionnaires including self-reported hip pain were taken. Logistic regression adjusted for possible confounders was used to determine the association between self-reported hip pain and the individual radiographic features of lumbar disk degeneration. RESULTS: The presence of dis space narrowing grade ?1 at level L1/L2 was significantly associated with hip pain in the last month (men OR = 2.0; 95 % CI 1.1-3.8 and women OR = 1.7; 95 % CI 1.1-2.5). The presence of disk space narrowing grade ?1 at level L2/L3 was only significantly associated with hip pain in women. The strength of the associations increased for self-reported chronic hip pain, especially in men (L1/L2 OR = 2.5; 95 % CI 1.3-5.0). The presence of disk space narrowing at the lower levels (L3/L4/L5/S1) was not significantly associated with hip pain. CONCLUSION: Our data provide evidence for an association between hip pain and disk space narrowing at disk level L1/L2 and L2/L3. In case of uncertainty of the cause of hip pain, evaluation of lumbar radiographs may help to identify those hip pain patients who might have pain arising from the lumbar spine. PMID:23135791

Background and aims PAP/HIP was first reported as an additional pancreatic secretory protein expressed during the acute phase of pancreatitis. It was shown in vitro to be anti?apoptotic and anti?inflammatory. This study aims to look at whether PAP/HIP plays the same role in vivo. Methods A model of caerulein?induced pancreatitis was used to compare the outcome of pancreatitis in PAP/HIP?/? and wild?type mice. Results PAP/HIP?/? mice showed the normal phenotype at birth and normal postnatal development. Caerulein?induced pancreatic necrosis was, however, less severe in PAP/HIP?/? mice than in wild?type mice, as judged by lower amylasemia and lipasemia levels and smaller areas of necrosis. On the contrary, pancreas from PAP/HIP?/? mice was more sensitive to apoptosis, in agreement with the anti?apoptotic effect of PAP/HIP in vitro. Surprisingly, pancreatic inflammation was more extensive in PAP/HIP?/? mice, as judged from histological parameters, increased myeloperoxidase activity and increased pro?inflammatory cytokine expression. This result, in apparent contradiction with the limited necrosis observed in these mice, is, however, in agreement with the anti?inflammatory function previously reported in vitro for PAP/HIP. This is supported by the observation that activation of the STAT3/SOCS3 pathway was strongly decreased in the pancreas of PAP/HIP?/? mice and by the reversion of the apoptotic and inflammatory phenotypes upon administration of recombinant PAP/HIP to PAP/HIP?/? mice. Conclusion The anti?apoptotic and anti?inflammatory functions described in vitro for PAP/HIP have physiological relevance in the pancreas in vivo during caerulein?induced pancreatitis.

An alumina (@a-Al"2O"3) bicrystal with a (0001)/[0001] low-angle twist grain boundary was fabricated by bonding two (0001) substrates at 1500^oC in air. Dislocation structures in the resultant grain boundary were extensively observed in plan view and cross-sectional direction by transmission electron microscopy (TEM). The grain boundary consisted of a hexagonal dislocation network of 1/3 basal screw dislocations and wavy belt structures. The atomic core structure of the screw dislocations was analyzed in end-on view by high-resolution TEM. It was evident that the 1/3 basal screw dislocation does not dissociate into partial dislocations, which is in contrast to the 1/3 basal edge dislocation that dissociates into 1/3 and 1/3 partial dislocations. Also...

...Required rapid response activities, as described in...adults and dislocated workers; (2) Information...workforce investment activities for adults, dislocated workers and youth, in order...continuously improving such activities to achieve...

...State dislocated worker unit's services and activities should include...services and activities carried out by the dislocated worker unit or office...report on its activities; (iv) The...needs of affected workers by devising...

eraged measures of dislocation arrangement, dislocation density, and inter- granular gracture. .... experiments on material points since at the microscopic level the continuum ..... Mechanical Behavior of Materials Under Dynamic Loads, p. 343 ...

The velocity of edge and screw dislocations moving in primary slip bands and the formation rate of primary slip bands were measured in stage I deformation of neutron-irradiated copper single crystals at different strain rates at room temperature using micro-cinematography and optical micrography. The average velocity of edge dislocations was larger at least by one order than that of screw ones, and that of screw dislocations did not depend so strongly on strain rate. The formation rate of primary slip bands was proportional to strain rate. From these results, it is concluded that (1) jogs produced on moving dislocations by cutting dislocation loops result in the difference in velocity between edge and screw dislocations and (2) the change in the density of mobile dislocations as well as velocity of dislocations is responsible for the change of plastic strain rate of a crystal. (author).

The study of the cyclic deformation behaviour in tension-compression of molybdenum single crystals described in Part I has been completed with the observation by transmission electron microscopy (TEM) of the dislocation substructures developed at 400 K. The dislocation microstructures' morphologies were determined, the dislocation densities measured and the dislocation Burgers vectors evaluated. The different regions of the c.s.s. curve were correlated with characteristic dislocation substructures. At low plastic-strain amplitudes the dislocation substructure consists of poorly developed tangles and, as the plastic-strain amplitude increases, dislocation bundles, walls and cells are formed and developed. Probably the most important feature is the presence of secondary dislocations, mainly with conjugate Burgers vectors, which increase very strongly with increasing plastic-strain amplitude. The characteristic shape of the c.s.s. curve obtained at the transition temperature is fully explained.

Spondyloepimetaphyseal dysplasia with joint laxity (SEMDJL), leptodactylic (lepto-SEMDJL) or Hall type, is an autosomal-dominant skeletal dysplasia manifesting with short stature, joint laxity with dislocation(s), limb malalignment, and spinal deformity. Its causative gene mutation has not yet been ...

The viscoplastic deformation (creep) of crystalline materials under constant stress involves the motion of a large number of interacting dislocations. Analytical methods and sophisticated `dislocation-dynamics' simulations have proved very effective in the study of dislocation patterning, and have led to macroscopic constitutive laws of plastic deformation. Yet, a statistical analysis of the dynamics of an assembly of interacting dislocations has not hitherto been performed. Here we report acoustic emission measurements on stressed ice single crystals, the results of which indicate that dislocations move in a scale-free intermittent fashion. This result is confirmed by numerical simulations of a model of interacting dislocations that successfully reproduces the main features of the experiment. We find that dislocations generate a slowly evolving configuration landscape which coexists with rapid collective rearrangements. These rearrangements involve a comparatively small fraction of the dislocations and lead ...

... Recent literature Genetic Conditions > Congenital deafness with labyrinthine aplasia, microtia, and microdontia (often shortened to LAMM syndrome ) ... What is LAMM syndrome? Congenital deafness with labyrinthine aplasia, microtia, and microdontia (also called LAMM syndrome) is ...

Background: Plastic and reconstructive uterus operations are performed in congenital uterine anomalies or benign uterine conditions. Congenital uterine anomalies are relatively rare diseases with various approaches for surgical treatment. Therefore, to address the question of the usefulness of a mi...

... that are quite broad. There clearly is a genetic, or inherited, component--but frequently we really don't, or can't, pinpoint a specific cause for congenital heart disease. How is congenital heart disease managed? Dr. Atkins: ...

... to... Añadir en... Favorites Delicious Digg Google Bookmarks Mortality From Congenital Heart Defects A recent CDC study ... have advanced, the rate of death (also called mortality ) due to congenital heart defects has been declining ...

The reverse voltage current characteristics and electroluminescence of small area 4H-SiC avalanche photodiodes were investigated and correlated with the presence of threading screw and edge dislocations. Localized electroluminescence was observed at threading dislocations at voltages close to breakdown whereas diodes without any extended defects exhibited uniform light emission in the active area. Diodes containing either edge or screw dislocations were found to have excess leakage currents and breakdown prematurely compared to diodes without dislocations.

Submicron-sized samples with 42,000 finite elements containing up to ~86million atoms have been simulated using a concurrent atomistic-continuum method. The simulations reproduce not only nucleation and growth of semicircular dislocation loops in Cu and Al, but also hexagonal shuffle dislocation loops in Si, with the loop radius approaching ~75nm. Details of leading and trailing partial dislocations connected by intrinsic stacking faults, dislocation loop coalescence through annihilation, and formation of junctions are reproduced.

Tensile tests were performed for two kinds of model alloys containing soft Cu particles or hard VC particles. Work hardening rate was obviously smaller in the Cu particle dispersion steel than in the VC particle dispersion steel. TEM observation for the cold-rolled specimens revealed the different dislocation arrangement; high density dislocations are introduced around the carbide particles in the VC steel, while dislocations are less accumulated in the Cu steel because dislocations can pass through Cu particles during plastic deformation.   

A new constitutive model describing material response to cyclic loading is presented. The model includes dislocation densities as internal variables characterizing the microstructural state of the material. In the formulation of the constitutive equations, the dislocation density evolution resulting from interactions between dislocations in channel-like dislocation patterns is considered. The capabilities of the model are demonstrated for INCONEL 738 LC and Alloy 800H.

The microstructure of a Zr-1% Nb is studied in a deformation macrolocalization zone during its transformation into a neck. The related dislocation transformations are found to be cyclic, and this cyclicity is accompanied by oscillatory changes in the volumes occupied by different dislocation substructures, the scalar dislocation density, the subboundary density, and periodic relaxation of internal stresses as a result of the decomposition of low-angle subboundaries and dislocation redistribution.

A case of atlanto-axial rotatory fixation (AARF) was presented in a 19-year-old female who developed sudden onset of neck pain and limitation of neck movement after direct carotid angiography for seizure disorder. Neurological examination was negative except for cock-robin posture and mild hypesthesia and hypalgesia in left C/sub 2/ distribution. Plain films of the cervical spine disclosed abnormal alignment of C/sub 1/-C/sub 2/ and possible rotational dislocation. Bilateral selective vertebral angiography showed marked anterior and posterior displacement of left and right vertebral artery, respectively, at the level of C/sub 1/. On CT metrizamide myelography, there was clockwise rotation of C/sub 1/ on C/sub 2/ with locked facet on the left but no evidence of cord compression was found. With diagnosis of AARF, manual reduction under general anesthesia and with fluoroscopic control was first attempted without success. Therefore, the patient underwent open reduction by using high speed air-drill and posterior fusion of C/sub 1/ to C/sub 3/ with acryl and wire. Postoperative course was uneventful and the patient went back to work as a computer operator in three months. The etiology of AARF was described by many authors, but in our case, congenital hypogenesis of transverse and alar ligaments plus minor trauma was most suggested. For neurological manifestations of AARF, occipital neuralgia, headache, neck pain, limitation of neck movement and cock-robin posture were reported, but the cock-robin posture was most characteristic and was an important symptom for the early diagnosis. In neuroradiological findings of AARF, plain CT and CT metrizamide myelography are very useful. Because they clearly demonstrate the degree of rotation and interlocking of atlanto-axial joints, and the presence of cord compression.

The stature of human is very important factor in human-being, especially in childhood. The stature depends on various different conditions, such as familial factor, constitutional factor, chromosomal anomalies, skeletal disorders, or endocrinopathies. The early diagnosis of dwarfism is very important problem, because if appropriate treatment is delayed, the complication or sequales are more increased. The survey of familial history or patient's past history, detail check up of physical examination, radiological evaluation, and other laboratory examinations are essentially needed for the accurate diagnosis of dwarfism. Among the patients admitted to Yonsei University college of Medicine, Severance Hospital since 1963, with chief complaint of short stature or other associated diseases, an analysis of radiological findings were made for the 72 cases of chromosomal anomalies, skeletal dysplasia, and cretinism in which radiologic evaluation was available. The conclusions are as follows; 1. The cause of short stature are chromosomal anomalies (48 cases), skeletal dysplasia (14 cases) and cretinism (10 cases). 2. in chromosomal anomalies, 43 cases of mongolism and 5 cease of Turner's syndrome are noted. In mongolism, 18 cases among the 30 cases below 1 year old are distributed below the 10 percentile of height. On radiologic findings, 11 paired ribs (22/43), congenital heart disease (14/43), decreased iliac index (8/12), and associated anomalies or diseases, such as pneumonia (14 cases), C1-C2 dislocation (1 case), imperforated anus (1 case), Morgagni's hernia (1 case) and leukemia with sepsis (1 case). In Turner's syndrome, decreased bone density (5/5), positive metacarpal sign (2/5), positive carpal sign (1/5), change of knee joint (3/5), hypoplasia of (1/3), and increased carrying angle of elbows (1/3) are noted.

Double kink generation in three-fold screw dislocations in bcc crystals is studied within the framework of the generalised Peierls-Nabarro (P-N) model in which the partial dislocations are described by non-singular displacement fields. The kink geometry is modelled by dividing the dislocation into e...

Electrochemical NI-AFM was used to examine the effect of hydrogen on dislocation nucleation. It was shown that hydrogen reduces the pop-in load in all of the tested materials except Cu. The reduced pop-in load can be interpreted as the HELP mechanism. Classical dislocation theory was used to model the homogeneous dislocation nucleation and it was shown that H reduces the activation energy for dislocation nucleation. The activation energy for dislocation nucleation is related to the material specific parameters; shear modulus, dislocation core radius and in the case of partial dislocation nucleation, stacking fault energy. These material properties can be influenced by H resulting in a reduced activation energy for dislocation nucleation. The universality of cohesion in metals relates the reduction of the shear modulus to the reduction of the cohesion, meaning HEDE mechanism. The increase in the core radius of a dislocation due to H is a direct evidence of decrease in dislocation line energy and H segregation on the dislocation line. In the case of partial dislocations, the H can segregate on to the stacking fault ribbon and decrease stacking fault energy. Thus, depending on the experimental approach utilized to probe the H effect, either HELP or HEDE can be observed. In this study by utilizing a proper experimental approach, it was possible to resolve the interconnected nature of the HE.