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1

A rare case of bilateral non-weight bearing posterior aspect of lateral femoral condyle osteochondral fracture and its management.  

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Osteochondral fracture of the lateral femoral condyle can be a real challenging injury to diagnose on initial presentation. The authors report a rare case of bilateral involvement of posterior aspect of lateral femoral condyle osteochondral fracture in a young 15-year-old boy. This was managed with excision of these osteochondral fragments, as the site involved was on the posterior non-weight bearing area of the femur along with chronicity of the injury dictating excision as a reasonable choice of management. Good outcome for such injury is based on an early diagnosis and prompt treatment along with an early rehabilitation for such cases. Our patient has an excellent 2 years outcome with a Knee Society score of 95 after undergoing excision of these osteochondral fragments in both knees in succession. PMID:24825555

Shaikh, Aamir Hassan; Stanclik, Jaroslaw; Murphy, Paul G D

2014-01-01

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Magnetic resonance imaging of articular cartilage abnormalities of the far posterior femoral condyle of the knee  

International Nuclear Information System (INIS)

Background: Incidental articular cartilage lesions of the far posterior femoral condyle (FPFC) are commonly detected. Whether or not these cartilage lesions are symptomatic or clinically significant is unknown. Purpose: To characterize and assess prevalence of articular cartilage abnormalities of the FPFC and associated bone marrow edema (BME) and/or internal derangements through magnetic resonance (MR) images. Material and Methods: 654 knee MR examinations were reviewed retrospectively. Sagittal fast spin-echo proton density-weighted images with and without fat suppression were acquired with a 1.5T scanner, and were evaluated by two readers by consensus. The following factors were assessed: 1) the prevalence of cartilage abnormalities, 2) laterality, 3) the type of cartilage abnormalities, 4) cartilage abnormality grading, 5) associated BME, 6) complications such as meniscal injury and cruciate ligament injury, and 7) knee alignment (femorotibial angle [FTA]). Results: Articular cartilage abnormalities of the FPFC were demonstrated in 157 of the 654 patients (24%). Of these, 40 patients demonstrated medial and lateral FPFC cartilage abnormalities and were thus counted as 80 cases. Focal lateral FPFC abnormalities were demonstrated in 117 of 197 cases (59.4%), while diffuse lateral FPFC abnormalities were demonstrated in 24 of 197 cases (12.2%). Focal medial FPFC abnormalities were demonstrated in 23 of 197 cases (11.6%), while diffuse medial FPFC abnormalities were demonstrated in 33 of 197 cases (16.8%). No statistically significant pattern of associated BME, FTA, or internal derangements including meniscal and cruciate ligament injury was demonstrated. Conclusion: Articular cartilage abnormalities of the FPFC are common and were demonstrated in 24% of patients or 30% of cases. Lateral FPFC abnormalities occur 2.5 times more frequently than medial FPFC abnormalities and were more frequently focal compared with medial cohorts. BME is associated in 36.5% of cases

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Magnetic resonance imaging of articular cartilage abnormalities of the far posterior femoral condyle of the knee  

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Background: Incidental articular cartilage lesions of the far posterior femoral condyle (FPFC) are commonly detected. Whether or not these cartilage lesions are symptomatic or clinically significant is unknown. Purpose: To characterize and assess prevalence of articular cartilage abnormalities of the FPFC and associated bone marrow edema (BME) and/or internal derangements through magnetic resonance (MR) images. Material and Methods: 654 knee MR examinations were reviewed retrospectively. Sagittal fast spin-echo proton density-weighted images with and without fat suppression were acquired with a 1.5T scanner, and were evaluated by two readers by consensus. The following factors were assessed: 1) the prevalence of cartilage abnormalities, 2) laterality, 3) the type of cartilage abnormalities, 4) cartilage abnormality grading, 5) associated BME, 6) complications such as meniscal injury and cruciate ligament injury, and 7) knee alignment (femorotibial angle [FTA]). Results: Articular cartilage abnormalities of the FPFC were demonstrated in 157 of the 654 patients (24%). Of these, 40 patients demonstrated medial and lateral FPFC cartilage abnormalities and were thus counted as 80 cases. Focal lateral FPFC abnormalities were demonstrated in 117 of 197 cases (59.4%), while diffuse lateral FPFC abnormalities were demonstrated in 24 of 197 cases (12.2%). Focal medial FPFC abnormalities were demonstrated in 23 of 197 cases (11.6%), while diffuse medial FPFC abnormalities were demonstrated in 33 of 197 cases (16.8%). No statistically significant pattern of associated BME, FTA, or internal derangements including meniscal and cruciate ligament injury was demonstrated. Conclusion: Articular cartilage abnormalities of the FPFC are common and were demonstrated in 24% of patients or 30% of cases. Lateral FPFC abnormalities occur 2.5 times more frequently than medial FPFC abnormalities and were more frequently focal compared with medial cohorts. BME is associated in 36.5% of cases

Ogino, Shuhei; Huang, Thomas; Watanabe, Atsuya; Iranpour-Boroujeni, Tannaz; Yoshioka, Hiroshi (Dept. of Radiology, Brigham and Women' s Hospital, Boston, MA (United States)), e-mail: hiroshi@uci.edu

2010-01-15

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Focal femoral condyle resurfacing.  

LENUS (Irish Health Repository)

Focal femoral inlay resurfacing has been developed for the treatment of full-thickness chondral defects of the knee. This technique involves implanting a defect-sized metallic or ceramic cap that is anchored to the subchondral bone through a screw or pin. The use of these experimental caps has been advocated in middle-aged patients who have failed non-operative methods or biological repair techniques and are deemed unsuitable for conventional arthroplasty because of their age. This paper outlines the implant design, surgical technique and biomechanical principles underlying their use. Outcomes following implantation in both animal and human studies are also reviewed. Cite this article: Bone Joint J 2013;95-B:301-4.

Brennan, S A

2013-03-01

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Tratamiento quirúrgico de la fractura posterior del condilo femoral / Traitement chirurgical de la fracture postérieure du condyle fémoral / Femoral condylar posterior fracture: Surgical treatment  

Scientific Electronic Library Online (English)

Full Text Available SciELO Cuba | Language: Spanish Abstract in spanish Las fracturas distales del fémur representan solamente el 6 % de todas las fracturas femorales. Presentamos el caso de un paciente masculino de 42 años que sufrió accidente del transito, que le provocó fractura unicondilar del extremo distal del fémur en el plano coronal, conocida como fractura de H [...] offa. Se muestra el tratamiento quirúrgico realizado mediante estudios radiológicos, donde se utilizó tornillo del sistema AO. Con este tipo de proceder se obtuvo reducción y estabilidad de la fractura. Se concluye que una planificación preoperatorio adecuada es necesaria para obtener resultados satisfactorios. Abstract in english Femoral distal fractures accounts for only the 6 % of all femoral ones. Authors present the case of a male patient aged 42 suffered a road accident provoking a unicondylar fracture of femur distal end in coronal plane , known as Hoffa fracture. Surgical treatment by radiological studies is showed, w [...] here we used a screw of AO system. Using this procedure we achieved the fracture reduction and stability. We conclude that an appropriate preoperative planning is necessary to get satisfactory results.

Orlando Manuel, Pérez Rivera; Lourdes E., Palanco Domínguez.

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Mathematical reconstruction of human femoral condyles.  

Science.gov (United States)

There is a direct correlation between ligament function and the articulating surface of the normal knee, and changes to any of these structures can affect the other. This is also true for knee replacements, where the articulating surface is greatly changed compared to the natural knee. This study investigated the morphometry of healthy knees and proposes a method to predict original normal knee profiles. A variety of mathematical techniques are compared in terms of the accuracy with which they can represent the original knee joint geometry. Additionally, a method of predicting the irregular femoral condyle geometry for an individual knee is described by making use of the mathematical techniques presented, and the accuracy of this method is also investigated. The mathematical approach using B-splines provides flexibility and can accurately describe the complex geometry of the femoral condyles in both the sagittal and transverse planes. It was further found that the condyles are highly asymmetrical; therefore simpler methods cannot portray the condyles sufficiently and are especially inaccurate in representing the lateral condyle. The study proposes a method for predicting the geometry of the femoral condyles with good accuracy. The B-spline model showed best results. PMID:21744933

van den Heever, Dawie J; Scheffer, Cornie; Erasmus, Pieter; Dillon, Edwin

2011-06-01

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Coronal fractures of the medial femoral condyle: a series of 6 cases and review of literature.  

Science.gov (United States)

Isolated coronal fracture of medial femoral condyle with intact lateral femoral condyle is extremely rare. We present our experience with such 6 cases of coronal fractures of medial femoral condyle. We reviewed all case records of cases of coronal fractures of femoral condyle which presented to our centre from Jan 2000 to Jun 2009. Of 72 such cases, 56 were of lateral condyle, 9 were bicondylar, and 7 were only medial femoral condyle fractures. However, one of the 7 cases was a skeletally immature child with a physeal injury and hence excluded. All the 6 patients with medial femoral condyle fractures were retrospectively evaluated both clinically and radiologically. Of the 6 patients with medial condyle fractures, three patients had an isolated medial femoral condyle fracture, while three of them had associated fractures. Four of these patients were identified at the initial presentation. However, the fracture was missed during initial evaluation in one of the patients, while another patient presented with neglected medial Hoffa fracture after 6 months of injury. Mechanism of injury was direct impact to the medial side of knee in flexion in 4 out of 6 cases. All cases were operated through medial or antero-medial approach, and fixation was achieved in all with antero-posterior screws. All cases united at a mean period of 4.6 months. Coronal fractures of the medial femoral condyle are very rare, and there is a highly likelihood of these fractures being missed by an average orthopaedic surgeon. A high index of suspicion is necessary for early diagnosis especially in cases of undisplaced fractures. Being intra-articular, the ideal management includes open reduction and internal fixation. Medial or antero-medial approach with antero-posterior screws is the preferred method for fixation. PMID:21904943

Dhillon, Mandeep Singh; Mootha, Aditya Krishna; Bali, Kamal; Prabhakar, Sharad; Dhatt, Sarvadeep Singh; Kumar, Vishal

2012-06-01

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Autologous chondrocyte implantation to treat femoral condyle and talar lesions  

Directory of Open Access Journals (Sweden)

Full Text Available Objective: To show the first Brazilian autologous chondrocyteimplantation. Methods: Young patients with localized lesions infemoral condyle and talus were selected. The clinical evaluationwas complemented with the imaginologic resources. Results: Theneoformed cartilage tissue occupies the defect. The patients showedimprove in the quality life, returning to the daily and sport activities. Conclusions: It was possible to concluded that the autologous chondrocyte implantation is a promising technique for the treatment of femoral condyle and talar condral lesions.

Moises Cohen

2008-03-01

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Autogenous osteochondral grafts for osteonecrosis of the femoral condyle.  

Directory of Open Access Journals (Sweden)

Full Text Available PURPOSE: To evaluate the long-term outcome following use of osteochondral autografts for the treatment of osteonecrosis of the femoral condyle. METHODS: Clinical, radiographic and arthroscopic findings were evaluated at follow-up. Patients were 14 women and 2 men, with a mean age of 64.9 years (range, 58-74 years. The osteochondral lesion was equivalent to Lotke 1-B in 12 knees, and was equivalent to 1-C in 4 knees. Preoperative femoral tibia angle ranged from 178 degrees to 190 degrees. RESULTS: The follow-up period ranged from 28 months to 111 months (mean, 67 months. Functional scores improved from 60 to 75 preoperatively to 80 to 100 postoperatively, and the grafts were satisfactorily accepted. Patients with a femoral tibia angle of less than 180 degrees in particular were found to respond favourably. CONCLUSION: Transplant surgery using osteochondral autografting appeared effective for the treatment of osteonecrosis of femoral condyle.

Kotani A

2003-12-01

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Coronal plane partial articular fractures of the distal femoral condyle: current concepts in management.  

Science.gov (United States)

Coronal plane fractures of the posterior femoral condyle, also known as Hoffa fractures, are rare. Lateral fractures are three times more common than medial fractures, although the reason for this is not clear. The exact mechanism of injury is likely to be a vertical shear force on the posterior femoral condyle with varying degrees of knee flexion. These fractures are commonly associated with high-energy trauma and are a diagnostic and surgical challenge. Hoffa fractures are often associated with inter- or supracondylar distal femoral fractures and CT scans are useful in delineating the coronal shear component, which can easily be missed. There are few recommendations in the literature regarding the surgical approach and methods of fixation that may be used for this injury. Non-operative treatment has been associated with poor outcomes. The goals of treatment are anatomical reduction of the articular surface with rigid, stable fixation to allow early mobilisation in order to restore function. A surgical approach that allows access to the posterior aspect of the femoral condyle is described and the use of postero-anterior lag screws with or without an additional buttress plate for fixation of these difficult fractures. PMID:23997126

Arastu, M H; Kokke, M C; Duffy, P J; Korley, R E C; Buckley, R E

2013-09-01

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[Spontaneous femoral condyle necrosis of the knee joint (Ahlbäck disease)].  

Science.gov (United States)

The aetiology of Morbus Ahlbäck (spontaneous osteonecrosis of the femoral condyles of the knee joint) is still unknown. Sudden onset of pain characterises the beginning of complaints. Only scintimetry results in early diagnosis. Larger osteonecroses are to be treated surgically, for example by osteotomy. In extensive osteonecroses we prefer alloarthroplastic replacement (mostly unicondylar). PMID:3895774

Albers, W; Blümlein, H; Sühler, H

1985-01-01

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Nonunion of coronal shear fracture of femoral condyle.  

Science.gov (United States)

Isolated coronal fractures of femoral condyle are rare in adults and nonunion of Hoffa fracture is reported only a few times in the literature. We analyzed six cases of nonunion of Hoffa fractures over a period of three years. Three patients were treated conservatively and three patients had fixation failures. Delay of presentation was 2 months to one year. Treatment protocol consisted of open reduction, excision of pseudoarthrosis, bone grafting and internal fixation along with knee arthrolysis. Union was achieved in all patients at mean 16 weeks. The treatment of nonunion of Hoffa fractures requires careful preoperative planning and meticulous surgical technique. The literature regarding the controversies in fracture management and surgical technique are reviewed. PMID:21635799

Singh, Ajay-Pal; Dhammi, Ish-Kumar; Vaishya, Raju; Jain, Anil-Kumar; Singh, Arun-Pal; Modi, Prashant

2011-06-01

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Mucoid degeneration of the anterior cruciate ligament with erosion of the lateral femoral condyle  

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We report a case of a mucoid degeneration of the anterior cruciate ligament (ACL) that produced osseous erosion of the medial aspect of the lateral femoral condyle. The MRI findings and differential diagnosis are discussed. (orig.)

Melloni, Pietro [Servei de Diagnostic per Imatge, Unitat de Diagnostic d' Alta Tecnologia (UDIAT), Corporacio Parc Tauli, Universitat Autonoma de Barcelona, Sabadell (Barcelona) (Spain); UDIAT, c/ Parc Tauli, s/n, 08208 Sabadell (Barcelona) (Spain); Valls, Rafael [Servei de Diagnostic per Imatge, Unitat de Diagnostic d' Alta Tecnologia (UDIAT), Corporacio Parc Tauli, Universitat Autonoma de Barcelona, Sabadell (Barcelona) (Spain); Yuguero, Mariano [Servei de Traumatologia i Ortopedia, Corporacio Parc Tauli, Universitat Autonoma de Barcelona, Sabadell (Barcelona) (Spain); Saez, Amparo [Servei de Anatomia Patologica, Corporacio Parc Tauli, Universitat Autonoma de Barcelona, Sabadell (Barcelona) (Spain)

2004-06-01

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Isolated Hoffa fracture of the medial femoral condyle in a skeletally immature patient.  

Science.gov (United States)

Intraarticular coronal fracture of the femoral condyle is rare, and an isolated medial Hoffa fracture in a child is extremely rare. To our knowledge, such a case has not yet been reported in the literature. Early diagnosis and prompt treatment are essential for a good long-term outcome. We report a case of 12-year-old male who suffered a traffic accident and sustained an isolated medial Hoffa fracture. Open reduction was performed using a subvastus approach and the joint surface congruity restored and secured by two large fragment partially threaded screws placed from anterior to posterior in the epiphysis. At the 36-month follow-up, the fracture was united, and the patient had full extension and approximately 130° flexion of knee. There was no varus or valgus instability or limb length discrepancy. This case highlights the importance of early diagnosis and prompt treatment in the form of epiphyseal fixation for the management of these fractures in skeletally immature individuals. PMID:22196392

Bali, Kamal; Mootha, Aditya Krishna; Prabhakar, Sharad; Dhillon, Mandeep Singh

2011-01-01

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Kissing contusion between the posterolateral tibial plateau and lateral femoral condyle: associated ligament and meniscal tears  

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Kissing contusion between the posterolateral tibial plateau and lateral femoral condyle is frequently found in association with a tear of the anterior cruciate liagment (ACL). The purpose of this study was to determine which ligamentous and meniscal tears are associated with kissing contusion. We retrospectively reviewed the findings depicted by 323 consecutive MR images of the knee and confirmed at arthroscopy. For the diagnosis of disruption, ligaments, medial menisci (MM) and lateral menisci (LM) were evaluated using accepted criteria. We compared the prevalence and location of meniscal and ligamentous tears between group I (44 knees with kissing contusion) and group II (279 knees without kissing contusion). For statistical analysis the chi-square test was used. ACLs were torn in all 44 knees (100%) with kissing contusion, and 78 (28%) of 279 without kissing contusion. There were ten medial collateral ligament (MCL) tears (23%) in group I, and 17 MCL tears (6%), five lateral collateral ligament (LCL) tears (2%) and ten posterior cruciate ligament (PCL) tears (4%) in group II. In group I, meniscal tears were found in 22 MM (50%) and in 19 LM (43%), while in group II, they occurred in 128 MM (46%) and 128 LM (46%), In group I, 17 (77%) of 22 MM tears and 13 (68%) of 19 LM tears were located in the posterior horn, while in group II, the corresponding figures were 97/128 (76%) and 60 of 128 (47%). The differing prevalence of ACL and MCL tears between the groups was statistically significant (p<0.05), but differences in the prevalence and location of meniscal tears were not (p>0.05). Although kissing contusion was a highly specific sign of ACL tears, its presence was also significant among MCL tears. There was no significant difference in meniscal tears with or without kissing contusion.

Hong, Hyun Pyo; Lee, Jae Gue; Park, Ji Seon; Ryu, Kyung Nam [Kyunghee Univ., Seoul (Korea, Republic of)

2004-02-01

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Kissing contusion between the posterolateral tibial plateau and lateral femoral condyle: associated ligament and meniscal tears  

International Nuclear Information System (INIS)

Kissing contusion between the posterolateral tibial plateau and lateral femoral condyle is frequently found in association with a tear of the anterior cruciate liagment (ACL). The purpose of this study was to determine which ligamentous and meniscal tears are associated with kissing contusion. We retrospectively reviewed the findings depicted by 323 consecutive MR images of the knee and confirmed at arthroscopy. For the diagnosis of disruption, ligaments, medial menisci (MM) and lateral menisci (LM) were evaluated using accepted criteria. We compared the prevalence and location of meniscal and ligamentous tears between group I (44 knees with kissing contusion) and group II (279 knees without kissing contusion). For statistical analysis the chi-square test was used. ACLs were torn in all 44 knees (100%) with kissing contusion, and 78 (28%) of 279 without kissing contusion. There were ten medial collateral ligament (MCL) tears (23%) in group I, and 17 MCL tears (6%), five lateral collateral ligament (LCL) tears (2%) and ten posterior cruciate ligament (PCL) tears (4%) in group II. In group I, meniscal tears were found in 22 MM (50%) and in 19 LM (43%), while in group II, they occurred in 128 MM (46%) and 128 LM (46%), In group I, 17 (77%) of 22 MM tears and 13 (68%) of 19 LM tears were located in the posterior horn, while in group II, the corresponding figures were 97/128 (76%) and 60 of 128 (47%). The differing prevalence of ACL and MCL tears between the groups was staL and MCL tears between the groups was statistically significant (p0.05). Although kissing contusion was a highly specific sign of ACL tears, its presence was also significant among MCL tears. There was no significant difference in meniscal tears with or without kissing contusion

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Osteochondritis dissecans in bilateral lateral femoral condyle in knees / Osteocondrite dissecante em côndilo femural lateral bilateral nos joelhos  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in portuguese A osteocondrite dissecante (OCD) é uma patologia de causa desconhecida, que classicamente acomete no joelho a borda lateral do côndilo femural medial. Apresentamos um raro caso de OCD no côndilo femural lateral bilateral. [...] Abstract in english The osteochondritis dissecans (OCD) is a disease of unknown cause that classically affects the knee lateral border of the medial femoral condyle. We present a rare case of OCD in bilateral lateral femoral condyle. [...

Ari, Zekcer; Ricardo Soares da, Silva; Renato Akira, Iwashita; Mario, Carneiro Filho.

2013-12-01

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Spontaneous osteonecrosis of the knee associated with tibial plateau and femoral condyle insufficiency stress fracture  

International Nuclear Information System (INIS)

The purpose of this article is to describe the association between spontaneous osteonecrosis and insufficiency stress fractures of the knee. To determine whether insufficiency stress fracture is associated with spontaneous osteonecrosis of the knee, we retrospectively reviewed the medical charts and imaging studies of all patients with spontaneous osteonecrosis of the knee, studied by MR imaging, seen in a tertiary hospital over an 8-year period. Four women (age range 66-84 years) presented spontaneous osteonecrosis of the knee associated with insufficiency stress fracture of the medial tibial plateau. One of these patients also presented a concomitant insufficiency stress fracture of the medial femoral condyle. Radiographs were diagnostic of spontaneous osteonecrosis of the medial femoral condyle in three cases, and insufficiency stress fracture of the medial tibial plateau was detected in one case. Magnetic resonance imaging allows the diagnosis of both conditions in all four cases. Spontaneous osteonecrosis of the knee may be associated with insufficiency stress fracture of the medial femoral condyle and the medial tibial plateau. This association provides additional arguments in favor of the traumatic etiology of spontaneous osteonecrosis of knee. (orig.)

19

Spontaneous osteonecrosis of the knee associated with tibial plateau and femoral condyle insufficiency stress fracture  

Energy Technology Data Exchange (ETDEWEB)

The purpose of this article is to describe the association between spontaneous osteonecrosis and insufficiency stress fractures of the knee. To determine whether insufficiency stress fracture is associated with spontaneous osteonecrosis of the knee, we retrospectively reviewed the medical charts and imaging studies of all patients with spontaneous osteonecrosis of the knee, studied by MR imaging, seen in a tertiary hospital over an 8-year period. Four women (age range 66-84 years) presented spontaneous osteonecrosis of the knee associated with insufficiency stress fracture of the medial tibial plateau. One of these patients also presented a concomitant insufficiency stress fracture of the medial femoral condyle. Radiographs were diagnostic of spontaneous osteonecrosis of the medial femoral condyle in three cases, and insufficiency stress fracture of the medial tibial plateau was detected in one case. Magnetic resonance imaging allows the diagnosis of both conditions in all four cases. Spontaneous osteonecrosis of the knee may be associated with insufficiency stress fracture of the medial femoral condyle and the medial tibial plateau. This association provides additional arguments in favor of the traumatic etiology of spontaneous osteonecrosis of knee. (orig.)

Narvaez, J.A.; Narvaez, J.; Lama, E.De; Sanchez, A. [Department of Magnetic Resonance Imaging, IDI Hospital Duran i Reynals, Ciutat Sanitaria i Universitaria de Bellvitge, Gran Via s/n, 08907, L' Hospitalet de Llobregat (Barcelona) (Spain)

2003-08-01

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A ganglion of the patellar tendon in patellar tendon-lateral femoral condyle friction syndrome.  

Science.gov (United States)

Intratendinous ganglia are rare. We report the case of a sedentary woman with chronic mechanical anterolateral pain of the knee and an extensive ganglion of the patellar tendon as indicated on magnetic resonance (MR) and ultrasound (US) examinations. There was evidence of a high-riding patella, patellar malalignment and patellar tendon-lateral femoral condyle friction syndrome with significantly close contact between the patellar tendon and the lateral facet of the femoral trochlea. The ultrasound-guided aspiration of the ganglion enabled a localized injection of an anti-inflammatory drug (cortivazol) and the cytopathological examination of the fluid, which confirmed the diagnosis. Clinical improvement was maintained with knee rehabilitation and was satisfactory at follow-up after 1 year. To our knowledge, we report the first case of a ganglion of the patellar tendon subsequent to patellar tendon-lateral femoral condyle friction syndrome. We found that this case was illustrative of mucoid degeneration in connective tissue due to chronic repetitive microtraumas. Additionally, this case provided the opportunity to discuss the management of this condition in a sedentary individual with a high-riding patella and patellar malalignment. PMID:23657611

Touraine, Sébastien; Lagadec, Matthieu; Petrover, David; Genah, Idan; Parlier-Cuau, Caroline; Bousson, Valérie; Laredo, Jean-Denis

2013-09-01

 
 
 
 
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Skeletal tuberculosis presenting as a small cystic lesion in the medial femoral condyle.  

Science.gov (United States)

Skeletal tuberculosis is an unusual disease involving bone and joints and it may have different manifestations. This report introduces a 25-year-old woman suffering from chronic knee pain without any response to conservative treatments for one year. X-ray was normal but CT-scan and MRI indicated a small lesion in medial condyle of the femur. The patient underwent percutaneous CT-guided biopsy. Following an evaluation of the obtained sample, tuberculous osteomyelitis was detected. After resection of the femoral mass and starting anti TB medical treatment, symptoms dramatically eliminated. PMID:25207301

Elmi, Asghar; Tabrizi, Ali; Tolouei, Fardin Mirza

2013-12-01

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Autogenous osteochondral graft transplantation for steroid-induced osteonecrosis of the femoral condyle: A report of three young patients  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Steroid-induced osteonecrosis of the femoral condyle is a relatively uncommon condition and is often difficult to select appropriate treatment especially in young patients. Three young men (aged 25, 18, and 24 presented with severe pain and dysfunction of the knee diagnosed as steroid-induced osteonecrosis of the femoral condyle by magnetic resonance imaging (MRIs. Full-thickness cartilage defects sized 20 × 10, 15 × 10, and 30 × 20 mm respectively were classified as International Cartilage Repair Society Grade IV lesions and treated with osteochondral autograft transplantation. They were treated successfully with osteochondral autograft transplantation certificated by post-operative MRI and second look arthroscopy.

Fujita Norifumi

2012-04-01

23

Undiagnosed Hoffa fracture of medial femoral condyle presenting as chronic pain in a post-polio limb.  

Science.gov (United States)

Isolated coronal fracture of medial femoral condyle with intact lateral femoral condyle is extremely rare. A high index of suspicion is necessary for early diagnosis especially in cases of undisplaced fractures. Here we report a case of medial Hoffa fracture in a post-polio limb presenting as chronic pain. Management of such fractures in limbs affected by late sequelae of poliomyelitis is particularly problematic in view of osteoporosis and osseous hypoplasia. The fracture was approached through medial parapatellar arthrotomy and fixation was done with cannulated cancellous screws in anteroposterior direction. Union was achieved at 16 weeks. PMID:24889985

Mootha, Aditya Krishna; Majety, Priyanka; Kumar, Vishal

2014-06-01

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Estudo anatômico da inserção femoral do ligamento cruzado posterior / Femoral insertion of the posterior cruciate ligament: an anatomical study  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese OBJETIVO: Identificar parâmetros objetivos para guiar a correta localização do LCP no fêmur. MÉTODOS: Os LCP de 20 cadáveres humanos foram ressecados. As seguintes porções foram medidas: da porção mais distal do ligamento, próximo ao teto, até a borda da cartilagem mais anterior (AB); distância da p [...] orção mais proximal do ligamento, próximo ao teto, até a cartilagem mais anterior (AC); distância entre as duas porções do ligamento próximo ao teto (BC); distância da borda distal do ligamento na sua porção posterior até a borda articular mais posterior (D-E); distância da borda distal do ligamento na sua porção posterior até o teto intercondilar (DF); e, finalmente, o formato da inserção ligamentar e área de abrangência no côndilo femoral. RESULTADOS: O LCP tem a forma de um quarto de elipse, com área de, em média, 153,5mm². As distâncias médias encontradas foram: AB de 2,1mm; AC de 10,7mm, BC de 8,6mm, D-E de 12.4mm e DF de 16,8mm. CONCLUSÕES: A borda próxima ao teto do feixe anterolateral é mais próxima da cartilagem articular (2,1mm) comparada com o feixe posteromedial, que mede 12,4mm a partir de sua borda proximal da cartilagem. Estas referências devem ajudar em um posicionamento melhor e mais acurado dos túneis femorais na reconstrução do LCP. Abstract in english OBJECTIVE: To identify objective parameters to guide correct location of the posterior cruciate ligament (PCL) in the femur. METHODS: The PCLs of 20 human cadavers were resected. The following portions were measured: distance from the most distal portion of the PCL, close to the roof, to the most an [...] terior edge of the cartilage (AB); distance from the most proximal portion of the PCL, close to the roof, to the most anterior cartilage (AC); distance between the two parts of the ligament close to the roof (BC); distance from the distal edge in its posterior portion, to the more posterior joint edge (DE); distance from the distal edge of the ligament in its posterior portion, to the intercondylar roof (DF); and finally, the format of the ligament insertion and area of coverage on the femoral condyle. RESULTS: The PCL has the shape of a quarter ellipse, with an average area of 153.5mm². The mean distances found were: AB of 2.1mm, AC of 10.7mm, BC of 8.6mm DE of 12.4mm and DF of 16.8mm. CONCLUSIONS: The edge close to the roof of the anterolateral bundle is closer to the joint cartilage (2.1mm) than the posteromedial bundle is, which is 12.4mm from the edge proximal to the cartilage. These references should assist in better and more accurate positioning of femoral tunnels in PCL reconstruction.

Ricardo de Paula Leite, Cury; Nilson Roberto, Severino; Osmar Pedro Arbix, Camargo; Tatsuo, Aihara; Leopoldo Viana, Batista Neto; Dedley Nelson, Goarayeb.

2011-10-01

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Estudo anatômico da inserção femoral do ligamento cruzado posterior / Femoral insertion of the posterior cruciate ligament: an anatomical study  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese OBJETIVO: Identificar parâmetros objetivos para guiar a correta localização do LCP no fêmur. MÉTODOS: Os LCP de 20 cadáveres humanos foram ressecados. As seguintes porções foram medidas: da porção mais distal do ligamento, próximo ao teto, até a borda da cartilagem mais anterior (AB); distância da p [...] orção mais proximal do ligamento, próximo ao teto, até a cartilagem mais anterior (AC); distância entre as duas porções do ligamento próximo ao teto (BC); distância da borda distal do ligamento na sua porção posterior até a borda articular mais posterior (D-E); distância da borda distal do ligamento na sua porção posterior até o teto intercondilar (DF); e, finalmente, o formato da inserção ligamentar e área de abrangência no côndilo femoral. RESULTADOS: O LCP tem a forma de um quarto de elipse, com área de, em média, 153,5mm². As distâncias médias encontradas foram: AB de 2,1mm; AC de 10,7mm, BC de 8,6mm, D-E de 12.4mm e DF de 16,8mm. CONCLUSÕES: A borda próxima ao teto do feixe anterolateral é mais próxima da cartilagem articular (2,1mm) comparada com o feixe posteromedial, que mede 12,4mm a partir de sua borda proximal da cartilagem. Estas referências devem ajudar em um posicionamento melhor e mais acurado dos túneis femorais na reconstrução do LCP. Abstract in english OBJECTIVE: To identify objective parameters to guide correct location of the posterior cruciate ligament (PCL) in the femur. METHODS: The PCLs of 20 human cadavers were resected. The following portions were measured: distance from the most distal portion of the PCL, close to the roof, to the most an [...] terior edge of the cartilage (AB); distance from the most proximal portion of the PCL, close to the roof, to the most anterior cartilage (AC); distance between the two parts of the ligament close to the roof (BC); distance from the distal edge in its posterior portion, to the more posterior joint edge (DE); distance from the distal edge of the ligament in its posterior portion, to the intercondylar roof (DF); and finally, the format of the ligament insertion and area of coverage on the femoral condyle. RESULTS: The PCL has the shape of a quarter ellipse, with an average area of 153.5mm². The mean distances found were: AB of 2.1mm, AC of 10.7mm, BC of 8.6mm DE of 12.4mm and DF of 16.8mm. CONCLUSIONS: The edge close to the roof of the anterolateral bundle is closer to the joint cartilage (2.1mm) than the posteromedial bundle is, which is 12.4mm from the edge proximal to the cartilage. These references should assist in better and more accurate positioning of femoral tunnels in PCL reconstruction.

Ricardo de Paula Leite, Cury; Nilson Roberto, Severino; Osmar Pedro Arbix, Camargo; Tatsuo, Aihara; Leopoldo Viana, Batista Neto; Dedley Nelson, Goarayeb.

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Untreated osteochondritis dissecans of the femoral condyles: prediction of patient outcome using radiographic and MR findings  

International Nuclear Information System (INIS)

Objective. We investigated the usefulness of plain film and MR findings in predicting the outcome of conservatively treated patients with femoral osteochondritis dissecans. Design. Without knowledge of the clinical outcome, we retrospectively reviewed the initial plain films and MR examinations. Each MR examination was evaluated for the four MR findings of instability. Patients. Fourteen patients were studied in whom osteochondritis dissecans of a femoral condyle had been treated conservatively for periods ranging from 1.2 to 8.5 years. Results and conclusion. Three of five patients with an open femoral growth plate and one of nine patients with a closed growth plate had a good clinical outcome. Both patients with lesions smaller than 160 mm2in area had a good outcome and ten of 12 patients with larger lesions had a poor outcome. Both patients with stable lesions by MR imaging had a good outcome while ten of 12 patients with a lesion unstable by MR imaging had poor outcomes. All six patients with a cartilage fracture or articular defect had poor outcomes. The results of this study should be considered preliminary since only 14 patients were followed. However, it appears that a good clinical outcome is likely when the femoral growth plate is open, when the osteochondritis dissecans is small, and when the lesion is stable by MR imaging. When a cartilage fracture or articular defect is found on MR imaging, the patient is likely to have a poor outcome. (orig.).is likely to have a poor outcome. (orig.). With 5 figs., 1 tab

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Mosaic arthroplasty of the medial femoral condyle in horses - An experimental study.  

Science.gov (United States)

One Arabian and 5 Hungarian half-bred horses were used to study the macroscopic and microscopic survival of autologous osteochondral grafts in the weight-bearing surface of the medial femoral condyle (MFC). Grafts were harvested from the cranial surface of the medial femoral trochlea (MFT) under arthroscopic control. Three of them were transplanted into the weight-bearing surface of the contralateral MFC using an arthrotomy approach. Three months later this transplantation procedure was repeated on the opposite stifle joints in the same animals, but at that time transplantation was performed arthroscopically. Follow-up arthroscopy was carried out 12 months after the first operations, and biopsies were taken from both the recipient and the donor sites for histological examination. During follow-up arthroscopy, the transplanted areas looked congruent and smooth. Microscopically, the characteristics of hyaline cartilage were present in 5 out of the 10 biopsies examined; however, in the other half of biopsies glycosaminoglycan (GAG) loss and change in the architecture of the transplanted cartilage was observed. In a 16-year-old horse, all grafts broke during harvesting, and thus transplantation was not performed. No radiological signs of osteoarthritic changes were detected 9 to 12 months after the operations in the donor and recipient joints. Clinically, no lameness or effusion was present three months after the transplantations. PMID:24334083

Bodó, Gábor; Vásárhelyi, Gábor; Hangody, László; Módis, László

2014-06-01

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A new automatic landmark extraction framework on ultrasound images of femoral condyles  

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In Computer Assisted Orthopaedic Surgery (CAOS), surgeons have to acquire some anatomical landmarks as inputs to the system. To do so, they use manual pointers that are localized in the Operating Room (OR) space using an infrared camera. When the needed landmark is not reachable through an opening, it is palpated directly on skin and there is a loss of precision that can vary from several millimeters to centimeters depending on the thickness of soft tissues. In this paper, we propose a new framework based on three main steps to register the bone surface and extract automatically anatomical landmarks with an ultrasound probe. This framework is based on an oriented gradient calculation, a simulated-compound and a contour closure using a graph representation. The oriented gradient allows extracting a set of pixels that probably belong to the bone surface. The simulatedcompound step allows using ultrasound images properties to define a set of small segments which may belong to the bone surface, and the graph representation allows eliminating false positive detection among remaining segments. The proposed method has been validated on a database of 230 ultrasound images of anterior femoral condyles (on the knee). The average computation time is 0.11 sec per image, and average errors are: 0.54 mm for the bone surface extraction, 0.31 mm for the condylar line, and 1.4 mm for the trochlea middle.

Masson-Sibut, Agnès; Nakib, Amir; Petit, Eric; Leitner, François

2012-03-01

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[Idiopathic osteonecrosis of the internal femoral condyle. Prognostic elements and role of different treatments].  

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In this retrospective study, 36 patients with a mean age of 72 years (range 60 to 82) underwent surgical treatment for osteonecrosis of the medial femoral condyle. The procedure consisted in tibial valgus osteotomy in 18 cases, unicompartmental arthroplasty in 15 cases, and total knee arthroplasty in 3 cases. Analysis of a number of factors (size of the lesion, knee deformity as assessed by goniometry, condition of the joint...) demonstrated that valgus osteotomy performed to reduce the load experienced by the necrotized area was effective in preventing extension of the lesion and development of a synovial pannus; furthermore, this procedure ensured preservation of the range of motion of the knee and, when performed sufficiently early, prevented deterioration of the medial femorotibial joint space. On the basis of our data, it can be concluded that arthroplasty is warranted only in patients aged 75 years or more and in those with extensive necrosis; unicompartmental arthroplasty should be performed whenever possible; total arthroplasty should be used only when the size of the lesion precludes secure implantation of a single-compartment device. PMID:8293006

Hernigou, P

1993-03-01

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Coronal fractures of the femoral condyle: a brief report of five cases.  

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Coronal fractures of the femoral condyle (Hoffa fractures) are uncommon injuries that have a better outcome when treated surgically. We report a series of five Hoffa fractures (including one nonunion) treated at a Level 1 trauma center by one surgeon employing a protocol of open reduction and internal fixation with lag screws through a formal parapatellar approach. Postoperatively, all patients began immediate unrestricted range of motion. Initial weight bearing was limited, but all patients were permitted full weight bearing by 10 weeks. All fractures healed within 12 weeks without complications. The final range of motion for the patients with acute fractures was at least 0 degrees to 115 degrees. The patient with a nonunion had a preoperative flexion contracture of 20 degrees and a final range of motion of 20 degrees to 125 degrees. Long-term follow-up (average 37 months, range 18-57 months) was available for 3 of the 5 patients, and Knee Society scores were calculated for these patients (average 173 of 200 points, range 160-180 points). The literature regarding the management of Hoffa fractures is reviewed. PMID:15105756

Holmes, Stephanie M; Bomback, David; Baumgaertner, Michael R

2004-01-01

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Clunealgia: CT-guided therapeutic posterior femoral cutaneous nerve block.  

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Clunealgia is caused by neuropathy of inferior cluneal branches of the posterior femoral cutaneous nerve resulting in pain in the inferior gluteal region. Image-guided anesthetic nerve injections are a viable and safe therapeutic option in sensory peripheral neuropathies that provides significant pain relief when conservative therapy fails and surgery is not desired or contemplated. The authors describe two cases of clunealgia, where computed-tomography-guided technique for nerve blocks of the posterior femoral cutaneous nerve and its branches was used as a cheaper, more convenient, and faster alternative with similar face validity as the previously described magnetic-resonance-guided injection. PMID:24667042

Kasper, Jared M; Wadhwa, Vibhor; Scott, Kelly M; Chhabra, Avneesh

2014-01-01

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Osteo-periosteal-cutaneous flaps of the medial femoral condyle: a valuable modification for selected clinical situations.  

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In situations of bony nonunions with poor skin coverage, transplantation of vascularized soft tissue in addition to bone graft is desirable. The use of the corticoperiosteal vascularized bone graft from the medial femoral condyle is well described. There are only anecdotal reports about its use as an osteocutaneous flap. This article presents our results with the use of an osteocutaneous flap from the medial femoral condyle. Between 2004 and 2009, four patients were treated with supracondylar osteocutaneous flaps for bony nonunions (tibia, ankle, calcaneous) with concomitant soft tissue defects. The size of the osseous grafts ranged from 3 x 5 to 6 x 5 cm. The supplying cutaneous vessels were an unnamed perforator of the descending genicular artery (two cases) or the saphenous branch (two cases). The first three cases healed primarily. Bony union was achieved between 32 and 170 days. The follow-up of the fourth case was too short to achieve a bony union. There was no flap loss or surgery-related complications at the donor site. The transfer of free combined vascularized corticoperiosteal-cutaneous flaps seems to be ideally suited for postradiation-induced fractures or chronic nonunions with poor chances of spontaneous healing and a concomitant small skin defect. PMID:20143299

Pelzer, Michael; Reichenberger, Matthias; Germann, Günter

2010-07-01

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Objective assessments of medial osteoarthritic knee severity by MRI: new computer software to evaluate femoral condyle contours  

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An irregular contour of the medial femoral condyle (MFC) on magnetic resonance imaging (MRI) appears to indicate the severity of medial-type knee osteoarthritis (OA). The purpose of this study was to establish a system to enable objective assessments of OA knee severity using newly developed software that semi-automatically measures irregularity of the MFC. (1) We evaluated 48 patients aged 50–83 years with 55 knees of medial-type OA. The following scores were recorded: Lysholm score, visual analogue scale (VAS) and the Japanese Knee Osteoarthritis Measure (JKOM). MFC irregularity was automatically calculated by newly programmed computer software. Four parameters for condyle irregularity were calculated: (a) the average thickness of the contour (ATC), (b) the ratio of the upper surface length to the lower surface length of the contour (RUL), (c) average squared thickness of the contour (ASTC) and (d) standard deviation of the contour thickness (SDC). (2) Nine knees that underwent total knee arthroplasty were further analysed histopathologically and compared with irregularity score. Statistically, the RUL and SDC were significantly correlated with the Lysholm score, VAS and JKOM, with good reliability. Histological examinations showed that an irregular contour reflected the density of cystic lesions formed in subchondral bone. An irregularity of MFC on MRI is correlated with OA disease severity clinically and histopathologically. The new computer software is useful to objectively assess OA disease severity. PMID:19763568

Ochiai, Nobuyasu; Tahara, Masamichi; Watanabe, Atsuya; Matsuki, Kei; Yamaguchi, Satoshi; Miyake, Yoichi; Nakaguchi, Toshiya; Wada, Yuichi; Moriya, Hideshige

2009-01-01

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Avaliação radiográfica da inserção femoral do ligamento cruzado posterior / Radiographic assessment of the femoral insertion of the posterior cruciate ligament  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese OBJETIVO: Determinar as imagens radiográficas da inserção femoral do ligamento cruzado posterior (LCP) para auxiliar na criação de túneis femorais anatômicos nas cirurgias e para a avaliação pós-operatória da localização destes túneis. MÉTODOS: Foram utilizados 30 joelhos de cadáveres adultos. Demar [...] camos os centros das bandas anterolateral (AL) e posteromedial (PM) do LCP com marcadores metálicos. Realizamos radiografias e estabelecemos um sistema de grades para localização da origem das bandas. Também determinamos o percentil da projeção do centro de cada banda em relação à linha de Blumensaat. RESULTADOS: Na incidência anteroposterior os centros das bandas AL e PM estiveram, em média, localizados nos percentis 42,48% e 38,14% da linha de Blumensaat, respectivamente. Nas radiografias em perfil os centros das bandas AL e PM estiveram, respectivamente, nos percentis 72,86% e 55,46% dessa linha. Em 73,33% dos joelhos o centro da banda AL esteve no quadrante 3D e, em 70% das amostras, a banda PM esteve no quadrante 2D. CONCLUSÃO: Estabelecemos um padrão radiográfico da inserção femoral do LCP que pode ser útil para o controle intraoperatório, antes da perfuração dos túneis, e para a avaliação pós-operatória da localização dos mesmos. Estudo Laboratorial Controlado. Abstract in english OBJECTIVE: To establish the radiographic images of the femoral insertion of the posterior cruciate ligament (PCL), in order to assist the creation of anatomical femoral tunnels during surgeries, and to be used as parameters in postoperative evaluation of the location of these tunnels. METHODS: Thirt [...] y adult cadaver knees were used. The PCL anterolateral (AL) and posteromedial (PM) bundles' centers were marked with a metallic marker. Radiographs were taken and a grid system was established to locate the position of bundles insertion. The percentile in which the projection of each bundle's center was in relation to the Blumensaat line was also determined. RESULTS: In the anteroposterior view, AL and PM bundles' centers were on average, on the 42.5% and 38.18% percentiles of Blumensaat's line, respectively. In lateral views, the AL and PM bundles' centers corresponded to the 72.94% and 55.56% percentiles of the line, respectively. In 73.33% of the knees the AL bundle center was on the 3D quadrant and in 70% of samples the PM bundle center was in quadrant 2D. CONCLUSIONS: We established an x-ray pattern of femoral insertion of PCL that may be of interest for intraoperative control, before tunnel drilling, and also for post-operative evaluation of tunnel location. Controlled Laboratory Study.

Julio Cesar, Gali; André Schmidt, Soares; Bruno Spagnuolo de, Lima; Filippo Santos Zozoloto, Vianna; Phelipe Augusto Cintra da, Silva; Edie Benedito, Caetano.

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Robotic-assisted unicompartmental knee arthroplasty in a patient with combined medial compartment arthritis and subchondral defect of the medial femoral condyle.  

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Subchondral defects, or severe osteoarthritic changes, of the medial compartment may complicate component positioning and require proper planning and exact placement to ensure adequate and stable fixation and proper postoperative kinematics. This is a case report on our experience with a CT-based robotic tactile guidance system for unicompartmental knee replacement in a patient with combined medial compartment degenerative joint disease and subchondral defect of the medial femoral condyle. Using the TGS in this case, an exact burring process of the femoral cavity adjacent to the subchondral defect resulted in accurate burring of the cavity depth and width, while preservation of the surrounding supporting bony boundary was possible. PMID:22264715

Suero, Eduardo M; Citak, Mustafa; Kraneburg, Ursula M; Pearle, Andrew D; Kendoff, Daniel O

2012-10-01

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Intraosseous ganglion in the subchondral region of the lateral femoral condyle in an 11-year-old girl: a case report  

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Full Text Available Abstract We report the case of a patient with intraosseous ganglion in the lateral femoral condyle. An 11-year-old girl presented with right knee pain following a twisting injury. Plain radiographs of the knee showed a small circumscribed radiolucency with a thin sclerotic margin in the subchondral region of the lateral femoral condyle. Although the image findings and location are not typical, the lesion was tentatively diagnosed as osteochodritis dissecans. Six months after the conservative treatment with a break from vigorous sports activities, the size of the bony lesion had not decreased. Thus, we performed arthroscopy to make a definitive diagnosis. Arthroscopic examination revealed an area with dimple and surface irregularity at the lateral femoral condyle. On excision of the overlying tissue, the lesion was cystic containing brown mucous fluid. No association between the cyst and the articular structures was observed. Histologic examination of the resected cyst wall showed dense fibrous tissue with spotty areas of calcification. Base on these findings, we made a diagnosis of intraosseous ganglion. At the nine-month postoperative follow-up, the radiographic examination showed healing of the lesion. We speculate that the lesion in this case might have occurred as a result of repetitive overstress or microtrauma.

Nakayama Hiroshi

2009-11-01

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Shockwave therapy in the management of complex regional pain syndrome in medial femoral condyle of the knee.  

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The aim of this prospective study was to assess the efficacy of shockwave (SW) therapy in the management of complex regional pain syndrome (CRPS). In this study, 30 patients (pts) who were affected by CRPS of the medial femoral condyle and unresponsive to previous standard physiotherapeutic and pharmacological treatment underwent 3 SW sessions at 72-h intervals, each consisting of 4000 shocks emitted by a MiniLith SL1 Storz electromagnetic generator. An energy flux density (EFD) of 0.035 or 0.09 mJ/mm(2) was used, depending on how well the patient endured the pain during the treatment. Satisfactory results were observed in 76.7% of the cases (23 pts) at the 2-month follow-up (FU) visit, and in 80% (24 pts) at the 6-month FU visit. The therapeutic effects of SW were caused by decreasing pain. The significant improvements we obtained bear witness to the potential value of SW therapy in the management of CRPS. PMID:20447749

Notarnicola, Angela; Moretti, Lorenzo; Tafuri, Silvio; Panella, Antonio; Filipponi, Marco; Casalino, Alessio; Panella, Michele; Moretti, Biagio

2010-06-01

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Spontaneous hyaline cartilage regeneration can be induced in an osteochondral defect created in the femoral condyle using a novel double-network hydrogel  

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Full Text Available Abstract Background Functional repair of articular osteochondral defects remains a major challenge not only in the field of knee surgery but also in tissue regeneration medicine. The purpose is to clarify whether the spontaneous hyaline cartilage regeneration can be induced in a large osteochondral defect created in the femoral condyle by means of implanting a novel double-network (DN gel at the bottom of the defect. Methods Twenty-five mature rabbits were used in this study. In the bilateral knees of each animal, we created an osteochondral defect having a diameter of 2.4-mm in the medial condyle. Then, in 21 rabbits, we implanted a DN gel plug into a right knee defect so that a vacant space of 1.5-mm depth (in Group I, 2.5-mm depth (in Group II, or 3.5-mm depth (in Group III was left. In the left knee, we did not apply any treatment to the defect to obtain the control data. All the rabbits were sacrificed at 4 weeks, and the gross and histological evaluations were performed. The remaining 4 rabbits underwent the same treatment as used in Group II, and real-time PCR analysis was performed at 4 weeks. Results The defect in Group II was filled with a sufficient volume of the hyaline cartilage tissue rich in proteoglycan and type-2 collagen. The Wayne's gross appearance and histology scores showed that Group II was significantly greater than Group I, III, and Control (p Conclusions This study demonstrated that spontaneous hyaline cartilage regeneration can be induced in vivo in an osteochondral defect created in the femoral condyle by means of implanting the DN gel plug at the bottom of the defect so that an approximately 2-mm deep vacant space was intentionally left in the defect. This fact has prompted us to propose an innovative strategy without cell culture to repair osteochondral lesions in the femoral condyle.

Onodera Shin

2011-02-01

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Osteocondrose bilateral de côndilos femorais laterais: relato de caso e revisão da literatura / Bilateral osteochondrosis of lateral femoral condyles: case report and literature review  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese A osteocondrose é uma falha na ossificação subcondral com predileção pelo esqueleto imaturo e cuja etiologia permanece indefinida. Pode afetar os côndilos femorais (geralmente o medial), e o acometimento é, na maioria, unilateral. Os autores chamam a atenção desse diagnóstico, geralmente tardio por [...] sua ocorrência infrequente, e relatam o caso raro de uma criança com osteocondrose bilateral de côndilos femorais laterais, ressaltando que, até o presente momento, apenas um caso semelhante foi descrito na literatura. Abstract in english Osteochondrosis is an injury on subchondral ossification with predominance of immature skeleton and whose etiology remains unknown. It may affect the femoral condyles (usually the medial condyle) and the involvement is mostly unilateral. The authors draw the attention to this usually late diagnosis [...] due to its infrequent occurrence and report a child's rare case of bilateral osteochondrosis on lateral femoral condyles, stressing that just one similar case has been described in the orthopaedic literature up to the present time.

Blanca Elena Rios Gomes, Bica; Danilo Garcia, Ruiz; Fernanda Frade, Paranhos; Antônio Vítor de, Abreu; Mário Newton Leitão de, Azevedo.

2012-10-01

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Osteocondrose bilateral de côndilos femorais laterais: relato de caso e revisão da literatura / Bilateral osteochondrosis of lateral femoral condyles: case report and literature review  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese A osteocondrose é uma falha na ossificação subcondral com predileção pelo esqueleto imaturo e cuja etiologia permanece indefinida. Pode afetar os côndilos femorais (geralmente o medial), e o acometimento é, na maioria, unilateral. Os autores chamam a atenção desse diagnóstico, geralmente tardio por [...] sua ocorrência infrequente, e relatam o caso raro de uma criança com osteocondrose bilateral de côndilos femorais laterais, ressaltando que, até o presente momento, apenas um caso semelhante foi descrito na literatura. Abstract in english Osteochondrosis is an injury on subchondral ossification with predominance of immature skeleton and whose etiology remains unknown. It may affect the femoral condyles (usually the medial condyle) and the involvement is mostly unilateral. The authors draw the attention to this usually late diagnosis [...] due to its infrequent occurrence and report a child's rare case of bilateral osteochondrosis on lateral femoral condyles, stressing that just one similar case has been described in the orthopaedic literature up to the present time.

Blanca Elena Rios Gomes, Bica; Danilo Garcia, Ruiz; Fernanda Frade, Paranhos; Antônio Vítor de, Abreu; Mário Newton Leitão de, Azevedo.

 
 
 
 
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Pullulan/dextran/nHA Macroporous Composite Beads for Bone Repair in a Femoral Condyle Defect in Rats  

Science.gov (United States)

The repair of bone defects is of particular interest for orthopedic, oral, maxillofacial, and dental surgery. Bone loss requiring reconstruction is conventionally addressed through bone grafting. Depending on the size and the location of the defect, this method has limits and risks. Biomaterials can offer an alternative and have features supporting bone repair. Here, we propose to evaluate the cellular penetration and bone formation of new macroporous beads based on pullulan/dextran that has been supplemented with nanocrystalline hydroxyapatite in a rat model. Cross-linked beads of 300–500 µm diameters were used in a lateral femoral condyle defect and analyzed by magnetic resonance imaging, micro-computed tomography, and histology in comparison to the empty defects 15, 30, and 70 days after implantation. Inflammation was absent for both conditions. For empty defects, cellularisation and mineralization started from the periphery of the defect. For the defects containing beads, cellular structures filling out the spaces between the scaffolds with increasing interconnectivity and trabecular-like organization were observed over time. The analysis of calcified sections showed increased mineralization over time for both conditions, but was more pronounced for the samples containing beads. Bone Mineral Density and Bone Mineral Content were both significantly higher at day 70 for the beads in comparison to empty defects as well as compared with earlier time points. Analysis of newly formed tissue around the beads showed an increase of osteoid tissue, measured as percentage of the defect surface. This study suggests that the use of beads for the repair of small size defects in bone may be expanded on to meet the clinical need for a ready-to-use fill-up material that can favor bone formation and mineralization, as well as promote vessel ingrowth into the defect site. PMID:25330002

Schlaubitz, Silke; Derkaoui, Sidi Mohammed; Marosa, Lydia; Miraux, Sylvain; Renard, Martine; Catros, Sylvain; Le Visage, Catherine; Letourneur, Didier; Amedee, Joelle; Fricain, Jean-Christophe

2014-01-01

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Pullulan/dextran/nHA Macroporous Composite Beads for Bone Repair in a Femoral Condyle Defect in Rats.  

Science.gov (United States)

The repair of bone defects is of particular interest for orthopedic, oral, maxillofacial, and dental surgery. Bone loss requiring reconstruction is conventionally addressed through bone grafting. Depending on the size and the location of the defect, this method has limits and risks. Biomaterials can offer an alternative and have features supporting bone repair. Here, we propose to evaluate the cellular penetration and bone formation of new macroporous beads based on pullulan/dextran that has been supplemented with nanocrystalline hydroxyapatite in a rat model. Cross-linked beads of 300-500 µm diameters were used in a lateral femoral condyle defect and analyzed by magnetic resonance imaging, micro-computed tomography, and histology in comparison to the empty defects 15, 30, and 70 days after implantation. Inflammation was absent for both conditions. For empty defects, cellularisation and mineralization started from the periphery of the defect. For the defects containing beads, cellular structures filling out the spaces between the scaffolds with increasing interconnectivity and trabecular-like organization were observed over time. The analysis of calcified sections showed increased mineralization over time for both conditions, but was more pronounced for the samples containing beads. Bone Mineral Density and Bone Mineral Content were both significantly higher at day 70 for the beads in comparison to empty defects as well as compared with earlier time points. Analysis of newly formed tissue around the beads showed an increase of osteoid tissue, measured as percentage of the defect surface. This study suggests that the use of beads for the repair of small size defects in bone may be expanded on to meet the clinical need for a ready-to-use fill-up material that can favor bone formation and mineralization, as well as promote vessel ingrowth into the defect site. PMID:25330002

Schlaubitz, Silke; Derkaoui, Sidi Mohammed; Marosa, Lydia; Miraux, Sylvain; Renard, Martine; Catros, Sylvain; Le Visage, Catherine; Letourneur, Didier; Amédée, Joëlle; Fricain, Jean-Christophe

2014-01-01

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Riscos e consequências do uso da técnica transportal na reconstrução do ligamento cruzado anterior: relação entre o túnel femoral, a artéria genicular lateral superior e o epicôndilo lateral do côndilo femoral / Risks and consequences of using the transportal technique in reconstructing the anterior cruciate ligament: relationships between the femoral tunnel, lateral superior genicular artery and lateral epicondyle of the femoral condyle  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese OBJETIVO: Definir zona de segurança para evitar possíveis complicações vasculares e ligamentares durante a reconstrução do ligamento cruzado anterior. MÉTODOS: Reconstrução artroscópica com uso de técnica transportal e transtibial em joelhos de cadáver foi realizada seguida de dissecção e mensuração [...] da distância entre o túnel femoral e a inserção proximal do ligamento colateral lateral e o túnel femoral e a artéria genicular lateral superior. RESULTADOS: A mensuração das distâncias analisadas mostra uma aproximação maior do principal ramo da artéria genicular lateral superior e da inserção proximal do ligamento colateral lateral com o túnel femoral, realizado com a técnica transportal. CONCLUSÃO: Percebemos que o uso da técnica transportal para reconstrução artroscópica do LCA apresenta maior probabilidade de lesão da artéria genicular lateral e da inserção do ligamento colateral lateral, favorecendo complicações pós-cirúrgicas como instabilidade do joelho, osteonecrose do côndilo femoral lateral e ligamentização do enxerto. Abstract in english OBJECTIVE: Define a security zone to avoid possibles vascular and ligamentar complications during anterior cruciate ligament reconstruction. METHODS: Arthroscopic reconstruction using the transtibial and transportal technique in cadaver knees was performed followed by dissection and measurement of t [...] he distance between the femoral tunnel and the proximal attachment of the lateral collateral ligament and the femoral tunnel and the lateral superior genicular artery. RESULTS: The measure of the analysed distances show us an aproximation between the major branch of the lateral superior genicular artery and the femoral insertion of the colateral lateral ligament and the femoral tunnel during the transportal technique. CONCLUSION: We realize that the use of technical ship it to arthroscopic ACL reconstruction has a higher probability of injury to the lateral geniculate artery and insertion of the lateral collateral ligament, promoting post-surgical complications such as instability of the knee, osteonecrosis of the femoral condyle and ligamentização graft.

Diego Costa, Astur; Vinicius, Aleluia; Ciro Veronese, Santos; Gustavo Gonçalves, Arliani; Ricardo, Badra; Saulo Gomes, Oliveira; Camila Cohen, Kaleka; Moisés, Cohen.

2012-10-01

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Riscos e consequências do uso da técnica transportal na reconstrução do ligamento cruzado anterior: relação entre o túnel femoral, a artéria genicular lateral superior e o epicôndilo lateral do côndilo femoral / Risks and consequences of using the transportal technique in reconstructing the anterior cruciate ligament: relationships between the femoral tunnel, lateral superior genicular artery and lateral epicondyle of the femoral condyle  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese OBJETIVO: Definir zona de segurança para evitar possíveis complicações vasculares e ligamentares durante a reconstrução do ligamento cruzado anterior. MÉTODOS: Reconstrução artroscópica com uso de técnica transportal e transtibial em joelhos de cadáver foi realizada seguida de dissecção e mensuração [...] da distância entre o túnel femoral e a inserção proximal do ligamento colateral lateral e o túnel femoral e a artéria genicular lateral superior. RESULTADOS: A mensuração das distâncias analisadas mostra uma aproximação maior do principal ramo da artéria genicular lateral superior e da inserção proximal do ligamento colateral lateral com o túnel femoral, realizado com a técnica transportal. CONCLUSÃO: Percebemos que o uso da técnica transportal para reconstrução artroscópica do LCA apresenta maior probabilidade de lesão da artéria genicular lateral e da inserção do ligamento colateral lateral, favorecendo complicações pós-cirúrgicas como instabilidade do joelho, osteonecrose do côndilo femoral lateral e ligamentização do enxerto. Abstract in english OBJECTIVE: Define a security zone to avoid possibles vascular and ligamentar complications during anterior cruciate ligament reconstruction. METHODS: Arthroscopic reconstruction using the transtibial and transportal technique in cadaver knees was performed followed by dissection and measurement of t [...] he distance between the femoral tunnel and the proximal attachment of the lateral collateral ligament and the femoral tunnel and the lateral superior genicular artery. RESULTS: The measure of the analysed distances show us an aproximation between the major branch of the lateral superior genicular artery and the femoral insertion of the colateral lateral ligament and the femoral tunnel during the transportal technique. CONCLUSION: We realize that the use of technical ship it to arthroscopic ACL reconstruction has a higher probability of injury to the lateral geniculate artery and insertion of the lateral collateral ligament, promoting post-surgical complications such as instability of the knee, osteonecrosis of the femoral condyle and ligamentização graft.

Diego Costa, Astur; Vinicius, Aleluia; Ciro Veronese, Santos; Gustavo Gonçalves, Arliani; Ricardo, Badra; Saulo Gomes, Oliveira; Camila Cohen, Kaleka; Moisés, Cohen.

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Contribuição ao estudo anatômico do retalho vascularizado corticoperiosteal do côndilo medial do fêmur / Contribution to the anatomical study of the corticoperiosteal flap of the medial femoral condyle  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese OBJETIVO: Realizar o estudo anatômico, em cadáveres, do retalho corticoperiosteal do côndilo femoral medial baseado na artéria genicular medial, avaliando a dificuldade de dissecção e padrões topográficos. MÉTODOS: Foram estudados 15 membros de oito cadáveres, com idade variando de 19 a 74 anos. Dis [...] postos em posição supina, foi realizada incisão longitudinal na face medial do terço distal da coxa, exposição dos vasos geniculares descendentes entre os músculos vasto medial e sartório. Foram analisados a distância entre a origem da artéria genicular descendente e a interlinha medial do joelho, o diâmetro do vaso, o comprimento do pedículo, a presença do ramo fasciocutâneo e sua localização. RESULTADOS: A distância entre a origem da artéria genicular descendente e a interlinha medial do joelho variou de 11,2cm a 14,5cm, com média de 12,63cm. O diâmetro médio da artéria foi de 2,5mm (de 2,25mm a 2,75mm). A distância entre a origem da artéria genicular descendente e o ramo fasciocutâneo variou entre 1,0 e 1,5cm. O comprimento médio do pedículo vascular, foi de 7,01cm, variando de 5,6 a 8,6cm. CONCLUSÃO: O retalho corticoperiosteal do côndilo femoral medial do joelho é de fácil dissecção, possui pedículo vascular constante, com comprimento médio de 7,0cm e diâmetro de 2,5mm, o que possibilita sua indicação em transplantes microcirúrgicos. Abstract in english OBJECTIVE: to perform the anatomical study, in cadavers, of the corticoperiosteal flap of the medial femoral condyle, based on the medial genicular artery, evaluating challenges in dissection and the topographic patterns. MATERIALS AND METHODS: fifteen limbs from eight cadavers were studied, ages ra [...] nging from 19 to 74 years old. They were placed at supine position, and a longitudinal incision on the medial face of the lower part of the thigh was performed, exposing medial vastus and sartorius muscles, with descendent genicular vessels being also exposed. The distance between the descendent genicular artery and the medial articular line of the knee, the diameter of the vessel, the length of the pedicle, and the presence of the fasciocutaneous branch and its location were analyzed. RESULTS: the distance between the origin of the descendent genicular artery and the medial articular line of the knee ranged from 11.2cm to 14.5cm, with an average of 12.63cm. The mean artery diameter was 2.5mm (from 2.25mm to 2.75mm). The distance between the descendent genicular artery and the fasciocutaneous branch ranged from 1.0 to 1.5cm. The mean length of the vascular pedicle was 7.01cm, ranging from 5.6cm to 8.6cm. CONCLUSION: the corticoperiosteal flap of the medial femoral condyle of the knee is easy to dissect, presents a constant vascular pedicle, with average length of 7.0cm and diameter of 2.5mm, enabling it to be indicated for microsurgical transplants.

Rômulo Guimarães, Andrade; Henrique Gubert, Bufáiçal; Leandro Alves de, Oliveira; Fabiano Inácio de, Souza; Mário Yoshihide, Kuwae; João Alírio Teixeira da, Silva Júnior.

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Hydroxylapatite supported Dacron plugs for repair of isolated full-thickness osteochondral defects of the rabbit femoral condyle: mechanical and histological evaluations from 6-48 weeks.  

Science.gov (United States)

The early degeneration of neocartilage commonly observed after experimental cartilage repair is attributed in part to the impaired cartilage-bone mechanics caused by an insufficient regrowth of the subchondral bone plate. In order to enhance bone regrowth after cartilage repair Dacron plugs supported by hydroxylapatite were implanted into 3 mm diameter full-thickness defects of both medial femoral condyles in 21 rabbits. In addition, the plug in one knee of each animal was wrapped with autologeous periosteum from the proximal tibia. The repair sites were evaluated at 6, 12, 24, and 48 weeks. Except for the mechanics of the repair site at 24 weeks additional periosteum did not improve the overall results. In specimens with additional periosteum the compression compliance of the repair sites improved gradually from abnormal high to almost normal values at 24 weeks, but were found softened again at 48 weeks. All other repairs were softer than normal cartilage at all time intervals. In all specimens a well-defined but irregularly shaped, subchondral bone plate had developed by 12 weeks. The neocartilage was initially thicker than normal cartilage, but the thickness decreased gradually and reached normal values by 48 months. Neocartilage formation with moderate morphological scores appeared already at 6 weeks, but the scores did not improve with time. High variations in quality of the regenerated tissue, from insufficient regeneration to hyaline-like cartilage, were found at all time intervals, but none of the specimens had developed normal cartilage. Most knees had a low-grade synovitis and some had particle debris. PMID:8113240

Messner, K

1993-12-01

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Bone marrow stimulation of the medial femoral condyle produces inferior cartilage and bone repair compared to the trochlea in a rabbit surgical model.  

Science.gov (United States)

The influence of the location of cartilage lesions on cartilage repair outcome is incompletely understood. This study compared cartilage and bone repair in medial femoral condylar (MFC) versus femoral trochlear (TR) defects 3 months after bone marrow stimulation in mature rabbits. Intact femurs from adult rabbits served as controls. Results from quantitative histomorphometry and histological scoring showed that bone marrow stimulation produced inferior soft tissue repair in MFC versus TR defects, as indicated by significantly lower % Fill (p?=?0.03), a significant increase in collagen type I immunostaining (p?posterior defect placement in the weight-bearing region. We conclude that the location of cartilage lesions influences cartilage repair, with better outcome in TR versus MFC defects in rabbits. Meniscal degeneration is associated with cartilage damage. PMID:23843172

Chen, Hongmei; Chevrier, Anik; Hoemann, Caroline D; Sun, Jun; Picard, Genevieve; Buschmann, Michael D

2013-11-01

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Clinical and radiological mid- to longterm results after transfer of the posterior femoral condyle (PCT) and MegaOATS  

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Seit 1996 wird bei jungen und aktiven Patienten mit großen osteochondralen Defekten in der femoralen Belastungszone ein autologer Transfer der posterioren Femurkondyle (MegaOATS) durchgeführt. Ziel der Studie war die Evaluierung mittel- bis langfristiger Ergebnisse. Dazu wurden die ersten 33 Patienten nachuntersucht, Röntgenaufnahmen und von 16 Patienten MRTs angefertigt. Der mediane Lysholm Score stieg nach durchschnittlich 66,4 Monaten hochsignifikant (p<0,001) von praeoperativ 49,...

Minzlaff, Philipp

2008-01-01

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Continuous Femoral Versus Posterior Lumbar Plexus Nerve Blocks for Analgesia After Hip Arthroplasty: A Randomized, Controlled Study  

Science.gov (United States)

BACKGROUND Hip arthroplasty frequently requires potent postoperative analgesia, often provided with an epidural or posterior lumbar plexus local anesthetic infusion. However, American Society of Regional Anesthesia guidelines now recommend against epidural and continuous posterior lumbar plexus blocks during administration of various perioperative anticoagulants often administered after hip arthroplasty. A continuous femoral nerve block is a possible analgesic alternative, but whether it provides comparable analgesia to a continuous posterior lumbar plexus block after hip arthroplasty remains unclear. We therefore tested the hypothesis that differing the catheter insertion site (femoral versus posterior lumbar plexus) after hip arthroplasty has no impact on postoperative analgesia. METHODS Preoperatively, subjects undergoing hip arthroplasty were randomly assigned to receive either a femoral or posterior lumbar plexus stimulating catheter inserted 5 to 15 cm or 0 to 1 cm past the needletip, respectively. Postoperatively, patients received perineural ropivacaine, 0.2% (basal 6 mL/hour, bolus 4 mL, 30 min lockout) for at least two days. The primary end point was the average daily pain scores as measured with a numeric rating scale (0–10) recorded in the 24-h period beginning at 07:30 the morning after surgery, excluding twice-daily physical therapy sessions. Secondary end points included pain during physical therapy, ambulatory distance, and supplemental analgesic requirements during the same 24-h period, as well as satisfaction with analgesia during hospitalization. RESULTS The mean (SD) pain scores for subjects receiving a femoral infusion (n = 25) were 3.6 (1.8) versus 3.5 (1.8) for patients receiving a posterior lumbar plexus infusion (n = 22) resulting in a group difference of 0.1 (95% confidence interval ?0.9 to 1.2; P = 0.78). Because the confidence interval was within a prespecified ?1.6 to 1.6 range, we conclude that the effect of the two analgesic techniques on postoperative pain was equivalent. Similarly, we detected no differences between the two treatments with respect to the secondary end points, with one exception: subjects with a femoral catheter ambulated a median (10th–90th percentiles) 2 (0–17) m the morning after surgery, compared with 11 (0–31) m for subjects with a posterior lumbar plexus catheter (data nonparametric; P = 0.02). CONCLUSIONS After hip arthroplasty, a continuous femoral nerve block is an acceptable analgesic alternative to a continuous posterior lumbar plexus block when using a stimulating perineural catheter. However, early ambulatory ability suffers with a femoral infusion. PMID:21467563

Ilfeld, Brian M.; Mariano, Edward R.; Madison, Sarah J.; Loland, Vanessa J.; Sandhu, NavParkash S.; Suresh, Preetham J.; Bishop, Michael L.; Kim, T. Edward; Donohue, Michael C.; Kulidjian, Anna A.; Ball, Scott T.

2011-01-01

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Posterior Wall Capture and Femoral Artery Stenosis Following Use of StarClose Closing Device: Diagnosis and Therapy  

International Nuclear Information System (INIS)

A case of femoral artery obstruction following application of a StarClose type arterial puncture closing device (APCD) is presented. Ultrasonographic and angiographic imaging of this complication was obtained. The posterior wall of the vessel was accidentally caught in the anchoring element of the nitinol clip. This complication was successfully resolved by endovascular treatment and the implantation of a stent

51

Posterior Wall Capture and Femoral Artery Stenosis Following Use of StarClose Closing Device: Diagnosis and Therapy  

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A case of femoral artery obstruction following application of a StarClose type arterial puncture closing device (APCD) is presented. Ultrasonographic and angiographic imaging of this complication was obtained. The posterior wall of the vessel was accidentally caught in the anchoring element of the nitinol clip. This complication was successfully resolved by endovascular treatment and the implantation of a stent.

Stefanczyk, Ludomir [Medical University of Lodz, First Department of Radiology and Diagnostic Imaging (Poland); Elgalal, Marcin T., E-mail: telgalal@yahoo.co.uk [Medical University of Lodz, Second Department of Radiology and Diagnostic Imaging (Poland); Szubert, Wojciech; Grzelak, Piotr [Medical University of Lodz, First Department of Radiology and Diagnostic Imaging (Poland); Szopinski, Piotr [Institute of Haematology and Transfusion Medicine, Department of Vascular Surgery (Poland); Majos, Agata [Medical University of Lodz, Second Department of Radiology and Diagnostic Imaging (Poland)

2013-10-15

52

Estudio Biométrico de la Arterias Femoral, Poplítea y Tibial Posterior en Relación a los Implantes de Stents / Biometric Study of the Femoral, Popliteal and Posterior Tibial Arteries in Relation to the Stents  

Scientific Electronic Library Online (English)

Full Text Available SciELO Chile | Language: Spanish Abstract in spanish Los aneurismas de la arteria poplítea son los más frecuentes entre los aneurismas periféricos, pudiendo ser tratados con stents a través de cirugía endovascular. Sin embargo, tales stents poseen el mismo diámetro en la parte proximal y distal, no siendo compatible con la anatomía vascular de ese seg [...] mento. El objetivo del presente estudio fue determinar la diferencia entre el diámetro del tercio distal de la arteria femoral y el diámetro de la arteria tibial posterior, además de obtener el diámetro de otras arterias del miembro inferior. Se utilizaron 28 cadáveres formolizados de individuos adultos, de ambos sexos, los que fueron disecados en la región correspondiente. Los diámetros registrados fueron los siguientes: en el tercio distal de la arteria femoral (inicio de la arteria poplítea), parte final de la arteria poplítea antes de su bifurcación en arterias tibial anterior y posterior, arterias tibial anterior y posterior (tronco tibiofibular). En el sexo masculino, desde el tercio distal de la arteria femoral hasta la arteria tibial posterior hubo una reducción del diámetro de 27,92% (p Abstract in english The popliteal artery aneurysms are the most common among peripheral aneurysms and can be treated with stents through endovascular surgery. However, these stents have the same diameter at the proximal and distal part , not being compatible with the vascular anatomy of that segment. The aim of this st [...] udy was determine the difference between the diameter of the distal third of the femoral artery and the diameter of the posterior tibial artery, and to obtain the diameter of others arteries of the lower limb. We study 28 formalized cadavers of adult individuals of both sexes, which were dissected in the corresponding region. The following arterial diameters were recorded: the distal third of the femoral artery, distal part of the popliteal artery, anterior tibial artery and posterior tibial artery. In males from the distal third of the femoral artery to the posterior tibial artery there was a narrowing of 27.92% (p

Moreira da, Costa Filho, E; Avelino, dos Santos, T. F; Avelino, dos Santos, F. T; Honorato, Pereira, V; Brandão, Pitta, G. B; M, del Sol; E, Olave; C. F, Sousa-Rodrigues.

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Estudio Biométrico de la Arterias Femoral, Poplítea y Tibial Posterior en Relación a los Implantes de Stents / Biometric Study of the Femoral, Popliteal and Posterior Tibial Arteries in Relation to the Stents  

Scientific Electronic Library Online (English)

Full Text Available SciELO Chile | Language: Spanish Abstract in spanish Los aneurismas de la arteria poplítea son los más frecuentes entre los aneurismas periféricos, pudiendo ser tratados con stents a través de cirugía endovascular. Sin embargo, tales stents poseen el mismo diámetro en la parte proximal y distal, no siendo compatible con la anatomía vascular de ese seg [...] mento. El objetivo del presente estudio fue determinar la diferencia entre el diámetro del tercio distal de la arteria femoral y el diámetro de la arteria tibial posterior, además de obtener el diámetro de otras arterias del miembro inferior. Se utilizaron 28 cadáveres formolizados de individuos adultos, de ambos sexos, los que fueron disecados en la región correspondiente. Los diámetros registrados fueron los siguientes: en el tercio distal de la arteria femoral (inicio de la arteria poplítea), parte final de la arteria poplítea antes de su bifurcación en arterias tibial anterior y posterior, arterias tibial anterior y posterior (tronco tibiofibular). En el sexo masculino, desde el tercio distal de la arteria femoral hasta la arteria tibial posterior hubo una reducción del diámetro de 27,92% (p Abstract in english The popliteal artery aneurysms are the most common among peripheral aneurysms and can be treated with stents through endovascular surgery. However, these stents have the same diameter at the proximal and distal part , not being compatible with the vascular anatomy of that segment. The aim of this st [...] udy was determine the difference between the diameter of the distal third of the femoral artery and the diameter of the posterior tibial artery, and to obtain the diameter of others arteries of the lower limb. We study 28 formalized cadavers of adult individuals of both sexes, which were dissected in the corresponding region. The following arterial diameters were recorded: the distal third of the femoral artery, distal part of the popliteal artery, anterior tibial artery and posterior tibial artery. In males from the distal third of the femoral artery to the posterior tibial artery there was a narrowing of 27.92% (p

Moreira da, Costa Filho, E; Avelino, dos Santos, T. F; Avelino, dos Santos, F. T; Honorato, Pereira, V; Brandão, Pitta, G. B; M, del Sol; E, Olave; C. F, Sousa-Rodrigues.

2014-06-01

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The movement of the normal tibio-femoral joint.  

Science.gov (United States)

This review describes the anatomy of the articular surfaces and their movement in the normal tibio-femoral joint, together with methods of measurement in volunteers. Forces and soft tissues are excluded. To measure movement, the articular surfaces and natural or inserted movement markers must be imaged by some combination of MRI, CT, RSA or fluoroscopy. With the aid of computer-imaging, the movements can then be related to an anatomy-based co-ordinate system to avoid kinematic cross-talk. Methods of depicting these movements which are understandable to engineers and clinicians are discussed. The shapes of the articular surfaces are reported. They are relevant to landmarks and co-ordinate systems and form a basis for inferring the nature of the movements which take place in the knee. The movements of the condyles are described from hyperextension to full passive flexion. Medially the condyle hardly moves antero-posteriorly from 0 degrees to 120 degrees but the contact area transfers from an anterior pair of tibio-femoral surfaces at 10 degrees to a posterior pair at about 30 degrees . Thus because of the shapes of the bones, the medial contact area moves backwards with flexion to 30 degrees but the condyle does not. Laterally the femoral condyle and the contact area move posteriorly but to a variable extent in the mid-range causing tibial internal rotation to occur with flexion around a medial axis. From 120 degrees to full flexion both condyles roll back onto the posterior horn so that the tibio-femoral joint subluxes. PMID:15598446

Freeman, M A R; Pinskerova, V

2005-02-01

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Comparative study of the areas of osteochondral defects produced in the femoral condyles of rabbits treated with gel of sugarcane biopolymer / Estudo comparativo das áreas de defeitos osteocondrais produzidas nos côndilos femorais de coelhos tratados com gel de biopolímero de cana  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in portuguese OBJETIVO: Mensurar as áreas cicatrizadas dos defeitos osteocondrais produzidos em côndilos femorais de coelhos preenchidos com gel de biopolímero da cana-de-açúcar e comparar com o grupo controle nos períodos de 90, 120 e 180 dias. MÉTODOS: Foram estudados, 16 coelhos da raça Nova Zelândia com seis [...] a sete meses de idade, entre 2,0 e 2,5 kg de peso. Foram feitos, com trefina, defeitos de 3,2 x 4 mm nos côndilos femorais dos joelhos direito e esquerdo. Como grupo de estudo foram utilizados os defeitos dos côndilos medial e lateral dos joelhos direito que foram preenchidos com gel de biopolímero da cana-de-açucar. Como grupo controle foram utilizados os defeitos dos côndilos medial e lateral dos joelhos esquerdos que foram deixados abertos para cicatrização natural. Os defeitos foram analisados nos períodos de 90, 120 e 180 dias após a cirurgia. Após a eutanásia, os joelhos foram retirados e fixados em solução de Bouin para posterior documentação fotográfica com maquina digital Nikon Coopix® 5400. As áreas cicatrizadas foram mensuradas nos grupos estudo e controle, através das imagens obtidas com o programa Image-J®. A análise estatística foi feita aplicando-se o teste não paramétrico Mann-Whitney. RESULTADOS: Não houve diferenças significantes entre as médias das áreas cicatrizadas nos grupos estudo e controle nos períodos de 90, 120 e 180 dias após a cirurgia. CONCLUSÃO: A dimensão das áreas cicatrizadas dos defeitos tratados com o gel do biopolímero da cana-de-açúcar, grupo de estudo foi semelhante as do grupo controle, cicatrizadas naturalmente. Abstract in english PURPOSE: To measure the healed areas of osteochondral defects produced in femoral condyles of rabbits filled with biopolymer sugar cane gel and to compare these with those of the control group at 90, 120 and 180 days. METHODS: A study was made of 16 New Zealand rabbits, 6 and 7 months old, weighing [...] between 2 and 2.5 kg. Defects of 3.2 x 4 mm were made, with trephine, in the femoral condyles of the right and left knees. As to the study group defects of the medial and lateral condyles of the right knee were used which were filled with Biopolymer Sugar Cane Gel; as to the Control Group defects of the medial and lateral condyles of the left t knees were used which were left open for natural healing. The defects were analyzed at 90, 120 and 180 days after surgery. After euthanasia, the knees were removed and fixed in Bouin's solution for later digital photographic documentation with a digital camera. The areas healed were measured in both the study and control groups using the images obtained from an Image-J® program. Statistical analysis was conducted using the non-parametric Mann-Whitney test. RESULTS: There were no significant differences between the means of the healed areas in the study and control groups at 90, 120 and 180 days after surgery. CONCLUSION: The dimension of the healed areas of the defects treated with the biopolymer sugar-cane gel in the study group was similar to those of the control group, which healed naturally.

Paulo Cezar Vidal Carneiro de, Albuquerque; José Lamartine de Andrade, Aguiar; Saulo Monteiro dos, Santos; Nicodemus, Pontes Filho; Roberto José Vieira de, Mello; Mariana Lúcia Correia Ramos, Costa; Clarissa Miranda Carneiro de, Albuquerque; Tarciana Mendonça de S., Almeida; Alessandro Henrique da Silva, Santos; Joacil Carlos da, Silva.

2011-10-01

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Anatomical study and morphometric analyses on the femoral insertions of the posterior cruciate ligament / Estudo anatomico e analise morfometrica das insercoes femorais do ligamento cruzado posterior  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in portuguese OBJETIVO: Fornecer bases anatômicas e morfométricas das inserções femorais do ligamento cruzado posterior (LCP) para auxiliar a criação de túneis femorais anatômicos na reconstrução cirúrgica desse ligamento. Desenho do estudo: Estudo laboratorial controlado. MATERIAIS E [...] MÉTODOS: Analisamos os detalhes macroscópicos das inserções femorais das bandas anterolateral (AL) e posteromedial (PM) do LCP em 24 peças anatômicas de joelhos. As peças foram fotografadas por uma câmera digital e as imagens obtidas foram estudadas por meio do programa ImageJ, com o qual medimos a área de inserção das bandas, em milímetros quadrados, e o comprimento de estruturas e as distâncias entre pontos significativos, em milímetros. RESULTADOS: A média da área total da inserção femoral do LCP foi de 87,80 ± 31,42 mm2. As médias das áreas de inserção das bandas AL e PM foram, respectivamente, 47,13 ± 19,14 e 40,67 ± 16,19 mm2. Em 95,8% dos joelhos estudados verificamos a presença da crista intercondilar medial e em 83,3% das peças notamos a crista medial bifurcada. O comprimento médio da crista intercondilar medial foi de 20,54 ± 2,26 mm e da crista medial bifurcada, 7,62 ± 2,35 mm. CONCLUSÕES: A banda AL tem uma área de inserção femoral maior do que a PM; as áreas de inserção dessas bandas foram menores do que as previamente descritas na literatura. Existiram variações individuais importantes em relação à área das bandas em nossa amostragem, sugerindo que deva haver indicação específica para reconstruções anatômicas do LCP com túnel femoral único ou duplo. Abstract in english PURPOSE: To provide an anatomical and morphometric basis for the femoral insertions of the posterior cruciate ligament (PCL) in order to aid in the creation of anatomical femoral tunnels in ligament surgical reconstruction. Study design: laboratory controlled study. MATE [...] RIAL AND METHODS: The macroscopic details of the femoral insertions of the PCL's anterolateral (AL) and posteromedial (PM) bundles were analyzed in 24 cadaver knees. The specimens were photographed with a digital camera and the images obtained were studied using the software ImageJ. The bundles' insertion areas were measured in square millimeters, and the length of the structures and the distances between significant points were measured in millimeters. RESULTS: The PCL's femoral insertion average total area was 87.29 ± 31.42 mm².The mean insertion's areas of the AL and PM bundles were, respectively, 47.13 ± 19.14 and 40.67 ± 16.19 mm². In 95.8% of the examined knees was verified the presence of the medial intercondylar ridge and in 83.3% of the knees was noted the medial bifurcated ridge. The average length of the medial intercondylar ridge was 20.54 ± 2.26 mm and the medial bifurcated ridge's average length was 7.62 ± 2.35 mm. CONCLUSIONS: The AL had a femoral insertion area larger than the PM bundle; these bundles' insertion areas were lower than those previously described in the literature. There were important individual variations related to the area of the bundles in the samples, suggesting that there should be an individual recommendation for anatomical reconstructions of the PCL with single or double femoral tunnels.

Julio Cesar, Gali; Heetor Campora de Sousa, Oliveira; Adriano Bordini, Camargo; Carlos Rodrigo Barbosa, Martins; Phelipe Augusto Cintra da, Silva; Edie Benedito, Caetano.

2013-04-01

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Combined posterior lumbar plexus–sciatic nerve block versus combined femoral–obturator–sciatic nerve block for ACL reconstruction  

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Full Text Available Ayman I TharwatAin Shams University, Cairo, EgyptBackground: We compared the efficacy of combined posterior lumbar plexus–sciatic nerve block with that of combined femoral–obturator–sciatic nerve block as anesthesia for anterior cruciate ligament reconstruction surgery, because both block combinations have been recommended for lower limb arthroscopic and reconstructive surgery.Methods: Forty-eight patients undergoing elective unilateral anterior cruciate ligament reconstruction under local anesthesia were randomized to undergo either combined posterior lumbar plexus–sciatic nerve block (Group 1, or combined femoral–obturator–sciatic nerve block (Group 2. Blocks were performed using nerve stimulation and bupivacaine 0.5% mixed with lignocaine 2%. Systolic and diastolic blood pressure, heart rate, and pulse oximetry were recorded. Quality of anesthesia, motor and sensory block, time to first analgesic use, sedation, and need for general anesthesia were recorded, along with verbal postoperative pain scores, and side effects.Results: No patient in Group 1 and two patients in Group 2 needed general anesthesia. Complete sensory blockade was higher in Group 1 than in Group 2. However, complete motor blockade was similar in both groups. In Group 1, verbal pain scores were lower than in Group 2. Time to first analgesic was similar between the two groups. Total analgesic consumption was lower in Group 1. No significant differences were found for heart rate, pulse oximetry, or systolic and diastolic blood pressure between the groups, and no signs of toxicity were encountered.Conclusion: Combined posterior lumbar plexus–sciatic nerve block provided more comfortable intraoperative anesthesia and better postoperative analgesia than combined femoral–obturator–sciatic nerve block for anterior cruciate ligament reconstruction surgery.Keywords: anterior cruciate ligament reconstruction, local anesthetic, nerve block 

Ayman I Tharwat

2011-02-01

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Anatomical relationships between Wrisberg meniscofemoral and posterior cruciate ligament's femoral insertions / Relacoes anatomicas entre as insercoes femorais dos ligamentos meniscofemoral de Wrisberg e cruzado posterior  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in portuguese OBJETIVO: Avaliar a frequência e a morfometria do ligamento meniscofemoral de Wrisberg e a relação de suas inserções femorais com aquelas do ligamento cruzado posterior (LCP). Desenho do estudo: Estudo laboratorial controlado. MÉTODOS: Foram feitas dissecções minuciosas das inserções femorais [...] dos ligamentos de Wrisberg (LW) e do LCP em 24 peças anatômicas de joelhos. As peças foram fotografadas com uma câmera digital e marcador milimetrado; o programa Image J foi usado para medir a área das inserções ligamentares, em milímetros quadrados. RESULTADOS: O LW esteve presente em 91,6% das peças estudadas. Nessas, seu formato foi elíptico em 12 peças (54,54%). Em 68% dos joelhos a inserção do LW esteve proximal à crista intercondilar medial, próximo à banda posteromedial do LCP. A área média da inserção femoral do LW foi de 20,46 ± 6,12 mm2 , o que correspondeu a 23,3% da área de inserção do LCP. CONCLUSÕES: O LW é estrutura frequente nos joelhos, com grande variabilidade de sua área média. Proporcionalmente ao LCP, sua área média sugere que esse ligamento pode contribuir para a estabilidade posterior do joelho. Abstract in english OBJECTIVE: To evaluate the frequency and morphometry of the Wrisberg's ligament and its relationships with the posterior cruciate ligament's femoral insertion. STUDY DESIGN: Controlled laboratory study. METHODS: 24 unpaired knee pieces, 12 right and 12 left were submitted to a deep dissect [...] ion of the Wrisberg and posterior cruciate ligaments. The pieces were photographed with a digital camera and ruler; the Image J software was used to measure the ligaments' insertion areas, in square millimeters. RESULTS: The Wrisberg ligament was present in 91.6% of the studied pieces. In those its shape was elliptical in 12 pieces (54.54%). In 68% of the knees, the WL insertion was proximal to the medial intercondilar ridge, close to the PCL posteromedial bundle. The average area for the WL was 20.46 ± 6.12 mm2. This number corresponded to 23.3% of the PCL's average area. CONCLUSIONS: WL ligament is a common structure in knees. There is a wide variation of its insertion area. Proportionally to the PCL's insertion area the WL ones suggests that it may contribute to the posterior stability of the knee joint.

Heetor Campora de Sousa, Oliveira; Julio Cesar, Gali; Edie Benedito, Caetano.

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Anatomical relationships between Wrisberg meniscofemoral and posterior cruciate ligament's femoral insertions / Relacoes anatomicas entre as insercoes femorais dos ligamentos meniscofemoral de Wrisberg e cruzado posterior  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in portuguese OBJETIVO: Avaliar a frequência e a morfometria do ligamento meniscofemoral de Wrisberg e a relação de suas inserções femorais com aquelas do ligamento cruzado posterior (LCP). Desenho do estudo: Estudo laboratorial controlado. MÉTODOS: Foram feitas dissecções minuciosas das inserções femorais [...] dos ligamentos de Wrisberg (LW) e do LCP em 24 peças anatômicas de joelhos. As peças foram fotografadas com uma câmera digital e marcador milimetrado; o programa Image J foi usado para medir a área das inserções ligamentares, em milímetros quadrados. RESULTADOS: O LW esteve presente em 91,6% das peças estudadas. Nessas, seu formato foi elíptico em 12 peças (54,54%). Em 68% dos joelhos a inserção do LW esteve proximal à crista intercondilar medial, próximo à banda posteromedial do LCP. A área média da inserção femoral do LW foi de 20,46 ± 6,12 mm2 , o que correspondeu a 23,3% da área de inserção do LCP. CONCLUSÕES: O LW é estrutura frequente nos joelhos, com grande variabilidade de sua área média. Proporcionalmente ao LCP, sua área média sugere que esse ligamento pode contribuir para a estabilidade posterior do joelho. Abstract in english OBJECTIVE: To evaluate the frequency and morphometry of the Wrisberg's ligament and its relationships with the posterior cruciate ligament's femoral insertion. STUDY DESIGN: Controlled laboratory study. METHODS: 24 unpaired knee pieces, 12 right and 12 left were submitted to a deep dissect [...] ion of the Wrisberg and posterior cruciate ligaments. The pieces were photographed with a digital camera and ruler; the Image J software was used to measure the ligaments' insertion areas, in square millimeters. RESULTS: The Wrisberg ligament was present in 91.6% of the studied pieces. In those its shape was elliptical in 12 pieces (54.54%). In 68% of the knees, the WL insertion was proximal to the medial intercondilar ridge, close to the PCL posteromedial bundle. The average area for the WL was 20.46 ± 6.12 mm2. This number corresponded to 23.3% of the PCL's average area. CONCLUSIONS: WL ligament is a common structure in knees. There is a wide variation of its insertion area. Proportionally to the PCL's insertion area the WL ones suggests that it may contribute to the posterior stability of the knee joint.

Heetor Campora de Sousa, Oliveira; Julio Cesar, Gali; Edie Benedito, Caetano.

2013-09-01

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Hypoplastic occipital condyle and third occipital condyle: review of their dysembryology.  

Science.gov (United States)

Disruption or embryologic derailment of the normal bony architecture of the craniovertebral junction (CVJ) may result in symptoms. As studies of the embryology and pathology of hypoplasia of the occipital condyles and third occipital condyles are lacking in the literature, the present review was performed. Standard search engines were accessed and queried for publications regarding hypoplastic occipital condyles and third occipital condyles. The literature supports the notion that occipital condyle hypoplasia and a third occipital condyle are due to malformation or persistence of the proatlas, respectively. The Pax-1 gene is most likely involved in this process. Clinically, condylar hypoplasia may narrow the foramen magnum and lead to lateral medullary compression. Additionally, this maldevelopment can result in transient vertebral artery compression secondary to posterior subluxation of the occiput. Third occipital condyles have been associated with cervical canal stenosis, hypoplasia of the dens, transverse ligament laxity, and atlanto-axial instability causing acute and chronic spinal cord compression. Treatment goals are focused on craniovertebral stability. A better understanding of the embryology and pathology related to CVJ anomalies is useful to the clinician treating patients presenting with these entities. PMID:23338989

Tubbs, R Shane; Lingo, Patrick Ryan; Mortazavi, Martin M; Cohen-Gadol, Aaron A

2013-11-01

 
 
 
 
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Rolamento posterior do fêmur na artroplastia total do joelho: comparação entre as próteses com preservação e com sacrifício do ligamento cruzado posterior / Femoral roll back in total knee arthroplasty: comparison between prostheses that preserve and sacrifice the posterior cruciate ligament  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese OBJETIVO: Comparar a posteriorização do ponto de contato entre o componente femoral e o polietileno tibial à medida em que o joelho é fletido em dois tipos de artroplastia total do joelho, uma com sacrifício e outra com preservação do ligamento cruzado posterior (LCP). MÉTODOS: Foram analisados, sob [...] fluoroscopia, 36 joelhos de 32 pacientes submetidos a artroplastia total do joelho. Analisando as imagens em perfil, foi medido o ponto de contato do fêmur com o polietileno tibial com o joelho em extensão completa e em 90 graus de flexão, mensurando-se o percentual de "rolamento" posterior do fêmur nas artroplastias em que o ligamento cruzado posterior (LCP) foi sacrificado e naquelas nas quais esse foi preservado. RESULTADOS: O percentual médio de posteriorização do fêmur foi de 13,24% nos casos em que o LCP foi sacrificado e de 5,75% nos casos em que esse foi preservado. A diferença entre essas medidas foi estatisticamente significativa, com p = 0,026615. CONCLUSÃO: Na artroplastia total do joelho, sacrificar o LCP aumenta a translação posterior do ponto de contato entre o fêmur e a tíbia à medida em que o joelho é flexionado até 90 graus. Abstract in english OBJECTIVE: To compare the rollback of the contact point between the femoral component and the tibial polyethylene as the knee is flexed, in two types of total knee arthroplasty: one that sacrifices and the other that preserves the posterior cruciate ligament (PCL). METHODS: Under fluoroscopy, 36 kne [...] es from 32 patients who underwent total knee arthroplasty were evaluated. Using lateral images, the contact points between the femur and the tibial polyethylene with the knee in complete extension and at 90° of flexion were measured, thereby measuring the percentage rollback of the femur in arthroplasties in which the PCL was sacrificed and in those in which it was preserved. RESULTS: The mean percentage rollback of the femur was 13.24% in the cases in which the PCL was sacrificed and 5.75% in the cases in which it was preserved. The difference between these measurements was statistically significant (p = 0.026615). CONCLUSION: In total knee arthroplasty, sacrificing the PCL increased the rollback of the contact point between the femur and tibia as the knee was flexed up to 90°.

Lúcio Honório de, Carvalho Júnior; Luiz Fernando Machado, Soares; Matheus Braga Jacques, Gonçalves; Leonardo Lanziotti, Costa; Lincoln Paiva, Costa; Rodrigo Rosa, Lessa; Marcelo Lobo, Pereira.

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Rolamento posterior do fêmur na artroplastia total do joelho: comparação entre as próteses com preservação e com sacrifício do ligamento cruzado posterior Femoral roll back in total knee arthroplasty: comparison between prostheses that preserve and sacrifice the posterior cruciate ligament  

Directory of Open Access Journals (Sweden)

Full Text Available OBJETIVO: Comparar a posteriorização do ponto de contato entre o componente femoral e o polietileno tibial à medida em que o joelho é fletido em dois tipos de artroplastia total do joelho, uma com sacrifício e outra com preservação do ligamento cruzado posterior (LCP. MÉTODOS: Foram analisados, sob fluoroscopia, 36 joelhos de 32 pacientes submetidos a artroplastia total do joelho. Analisando as imagens em perfil, foi medido o ponto de contato do fêmur com o polietileno tibial com o joelho em extensão completa e em 90 graus de flexão, mensurando-se o percentual de "rolamento" posterior do fêmur nas artroplastias em que o ligamento cruzado posterior (LCP foi sacrificado e naquelas nas quais esse foi preservado. RESULTADOS: O percentual médio de posteriorização do fêmur foi de 13,24% nos casos em que o LCP foi sacrificado e de 5,75% nos casos em que esse foi preservado. A diferença entre essas medidas foi estatisticamente significativa, com p = 0,026615. CONCLUSÃO: Na artroplastia total do joelho, sacrificar o LCP aumenta a translação posterior do ponto de contato entre o fêmur e a tíbia à medida em que o joelho é flexionado até 90 graus.OBJECTIVE: To compare the rollback of the contact point between the femoral component and the tibial polyethylene as the knee is flexed, in two types of total knee arthroplasty: one that sacrifices and the other that preserves the posterior cruciate ligament (PCL. METHODS: Under fluoroscopy, 36 knees from 32 patients who underwent total knee arthroplasty were evaluated. Using lateral images, the contact points between the femur and the tibial polyethylene with the knee in complete extension and at 90° of flexion were measured, thereby measuring the percentage rollback of the femur in arthroplasties in which the PCL was sacrificed and in those in which it was preserved. RESULTS: The mean percentage rollback of the femur was 13.24% in the cases in which the PCL was sacrificed and 5.75% in the cases in which it was preserved. The difference between these measurements was statistically significant (p = 0.026615. CONCLUSION: In total knee arthroplasty, sacrificing the PCL increased the rollback of the contact point between the femur and tibia as the knee was flexed up to 90°.

Lúcio Honório de Carvalho Júnior

2011-01-01

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Nontraumatic Fracture of the Femoral Condylar Prosthesis in a Total Knee Arthroplasty Leading to Mechanical Failure  

Science.gov (United States)

This paper reports a case of fatigue fracture of the femoral component in a cruciate-retaining cemented total knee arthroplasty (TKA). A 64-year-old man had undergone a primary TKA for osteoarthritis 10 years previously at another institution using the PFC-Sigma prosthesis. The patient recovered fully and was back to his regular activities. He presented with a history of sudden onset pain and locking of the left knee since the preceding three months. There was no history of trauma, and the patient was mobilizing with difficulty using crutches. Radiographs revealed fracture of the posterior condyle of the femoral prosthesis. Revision surgery was performed as an elective procedure revealing the broken prosthesis. The TC3RP-PFC revision prosthesis was used with a medial parapatellar approach. The patient recovered fully without any squeal. Mechanical failure of the knee arthroplasty prosthesis is rare, and nontraumatic fracture of the femoral metallic component has not been reported before. PMID:24587928

Swamy, Girish N.; Quah, Conal; Bagouri, Elmunzar; Badhe, Nitin P.

2014-01-01

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Effect of posterior design changes on postoperative flexion angle in cruciate retaining mobile-bearing total knee arthroplasty  

Digital Repository Infrastructure Vision for European Research (DRIVER)

The Dual Bearing Knee (DBK) prosthesis is a new concept which has a mobile-bearing insert. In May 2001, the posterior femoral condyle design of the DBK was changed to become smaller and there was a posterior shift in the base of the insert dish (Hi-Flex). Between 1998 and 2004, 371 DBKs (112 Hi-Flex and 220 Standard) were performed by one surgical team. There was a significant difference in postoperative flexion angle between the Hi-Flex and Standard DBKs (117.0° and 111.3°; p?=?0.001)....

Tsuji, Shigeyoshi; Tomita, Tetsuya; Hashimoto, Hideo; Fujii, Masakazu; Yoshikawa, Hideki; Sugamoto, Kazuomi

2011-01-01

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Overview of Mandibular Condyle Fracture  

Directory of Open Access Journals (Sweden)

Full Text Available The mandibular condyle is a region that plays a key role in the opening and closing ofthe mouth, and because fracture causes functional and aesthetic problems such as facialasymmetry, it is very important to perform accurate reduction. Traditionally, there has beendisagreement on how to manage fracture of the mandibular condyle. This review exploresthe misunderstanding of mandibular condyle fracture treatment and modern-day treatmentstrategies.

Su-Seong Park

2012-07-01

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Biotribology of a mobile bearing posterior stabilised knee design--effect of motion restraint on wear, tibio-femoral kinematics and particles.  

Science.gov (United States)

The objective of our study was to evaluate the impact of a biphaseal anterior-posterior (AP) and internal-external (IE) motion restraint system on the wear behaviour, tibio-femoral kinematics and particle release of a mobile bearing posterior stabilised knee design in comparison to the widely used linear restraint. in vitro wear simulation was performed using a posterior stabilised total knee replacement with a mobile rotating platform gliding surface design to compare the standard ISO 14243-1:2002 (E) protocol with a linear AP and IE motion restraint and the new ISO 14243-1:2009 (E) protocol with a biphaseal AP and IE motion restraint. For the mobile gliding surfaces, an increase in wear rate by more than a magnitude was measured applying the biphaseal protocol (8.5±1.6 mg/million cycles) in a direct comparison to the linear protocol (0.33±0.07 mg/million cycles), with statistically significant difference. The amplitudes of AP displacement were 3.22±0.47 mm for the biphaseal test, compared to 1.97±0.22 mm in the linear test and the amplitudes of the IE rotation angle had mean values of 7.32°±0.91° under the biphaseal setup, compared to 1.97°±0.14° under linear motion restraint test conditions. From our observations, we conclude that the changes in AP translation and IE rotation motion restraints from ISO linear to ISO biphaseal test conditions highly impact the knee joint kinematics and wear behaviour of a mobile bearing posterior stabilised knee design. PMID:24837220

Grupp, Thomas M; Schroeder, Christian; Kyun Kim, Tae; Miehlke, Rolf K; Fritz, Bernhard; Jansson, Volkmar; Utzschneider, Sandra

2014-07-18

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A case report of unilateral hypertrophy of the mandibular condyle  

International Nuclear Information System (INIS)

Authors have observed a rare case of unilateral hypertrophy occurred in the left mandibular condyle of 25 year old man. In the serial roentgenograms, Authors have drawn following conclusions. 1. The patients face is markedly asymmetrical. The asymmetry consisted of elongation and widening of the left mandibular ramus, neck and head of condyle which pushed the chin to the other side. 2. Left mandibular angle is flattened, and mandibular inferior border is lower than right. 3. In the relationship of the left posterior teeth, severe mesioocclusion is occurred.

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A case report of unilateral hypertrophy of the mandibular condyle  

Energy Technology Data Exchange (ETDEWEB)

Authors have observed a rare case of unilateral hypertrophy occurred in the left mandibular condyle of 25 year old man. In the serial roentgenograms, Authors have drawn following conclusions. 1. The patients face is markedly asymmetrical. The asymmetry consisted of elongation and widening of the left mandibular ramus, neck and head of condyle which pushed the chin to the other side. 2. Left mandibular angle is flattened, and mandibular inferior border is lower than right. 3. In the relationship of the left posterior teeth, severe mesioocclusion is occurred.

Kim, Han Pyoung; Kim, Jong Youl; Kim, Seong Oak; Chung, Sung Chul [Department of Oral Diagnosis and Radiology, College of Dentistry, Yensei University, Seoul (Korea, Republic of)

1977-11-15

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A radiographic study of mandibular condyle shape and position a comparision of trascranial radiograms and individualized corrected tomograms  

International Nuclear Information System (INIS)

The purpose of this study was to observe mandibular condyle shape and position in an asymptomatic population. In order to carry out this study, 142 temporomandibular joints in 71 adults (35 males, 36 females), who were asymptomatic for temporomandibular joint disorders and had no history of prosthodontic or orthodontic treatments, were selected, and rad ideograph using the Accurd-200 head holder (Denar Co., U.S.A.) for lateral individualized corrected tomograms. Mandibular condyles were classified morphologically and evaluated in positional relationships with articular fossae and articular eminences at centric occlusion and 1 inch mouth opening. The obtained results were as follows : 1. In the classification of mandibular condyle shape, the convex type was more prevalent in trascranial radiograms and tomograms taken at medial, central, and lateral locations. 2. In the mandibular condyle position at centric occlusion, the mandibular condyles were placed posterior to the center of articular fossae in trascranial radiograns and anterior to the center of articular fossae in tomograms taken at medi al, central, and lateral locations. 3. In the mandibular condyle position in right and left TMJs at centric occlusion, the mandibular condyles were placed bilateral asymmetric relationships to the articular fossae in trascranial radiograms and tomograms taken at medial, central, and lateral location. 4. In the mandibular condyle position at 1 inch mouth opening, the mandibular condyles were placed anterior to the articular eminences in trascranial radiogramas and tomograms taken at central location and posterior to the articular eminences in tomograms taken at medial and lateral locations.

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Improved repair of chondral and osteochondral defects in the ovine trochlea compared with the medial condyle.  

Science.gov (United States)

Associations between topographic location and articular cartilage repair in preclinical animal models are unknown. Based on clinical investigations, we hypothesized that lesions in the ovine femoral condyle repair better than in the trochlea. Full-thickness chondral and osteochondral defects were simultaneously established in the weightbearing area of the medial femoral condyle and the lateral trochlear facet in sheep, with chondral defects subjected to subchondral drilling. After 6 months in vivo, cartilage repair and osteoarthritis development was evaluated by macroscopic, histological, immunohistochemical, and biochemical analyses. Macroscopic and histological articular cartilage repair and type-II collagen immunoreactivity were better in the femoral trochlea, regardless of the defect type. Location-independently, osteochondral defects induced more osteoarthritic degeneration of the adjacent cartilage than drilled chondral lesions. DNA and proteoglycan contents of chondral defects were higher in the condyle, reflecting physiological topographical differences. The results indicate that topographic location dictates the structural patterns and biochemical composition of the repair tissue in sheep. These findings suggest that repair of cartilage defects at different anatomical sites of the ovine stifle joint needs to be assessed independently and that the sheep trochlea exhibits cartilage repair patterns reflective of the human medial femoral condyle. PMID:23813860

Orth, Patrick; Meyer, Heinz-Lothar; Goebel, Lars; Eldracher, Mona; Ong, Mei Fang; Cucchiarini, Magali; Madry, Henning

2013-11-01

71

The resident's ridge as an arthroscopic landmark for anatomical femoral tunnel drilling in ACL reconstruction.  

Science.gov (United States)

The purposes of this study were to establish the technique to arthroscopically identify the resident's ridge without bony notchplasty even in patients with chronic ACL insufficiency and to elucidate if the ridge could be used as a landmark for anatomical femoral tunnel for ACL graft. There were 50 consecutive patients undergoing arthroscopic ACL reconstruction. With the thigh kept horizontal using a leg holder, a meticulous effort was made to find out a linear ridge running proximo-distal in a posterior one-third of the lateral notch wall, after removal of superficial soft tissue with radiofrequency energy. If the ridge was found, a socket with a rectangular aperture of 5 x 10 mm was created just behind the ridge. At 3-4-weeks post surgery, three-dimensional computed tomography (3-D CT) was performed to geographically identify the location of the ridge using the socket as a reference. Arthroscopically, a linear ridge running from superior-anterior to inferior-posterior on the lateral notch wall was consistently observed 7-10 mm anterior to the posterior articular cartilage margin of the lateral femoral condyle in all of the patients. The 3-D CT pictures proved the arthroscopically identified ridge to be the resident's ridge. The resident's ridge is arthroscopically identifiable after non-mechanical removal of the soft tissues without bony notchplasty. The ridge is a useful landmark for anatomical femoral tunnel drilling in arthroscopic ACL reconstruction. PMID:19915823

Shino, Konsei; Suzuki, Tomoyuki; Iwahashi, Takehiko; Mae, Tatsuo; Nakamura, Norimasa; Nakata, Ken; Nakagawa, Shigeto

2010-09-01

72

Increased post-operative ischemia in the femoral head found by microdialysis by the posterior surgical approach : a randomized clinical trial comparing surgical approaches in hip resurfacing arthroplasty  

DEFF Research Database (Denmark)

Hip resurfacing arthroplasty (HRA) is associated with osteonecrosis of the femoral head and femoral neck fracture, which may be caused by a decrease in the perfusion of the bone initiated at surgery. Several studies have demonstrated a decreased blood flow during surgery depending on the choice of surgical approach. We investigated the effect of the surgical approach on the blood flow and metabolism in the femoral head and neck in HRA by Laser Doppler flowmetry (LDF) and microdialysis.

Lorenzen, Nina Dyrberg; Stilling, Maiken

2013-01-01

73

Unsupervised definition of the tibia-femoral joint regions of the human knee and its applications to cartilage analysis  

Science.gov (United States)

Abnormal MR findings including cartilage defects, cartilage denuded areas, osteophytes, and bone marrow edema (BME) are used in staging and evaluating the degree of osteoarthritis (OA) in the knee. The locations of the abnormal findings have been correlated to the degree of pain and stiffness of the joint in the same location. The definition of the anatomic region in MR images is not always an objective task, due to the lack of clear anatomical features. This uncertainty causes variance in the location of the abnormality between readers and time points. Therefore, it is important to have a reproducible system to define the anatomic regions. This works present a computerized approach to define the different anatomic knee regions. The approach is based on an algorithm that uses unique features of the femur and its spatial relation in the extended knee. The femur features are found from three dimensional segmentation maps of the knee. From the segmentation maps, the algorithm automatically divides the femur cartilage into five anatomic regions: trochlea, medial weight bearing area, lateral weight bearing area, posterior medial femoral condyle, and posterior lateral femoral condyle. Furthermore, the algorithm automatically labels the medial and lateral tibia cartilage. The unsupervised definition of the knee regions allows a reproducible way to evaluate regional OA changes. This works will present the application of this automated algorithm for the regional analysis of the cartilage tissue.

Tamez-Peña, José G.; Barbu-McInnis, Monica; Totterman, Saara

2006-03-01

74

The role-share-influence of the posterior tibial slope on rupture of the anterior cruciate ligament  

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Full Text Available Background/Aim. Posterior tibial slope is one of the most citated factors wich cause rupture of the anterior cruciate ligament (ACL. The aim of this study was to determine the association of a greather posterior tibial slope on the lateral condyle, that is a lesser posterior tibial slope on the medial condyle, with ACL rupture. Methods. The patients were divided into two groups. The study group included the patients with chronic instability of the knee besause of a previous rupture of ACL. The control group included the patients with knee lesion, but without ACL rupture. Posterior tibial slope measuring was performed by sagittal MR slices supported by lateral radiograph of the knee. We measured posterior tibial slope on lateral and medial condyles of the tibia. Using these values we calculated an average posterior tibial slope as well as the difference between slopes on lateral and medial condyles. Results. Patients with ACL rupture have highly statistically significantly greather posterior tibial slope (p < 0.01 on lateral tibial condyle (7.1° : 4.5° as well as statistically significantly lesser posterior tibial slope (p < 0.05 on medial tibial condyle (5.0° : 6.6° than patients with intact ACL. Conclusion. Great posterior tibial slope on lateral tibial condyle associated with the small posterior tibial slope on the medial tibial condyle, that is a positive differentce between lateral and medial tibial condyles are factors wich may cause ACL rupture.

Stijak Lazar

2012-01-01

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THE INCREASED FEMORAL NECK ANTEVERSION IN MEDIEVAL CEMETERY OF PECENJEVCE: AETIOLOGY AND DIFFERENTIAL DIAGNOSIS IN ARCHAEOLOGICAL CONTEXT / ANTEVERSIÓN FEMORAL AUMENTADA EN EL CEMENTERIO MEDIEVAL DE PECENJEVCE: ETIOLOGÍA Y DIAGNÓSTICO DIFERENCIAL EN EL CONTEXTO ARQUEOLÓGICO  

Scientific Electronic Library Online (English)

Full Text Available SciELO Chile | Language: English Abstract in spanish Anteversión femoral se define como el ángulo entre el eje cérvico-cefálico y la tangente posterior bicondílea que pasa por el plano horizontal. Dado que no hay datos sobre el diagnóstico diferencial de esta característica en las poblaciones arqueológicas, la intención de este estudio fue investigar [...] anteversión femoral (FNA) en los esqueletos de una población medieval de Serbia. Los resultados demostraron valores de este ángulo de 11 a 24 grados en adultos, pero una persona tenía el ángulo de anteversión femoral significativamente aumentada (casi 60 grados). En la discusión hemos enfocado en el diagnóstico diferencial de alta FNA causada por diferente etiología, así como sobre las limitaciones diagnósticas en los huesos secos. La más probable etiología de aumento de FNA en nuestro caso es la forma asimétrica de parálisis cerebral. Revisión sistemática de la anteversión femoral puede demostrar las huellas de diversos trastornos ortopédicos y neuromusculares en las poblaciones humanas del pasado. Abstract in english The femoral neck anteversion (FNA) is defined as the angle between the longitudinal axis of the neck of a femur and the axis passing horizontally through femoral condyles. However, there is no data regarding this feature in archaeological populations. Therefore, the aim of this study was to investig [...] ate FNA in a medieval skeletal population from Serbia. According to the results the analysed angle ranged from 11 to 24 degrees in adults, apart from only one individual with significantly increased femoral neck anteversion of nearly 60 degrees. The discussion of the present paper is focused on the differential diagnosis of this condition and its aetiology, especially outlining diagnostic limitations when dealing with dry bones. Finally, the most probable aetiology of increased FNA in our case is the asymmetric form of cerebral palsy. Overall, the traces of various orthopaedic and neuromuscular disorders in past human populations could be revealed by systematic recording of the femoral neck anteversion during anthropological analyses.

Ksenija, Djukic; Petar, Milenkovic; Petar, Milovanovic; Milos, Dakic; Marija, Djuric.

76

Size, shape and age-related changes of the mandibular condyle during childhood  

International Nuclear Information System (INIS)

To determine age-related differences in the size and shape of the mandibular condyle in children to establish anatomical reference values. A total of 420 mandibular condyles in 210 children (mean age, 7 years) were retrospectively analysed by using computed tomography (CT) imaging. The greatest left-right (LRD) and anterior-posterior (APD) diameters and the anteversion angles (AA) were measured by two readers. An APD/LRD ratio was calculated. The shape of the condyles was graded into three types on sagittal images. Correlations of parameters with the children's age were assessed by using Pearson's correlation analyses. The LRD (mean, 14.1 ± 2.4 mm), APD (mean, 7.3 ± 1.0 mm) and LRD/APD ratio (mean, 1.9 ± 0.3) increased (rLRD = 0.70, p APD = 0.56, p rat = 0.28, p antang = -0.26, p < 0.001) with age. The condylar shape as determined on sagittal images correlated significantly with age (r = 0.69, p < 0.05). Boys had significantly higher anteversion angles (p < 0.01), greater LRDs (p < 0.05) and greater mean ratios (p < 0.05). The mandibular condyle is subject to significant age-related changes in size and shape during childhood. As the size of the condyles increases with age, the anteversion angles decrease and the shape of the condyle turns from round to oval. (orig.)

77

21 CFR 872.3960 - Mandibular condyle prosthesis.  

Science.gov (United States)

...2010-04-01 false Mandibular condyle prosthesis. 872.3960 Section 872.3960... § 872.3960 Mandibular condyle prosthesis. (a) Identification. A mandibular condyle prosthesis is a device that is intended to...

2010-04-01

78

Occipital condyle syndrome: self diagnosed  

Science.gov (United States)

We present the case of a 71-year-old man who presented to us with unilateral lower motor neuron hypoglossal palsy along with the characteristic occipital headache. He himself forwarded a paper on occipital condyle syndrome to the clinician who initially reviewed him. Later the patient underwent a series of investigations that confirmed the diagnosis of underlying prostatic carcinoma with widespread metastasis to bones including the base of the skull. Seven months after the diagnosis he is doing well, his headache is much better and the tongue deviation is stable. He was initially treated with tapering doses of dexamethasone and is currently receiving the depo gonadorelin analogue leuprorelin. PMID:21686711

Saraswat, Manoj Kumar; Perera, Ranjit W; Renwick, Ian; Zuromskis, Tadas; Singh, Vijay; Jones, Edward

2009-01-01

79

Multiple-slice spiral CT evaluation of occipital condyle fractures  

International Nuclear Information System (INIS)

Objective: To explore the MSCT findings of occipital condyle fracture (OCF) and improve its diagnostic accuracy. Methods: Nineteen patients with OCF, selected from 110 patients suffering high energy injuries at the craniocervical junction, were enrolled into the study. The MSCT appearances of OCFs were retrospectively analyzed by two experienced radiologists. OCF had four types: type ? was a comminuted fracture, type ? was a extension of basilar skull fracture, type ? was an avulsion fracture at the attachment site of alar ligament on occipital condyle, type ? was a fracture of mixed pattern consisting of two or more above fracture types. Results: In 19 patients, the left, right and bilateral OCFs were seen in 7, 11 cases, and 1 case, respectively. Type ? was found in one case, which was a comminution of the left occipital condyle. Type ? was found in 5 cases, which involved the middle and posterior parts of occipital condyles with 2 on the left and 3 on the right, Type ? was found in 12 cases which showed various degree of fragment displacement with 3 occurring on the left, 8 on the right, 1 involving bilateral sides, 6 involving articular surfaces and 7 accompanying by enlargement of alar ligaments. Type ? was found in one case, with coexistence of Type ? and type ? In addition, OCFs were accompanied by head and (or) cervical spine injuries in 14 cases, which included cranial fracture in 8 cases, epidural hematoma in 4 cases, subarachnoid hemorrhage in one case, cerebral contusion and laceration in one case, subfalcial hernia in one case, cervical spine fracture and dislocation in 9 cases, and so on. Conclusion: OCFs can be accurately diagnosed by MSCT, which is important for selection of treatment protocols. (authors)

80

Total hip replacement through a posterior approach using a 22 mm diameter femoral head : the role of the transverse acetabular ligament and capsular repair in reducing the rate of dislocation.  

Science.gov (United States)

Despite a lack of long-term follow-up, there is an increasing trend towards using femoral heads of large diameter in total hip replacement (THR), partly because of the perceived advantage of lower rates of dislocation. However, increasing the size of the femoral head is not the only way to reduce the rate of dislocation; optimal alignment of the components and repair of the posterior capsule could achieve a similar effect. In this prospective study of 512 cemented unilateral THRs (Male:Female 230:282) performed between 2004 and 2011, we aimed to determine the rate of dislocation in patients who received a 22 mm head on a 9/10 Morse taper through a posterior approach with capsular repair and using the transverse acetabular ligament (TAL) as a guide for the alignment of the acetabular component. The mean age of the patients at operation was 67 years (35 to 89). The mean follow-up was 2.8 years (0.5 to 6.6). Pre- and post-operative assessment included Oxford hip, Short Form-12 and modified University of California Los Angeles and Merle D'Aubigne scores. The angles of inclination and anteversion of the acetabular components were measured using radiological software. There were four dislocations (0.78%), all of which were anterior. In conclusion, THR with a 22 mm diameter head performed through a posterior approach with capsular repair and using the TAL as a guide for the alignment of the acetabular component was associated with a low rate of dislocation. PMID:25183591

Kumar, V; Sharma, S; James, J; Hodgkinson, J P; Hemmady, M V

2014-09-01

 
 
 
 
81

The structure of the mandibular condyle in the panoramic radiograph -II-  

International Nuclear Information System (INIS)

The author has evaluated the panoramic image of the mandibular condyle according to its horizontal condylar angle (00, 100, 200, 300, 400) and intercondlar distance (99.5, 11.0, 12.5,14.0 cm). The results were as follows: 1. In all horizontal condylar angle, the farther the intercondylar distance was, the smaller the horizontal length in radiogram was. 2. The increased the horizontal condylar angle was, the longer in horizontal direction and the shorter in vertical direction the image of superior condylar surface was. 3. In case of large horizontal condylar angle, the real mesial surface of condyle was projected to the posterior surface on radiograph.

82

The structure of the mandibular condyle in the panoramic radiograph -II-  

Energy Technology Data Exchange (ETDEWEB)

The author has evaluated the panoramic image of the mandibular condyle according to its horizontal condylar angle (00, 100, 200, 300, 400) and intercondlar distance (99.5, 11.0, 12.5,14.0 cm). The results were as follows: 1. In all horizontal condylar angle, the farther the intercondylar distance was, the smaller the horizontal length in radiogram was. 2. The increased the horizontal condylar angle was, the longer in horizontal direction and the shorter in vertical direction the image of superior condylar surface was. 3. In case of large horizontal condylar angle, the real mesial surface of condyle was projected to the posterior surface on radiograph.

Choi, Soon Chul [Dept. of Oral Radiology, College of Dentistry, Seoul National University, Seoul (Korea, Republic of)

1993-08-15

83

Relationship between the effect of medial rotation of the foot axis by ankle dorsiflexion and the ability to visualize the femoral neck axis in the hip joint anterio-posterior radiography. Evaluation by magnetic resonance images  

International Nuclear Information System (INIS)

In scanning of the hip joint anterio-posterior radiography, by changing the lower extremities to the extension position and moving the foot axis (base line of the foot) by medial rotation, the angle of anteversion of the femoral neck is corrected. In this study, we assessed the effects on medial rotation of the femoral neck when keeping the planta vertically-positioned by ankle dorsiflexion (intermediate position of the ankle) and making change of the medial rotation angle of the foot axis by scanning the magnetic resonance (MR) images of knee joints and hip joints. The subjects in this study were 12 males (age: 37.9±13.8, weight: 67.3±5.5 kg) and 7 females (age: 27.6±5.1, weight: 50.0±4.5 kg). We measured the medial rotation angles of knee joints and femoral necks on MR images. Also, differences of these angles between males and females were compared. Although the gender differences were not found in medial rotation angle of both joints at all leg positions (P>0.05), the medial rotation angles increased by approximately 1.5 to 2.0 times larger by putting them at the intermediate position, and there were significant differences between the naturally plantar-flexed position and the intermediate position (P<0.05). In conclusion, our results showed that the optimal leg position for correcting the angle of anteversion was 20 degrees medial rotation of the foot axis at the naturally plantar-flexed position, or 10 degrees medial rotation of the foot axis at the intermediate position, regardless of gender. (author)

84

Fatigue fracture of the femoral component in a mobile bearing knee prosthesis.  

Science.gov (United States)

Stress fracture of the femoral component is a rare complication following total knee arthroplasty. We report one such complication which occurred 6.5 years after primary implantation of an uncemented meniscal Low Contact Stress (LCS) prosthesis. The fracture affected the medial condyle of the femoral component, and a large osteolytic lesion was present in the underlying femoral condyle. The patient underwent revision arthroplasty with a cemented constrained condylar knee, which is still in place with a satisfactory result 12 years later. This complication appears to be very rare, although a number of cases probably go unreported. From data available in literature, it appears that stress fractures of the femoral component have predominantly affected the medial condyle, following uncemented implantation of fixed-bearing as well as mobile-bearing knees. Different mechanisms may be involved: specific design features of the implant, failure of bone ingrowth in uncemented components, and osteolysis from particulate wear debris. PMID:20503957

Lemaire, Roger

2010-04-01

85

Femoral hernia  

International Nuclear Information System (INIS)

A retrospective study of 18 patients with femoral hernia assessed by herniography is presented. Although a palpable lump was present in 11 patients (61%), the diagnosis of a femoral hernia was not made before herniography. Surgical exploration was performed in 12 patients and a femoral hernia was found and repaired with beneficial outcome in 9 of them. In conclusion: herniography is of value for the diagnosis of a femoral hernia in patients with obscure groin pain. (author). 14 refs.; 2 figs

86

Evaluation of condyle defects using different reconstruction protocols of cone-beam computed tomography  

Energy Technology Data Exchange (ETDEWEB)

This study was conducted to investigate how well cone-beam computed tomography (CBCT) can detect simulated cavitary defects in condyles, and to test the influence of the reconstruction protocols. Defects were created with spherical diamond burs (numbers 1013, 1016, 3017) in superior and / or posterior surfaces of twenty condyles. The condyles were scanned, and cross-sectional reconstructions were performed with nine different protocols, based on slice thickness (0.2, 0.6, 1.0 mm) and on the filters (original image, Sharpen Mild, S9) used. Two observers evaluated the defects, determining their presence and location. Statistical analysis was carried out using simple Kappa coefficient and McNemar’s test to check inter- and intra-rater reliability. The chi-square test was used to compare the rater accuracy. Analysis of variance (Tukey's test) assessed the effect of the protocols used. Kappa values for inter- and intra-rater reliability demonstrate almost perfect agreement. The proportion of correct answers was significantly higher than that of errors for cavitary defects on both condyle surfaces (p < 0.01). Only in identifying the defects located on the posterior surface was it possible to observe the influence of the 1.0 mm protocol thickness and no filter, which showed a significantly lower value. Based on the results of the current study, the technique used was valid for identifying the existence of cavities in the condyle surface. However, the protocol of a 1.0 mm-thick slice and no filter proved to be the worst method for identifying the defects on the posterior surface. (author)

Bastos, Luana Costa; Campos, Paulo Sergio Flores, E-mail: bastosluana@ymail.com [Universidade Federal da Bahia (UFBA), Salvador, BA (Brazil). Fac. de Odontologia. Dept. de Radiologia Oral e Maxilofacial; Ramos-Perez, Flavia Maria de Moraes [Universidade Federal de Pernambuco (UFPE), Recife, PE (Brazil). Fac. de Odontologia. Dept. de Clinica e Odontologia Preventiva; Pontual, Andrea dos Anjos [Universidade Federal de Pernambuco (UFPE), Camaragibe, PE (Brazil). Fac. de Odontologia. Dept. de Radiologia Oral; Almeida, Solange Maria [Universidade Estadual de Campinas (UNICAMP), Piracicaba, SP (Brazil). Fac. de Odontologia. Dept. de Radiologia Oral

2013-11-15

87

Femoral head vitality at reoperation for femoral neck fracture complications.  

Science.gov (United States)

In seven patients suffering redisplacement, nonunion or segmental collapse after nailing of femoral neck fractures, subsequent changes in the vitality of the femoral head were studied with tetracycline labeling and 99mTc-MDP scintimetry. At reoperation (total hip arthroplasty), the femoral heads were extracted and sawn into slices which were then analyzed. Vitality before nailing was totally lacking (tetracycline labeling) in one case (nonunion), and in the remaining cases moderate reduction was seen, most pronounced in the apical part of the head. In all cases, scintimetry 1-2 weeks after nailing showed reduced femoral head uptake of 99mTc-MDP, but scintimetry some hours before reoperation showed increased femoral head uptake. Isotope analysis of the slices from the extracted femoral heads showed marked reduction of uptake in the apical part of the head, moderate reduction in the distal and anterior parts, and satisfactory uptake in the posterior part of the head and the foveal region, though with individual variations. It was concluded that there is a genuine increase in uptake (revascularization) later in the course in postoperatively avascular heads, and that the apical part of the femoral head sustains the most pronounced vascular damage in femoral neck fracture and is probably the slowest to revascularize. PMID:6239605

Strömqvist, B; Hansson, L I; Palmer, J; Thorngren, K G

1984-01-01

88

Extra corporeal fixation of fractured mandibular condyle.  

Science.gov (United States)

Condylar fracture is the second most common site in the mandibular fractures. Motor vehicle accident and fall are the major causes of such fractures. Because of the anatomical weakness of the condyle and the shape of the condylar head the antero-medial dislocation of the condyle is common. Open reduction and closed reduction is always debatable. The open reduction will bring back the normal function much earlier than closed reduction. Medially dislocated condylar fracture fragments are always managed with open method. In superior or high condylar fractures,exact reduction with conventional open reduction can be difficult due to the limited surgical and visual fields. In such cases extracorporeal fixation of condyle using vertical ramus osteotomy may be better choice to achieve perfect alignment and absolute maintaince of vertical height of the ramus and facial symmetry. We here present a case of extracorporeal fixation of unilateral left high condylar fracture. PMID:25386546

Kannadasan, Kamal; Shenoy K, Vandana; Kengagsubbiah, Srivatsa; V, Sathyabhama; Priya, Vishnu

2014-09-01

89

21 CFR 872.3960 - Mandibular condyle prosthesis.  

Science.gov (United States)

...2010-04-01 false Mandibular condyle prosthesis. 872.3960 Section 872.3960 Food and Drugs FOOD AND DRUG ADMINISTRATION...MEDICAL DEVICES DENTAL DEVICES Prosthetic Devices § 872.3960 Mandibular condyle prosthesis. (a)...

2010-04-01

90

Modeling of the condyle elements within a biomechanical knee model  

DEFF Research Database (Denmark)

The development of a computational multibody knee model able to capture some of the fundamental properties of the human knee articulation is presented. This desideratum is reached by including the kinetics of the real knee articulation. The research question is whether an accurate modeling of the condyle contact in the knee will lead to reproduction of the complex combination of flexion/extension, abduction/adduction, and tibial rotation observed in the real knee. The model is composed by two anatomic segments, the tibia and the femur, whose characteristics are functions of the geometric and anatomic properties of the real bones. The biomechanical model characterization is developed under the framework of multibody systems methodologies using Cartesian coordinates. The type of approach used in the proposed knee model is the joint surface contact conditions between ellipsoids, representing the two femoral condyles, and points, representing the tibial plateau and the menisci. These elements are closely fitted to the actual knee geometry. This task is undertaken by considering a parameter optimization process to replicate experimental data published in the literature, namely that by Lafortune and his coworkers in 1992. Then kinematic data in the form of flexion/extension patterns are imposed on the model corresponding to the stance phase of the human gait. From the results obtained, by performing several computational simulations, it can be observed that the knee model approximates the average secondary motion patterns observed in the literature. Because the literature reports considerable inter-individual differences in the secondary motion patterns, the knee model presented here is also used to check whether it is possible to reproduce the observed differences with reasonable variations of bone shape parameters. This task is accomplished by a parameter study, in which the main variables that define the geometry of condyles are taken into account. It was observed that the data reveal a difference in secondary kinematics of the knee in flexion versus extension. The likely explanation for this fact is the elastic component of the secondary motions created by the combination of joint forces and soft tissue deformations. The proposed knee model is, therefore, used to investigate whether this observed behavior can be explained by reasonable elastic deformations of the points representing the menisci in the model.

Ribeiro, Ana; Rasmussen, John

2012-01-01

91

Evaluation of condyle defects using different reconstruction protocols of cone-beam computed tomography  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in english This study was conducted to investigate how well cone-beam computed tomography (CBCT) can detect simulated cavitary defects in condyles, and to test the influence of the reconstruction protocols. Defects were created with spherical diamond burs (numbers 1013, 1016, 3017) in superior and/or posterior [...] surfaces of twenty condyles. The condyles were scanned, and cross-sectional reconstructions were performed with nine different protocols, based on slice thickness (0.2, 0.6, 1.0 mm) and on the filters (original image, Sharpen Mild, S9) used. Two observers evaluated the defects, determining their presence and location. Statistical analysis was carried out using simple Kappa coefficient and McNemar's test to check inter- and intra-rater reliability. The chi-square test was used to compare the rater accuracy. Analysis of variance (Tukey's test) assessed the effect of the protocols used. Kappa values for inter- and intra-rater reliability demonstrate almost perfect agreement. The proportion of correct answers was significantly higher than that of errors for cavitary defects on both condyle surfaces (p

Luana Costa, Bastos; Paulo Sergio Flores, Campos; Flavia Maria de Moraes, Ramos-Perez; Andrea dos Anjos, Pontual; Solange Maria, Almeida.

2013-12-01

92

The radiologic spectrum of occipital condyle fractures  

International Nuclear Information System (INIS)

Full text: Occipital condyle fractures (OCFs) are increasingly diagnosed in survivors of high energy blunt trauma, and may be associated with craniocervical junction disruption.We aimed to describe and classify the imaging appearances of occipital condyle fractures in a large series of trauma patients. We reviewed conventional radiographs, computed tomography (CT), and magnetic resonance (MR) imaging in 95 patients with 107 OCFs, who were treated at a level 1 trauma centre (1992-1999). We described fracture patterns according to two current classification systems (Anderson and Montesano, and Tuli), and correlated imaging appearances with clinical findings, neurosurgical management and patient outcome. Fracture morphology and craniocervical junction integrity were best assessed by 1-1.5mm collimation CT. Inferomedial occipital condyle avulsion fractures (Anderson and Montesano type III) were the commonest OCF category, comprising 80/107 (75%). Unilateral OCFs were found in 73/95 (77%) patients, 58 of whom were managed by cervical orthotic brace or collar. Bilateral OCFs or occipito-atlanto-axial joint injuries were seen in the remaining 22/95 (23%) patients. Occipitocervical fusion or craniocervical halo traction were required in 12 patients, all of whom had CT evidence of bilateral occipito-atlanto-axial joint disruption. Associated cervical spine injuries were present in 29/95 (31%) patients. Ten (10/95, 10.5%) patients died in hospital, and 30/95 (32%) showed continuing disability. The remaining 55/95 (57.5%) patients showed good outcome and functional independence at 1 month. Occipital condyle fractures are rare injuries with a wide range of morphology, stability and clinical significance. Thorough radiological evaluation of all components of the occipito-atlanto-axial joint complex must be performed in order to determine the full extent of injury. In this series, most unilateral OCFs were managed by non-operative immobilisation, whereas bilateral occipito-atlanto-axial joint injuries often required neurosurgical stabilisation. Copyright (2002) Blackwell Science Pty Ltd

93

TMJ in facial class III deformity. Condyle/fossa relations  

Science.gov (United States)

The aim of this study was to ascertain the joint space present in the TMJ of subjects diagnosed with Class III dentofacial deformity with an indication for orthognathic surgery. Fourteen subjects were recruited from the Division of Oral and Maxillofacial Surgery at the Universidad de La Frontera, Chile. All subjects were admitted to the study after signing an informed consent and undergoing cephalometric analyses to define the severity of the deformity. Then, the joint space was analyzed, studying a cone beam CT image of the TMJ, which was evaluated in the coronal and sagittal views, defining the most anterior, median and posterior joint space (sagittal view), as well as the lateral, median and medial joint space (coronal view). The data were recorded in millimeters by an observer and data were analyzed after measuring the same parameter at three different times. A student’s t-test was used for the analyses. Differences observed in both joints were not greater than 0.2 mm with spaces between 2 mm and 1.5 mm, thereby establishing the homogeneity of the sample, which presented no significant differences between the two joint spaces (right and left). It can be concluded that the joint space is symmetrical in both condyles and that no important changes are present compared to the results indicated in the international literature. PMID:25356133

Munoz, Gonzalo; Olate, Sergio; Cantin, Mario; Vasquez, Belgica; del Sol, Mariano; Farina, Rodrigo

2014-01-01

94

Reconstrução do ligamento cruzado posterior com enxerto autólogo do tendão do músculo semitendinoso duplo e do terço médio do tendão do quadríceps em duplo túnel no fêmur e único na tíbia: resultados clínicos em dois anos de seguimento / Posterior cruciate ligament reconstruction with autograft of the double semitendinosus muscles and middle third of the quadriceps tendon with double femoral and single tibial tunnels: clinical results in two years follow up  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese OBJETIVO: Avaliar os aspectos cirúrgicos que possam oferecer bons resultados anatômicos e funcionais na reconstrução do ligamento cruzado posterior (LCP) utilizando enxerto autólogo do tendão do quadríceps e duplo semitendinoso através de um túnel femoral duplo. MÉTODOS: Quatorze pacientes com lesõe [...] s isoladas do LCP, instabilidade e dor foram operados por artroscopia e avaliados de acordo com as escalas do International Knee Documentation Committee (IKDC) e de Lysholm. A lassidão foi examinada com o artrômetro KT 1000. RESULTADOS: Na avaliação pós-operatória, a translação posterior comparando-se com joelho contralateral foi entre 0-2mm em 57,1% dos pacientes e entre 3 e 5mm em 35,7% dos casos. A média da escala de Lysholm foi de 93 pontos na avaliação final. Na avaliação pelo IKDC, três pacientes tiveram grau A, 10 grau B e 1 teve grau C. Conclusões: A reconstrução artroscópica do LCP com feixe duplo baseada no posicionamento anatômico dos túneis, com tendão duplo semitendinoso e único do quadríceps, oferece redução clinicamente evidente dos sintomas e recupera satisfatoriamente a estabilidade, embora diferença significativa não tenha sido encontrada devido ao pequeno tamanho da amostra. Abstract in english OBJECTIVE: To evaluate the surgical aspects that may offer good anatomic and functional results in posterior cruciate ligament (PCL) reconstruction using an autologous graft of the quadriceps tendon and double semitendinosus through a double femoral tunnel. METHODS: Fourteen patients with isolated P [...] CL lesions, instability and pain were operated on by arthroscopy and evaluated according to the International Knee Documentation Committee (IKDC) and Lysholm scales. Posterior knee laxity was examined with a KT 1000 arthrometer. RESULTS: The mean postoperative posterior side-to-side difference was between 0-2 mm in 57.1% of patients and between 3 and 5 mm in 35.7% of cases. The average Lysholm score was 93 points in the final follow-up. In the IKDC evaluation, 3 patients were graded A, 10 were graded B, and 1 patient was graded C. Conclusions: Double bundle arthroscopic PCL reconstruction based on the anatomical positioning of the tunnels, with double semitendinosus tendon and single quadriceps, provides a clinically evident reduction in symptoms and restores satisfactory stability, although no statistically significant difference was found due to the small sample.

Ricardo de Paula Leite, Cury; Nilson Roberto, Severino; Osmar Pedro Arbix, Camargo; Tatsuo, Aihara; Victor Marques de, Oliveira; Roger, Avakian.

2012-02-01

95

Reconstrução do ligamento cruzado posterior com enxerto autólogo do tendão do músculo semitendinoso duplo e do terço médio do tendão do quadríceps em duplo túnel no fêmur e único na tíbia: resultados clínicos em dois anos de seguimento Posterior cruciate ligament reconstruction with autograft of the double semitendinosus muscles and middle third of the quadriceps tendon with double femoral and single tibial tunnels: clinical results in two years follow up  

Directory of Open Access Journals (Sweden)

Full Text Available OBJETIVO: Avaliar os aspectos cirúrgicos que possam oferecer bons resultados anatômicos e funcionais na reconstrução do ligamento cruzado posterior (LCP utilizando enxerto autólogo do tendão do quadríceps e duplo semitendinoso através de um túnel femoral duplo. MÉTODOS: Quatorze pacientes com lesões isoladas do LCP, instabilidade e dor foram operados por artroscopia e avaliados de acordo com as escalas do International Knee Documentation Committee (IKDC e de Lysholm. A lassidão foi examinada com o artrômetro KT 1000. RESULTADOS: Na avaliação pós-operatória, a translação posterior comparando-se com joelho contralateral foi entre 0-2mm em 57,1% dos pacientes e entre 3 e 5mm em 35,7% dos casos. A média da escala de Lysholm foi de 93 pontos na avaliação final. Na avaliação pelo IKDC, três pacientes tiveram grau A, 10 grau B e 1 teve grau C. Conclusões: A reconstrução artroscópica do LCP com feixe duplo baseada no posicionamento anatômico dos túneis, com tendão duplo semitendinoso e único do quadríceps, oferece redução clinicamente evidente dos sintomas e recupera satisfatoriamente a estabilidade, embora diferença significativa não tenha sido encontrada devido ao pequeno tamanho da amostra.OBJECTIVE: To evaluate the surgical aspects that may offer good anatomic and functional results in posterior cruciate ligament (PCL reconstruction using an autologous graft of the quadriceps tendon and double semitendinosus through a double femoral tunnel. METHODS: Fourteen patients with isolated PCL lesions, instability and pain were operated on by arthroscopy and evaluated according to the International Knee Documentation Committee (IKDC and Lysholm scales. Posterior knee laxity was examined with a KT 1000 arthrometer. RESULTS: The mean postoperative posterior side-to-side difference was between 0-2 mm in 57.1% of patients and between 3 and 5 mm in 35.7% of cases. The average Lysholm score was 93 points in the final follow-up. In the IKDC evaluation, 3 patients were graded A, 10 were graded B, and 1 patient was graded C. Conclusions: Double bundle arthroscopic PCL reconstruction based on the anatomical positioning of the tunnels, with double semitendinosus tendon and single quadriceps, provides a clinically evident reduction in symptoms and restores satisfactory stability, although no statistically significant difference was found due to the small sample.

Ricardo de Paula Leite Cury

2012-02-01

96

Mandibular condyle position in cone beam computed tomography  

International Nuclear Information System (INIS)

To evaluate position of the mandibular condyle within articular fossa in an asymptomatic population radiographically by a cone beam computed tomography. Cone beam computed tomography of 60 temporomandibular joints was performed on 15 males and 15 females with no history of any temporomandibular disorders, or any other orthodontic or photoconductors treatments. Position of mandibular condyle within articular fossa at centric occlusion was evaluated. A statistical evaluation was done using a SPSS. In the sagittal views, mandibular condyle within articular fossa was laterally located at central section. Mandibular condyles in the right and left sides were showed asymmetric positional relationship at medial, central, and lateral sections. Mandibular condyle within articular fossa in an asymptomatic population was observed non-concentric position in the sagittal and coronal views

97

The relationship between posterior tibial slope and anterior cruciate ligament injury  

Directory of Open Access Journals (Sweden)

Full Text Available Introduction. The aim of this study was to identify an increased posterior tibial slope as a possible risk factor for anterior cruciate ligament injury. Material and Methods. Sixty patients were divided into two groups (with and without anterior cruciate ligament rupture. The posterior tibial slope on the lateral and medial condyles was measured by sagittal magnetic resonance imaging slices by means of computerized method using circles to determine tibial axis. Results. The patients with anterior cruciate ligament rupture had a statistically significantly (p=0.06 greater posterior tibial slope on the lateral tibial condyle than the control group (6.68º:5.64º, and a greater slope on the medial condyle (5.49º:4.67º in comparison to the patients with the intact anterior cruciate ligament. No significant difference in the average values of angles was observed between males and females with anterior cruciate ligament rupture, the average value being 6.23º in men and 5.84º in women on the lateral condyle, and 4.53º in men and 4.53º in women on the medial condyle. Discussion and Conclusion. A statistically significant difference between the values of posterior tibial slope was observed between the groups with and without anterior cruciate ligament rupture, the sex having no affect on the value of the posterior tibial slope. The method of measuring angles should be unique.

Risti? Vladimir

2014-01-01

98

Positional change of the condyle after orthodontic-orthognathic surgical treatment: is there a relationship to skeletal relapse?  

Science.gov (United States)

Objectives The purpose of this study was to evaluate the condylar position in relation to the glenoid fossa before and after orthodontic-orthognathic surgical treatment and to investigate the relationship with skeletal relapse. Materials and Methods Lateral cephalograms and temporomandibular joint tomograms from 19 patients with mandibular prognathism who received orthodontic-orthognathic surgery were included in this study. Samples were divided into two groups based on skeletal change during the retention period. The relapse group consisted of 7 patients (3 females and 4 males; mean age, 21.9 years) whose pogonion or menton displaced more than 1 mm during the retention period and the stable group consisted of 12 patients (5 females and 7 males; mean age, 21.7 years). Anterior joint space, posterior joint space, superior joint space, and anteroposterior index were measured on tomograms at pretreatment and posttreatment timepoints. Condyle position and frequency of the positional change were compared between both groups. Results In the relapse group and stable group, 42.9% and 45.8% of the condyles, respectively, showed forward or backward displacement at posttreatment. However, the changes were small and the mean anterior, posterior, superior joint spaces and frequencies of the positional changes did not differ statistically between both groups. Conclusion Our results suggest that small positional changes of the condyle, which may occur after orthodontic-orthognathic surgery treatment, may not be related to skeletal relapse after removal of the orthodontic appliances.

Zafar, Husanov; Jang, Insan; Cha, Bong-Kuen; Park, Young-Wook

2014-01-01

99

Aneurysmal Bone Cyst located in the Mandibular Condyle  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract A rare case of aneurysmal bone cyst (ABC located in the mandibular condyle in a 10-year-old boy is presented. The patient came to our attention for a sudden swelling in the right temporomandibular region, the mouth opening was not reduced. A rapid growing mass, depicting soft tissue invasion, in the right condyle of the mandible was found. Clinically and radiographically it resembled to a malignant lesion. The surgical excision of the mandibular condyle allowed a complete removal of the lesion. The histological examination revealed a pseudocystic expanding osteolytic lesion containing blood-filled space separated by connective tissue and many osteoclastic giant cells, which was a conventional vascular ABC. The ABC is an infrequent bone lesion which can only be found very rarely at the craniofacial skeleton. There have been described about 160 cases of ABC originated in the molar region or in upper maxilla and even more rare is the location of this cyst in the mandibular condyle. Only 6 cases were reported in the literature to date. A complete surgical resection of this osteolytic lesion is the treatment of choice considering its high recurrence rate. The condyle was not replaced with any graft. Therefore a functional device was used after surgery to overcome the lack of the condyle and to stimulate the growth of the ramus.

Moro Alessandro

2009-02-01

100

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

Science.gov (United States)

Hoffa fracture associated with ipsilateral femoral shaft fracture is very rare. Three cases of this rare type of injury were retrospectively reviewed. The sites of femoral shaft fractures and Hoffa fractures were documented. All femoral shaft fractures were managed with internal fixation. The rate of misdiagnosis for the Hoffa fractures was documented. Functions of the affected knees were evaluated according to the modified Hospital for Special Surgery (HSS) scores at two years follow-up. Femoral fractures were either transverse or composite in all three cases. Ipsilateral Hoffa fractures occurred at medial condyle in two cases, and lateral condyle in one case. Only one Hoffa fracture was identified preoperatively. All the femoral shaft fractures healed uneventfully. In the patient whose Hoffa fracture was correctly diagnosed, the modified HSS score was 94. In another patient, whose Hoffa fracture was treated by a second operation, the modified HSS score was 93. And in the third case, who refused additional operation for the Hoffa fracture, the modified HSS score was only 70. Conclusively femoral shaft fracture can be associated with ipsilateral Hoffa fracture, especially in motorcycle accident. This type of injury is very rare and misdiagnosis is common. PMID:22152144

Gong, Yu-Bao; Li, Qing-Song; Yang, Chen; Li, Shu-Qiang; Liu, Jian-Guo; Qi, Xin

2011-01-01

 
 
 
 
101

Total Knee Arthroplasty Designed to Accommodate the Presence or Absence of the Posterior Cruciate Ligament  

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Evidence for selecting the same total knee arthroplasty prosthesis whether the posterior cruciate ligament (PCL) is retained or resected is rarely documented. This study reports prospective midterm clinical, radiographic, and functional outcomes of a fixed-bearing design implanted using two different surgical techniques. The PCL was completely retained in 116 knees and completely resected in 43 knees. For the entire cohort, clinical knee (96 ± 7) and function (92 ± 13) scores and radiographic outcomes were good to excellent for 84% of patients after 5–10 years in vivo. Range of motion averaged 124° ± 9°, with 126 knees exhibiting ?120° flexion. Small differences in average knee flexion and function scores were noted, with the PCL-resected group exhibiting an average of 5° more flexion but an average function score that was 7 points lower compared to the PCL-retained group. Fluoroscopic analysis of 33 knees revealed stable tibiofemoral translations. This study demonstrates that a TKA articular design with progressive congruency in the lateral compartment can provide for femoral condyle rollback in maximal flexion activities and achieve good clinical and functional performance in patients with PCL-retained and PCL-resected TKA. This TKA design proved suitable for use with either surgical technique, providing surgeons with the choice of maintaining or sacrificing the PCL. PMID:25374697

Harman, Melinda K.; Bonin, Stephanie J.; Leslie, Chris J.; Banks, Scott A.; Hodge, W. Andrew

2014-01-01

102

Total knee arthroplasty designed to accommodate the presence or absence of the posterior cruciate ligament.  

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Evidence for selecting the same total knee arthroplasty prosthesis whether the posterior cruciate ligament (PCL) is retained or resected is rarely documented. This study reports prospective midterm clinical, radiographic, and functional outcomes of a fixed-bearing design implanted using two different surgical techniques. The PCL was completely retained in 116 knees and completely resected in 43 knees. For the entire cohort, clinical knee (96 ± 7) and function (92 ± 13) scores and radiographic outcomes were good to excellent for 84% of patients after 5-10 years in vivo. Range of motion averaged 124° ± 9°, with 126 knees exhibiting ?120° flexion. Small differences in average knee flexion and function scores were noted, with the PCL-resected group exhibiting an average of 5° more flexion but an average function score that was 7 points lower compared to the PCL-retained group. Fluoroscopic analysis of 33 knees revealed stable tibiofemoral translations. This study demonstrates that a TKA articular design with progressive congruency in the lateral compartment can provide for femoral condyle rollback in maximal flexion activities and achieve good clinical and functional performance in patients with PCL-retained and PCL-resected TKA. This TKA design proved suitable for use with either surgical technique, providing surgeons with the choice of maintaining or sacrificing the PCL. PMID:25374697

Harman, Melinda K; Bonin, Stephanie J; Leslie, Chris J; Banks, Scott A; Hodge, W Andrew

2014-01-01

103

Classification of fractures of the tibial condyles.  

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We analysed 131 fractures of the tibial condyles in 130 patients, using a modification of the classification of Schatzker, McBroom and Bruce (1979). The patients were reviewed at an average of 7.6 years after the injury. Fifty-five (42%) fractures had been treated conservatively and 76 (58%) operatively. Medial unicondylar and medially tilted bicondylar fractures tended to redisplace into varus position and lateral unicondylar and laterally tilted bicondylar fractures into valgus. There were significant differences when the results were evaluated according to the methods of Hohl and Luck (1956) and Rasmussen (1973). Using our method in conservatively treated cases, the subjective results were acceptable in 49.1%, the functional results in 60.0% and the clinical results in 52.7%. In cases treated by operation the equivalent figures were 57.9%, 73.7% and 52.6%. The poorest results followed displaced medial condylar and medially tilted bicondylar fractures. Varus alignment of the tibial plateau was tolerated worse than valgus alignment. PMID:1447244

Honkonen, S E; Järvinen, M J

1992-11-01

104

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

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Full Text Available The incidence of condylar fractures is high,but the management of fractures of the mandibularcondyle continues to be controversial. Historically, maxillomandibular fixation, externalfixation, and surgical splints with internal fixation systems were the techniques commonlyused in the treatment of the fractured mandible. Condylar fractures can be extracapsularor intracapsular, undisplaced, deviated, displaced, or dislocated. Treatment depends on theage of the patient, the co-existence of other mandibular or maxillary fractures, whether thecondylar fracture is unilateral or bilateral, the level and displacement of the fracture, thestate of dentition and dental occlusion, and the surgeonnds on the age of the patient, theco-existence of othefrom which it is difficult to recover aesthetically and functionally;anappropriate treatment is required to reconstruct the shape and achieve the function oftheuninjured status. To do this, accurate diagnosis, appropriate reduction and rigid fixation, andcomplication prevention are required. In particular, as mandibular condyle fracture may causelong-term complications such as malocclusion, particularly open bite, reduced posterior facialheight, and facial asymmetry in addition to chronic pain and mobility limitation, great cautionshould be taken. Accordingly, the authors review a general overview of condyle fracture.

Kang-Young Choi

2012-07-01

105

Enlarging bilateral femoral condylar bone cysts without scintigraphic uptake in a yearling foal  

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Bilateral subchondral bone cysts of the femoral condyles were diagnosed by conventional radiography in a 14 month old Appaloosa colt. Surgical debridement was performed, and over the next 18 months the appearance of the cysts was evaluated with radiography and bone scintigraphy. On the preoperative scintigrams, increased radiopharmaceutical uptake was associated with the cysts. Despite continued radiographic enlargement, the cysts did not demonstrate increased radiopharmaceutical uptake post-operatively

106

Conservative orthodontic treatment of mandibular bilateral condyle fracture.  

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Maxillofacial trauma is rare in children younger than the age of 5 years (range 0.6%-1.2%), and they can require different clinical treatment strategies compared with fractures in the adult population because of concerns regarding mandibular growth and development of dentition. A 5-year-old girl with a history of falling from a bicycle 7 hours earlier was referred to the department of oral and maxillofacial surgery. Multislice computed tomographic examination demonstrated a bilateral fracture of the mandibular condyle neck associated with minimal fracture of the alveolar ridge of the maxilla. The multislice computed tomographic scan also demonstrated dislocation on the right condyle neck and, on the left side, a medial inclination of approximately 45 degrees associated with greenstick fracture of the right parasymphysis region. In this particular case, orthodontic rubber elastics in combination with fixed orthodontic brackets provided good results in the treatment of bilateral condyle neck fractures associated with greenstick fracture of parasymphysis. PMID:25098573

Gašpar, Goran; Brakus, Ivan; Kova?i?, Ivan

2014-09-01

107

Influence of Unerupted Third Molars on Angle and Condyle Fracture  

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Full Text Available Condylar and angle fractures are the most common types of mandibular injuries. There is evidence in the literature suggesting that the presence of unerupted lower third molars increases the risk of angle fracture and reduces the chance of condyle fracture. The present paper reports on a case of a 19-year-old Caucasian man who had bilateral angle fracture associated with the two lower unerupted third molars. No other fracture was detected on the panoramic radiograph. This case suggests that unerupted lower third molars increase the risk of angle fracture whereas preventing condyle fracture. Reduction of the bone mass of the angle in the presence of third molars and disruption of the oblique ridge with partially erupted molars support our fi ndings. As the treatment of condyle fracture is more complex, it might not be appropriate to strengthen the mandibular angle, making the mandible more vulnerable to condylar fractures by means of prophylactic extraction of asymptomatic unerupted third molars.

Sergio Lins de-Azevedo-Vaz

2012-01-01

108

Approximation of the functional kinematics of posterior stabilised total knee replacements using a two-dimensional sagittal plane patello-femoral model: comparing model approximation to in vivo measurement.  

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Previous in vivo studies have observed that current designs of posterior stabilised (PS) total knee replacements (TKRs) may be ineffective in restoring normal kinematics in Late flexion. Computer-based models can prove a useful tool in improving PS knee replacement designs. This study investigates the accuracy of a two-dimensional (2D) sagittal plane model capable of predicting the functional sagittal plane kinematics of PS TKR implanted knees against direct in vivo measurement. Implant const...

Duren, B.; Pandit, H.; Murray, D.; Gill, H.

2014-01-01

109

A clinico-radiologic study of bony remodeling of the fractured condyles in children  

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Bony remodeling pattern of condyle fractures in children are different from in adult for growing of condyle, also might affect treatment and prognosis of the condyle fracture. Subjects of this clinical and radiologic study were 26 temporomandibular joints diagnosed as condyle fracture in 23 patients under 15 years old age, They were treated with conservative method at Dental Hospital of Yonsei University from Jan., 1986 to Oct., 1994. Bony remodeling related with fracture pattern was evaluated. The results obtained are as follows: 1. The ratio of male to female in patients with condyle fracture was 1 : 0.9 and the difference of sex ratio was not noted. Comparing with preschool-age group and school-age group, age frequency was higher in preschool-age group (83%). 2. Fallen down (54%) was the most frequent cause of condyle fractures. Traffic accident and slip down were followed. 3. The most common clinical sign of condyle fractures was tenderness to palpation (19 cases). Mouth opening limitation (17 cases), swelling (7 cases), malocclusion (3 cases) were next in order. 4. According to sites of condyle fractures, unilateral fractures were in 20 patients and bilateral fractures in 3 patients, therefore total 23 patients-26 cases of condyle fracture were observed. According to fracture distribution, condyle fractures were in 10 patients (44%). Condyle fractures with symphysis fracture (9 patients, 39%), condyle fractures with ascending ramus fracture (2 patients, 9%), condyle fracture with mandibular body fracture (1 patient, 4%), and condyle fractures with mandibular angle fracture (1 patient, 4%) were followed. 5. In displacement pattern of fractured fragment of mandibular condyle, displacement (17 cases, 66%) was most common. Dislocation (5 cases, 19%) and deviation (4 cases, 15%) were next in order. 6. During the observation period of fractured condyles, remodeling patterns of fracture sites related with articular fossa were observed with usual congealer shape in 23 cases and with prominently different shape in 3 cases.

Cho, Jeong Shin; Park, Chang Seo [Department of Dentistry, The Graduate School, Yonsei University, Seoul (Korea, Republic of)

1995-08-15

110

A clinico-radiologic study of bony remodeling of the fractured condyles in children  

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Bony remodeling pattern of condyle fractures in children are different from in adult for growing of condyle, also might affect treatment and prognosis of the condyle fracture. Subjects of this clinical and radiologic study were 26 temporomandibular joints diagnosed as condyle fracture in 23 patients under 15 years old age, They were treated with conservative method at Dental Hospital of Yonsei University from Jan., 1986 to Oct., 1994. Bony remodeling related with fracture pattern was evaluated. The results obtained are as follows: 1. The ratio of male to female in patients with condyle fracture was 1 : 0.9 and the difference of sex ratio was not noted. Comparing with preschool-age group and school-age group, age frequency was higher in preschool-age group (83%). 2. Fallen down (54%) was the most frequent cause of condyle fractures. Traffic accident and slip down were followed. 3. The most common clinical sign of condyle fractures was tenderness to palpation (19 cases). Mouth opening limitation (17 cases), swelling (7 cases), malocclusion (3 cases) were next in order. 4. According to sites of condyle fractures, unilateral fractures were in 20 patients and bilateral fractures in 3 patients, therefore total 23 patients-26 cases of condyle fracture were observed. According to fracture distribution, condyle fractures were in 10 patients (44%). Condyle fractures with symphysis fracture (9 patients, 39%), condyle fractures with ascending ramus fracture (2 patients, 9%), condyle fracture with mandibular body fracture (1 patient, 4%), and condyle fractures with mandibular angle fracture (1 patient, 4%) were followed. 5. In displacement pattern of fractured fragment of mandibular condyle, displacement (17 cases, 66%) was most common. Dislocation (5 cases, 19%) and deviation (4 cases, 15%) were next in order. 6. During the observation period of fractured condyles, remodeling patterns of fracture sites related with articular fossa were observed with usual congealer shape in 23 cases and with prominently different shape in 3 cases.

111

[Total endoprosthesis of knee joint for the severe deformity of the femoral and tibial condyles].  

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The method of knee joint endoprosthesis for its pronounced deformity was proposed. As a transplant there was applied the ceramic hydroxiapatite, manufactured according to special technology. The implant was fixed on the transplant adjusted. PMID:11288279

Ternovo?, N K; Zazirny?, I M; Kosiakov, A N; Dubok, V A; Ul'ianich, N V; Kikhniakevich, T G; Evseenko, V G

2000-06-01

112

SEXUAL DIMORPHISM OF MAXIMUM FEMORAL LENGTH  

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Full Text Available Sexual identification from the skeletal parts has medico legal and anthropological importance. Present study aims to obtain values of maximum femoral length and to evaluate its possible usefulness in determining correct sexual identification. Study sample consisted of 184 dry, normal, adult, human femora (136 male & 48 female from skeletal collections of Anatomy department, M. P. Shah Medical College, Jamnagar, Gujarat. Maximum length of femur was considered as maximum vertical distance between upper end of head of femur and the lowest point on femoral condyle, measured with the osteometric board. Mean Values obtained were, 451.81 and 417.48 for right male and female, and 453.35 and 420.44 for left male and female respectively. Higher value in male was statistically highly significant (P< 0.001 on both sides. Demarking point (D.P. analysis of the data showed that right femora with maximum length more than 476.70 were definitely male and less than 379.99 were definitely female; while for left bones, femora with maximum length more than 484.49 were definitely male and less than 385.73 were definitely female. Maximum length identified 13.43% of right male femora, 4.35% of right female femora, 7.25% of left male femora and 8% of left female femora. [National J of Med Res 2011; 1(2.000: 67-70

Pandya A M

2011-04-01

113

An experimental study of devices for internal fixation of distal femoral fractures.  

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Tibial traction for distal femoral fractures, followed after four to eight weeks by plaster, is the common treatment. Because of improved methodology, the proportion of surgically treated fractures had increased. Stable osteosynthesis with different plates is an established therapy for distal femoral fractures. In elderly or other patients with bone fragility, however, these operations often fail. The majority of the distal femoral fractures occur in such patients, and traction in bed is therefore often used. A less rigid device was constructed to meet the special circumstances with bone fragility. This device consists of two Ender's nails: one is inserted from each condyle, and each is connected to two cancellous screws traversing both condyles. The strength of this semielastic osteosynthesis was compared with four existing devices (AO, Rush, Zickel, Ender). Fixation was carried out in 17 pairs of osteotomized postmortem preparations from patients older than 60 years of age. The specimens were submitted to constant bending rate, and the load deformation was registered. The fixation with the condylar plate was strongest and showed the lowest flexibility. The Ender's nails and the Rush pins showed a tendency to lose their Condylar stabilization early. This was less pronounced with the Zickel nail, which, however, tended to displace at the osteotomy site during insertion and fracture the proximal fragment due to the limited bending ability of the blade construction. The new, semielastic device (ECS) was constructed to meet the special circumstances with bone fragility. It consists of two cancellous screws traversing both condyles. It combined easy insertion with moderate flexibility and high residual strength. In extension, it deflected 40 degrees without influencing residual stability. It is an interesting alternative to rigid internal fixation or traction in bed for osteoporotic patients with distal femoral fractures. In combines rigid screw fixation in the condylar part with an elastic adjustment in the femoral shaft above. PMID:7140081

Kolmert, L; Persson, B M; Romanus, B

1982-01-01

114

Surgical Treatment of Posterior Cruciate Ligament Injury  

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Successful posterior cruciate ligament (PCL) reconstructionis challenging because of the complex structures and difficultreconstruction techniques that are required. The reportedresults have been inconsistent. Variables that affect the resultsof surgery to restore PCL function include combined associatedligaments injury, difficulty to duplicate PCL anatomy, widevariation in broad femoral insertion footprint, difficulty inaccurate placement of the transtibial tunnel, tunnel erosion,high intern...

Chih-Hwa Chen

2007-01-01

115

Robust femur condyle disambiguation on biplanar X-rays.  

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Three-dimensional (3D) reconstruction of the skeleton from biplanar X-rays relies on scarce information digitalised by an operator on both frontal and lateral radiographs. In clinical routine, difficulties occur for non-skilled operators to discriminate the medial from the lateral femur condyle on the lateral view. Our study proposes an algorithm able to detect automatically a possible inversion of the two condyles by the operator at an early stage of the reconstruction process. It relies on the computation of two 3D femur surfaces, one directly from the operator digitalisation and the other from the same digitalisation with medial and lateral condyles automatically swapped. Pairs of virtual biplanar X-rays are computed for both reconstructions and the closest pair to the original X-rays is selected on the basis of similarity measures, pointing the correct 3D surface. The algorithm shows a success rate higher than 85% for both asymptomatic and pathological femurs whatever the initial condyle digitalisation of the operator, bringing automatically non-skilled operators acting in clinical routine to the level of skilled operators. This study validates moreover the proof-of-concept of automatic shape adjustments of a 3D surface on the basis of similarity measures in the process of 3D reconstruction from biplanar X-rays. PMID:22349135

Serrurier, Antoine; Quijano, Sergio; Nizard, Remy; Skalli, Wafa

2012-12-01

116

Chondrosarcoma of the Mandibular Condyle: A Case Report  

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Full Text Available Chondrosarcomas are slow-growing, malignant mesenchymal neoplasms characterized by formation of cartilage by the tumoral cells. They display a wide range of morphological features from a well-differentiated growing mass resembling a benign cartilage tumour to a high-grade malignancy with aggressive local invasion. Only 5% to 10% of this neoplasm is confined to the head and neck region. Chondrosarcomas of the mandibular condyle may manifest the typical symptoms of the temporomandibular joint dysfunction syndrome. Tumours of the condyle can reach a large size without producing clinically obvious swellings. A rare case of chondrosarcoma of the mandibular condyle in a 34-years old woman is presented in this report. Patient’s chief complaint was pain in the right temporomandibular joint when her mouth was in a maximum opening position. Mild malocclusion, figured as an occlusal discrepancy, was also detected. Radiographs illustrated erosion in the head of condyle. After condylectomy, the excised mass was histologically diagnosed as a grade II chondrosarcoma.

Keshani F.

2012-12-01

117

Sagittal plane articulation of the contralateral knee of subjects with posterior cruciate ligament deficiency: an observational study  

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Full Text Available Abstract Background The aim of the present study was to compare the in vivo articulation of the healthy knee to the contralateral knee of subjects with acute and chronic PCL injuries. Methods Magnetic resonance was used to generate sagittal images of 10 healthy knees and 10 knees with isolated PCL injuries (5 acute and 5 chronic. The subjects performed a supine leg press against a 150 N load. Images were generated at 15 degree intervals as the knee flexed from 0 to 90 degrees. The tibiofemoral contact (TFC, and the centre of the femoral condyle (as defined by the flexion facet centre (FFC, were measured from the posterior tibial cortex. Results There was no significant difference in the TFC and FFC between the healthy knee and contralateral knee of subjects with acute and chronic PCL injuries in the medial and lateral compartments of the knee. Conclusions The findings of this study suggest there is no predisposing articulation abnormality to PCL injury, in the setting of chronic injury the contralateral knee does not modify its articulation profile and the contralateral knee can be used as a valid control when evaluating the articulation of the PCL deficient knee.

Chandrasekaran Sivashankar

2012-03-01

118

Development of a method for measuring femoral torsion using real-time ultrasound.  

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Excessive femoral torsion has been associated with various musculoskeletal and neurological problems. To explore this relationship, it is essential to be able to measure femoral torsion in the clinic accurately. Computerized tomography (CT) and magnetic resonance imaging (MRI) are thought to provide the most accurate measurements but CT involves significant radiation exposure and MRI is expensive. The aim of this study was to design a method for measuring femoral torsion in the clinic, and to determine the reliability of this method. Details of design process, including construction of a jig, the protocol developed and the reliability of the method are presented. The protocol developed used ultrasound to image a ridge on the greater trochanter, and a customized jig placed on the femoral condyles as reference points. An inclinometer attached to the customized jig allowed quantification of the degree of femoral torsion. Measurements taken with this protocol had excellent intra- and inter-rater reliability (ICC2,1 = 0.98 and 0.97, respectively). This method of measuring femoral torsion also permitted measurement of femoral torsion with a high degree of accuracy. This method is applicable to the research setting and, with minor adjustments, will be applicable to the clinical setting. PMID:24854205

Hafiz, Eliza; Hiller, Claire E; Nicholson, Leslie L; Nightingale, E Jean; Clarke, Jillian L; Grimaldi, Alison; Eisenhuth, John P; Refshauge, Kathryn M

2014-07-01

119

Severe destruction of the temporomandibular joint with complete resorption of the condyle associated with synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome.  

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The synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome consists of a combination of inflammatory bone disorders and dermatologic pathology. Bone lesions as a form of diffuse sclerosing osteomyelitis in the mandible occur in the posterior body and ramus. Bone lesions rarely spread to the temporomandibular joint (TMJ) where ankylosis may result. Herein we present an unusual case of SAPHO syndrome with TMJ involvement in which severe destruction of the TMJ occurred. We observed an extension of the invasive soft tissue lesion into the infratemporal fossa from the TMJ with complete resorption of the condyle. In contrast to other previously reported cases, in our case the condyle was strongly suspected as the primary site of the bone lesion with subsequent extension to the ramus and infratemporal fossa. The destructive nature and related symptoms resembled a malignant tumor. PMID:23664782

Kodama, Yasumitsu; Tanaka, Ray; Kurokawa, Akira; Ohnuki, Hisashi; Sultana, Sara; Hayashi, Takafumi; Iizuka, Tateyuki; Takagi, Ritsuo

2013-08-01

120

Hybrid approach to limb salvage in the setting of an infected femoral-femoral bypass graft.  

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Prosthetic vascular graft infection in patients with advanced peripheral arterial disease can lead to multiple additional procedures, including extra-anatomic bypass or even amputation. We report the case of an 88-year-old woman with critical limb ischemia and an infected prosthetic femoral-femoral bypass graft. Using a planned hybrid 2-stage approach, we performed endovascular recanalization of the native left iliac arterial system using remote access via the superficial femoral artery to avoid infected groin wounds. Recanalization of the patient's Trans-Atlantic Inter-Society Consensus II D chronic iliac occlusion allowed for removal of the infected graft and placement of a profunda femoris artery to proximal posterior tibial artery bypass, thereby restoring inflow and avoiding the infected left groin. Newer endovascular techniques coupled with open surgical options may lead to limb salvage in patients with previously unreconstructable peripheral arterial disease. PMID:24517994

Jones, Douglas W; Meltzer, Andrew J; Schneider, Darren B

2014-08-01

 
 
 
 
121

The Osteochondroma of the Mandibular Condyle: report of a case  

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The osteochondroma, also known as osteocartilagenous exostosis, is one of the most common benign tumors of the axial skeleton, but is rarely found in the facial bones. When present, the tumor is most often reported to affect the mandibular coronoid process. Osteochondroma of the mandibular condyle is extremely rare and may cause signs and symptoms like those seen in patients with temporomandibular joint dysfunction. Sometimes, differentiation between osteochondroma and condylar hyperplasia is not possible on histologic grounds alone, but the radiographic and intraoperative findings together are usually sufficient to establish a definite diagnosis. This report reviews the literature concerning osteochondroma, especially of the maxillofacial region, and describes a case of osteochondroma of the condyle.

122

The Osteochondroma of the Mandibular Condyle: report of a case  

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The osteochondroma, also known as osteocartilagenous exostosis, is one of the most common benign tumors of the axial skeleton, but is rarely found in the facial bones. When present, the tumor is most often reported to affect the mandibular coronoid process. Osteochondroma of the mandibular condyle is extremely rare and may cause signs and symptoms like those seen in patients with temporomandibular joint dysfunction. Sometimes, differentiation between osteochondroma and condylar hyperplasia is not possible on histologic grounds alone, but the radiographic and intraoperative findings together are usually sufficient to establish a definite diagnosis. This report reviews the literature concerning osteochondroma, especially of the maxillofacial region, and describes a case of osteochondroma of the condyle.

Choi, Wook Jin; Hwang, Eui Hwan; Lee, Sang Rae [Dept. of Oral and Maxillofacial Radiology, College of Dentistry, Kyunghee University, Seoul (Korea, Republic of)

2000-06-15

123

Aneurysmal Bone Cyst, a Lesion of the Mandibular Condyle  

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Benign and malignant tumors of the temporomandibular joint are rare. An aneurysmal bone cyst (ABC) of the condyle is even more unusual and usually presents as a slowly enlarging firm swelling which occasionally may be associated with pain and tenderness. Surgical curettage or excision is the treatment of choice, in an attempt to reduce the potential problem of recurrence; we undertook surgical resection of the affected bone. Immediate mandibular reconstruction using autologous bone was deferr...

Rai, Kirthi Kumar; Rana Dharmendrasinh N; Shiva Kumar, H. R.

2012-01-01

124

Assessing the mobility of the mandibular condyle by sonography  

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Purpose Traditionally, the measurement of the maximal mouth opening was regarded as the mobility of the temporomandibular joint. The information, however, was not reliable. Sonography was often used to diagnose disc displacement in the temporomandibular joint and its validity was well established. The tool was also appropriate for measuring the outcome of temporomandibular disorders management. Therefore, the purpose of the study was to examine completely the reliability and error for evaluating the mobility of the mandibular condyle by sonography. In addition, the existing methods were modified to improve the repeatability. Patients and methods The reliability examinations included between-image and within-image explorations to represent the reliabilities of the image capturing and the mobility measuring, respectively. Sixty-two subjects were recruited to receive ultrasonic examination for condylar mobility. The images of the condyle in mouth closing and opening were captured and the horizontal displacement of the condyles was measured as the anterior translation of the condyle. To confirm that the probe did not move during mouth opening, a marker was placed between the skin and the ultrasonic probe as the landmark. Results The results demonstrated that the intrarater and interrater reliabilities in the within-image test were 0.986 and 0.970 and the reliabilities in the between-image test were 0.904 and 0.857, respectively. The standard errors of measurement in the within-image and between-image tests were 0.04 cm and 0.09 cm, respectively. Conclusion Sonography is a reliable tool to assess condylar mobility and can be used to measure the treatment outcome for temporomandibular disorders. PMID:25342888

Chen, Han-Yu; Wu, Shyi-Kuen; Lu, Chuan-Chin; You, Jia-Yuan; Lai, Chung-Liang

2014-01-01

125

Indications for surgical treatment of tibial condyle fractures.  

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The residual radioanatomic changes influencing the functional, subjective, and clinical outcome of 131 tibial condyle fractures were studied. Clinical function was found to deteriorate rapidly with increasing values of residual medial tilt of the tibial plateau, whereas lateral tilt of the plateau was well tolerated up to 5 degrees. Articular step-off up to 3 mm and condylar widening up to 5 mm had no adverse effects. Seventy percent of knees with moderate or severe instability were functionally unacceptable. It was concluded that a medial unicondylar fracture with any displacement, and all medially tilted bicondylar fractures, should be operated upon. In fracture of the lateral condyle, open reduction and internal fixation is indicated when lateral tilt or valgus malalignment exceeds 5 degrees, articular step-off exceeds 3 mm, or condylar widening exceeds 5 mm. The same limits apply to laterally tilted bicondylar fractures, provided that the medial condyle is undisplaced. Any displacement seen in the axial bicondylar fracture is an indication for surgical treatment. If there is any mediolateral instability in the extended knee joint after rigid internal fixation, repair of a collateral ligament should be considered. An avulsed anterior cruciate ligament should be fixed, if pathologic laxity exists, but the torn ligament can be ignored and reconstructed later if needed. PMID:8168301

Honkonen, S E

1994-05-01

126

Assessing the mobility of the mandibular condyle by sonography  

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Full Text Available Han-Yu Chen,1 Shyi-Kuen Wu,1 Chuan-Chin Lu,1,2 Jia-Yuan You,3 Chung-Liang Lai4 1Department of Physical Therapy, Hungkuang University, Taichung, Taiwan; 2Department of Rheumatology, Taichung Hospital, Department of Health, Taiwan; 3Department of Physical Therapy, I-Shou University, Kaohsiung, Taiwan; 4Department of Physical Medicine and Rehabilitation, Taichung Hospital, Department of Health, Taiwan Purpose: Traditionally, the measurement of the maximal mouth opening was regarded as the mobility of the temporomandibular joint. The information, however, was not reliable. Sonography was often used to diagnose disc displacement in the temporomandibular joint and its validity was well established. The tool was also appropriate for measuring the outcome of temporomandibular disorders management. Therefore, the purpose of the study was to examine completely the reliability and error for evaluating the mobility of the mandibular condyle by sonography. In addition, the existing methods were modified to improve the repeatability.Patients and methods: The reliability examinations included between-image and within-image explorations to represent the reliabilities of the image capturing and the mobility measuring, respectively. Sixty-two subjects were recruited to receive ultrasonic examination for condylar mobility. The images of the condyle in mouth closing and opening were captured and the horizontal displacement of the condyles was measured as the anterior translation of the condyle. To confirm that the probe did not move during mouth opening, a marker was placed between the skin and the ultrasonic probe as the landmark.Results: The results demonstrated that the intrarater and interrater reliabilities in the within-image test were 0.986 and 0.970 and the reliabilities in the between-image test were 0.904 and 0.857, respectively. The standard errors of measurement in the within-image and between-image tests were 0.04 cm and 0.09 cm, respectively.Conclusion: Sonography is a reliable tool to assess condylar mobility and can be used to measure the treatment outcome for temporomandibular disorders. Keywords: temporomandibular disorders, sonography, mandibular condyle, reliability

Chen HY

2014-10-01

127

Ensayo clínico de asignación aleatoria, para evaluar la eficacia de dos técnicas de compresión en la disminución de complicaciones en el sitio de acceso vascular femoral, posterior a cateterismo diagnóstico y terapéutico / Randomized, controlled trial, to assess the efficacy of two vascular compression techniques in reducing complications at vascular access sites after therapeutic or diagnostic catheterization  

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Full Text Available SciELO Mexico | Language: Spanish Abstract in spanish Objetivo: Comparar la incidencia de falla en la hemostasia y frecuencia de eventos vasculares, durante y después de la compresión con dos maniobras diferentes. Métodos: Se realizó un ensayo clínico de asignación aleatoria a compresión mecánica o compresión manual, para el retiro de introductor en ar [...] teria femoral posterior a cateterismo diagnóstico o terapéutico. Resultados: Se incluyeron 100 pacientes en el grupo de compresión con compresor (grupo uno) y 112 de forma manual (grupo dos). La falla para lograr hemostasia se presentó en 48% del grupo uno vs 19.7% en el grupo dos (p4 cm durante el seguimiento con ultrasonido, en el grupo con compresor 11.4% vs el grupo manual 4.6% (p=0.062). En el análisis de regresión logística sólo se encontró que los factores independientes para falla en la hemostasia fueron: uso de compresor con OR 4.34 (IC 95%, 2.24-8.43, p Abstract in english Objective: To compare the incidence of hemostatic failure and rate of vascular events during and after vascular compression using two different techniques. Methods: Patients were randomized to mechanical or manual compression after a therapeutic or diagnostic catheterization procedure. Results: One [...] hundred patients were enrolled in the mechanical compression group (group one) and 112 patients in the manual compression group (group two). Failed hemostasis was observed in 48% of patients in group 1 and 19.7% in group two (p4cm) formation was found on ultrasound follow-up in group 1 (11.4% vs 4.6%, p=0.062). Logistic regression analysis found that the only independent factors for hemostatic failure were: use of mechanical compression device (OR 4.34, 95% CI 2.24-8.43, p

Álvaro Eduardo, Ramírez-Gutiérrez; Guering, Eid-Lidt; Juan Carlos, Esquinca-Vera; Félix, Damas-de los Santos; Alberto, Pérez-González; Eric, Kimura-Hayama; Ulises, Bacilio-Pérez; Jorge, Gaspar-Hernández.

128

The Structure of the Mandibular Condyle in the Panoramic Radiograph  

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The author has evaluated the panoramic image of the mandibular condyle according to its horizontal condylar angle (0 degree, 10 degree, 20 degree, 30 degree, 40 degree) and mandibular position (standard, 25 mm forward and reverse position). The results were as follows: 1. The larger the horizontal condylar angle was, the larger the horizontal magnification was in all positions. 2. In case of small horizontal condylar angle, profile view could be obtained in 25 mm forward and reverse position. 3. In case of large horizontal condylar angle, profile view could not be obtained in any positions.

129

The Structure of the Mandibular Condyle in the Panoramic Radiograph  

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The author has evaluated the panoramic image of the mandibular condyle according to its horizontal condylar angle (0 degree, 10 degree, 20 degree, 30 degree, 40 degree) and mandibular position (standard, 25 mm forward and reverse position). The results were as follows: 1. The larger the horizontal condylar angle was, the larger the horizontal magnification was in all positions. 2. In case of small horizontal condylar angle, profile view could be obtained in 25 mm forward and reverse position. 3. In case of large horizontal condylar angle, profile view could not be obtained in any positions.

Choi, Soon Chul [Dept. of Oral Radiology, College of Dentistry, Seoul National University, Seoul (Korea, Republic of)

1990-08-15

130

Retrograde reamed femoral nailing.  

Science.gov (United States)

Closed, reamed, antegrade nailing remains the standard of care for femoral shaft fractures. This technique however, may be less attractive in the management of femoral shaft fractures associated with (a) ipsilateral acetabular, pelvis, or femoral neck fractures; (b) poly trauma requiring multiple simultaneous surgical procedures; and (c) pregnancy. We now report on our experience with the retrograde femoral nailing as a treatment option in these situations. Between 4/88 and 10/90, 29 retrograde femoral nailing in 24 patients were attempted. Average age was 29.3 (16-74) years. Five fractures were open. Fracture location was isthmal in 14 and infraisthmal in 15. The comminution was classified according to Winquist and Hansen: I(10), II(7), III(7), and IV(5). Nailing was possible in 28/29 cases. Insertion was made through an extraarticular medial condylar portal. Nail diameter ranged from 10 to 13 mm. An AO Universal Femoral Nail was used in the first 11 cases; all subsequent fractures were stabilized using an AO Universal Tibial Nail because its design appeared better suited to this technique. Follow-up was possible for 25 fractures in 21 patients and averaged 16.0 (range, 11-27); months 23/25 (92%) fractures healed within 12 weeks. No case was associated with an infection, loss of reduction, or nail failure. Knee flexion averaged 122°; only two knees had an extensor lag of >5°. Intraoperative complications included three cases of crack propagation at the insertion site, and four infraisthmal malreductions (two valgus, two flexion). Based on these results, we feel that retrograde reamed femoral nailing is a suitable alternative to antegrade nailing and should be considered in situations where proximal access is neither possible nor desirable. PMID:25046411

Sanders, Roy; Koval, Kenneth J; DiPasquale, Thomas; Helfe, David L; Frankle, Mark

2014-08-01

131

CT findings of traumatic posterior hip dislocation after reduction  

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To evaluate the CT images of reduced hips after posterior hip dislocation and to propose specific diagnostic criteria based on the CT results. We retrospectively reviewed the CT findings on 18 reduced hips from 17 patients with radiographs and clinical histories of traumatic posterior hip dislocations by evaluating 18 corresponding CT scans for joint space asymmetry, intra-articular abnormalities (intra-articular fat obliteration, loose bodies, and joint effusion), changes in posterior soft tissue (capsule, muscles, and adjacent fat), the presence, and location of fractures (acetabulum and femoral head). All 18 hips (100%) showed posterior soft tissue changes. In total, 17 hips (94.4%) had intra-articular abnormalities and 15 hips (83.3%) had joint space asymmetries. In addition, 17 hips (94.4%) had fractures involving the acetabula (15 cases, 88.2%) the femoral head (13 cases, 76.5%), or on both sides (11 cases, 64.7%). The most frequent fracture location was in he posterior wall (13/15, 86.7%) of the acetabulum and in the anterior aspect (10/13, 76.9%) of the femoral head. Patients with a prior history of posterior hip dislocation showed specific CT findings after reduction, suggesting the possibility of previous posterior hip dislocations in patients

132

Proximal focal femoral deficiency.  

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The term proximal focal femoral deficiency (PFFD) is applied to a spectrum of conditions characterized by partial absence and shortening of the proximal femora and thought to result from an early disturbance of growing mesenchyme. The mildest cases, Classes A and B, exhibit a relatively normal acetabulum and capital femoral epiphysis, despite the dysplastic shaft. There may be a subtrochanteric varus deformity or a pseudoarthrosis accompanying the shortening of the femoral shaft. At the opposite end of the spectrum, the most severely deformed cases, Classes C and D, have involvement of the acetabulum, and the entire proximal femur. In cases of advanced dysgenesis, the findings include: a stunted severely shortened femur with a club-shaped or pointed proximal end, an iliac projection just above the anatomic site of the acetabulum, a spherical obturator foramen, and squaring of the iliac crest. Twenty-one patients (2 bilateral) with proximal focal femoral deficiency are presented (23 femurs). Differentiation of proximal focal femoral deficiency from other congenital and acquired deformities of the hip joint is essential for selecting the proper treatment. PMID:96119

Goldman, A B; Schneider, R; Wilson, P D

1978-06-01

133

Fragmented coronoid process and incomplete ossification of the humeral condyle in a rottweiler  

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Objective-To describe incomplete ossification of the humeral condyle and fragmentation of the medial coronoid process in a Rottweiler. Study Design-Clinical report. Animal Population-A 4-year-old sexually intact male Rottweiler. Methods-Physical examination, radiography, and computed tomography of both elbow joints were performed initially. Drill holes were made across the humeral condyle to promote ossification. Radiography and computed tomography were repeated 14 weeks later. Radiography was repeated 15 months later. A mild, intermittent lameness remained. Results-Preoperatively a radiolucent line was present across theright humeral condyle. This radiolucent line remained unchanged 14 weeks after drill holes were made across the condyle. Conclusions-Incomplete ossification of the humeral condyle is present in Rottweilers. Clinical Relevance-Incomplete ossification of the humeral condyle is present in Rottweilers and may coexist with fragmentation of the medial coronoid process in that breed. The radiographic diagnosis may be difficult because precise positioning is required to see the area of incomplete ossification. Computed tomography may be required to confirm the presence of incomplete ossification of the humeral condyle. Drilling holes across the humeral condyle does not appear to lead to union of the area of incomplete ossification. (C)Copyright 1998 by The American College of Veterinary Surgeons

134

Laser Doppler flowmetry for bone blood flow measurement: correlation with microsphere estimates and evaluation of the effect of intracapsular pressure on femoral head blood flow  

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Laser Doppler flowmetry (LDF) was used to measure bone blood flow in the rabbit femoral condyles. To correlate the LDF output signal blood cell flux to in vivo blood flow, simultaneous measurements using LDF and 85Sr-labeled microspheres were made in an adult rabbit model. There was no correlation between the two methods for blood flow in the femoral condyles and the correlation between the two methods for blood flow in the femoral head does not achieve statistical significance. An LDF signal of 0.4 V was approximately equal to a microsphere measured flow rate of 0.4 ml blood/g bone/min. The strength of the correlation in the latter case may have been affected by (a) large arteriovenous shunts, (b) inadequate mixing of the microspheres with a left ventricular injection, and (c) insufficient numbers of microspheres present in the bone samples. When LDF was used to evaluate the effect of elevated intracapsular pressure on femoral head blood flow in skeletally mature rabbits, femoral head subchondral bone blood flow declined with increasing intracapsular pressure from a baseline value of 0.343 +/- 0.036 to a value of 0.127 +/- 0.27 at 120 cm of water pressure. The decline in femoral head blood flow was statistically significant at pressures of 40 cm of water or higher (p less than 0.001), and evaluation of sections of the proximal femora made from preterminal disulphine blue injections confirmed these findings. Intracapsular tamponade has an adverse effect on femoral head blood flow beginning well below central venous pressure and should be considered in the pathophysiology of posttraumatic and nontraumatic necrosis of the femoral head. Laser Doppler flowmetry was easy to use and appears to be a reproducible technique for evaluating femoral head blood flow, offering distinct advantages over the microsphere technique for measuring bone blood flow

135

Critical role of Bmpr1a in mandibular condyle growth.  

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The importance of Bone Morphogenetic Proteins (BMPs) in the regulation of cell fate, differentiation and proliferation in the growth plate is well-known. However, in secondary cartilages (such as that in the temporomandibular joint) that grow by proliferation of prechondrocytes and differ in their pattern of growth, the role of BMPs is largely unexplored. To examine this question, we ablated Bmpr1a in the condylar cartilage of neonatal mice and assessed the consequences for mandibular condyle growth and organization at intervals over the ensuing 4 weeks. Bmpr1a deficiency caused significant chondrodysplasia and almost eliminated the chondrocytic phenotype in the TMJ. Expression of Sox9, collagen II, proteoglycan were all greatly reduced, and cell proliferation as detected by BrdU was almost non-existent in the knockout mice. Primary bone spongiosa formation was also disturbed and was accompanied by reduced Osterix expression. These findings strongly suggest that Bmpr1a is critical for the development and growth of the mandibular condyle via its effect on proliferation of prechondroblasts and chondrocyte differentiation. PMID:25158185

Jing, Junjun; Hinton, Robert J; Mishina, Yuji; Liu, Ying; Zhou, Xuedong; Feng, Jian Q

2014-08-01

136

MRI of the temporo-mandibular joint: which sequence is best suited to assess the cortical bone of the mandibular condyle? A cadaveric study using micro-CT as the standard of reference  

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To determine the best suited sagittal MRI sequence out of a standard temporo-mandibular joint (TMJ) imaging protocol for the assessment of the cortical bone of the mandibular condyles of cadaveric specimens using micro-CT as the standard of reference. Sixteen TMJs in 8 human cadaveric heads (mean age, 81 years) were examined by MRI. Upon all sagittal sequences, two observers measured the cortical bone thickness (CBT) of the anterior, superior and posterior portions of the mandibular condyles (i.e. objective analysis), and assessed for the presence of cortical bone thinning, erosions or surface irregularities as well as subcortical bone cysts and anterior osteophytes (i.e. subjective analysis). Micro-CT of the condyles was performed to serve as the standard of reference for statistical analysis. Inter-observer agreements for objective (r = 0.83-0.99, P < 0.01) and subjective (? = 0.67-0.88) analyses were very good. Mean CBT measurements were most accurate, and cortical bone thinning, erosions, surface irregularities and subcortical bone cysts were best depicted on the 3D fast spoiled gradient echo recalled sequence (3D FSPGR). The most reliable MRI sequence to assess the cortical bone of the mandibular condyles on sagittal imaging planes is the 3D FSPGR sequence. (orig.)

137

MRI of the temporo-mandibular joint: which sequence is best suited to assess the cortical bone of the mandibular condyle? A cadaveric study using micro-CT as the standard of reference  

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To determine the best suited sagittal MRI sequence out of a standard temporo-mandibular joint (TMJ) imaging protocol for the assessment of the cortical bone of the mandibular condyles of cadaveric specimens using micro-CT as the standard of reference. Sixteen TMJs in 8 human cadaveric heads (mean age, 81 years) were examined by MRI. Upon all sagittal sequences, two observers measured the cortical bone thickness (CBT) of the anterior, superior and posterior portions of the mandibular condyles (i.e. objective analysis), and assessed for the presence of cortical bone thinning, erosions or surface irregularities as well as subcortical bone cysts and anterior osteophytes (i.e. subjective analysis). Micro-CT of the condyles was performed to serve as the standard of reference for statistical analysis. Inter-observer agreements for objective (r = 0.83-0.99, P < 0.01) and subjective ({kappa} = 0.67-0.88) analyses were very good. Mean CBT measurements were most accurate, and cortical bone thinning, erosions, surface irregularities and subcortical bone cysts were best depicted on the 3D fast spoiled gradient echo recalled sequence (3D FSPGR). The most reliable MRI sequence to assess the cortical bone of the mandibular condyles on sagittal imaging planes is the 3D FSPGR sequence. (orig.)

Karlo, Christoph A. [University Hospital Zurich, Department of Diagnostic and Interventional Radiology, Zurich (Switzerland); University Children' s Hospital Zurich, Department of Diagnostic Imaging, Zurich (Switzerland); Patcas, Raphael; Signorelli, Luca; Mueller, Lukas [University of Zurich, Clinic for Orthodontics and Pediatric Dentistry, Center of Dental Medicine, Zurich (Switzerland); Kau, Thomas; Watzal, Helmut; Kellenberger, Christian J. [University Children' s Hospital Zurich, Department of Diagnostic Imaging, Zurich (Switzerland); Ullrich, Oliver [University of Zurich, Institute of Anatomy, Faculty of Medicine, Zurich (Switzerland); Luder, Hans-Ulrich [University of Zurich, Section of Orofacial Structures and Development, Center of Dental Medicine, Zurich (Switzerland)

2012-07-15

138

Femoral shaft fractures  

International Nuclear Information System (INIS)

The femur is the longest, largest, and strongest bone in the body. Because of its length, width, and role as primary weight-bearing bone, it must tolerate the extremes of axial loading and angulatory stresses. Massive musculature envelopes the femur. This masculature provides abundant blood supply to the bone, which also allows great potential for healing. Thus, the most significant problem relating to femoral shaft fractures is not healing, but restoration of bone length and alignment so that the femoral shaft will tolerate the functional stresses demanded of it

139

Successful vascular reconstruction after inadvertent femoral artery "stripping".  

Science.gov (United States)

A case of total stripping of the femoral axis secondary to saphenectomy is reported. This type of accident is followed by amputation unless quickly recognised and corrected. A combined saphenous vein and PTFE graft interposed between the origin of the superficial femoral and the distal part of the posterior tibial remained patent for three months. Its eventual thrombosis, however, did not result in loss of the limb, because a sound compensatory circulation had been established in the meanwhile. It is therefore felt that repair surgery is always worth attempting, even in the case of extensive arterial lesions that will otherwise necessitate amputation. PMID:3597538

Pegoraro, M; Baracco, C; Ferrero, F; Palladino, F

1987-01-01

140

Medial circumflex femoral artery flap for ischial pressure sore  

Directory of Open Access Journals (Sweden)

Full Text Available A new axial pattern flap based on the terminal branches of the medial circumflex femoral artery is described for coverage of ischial pressure sore. Based on the terminal branches of the transverse branch of medial circumflex femoral artery, which exit through the gap between the quadratus femoris muscle above and the upper border of adductor magnus muscle below, this fascio cutaneous flap is much smaller than the posterior thigh flap but extremely useful to cover ischeal pressure sores. The skin redundancy below the gluteal fold allows a primary closure of the donor defect. It can also be used in combination with biceps femoris muscle flap.

Palanivelu S

2009-01-01

 
 
 
 
141

Importance of sagittal MR imaging in nontraumatic femoral head osteonecrosis in children  

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In nontraumatic femoral head osteonecrosis, characterization of femoral head collapse is important in staging disease progression and planning treatment. Few prior studies have quantitatively compared the ability of sagittal and coronal MR images to detect femoral head collapse. We hypothesized that sagittal MR images show a greater degree and angular span of femoral head collapse than coronal images. We reviewed 38 hip MRI scans of nontraumatic femoral head osteonecrosis from 34 pediatric patients. In both sagittal and coronal images, the maximal extent and angular location along with the angular span of the femoral head collapse were measured. Differences were evaluated using a paired t-test. The extent of bone and cartilage loss from the femoral head was evaluated. Sagittal MR images showed 29% maximal femoral head radius collapse, whereas coronal images showed 16% collapse (P<0.001). Sagittal images showed a larger angular span of collapse (115 ) than coronal images (55 , P<0.001). Sagittal images showed greater epiphyseal bone loss in the anterior than in the posterior portion (P<0.001), whereas coronal images did not show a significant difference in bone loss between the medial and lateral portion (P=0.32). Sagittal images show greater femoral head collapse than coronal images in nontraumatic femoral head osteonecrosis. (orig.)

Ha, Alice S. [Hospital of the University of Pennsylvania, Department of Radiology, Philadelphia, PA (United States); Wells, Lawrence [Children' s Hospital of Philadelphia, Department of Orthopedic Surgery, Philadelphia, PA (United States); Jaramillo, Diego [Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States)

2008-11-15

142

Rarefied femoral neck trabecular patterns, fracture displacement, and femoral head vitality in femoral neck fractures.  

Science.gov (United States)

Before operation, 99mTc-MDP scintimetry was performed in 103 patients with femoral neck fractures. There was a significant correlation (r = 0.63, p less than .01) between osteoporosis and fracture displacement, but no correlation (r = 0.07, p greater than .01) between femoral neck trabecular bone patterns and femoral head viability and no correlation (r = 0.11, p less than .01) between fracture displacement and femoral head viability. PMID:3720109

Dalén, N; Jacobsson, B

1986-06-01

143

Hoffa fracture associated with femoral shaft and proximal tibial fractures: report of two cases.  

Science.gov (United States)

Solitary coronal shear fractures of femoral condyle, such as Hoffa's fracture, are usually associated with supracondylar or intercondylar fractures of the femur. These fractures are rare and seen in the context of high energy mechanism leading to multiple injuries; therefore a thorough workup of the patient is required to rule out other significant injuries. Hoffa's fracture associated with femoral shaft and proximal tibial fractures is extremely rare and no such injury has been reported previously. We report two such cases which were managed with standard operative fixation techniques and demonstrated good to excellent functional outcome after a follow-up of one year. This report emphasizes that high index of suspicion is required for di- agnosis of these injuries and a thorough workup is mandatory to rule out other associated injuries. We also propose a possible mechanism of injury. PMID:23186929

Jain, Anuj; Agrawal, Prakash; Chadha, Manish; Pankaj, Amite

2012-01-01

144

Arthrography and the medial compartment of the patello-femoral joint.  

Science.gov (United States)

In four groups of patients with normal patellar cartilage, synovitis, patellar chondropathy , and degenerative changes of the patellar surface of the femur, the anatomical relationships within the medial compartment of the patello-femoral joint were examined. Clear differences were observed between these groups in the incidence of visualization of the medial alar plica and the mediopatellar synovial plica. As a consequence, an explanation has been sought for the occurrence of patellar chondropathy and degenerative changes of the patellar surface of the femur. It seems probable that a long-standing traumatic synovitis with effusion, attenuation of the synovial membrane, and the composition of the synovial fluid can lead to patellar chondropathy . The degenerative changes of the patellar surface of the femur are usually secondary to those of the load-bearing patellar facet. Insufficient covering of the cartilage by soft tissue may play a role in chondropathy of the nonload -bearing portion of the patella and the femoral condyle. PMID:6719143

Thijn, C J; Hillen, B

1984-01-01

145

A study of the mandibular condyle shape on the individualized corrected the tomograph and submentovertex radiograph  

International Nuclear Information System (INIS)

The purpose of this study was to observe mandibular condyle shape in an asymptomatic population. In order to carry out this study, 96 temporomandibular joints in 48 adults (22 males, 26 females), who were asymptomatic for temporomandibular disturbances and had no history of prosthodontic or orthodontic treatments, were selected, and radiographed using the Sectograph(Denar Co., U.S.A.) for lateral and frontal individualized corrected TMJ tomograph and submentovertex radiograph. Mandibular condyles were classified morphologically, and measured mediolateral and anteroposterior dimensions and condylar angulation. The obtained results were as follows. 1. In the classification of condyle shape on lateral tomographs, 94.8% were convex type and 5.2% were angled type. 2. In the classification of condyle shape on frontal tomographs, 45.3% were convex type, 32.0% were round type, 16.0% were flat type, and 6.7% were angled type. 3. In the classification of condyle shape on submentovertex radiographs, 34.5% were flat-convex type, 22.9% were flat-flat type, 20.8% were concave-convex type, 19.8% were convex-concave type, and flat-concave type were not observed. 4. The average mediolateral length of the condyle was 19.3 mm and the average anteroposterior length was 9.4 mm. The average angle between the long axis of condyle and the coronal plane made on submentovertex view was 19.6 degrees.

146

A study of the mandibular condyle shape on the individualized corrected the tomograph and submentovertex radiograph  

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The purpose of this study was to observe mandibular condyle shape in an asymptomatic population. In order to carry out this study, 96 temporomandibular joints in 48 adults (22 males, 26 females), who were asymptomatic for temporomandibular disturbances and had no history of prosthodontic or orthodontic treatments, were selected, and radiographed using the Sectograph(Denar Co., U.S.A.) for lateral and frontal individualized corrected TMJ tomograph and submentovertex radiograph. Mandibular condyles were classified morphologically, and measured mediolateral and anteroposterior dimensions and condylar angulation. The obtained results were as follows. 1. In the classification of condyle shape on lateral tomographs, 94.8% were convex type and 5.2% were angled type. 2. In the classification of condyle shape on frontal tomographs, 45.3% were convex type, 32.0% were round type, 16.0% were flat type, and 6.7% were angled type. 3. In the classification of condyle shape on submentovertex radiographs, 34.5% were flat-convex type, 22.9% were flat-flat type, 20.8% were concave-convex type, 19.8% were convex-concave type, and flat-concave type were not observed. 4. The average mediolateral length of the condyle was 19.3 mm and the average anteroposterior length was 9.4 mm. The average angle between the long axis of condyle and the coronal plane made on submentovertex view was 19.6 degrees.

Lee, Sang Rae [Dept. of Oral and Maxillofacial Radiology, College of Dentistry, Kyung Hee University, Seoul (Korea, Republic of)

1994-08-15

147

Three-dimensional computerized tomography in mandibular condyle fractures  

International Nuclear Information System (INIS)

Now, car accidents are so commons, this associated to the high technology in produce automobiles make this type of accidents so serious and the consequences of mandibular condyle fractures are more commons and with more gravity, some of these patients, generally need a traqueostomy to be operated, that is why every second that we can save during the surgery is important. The normal exams as X rays and simple TAC give as an important idea but no complete, on the contrary the three-dimensional TAC permits to observe every damages and its exact location, this contribute to make a better surgery organization, the number and type of plates that we have to put and the better way to treat each case, that contribute to reduce time in operating theatre which is in benefit of the patient, diminishing risks in serious patients as they are, that is why we recommend the utilization of the three-dimensional TAC. (The author)

148

Medial humeral condyle fractures in adolescents: treatment and complications.  

Science.gov (United States)

The very rare isolated medial humeral condyle fractures in children and adolescents pose significant problems to orthopedic surgeons such as ulnar nerve injury, trochlear irregularities, fishtail deformity and motion loss. Six adolescent boys with displaced medial humeral condyle fractures with an average age of 14.8 (range 12-17) were included in this study. Patients were followed-up with a mean of 39.8 months (range 21-72). In three patients, there were clinical signs of ulnar nerve dysfunction at initial presentation. Of these, two had only mild hypoesthesia on the ulnar side. The other patient had sensory and motor loss of ulnar nerve at initial presentation complicated by hypothenar atrophy and anhydrosis during follow-up. Complete recovery was seen in this patient only at 2 years. One patient without a neurologic compliant at initial presentation developed mild hypoesthesia on the ulnarly innervated areas postoperatively with complete resolution. Medial skin incision was used for open reduction and internal fixation. No signs of gross morphologic damage were seen on the nerve. The symptoms resolved postoperatively in 3 months time in three of the patients, but in the remaining one, it took 2 years for complete resolution of the symptoms. Also, trochlear irregularity and fishtail deformity were seen on radiographs of two different patients. In all but one patients, motion loss ranging from 10° to 20° was evident on physical examination. The most important finding of this study revealed that transient ulnar nerve dysfunction was seen two-thirds of the patients in this series than any other series reported previously. In three series, only one case of ulnar nerve injury was reported from a total of 19 patients. A possible explanation for such a difference may be the older age in this series. PMID:23934502

Sa?lam, Necdet; Saka, Gürsel; Kurtulmu?, Tuhan; Cem Co?kun, Avc?; Türker, Mehmet

2014-10-01

149

Recurrent simple bone cyst of the mandibular condyle: a case report  

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Cysts of the mandibular condyle are rare and can be difficult to diagnose and treat. Clinically, a simple bone cyst is asymptomatic and often discovered incidentally on routine radiographic examination. This report shows an atypical simple bone cyst occurring in the mandibular condyle showing recurrence after surgical curettage. Radiologically, this lesion involving the mandibular condyle should be distinguished from other similar lesions such as a chondriome, a central giant cell granuloma, and an aneurysmal bone cyst. Radiographic assessment was useful for forecasting the prognosis of a simple bone cyst. Possible reasons for the recurrence were discussed radiographically.

Kim, Kyung A; Koh, Kwang Joon [Dept. of Oral and Maxillofacial Radiology, School of Dentistry, and Institute of Oral Bio Science, Chonbuk National University, Jeonju (Korea, Republic of)

2013-03-15

150

Subchondral bone density distribution in the human femoral head  

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This study aims to quantitatively characterize the distribution of subchondral bone density across the human femoral head using a computed tomography derived measurement of bone density and a common reference coordinate system. Femoral head surfaces were created bilaterally for 30 patients (14 males, 16 females, mean age 67.2 years) through semi-automatic segmentation of reconstructed CT data and used to map bone density, by shrinking them into the subchondral bone and averaging the greyscale values (linearly related to bone density) within 5 mm of the articular surface. Density maps were then oriented with the center of the head at the origin, the femoral mechanical axis (FMA) aligned with the vertical, and the posterior condylar axis (PCA) aligned with the horizontal. Twelve regions were created by dividing the density maps into three concentric rings at increments of 30 from the horizontal, then splitting into four quadrants along the anterior-posterior and medial-lateral axes. Mean values for each region were compared using repeated measures ANOVA and a Bonferroni post hoc test, and side-to-side correlations were analyzed using a Pearson's correlation. The regions representing the medial side of the femoral head's superior portion were found to have significantly higher densities compared to other regions (p < 0.05). Significant side-to-side correlations were found for all regions (r {sup 2} = 0.81 to r {sup 2} = 0.16), with strong correlations for the highest density regions. Side-to-side differences in measured bone density were seen for two regions in the anterio-lateral portion of the femoral head (p < 0.05). The high correlation found between the left and right sides indicates that this tool may be useful for understanding 'normal' density patterns in hips affected by unilateral pathologies such as avascular necrosis, fracture, developmental dysplasia of the hip, Perthes disease, and slipped capital femoral head epiphysis. (orig.)

Wright, David A.; Meguid, Michael; Lubovsky, Omri; Whyne, Cari M. [Sunnybrook Research Institute, Orthopaedic Biomechanics Laboratory, Toronto, Ontario (Canada)

2012-06-15

151

Subchondral bone density distribution in the human femoral head  

International Nuclear Information System (INIS)

This study aims to quantitatively characterize the distribution of subchondral bone density across the human femoral head using a computed tomography derived measurement of bone density and a common reference coordinate system. Femoral head surfaces were created bilaterally for 30 patients (14 males, 16 females, mean age 67.2 years) through semi-automatic segmentation of reconstructed CT data and used to map bone density, by shrinking them into the subchondral bone and averaging the greyscale values (linearly related to bone density) within 5 mm of the articular surface. Density maps were then oriented with the center of the head at the origin, the femoral mechanical axis (FMA) aligned with the vertical, and the posterior condylar axis (PCA) aligned with the horizontal. Twelve regions were created by dividing the density maps into three concentric rings at increments of 30 from the horizontal, then splitting into four quadrants along the anterior-posterior and medial-lateral axes. Mean values for each region were compared using repeated measures ANOVA and a Bonferroni post hoc test, and side-to-side correlations were analyzed using a Pearson's correlation. The regions representing the medial side of the femoral head's superior portion were found to have significantly higher densities compared to other regions (p 2 = 0.81 to r 2 = 0.16), with strong correlations for the h 0.16), with strong correlations for the highest density regions. Side-to-side differences in measured bone density were seen for two regions in the anterio-lateral portion of the femoral head (p < 0.05). The high correlation found between the left and right sides indicates that this tool may be useful for understanding 'normal' density patterns in hips affected by unilateral pathologies such as avascular necrosis, fracture, developmental dysplasia of the hip, Perthes disease, and slipped capital femoral head epiphysis. (orig.)

152

Proximal Focal Femoral Deficiency  

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Full Text Available Proximal focal femoral deficiency (PFFD is a developmental disorder of the proximal segment of thefemur and of acetabulum resulting in shortening of the affected limb and impairment of the function. It isa spectrum of congenital osseous anomalies characterized by a deficiency in the structure of the proximalfemur. The diagnosis is often made by radiological evaluation which includes identification and descriptionof PFFD and evaluation of associated limb anomalies by plain radiographs. Contrast arthrography orMagnetic Resonance Imaging is indicated when radiological features are questionable and to disclose thepresence and location of the femoral head and any cartilagenous anlage. The disorder is more commonlyunilateral and is apparent at birth. However, bilateral involvement is rarely seen. Therapy of the disorder isdirected towards satisfactory ambulation and specific treatment depending on the severity of dysplasia.

Vishal Kalia, Vibhuti

2008-01-01

153

Iodixanol in femoral arteriography  

Energy Technology Data Exchange (ETDEWEB)

Two contrast media, iodixanol (Visipaque, Nycomed) 270 mg I/ml and iohexol (Omnipaque, Nycomed) 300 mg I/ml, were compared in femoral arteriography, in 147 patients. Both contrast media were diagnostically effective for use in femoral arteriography, without any significant difference. Pain was reported in connection with injection of iohexol by 36% of the patients, after injection of iodixanol none reported pain. Seventy-two percent of the patients in the iodixanol group reported a sensation of warmth in connection with contrast injection versus 90% in the iohexol group. The average intensity of the warmth was greater with iohexol than with iodixanol. Fourteen percent of patients in the iodixanol group and 1% in the iohexol group reported one or more subjective adverse events. (orig.).

Thorstensen, Oe. [Depts. of Radiology, Karolinska Inst., Stockholm (Sweden)]|[Univ. Hospital, Lund (Sweden)]|[Dept. of Surgery, Univ. Hospital, Lund (Sweden)]|[Nycomed Imaging AS, Oslo (Norway); Albrechtsson, U. [Depts. of Radiology, Karolinska Inst., Stockholm (Sweden)]|[Univ. Hospital, Lund (Sweden)]|[Dept. of Surgery, Univ. Hospital, Lund (Sweden)]|[Nycomed Imaging AS, Oslo (Norway); Calissendorff, B. [Depts. of Radiology, Karolinska Inst., Stockholm (Sweden)]|[Univ. Hospital, Lund (Sweden)]|[Dept. of Surgery, Univ. Hospital, Lund (Sweden)]|[Nycomed Imaging AS, Oslo (Norway); Larusdottir, H. [Depts. of Radiology, Karolinska Inst., Stockholm (Sweden)]|[Univ. Hospital, Lund (Sweden)]|[Dept. of Surgery, Univ. Hospital, Lund (Sweden)]|[Nycomed Imaging AS, Oslo (Norway); Norgren, L. [Depts. of Radiology, Karolinska Inst., Stockholm (Sweden)]|[Univ. Hospital, Lund (Sweden)]|[Dept. of Surgery, Univ. Hospital, Lund (Sweden)]|[Nycomed Imaging AS, Oslo (Norway); Tengvar, M. [Depts. of Radiology, Karolinska Inst., Stockholm (Sweden)]|[Univ. Hospital, Lund (Sweden)]|[Dept. of Surgery, Univ. Hospital, Lund (Sweden)]|[Nycomed Imaging AS, Oslo (Norway); Bolstad, B. [Depts. of Radiology, Karolinska Inst., Stockholm (Sweden)]|[Univ. Hospital, Lund (Sweden)]|[Dept. of Surgery, Univ. Hospital, Lund (Sweden)]|[Nycomed Imaging AS, Oslo (Norway); Aspelin, P. [Depts. of Radiology, Karolinska Inst., Stockholm (Sweden)]|[Univ. Hospital, Lund (Sweden)]|[Dept. of Surgery, Univ. Hospital, Lund (Sweden)]|[Nycomed Imaging AS, Oslo (Norway)

1994-11-01

154

Iodixanol in femoral arteriography  

International Nuclear Information System (INIS)

Two contrast media, iodixanol (Visipaque, Nycomed) 270 mg I/ml and iohexol (Omnipaque, Nycomed) 300 mg I/ml, were compared in femoral arteriography, in 147 patients. Both contrast media were diagnostically effective for use in femoral arteriography, without any significant difference. Pain was reported in connection with injection of iohexol by 36% of the patients, after injection of iodixanol none reported pain. Seventy-two percent of the patients in the iodixanol group reported a sensation of warmth in connection with contrast injection versus 90% in the iohexol group. The average intensity of the warmth was greater with iohexol than with iodixanol. Fourteen percent of patients in the iodixanol group and 1% in the iohexol group reported one or more subjective adverse events. (orig.)

155

Dual mobility cup reduces dislocation rate after arthroplasty for femoral neck fracture  

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Full Text Available Abstract Background Hip dislocation after arthroplasty for femoral neck fractures remains a serious complication. The aim of our study was to investigate the dislocation rate in acute femoral neck fracture patients operated with a posterior approach with cemented conventional or dual articulation acetabular components. Methods We compared the dislocation rate in 56 consecutive patients operated with conventional (single mobility cemented acetabular components to that in 42 consecutive patients operated with dual articulation acetabular components. All the patients were operated via posterior approach and were followed up to one year postoperatively. Results There were 8 dislocations in the 56 patients having conventional components as compared to no dislocations in those 42 having dual articulation components (p = 0.01. The groups were similar with respect to age and gender distribution. Conclusions We conclude that the use of a cemented dual articulation acetabular component significantly reduces the dislocation rates in femoral neck fracture patients operated via posterior approach.

Robertsson Otto

2010-08-01

156

Posterior ankle impingement.  

Science.gov (United States)

Posterior ankle impingement is a common cause of chronic ankle pain and results from compression of bony or soft tissue structures during ankle plantar flexion. Bony impingement is most commonly related to an os trigonum or prominent trigonal process. Posteromedial soft tissue impingement generally arises from an inversion injury, with compression of the posterior tibiotalar ligament between the medial malleolus and talus. Posterolateral soft tissue impingement is caused by an accessory ligament, the posterior intermalleolar ligament, which spans the posterior ankle between the posterior tibiofibular and posterior talofibular ligaments. Finally, anomalous muscles have also been described as a cause of posterior impingement. PMID:23520307

Giannini, Sandro; Buda, Roberto; Mosca, Massimiliano; Parma, Alessandro; Di Caprio, Francesco

2013-03-01

157

Impact of posterior occlusal support on the condylar position.  

Science.gov (United States)

The purpose of this study was to investigate condylar displacement related to the loss of posterior occlusal support. Each of 23 subjects received one occlusal adjusted splint that covered all teeth from the right to the left second mandibular molar. None of the subjects had a third molar and none of them had a missing tooth or showed tooth mobility. The splint was inserted and vertical and horizontal condylar position was measured by an ultrasonic motion analyser. The splint was then unilateraly shortened tooth-by-tooth up to the canine tooth and the measurement was repeated after each shortening. Cutting off the splint's second molar on one side lead to a slight ipsilateral cranial motion of the condyle if subjects clenched with maximum voluntary force. If the second and first molar were cut off, a noticeable cranial condylar movement of about 0.3 mm was observed even when teeth occluded with low force. These results suggest that loss of posterior occlusal support as it happens in routine oral rehabilitation leads to a noticeable cranial condyle movement during registration, even if the clenching force is low. PMID:15265211

Seedorf, H; Seetzen, F; Scholz, A; Sadat-Khonsari, M R; Kirsch, I; Jüde, H D

2004-08-01

158

Radiological analysis on femoral tunnel positioning between isometric and anatomical reconstructions of the anterior cruciate ligament / Análise radiológica do posicionamento do túnel femoral com as técnicas de reconstrução isométrica ou de reconstrução anatômica do LCA  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in portuguese OBJETIVO: Avaliar radiologicamente a posição do túnel femoral na reconstrução do ligamento cruzado anterior pelas técnicas isométrica e anatômica. MÉTODOS: Foi feito estudo analítico prospectivo em pacientes submetidos à reconstrução do ligamento cruzado anterior (LCA), por meio da técnica iso [...] métrica e anatômica, com o uso de enxerto de tendões flexores do joelho ou de tendão patelar. Foram captados 28 pacientes, em pós-operatório imediato, no ambulatório de cirurgia do joelho da FCMMG-HUSJ. Foram feitas radiografias do joelho operado nas incidências em anteroposterior (AP) com apoio bipodálico e perfil em 30? de flexão. Foram traçadas as linhas e medidos os ângulos e as distâncias na radiografia em perfil para avaliar o plano sagital. Foi medida a distância do centro do parafuso à cortical posterior do côndilo lateral e dividido pela linha de Blumensaat. Com relação à altura do parafuso, foi medida a distância do centro dele até a superfície articular do côndilo lateral do joelho. Na radiografia em AP, que avalia o plano coronal, mede-se a angulação entre o eixo anatômico do fêmur e uma linha traçada no centro do parafuso. RESULTADOS: Pelos testes, o p-valor (0,4213) é maior do que o nível de significância adotado (0,05), a hipótese nula não é rejeitada e pode ser afirmado que não há diferença estatisticamente significativa entre as técnicas anatômica (TAN) e isométrica (TIS) no que diz respeito à Medida P (posteriorização do parafuso de interferência). Como o p-valor (0,0006) observado é menor do que o nível de significância adotado (0,05), rejeita-se a hipótese nula e pode ser afirmado que há diferença estatisticamente significativa entre a TAN e a TIS no que diz respeito à Medida H (altura do parafuso em relação à cortical inferior do joelho). Pode-se concluir que essa diferença ocorre porque a TIS gera valores maiores para a Medida H do que a TAN. Como o p-valor observado (0,000) é menor do que o nível de significância (5%), rejeitou-se a hipótese nula e afirmamos com 95% de confiança que há diferença significativa entre a TAN e a TIS no que diz respeito à variável MED (posição do parafuso na radiografia em AP). Houve diferença estatisticamente significativa na avaliação radiológica do túnel femoral, tanto no plano sagital como no coronal, entre as técnicas de reconstrução do LCA. Abstract in english OBJECTIVE: the aim of this study was to radiologically evaluate the femoral tunnel position in anterior cruciate ligament (ACL) reconstructions using the isometric and anatomical techniques. METHODS: a prospective analytical study was conducted on patients undergoing ACL reconstruction by mean [...] s of the isometric and anatomical techniques, using grafts from the knee flexor tendons or patellar tendon. Twenty-eight patients were recruited during the immediate postoperative period, at the knee surgery outpatient clinic of FCMMG-HUSJ. Radiographs of the operated knee were produced in anteroposterior (AP) view with the patient standing on both feet and in lateral view with 30? of flexion. The lines were traced out and the distances and angles were measured on the lateral radiograph to evaluate the sagittal plane. The distance from the center of the screw to the posterior cortical bone of the lateral condyle was measured and divided by the Blumensaat line. In relation to the height of the screw, the distance from the center of the screw to the joint surface of the lateral condyle of the knee was measured. On the AP radiograph, evaluating the coronal plane, the angle between the anatomical axis of the femur and a line traced at the center of the screw was measured. RESULTS: with regard to the p measurement (posteriorization of the interference screw), the tests showed that the p-value (0.4213) was greater than the significance level used (0.05); the null hypothesis was not rejected and it could be stated that there was no statistically significant d

Rodrigo Barreiros, Vieira; Leonardo Augusto de Pinho, Tavares; Rodrigo Campos Pace, Lasmar; Fernando Amaral da, Cunha; Lucas Araujo de Melo, Lisboa.

159

Radiological analysis on femoral tunnel positioning between isometric and anatomical reconstructions of the anterior cruciate ligament / Análise radiológica do posicionamento do túnel femoral com as técnicas de reconstrução isométrica ou de reconstrução anatômica do LCA  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in portuguese OBJETIVO: Avaliar radiologicamente a posição do túnel femoral na reconstrução do ligamento cruzado anterior pelas técnicas isométrica e anatômica. MÉTODOS: Foi feito estudo analítico prospectivo em pacientes submetidos à reconstrução do ligamento cruzado anterior (LCA), por meio da técnica iso [...] métrica e anatômica, com o uso de enxerto de tendões flexores do joelho ou de tendão patelar. Foram captados 28 pacientes, em pós-operatório imediato, no ambulatório de cirurgia do joelho da FCMMG-HUSJ. Foram feitas radiografias do joelho operado nas incidências em anteroposterior (AP) com apoio bipodálico e perfil em 30? de flexão. Foram traçadas as linhas e medidos os ângulos e as distâncias na radiografia em perfil para avaliar o plano sagital. Foi medida a distância do centro do parafuso à cortical posterior do côndilo lateral e dividido pela linha de Blumensaat. Com relação à altura do parafuso, foi medida a distância do centro dele até a superfície articular do côndilo lateral do joelho. Na radiografia em AP, que avalia o plano coronal, mede-se a angulação entre o eixo anatômico do fêmur e uma linha traçada no centro do parafuso. RESULTADOS: Pelos testes, o p-valor (0,4213) é maior do que o nível de significância adotado (0,05), a hipótese nula não é rejeitada e pode ser afirmado que não há diferença estatisticamente significativa entre as técnicas anatômica (TAN) e isométrica (TIS) no que diz respeito à Medida P (posteriorização do parafuso de interferência). Como o p-valor (0,0006) observado é menor do que o nível de significância adotado (0,05), rejeita-se a hipótese nula e pode ser afirmado que há diferença estatisticamente significativa entre a TAN e a TIS no que diz respeito à Medida H (altura do parafuso em relação à cortical inferior do joelho). Pode-se concluir que essa diferença ocorre porque a TIS gera valores maiores para a Medida H do que a TAN. Como o p-valor observado (0,000) é menor do que o nível de significância (5%), rejeitou-se a hipótese nula e afirmamos com 95% de confiança que há diferença significativa entre a TAN e a TIS no que diz respeito à variável MED (posição do parafuso na radiografia em AP). Houve diferença estatisticamente significativa na avaliação radiológica do túnel femoral, tanto no plano sagital como no coronal, entre as técnicas de reconstrução do LCA. Abstract in english OBJECTIVE: the aim of this study was to radiologically evaluate the femoral tunnel position in anterior cruciate ligament (ACL) reconstructions using the isometric and anatomical techniques. METHODS: a prospective analytical study was conducted on patients undergoing ACL reconstruction by mean [...] s of the isometric and anatomical techniques, using grafts from the knee flexor tendons or patellar tendon. Twenty-eight patients were recruited during the immediate postoperative period, at the knee surgery outpatient clinic of FCMMG-HUSJ. Radiographs of the operated knee were produced in anteroposterior (AP) view with the patient standing on both feet and in lateral view with 30? of flexion. The lines were traced out and the distances and angles were measured on the lateral radiograph to evaluate the sagittal plane. The distance from the center of the screw to the posterior cortical bone of the lateral condyle was measured and divided by the Blumensaat line. In relation to the height of the screw, the distance from the center of the screw to the joint surface of the lateral condyle of the knee was measured. On the AP radiograph, evaluating the coronal plane, the angle between the anatomical axis of the femur and a line traced at the center of the screw was measured. RESULTS: with regard to the p measurement (posteriorization of the interference screw), the tests showed that the p-value (0.4213) was greater than the significance level used (0.05); the null hypothesis was not rejected and it could be stated that there was no statistically significant d

Rodrigo Barreiros, Vieira; Leonardo Augusto de Pinho, Tavares; Rodrigo Campos Pace, Lasmar; Fernando Amaral da, Cunha; Lucas Araujo de Melo, Lisboa.

2014-04-01

160

Occipital condyle fracture with isolated unilateral hypoglossal nerve palsy.  

Science.gov (United States)

Occipital condyle fractures (OCFs) with selective involvement of the hypoglossal canal are rare. OCFs usually occur after major trauma and combine multiple fractures. We describe a 38-year-old man who presented with neck pain and a tongue deviation to the right side after a traffic accident. Severe limitations were detected during active and passive range of neck motion in all directions. A physical examination revealed a normal gag reflex and normal mobility of the palate, larynx, and shoulder girdle. He had normal taste and general sensation in his tongue. However, he presented with a tongue deviation to the right side on protrusion. A videofluoroscopic swallowing study revealed piecemeal deglutition due to decreased tongue mobility but no aspiration of food. Plain X-ray film findings were negative, but a computed tomography study with coronal reconstruction demonstrated a right OCF involving the hypoglossal canal. An electrodiagnostic study revealed evidence of right hypoglossal nerve palsy. We report a rare case of isolated hypoglossal nerve palsy caused by an OCF. PMID:25379499

Yoon, Jin Won; Lim, Oh Kyung; Park, Ki Deok; Lee, Ju Kang

2014-10-01

 
 
 
 
161

Proximal femoral focal deficiency.  

Science.gov (United States)

Proximal femoral focal deficiency (PFFD) is an uncommon congenital defect that involves the femur and acetabulum in varying degrees. It may occur with or without fibular hemimelia and can be unilateral or bilateral in presentation. Children with PFFD and their families are faced with many treatment decisions, both nonsurgical and surgical. Nursing care is central in the care of these children and their families both for psychosocial support and teaching during the decision-making process and for being a patient advocate to help meet postoperative and rehabilitation goals. PMID:9369731

Stormer, S V

1997-01-01

162

Estudo morfométrico da fossa intercondilar femoral em joelhos com e sem lesão do ligamento cruzado anterior (L.C.A., através da aplicação de um software sobre imagens radiográficas digitalizadas Morphometric study of the femoral intercondylar notch of knees with and without injuries of anterior cruciate ligament (A.C.L., by the use of software in digitalized radiographic images  

Directory of Open Access Journals (Sweden)

Full Text Available Os autores sugerem a aplicação de um software sobre imagens radiográficas digitalizadas para análise morfométrica da fossa intercondilar e dos côndilos femorais. O programa permite o tracejamento de linhas guias que facilitam a mensuração da extremidade distal do fêmur. Foram analisadas 39 radiografias simples da fossa intercondilar femoral dos joelhos direito e esquerdo, obtidas de indivíduos do sexo masculino reunidos em grupo normal (n=23 e grupo lesionado (n=16. A média de idade da amostra foi de 26,56 anos. As variáveis analisadas foram largura bicondilar femoral, larguras da fossa intercondilar ao nível do sulco poplíteo e da base da fossa, a altura da fossa intercondilar e a largura do côndilo femoral lateral. A fossa intercondilar foi classificada quanto ao formato em cônica, circular e retangular. Os resultados encontrados sugerem que a largura da base da fossa e a largura do côndilo femoral lateral seriam fatores de risco importantes na lesão do L.C.A. Os valores médios das variáveis analisadas aproximam-se dos descritos na literatura especializada em mensurações diretas em peças cadavéricas e ressonância nuclear magnética e demonstram que a aplicação de um software sobre as imagens radiográficas digitalizadas proporciona uma mensuração confiável, mesmo utilizando-se de imagens radiográficas simples e de baixo custo.The authors suggest the use of software in digitalized radiographic images to morphometric analysis of the intercondylar notch and the femoral condyles. The software allows the draw of guide lines which facilitate the measurement of the distal extremity of femur. Thirty-nine radiographic simple has been analyzed of femoral intercondylar notch of right and left knees, of male sex individuals collected into normal (n=23 and injured (n=16 groups. The age average was 26-56 years old.The analyzed variable had been femoral bicondylar width, widths of intercondylar notch to the level of the popliteal groove and the notch base, intercondylar notch height and the width of lateral femoral condyle. The intercondylar notch was classified according to its shape into conical , circular and rectangular. The results suggest that the base width of the notch and the width of the femoral condyle would be important risk factors of the injury of A.C.L. The average range of analyzed variables are near to the ones described in the specialized literature in direct measurements in corpse pieces and magnetic resonance imaging and demonstrate that the use of a software in digitalized radiographic images provides a realiable measurement, even if simple and low cost radiographic images are used.

Rita di Cássia de Oliveira Angelo

2004-09-01

163

Estudo morfométrico da fossa intercondilar femoral em joelhos com e sem lesão do ligamento cruzado anterior (L.C.A.), através da aplicação de um software sobre imagens radiográficas digitalizadas / Morphometric study of the femoral intercondylar notch of knees with and without injuries of anterior cruciate ligament (A.C.L.), by the use of software in digitalized radiographic images  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese Os autores sugerem a aplicação de um software sobre imagens radiográficas digitalizadas para análise morfométrica da fossa intercondilar e dos côndilos femorais. O programa permite o tracejamento de linhas guias que facilitam a mensuração da extremidade distal do fêmur. Foram analisadas 39 radiograf [...] ias simples da fossa intercondilar femoral dos joelhos direito e esquerdo, obtidas de indivíduos do sexo masculino reunidos em grupo normal (n=23) e grupo lesionado (n=16). A média de idade da amostra foi de 26,56 anos. As variáveis analisadas foram largura bicondilar femoral, larguras da fossa intercondilar ao nível do sulco poplíteo e da base da fossa, a altura da fossa intercondilar e a largura do côndilo femoral lateral. A fossa intercondilar foi classificada quanto ao formato em cônica, circular e retangular. Os resultados encontrados sugerem que a largura da base da fossa e a largura do côndilo femoral lateral seriam fatores de risco importantes na lesão do L.C.A. Os valores médios das variáveis analisadas aproximam-se dos descritos na literatura especializada em mensurações diretas em peças cadavéricas e ressonância nuclear magnética e demonstram que a aplicação de um software sobre as imagens radiográficas digitalizadas proporciona uma mensuração confiável, mesmo utilizando-se de imagens radiográficas simples e de baixo custo. Abstract in english The authors suggest the use of software in digitalized radiographic images to morphometric analysis of the intercondylar notch and the femoral condyles. The software allows the draw of guide lines which facilitate the measurement of the distal extremity of femur. Thirty-nine radiographic simple has [...] been analyzed of femoral intercondylar notch of right and left knees, of male sex individuals collected into normal (n=23) and injured (n=16) groups. The age average was 26-56 years old.The analyzed variable had been femoral bicondylar width, widths of intercondylar notch to the level of the popliteal groove and the notch base, intercondylar notch height and the width of lateral femoral condyle. The intercondylar notch was classified according to its shape into conical , circular and rectangular. The results suggest that the base width of the notch and the width of the femoral condyle would be important risk factors of the injury of A.C.L. The average range of analyzed variables are near to the ones described in the specialized literature in direct measurements in corpse pieces and magnetic resonance imaging and demonstrate that the use of a software in digitalized radiographic images provides a realiable measurement, even if simple and low cost radiographic images are used.

Rita di Cássia de Oliveira, Angelo; Sílvia Regina Arruda de, Moraes; Luciano Carvalho, Suruagy; Tetsuo, Tashiro; Helena Medeiros, Costa.

164

Nontraumatic bifid mandibular condyles in asymptomatic and symptomatic temporomandibular joint subjects  

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This study was performed to determine the prevalence of bifid mandibular condyles (BMCs) in asymptomatic and symptomatic temporomandibular joint (TMJ) subjects with no traumatic history, and to assess their impact on clinical and radiographic manifestations of TMJ. A total of 3,046 asymptomatic and 4,378 symptomatic patients were included in the study. Cone-beam computed tomography (CBCT) images were reviewed for bifid condyles. T-tests were used to compare the frequency of BMCs when stratified by symptom, gender, and side. In BMC patients, the clinical features of pain and noise, osseous changes, and parasagittal positioning of the condyles were compared between the normally shaped condyle side and the BMC side using chi-squared tests. Fifteen (0.49%) asymptomatic and 22 (0.50%) symptomatic patients were found to have BMCs. Among the bilateral cases, the number of condyles were 19 (0.31%) and 25 (0.29%), respectively. No statistically significant differences were found between asymptomatic and symptomatic patients, between female and male patients, or between the right and left sides (p>0.05). Compared with the normally shaped condyle side, the BMC side showed no statistically significant differences in the distribution of pain and noise, parasagittal condylar position, or condylar osseous changes, with the exception of osteophytes. In the symptomatic group, osteophytes were found more frequently on the normally shaped condyle side than the BMC side (p<0.05). BMCs tended to be identified as an incidental finding. The presence of BMC would not lead to any TMJ symptoms or cause osseous changes.

Cho, Bong Hae; Jung, Yun Hoa [Dept. of Oral and Maxillofacial Radiology, School of Dentistry, Pusan National University, Yangsan (Korea, Republic of)

2013-03-15

165

The influence of femoral condylar lift-off on the wear of artificial knee joints.  

Science.gov (United States)

In vivo fluoroscopic studies of patients with total knee replacements (TKRs) have shown lift-off of the femoral condyles from the tibial insert. This study investigated the influence of femoral condylar lift-off on the ultra-high molecular weight polyethylene (UHMWPE) wear of fixed bearing (FB) and rotating platform mobile bearing (RP MB) total knee replacements, using a physiological knee joint simulator. In the absence of lift-off, the RP MB knees exhibited a lower wear rate of 5.2 +/- 2.2 mm3 per million cycles (mm3/MC) compared with 8.8 +/- 4.8 mm3/MC for the FB knees. The presence of femoral condylar lift-off was found to accelerate the wear of the FB and RP MB knees tested in this study to 16.4 +/- 2.9 and 16.9 +/- 2.9 mm3/MC respectively. For the RP MB knees the increase in wear rate was more marked, resulting in a similar wear rate for both designs of knee under lift-off conditions. In both cases the medial condyle displayed more wear damage. This study has shown that a small amount of abduction/adduction lift-off and medial-lateral shift increases wear and that the increase in wear is design dependent. In this simulator test, lift-off was simulated on every cycle, whereas the amount of wear and effect of lift-off clinically would depend on the frequency of occurrence of lift-off in vivo. PMID:17539585

Jennings, L M; Bell, C I; Ingham, E; Komistek, R D; Stone, M H; Fisher, J

2007-04-01

166

A comparison of transcranial with panoramic TMJ radiographs to assess the movement of the mandibular condyle  

International Nuclear Information System (INIS)

To evaluate the difference of the movement of the mandibular condyles between transcranial and panoramic TMJ radiographs to view the movement of the mandibular condyles. Thirty-four paired transcranial and panoramic TMJ radiographs of patients were used to evaluate the movement of the mandibular condyle. The distances, from the most superior point of the mandibular condyle to the most inferior point of the articular eminence on both radiographs, were measured. The measurements were taken at closed state and maximum opening state of each radiograph on both side. Differences between matched pairs were analysed by paired t-test, with significance established at P<0.05. The mean distance, from the most superior point of the mandibular condyle to the most inferior point of the articular eminence on both radiographs, was statistically different at each side (P<0.05). At closing state, the mean distance measured on panoramic TMJ radiographs was longer than on transcranial radiographs (0.85 mm at right side, 1.20 mm at left side). But at maximum opening state, the mean distance on transcranial radiographs was longer (1.00 mm at right side, 0.62 mm at left side) than panoramic TMJ radiographs.

167

Volumetric analysis of the mandibular condyle using cone beam computed tomography  

International Nuclear Information System (INIS)

Objective: The aim was to determine the accuracy of volumetric analysis of the mandibular condyle using cone-beam computed tomography (CBCT). Materials and methods: Five dry mandibles containing 9 condyles were used. CBCT scans of the mandibles and an impression of each condylar area were taken. The physical volumes of the condyles were calculated as the gold standard using the water displacement technique. After isolating, the condylar volume was sectioned in the sagittal plane, and 0.3 mm thick sections with 0.9 mm intervals were obtained from 3D reconstructions. Using the Cavalieri principle, the volume of each condyle was estimated from the CBCT images by three observers. The accuracy of the CBCT volume measurements and the relation agreements between the results of the three observers were assessed using the Wilcoxon Signed Rank test and Pearson correlation test. The level of statistical significance was set at 0.05. Results: The results of the Pearson correlation showed that there were highly significant positive correlations between the observers’ measurements. According to the results of the Wilcoxon Signed Rank test comparing the physical and observers’ measurements, there were no statistically significant differences (p > 0.05). Conclusion: The Cavalieri principle, used in conjunction with a planimetry method, is a valid and effective method for volume estimation of the mandibular condyle on CBCT images.

168

Sex determination using discriminant analysis of the medial and lateral condyles of the femur in Koreans.  

Science.gov (United States)

The proximal and distal parts of the femur show the differences between the sexes. Head diameter and the breadth of the epicondyle of the femur are known to distinguish males from females. The proximal end of the femur is studied to determine sex using discriminant analysis but; its distal end is not done. This study aims to develop an equation specific to Koreans by using the medial and lateral condyles of the femur, and to demonstrate the usefulness of equations for specific population groups. We used three-dimensional images from 202 Korean femurs. Twelve variables were measured with a computer program after the femurs were in alignment. Eleven variables showed a statistically significant difference between the sexes (P<0.01). The most accurate equation used width of the medial and lateral condyles (WDC), with of the medial condyle (WMC), depth of the lateral condyle (DLC), and depth of the intercondylar notch (DIN) (94.1%), and is as follows: D = 0.336 × WDC + (-0.097) × WMC + (-0.153) × DLC + 0.372 × DIN - 20.912. The second highest accuracy was 90.1% for the width dimensional group and WDC. This study shows that the medial and lateral condyles of the femur should be helpful for sex determination in situations where the skull and pelvis are missing and part of the femur is available. The study also demonstrates the need for different equations for different population groups. PMID:24314510

Kim, Deog-Im; Kwak, Dai-Soon; Han, Seung-Ho

2013-12-10

169

Metastatic pancreatic adenocarcinoma to the mandibular condyle: a rare clinical presentation.  

Science.gov (United States)

Metastatic disease to the oral cavity is rare, representing only 1-8% of oral malignancies, and involvement of the mandibular condyle is even less prevalent. In a recent literature review of 796 cases of metastatic disease to the oral cavity, only 39 (13.8%) involved the condyle. This report is a unique case of metastatic pancreatic adenocarcinoma to the condyle. There are only 5 documented cases of metastatic pancreatic adenocarcinoma to the oral cavity, one of which metastasized to the condyle. This is an important case because metastatic lesions to the condyle may mimic temporomandibular joint disorders making clinical diagnosis and decision-making extremely challenging for the oral and maxillofacial surgeon. The requirement for arrival at an appropriate and prompt diagnosis is crucial for determining the most appropriate treatment regimens and improved outcomes. Additionally, in approximately 33% of cases, the oral metastatic lesion may be the first indication of an undiscovered distant primary tumor, making timely evaluation and treatment critical from an oncologic perspective. PMID:23911149

Kolokythas, Antonia; Miloro, M Beth; Olsson, Alexis B; Miloro, Michael

2014-01-01

170

The Extreme Lateral Transcondylar Approach to Aneurysms of the Vertebrobasilar Junction, the Vertebral Artery, and the Posterior Inferior Cerebellar Artery  

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The unilateral suboccipital craniotomy is the commonly performed approach to aneurysms of the vertebrobasilar junction, the vertebral artery, and the posterior inferior cerebellar artery (PICA). Many of these aneurysms are placed anterior or anterolateral to the brain stem, necessitating brain stem retraction for adequate exposure. Small dorsolateral enlargement of the foramen magnum, partial resection of the occipital condyle, and removal of the jugular tubercle allow access to the neurovasc...

Rohde, Veit; Schaller, Carlo; Hassler, Werner

1994-01-01

171

Escleritis posterior bilateral Bilateral posterior scleritis  

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Full Text Available La escleritis posterior es un proceso inflamatorio de la parte posterior de la esclera. Su prevalencia es muy baja y el diagnóstico puede resultar complicado por la ausencia de signos oculares externos. Es más frecuente en mujeres. Cuando aparece en pacientes jóvenes no suele tener otras patologías asociadas, pero en mayores de 55 años hasta un tercio de los casos tienen relación con alguna enfermedad sistémica, sobre todo la artritis reumatoide. El diagnóstico de esta patología puede requerir un abordaje multidisciplinar y la colaboración de oftalmólogos con neurólogos, internistas o reumatólogos. En este artículo se describe un caso de escleritis posterior bilateral idiopática.Posterior scleritis is an inflammatory process of the posterior part of the sclera. Its prevalence is very low and its diagnosis can be complicated due to the absence of external ocular signs. It is more frequent in women. In young patients it does not usually have other associated pathologies, but in those over 55 years nearly one-third of the cases have a relation with some systemic disease, above all rheumatoid arthritis. The diagnosis of this pathology can require a multidisciplinary approach and the collaboration of ophthalmologists with neurologists, internists or rheumatologists. This article describes a case of idiopathic bilateral posterior scleritis.

A. Zurutuza

2011-08-01

172

Escleritis posterior bilateral / Bilateral posterior scleritis  

Scientific Electronic Library Online (English)

Full Text Available SciELO Spain | Language: Spanish Abstract in spanish La escleritis posterior es un proceso inflamatorio de la parte posterior de la esclera. Su prevalencia es muy baja y el diagnóstico puede resultar complicado por la ausencia de signos oculares externos. Es más frecuente en mujeres. Cuando aparece en pacientes jóvenes no suele tener otras patologías [...] asociadas, pero en mayores de 55 años hasta un tercio de los casos tienen relación con alguna enfermedad sistémica, sobre todo la artritis reumatoide. El diagnóstico de esta patología puede requerir un abordaje multidisciplinar y la colaboración de oftalmólogos con neurólogos, internistas o reumatólogos. En este artículo se describe un caso de escleritis posterior bilateral idiopática. Abstract in english Posterior scleritis is an inflammatory process of the posterior part of the sclera. Its prevalence is very low and its diagnosis can be complicated due to the absence of external ocular signs. It is more frequent in women. In young patients it does not usually have other associated pathologies, but [...] in those over 55 years nearly one-third of the cases have a relation with some systemic disease, above all rheumatoid arthritis. The diagnosis of this pathology can require a multidisciplinary approach and the collaboration of ophthalmologists with neurologists, internists or rheumatologists. This article describes a case of idiopathic bilateral posterior scleritis.

A., Zurutuza; J., Andonegui; L., Berástegui; N., Arruti.

173

Instrumented hip joint replacements, femoral replacements and femoral fracture stabilizers.  

Science.gov (United States)

This paper reviews instrumented hip joint replacements, instrumented femoral replacements and instrumented femoral fracture stabilizers. Examination of the evolution of such implants was carried out, including the detailed analysis of 16 architectures, designed by 8 research teams and implanted in 32 patients. Their power supply, measurement, communication, processing and actuation systems were reviewed, as were the tests carried out to evaluate their performance and safety. These instrumented implants were only designed to measure biomechanical and thermodynamic quantities in vivo, in order to use such data to conduct research projects and optimize rehabilitation processes. The most promising trend is to minimize aseptic loosening and/or infection following hip or femoral replacements or femoral stabilization procedures by using therapeutic actuators inside instrumented implants to apply controlled stimuli in the bone-implant interface. PMID:25234709

Soares Dos Santos, Marco P; Ferreira, Jorge Af; Ramos, António; Simões, José Ao; Morais, Raul; Silva, Nuno M; Santos, Paulo M; Reis, Manuel C; Oliveira, Tatiana

2014-11-01

174

Total Knee Replacement for Women  

Medline Plus

Full Text Available ... inch osteotome. I want to allow for some external rotation of my femoral component, and I do ... will give me a degree or two of external rotation when I use my posterior condyles as ...

175

Proximal femoral focal deficiency (PFFD).  

Science.gov (United States)

A 1-year-old child with proximal femoral focal deficiency (PFFD) is presented. The clinical spectrum and associated abnormalities is described and the diagnosis and management of this entity is discussed. PMID:10773937

Shetty, A K; Khubchandani, R P

1998-01-01

176

Fracture of the occipital condyle caused by minor trauma in child.  

Science.gov (United States)

We report a case of fractured occipital condyle caused by minor trauma accompanied by light pain on palpation at the lateral cervical trigonum. A 15-year-old boy complained of nuchal pain, particularly pain on palpation at the left lateral cervical trigonum in the absence of neurologic deficits after head deceleration trauma. Computed tomography demonstrated a unilateral nonluxated fracture of the occipital condyle. Owing to consequent immobilization by means of cervical orthosis, pain disappeared after the first 48 hours. Follow-up examination 4 weeks later showed no neurologic deficits. The boy had no severe impairment of movements at the cervical spine. PMID:17011288

Kapapa, Thomas; Tschan, Christoph A; König, Kathrin; Schlesinger, Arkadius; Haubitz, Bernd; Becker, Hartmut; Zumkeller, Matthias; Eckhard, Rickels

2006-10-01

177

Functional outcomes of preauricular underparotid retrograde approach for mandibular condyle fractures.  

Science.gov (United States)

Management of condyle fractures includes a wide spectrum of alternatives including analgesia alone, physiotherapy, intermaxillary fixation, and open reduction and internal fixation. Various approaches have been previously mentioned for the access to the mandibular condyle. The aim of this retrospective clinical study was to evaluate our clinical results on preauricular underparotid retrograde approach for condylar fractures. This retrospective study included 20 condylar fractures in 16 patients who were treated surgically using a preauricular transparotid retrograde approach between 2010 and 2013. Functional outcomes with this method were addressed in light of the results obtained in this clinical series. We suggest this method in the management of condylar fractures. PMID:24717314

Pilanci, Özgur; Basaran, Karaca; Ceran, Fatih; Kuvat, Samet Vasfi

2014-05-01

178

Posterior lymphadenopathy in sarcoidosis.  

Science.gov (United States)

Chest radiographs were reviewed in 30 cases of biopsy proven sarcoidosis; posterior mediastinal or para-aortic lymph node enlargement was found in 6 patients (20%) who also had symmetrical hilar and/or paratracheal lymph node enlargement. The radiographic behavior of the hilar, mid- and posterior mediastinal lymph nodes was the same. Posterior mediastinal lymph node enlargement in otherwise typical sarcoidosis is not unusual. PMID:725029

Schabel, S I; Foote, G A; McKee, K A

1978-12-01

179

Posterior knee pain  

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Posterior knee pain is a common patient complaint. There are broad differential diagnoses of posterior knee pain ranging from common causes such as injury to the musculotendinous structures to less common causes such as osteochondroma. A precise understanding of knee anatomy, the physical examination, and of the differential diagnosis is needed to accurately evaluate and treat posterior knee pain. This article provides a review of the anatomy and important aspects of the history and physical ...

English, S.; Perret, D.

2010-01-01

180

Computed tomography imaging findings of simultaneous bifid mandibular condyle and temporomandibular joint ankylosis: case report  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in portuguese O côndilo mandibular bífido (BMC) é uma entidade incomum descrita na literatura e de etiologia controversa. Apesar da ausência de sintomatologia clínica, o radiologista deve estar alerta e deve ter conhecimento a respeito desta anormalidade, bem como suas implicações funcionais e mudanças morfológic [...] as. A anquilose de articulação temporomandibular é uma patologia incapacitante com envolvimento do côndilo mandibular, fossa articular e base do crânio. A associação entre côndilo mandibular bífido e anquilose temporomandibular é rara e deve ser avaliada cuidadosamente. O objetivo deste artigo é relatar um caso simultâneo de côndilo mandibular bífido (BMC) e anquilose temporomandibular e descrever seus achados em tomografia computadorizada (CT). Abstract in english Bifid mandibular condyle is an uncommon entity described in the literature as having a controversial etiology. Despite the absence of clinical symptomatology, the radiologist must be aware and should have some knowledge of this abnormality, as well its implications regarding functional and morpholog [...] ical changes. TMJ ankylosis is a disabling disease with involvement of the mandibular condyle, articular fossa and base of the skull. The association of bifid condyle with temporomandibular joint ankylosis is rare and must be carefully evaluated. The purpose of this paper is to report a case of simultaneous bifid mandibular condyle and temporomandibular joint ankylosis and to describe its computed tomography imaging findings.

Marcelo Augusto Oliveira, Sales; Jefferson Xavier, Oliveira; Marcelo Gusmão Paraíso, Cavalcanti.

 
 
 
 
181

Interpretation of mandibular condyle fractures using 2D- and 3D-computed tomography  

Directory of Open Access Journals (Sweden)

Full Text Available Computed tomography (CT has been increasingly used in the examination of patients with craniofacial trauma. This technique is useful in the examination of the temporomandibular joint and allows the diagnosis of fractures of the mandibular condyle. Aiming to verify whether the three-dimensional reconstructed images from CT (3D-CT produce more effective visual information than the two-dimensional (2D-CT ones, we evaluated 2D-CT and 3D-CT examinations of 18 patients with mandibular condyle fractures. We observed that 2D-CT and 3D-CT reconstructed images produced similar information for the diagnosis of fractures of the mandibular condyle, although the 3D-CT allowed a better visualization of the position and displacement of bone fragments, as well as the comminution of fractures. These results, together with the possibility of refining and manipulating perspectives in 3D images, reinforce the importance of its use in the surgical planning and evaluation of treatment. We concluded that 3D-CT presented supplementary information for a more effective diagnosis of mandibular condyle fractures.

Costa e Silva Adriana Paula de Andrade da

2003-01-01

182

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

International Nuclear Information System (INIS)

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

183

Arthroscopically Confirmed Femoral Button Deployment  

Science.gov (United States)

The anterior cruciate ligament TightRope RT (Arthrex, Naples, FL) is a graft suspension device for cruciate ligament reconstruction. It is an adjustable-length graft loop cortical fixation device designed to eliminate the requirement for loop length calculation and to facilitate complete graft fill of short femoral sockets that are common with anatomic anterior cruciate ligament placement. The adjustable loop length means “one size fits all,” thus removing the need for multiple implant sizes and allowing graft tensioning even after fixation. However, the device has been associated with the same complications that have been described with EndoButton (Smith & Nephew Endoscopy, Andover, MA) fixation. The button of the TightRope RT may remain in the femoral tunnel rather than flipping outside of the tunnel to rest on the lateral femoral cortex, or it may become jammed inside the femoral canal. Conversely, the button may be pulled too far off the femoral cortex into the overlying soft tissue and flip in the substance of the vastus lateralis. We describe a new and simple arthroscopic technique to directly visualize the deployment and seating of the TightRope button on the lateral cortex of the femur to avoid all the aforementioned complications. PMID:25126492

Sonnery-Cottet, Bertrand; Rezende, Fernando C.; Martins Neto, Ayrton; Fayard, Jean M.; Thaunat, Mathieu; Kader, Deiary F.

2014-01-01

184

Assessment of simulated mandibular condyle bone lesions by cone beam computed tomography  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in english There are many limitations to image acquisition, using conventional radiography, of the temporomandibular joint (TMJ) region. The Computed Tomography (CT) scan is a better option, due to its higher accuracy, for purposes of diagnosis, surgical planning and treatment of bone injuries. The aim of the [...] present study was to analyze two protocols of cone beam computed tomography for the evaluation of simulated mandibular condyle bone lesions. Spherical lesions were simulated in 30 dry mandibular condyles, using dentist drills and drill bits sizes 1, 3 and 6. Each of the mandibular condyles was submitted to cone beam computed tomography (CBCT) using two protocols: 1) axial, coronal and sagittal multiplanar reconstruction (MPR); and 2) sagittal plus coronal slices throughout the longitudinal axis of the mandibular condyles. For these protocols, 2 observers analyzed the CBCT images independently, regarding the presence or not of injuries. Only one of the observers, however, performed on 2 different occasions. The results were compared to the gold standard, evaluating the percentage of agreement, degree of accuracy of CBCT protocols and observers' examination. The z test was used for the statistical analysis. The results showed there were no statistically significant differences between the 2 protocols. There was greater difficulty in the assessment of small-size simulated lesions (drill # 1). From the results of this study, it can be concluded that CBCT is an accurate tool for analyzing mandibular condyle bone lesions, with the MPR protocol showing slightly better results than the sagittal plus coronal slices throughout the longitudinal axis.

Alexandre Perez, Marques; Andréia, Perrella; Emiko Saito, Arita; Marlene Fenyo Soeiro de Matos, Pereira; Marcelo de Gusmão Paraíso, Cavalcanti.

2010-12-01

185

MR imaging of posterior cruciate ligament injury  

International Nuclear Information System (INIS)

There is increasing awareness of the clinical importance of early detection and treatment of posterior cruciate ligament(PCL) injury. We evaluate the usefulness of Magnetic resonance(MR) imaging in the diagnosis of PCL injury. We retrospectively analysed the MR images of 140 cases with clinically suspected knee injury. Arthroscopic or surgical correlation was available in 63 cases. We observed the finding and extent of PCL injury and other associated abnormalities. The frequency of anterior and posterior meniscofemoral ligament was evaluated. Eleven PCL injuries were observed, six midsubstance tears, two tibial attachment tears, two femoral attachment tear, one laxity. The sensitivity, specificity and accuracy of MR imaging diagnosis are 100%, 98.1%, 98.4%. MR findings of PCL injury are discontinuity and focal mass formation, irregular increased signal intensity, detachment or redundancy of the ligament with avulsed bony fragment. In all cases of injured PCL, other associated abnormalities of adjacent structures were observed. Accessory anterior and posterior meniscofemoral ligaments were observed in 67.4%(87/129). MR imaging is useful in evaluation of presence or absence of PCL injury, accurate extent of PCL injury and other important associated abnormalities of adjacent structures

186

Surgical Treatment of Posterior Cruciate Ligament Injury  

Directory of Open Access Journals (Sweden)

Full Text Available Successful posterior cruciate ligament (PCL reconstructionis challenging because of the complex structures and difficultreconstruction techniques that are required. The reportedresults have been inconsistent. Variables that affect the resultsof surgery to restore PCL function include combined associatedligaments injury, difficulty to duplicate PCL anatomy, widevariation in broad femoral insertion footprint, difficulty inaccurate placement of the transtibial tunnel, tunnel erosion,high internal graft stresses and graft elongation. The outcomeof conservative treatment of isolated PCL injuries with mild ormoderate laxity is generally acceptable. However, more severestraight posterior laxity or combined injury patterns usuallylead to a worse prognosis. Surgical reconstruction for PCL canachieve satisfactory results for most patients if adequate surgicalprinciples and techniques are followed. Recent studies onthe anatomy and the biomechanics of PCL have led to a better understanding of its biomechanicalproperties for the reconstruction. It has been generally agreed that surgical reconstructionis indicated for symptomatic severe posterior knee instability and multiple ligamentinjuries for better functional recovery after PCL injuries. Accepted surgical techniques forthe treatment of PCL tears include primary repair for PCL avulsion fracture, as well as openor arthroscopic reconstruction using the transtibial or tibial inlay technique. Controversycontinues over the choice of graft tissue, one or two bundle reconstruction, location of tunnelplacement, knee position when securing the graft, and fixation technique. From the accumulatedclinical experience and surgical concepts in clinical practice, we have developedvarious surgical techniques to improve the outcomes of reconstruction.

Chih-Hwa Chen

2007-12-01

187

Traumatic posterior dislocation of the hip in a 3-year-old child.  

LENUS (Irish Health Repository)

We report the case of a traumatic posterior dislocation of the hip in a 3-year-old boy. After a fall in the garden, the boy was brought to our emergency department where an x-ray confirmed a posterior dislocation of his right hip. A successful prompt reduction was performed in the operating room under general anesthesia. This uncommon injury represents an orthopedic emergency and requires prompt reduction to lessen the risk of complications including avascular necrosis of the femoral head.

Forde, James C

2012-02-01

188

[Bilateral posterior scleritis].  

Science.gov (United States)

Posterior scleritis is an inflammatory process of the posterior part of the sclera. Its prevalence is very low and its diagnosis can be complicated due to the absence of external ocular signs. It is more frequent in women. In young patients it does not usually have other associated pathologies, but in those over 55 years nearly one-third of the cases have a relation with some systemic disease, above all rheumatoid arthritis. The diagnosis of this pathology can require a multidisciplinary approach and the collaboration of ophthalmologists with neurologists, internists or rheumatologists. This article describes a case of idiopathic bilateral posterior scleritis. PMID:21904415

Zurutuza, A; Andonegui, J; Berástegui, L; Arruti, N

2011-01-01

189

The functional shift of the mandible in unilateral posterior crossbite and the adaptation of the temporomandibular joints: a pilot study.  

Science.gov (United States)

Changes in the functional shift of the mandibular midline and the condyles were studied during treatment of unilateral posterior crossbite in six children, aged 7-11 years. An expansion plate with covered occlusal surfaces was used as a reflex-releasing stabilizing splint during an initial diagnostic phase (I) in order to determine the structural (i.e. non-guided) position of the mandible. The same plate was used for expansion and retention (phase II), followed by a post-retention phase (III) without the appliance. Before and after each phase, the functional shift was determined kinesiographically and on transcranial radiographs by concurrent recordings with and without the splint. Transverse mandibular position was also recorded on cephalometric radiographs. Prior to phase I, the mandibular midline deviated more than 2 mm and, in occlusion (ICP), the condyles showed normally centred positions in the sagittal plane. With the splint, the condyle on the crossbite side was displaced 2.4 mm (P < 0.05) forwards compared with the ICP, while the position of the condyle on the non-crossbite side was unaltered. After phase III, the deviation of the midline had been eliminated. Sagittal condylar positions in the ICP still did not deviate from the normal, and the splint position was now obtained by symmetrical forward movement of both condyles (1.3 and 1.4 mm). These findings suggest that the TMJs adapted to displacements of the mandible by condylar growth or surface modelling of the fossa. The rest position remained directly caudal to the ICP during treatment. Thus, the splint position, rather than the rest position should be used to determine the therapeutic position of the mandible. PMID:10327739

Nerder, P H; Bakke, M; Solow, B

1999-04-01

190

Bilateral Femoral Neck Fracture-Related Hyperparathyroidism  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Bilateral femoral neck fracture is not common as unilateral femoral fracture. Femoral neck fracture generally occurs by the high energized traumas. Traffic accidents and fallings are the most common reason for this fracture kind. But suddenly and minor traumatic fractures is not common. Especially, in the hormonal and pathogenic fractures is not common. In this case minor traumatic bilateral femoral fracture is presented. The fracture occurs in the background of critical medical condition by ...

Naci Ezirmik; Kadri Yildiz; Kenan Cadirci

2011-01-01

191

Avaliação por tomografia computadorizada helicoidal dos efeitos da expansão rápida da maxila no posicionamento condilar em pacientes com mordida cruzada posterior funcional / Evaluation with helicoidal computed tomography of rapid maxillary expansion effects in the condylar position of patients with functional posterior crossbite  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese OBJETIVO: este estudo clínico avaliou, por meio da tomografia computadorizada helicoidal, os efeitos da expansão rápida da maxila no posicionamento condilar de pacientes com mordida cruzada posterior funcional na fase da dentadura mista. MÉTODOS: dez pacientes com faixa etária entre os 7 anos e 2 me [...] ses e os 11 anos e 2 meses - apresentando mordida cruzada posterior funcional, com desvio da linha média de pelo menos 2,5mm para o lado do cruzamento - foram tratados com expansão rápida da maxila. Após a obtenção de cortes tomográficos sagitais da articulação temporomandibular, as medidas dos espaços articulares anterior, posterior e superior foram realizadas e o posicionamento relativo do côndilo foi calculado. Utilizando-se cortes tomográficos axiais, avaliou-se o posicionamento anteroposterior e transversal dos côndilos em relação às estruturas da base craniana. RESULTADOS: foram identificadas diferenças significativas, antes do tratamento, entre os espaços articulares posteriores, na posição relativa do côndilo e um posicionamento mais anterior e mais próximo ao plano sagital mediano do côndilo do lado não-cruzado. Após o tratamento, não foram evidenciadas diferenças significativas nessas medidas. CONCLUSÕES: após a expansão rápida da maxila, um posicionamento mais centralizado dos côndilos nas fossas articulares foi observado, além de uma maior simetria anteroposterior e transversal entre os mesmos. Abstract in english AIM: This clinical study evaluated, through helicoidal computed tomography (CT), the effects of rapid maxillary expansion in the condylar position of patients with functional posterior crossbite in mixed dentition stage. METHODS: Ten patients aged between 7 years and 2 months and 11 years and 2 mont [...] hs were selected. This patients which presented functional unilateral posterior crossbite with mandibular midline deviation of at least 2.5mm to the crossbite side were submitted to rapid maxillary expansion. After obtaining sagittal CT slices of the temporomandibular joints, measurements of the anterior, posterior and superior joint spaces were carried out and the relative positioning of the condyle was calculated. Axial slices of the temporomandibular joint were also used to evaluate the anteroposterior and transversal position of the condyles in relation to the cranial base structures. RESULTS: Before treatment, significant differences were observed in the posterior joint spaces, in the relative positioning of the condyle and with the non-crossbite side condyle displaced more anteriorly and medially in relation to midsagittal line. After treatment there was no statistically significant difference. CONCLUSION: After the rapid maxillary expansion, a more centralized position of the condyles in the joint cavities was observed, and a greater anteroposterior and transverse symmetry between them.

Edgard Norões Rodrigues da, Matta; Margareth Maria Gomes de, Souza; Eduardo Franzotti de, Sant' Anna; Silvio Chagas da, Silva.

192

Biomechanical model of the shear stress distribution in the femoral neck  

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Full Text Available Background and Purpose. The shear stress distribution in the femoral neck is an important biomechanical parameter in the development of slipped capital femoral epiphysis. In our work we present a simple non-invasive method for computation of the shear stress distribution in the femoral neck of an individual hip based on anterior-posterior pelvic radiograph. Methods. A mathematical model of the resultant hip force is used and the shear stress tensor is computed according to the procedure for a loaded beam. Results. Preliminary results from an illustrative set of three patients with slipped capital femoral epiphysis show that the collum-diaphysis angle, the femoral neck width and the resultant hip force have important influence on shear stress distribution. Conclusion. Unfavorable high values of the resultant hip force can be compensated by larger collum-diaphysis angle and wider femoral neck. In further research the method could be used on a larger series of patients to determine the predictive value of the shear stress for different clinical outcomes.

Aleš Iglič

2005-12-01

193

Patient effective dose and radiogenic risks from fluoroscopically assisted surgical reconstruction of femoral fractures  

International Nuclear Information System (INIS)

The objectives were to assess patient effective radiation dose from fluoroscopically guided surgical reconstruction of femoral fractures and provide normalized data for the estimation of patient effective dose and risks associated with such procedures performed in any laboratory. The fluoroscopic control required during surgical reconstruction of femoral fractures was classified into two types identified by beam orientation, i.e., posterior-anterior (PA) and lateral cross-table (LC) exposures. The duration and the dose area product (DAP) of each exposure were monitored in 24 patients with femoral fractures. Patient dose per DAP unit and per minute of fluoroscopy were measured at 14 radiosensitive organs/tissues using an anthropomorphic phantom and thermoluminescence dosimetry. The typical effective dose to patients with femoral fracture treated surgically in our institution was 11.6-21.7 ?Sv. This effective dose is estimated to cause an excess of 1.4 fatal cancers per million patients treated, and an excess of 0.4 hereditary disorders per million of births. Induction of deterministic skin injuries to treated patients is highly improbable at the dose levels found in this study. Patient effective dose and associated risks from a typical fluoroscopically guided surgical fixation of femoral fracture are low. However, they may be significantly elevated if treated patients are young individuals and/or the fluoroscopic exposure is prolonged. The present data may be used to olonged. The present data may be used to determine effective dose to patients undergoing surgical reconstruction of femoral fracture in any institution. (authors)

194

Posterior ankle impingement syndrome.  

Science.gov (United States)

Posterior ankle impingement syndrome is a clinical disorder characterized by posterior ankle pain that occurs in forced plantar flexion. The pain may be acute as a result of trauma or chronic from repetitive stress. Pathology of the os trigonum-talar process is the most common cause of this syndrome, but it also may result from flexor hallucis longus tenosynovitis, ankle osteochondritis, subtalar joint disease, and fracture. Patients usually report chronic or recurrent posterior ankle pain caused or exacerbated by forced plantar flexion or push-off maneuvers, such as may occur during dancing, kicking, or downhill running. Diagnosis of posterior ankle impingement syndrome is based primarily on clinical history and physical examination. Radiography, scintigraphy, computed tomography, and magnetic resonance imaging depict associated bone and soft-tissue abnormalities. Symptoms typically improve with nonsurgical management, but surgery may be required in refractory cases. PMID:16224109

Maquirriain, Javier

2005-10-01

195

Tratamiento conservador de las fracturas del cóndilo: Evaluación radiológica y clínica Conservative treatment of condyle fractures: Radiological and clinical evaluation  

Directory of Open Access Journals (Sweden)

Full Text Available Las ventajas del tratamiento quirúrgico de las fracturas del proceso condilar hasta la fecha han despertado controversia en la literatura. El tratamiento conservador es el método de elección en nuestra clínica, por lo tanto, el propósito de este estudio es evaluar los resultados obtenidos en un grupo de nuestros pacientes, seleccionados y aleatorizados, que recibieron un tratamiento conservador de fracturas del proceso condilar. Se evaluaron las intervenciones terapéuticas entre 1997 y 2000 en 30 pacientes (18 varones, 12 mujeres, edad media de 25 años con fracturas del cóndilo y un tiempo de seguimiento medio de 12 meses. Se incluyó un total de 35 fracturas del cóndilo en este estudio. El tratamiento utilizado fue la fijación maxilomandibular (FMM, que se aplicó durante 2 semanas en las fracturas unilaterales y durante 3 a 4 semanas en las fracturas bilaterales. Se realizó una evaluación radiológica inicial del ángulo del proceso condilar fracturado y del acortamiento de la rama ascendente. Se evaluaron las exploraciones clínicas y radiológicas a intervalos regulares (6 semanas y 3, 6 y 12 meses. Cinco pacientes presentaron fracturas bilaterales; todos con luxación anterior. En el grupo de las fracturas unilaterales, 12 pacientes presentaron luxación anterior (valor medio 23° en la radiografía panorámica. Trece pacientes presentaron luxación posterior (valor medio 10°. En la proyección posteroanterior se observó la luxación medial en 12 fracturas (valor medio 14° y luxación lateral en 4 fracturas (valor medio 6°. El acortamiento de la rama ascendente alcanzó un valor medio de 5,40 mm. Se logró una funcionalidad y movilidad satisfactorias en todos los pacientes tratados. Las secuelas postraumáticas fueron el chasquido de la articulación temporomandibular (ATM (5 de 29, la desviación de la boca al abrirse (14 de 27, la reducción de los movimientos laterales y de la protrusión (15 de 29 y finalmente un rango de apertura de la boca de 30 a 60 mm. Para concluir, el tratamiento conservador de las fracturas del proceso condilar es un método de tratamiento seguro que evita la cirugía y produce fiablemente buenos resultados. El grado de desplazamiento o de acortamiento de la rama ascendente no precluyó obtener buenos resultados en este estudio.Benefits of surgical treatment for condylar fractures are to date discussed controversially in the literature. As conservative treatment is the method of choice in our clinic, the purpose of this study is to evaluate the outcomes of a randomised selected group of our patients who received conservative treatment for condylar fractures. The acts of 30 patients (18 males, 12 females, mean age of 25 years treatment for condylar fractures between 1997 and 2000 with a mean follow up time of 12 months have been assessed. A total of 35 condyle fractures were included in this study. The treatment applied was maxillo-mandibular fixation (MMF for 2 weeks on unilateral fractures, and 3 - 4 weeks on bilateral fractures. Initial radiological evaluation of the broken condyles angulations and shortening of the ascending ramus was performed. Clinical and radiological examinations were assessed in regular intervals (6 weeks, 3, 6 and 12 months. 5 patients presented bilateral fractures; all of them had anterior dislocation. In the unilateral fracture group 12 presented anterior dislocations (mean value of 23° on the panoramic x-ray. 13 cases presented posterior dislocation (mean value of 10°. On the (PA projections 12 fractures presented medial dislocation (mean value of 14°, 4 presented lateral dislocation (mean value of 6°. Ascending ramus shortening reached a mean value of 5.40 mm. Satisfactory function and mobility were observed in all the treated cases. Posttraumatic sequels as TMJ clicking (5 of 29, deviation by mouth opening (14 of 27, reduction of lateral movements and protrusion (in 15 of 29 and finally mouth opening ranged 30 to 60 mm. In conclusion, conservative treatment of condylar fractures is a safe treatment method avoiding surg

A. Wassouf

2005-04-01

196

Tratamiento conservador de las fracturas del cóndilo: Evaluación radiológica y clínica / Conservative treatment of condyle fractures: Radiological and clinical evaluation  

Scientific Electronic Library Online (English)

Full Text Available SciELO Spain | Language: Spanish Abstract in spanish Las ventajas del tratamiento quirúrgico de las fracturas del proceso condilar hasta la fecha han despertado controversia en la literatura. El tratamiento conservador es el método de elección en nuestra clínica, por lo tanto, el propósito de este estudio es evaluar los resultados obtenidos en un grup [...] o de nuestros pacientes, seleccionados y aleatorizados, que recibieron un tratamiento conservador de fracturas del proceso condilar. Se evaluaron las intervenciones terapéuticas entre 1997 y 2000 en 30 pacientes (18 varones, 12 mujeres, edad media de 25 años) con fracturas del cóndilo y un tiempo de seguimiento medio de 12 meses. Se incluyó un total de 35 fracturas del cóndilo en este estudio. El tratamiento utilizado fue la fijación maxilomandibular (FMM), que se aplicó durante 2 semanas en las fracturas unilaterales y durante 3 a 4 semanas en las fracturas bilaterales. Se realizó una evaluación radiológica inicial del ángulo del proceso condilar fracturado y del acortamiento de la rama ascendente. Se evaluaron las exploraciones clínicas y radiológicas a intervalos regulares (6 semanas y 3, 6 y 12 meses). Cinco pacientes presentaron fracturas bilaterales; todos con luxación anterior. En el grupo de las fracturas unilaterales, 12 pacientes presentaron luxación anterior (valor medio 23°) en la radiografía panorámica. Trece pacientes presentaron luxación posterior (valor medio 10°). En la proyección posteroanterior se observó la luxación medial en 12 fracturas (valor medio 14°) y luxación lateral en 4 fracturas (valor medio 6°). El acortamiento de la rama ascendente alcanzó un valor medio de 5,40 mm. Se logró una funcionalidad y movilidad satisfactorias en todos los pacientes tratados. Las secuelas postraumáticas fueron el chasquido de la articulación temporomandibular (ATM) (5 de 29), la desviación de la boca al abrirse (14 de 27), la reducción de los movimientos laterales y de la protrusión (15 de 29) y finalmente un rango de apertura de la boca de 30 a 60 mm. Para concluir, el tratamiento conservador de las fracturas del proceso condilar es un método de tratamiento seguro que evita la cirugía y produce fiablemente buenos resultados. El grado de desplazamiento o de acortamiento de la rama ascendente no precluyó obtener buenos resultados en este estudio. Abstract in english Benefits of surgical treatment for condylar fractures are to date discussed controversially in the literature. As conservative treatment is the method of choice in our clinic, the purpose of this study is to evaluate the outcomes of a randomised selected group of our patients who received conservati [...] ve treatment for condylar fractures. The acts of 30 patients (18 males, 12 females, mean age of 25 years) treatment for condylar fractures between 1997 and 2000 with a mean follow up time of 12 months have been assessed. A total of 35 condyle fractures were included in this study. The treatment applied was maxillo-mandibular fixation (MMF) for 2 weeks on unilateral fractures, and 3 - 4 weeks on bilateral fractures. Initial radiological evaluation of the broken condyles angulations and shortening of the ascending ramus was performed. Clinical and radiological examinations were assessed in regular intervals (6 weeks, 3, 6 and 12 months). 5 patients presented bilateral fractures; all of them had anterior dislocation. In the unilateral fracture group 12 presented anterior dislocations (mean value of 23°) on the panoramic x-ray. 13 cases presented posterior dislocation (mean value of 10°). On the (PA) projections 12 fractures presented medial dislocation (mean value of 14°), 4 presented lateral dislocation (mean value of 6°). Ascending ramus shortening reached a mean value of 5.40 mm. Satisfactory function and mobility were observed in all the treated cases. Posttraumatic sequels as TMJ clicking (5 of 29), deviation by mouth opening (14 of 27), reduction of lateral movements and protrusion (in 15 of 29) and finally mouth opening ranged 30

A., Wassouf; R., Verdeja; K.W., Grätz.

2005-04-01

197

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

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

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

2012-11-15

198

Morphologic characteristics of acetabular dysplasia in proximal femoral focal deficiency.  

Science.gov (United States)

A retrospective radiographic analysis of the acetabulum of 13 patients (14 hips) with proximal femoral focal deficiency (PFFD), clinically classified into Gillespie and Torode type 1, was performed to better understand its morphologic features at maturity. The version of the proximal part of the acetabulum was determined quantitatively and qualitatively. All 14 hips showed residual or borderline acetabular dysplasia with a mean lateral centre-edge angle of -1.5degrees and an acetabular index of 30degrees. The acetabular dome was retroverted in all hips and averaged -24degrees. Acetabular deficiency compared with the opposite side, while not present with respect to the anterior wall, averaged 12% with respect to the posterior wall. Dysplasia associated with type 1 PFFD is therefore fundamentally different from that seen in developmental residual hip dysplasia. Clinically, despite radiographic evidence of dysplasia, 57% were without clinical manifestations of hip pathology. This may be due to a number of factors including age of last radiograph, severity of dysplasia, and the decreased functional demand placed on the hip in some individuals with associated malformations. For the symptomatic hip, the posterior insufficiency and relative retroversion of the acetabular dome should be taken into consideration in planning reorientation procedures. This can help to prevent problems of persistent subluxation or acetabulo-femoral impingement following reconstruction. PMID:15076584

Dora, Claudio; Bühler, Martin; Stover, Michael D; Mahomed, Mohamed N; Ganz, Reinhold

2004-03-01

199

Bilateral Femoral Neck Fracture-Related Hyperparathyroidism  

Directory of Open Access Journals (Sweden)

Full Text Available Bilateral femoral neck fracture is not common as unilateral femoral fracture. Femoral neck fracture generally occurs by the high energized traumas. Traffic accidents and fallings are the most common reason for this fracture kind. But suddenly and minor traumatic fractures is not common. Especially, in the hormonal and pathogenic fractures is not common. In this case minor traumatic bilateral femoral fracture is presented. The fracture occurs in the background of critical medical condition by hyperparathyroidism. It can be said chronic hyperparathyroidism conditions must be determined for femoral neck fracture. Because these patients many times fell little disturbed by this fracture, diagnosis can be missed many times.

Naci Ezirmik

2011-04-01

200

[Femoral neck structure in hip fracture].  

Science.gov (United States)

Hip fracture occurs relating to fall and decreased mechanical integrity of the femoral neck. Mechanical strength of the femoral neck is determined by both bone mineral density and other factors such as bone quality and hip geometry. Histomorphometrical studies show that cortical thinning, regional hyper-mineralization, decreased osteocyte lacunae and microdamage accumulation occur in aged or fractured subjects, suggesting that bone quality contributes mechanical integrity of femoral neck. Recent dual energy X-ray absorptiometry (DXA) studies revealed that hip axis length, longer in femoral neck fracture patients may contribute to the risk of femoral neck fracture. PMID:17142923

Mori, Satoshi

2006-12-01

 
 
 
 
201

Inflammatory pseudotumor of the occipital condyle imitating a malignant neoplasm - a case report  

International Nuclear Information System (INIS)

Inflammatory pseudotumor is a non-neoplastic process of unknown etiology characterized by proliferation of connective tissue with an inflammatory infiltrate. IPT most frequently arises in the orbit, but can also be found in the larynx, the paranasal sinus and rarely in the skull base. We present the case of a 20-year-old patient with a 4-month history of headache and insomnia. Neurological examination showed limited head mobility and hypoglossal nerve dysfunction. The patient was afebrile and no abnormalities in blood tests were found. CT revealed the presence of a tumor mass destructing the right occipital condyle. MRI was performed and the mass was surgically removed. The histological diagnosis was non-specific chronic inflammatory granulation tissue. Inflammatory pseudotumors can often mimic malignant neoplasms, especially in cases where bone destruction is observed. IPT of the occipital condyle is a rare but aggressive lesion that should be treated by surgical excision. (author)

202

Mechanical properties of cancellous bone in the human mandibular condyle are anisotropic  

DEFF Research Database (Denmark)

The objective of the present study was (1) to test the hypothesis that the elastic and failure properties of the cancellous bone of the mandibular condyle depend on the loading direction, and (2) to relate these properties to bone density parameters. Uniaxial compression tests were performed on cylindrical specimens (n=47) obtained from the condyles of 24 embalmed cadavers. Two loading directions were examined, i.e., a direction coinciding with the predominant orientation of the plate-like trabeculae (axial loading) and a direction perpendicular to the plate-like trabeculae (transverse loading). Archimedes' principle was applied to determine bone density parameters. The cancellous bone was in axial loading 3.4 times stiffer and 2.8 times stronger upon failure than in transverse loading. High coefficients of correlation were found among the various mechanical properties and between them and the apparent density and volume fraction. The anisotropic mechanical properties can possibly be considered as a mechanical adaptation to the loading of the condyle in vivo.

Giesen, EB; Ding, Ming

2001-01-01

203

Central giant cell granuloma of the mandibular condyle: a case report and review of the literature.  

Science.gov (United States)

Central giant cell granuloma (CGCG) is a benign intraosseous lesion. The true nature of this lesion is controversial and remains unknown; the three competing theories are that it could be a reactive lesion, a developmental anomaly or a benign neoplasm. Furthermore, the actual aetiology of CGCG is still unclear, although inflammation, haemorrhage and local trauma have all been suggested; it has also been hypothesized that CGCG may have a genetic aetiology. Lesions central to the mandibular condylar head are very rare, with only three documented cases in the English language literature, none of which elaborates on the CT features. In this case report, a 31-year-old male patient complaining of a left pre-auricular mass underwent radiographic investigation. CT images revealed a lesion central to the mandibular condyle and demonstrated features that were highly suggestive of CGCG. The patient underwent surgical curettage, and the subsequent histopathological examination confirmed the diagnosis of CGCG. 3 years after the procedure the patient presented with a recurrence and underwent complete resection of the mandibular condyle with immediate reconstruction. This report presents CT characteristics of a rare occurrence of CGCG of the mandibular condyle, compares it with other published cases and poses the question of the role of radiology in predicting the degree of aggressive behaviour of these lesions before surgery. PMID:21159917

Jadu, F M; Pharoah, M J; Lee, L; Baker, G I; Allidina, A

2011-01-01

204

Disadvantages and advantages of transtibial technique for creating the anterior cruciate ligament femoral socket.  

Science.gov (United States)

Anterior cruciate ligament (ACL) femoral socket techniques have distinct advantages and disadvantages when considering the following techniques: transtibial, anteromedial portal, outside-in, and outside-in retroconstruction. There is no one perfect technique and we have an incomplete understanding of anatomical, biomechanical, isometry, stability, and clinical outcomes. Our primary focus is transtibial technique for creating the ACL femoral socket. Advantages include less invasive, isometric graft placement, stable Lachman exam, and minimal graft impingement with the tunnel and notch. Disadvantages include nonanatomic vertical graft placement that can cause rotational instability and positive pivot shift, interference screw divergence, graft-tunnel length mismatch, femoral socket constraint, posterior cruciate ligament impingement, and a short, oblique tibial tunnel that may undermine the medial plateau in an attempt to achieve anatomic ACL reconstruction. PMID:24951951

Robin, Brett N; Lubowitz, James H

2014-10-01

205

Femoral neck morphology differentiates femoral neck from vertebral osteoporotic fracture  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Mineral density and bone geometry are the two main biomechanical factors related to bone resistance to stress. Objective: In this study we assess whether differences in the proximal femur geometry (PFG) characterize different types of osteoporotic fractures. Methods: We studied 533 postmenopausal women aged 50 - 85. They were divided into four groups matched for bone mineral density at the femoral neck; without fractures (165), vertebral fractures (139), trochanteric fractures (102), and hip ...

Mule?, R.; Frigato, M.; Malavolta, N.; Ripamonti, C.

2011-01-01

206

Creation of an anatomic femoral tunnel with minimal damage to the remnant bundle in remnant-preserving anterior cruciate ligament reconstruction using an outside-in technique.  

Science.gov (United States)

We established a method for creation of an anatomic femoral tunnel with minimal damage to the remnant bundle in remnant-preserving anterior cruciate ligament (ACL) reconstruction. The goals of this surgical technique were to preserve the remnant bundle as much as possible, especially at the femoral insertion, and to make the tunnel at the anatomic position. The critical points are that the posterior side of the femoral footprint of the ACL is observed through the posterolateral portal using a 70° arthroscope and a femoral tunnel is made by use of an outside-in technique with remnant preservation. This technique allows for easy viewing of the posterior side of the ACL and enables performance of an anatomic ACL reconstruction. PMID:24749041

Ahn, Jin Hwan; Lee, Yong Seuk; Lee, Seung Hee

2014-02-01

207

Posterior tracheal diverticulosis.  

Science.gov (United States)

Multiple tracheal diverticulosis is a rare clinical entity. Tracheal diverticula are usually recognized radiologically as solitary right paratracheal air collections on thoracic computed tomography examination. They are usually asymptomatic but can occasionally present with persistent symptoms. We herein report the case of a 50-year-old male patient who underwent extensive evaluation for persistent cough. Multiple posterior right paratracheal air collections were recognized on thoracic multidetector computed tomography examination, which was confirmed as multiple-acquired posterior upper tracheal diverticula on flexible bronchoscopy. The patient improved with conservative medical management. PMID:25321454

Madan, Karan; Das, Chandan J; Guleria, Randeep

2014-10-01

208

[Prediction of segmental collapse of femoral head after femoral neck fracture by scintimetry].  

Science.gov (United States)

A follow-up study regarding the occurrence of segmental collapse of femoral head has been done in 53 patients of united femoral neck fracture including a periodic examination by 99mTc-MDP scintimetry. The results showed that the sequential variations in the nuclide uptake ratio of the femoral heads could reflect the histological repairing process and metabolic level in the femoral head. A sustainedly high nuclide uptake in 12 months after operation often denotes that there are defects in the repairing process of the ischemic femoral head, and that the segmental collapse of the femoral head will ensue. PMID:7720419

Dong, Q R; Wang, J X; Dong, T H

1994-09-01

209

Correlation between Eminence Steepness and Condyle Disk Movements in Temporomandibular Joints Affected by Internal Derangements Using Magnetic Resonance Imaging  

Directory of Open Access Journals (Sweden)

Full Text Available Background and Aims: Internal derangement of the Temporomandibular joint (TMJ is the most common form of Temporomandibular disorders, which represents an abnormal internal strucural and functional change of the disk, as well as an abnormal relationship of the disk to the condyle, glenoid fossa and articular eminence when the teeth are in the closed- mouth position. The aim of this study was to evaluate the correlation between eminence steepness and condyle disk movements in TMJs affected by internal derangements using magnetic resonance imaging (MRI. Materials and Methods: In this cross-sectional study, digital MRI files of 90 joints belong to 45 patients in open and closed-mouth positions were evaluated. Patients were subdivided into two groups: 64 individuals with anterior diskdisplacement with reduction and 26 individuals with anterior disk displacement without reduction. Appropriate oblique sagittal sections were selected and printed. Outlines of the fossa, eminence, condyle and disk were traced on matte acetate sheets and evaluated by an oral and maxillofacial radiologist and a postgraduate student of oral and maxillofacial radiology. Disk rotation, condyle rotation, condyle translation and eminence steepness were measured.The data were analyzed using T-test.Results: In this study, no significant difference was found in measurements between the two groups, (for steepness P=0.64, for Disc rotation P=0.77, for condyle rotation P=0.28 and for condyle translation P=0.12. Disk rotation showed statistically significant correlation with eminence steepness in the anterior disk displacement with reduction group 34 .Although this correlation was weak (r=0.27 (P>0.05. No statistically significant correlations were found between other variables and eminence steepness in this group (for condyle rotation P=0.3 and for condyle translation P=0.98. Disk rotation and condyle translation had statistically significant relationship in the anterior disk displacement without reduction group (P=0.011, r=-0.49. In addition, a significant difference was found between disk rotation and condyle rotation in this group (P=0.004, r=0.54. The relationship between other variables and eminence steepness werenot statistically significant(for disc rotation P=0.06, for condyle rotation P=0.72 and for condyle translation P=0.73 (P>0.05.Conclusion: According to the results of the present study, there is no obvious relationship between eminence steepness and movements of the condyle- disk assembly in patients with TMJ internal derangements. Therefore, the hypothesis that a steep articular eminence of the TMJ is a predisposing factor for disk displacement without reduction could not be verified. Performing prophylactic Eminectomy as a part of patient treatment plan is doubtful and need further evaluations.

Nilofar Mofidi

2013-02-01

210

Diagnostic gait pattern of a patient with longstanding left femoral nerve palsy: a case report.  

LENUS (Irish Health Repository)

The gait pattern of a 35-year-old man with longstanding, left femoral nerve palsy was assessed using 3-dimensional kinematic and kinetic analysis. Stability of his left knee in stance was achieved by manipulating the external moments of the limb so that the ground reaction force passes in front of the knee joint. This compensatory mechanism of locking the knee in extension is reliant on the posterior capsular structures. The patient was managed conservatively and continued to walk without aids.

Burke, Neil G

2010-12-01

211

Bloqueo TAP cuadrado lumbar versus bloqueo femoral, ambos ecoguiados, para analgesia postoperatoria en artroplastia de cadera  

Digital Repository Infrastructure Vision for European Research (DRIVER)

[ES] El bloqueo del plano transverso abdominal es una nueva técnica de anestesia regional periférica, que envuelve a los nervios de la pared abdominal. Consiste en la inyección de anestésico local en el plano entre el músculos transverso abdominal y el oblicuo interno. Este ensayo clínico aleatorizado compara la eficacia analgésica del bloqueo TAP vía posterior ecoguiado versus el bloqueo femoral ecoguiado, que se realizan en pacientes mayores de 65 años programados para cirugía...

Parras-maldonado, Mari?a-teresa

2013-01-01

212

Subcapital femoral neck fracture in patients with HIV and osteonecrosis of the femoral head  

Scientific Electronic Library Online (English)

Full Text Available SciELO South Africa | Language: English Abstract in english BACKGROUND: Osteonecrosis of the femoral head generally presents with collapse of the femoral head. A small subset of patients with osteonecrosis of the femoral head, however, have been described in various case reports as presenting with subcapital femoral neck fracture instead. METHODS: The three [...] cases presented were gathered retrospectively from the National Joint Registry in Malawi. RESULTS: We present three case reports of patients with HIV who suffered atraumatic subcapital femoral neck fractures in the setting of osteonecrosis of the femoral head. DISCUSSION: Patients with subcapital femoral neck fractures and osteonecrosis of the femoral head in the setting of HIV represent a unique population with diagnostic and management dilemmas that require careful consideration.

M, Tompkins; NC, Mkandawire; J, Harrison.

213

Origins, distributions, and ramifications of the femoral nerves in giant anteater (Myrmecophaga tridactyla Linnaeus, 1758  

Directory of Open Access Journals (Sweden)

Full Text Available The study of nerves making up the lumbosacral plexus is extremely important, because it relates the various evolutionary aspects of animals’ posture and locomotion. Taking into account that the femoral nerve is the largest one in the cranial part of the lumbosacral plexus, one aimed to describe the origins, distributions, and ramifications of femoral nerves in giant anteater (Myrmecophaga tridactyla, comparing them to the literature describing domestic and wild animals, in order to establish correlations of morphological similarities and provide the related areas with means. One used three specimens, prepared through an injection of 10% aqueous formaldehyde solution via femoral artery, for their conservation and posterior dissection. The origins in the right and left antimeres took place in the ventral braches of lumbar spinal nerves 1, 2, and 3. The distributions and ramifications were observed for the major and minor psoas, lateral and medial iliac, pectineus, adductor magnus, sartorius, and femoral quadriceps muscles. Having the origins of the M. tridactyla femoral nerves as a basis, a reframing was observed due to the variance in the number of lumbar vertebrae (L1, L2, and L3. However, a partial morphological similarity was kept with regard to the distributions and ramifications, when compared to the domestic and wild animals taken into account in this study.

Roseâmely Angélica de Carvalho-Barros

2013-11-01

214

Evaluation of perfusion of the femoral head after femoral neck fracture using bone scintigraphy  

Energy Technology Data Exchange (ETDEWEB)

We treated 13 patients for femoral neck fracture. They consisted of 2 males and 11 females, and were classified according to Garden stage classification; Stage I, 3 cases; Stage II, 2 cases; Stage III, 2 cases; Stage IV, 4 cases. Two trochanteric fracture cases were used by control. We evaluated perfusion of the femoral head after femoral neck fracture using bone scintigraphy, which is considered useful for evaluation of perfusion of the femoral neck before operation. (author)

Yamaguchi, Satoshi; Ishido, Yasuhiro [Saiseikai Sendai Hospital, Kagoshima (Japan); Okano, Toshihiro [Ibusuki National Hospital, Kagoshima (Japan); Komiya, Setsuro [Kagoshima Univ. (Japan). Faculty of Medicine

2002-09-01

215

Risk of femoral hernia after inguinal herniorrhaphy.  

DEFF Research Database (Denmark)

BACKGROUND: Small case series have suggested an increased risk of femoral hernia after previous inguinal herniorrhaphy, but no large-scale data with complete follow-up are available. METHODS: Data were extracted from the Danish Hernia Database covering the interval from 1 January 1998 to 1 July 2001, and included 34 849 groin hernia repairs. RESULTS: Of 1297 femoral hernia repairs, 71 patients had previously had an operation for inguinal hernia within the observation period. These 71 femoral hernias represented 7.9 per cent of all reoperations for groin hernia recorded in the database. The median time to reoperation for a 'recurrent' femoral hernia after previous inguinal herniorrhaphy was 7 months, compared with 10 months for inguinal recurrences. The risk of developing a 'recurrent' femoral hernia after previous inguinal herniorrhaphy was 15 times higher than the rate of femoral hernia repair in the general population. CONCLUSION: This study of 34 849 groin hernia repairs demonstrated a 15-fold greater incidence of femoral hernia after inguinal herniorrhaphy compared with the spontaneous incidence. These femoral recurrences occurred earlier than inguinal recurrences, suggesting that they were possibly femoral hernias overlooked at the primary operation.

Mikkelsen, T; Bay-Nielsen, M

2002-01-01

216

Femoral fracture repair and postoperative management in new zealand white rabbits.  

Science.gov (United States)

Low bone density and large muscle mass predispose rabbits to femoral fractures. However, there are few reports describing treatment and prognosis. Two New Zealand White rabbits presented with unilateral left rear limb abduction and lateral rotation of the distal left rear limb 2 and 17 days after experimental surgery to create a "stair step" in the patellar groove of the left medial femoral chondyle. This procedure was performed after approval by the Institutional Animal Care and Use Committee. Radiography revealed a spiral oblique mid-shaft fracture of the left femur in both rabbits. Open fracture reduction was undertaken. Because of the presence of screws and Kirschner-wires in the medial femoral condyle, a lateral approach to surgical correction was chosen. Intramedullary fixation was used to reduce and stabilize the fractures. A 0.062" Kirschner wire was selected for the intramedullary device, because it was sufficiently flexible to allow easy passage into the femoral canal while being sufficiently stiff to promote reduction of the fracture. In addition, the ends of the fracture were secured with a 0.032" Kirschner cerclage wire to provide additional control of rotation and angulation. Then we assessed the range of motion of the knee joint to determine fracture stability and ensure that the hardware did not impinge on soft-tissue elements. After closure and application of sterile dressing, the hind legs were hobbled proximal to the hock by using elastic veterinary wrap in a figure-eight pattern to maintain limb alignment and prevent formation of pressure ulcers. Intraoperative fluoroscopic evaluation and postoperative radiographs confirmed fracture reduction. Bruising and seroma formation occurred at the surgical site, and transient anorexia developed. Rabbits were treated with fluids, analgesics, antibiotics, and fitted with Elizabethan collars. They were housed in isolation to limit excessive environmental stimulation, which could alarm them and provoke "thumping" of the rear legs. Muscular weakness and atrophy developed in the affected legs, but the fractures remained immobilized. Radiographs obtained 21 days after surgery confirmed marked callus formation and integrity of the implanted hardware. Four weeks after surgical fixation, both rabbits showed increased muscle development in the repaired leg and were ambulating normally. The long-term prognosis was excellent. These cases demonstrate that repair of femoral fractures in rabbits can be achieved by using basic orthopedic techniques and diligent post-operative management. PMID:12109898

Reuter, Jon D; Ovadia, Shira; Howell, Paula; Jaskwich, David H

2002-07-01

217

Reversible Posterior Leukoencephalopathy Syndrome  

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Full Text Available We read with interest the article by Drs Günther and Hermann in the first issue of 2005 ‘Journal of Neurological Sciences (Turkish’, about series of four patients with “reversible posterior leukoencephalopathy syndrome” that were induced with cyclosporine A. The purpose of their article was to present neurotoxic side effects of cyclosporine A given for immunosuppressive therapy after allogeneic hematopoietic stem cell transplantation. All patients were treated with dose reduction or withdrawal of cyclosporine A 4.

Tulay OZER

2005-06-01

218

The Effect of Tomographic Angles on the Osteophytic Lesion Detectability of the Mandibular Condyle  

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To find out the effects that different tomographic angles have on the osteophytic lesion detectability of condyle head by comparison the individualized lateral tomographic image with the various tomographic angled images using SCANORA . This study is performed to simulate osteophytic lesions by a series of dentin chips placed at six locations on condyle head. The control angle is 15 and from this angle, tomographic angle were varied with -10 , +10 , +20 . All the images with each sized dentin chip were scored by three dental radiologists with the use of confidence levels for presence or absence of the lesion, each examiner viewed one of the images twice. A rating scale from 0 to 2 (0, lesion definitely not present; 1, uncertain if lesion is present; 2, lesion definitely present). Responses were assessed by Tukey's multiple comparison method and kappa value. 1. The lesion size of 0.3 mm could not be detected in all the tomographic angles. As the size of the lesion increased the average value of lesion detectability also increased. Therefore the average value for the lesion size of 2.0 mm was the highest in every angle.2. In the leson sizes of 0.7 mm there was statistically significant difference between the 15 control angle and the altered tomographic angles (p<0.05). In 1.0 mm lesion there was no significant difference in the 10 altered angles (p>0.05), but there was significant difference in the +20 altered angle (p<0.05). In the lesion sizes of 0.3 mm and 2.0 mm there was no significant difference between the 15 control angle and all the altered angles (p>0.05).3. In the medial, superocentral, lateral area of the condyle there was no significant difference between the 15 control angle and all the altered angles (p>0.05). In the anteromedial, anterosuperior, anterolateral area there was no significant difference between the 15 control angle and the 10 altered angle (p>0.05), but in the comparison with the +20 alterd angle there was significant difference (p<0.05). When imaging the lateral tomography of the temporomandibular joint used by SCANORA , it can be considered that in the osteophytic lesion size of 2 mm and above, the tomographic angle difference within +20 to the horizontal angle of the condyle, has little effect on the lesion detectability. And in the lesion size of 1 mm, the altered angle within 10 also has little effect on the lesion detectability.

Han, Sang Sun; Kim, Kee Deog [Dept. of Oral and Maxillofacial Radiology, College of Dentistry, Yensei University, Seoul (Korea, Republic of)

1999-02-15

219

OSTEONECROSIS DE CABEZA FEMORAL. ETIOPATOGENIA  

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Full Text Available Se realizó una revisión bibliográfica y actualización sobre la patogenia y etiología de la osteonecrosis de la cabeza femoral. En la patogenia se profundizó en la historia natural de la enfermedad con las diferentes teorías responsables de los episodios isquémicos como teoría del infarto óseo, embolismo graso, acumulación de las células de estrés y de la isquemia progresiva. Con respecto a la etiología se abordaron las causas traumáticas y atraumáticas en las cuales se incluyó el uso de corticoesteroides, consumo de alcohol, pacientes transplantados, trombofilia e hipofibrinolisis, enfermedad de Caison y Gaucher.

Carlos Casanova Morote

2007-01-01

220

Retrograde nailing of a femoral supracondyle.  

Science.gov (United States)

Because standard femoral supracondylar nails have certain disadvantages, they are often replaced by traditional femoral or tibial locked nails. The purpose of this study was to make a biomechanical comparison between both types of traditional locked nails to determine which technique was more suitable for treating unstable femoral supracondylar fractures. Fourteen left Sawbones femurs (Pacific Research Laboratories, Vashon, Washington) were osteotomized in the femoral supracondylar area. One centimeter of the medial cortex in the proximal fragment was obliquely removed to simulate an unstable fracture without shortening. Seven specimens were treated with traditional retrograde dynamic femoral locked nails, and the other 7 with traditional retrograde dynamic tibial locked nails. All specimens were tested with a servohydraulic materials testing machine to compare their relative stability. Static compression, dynamic cyclic compression, and static compression to failure were tested. An extensometer was used to measure the displacement of fragments. Displacement between the fragments increased following the increment in loads in both nails. The load-displacement curve was nearly linear up to 1000 N for both nails. The femoral nail had a greater stiffness compared with the tibial nail at 100 and 200 N (P=.02 and P=.04, respectively) in static compression and at 700 to 1000 N (P=.01 in each case) in dynamic cyclic compression, as well as larger loads in static compression to failure (8663 vs 7547 N, respectively; Pfemoral locked nail may be more suitable to replace a standard femoral supracondylar nail in a retrograde fashion to treat an unstable femoral supracondylar fracture. PMID:22495848

Wu, Chi-Chuan; Tai, Ching-Lung

2012-04-01

 
 
 
 
221

Reversible posterior leukoencephalopathy syndrome  

International Nuclear Information System (INIS)

To review reversible posterior leukoencephalopathy syndrome. We reviewed 22 patients (M:F=3:19; age, 17-46 years) with the characteristic clinical and imaging features of reversible posterior leukoencephalopathy syndrome. All underwent brain MRI, and in three cases both CT and MRI were performed. In one, MRA was obtained, and in eleven, follow-up MR images were obtained. We evaluated the causes of this syndrome, its clinical manifestations, and MR findings including the locations of lesions, the presence or absence of contrast enhancement, and the changes seen at follow-up MRI. Of the 22 patients, 13 had eclampsia (six during pregnancy and seven during puerperium). Four were receiving immunosuppressive therapy (three, cyclosporine ; one, FK 506). Four suffered renal failure and one had complicated migraine. The clinical manifestations included headache (n=12), visual disturbance (n=13), seizure (n=15), focal neurologic sign (n=3), and altered mental status (n=2). Fifteen patients had hypertension and the others normotension. MRI revealed that lesions were bilateral (n=20) or unilateral (n=2). In all patients the lesion was found in the cortical and subcortical areas of the parieto-occipital lobes ; other locations were the basal ganglia (n=9), posterior temporal lobe (n=8), frontal lobe (n=5), cerebellum (n=5), pons (n=2), and thalamus (n=1). All lesions were of high signal intensity on T2-weighted images, and of iso to low intensity on T1-weighted images. One was comtensity on T1-weighted images. One was combined with acute hematoma in the left basal ganglia. In eight of 11 patients who underwent postcontrast T1-weighted MRI, there was no definite enhancement ; in one, enhancement was mild, and in tow, patchy. CT studies showed low attenuation, and MRA revealed mild vasospasm. The symptoms of all patients improved. Follow-up MRI in nine of 11 patients depicted complete resolution of the lesions ; in two, small infarctions remained but the extent of the lesions had decreased. Reversible posterior leukoencephalopathy syndrome develops in patients with toxemia of pregnancy, renal insufficiency or complicated migraine, and those who undergo immunosuppresive therapy. The characteristic MR finding in edema in cortical or subcortical areas of the parietal and occipital lobes, without enhancement after Gd-DTPA injection. Early recognition of this readily treatable condition may obviate the meed for extensive, invasive investigations, and prompt treatment can lead to a favorable prognosis

222

Reversible posterior leukoencephalopathy syndrome  

Energy Technology Data Exchange (ETDEWEB)

To review reversible posterior leukoencephalopathy syndrome. We reviewed 22 patients (M:F=3:19; age, 17-46 years) with the characteristic clinical and imaging features of reversible posterior leukoencephalopathy syndrome. All underwent brain MRI, and in three cases both CT and MRI were performed. In one, MRA was obtained, and in eleven, follow-up MR images were obtained. We evaluated the causes of this syndrome, its clinical manifestations, and MR findings including the locations of lesions, the presence or absence of contrast enhancement, and the changes seen at follow-up MRI. Of the 22 patients, 13 had eclampsia (six during pregnancy and seven during puerperium). Four were receiving immunosuppressive therapy (three, cyclosporine ; one, FK 506). Four suffered renal failure and one had complicated migraine. The clinical manifestations included headache (n=12), visual disturbance (n=13), seizure (n=15), focal neurologic sign (n=3), and altered mental status (n=2). Fifteen patients had hypertension and the others normotension. MRI revealed that lesions were bilateral (n=20) or unilateral (n=2). In all patients the lesion was found in the cortical and subcortical areas of the parieto-occipital lobes ; other locations were the basal ganglia (n=9), posterior temporal lobe (n=8), frontal lobe (n=5), cerebellum (n=5), pons (n=2), and thalamus (n=1). All lesions were of high signal intensity on T2-weighted images, and of iso to low intensity on T1-weighted images. One was combined with acute hematoma in the left basal ganglia. In eight of 11 patients who underwent postcontrast T1-weighted MRI, there was no definite enhancement ; in one, enhancement was mild, and in tow, patchy. CT studies showed low attenuation, and MRA revealed mild vasospasm. The symptoms of all patients improved. Follow-up MRI in nine of 11 patients depicted complete resolution of the lesions ; in two, small infarctions remained but the extent of the lesions had decreased. Reversible posterior leukoencephalopathy syndrome develops in patients with toxemia of pregnancy, renal insufficiency or complicated migraine, and those who undergo immunosuppresive therapy. The characteristic MR finding in edema in cortical or subcortical areas of the parietal and occipital lobes, without enhancement after Gd-DTPA injection. Early recognition of this readily treatable condition may obviate the meed for extensive, invasive investigations, and prompt treatment can lead to a favorable prognosis.

Lee, Eun Ja; Yu, Won Jong; Ahn, Kook Jin; Jung, So Lyung; Lee, Yeon Soo; Kim, Ji Chang; Kang, Si Won [The Catholic Univ. of Korea, Taejon (Korea, Republic of); Song, Chang Joon [Chungnam National Univ. School of Medicine, Cheonju (Korea, Republic of); Song, Soon-Young; Koo, Ja Hong [Kwandong Univ. College of Medicine, Myungji Hospital, Seoul (Korea, Republic of); Kim, Man Deuk [College of Medicine Pochon CHA Univ., Seoul (Korea, Republic of)

2001-10-01

223

Posterior mediastinal neuroblastoma  

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Full Text Available Neuroblastoma is the 3rd most common malignant tumor in infancy, following leukemia and CNS tumors. It is the second most common tumor encountered during childhood. Neuroblastoma is a malignant tumor originating from the neural crest . Patients are usually younger than 4 years of age. 46% of the cases are derived from the surrenal glands. But the tumor can be detected anywhere from the neck to the sacrum, wherever the sympathetic chain exists. 14% of the neuroblastomas originate within the thoracal region. Here we report a case of posterior mediastinal neuroblastoma which has some rarely encountered yet typical radiological findings.

Sibel Bayramo?lu

2005-01-01

224

Radiographic structural findings in the mandibular condyles of young individuals receiving orthodontic treatment  

International Nuclear Information System (INIS)

Radiographic findings in mandibular condyles were studied from the pre- and post-treatment panoramic radiographs of 625 orthodontic patients. The subjects' mean age was 11 years at the start and 14 years at the end of active orthodontic treatment. Radiographic condylar findings were seen in 14 subjects before treatment and in 54 subjects after treatment. In age-related controls condylar findings were seen in 3%. The condylar findings was ''flattening only'' in half of the patients and in one-third of the controls with condylar findings. Activator treatment was associated with condylar findings. Condylar findings increased with age in the orthodontically treated subjects, but not in the unselected population controls. This may mean that condyles become more sensitive with age in children. Increase with age may be partly due to the radiographic interpretation, since minor condylar findings are difficult to observe in young children, and partly due to differences in treatment modalities and the duration of treatment. 44 refs., 1 fig., 3 tabs

225

Radiographic structural findings in the mandibular condyles of young individuals receiving orthodontic treatment  

Energy Technology Data Exchange (ETDEWEB)

Radiographic findings in mandibular condyles were studied from the pre- and post-treatment panoramic radiographs of 625 orthodontic patients. The subjects` mean age was 11 years at the start and 14 years at the end of active orthodontic treatment. Radiographic condylar findings were seen in 14 subjects before treatment and in 54 subjects after treatment. In age-related controls condylar findings were seen in 3%. The condylar findings was ``flattening only`` in half of the patients and in one-third of the controls with condylar findings. Activator treatment was associated with condylar findings. Condylar findings increased with age in the orthodontically treated subjects, but not in the unselected population controls. This may mean that condyles become more sensitive with age in children. Increase with age may be partly due to the radiographic interpretation, since minor condylar findings are difficult to observe in young children, and partly due to differences in treatment modalities and the duration of treatment. 44 refs., 1 fig., 3 tabs.

Peltola, J.S.; Nystroem, M.; Koenoenen, M.; Wolf, J. [Dept. of Dental Radiology, Univ. og Helsinki (Finland)

1995-04-01

226

Current Concepts in the Mandibular Condyle Fracture Management Part II: Open Reduction Versus Closed Reduction  

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Full Text Available In the treatment of mandibular condyle fracture, conservative treatment using closedreduction or surgical treatment using open reduction can be used. Management of mandibularcondylar fractures remains a source of ongoing controversy in oral and maxillofacial trauma.For each type of condylar fracture,the treatment method must be chosen taking intoconsideration the presence of teeth, fracture height, patient’sadaptation, patient’s masticatorysystem, disturbance of occlusal function, and deviation of the mandible. In the past, closedreduction with concomitant active physical therapy conducted after intermaxillary fixationduring the recovery period had been mainly used, but in recent years, open treatment ofcondylar fractures with rigid internal fixation has become more common. The objectiveof this review was to evaluate the main variables that determine the choice of an open orclosed method for treatment of condylar fractures, identifying their indications, advantages,and disadvantages, and to appraise the current evidence regarding the effectiveness ofinterventions that are used in the management of fractures of the mandibular condyle.

Kang-Young Choi

2012-07-01

227

Architectural measures of the cancellous bone of the mandibular condyle identified by principal components analysis.  

DEFF Research Database (Denmark)

As several morphological parameters of cancellous bone express more or less the same architectural measure, we applied principal components analysis to group these measures and correlated these to the mechanical properties. Cylindrical specimens (n = 24) were obtained in different orientations from embalmed mandibular condyles; the angle of the first principal direction and the axis of the specimen, expressing the orientation of the trabeculae, ranged from 10 degrees to 87 degrees. Morphological parameters were determined by a method based on Archimedes' principle and by micro-CT scanning, and the mechanical properties were obtained by mechanical testing. The principal components analysis was used to obtain a set of independent components to describe the morphology. This set was entered into linear regression analyses for explaining the variance in mechanical properties. The principal components analysis revealed four components: amount of bone, number of trabeculae, trabecular orientation, and miscellaneous.They accounted for about 90% of the variance in the morphological variables. The component loadings indicated that a higher amount of bone was primarily associated with more plate-like trabeculae, and not with more or thicker trabeculae. The trabecular orientation was most determinative (about 50%) in explaining stiffness, strength, and failure energy. The amount of bone was second most determinative and increased the explained variance to about 72%. These results suggest that trabecular orientation and amount of bone are important in explaining the anisotropic mechanical properties of the cancellous bone of the mandibular condyle.

Ding, Ming

2003-01-01

228

The Effect of Tomographic Angles on the Osteophytic Lesion Detectability of the Mandibular Condyle  

International Nuclear Information System (INIS)

the lesion sizes of 0.3 mm and 2.0 mm there was no significant difference between the 15 control angle and all the altered angles (p>0.05).3. In the medial, superocentral, lateral area of the condyle there was no significant difference between the 15 control angle and all the altered angles (p>0.05). In the anteromedial, anterosuperior, anterolateral area there was no significant difference between the 15 control angle and the 10 altered angle (p>0.05), but in the comparison with the +20 alterd angle there was significant difference (p<0.05). When imaging the lateral tomography of the temporomandibular joint used by SCANORA , it can be considered that in the osteophytic lesion size of 2 mm and above, the tomographic angle difference within +20 to the horizontal angle of the condyle, has little effect on the lesion detectability. And in the lesion size of 1 mm, the altered angle within 10 also has little effect on the lesion detectability.

229

Hidroma subdural na fossa posterior Subdural hydroma of posterior fossa  

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Full Text Available Os autores relatam um caso de hidroma subdural na fossa craniana posterior conseqüente a traumatismo na região occipital. O paciente foi operado com pleno sucesso. A raridade da localização de hidroma na fossa posterior é salientada, sendo discutidos os possíveis mecanismos etio-patogênicos.A case of subdural hydroma in the posterior fossa is reported. The patient who had suffered an occipital traumatism was sucessfully operated. The rarity of the sub-tentorial hidromas is enphazised. The etiopathogenesis is discussed.

José Carlos Vasques

1970-03-01

230

Total knee reconstruction without posterior stabilization in rheumatoid arthritis patients  

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Full Text Available Objectives: to present the results with posterior cruciate ligament-retaining total knee arthroplasty in rheumatoid arthritis (RA patients. Background: Total knee replacement in RA patients has many particularities. One of them is the difficulty of obtaining a proper ligamentous balance.Methods: 24 RA patients were followed for a 5-year period after posterior cruciate ligament-retaining total knee arthroplasty. Clinical assessments analyzed general health status by using Hospital for Special Surgery Knee Evaluation Form (HSSKEF and mediolateral and anteroposterior ligament stability by using varus-valgus and posterior drawer tests. Radiological assessments evaluated axial alignment, size and position of components, radiolucent lines in anteroposterior and lateral standard views, integrity of the posterior cruciate ligament on lateral view X-ray at 45 degrees of flexion.Results: the mean HSSKEF score increased from 32 to 84 points at the end of follow-up. Preoperative mean range of motion was 60 degrees; postoperative mean range of motion was of 105 degrees, with significant statistical difference (p<0.05. The mean femoral component axial deviation was 6 degrees. The tibial component had a mean axial deviation of 1 degree of varus. There were no radioluscency lines of more than 1mm. 21 patients had excellent results. None of the knees was unstable. Conclusion: posterior cruciate ligament-retaining total knee arthroplasty can be used in RA patients without excessive valgus deformity (over 15 degrees, providing thus sufficient stabilization. The outcomes re similar to those patients who followed a posterior stabilized endoprosthesis.

Radu Prejbeanu

2010-12-01

231

Subchondral insufficiency fractures of the femoral head  

International Nuclear Information System (INIS)

The aim of this study was to increase awareness of, and to show the variable clinical and radiological features of, subchondral insufficiency fractures of the femoral head. The clinical and radiological findings in 7 patients with subchondral insufficiency fractures of the femoral head were reviewed retrospectively. The diagnosis was confirmed histologically in 4 patients. Radiographs were performed in all patients, MRI in 5 and scintigraphy in 4 patients. Radiographs showed varying degrees of femoral head collapse in 4 patients. In the remaining 3 patients radiographs showed a normal femoral head, regional osteoporosis and focal sclerosis, respectively. Magnetic resonance imaging showed a low-signal band on T1- and T2-weighted images in the subchondral bone adjacent or parallel to the articular surface associated with bone marrow oedema. Scintigraphy showed increased uptake in the femoral head. Insufficiency fractures of the femoral head are easily overlooked or confused with avascular necrosis and, when there is significant joint destruction, osteoarthritis. Unsuspected insufficiency fracture of the femoral head can lead to significant and rapid loss of bone stock in osteoporotic patients waiting for arthroplasty for osteoarthritis. Increased awareness of this condition will hopefully lead to earlier diagnosis and a successful outcome of conservative treatment. (orig.)

232

Posterior glenoid rim deficiency in recurrent (atraumatic) posterior shoulder instability  

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Objective. To assess the shape of the posterior glenoid rim in patients with recurrent (atraumatic) posterior instability.Design and patients. CT examinations of 15 shoulders with recurrent (atraumatic) posterior instability were reviewed in masked fashion with regard to abnormalities of the glenoid shape, specifically of its posterior rim. The glenoid version was also assessed. The findings were compared with the findings in 15 shoulders with recurrent anterior shoulder instability and 15 shoulders without instability. For all patients, surgical correlation was available.Results. Fourteen of the 15 (93%) shoulders with recurrent (atraumatic) posterior shoulder instability had a deficiency of the posteroinferior glenoid rim. In patients with recurrent anterior instability or stable shoulders such deficiencies were less common (60% and 73%, respectively). The craniocaudal length of the deficiencies was largest in patients with posterior instability. When a posteroinferior deficiency with a craniocaudal length of 12 mm or more was defined as abnormal, sensitivity and specificity for diagnosing recurrent (atraumatic) posterior instability were 86.7% and 83.3%, respectively. There was a statistically significant difference in glenoid version between shoulders with posterior instability and stable shoulders (P=0.01).Conclusion. Recurrent (atraumatic) posterior shoulder instability should be considered in patients with a bony deficiency of the posteroinferior glenoid rim with a craniocaudal length of more than 12 mm. (orig.)

Weishaupt, D.; Zanetti, M.; Hodler, J. [Dept. of Radiology, University Hospital Balgrist, Zurich (Switzerland); Nyffeler, R.W.; Gerber, C. [Dept. of Orthopedic Surgery, University Hospital Balgrist, Zurich (Switzerland)

2000-04-01

233

Posterior Cruciate Ligament Function Following Total Knee Arthroplasty: The Effect of Joint Line Elevation  

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One of the most commonly cited reasons for retaining the posterior cruciate ligament (PCL) during total knee arthroplasty is to preserve femoral rollback and theoretically improve extensor mechanism efficiency (lengthening the moment arm). This study was undertaken to assess PCL function in this regard and to delineate the effects of joint line elevation that can be manipulated intraoperatively by the surgeon. The anterior movement of tibiofemoral contact following PCL resection at flexion an...

Emodi, George J.; Callaghan, John J.; Pedersen, Douglas R.; Brown, Thomas D.

1999-01-01

234

Positioning of the femoral tunnel for arthroscopic reconstruction of the anterior cruciate ligament: comparative study of 2 techniques Posicionamento do túnel femoral na reconstrução artroscópica do LCA: estudo comparativo de duas técnicas  

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Full Text Available OBJECTIVE: To compare the accuracy of positioning of the femoral tunnel in reconstructing the anterior cruciate ligament by means of 2 techniques: tibial tunnel and anteromedial portal. METHOD: Femoral tunnels were drilled in 20 knees from human cadavers by means of arthroscopy. Group I had the femoral tunnel drilled via a trans-tibial tunnel, and Group II via the anteromedial portal. Four variables were measured: A posterior wall thickness; B tunnel positioning at the notch; C tunnel inclination in relation to the femoral axis; and D distance between the wire guide exit and the lateral epicondyle. RESULTS: As above, respectively, A 2.23 mm for group I and 2.36 mm for group II (P =.54; B 25.5° for group I and 30.0° for group II (P =.23; C 23.9° for group I and 32.0° for group II (P =.02; D 7.8 cm for group I and 3.9 cm for group II (P OBJETIVO: Comparar a acurácia do posicionamento do túnel femoral na reconstrução do ligamento cruzado anterior através de duas vias: túnel tibial e portal ântero - medial. MÉTODO: Foram perfurados túneis femorais em vinte joelhos de cadáveres humanos por via artroscópica. Grupo I: túnel femoral por acesso trans túnel tibial. Grupo II: via portal ântero-medial. Quatro variáveis foram estudadas: A espessura da parede posterior; B posicionamento do túnel no intercôndilo; C angulação do túnel em relação ao eixo do fêmur; D distância entre a saída do fio guia e o epicôndilo lateral. RESULTADO: A grupo I: 2,23 mm, grupo II: 2,36 mm (p=0,543; B grupo I: 25,5º, grupo II: 30º (p=0,226; C grupo I: 23,9º, grupo II: 32º (p= 0,014; D grupo I: 7,8 cm, grupo II 3,9 cm (p<0,001. CONCLUSÃO: As duas técnicas obteveram o posicionamento desejado da entrada do túnel femoral e espessura adequada da cortical posterior. A perfuração via portal ântero-medial pode propiciar maior proteção contra rotura da parede posterior.

Roberto Freire da Mota Albuquerque

2007-01-01

235

Unilateral atypical disposition of femoral vessels: clinico- embryological annotations.  

Science.gov (United States)

The boundaries and contents of femoral triangle constitute an important lesson in gross anatomy teaching to undergraduate medical students. Apart from this, the normal disposition of the femoral vessels in the femoral triangle is vital for planning certain operating maneuvers in this region. Femoral vessels are very frequently utilized, during various surgical and clinical procedures. Thus, the precise knowledge of the normal anatomy as well as the variations in the femoral vessels is important for surgeons and anatomists. We report a unilateral variation in the disposition of femoral vessels in the femoral triangle, in a 42 yr old male formalin- preserved cadaver. The femoral artery traversed anterior to femoral vein to occupy a medial position in close proximity to the Sapheno-femoral junction. The embryological and clinical implications of the observed variation are discussed. PMID:24999568

Pakhiddey, R; Pangtey, B; Mehta, V; Suri, R K

2014-01-01

236

Flattening of the distal femoral epiphyses in the trichorhinophalangeal syndrome  

International Nuclear Information System (INIS)

A new finding in the trichorhinophalangeal syndrome, flattening of the distal femoral epiphyses, is described in seven patients. Measurement of the ratio of the height of the distal femoral epiphysis versus both the width of the distal femoral metaphysis and the width of the distal femoral epiphysis and comparison to normal standards confirmed the subjectively observed flattening of the distal femoral epiphysis in these patients, further suggesting that the disease is a generalized process rather than a local disorder. (orig.)

237

Slipped capital femoral epiphysis following radiotherapy  

International Nuclear Information System (INIS)

Two children with rhabdomyosarcoma who developed slipped capital femoral epiphyses following pelvic irradiation are described. Previous case reports are summarized, and the relevant orthopedic implications of the disorder discussed

238

Acute appendicitis in a femoral hernia  

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Full Text Available INTRODUCTION Acute appendicitis in a femoral hernia is an uncommon condition that can be serious. Complications are more frequent if the diagnosis is delayed and surgery is not performed on time. CASE REPORT We present a 71-year-old man with a painful swollen mass. The patient presented with fatigue and loss of appetite, while body temperature was normal. The abdomen was not painful, and peristaltic was normal. All laboratory findings were normal. After anamnesis and physical examination, the presumed diagnosis was incarcerated femoral hernia and the patient was sent to the operating room. Intraoperative findings revealed an incarcerated femoral hernia within a phlegmonous inflammated appendix. Appendectomy and McVay hernioplastics were done. The postoperative course was without complications. CONCLUSION It is very important to bear in mind that right femoral hernia with signs of incarceration and inflammation may contain an acutely inflamed appendix. Delayed diagnosis and misdiagnosis cause greater morbidity and mortality.

Zdravkovi? Darko

2007-01-01

239

Herniography off femoral, obturator and perineal hernias  

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Positive contrast herniography was used in the workup of 550 patients with unclear groin pain. The majority of these patients had rather characteristic hernias of indirect, direct or femoral type. However, now and then diagnostic problems arose. A femoral hernia may look like a direct or even obturator hernia. There is also a variety of multilocular femoral hernias and other types. A femoral hernia may be present together with other hernias in the ipsilateral or contralateral groin. Obturator hernias are usually small but are always confined to the obturator canal laterally in the obturator foramen. Abnormalities in the pouch of Douglas may include a deep rectogenital pouch, diverticula and true herniations. These uncommon herniographic findings are described and discussed.

Ekberg, O.; Nordblom, I.; Fork, F.T.; Gullmo, A.

1985-08-01

240

Herniography off femoral, obturator and perineal hernias  

International Nuclear Information System (INIS)

Positive contrast herniography was used in the workup of 550 patients with unclear groin pain. The majority of these patients had rather characteristic hernias of indirect, direct or femoral type. However, now and then diagnostic problems arose. A femoral hernia may look like a direct or even obturator hernia. There is also a variety of multilocular femoral hernias and other types. A femoral hernia may be present together with other hernias in the ipsilateral or contralateral groin. Obturator hernias are usually small but are always confined to the obturator canal laterally in the obturator foramen. Abnormalities in the pouch of Douglas may include a deep rectogenital pouch, diverticula and true herniations. These uncommon herniographic findings are described and discussed. (orig.)

 
 
 
 
241

Stent fractures after superficial femoral artery stenting.  

Science.gov (United States)

Stent fracture is one of the major factors compromising implanted stent patency due to its consequences including in-stent restenosis, thrombosis, perforation, and migration. Stent fracture can occur from stress (extrinsic or intrinsic) and biomechanical forces at different implantation sites. We report on 2 cases of stent fractures and pertinent literature. One patient, a 75-year-old male, presented with recurrence of claudication 14 months after superficial femoral artery stenting; a femoral artery occlusion with stent fracture was found, and he underwent femoropopliteal bypass. The other patient, a 72-year-old male presented with recurrence of claudication; a stent fracture was found without femoral artery occlusion, and he was treated with additional femoral artery stenting to secure the fracture site. PMID:22977767

Park, Jae Young; Jeon, Yong Sun; Cho, Soon Gu; Jin, Chan Ik; Kim, Kyung Rae; Shin, Woo Young; Kim, Jang Yong; Hong, Kee Chun

2012-09-01

242

Morphological Changes of Condyles and Helkimo Clinical Dysfunction Index in Patients Treated with Herbst - Orthodontic Appliance  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in portuguese Este estudo avaliou as mudanças morfológicas nas cabeças da mandíbula das articulações temporo mandibulares (ATMs) e calculou o índex de disfunção clínico de Helkimo (IDC) em adolescentes com má oclusão de Classe II Divisão1 e retrognatismo mandibular, tratados com aparelho de Herbst (fase I) e apar [...] elho ortodôntico fixo (fase II). Trinta e dois adolescentes consecutivos passaram pela fase I e 23 completaram a fase II. As ATMs foram avaliadas qualitativamente por meio de imagem da resonância magnética (IRM) ao início do tratamento (T1), durante a fase I (T2), no final da fase I (T3) e no final da fase II (T4). O IDC foi calculado em T1, T3 e T4. De T1 a T3 (p=0,326) não ocorreram mudanças na morfologia da cabeça da mandíbula em 86,0% das ATMs. De T3 a T4 (p Abstract in english This study evaluated the morphological changes in the temporomandibular joint (TMJ) condyles and calculated the Helkimo clinical dysfunction index (CDI) in adolescents with Class II Division 1 malocclusion and mandibular retrognathism treated with the Herbst appliance (phase I) and fixed orthodontic [...] appliances (phase II). Thirty-two consecutive adolescents underwent phase I, and 23 completed phase II. The TMJs were evaluated qualitatively using magnetic resonance imaging (MRI) at the beginning of treatment (T1), during phase I (T2), at the end of phase I (T3) and at the end of phase II (T4). The CDI was calculated at T1, T3 and T4. From T1 to T3 (p=0.326), there were no changes in condyle morphology in 86.0% of the TMJs. From T3 to T4 (p

Luis Antonio de Arruda, Aidar; Marcio, Abrahao; Helio K., Yamashita; Gladys Cristina, Dominguez.

243

Morphological Changes of Condyles and Helkimo Clinical Dysfunction Index in Patients Treated with Herbst - Orthodontic Appliance  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in portuguese Este estudo avaliou as mudanças morfológicas nas cabeças da mandíbula das articulações temporo mandibulares (ATMs) e calculou o índex de disfunção clínico de Helkimo (IDC) em adolescentes com má oclusão de Classe II Divisão1 e retrognatismo mandibular, tratados com aparelho de Herbst (fase I) e apar [...] elho ortodôntico fixo (fase II). Trinta e dois adolescentes consecutivos passaram pela fase I e 23 completaram a fase II. As ATMs foram avaliadas qualitativamente por meio de imagem da resonância magnética (IRM) ao início do tratamento (T1), durante a fase I (T2), no final da fase I (T3) e no final da fase II (T4). O IDC foi calculado em T1, T3 e T4. De T1 a T3 (p=0,326) não ocorreram mudanças na morfologia da cabeça da mandíbula em 86,0% das ATMs. De T3 a T4 (p Abstract in english This study evaluated the morphological changes in the temporomandibular joint (TMJ) condyles and calculated the Helkimo clinical dysfunction index (CDI) in adolescents with Class II Division 1 malocclusion and mandibular retrognathism treated with the Herbst appliance (phase I) and fixed orthodontic [...] appliances (phase II). Thirty-two consecutive adolescents underwent phase I, and 23 completed phase II. The TMJs were evaluated qualitatively using magnetic resonance imaging (MRI) at the beginning of treatment (T1), during phase I (T2), at the end of phase I (T3) and at the end of phase II (T4). The CDI was calculated at T1, T3 and T4. From T1 to T3 (p=0.326), there were no changes in condyle morphology in 86.0% of the TMJs. From T3 to T4 (p

Luis Antonio de Arruda, Aidar; Marcio, Abrahao; Helio K., Yamashita; Gladys Cristina, Dominguez.

2013-07-01

244

Quantitative Assessment of Radioisotope Uptake in Condyles by SPECT Bone Scintigraphy  

Directory of Open Access Journals (Sweden)

Full Text Available Statement of problem: Condylar hyperplasia of the mandible is a self limiting abnormality which can cause facial asymmetry, temporomandibular joint (TMJdysfunction and esthetic problems. Treatment planning is based on the results of isotope scanning, clinical findings and patient age. Single photon emission tomography(SPECT is considered to be a sensitive method in the calculation of condylar uptake differences.Purpose: The aim of this study was to determine the growth activity occurring in the mandibular condyles, and to devise an index of side-to-side differences in condylar activity in different individuals.Material and Methods: 38 patients, with an age range of 13 to 34 years, undergoing skeletal scintigraphy for a variety of conditions, were chosen for this study. 25 mci TC-99 was injected to all subjects in order to assess the difference between right (Rt andleft (Lt condylar uptake percentage and to calculate the Lt to Rt condylar uptake ratio.The normal index was determined.Results: The maximum amount of difference between the uptake of Rt and Lt condyles was 6.2 percent (Lt side and Rt side were 53.1 % and 46.9 %, respectively in the male patients and 5.7 percent in the female patients (Lt side and Rt side were 52.85 % and 47.15 %, respectively. The condylar activity difference and ratio of Lt to Rt condylar uptakes did not show a significant difference between the male and female groups.Conclusion: The difference between the growth activity of RT and LT normal TMJs was less than 6.2 percent.

Z. Dalili

2006-03-01

245

Clinical experience of ioxaglate in femoral angiography  

International Nuclear Information System (INIS)

Painless femoral angiography could be performed in patients under slight analgesic premedication by using ioxaglate (320 mg I/ml). Slower flow of ioxaglate resulted in longer segments of the arteries being filled by the contrast column that by using iothalamate, which was confirmed by serial whole-limb angiography. The dynamic characteristics of ioxaglate, in addition to marked reduction of pain, fulfilled the requirements for its use as a contrast medium in femoral or peripheral angiography. (Auth.)

246

Relationship between the shortening of the posterior muscle chain and the forward shift of the head and shoulder in female athletes from the youth category Relação entre o encurtamento de cadeia muscular posterior e a anteriorização da cabeça e ombros em atletas infanto-juvenis do gênero feminino  

Directory of Open Access Journals (Sweden)

Full Text Available The aim of the present study was to analyze the relationship between the shortening of the posterior muscle chain, mainly the hamstrings and the forward shift of the head and shoulder, as a possible adaptation in high level/performance athletes. The sample involved 59 female athletes from the youth category of different sports modalities. Group 1: 35 athletes with significant hamstrings’ shortening evaluated by the “bear’s position”; Control group: 24 athletes without hamstrings’ shortening, evaluated by the same position. Data collection was performed using digital analysis of pictures taken with the athlete standing (lateral vision in the “bear’s position”. Luminous markers were placed in the temporomandibular joint, lateral region of the acromio, femur great trochanter, external femoral condyle and lateral malleolus. Variables were measured by the computerized angular cinematic analysis, using the software for posture evaluation SAPO, 0.68 version, always performed by the same rater. Statistical analysis was performed with the Shapiro Wilk test, Unpaired t test and Pearson’s correlation coefficient. The level of significance was set at p?0.05. Group 1 showed 2.5 degrees (SD=1,12 of forward inclination in the lateral view and 43.15 degrees (SD=9,41 of knee flexion in the “bear’s position”. In group 2, there was 2.77 (DP=1.02 degrees in the lateral analysis and -2.19 (DP=4.05 degrees in the “bear’s position”. The statistical analysis between the two groups showed p=0.50 for the comparison of the anterior trunk imbalance in the lateral view and p=0,00 for the comparison of the “bear’s position”. The correlation analysis between the anterior trunk imbalance and the posterior muscle chain shortening, emphasizing the hamstrings, showed r=0.04 in the group with posterior chain shortening and r=0.1 in the control group. It can be concluded that the hamstrings’ muscle shortening did not show any relation with the forward shift of the head and shoulder. On the other hand, in the group with greater flexibility of the muscles from the posterior chain, a greater forward shift of the head and shoulder was observed, without significant results. Analisou-se a relação entre o encurtamento da cadeia muscular posterior, os músculos isquitibiais, e a anteriorização de cabeça e ombros, em atletas de nível competitivo. A amostra foi composta por 59 atletas, do sexo feminino e categoria infanto-juvenil, praticantes de diversas modalidades, divididos em dois grupos: o grupo 1 formado por 35 atletas com encurtamento significativo dos músculos isquiotibiais na postura de urso; o grupo-controle, com 24 atletas sem encurtamento dos isquiotibiais. Realizou-se, por análise digital, fotografias em perfil e na postura de urso. Fixaram-se marcadores luminosos na articulação temporomandibular, acrômio (lateral, trocanter maior do fêmur, côndilo femoral externo e maléolo lateral. Realizou-se a análise cinemática angular computadorizada com o Software para Avaliação Postural (SAPO, versão 0.68. Para a análise estatística, aplicaram-se os testes de Shapiro Wilk, t para amostras independentes e de correção de Pearson. O nível de significância foi estabelecido em 5%. Como resultado, foi observado, no grupo 1, 2,5 graus (DP=1,12 de inclinação anterior na vista lateral e 43,15 graus (DP=9,41 de flexão do joelho na postura do urso. Para o grupo 2, obteve-se o resultado de 2,77 (DP=1,02 graus para a análise do perfil, e -2,19 (DP=4,05 para a postura do urso. A análise estatística entre os grupos apresentou p=0,50 na comparação do desequilíbrio anterior do tronco em vista lateral e p=0,00 para a comparação da postura do urso. A correlação entre o desequilíbrio anterior do tronco e o encurtamento da cadeia posterior, apresentou r=0,04 para o grupo com encurtamento da cadeia posterior e r=0,1 para o controle. Assim, o encurtamento dos músculos isquitibiais não apresentou relação com a anteriorização da cabeça e ombros. Porem, no grupo com maior flexibilidade,

Lucas Maciel Rabello

2010-10-01

247

Unusual Branches of Femoral Artery in the Femoral Triangle: A Case Report / Ramas Inusuales de la Arteria Femoral en el Triángulo Femoral: Reporte de Caso  

Scientific Electronic Library Online (English)

Full Text Available SciELO Chile | Language: English Abstract in spanish La arteria femoral es la principal arteria del miembro inferior. Se observan algunas variaciones en su patrón de ramificación. Una variante rara, pero clínicamente importante es el origen común de las arterias circunfleja iliaca profunda y epigástrica inferior no desde la arteria ilíaca externa. Pre [...] sentamos el origen bilateral de las arterias epigástricas inferiores y circunfleja ilíaca profunda desde la arteria femoral. Ambas arterias pasaron profundas al ligamento inguinal y tuvieron un curso y distribución normal después de cruzar el ligamento inguinal. El conocimiento de estas variaciones son de importancia en la cirugía plástica, en el acceso anterior a la articulación de la cadera, el drenaje absceso del músculo psoas mayor o para reducir una hernia femoral. Abstract in english Femoral artery is the major artery of the lower limb. It shows some variations in its branching pattern. One of the rare but clinically important variations is the origin of deep circumflex iliac and inferior epigastric arteries from it instead of from external iliac artery. We report here the origi [...] n of inferior epigastric and deep circumflex iliac arteries from the femoral artery bilaterally. Both the arteries passed up deep to the inguinal ligament and had a normal course and distribution after crossing the inguinal ligament. Knowledge of these variations is of importance in plastic surgery, anterior approach to the hip joint, draining psoas abscess or reducing a femoral hernia.

Satheesha, Nayak B; Snigdha, Mishra; Bincy M, George; Saju Binu, Cherian; Surekha D, Shetty.

2013-09-01

248

Unusual Branches of Femoral Artery in the Femoral Triangle: A Case Report / Ramas Inusuales de la Arteria Femoral en el Triángulo Femoral: Reporte de Caso  

Scientific Electronic Library Online (English)

Full Text Available SciELO Chile | Language: English Abstract in spanish La arteria femoral es la principal arteria del miembro inferior. Se observan algunas variaciones en su patrón de ramificación. Una variante rara, pero clínicamente importante es el origen común de las arterias circunfleja iliaca profunda y epigástrica inferior no desde la arteria ilíaca externa. Pre [...] sentamos el origen bilateral de las arterias epigástricas inferiores y circunfleja ilíaca profunda desde la arteria femoral. Ambas arterias pasaron profundas al ligamento inguinal y tuvieron un curso y distribución normal después de cruzar el ligamento inguinal. El conocimiento de estas variaciones son de importancia en la cirugía plástica, en el acceso anterior a la articulación de la cadera, el drenaje absceso del músculo psoas mayor o para reducir una hernia femoral. Abstract in english Femoral artery is the major artery of the lower limb. It shows some variations in its branching pattern. One of the rare but clinically important variations is the origin of deep circumflex iliac and inferior epigastric arteries from it instead of from external iliac artery. We report here the origi [...] n of inferior epigastric and deep circumflex iliac arteries from the femoral artery bilaterally. Both the arteries passed up deep to the inguinal ligament and had a normal course and distribution after crossing the inguinal ligament. Knowledge of these variations is of importance in plastic surgery, anterior approach to the hip joint, draining psoas abscess or reducing a femoral hernia.

Satheesha, Nayak B; Snigdha, Mishra; Bincy M, George; Saju Binu, Cherian; Surekha D, Shetty.

249

Can martial arts techniques reduce fall severity? An in vivo study of femoral loading configurations in sideways falls.  

Science.gov (United States)

Sideways falls onto the hip are a major cause of femoral fractures in the elderly. Martial arts (MA) fall techniques decrease hip impact forces in sideways falls. The femoral fracture risk, however, also depends on the femoral loading configuration (direction and point of application of the force). The purpose of this study was to determine the effect of fall techniques, landing surface and fall height on the impact force and the loading configuration in sideways falls. Twelve experienced judokas performed sideways MA and Block ('natural') falls on a force plate, both with and without a judo mat on top. Kinematic and force data were analysed to determine the hip impact force and the loading configuration. In falls from a kneeling position, the MA technique reduced the impact force by 27%, but did not change the loading configuration. The use of the mat did not change the loading configuration. Falling from a standing changed the force direction. In all conditions, the point of application was distal and posterior to the greater trochanter, but it was less distal and more posterior in falls from standing than from kneeling position. The present decrease in hip impact force with an unchanged loading configuration indicates the potential protective effect of the MA technique on the femoral fracture risk. The change in loading configuration with an increased fall height warrant further studies to examine the effect of MA techniques on fall severity under more natural fall circumstances. PMID:22537568

van der Zijden, A M; Groen, B E; Tanck, E; Nienhuis, B; Verdonschot, N; Weerdesteyn, V

2012-06-01

250

Posterior wall prolapse and repair.  

Science.gov (United States)

Most posterior wall defects occur in combination with other pelvic support disorders. Some patients with rectoceles, the most common posterior wall defect, are asymptomatic, whereas others experience a range of symptoms from a sensation of lower pelvic fullness to defecatory and/or sexual dysfunction. If patients are symptomatic, rectoceles can be treated conservatively with pelvic floor physiotherapy, behavioral therapy, or pessaries. Surgically, the most common rectocele repair is a traditional posterior colporrhaphy which provides excellent cure rates of up to 95%. The studies published to date do not support the use of biologic or synthetic absorbable grafts in reconstructive surgical procedures of the posterior compartment as these repairs have not improved anatomic or functional outcomes over traditional posterior colporrhaphy. PMID:20142644

Kudish, Bela I; Iglesia, Cheryl B

2010-03-01

251

Characterization of Occipital Condyle and Comparison of its Dimensions with Head and Foramen Magnum Circumferences in Dry Skulls of Iran / Caracterización del Cóndilo Occipital y Comparación de sus Dimensiones con la Circunferencia de la Cabeza y Foramen Magno en Cráneos Secos de Irán  

Scientific Electronic Library Online (English)

Full Text Available SciELO Chile | Language: English Abstract in spanish El cóndilo occipital (CO) es una estructura relevante en la cirugía craneovertebral, pero sus características anatómicas y procedimientos quirúrgicos relativos al CO no se han estudiado detalladamente. El objetivo fue revisar la anatomía de la región del CO y evaluar las variaciones de sus estructur [...] as circundantes. Fueron observados 50 cráneos secos (100 lados) y se determinaron las mediciones del CO. La longitud media según lado fue 19,43±3,27 mm (derecho) y 19,28 ± 3,57 mm (izquierdo), el ancho medio fue 9,21±1,97 mm (derecho) y 9,40±1,87 mm (izquierda) y la altura media fue 7,21±1,9 mm (derecho) y 7,33±2,74 mm (izquierdo). Hubo diferencias significativas entre los CO derechos e izquierdos. La distancia intercondílea anterior y posterior media fue de 15,39±7 mm y 35,60±8,4 mm, respectivamente. La variación de formas del CO fue de riñon (34,4%), de S (25,6%), triangular (13,3%), oval (10,0%), de anillo (7,8%), de ocho (6,7%) y deformada (2,2%). La fosa condilar se observó en el 60% de los casos, 24% en lado derecho y 36% en el izquierdo; también el foramen condilar se encontró en el 60% de los casos. No se encontró relación entre la circunferencia de la cabeza y la longitud del CO, pero encontramos relación entre la circunferencia de la cabeza y el ancho del CO (0,527) y circunferencia del foramen magno (0,433). El CO y foramen magno son las principales estructuras óseas que constribuyen a rodear y proteger el tronco cerebral. Las diferencias en el tamaño y forma del CO tiene algunas diferencias y similitudes entre subgrupos raciales. La vena condilar posterior puede presentarse de manera asimétrica. La correlación del tamaño de foramen magno con el ancho de los CO muestra su relevancia en movimientos laterales y anteroposteriores. Abstract in english The occipital condyle (OC) is an important area in craniovertebral surgery, but its anatomical features and the procedures concerning the OC have not been studied in detail yet. The aim of this study was to revisit the anatomy of the occipital condyle region and assess variations of the surrounding [...] structures. Observations, on fifty dry skulls (dried specimens, 100 sides) and determined of condyle measurements. The mean length, width and height of occipital condyle were found to be 19.43±3.27 (right), 19.28±3.57 (left), 9.21±1.97 (right) 9.40±1.87 (left), 7.21±1.9 (right) and 7.33±2.74 mm (left), respectively. There were significant differences between right and left occipital condyles. The mean anterior intercondylar distance and posterior intercondylar distance were measured as 15.39±7 and 35.60±8.4 mm, respectively. Variations of occipital condyle shapes were kidney like (34.4%), S-like (25.6), triangular (13.3%) oval (10.0%), ring like (7.8%), eight like (6.7%) and deformed (2.2%) respectively. The condylar fossa presented in 60% of dry skull, 24% in right side and 36% in left side and also the condylar foramen was found in 60% of the specimens studied. There was no relation between the circumference of the head and the length of OC but we found relation between the circumference of the head and the width of OC (0.527) and foramen magnum circumference (0.433). The OC and FM are the main bony structures obstructing the surround of the brainstem. The differences in the size and the shape of occipital condyle have some differences and also similarities among racial subgroups. The posterior condylar vein may act asymmetrically. The correlation of the size of foramen magnum with the width of occipital condyles shows the importance of occipital condyle for lateral movements besides antero-posterior movements.

Parvindokht, Bayat; Mahdie, Bagheri; Ali, Ghanbari; Amir, Raoofi.

2014-06-01

252

Characterization of Occipital Condyle and Comparison of its Dimensions with Head and Foramen Magnum Circumferences in Dry Skulls of Iran / Caracterización del Cóndilo Occipital y Comparación de sus Dimensiones con la Circunferencia de la Cabeza y Foramen Magno en Cráneos Secos de Irán  

Scientific Electronic Library Online (English)

Full Text Available SciELO Chile | Language: English Abstract in spanish El cóndilo occipital (CO) es una estructura relevante en la cirugía craneovertebral, pero sus características anatómicas y procedimientos quirúrgicos relativos al CO no se han estudiado detalladamente. El objetivo fue revisar la anatomía de la región del CO y evaluar las variaciones de sus estructur [...] as circundantes. Fueron observados 50 cráneos secos (100 lados) y se determinaron las mediciones del CO. La longitud media según lado fue 19,43±3,27 mm (derecho) y 19,28 ± 3,57 mm (izquierdo), el ancho medio fue 9,21±1,97 mm (derecho) y 9,40±1,87 mm (izquierda) y la altura media fue 7,21±1,9 mm (derecho) y 7,33±2,74 mm (izquierdo). Hubo diferencias significativas entre los CO derechos e izquierdos. La distancia intercondílea anterior y posterior media fue de 15,39±7 mm y 35,60±8,4 mm, respectivamente. La variación de formas del CO fue de riñon (34,4%), de S (25,6%), triangular (13,3%), oval (10,0%), de anillo (7,8%), de ocho (6,7%) y deformada (2,2%). La fosa condilar se observó en el 60% de los casos, 24% en lado derecho y 36% en el izquierdo; también el foramen condilar se encontró en el 60% de los casos. No se encontró relación entre la circunferencia de la cabeza y la longitud del CO, pero encontramos relación entre la circunferencia de la cabeza y el ancho del CO (0,527) y circunferencia del foramen magno (0,433). El CO y foramen magno son las principales estructuras óseas que constribuyen a rodear y proteger el tronco cerebral. Las diferencias en el tamaño y forma del CO tiene algunas diferencias y similitudes entre subgrupos raciales. La vena condilar posterior puede presentarse de manera asimétrica. La correlación del tamaño de foramen magno con el ancho de los CO muestra su relevancia en movimientos laterales y anteroposteriores. Abstract in english The occipital condyle (OC) is an important area in craniovertebral surgery, but its anatomical features and the procedures concerning the OC have not been studied in detail yet. The aim of this study was to revisit the anatomy of the occipital condyle region and assess variations of the surrounding [...] structures. Observations, on fifty dry skulls (dried specimens, 100 sides) and determined of condyle measurements. The mean length, width and height of occipital condyle were found to be 19.43±3.27 (right), 19.28±3.57 (left), 9.21±1.97 (right) 9.40±1.87 (left), 7.21±1.9 (right) and 7.33±2.74 mm (left), respectively. There were significant differences between right and left occipital condyles. The mean anterior intercondylar distance and posterior intercondylar distance were measured as 15.39±7 and 35.60±8.4 mm, respectively. Variations of occipital condyle shapes were kidney like (34.4%), S-like (25.6), triangular (13.3%) oval (10.0%), ring like (7.8%), eight like (6.7%) and deformed (2.2%) respectively. The condylar fossa presented in 60% of dry skull, 24% in right side and 36% in left side and also the condylar foramen was found in 60% of the specimens studied. There was no relation between the circumference of the head and the length of OC but we found relation between the circumference of the head and the width of OC (0.527) and foramen magnum circumference (0.433). The OC and FM are the main bony structures obstructing the surround of the brainstem. The differences in the size and the shape of occipital condyle have some differences and also similarities among racial subgroups. The posterior condylar vein may act asymmetrically. The correlation of the size of foramen magnum with the width of occipital condyles shows the importance of occipital condyle for lateral movements besides antero-posterior movements.

Parvindokht, Bayat; Mahdie, Bagheri; Ali, Ghanbari; Amir, Raoofi.

253

Hidroma subdural na fossa posterior / Subdural hydroma of posterior fossa  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese Os autores relatam um caso de hidroma subdural na fossa craniana posterior conseqüente a traumatismo na região occipital. O paciente foi operado com pleno sucesso. A raridade da localização de hidroma na fossa posterior é salientada, sendo discutidos os possíveis mecanismos etio-patogênicos. [...] Abstract in english A case of subdural hydroma in the posterior fossa is reported. The patient who had suffered an occipital traumatism was sucessfully operated. The rarity of the sub-tentorial hidromas is enphazised. The etiopathogenesis is discussed. [...

José Carlos, Vasques; Mário F., Coutinho.

254

Radionuclide scintigraphy of femoral head specimens removed at arthroplasty for failed femoral neck fractures.  

Science.gov (United States)

In order to determine the value of scintimetry as a tool for quantitative measurement of femoral head vascularity, the results of postoperative scintigraphic and histologic examination of surgically removed femoral head specimens were compared with those of preoperative radionuclide scintigraphy in 19 failed femoral neck fractures. Following intravenous administration of 600 MBq of Tc-99m MDP before hip replacement, the activity distribution in femoral head sections was recorded with a gamma camera and the area of isotope uptake calculated. A correlation was found between the results of preoperative noninvasive radionuclide scintigraphy and the assessment of isotope uptake in the removed femoral head specimens (r = 0.83, p less than .001) and was confirmed by the results of histologic examination. There is a risk, however, of overestimating the ratio of isotope uptake between the femoral head on the fracture side relative to the contralateral side with respect to quantitative assessment of femoral head vascularity, due to the general increase in isotope owing to accumulation in the injured hip region. The calculations, however, reflect the levels of radionuclide uptake and the varying degrees of femoral head vascularity. PMID:3486078

Alberts, K A; Dahlborn, M; Glas, J E; Hindmarsh, J; Ringertz, H

1986-04-01

255

Early diagnosis for segmental collapse of the femoral head after femoral neck fracture by scintigraphy  

International Nuclear Information System (INIS)

In order to obtain an early prediction for segmental collapse of the femoral head after femoral neck fracture, we have studied in 53 cases of the femoral neck fracture using 99mTC-MDP scintimetry. According to the radionuclide uptake ratio of the femoral heads, we can estimate the gravity of the avascular necrosis of the femoral head after fracture and recognize the repair process in the necrotic head. Fifty-three cases of fresh fracture were examined by sequential scintigraphy before operation and during follow up examinations after operation. The radionuclide uptake were all increased in 3 to 4 months after operation as comparing with that done before operation. The uptake ratios in 37 cases decreased gradually and approached 1 in 12 months after operation. All of them have an excellent result during follow up examination 36 months after surgery. The uptake ratios in 19 cases were also increased after operation, but still maintained at a high level in 6 to 12 months. They all showed radiographical signs of segmental collapse 18 to 24 months after operation. These results showed that uptake ratio of the radionuclide bone imaging is able to predict the occurrence of segmental collapse of the femoral head after femoral neck fracture. The time of the diagnosis by scintigraphy for segmental collapse of the femoral head is earlier than that by radiography. (authors). 5 refs., 1 tab

256

Femoral neck shortening after internal fixation of a femoral neck fracture.  

Science.gov (United States)

This study assesses femoral neck shortening and its effect on gait pattern and muscle strength in patients with femoral neck fractures treated with internal fixation. Seventy-six patients from a multicenter randomized controlled trial participated. Patient characteristics and Short Form 12 and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were collected. Femoral neck shortening, gait parameters, and maximum isometric forces of the hip muscles were measured and differences between the fractured and contralateral leg were calculated. Variables of patients with little or no shortening, moderate shortening, and severe shortening were compared using univariate and multivariate analyses. Median femoral neck shortening was 1.1 cm. Subtle changes in gait pattern, reduced gait velocity, and reduced abductor muscle strength were observed. Age, weight, and Pauwels classification were risk factors for femoral neck shortening. Femoral neck shortening decreased gait velocity and seemed to impair gait symmetry and physical functioning. In conclusion, internal fixation of femoral neck fractures results in permanent physical limitations. The relatively young and healthy patients in our study seem capable of compensating. Attention should be paid to femoral neck shortening and proper correction with a heel lift, as inadequate correction may cause physical complaints and influence outcome. PMID:23823040

Zielinski, Stephanie M; Keijsers, Noël L; Praet, Stephan F E; Heetveld, Martin J; Bhandari, Mohit; Wilssens, Jean Pierre; Patka, Peter; Van Lieshout, Esther M M

2013-07-01

257

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

Science.gov (United States)

Lateral humeral condyle fractures account for 17 % of the distal humeral condyle fractures. Displaced and/or rotated fractures require appropriate reduction and stabilisation. There are, however, a number of controversies in the surgical management of these patients. The aim of the present study was to review the results of patients with a displaced lateral humeral condyle fracture treated with open reduction and internal fixation (ORIF). We retrospectively reviewed children treated with ORIF of lateral humeral condyle fractures at a single institution over a period of 13 years. All cases were identified through the trauma register. Case notes and radiographs were retrieved. Fracture classification, mode of fixation, time to union, and final outcomes at the latest follow-up were reviewed. One hundred and five lateral condyle fractures were identified in 76 male and 29 female patients. Average age was 6.2 years. Ninety-two were Milch type II and 13 Milch type I. According to the Jacob's classification, 38 were type II and 67 type III. All fractures were treated with open reduction and fixation with K-wires. Average time to radiological union was 33 days. Follow-up ranged between 2 and 8 years (average 3.2 years). Radiological hypertrophy of the lateral condyle was present in 45 cases (42 %). Three patients developed a pseudo-cubitus varus deformity. Further four patients developed a true cubitus varus. There was one case of superficial infection of the K-wires and one case of delayed union. At the latest follow-up, 96 % of the patients achieved an excellent final result and 4 % a good final result. Our results demonstrate that fracture union and excellent final outcomes can be expected in all patients using our protocol, whereby all patients with a displaced fracture are managed by ORIF with K-wire fixation, with the wires only being removed after there is evidence of radiological union. Compared to recent reports of closed reduction internal fixation, this series demonstrates good results with no complications directly relating to the open reduction technique. Level of evidence Case series, Level IV. PMID:25022896

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

2014-08-01

258

US-Guided Femoral and Sciatic Nerve Blocks for Analgesia During Endovenous Laser Ablation  

International Nuclear Information System (INIS)

Endovenous laser ablation may be associated with significant pain when performed under standard local tumescent anesthesia. The purpose of this study was to investigate the efficacy of femoral and sciatic nerve blocks for analgesia during endovenous ablation in patients with lower extremity venous insufficiency. During a 28-month period, ultrasound-guided femoral or sciatic nerve blocks were performed to provide analgesia during endovenous laser ablation in 506 legs and 307 patients. The femoral block (n = 402) was performed at the level of the inguinal ligament, and the sciatic block at the posterior midthigh (n = 124), by injecting a diluted lidocaine solution under ultrasound guidance. After the blocks, endovenous laser ablations and other treatments (phlebectomy or foam sclerotherapy) were performed in the standard fashion. After the procedures, a visual analogue pain scale (1–10) was used for pain assessment. After the blocks, pain scores were 0 or 1 (no pain) in 240 legs, 2 or 3 (uncomfortable) in 225 legs, and 4 or 5 (annoying) in 41 legs. Patients never experienced any pain higher than score 5. The statistical analysis revealed no significant difference between the pain scores of the right leg versus the left leg (p = 0.321) and between the pain scores after the femoral versus sciatic block (p = 0.7). Ultrasound-guided femoral and sciatic nerve blocks may provide considerable reduction of pain during endovenous laser and other treatments, such as ambulatory phlebectomy and foam sclerotherapy. They may make these procedures more comfortable for the patient and easier for the operator.

259

US-Guided Femoral and Sciatic Nerve Blocks for Analgesia During Endovenous Laser Ablation  

Energy Technology Data Exchange (ETDEWEB)

Endovenous laser ablation may be associated with significant pain when performed under standard local tumescent anesthesia. The purpose of this study was to investigate the efficacy of femoral and sciatic nerve blocks for analgesia during endovenous ablation in patients with lower extremity venous insufficiency. During a 28-month period, ultrasound-guided femoral or sciatic nerve blocks were performed to provide analgesia during endovenous laser ablation in 506 legs and 307 patients. The femoral block (n = 402) was performed at the level of the inguinal ligament, and the sciatic block at the posterior midthigh (n = 124), by injecting a diluted lidocaine solution under ultrasound guidance. After the blocks, endovenous laser ablations and other treatments (phlebectomy or foam sclerotherapy) were performed in the standard fashion. After the procedures, a visual analogue pain scale (1-10) was used for pain assessment. After the blocks, pain scores were 0 or 1 (no pain) in 240 legs, 2 or 3 (uncomfortable) in 225 legs, and 4 or 5 (annoying) in 41 legs. Patients never experienced any pain higher than score 5. The statistical analysis revealed no significant difference between the pain scores of the right leg versus the left leg (p = 0.321) and between the pain scores after the femoral versus sciatic block (p = 0.7). Ultrasound-guided femoral and sciatic nerve blocks may provide considerable reduction of pain during endovenous laser and other treatments, such as ambulatory phlebectomy and foam sclerotherapy. They may make these procedures more comfortable for the patient and easier for the operator.

Yilmaz, Saim, E-mail: ysaim@akdeniz.edu.tr; Ceken, Kagan; Alimoglu, Emel; Sindel, Timur [Akdeniz University School of Medicine, Department of Radiology (Turkey)

2013-02-15

260

Current concept in dysplastic hip arthroplasty: Techniques for acetabular and femoral reconstruction.  

Science.gov (United States)

Adult patients with developmental dysplasia of the hip develop secondary osteoarthritis and eventually end up with total hip arthroplasty (THA) at younger age. Because of altered anatomy of dysplastic hips, THA in these patients represents technically demanding procedure. Distorted anatomy of the acetabulum and proximal femur together with conjoined leg length discrepancy present major challenges during performing THA in patients with developmental dysplasia of the hip. In addition, most patients are at younger age, therefore, soft tissue balance is of great importance (especially the need to preserve the continuity of abductors) to maximise postoperative functional result. In this paper we present a variety of surgical techniques available for THA in dysplastic hips, their advantages and disadvantages. For acetabular reconstruction following techniques are described: Standard metal augments (prefabricated), Custom made acetabular augments (3D printing), Roof reconstruction with vascularized fibula, Roof reconstruction with pedicled iliac graft, Roof reconstruction with autologous bone graft, Roof reconstruction with homologous bone graft, Roof reconstruction with auto/homologous spongious bone, Reinforcement ring with the hook in combination with autologous graft augmentation, Cranial positioning of the acetabulum, Medial protrusion technique (cotyloplasty) with chisel, Medial protrusion technique (cotyloplasty) with reaming, Cotyloplasty without spongioplasty. For femoral reconstruction following techniques were described: Distraction with external fixator, Femoral shortening through a modified lateral approach, Transtrochanteric osteotomies, Paavilainen osteotomy, Lesser trochanter osteotomy, Double-chevron osteotomy, Subtrochanteric osteotomies, Diaphyseal osteotomies, Distal femoral osteotomies. At the end we present author's treatment method of choice: for acetabulum we perform cotyloplasty leaving only paper-thin medial wall, which we break during acetabular cup impacting. For femoral side first we peel of all rotators and posterior part of gluteus medius and vastus lateralis from greater trochanter on the very thin flake of bone. This method allows us to adequately shorten proximal femoral stump, with possibility of additional resection of proximal femur. Furthermore, several advantages and disadvantages of this procedure are also discussed. PMID:25232518

Bicanic, Goran; Barbaric, Katarina; Bohacek, Ivan; Aljinovic, Ana; Delimar, Domagoj

2014-09-18

 
 
 
 
261

Does high-flexion total knee arthroplasty promote early loosening of the femoral component?  

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High-flexion knee replacements have been developed to accommodate a large range of motion (RoM?>?120°). Knee implants that allow for higher flexion may be more sensitive to femoral loosening as the knee load is relatively high during deep knee flexion, which could result in an increased failure potential at the implant-cement interface of the femoral component. A 3D finite element knee model was developed including a posterior-stabilized high-flexion knee replacement to analyze the stress state at the femoral implant-cement interface during a full squatting movement (RoM???155°). During deep flexion (RoM?>?120°), tensile and shear stress concentrations were found at the implant-cement interface beneath the proximal part of the anterior flange. Particularly, the shear stresses at this interface location increased during high flexion, from a peak stress of 4.03?MPa at 90° to 6.89?MPa at 140° of flexion. Tensile stresses were substantially lower, having a peak stress of 0.72?MPa at 100° of flexion. Using data from earlier interface strength experiments, none of the interface beneath the anterior flange was predicted to fail in the normal flexion range (RoM???120°), whereas the prediction increased to 2.2% of the interface during deeper knee flexion. Thigh-calf contact reduced the knee forces, interface load, and failure risk beyond 140-145° of flexion. Based on the more critical stresses at the femoral fixation site between 120° and 145° of flexion, we conclude that the femoral component has a higher risk of loosening at high-flexion angles. PMID:21308756

Zelle, Jorrit; Janssen, Dennis; Van Eijden, Jolanda; De Waal Malefijt, Maarten; Verdonschot, Nico

2011-07-01

262

Pseudoaneurysm of the superficial femoral artery after retrograde intramedullary nailing for a supracondylar femoral fracture.  

Science.gov (United States)

Vascular complications of distal femoral fractures are rare but can have disastrous consequences if not recognised and treated promptly. We present the case of a 55-year-old woman who developed a pseudoaneurysm of the superficial femoral artery after osteosynthesis to repair a supracondylar femoral fracture. Eight weeks after surgery, swelling of the right thigh persisted and was accompanied by severe pain. Enhanced computed tomography revealed a pseudoaneurysm in the medial aspect of the affected thigh. Open surgical repair was performed by direct arterial suture. Although the true aetiology of the development of the pseudoaneurysm is unknown, a bony fragment from the reduction manoeuvre may have damaged the adventitia of the superficial femoral artery. In cases of continuous thigh swelling after osteosynthesis to repair a supracondylar femoral fracture, a diagnosis of pseudoaneurysm should be considered and treatment should be initiated immediately. PMID:25245711

Hirota, Ryosuke; Emori, Makoto; Ito, Toshiro; Watanabe, Kota; Hirano, Akira; Kamiya, Tomoaki; Terashima, Yoshinori; Yamashita, Toshihiko

2014-10-01

263

Evaluation of a pig femoral head osteonecrosis model  

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Full Text Available Abstract Background A major cause of osteonecrosis of the femoral head is interruption of a blood supply to the proximal femur. In order to evaluate blood circulation and pathogenetic alterations, a pig femoral head osteonecrosis model was examined to address whether ligature of the femoral neck (vasculature deprivation induces a reduction of blood circulation in the femoral head, and whether transphyseal vessels exist for communications between the epiphysis and the metaphysis. We also tested the hypothesis that the vessels surrounding the femoral neck and the ligamentum teres represent the primary source of blood flow to the femoral head. Methods Avascular osteonecrosis of the femoral head was induced in Yorkshire pigs by transecting the ligamentum teres and placing two ligatures around the femoral neck. After heparinized saline infusion and microfil perfusion via the abdominal aorta, blood circulation in the femoral head was evaluated by optical and CT imaging. Results An angiogram of the microfil casted sample allowed identification of the major blood vessels to the proximal femur including the iliac, common femoral, superficial femoral, deep femoral and circumflex arteries. Optical imaging in the femoral neck showed that a microfil stained vessel network was visible in control sections but less noticeable in necrotic sections. CT images showed a lack of microfil staining in the epiphysis. Furthermore, no transphyseal vessels were observed to link the epiphysis to the metaphysis. Conclusion Optical and CT imaging analyses revealed that in this present pig model the ligatures around the femoral neck were the primary cause of induction of avascular osteonecrosis. Since the vessels surrounding the femoral neck are comprised of the branches of the medial and the lateral femoral circumflex vessels, together with the extracapsular arterial ring and the lateral epiphyseal arteries, augmentation of blood circulation in those arteries will improve pathogenetic alterations in the necrotic femoral head. Our pig model can be used for further femoral head osteonecrosis studies.

Kim Harry

2010-03-01

264

Classification of posterior vitreous detachment  

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Full Text Available Akihiro Kakehashi,1 Mikiko Takezawa,1 Jun Akiba21Department of Ophthalmology, Jichi Medical University, Saitama Medical Center, Saitama, 2Kanjodori Eye Clinic, Asahikawa, JapanAbstract: Diagnosing a posterior vitreous detachment (PVD is important for predicting the prognosis and determining the indication for vitreoretinal surgery in many vitreoretinal diseases. This article presents both classifications of a PVD by slit-lamp biomicroscopy and of a shallow PVD by optical coherence tomography (OCT. By biomicroscopy, the vitreous condition is determined based on the presence or absence of a PVD. The PVD then is classified as either a complete posterior vitreous detachment (C-PVD or a partial posterior vitreous detachment (P-PVD. A C-PVD is further divided into a C-PVD with collapse and a C-PVD without collapse, while a P-PVD is divided into a P-PVD with shrinkage of the posterior hyaloid membrane (P-PVD with shrinkage and a P-PVD without shrinkage of the posterior hyaloid membrane (P-PVD without shrinkage. A P-PVD without shrinkage has a subtype characterized by vitreous gel attachment through the premacular hole in a posterior hyaloid membrane to the macula (P-PVD without shrinkage [M]. By OCT, a shallow PVD is classified as the absence of a shallow PVD or as a shallow PVD. A shallow PVD is then subclassified as a shallow PVD without shrinkage of the posterior vitreous cortex, a shallow PVD with shrinkage of the posterior vitreous cortex, and a peripheral shallow PVD. A shallow PVD without shrinkage of the posterior vitreous cortex has two subtypes: an age-related shallow PVD and a perifoveal PVD associated with a macular hole.Keywords: classification, optical coherence tomography, PVD, slit-lamp biomicroscopy

Kakehashi A

2013-12-01

265

Classification of posterior vitreous detachment.  

Science.gov (United States)

Diagnosing a posterior vitreous detachment (PVD) is important for predicting the prognosis and determining the indication for vitreoretinal surgery in many vitreoretinal diseases. This article presents both classifications of a PVD by slit-lamp biomicroscopy and of a shallow PVD by optical coherence tomography (OCT). By biomicroscopy, the vitreous condition is determined based on the presence or absence of a PVD. The PVD then is classified as either a complete posterior vitreous detachment (C-PVD) or a partial posterior vitreous detachment (P-PVD). A C-PVD is further divided into a C-PVD with collapse and a C-PVD without collapse, while a P-PVD is divided into a P-PVD with shrinkage of the posterior hyaloid membrane (P-PVD with shrinkage) and a P-PVD without shrinkage of the posterior hyaloid membrane (P-PVD without shrinkage). A P-PVD without shrinkage has a subtype characterized by vitreous gel attachment through the premacular hole in a posterior hyaloid membrane to the macula (P-PVD without shrinkage [M]). By OCT, a shallow PVD is classified as the absence of a shallow PVD or as a shallow PVD. A shallow PVD is then subclassified as a shallow PVD without shrinkage of the posterior vitreous cortex, a shallow PVD with shrinkage of the posterior vitreous cortex, and a peripheral shallow PVD. A shallow PVD without shrinkage of the posterior vitreous cortex has two subtypes: an age-related shallow PVD and a perifoveal PVD associated with a macular hole. PMID:24376338

Kakehashi, Akihiro; Takezawa, Mikiko; Akiba, Jun

2014-01-01

266

Posterior sampling with improved efficiency  

Energy Technology Data Exchange (ETDEWEB)

The Markov Chain Monte Carlo (MCMC) technique provides a means to generate a random sequence of model realizations that sample the posterior probability distribution of a Bayesian analysis. That sequence may be used to make inferences about the model uncertainties that derive from measurement uncertainties. This paper presents an approach to improving the efficiency of the Metropolis approach to MCMC by incorporating an approximation to the covariance matrix of the posterior distribution. The covariance matrix is approximated using the update formula from the BFGS quasi-Newton optimization algorithm. Examples are given for uncorrelated and correlated multidimensional Gaussian posterior distributions.

Hanson, K.M.; Cunningham, G.S.

1998-12-01

267

Effects of Articaine on Intrapulpal, Mandibular, and Femoral Pressures in Dogs  

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Articaine, a new local anesthetic and the first substance of the amide type with a thiophene ring, has been studied to evaluate its effects on intrapulpal blood pressure (IPP) and mandibular and femoral pressures (MAP, FAP) after injections in the posterior mental foramen (PMF). Eight mongrel dogs of either sex, 9-12 months of age weighing from 15-25 kg were anesthetized. The PMF and the middle foramen were uncovered to expose the vascular-nerve bundle. The mandibular artery was dissected, ca...

Simard-savoie, S.; Perrault, I.; Perron, M. J.

1990-01-01

268

Acute popliteal pseudoaneurysm rupture secondary to distal femoral osteochondroma in a patient with hereditary multiple exostoses.  

Science.gov (United States)

A 21-year-old man with known hereditary multiple exostoses presented with a 24-hour history of atraumatic bruising and swelling of the posterior thigh. A leaking popliteal pseudoaneurysm was diagnosed on ultrasonography and an emergency saphenous vein bypass graft procedure performed. The patient required a post-operative blood transfusion but otherwise made a full recovery. Vascular complications from osteochondromas are rare and include vessel displacement, stenosis, occlusion, arteriovenous fistulas and pseudoaneurysm formation. Pseudoaneurysms usually present as an enlarging mass behind the knee. Acute rupture of an occult popliteal pseudoaneurysm caused by a distal femoral exostosis has not been reported previously. PMID:22507712

Vanhegan, I S; Shehzad, K N; Bhatti, T S; Waters, T S

2012-04-01

269

Femoral head vitality after intracapsular hip fracture  

International Nuclear Information System (INIS)

Femoral head vitality before, during and at various intervals from the operation was determined by tetracycline labeling and/or 99 sp (m)Tc-MDP scintimetry. In a three-year follow-up, healing prognosis could be determined by scintimetry 3 weeks from operation; deficient femoral head vitality predicting healing complications and retained vitality predicting uncomplicated healing. A comparison between pre- and postoperative scintimetry indicated that further impairment of the femoral head vitality could be caused by the operative procedure, and as tetracycline labeling prior to and after fracture reduction in 370 fractures proved equivalent, it was concluded that the procedure of osteosynthesis probably was responsible for capsular vessel injury, using a four-flanged nail. The four-flanged nail was compared with a low-traumatic method of osteosynthesis, two hook-pins, in a prospective randomized 14 month study, and the postoperative femoral head vitality was significantly better in the hook-pin group. This was also clearly demonstrated in a one-year follow-up for the fractures included in the study. Parallel to these investigations, the reliability of the methods of vitality determination was found satisfactory in methodologic studies. For clinical purpose, primary atraumatic osteosynthesis, postoperative prognostic scintimetry and early secondary arthroplasty when indicated, was concluded to be the appropriate approach to femoral neck fracture treatment. (Author)

270

Management of ipsilateral femoral and tibial fractures.  

Science.gov (United States)

This is a retrospective study of 18 patients who had ipsilateral femoral and tibial fractures. They were treated by the retrograde femoral and antegrade tibial intramedullary nail from a single incision in the knee. The average time for union of femoral shaft fractures was 27.6 (18--40) weeks. One patient required antegrade nailing with a bone graft due to metal failure after using the short nail. Two tibial fractures required bone grafting due to bone loss, with an initial open fracture. The average time for union of tibial fractures was 24.5 (18--30) weeks. Functional results using the Karlstrom-Olerud criteria were excellent in 14, good in three, and acceptable in one. The only acceptable result was in a supra- and inter-condylar femoral fracture, with protrusion of the nail tip into the knee joint, which created moderate limitation of knee motion. Simultaneous retrograde femoral and antegrade tibial nailing with a single incision in the knee can achieve satisfactory results in the management of these types of fracture. PMID:15928912

Oh, Chang-Wug; Oh, Jong-Keon; Min, Woo-Kie; Jeon, In-Ho; Kyung, Hee-Soo; Ahn, Hyung-Soo; Park, Byung-Chul; Kim, Poong-Taek

2005-08-01

271

Posterior extradural lumbar disk fragment.  

Science.gov (United States)

We present the unique case of a patient with a sequestered disk fragment posterior to the thecal sac producing symptoms of spinal stenosis with neurogenic claudication. The majority of sequestered disk fragments migrate in either a cranial or caudal direction. In only a few cases have disk fragments been identified posterior to the thecal sac. Our patient had a sudden onset of bilateral groin and anterior thigh pain. Magnetic resonance imaging showed relatively severe stenosis at L4-5 with mild disk bulging. Intraoperatively, a large posteriorly placed encapsulated mass of soft tissue was found compressing the posterior portion of the thecal sac. Patients with acute onset of symptoms of spinal stenosis should have herniated disk included in their differential diagnosis, even in the absence of imaging confirmation. PMID:12132869

Hodges, S D; Humphreys, S C; Eck, J C; Covington, L A

1999-01-01

272

Posterior scleral tuberculoma: case report.  

Science.gov (United States)

Posterior scleral tuberculoma formation is an extremely rare condition. The few reports on scleral involvement in tuberculosis refer to cases of anterior scleritis. In the present manuscript we describe a patient who had rheumatoid arthritis and developed a large posterior scleral tuberculoma. The lesion provoked retinal detachment and visual loss and was diagnosed only after enucleation due to a misdiagnosis of choroidal melanoma. PMID:21670909

Velasco e Cruz, Antonio Augusto; Chahud, Fernando; Feldman, Rodrigo; Akaishi, Patricia Mitiko Santello

2011-01-01

273

Usefulness of the anterior surface and supracondylar region of the femur as a landmark for femoral rotational alignment in knee surgery  

International Nuclear Information System (INIS)

We investigated the possibility that a line tangential to the anterior surface of the femur could serve as a landmark for rotational alignment of the femoral component in total knee arthroplasty (TKA). The subjects were 37 women treated with TKA for medial knee osteoarthritis. Before surgery X-ray films and computed tomography scans were obtained. The three axes -the posterior condylar axis, the transepicondylar axis, and the anterior surface at the supracondyle- were constructed on each CT scan, and the angles between two axes were measured with the X-Caliper system. The results obtained from 35 subjects showed that the angle between the transepicondylar axis and the posterior condylar axis ranged from 3.1 to 10.7 degrees and bad a mean value of 6.35±1.93 degrees. The angle between the transepicondylar axis and the anterior femoral surface at the supracondyle ranged from 6.1 to 15.4 degrees and had a mean value of 11.21±2.48 degrees. The anterior surface was internally rotated relative to the posterior condylar axis in all cases, and its value indicated the degree of anterolateral notching. The anterior femoral surface at the supracondylar level is easy to identify during surgery. Thus, it may be a useful landmark for determining the correct rotational alignment of the femoral component in TKA. (author)

274

Guide Wire Migration During Femoral Vein Catheterization  

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Full Text Available Central vein catheterization is a routine and relatively safe procedure in critically ill patients. Complications with this procedure depend to the site of catheterization and the skill of the operator. In addition to the common complications with femoral vein catheterization there are some rare usually preventable side effects related to guide wire and catheter. In our patient who underwent femoral catheterization for acute hemodialysis, we report migration of guide wire through the systemic circulation from the femoral vein to the jugular vein. This is a very rare complication that is a human error and is totally preventable by doing the procedure by a skilled doctor and considering the standards described for central vein catheter insertion.

Mohammad Reza Khatami

2010-09-01

275

Navigated femoral shaft fracture treatment: current status.  

Science.gov (United States)

Femoral malrotation is a common complication after internal fixation of a femoral shaft fracture. The only valid, objective monitoring method is computer tomography-assisted torsion measurement between the proximal and distal femur; unfortunately, this can only be carried out postoperatively. A difference of 15° compared to the contralateral femur is seen as an indication for revision. With the development of computer-assisted surgery, new possibilities for performing torsion control and correction intraoperatively has been introduced. These methods also allow for navigation-assisted definition of the optimal incision site, intramedullary access, femoral nail and interlocking. The main problem lies in the extra time of surgery, which is due to performing all the steps of the surgery navigated. The solution for this problem is "hybrid navigation", in which the surgeon can select the steps he needs from the navigation system, depending on his experience or surgical technique. PMID:22297715

Hawi, Nael; Haentjes, Jonas; Suero, Eduardo M; Liodakis, Emmanouil; Krettek, Christian; Stübig, Timo; Hüfner, Tobias; Citak, Musa

2012-01-01

276

OSTEONECROSIS OF THE FEMORAL HEAD – DIFFERENTIAL DIAGNOSIS  

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Full Text Available Osteonecrosis of the femoral head (ONFH is a disabling condition that affects mainly young subjects (average age 33-38 years old; to this day, it has remained a devastating disease. Osteonecrosis may be defined as the death of the cell components of bone - both osteocytes and bone marrow cells. ONFH is not a specific entity, but the final common pathway of various conditions that impair the blood supply to the femoral head - hence the frequently used term avascular necrosis. Surgical technological advancements have improved outcomes for these patients. However, due to the relatively young age of onset, these patients are often subjected to multiple operative procedures during their lifetime. Differential diagnosis should be made with: pigmented villonodular synovitis; idiopathic transient osteoporosis of the hip; stress fractures of femoral neck; metastastic bone carcinoma.

C. Zar?

2009-11-01

277

Femoral component loosening after hip resurfacing arthroplasty  

International Nuclear Information System (INIS)

Before the re-introduction of the current generation of total hip resurfacing arthroplasty, component loosening and osteolysis were of great concern to the orthopaedic community. Early, mid- and long-term clinical results are encouraging, but component loosening still exists. Macroscopic, contact radiographic and histopathological analyses after undecalcified preparation of bone tissue specimens were performed. To investigate the frequency and morphological patterns of the loosening of the femoral component, we analysed a series of 190 retrieved femoral remnants that were revised for aseptic failures. Thirty-five (18.4%) hips were revised for clinical and/or radiographic loosening of the femoral component. Pseudoarthrosis (n = 17; median in situ time: 16 weeks, interquartile range [IQR]: 9 to 34), collapsed osteonecrosis (n = 5; median in situ time: 79 weeks, IQR: 63 to 97), cement-socket debonding (n = 3; median in situ time: 89 weeks, IQR: 54 to 97) and at later follow-up bone-cement loosening (n = 10; median in situ time: 175 weeks; IQR 112 to 198; p =0.005) were distinct patterns of the femoral remnant-implant loosening. Fibrocartilaginous metaplasia of interface bone trabeculae (n = 38; median in situ time: 61 weeks, IQR: 32 to 138) was strongly associated with femoral component loosening (p = 0.009). Both the trabecular hyperosteoidosis (n = 32; median in situ time: 71 weeks, IQR 50 to 129) and excessive intraosseous lymphocyte infiltration (n = 12; median in situ time: 75 weeks, IQR 51 to 98) at the bone-cement interface correlated strongly with fibrocartilaginous metaplasia (p = 0.001 and p = 0.016 respectively) and all three lesions were associated with the female gender (p = 0.021, p = 0.009, and p = 0.051). Femoral component loosening at early follow-up was mostly caused by pathological changes of the femoral remnant bone tissue: pseudoarthrosis and collapsed osteonecrosis. Fibrocartilaginous metaplasia was frequently observed in hips with femoral component loosening. The potential role of interface hyperosteoidosis as a precursor lesion of bone-cement loosening and its possible association with delayed type hypersensitivity reaction are discussed. (orig.)

278

Interprosthetic fracture of the femoral shaft.  

Science.gov (United States)

Experience in the management of a complication of ipsilateral hip and knee arthroplasty is described. The cases of four female patients who sustained a femoral shaft fracture after ipsilateral hip and knee arthroplasty are reported. All fractures were treated operatively, and in all cases internal fixation devices failed. This complication of multiple joint arthroplasty presents a difficult management problem. Rigid fixation has a high failure rate for this type of fracture. Surface knee arthroplasty provides a better opportunity for internal fixation than a knee arthroplasty with a stemmed femoral component. PMID:9590651

Kenny, P; Rice, J; Quinlan, W

1998-04-01

279

Isoelastic femoral component in primary cementless total hip arthroplasty  

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We followed 100 patients (111 hips) who underwent primary total hip arthroplasty between July 1988 and June 1995 using the isoelastic femoral component. The average age was 61 (30–70) years. Mean follow-up time was 8.4 (5–12) years. Three femoral components were revised for aseptic loosening and one for disabling thigh pain. Six additional femoral components were considered probably loose by the radiographic criteria. Osteolysis around the femoral component was noted in only two patients ...

Ali, Salaman M.; Kumar, A.

2002-01-01

280

MRI evaluation of abnormalities of subchondral bone after tibial condyle valgus osteotomy  

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We evaluated subchondral low signal intence abnormality on T1-weighted MRI in the osteoarthritis (OA) and osteonecrosis (ON), of the knee after tibial condyle valgus osteotomy (TCVO). Subjects consisted of 11 OA patients, aged 71 on average (range: 66-79) and 3 ON patients, aged 59 on average (range:46-72). The MRI follow-up period was 18 months (range: 12-25) in the OA group and 17 months (range: 12-24) in the ON group. Clinical improvement was observed in all patients. Except for one patient in the OA group, T1-weighteed MRI showed low signal intense area in the medial compartment of the knee. At follow-up, the MRI evaluation revealed a decrease in the low signal intense areas in 9 of the 10 OA patients and in 2 of the 3 ON patients. These results suggest that bone remodelling of the subchondral lesion can be expected after decompression and stabilizing surgery, TCVO. (author)

Otsuka, Kazutaka; Mimura, Hiroshi; Yuge, Daishiro [Yamaguchi Central Hospital, Hofu (Japan); Teramoto, Tsukasa [Nagasaki Friendship Hospital, Sanwa (Japan); Taguchi, Katsuki [Goto Central Hospital, Fukue, Nagasaki (Japan)

2002-03-01

 
 
 
 
281

Pathology of the distal condyles of the third metacarpal and third metatarsal bones of the horse  

International Nuclear Information System (INIS)

This study examined material from Thoroughbred horses, the majority of which had been in race training, for evidence of pathology in the third metacarpal (McIII) and third metatarsal (MtIII) bones which might be related to the occurrence of distal condylar fractures. Whole bone samples were studied and documented by macrophotography prior to macroradiography and computed tomographic (CT) imaging. Microradiographs were made from 100 microm thick mediolateral sections cut perpendicular to the dorsal and palmar/plantar articular surfaces of distal condylar regions of McIII and MtIII. Blocks were prepared for morphological imaging using the backscattered electron mode of scanning electron microscopy (BSE SEM). Linear defects in mineralised articular cartilage and subchondral bone were found in the palmar/plantar aspects of the condylar grooves adjacent to the sagittal ridge. These were closely related to the pattern of densification of the subchondral bone and were associated with intense focal remodelling of the immediately adjacent and subjacent bone. Parasagittal fractures of the condyles originated in similar defects. A unifying hypothesis for the aetiopathogenesis of these fractures is presented

282

Effect of non-working occlusal contacts on vertical condyle position.  

Science.gov (United States)

The presence of non-working occlusal contacts is often considered harmful for the temporomandibular joint. Thus, the purpose of this study was to investigate the effect of non-working occlusal contacts on the condylar position during submaximal and maximal clenching. The study comprised 22 healthy subjects having a canine-guided occlusion. None of them had a third molar and none of them had a missing tooth or showed tooth mobility. All subjects clenched on (i) the canine, (ii) the canine while a stiff bite registration material was positioned between the second premolar and the first molar on the non-working side. The clenching level was controlled by surface electromyography of the masseter muscle. During clenching, the vertical and horizontal condylar position was predicted using six degrees of freedom ultrasonic motion analyser. Clenching on the canine caused a cranial movement of the non-working side condyle. This movement was reduced by 0.6-0.9 mm when the subjects clenched while the artificial non-working side contacts were in place. These results indicate that the contacts on the non-working side may be able to prevent upward joint movement. PMID:19422437

Seedorf, H; Weitendorf, H; Scholz, A; Kirsch, I; Heydecke, G

2009-06-01

283

The 45-Degree Arthroscope Improves Visualization of the Femoral Attachment of the Anterior Cruciate Ligament  

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Full Text Available Background: Exposure of the insertion site of the anterior cruciate ligament (ACL is important for appropriate tunnel placement in ACL reconstruction surgery. However, observing the femoral ACL insertion site via the standard anterolateral portal is sometimes difficult. In this study, we compared views of the femoral ACL insertion site between 30-degree and the 45-degree arthroscopes. Methods: We first inserted the 30-degree and the 45-degree arthroscope into the anterolateral portal of a knee simulator in which we had drawn a lattice pattern on the lateral intercondylar notch based on the quadrant method. Next, we compared the arthroscopic views provided by the 30-degree and 45-degree arthroscopes during ACL reconstruction surgery by measuring the area of the lateral intercondylar notch visible through each of the arthroscopes. Results: In the knee simulator, the 45-degree arthroscope showed the entire area of the lateral intercondylar notch, whereas the 30-degree arthroscope had to be introduced more deeply to show the most superior and posterior quadrant, where the attachment of the anteromedial bundle of ACL is located. During the ACL reconstruction, the area of the lateral intercondylar notch in the field of view was larger through the 45-degree arthroscope than through the 30-degree arthroscope. Conclusion: The 45-degree arthroscope provides a better view of the femoral ACL insertion site via the anterolateral portal, which may be helpful during ACL reconstruction.

Yukihide Iwamoto

2012-01-01

284

Bipolar hemiarthroplasty for femoral neck fracture using the direct anterior approach  

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Full Text Available AIM: To evaluate whether walking ability recovers early after bipolar hemiarthroplasty (BHA using a direct anterior approach. METHODS: Between 2008 and 2010, 81 patients with femoral neck fracture underwent BHA using the direct anterior approach (DAA or the posterior approach (PA. The mean observation period was 36 mo. The age, sex, body mass index (BMI, time from admission to surgery, length of hospitalization, outcome after discharge, walking ability, duration of surgery, blood loss and complications were compared. RESULTS: There was no significant difference in the age, sex, BMI, time from admission to surgery, length of hospitalization, outcome after discharge, duration of surgery and blood loss between the two groups. Two weeks after the operation, assistance was not necessary for walking in the hospital in 65.0% of the patients in the DAA group and in 33.3% in the PA group (P < 0.05. As for complications, fracture of the femoral greater trochanter developed in 1 patient in the DAA group and calcar crack and dislocation in 1 patient each in the PA group. CONCLUSION: DAA is an approach more useful for BHA for femoral neck fracture in elderly patients than total hip arthroplasty in terms of the early acquisition of walking ability.

Tomonori Baba

2013-01-01

285

Hematomas na fossa craniana posterior Haematomata in the posterior fossa  

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Full Text Available São relatados 6 casos de hematomas sub-tentorias (um de hematoma subdural crônico, quatro de hematomas intra-cerebelares, um de hematoma extra-dural. Salientando a pequena freqüência dos hematomas da fossa craniana posterior, o autor mostra a necessidade de vários exames complementares para o diagnóstico exato, indispensável para a aplicação de terapêutica cirúrgica adequada.Six cases of sub-tentorial haematomata (one chronic sub-dural, four intra-cerebellar, one extra-dural are reported. Emphasizing the relative rarity of haematomata in the posterior cranial fossa, the author claims the necessity of complementary examinations for proper diagnosis, indispensable for adequate surgical treatment.

Mário S. Cademartori

1969-09-01

286

Aseptic necrosis of femoral head complicating thalassemia  

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Aseptic necrosis of the femoral head is described in 4 patients, selected from 280 patients with homozygous ..beta..-thalassemia (Cooley anemia). The incidence of the complication appears to be very high (14.5per mille) in thalassemia, compared to the general population. The possible mechanism are discussed.

Orzincolo, C.; Castaldi, G.; Scutellary, P.N.; Bariani, L.; Pinca, A.

1986-10-01

287

Femoral neck fracture following groin irradiation  

International Nuclear Information System (INIS)

ologic malignancies. Fracture in our database appears to be related to irradiation dose, cigarette use, and x-ray evidence of osteoporosis. Special attention should be given in treatment planning (i.e., shielding of femoral head/neck and use of appropriate electron beam energies for a portion of treatment) to reduce the incidence of this complication

288

Aseptic necrosis of femoral head complicating thalassemia  

International Nuclear Information System (INIS)

Aseptic necrosis of the femoral head is described in 4 patients, selected from 280 patients with homozygous ?-thalassemia (Cooley anemia). The incidence of the complication appears to be very high (14.5per mille) in thalassemia, compared to the general population. The possible mechanism are discussed. (orig.)

289

Malformação ílio-femoral / Iliofemoral arterial malformation  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese Durante uma dissecção de rotina realizada em um cadáver do sexo masculino com 65 anos de idade foi constatada malformação arterial iliofemoral. A aorta abdominal estava consideravelmente deslocada lateralmente e também bifurcava em nível mais alto. A artéria ilíaca comum dividia-se uma vértebra acim [...] a do nível normal e a artéria femoral dava origem à artéria femoral profunda aproximadamente l,2 cm abaixo do ligamento inguinal, o que é consideravelmente proximal ao seu nível normal. Aqui nós apresentamos uma breve revisão de literatura e base embriológica dessas anomalias. Abstract in english During routine dissection, an Iliofemoral arterial malformation was noticed in a 65 year old male cadaver. The abdominal aorta was considerably laterally displaced and also bifurcated higher up. The common iliac artery divided one vertebral level higher and the femoral artery gave the profunda femor [...] is artery about 1.2 cm below the inguinal ligament, which is considerably proximal to its usual level of origin. A brief review of literature and embryological basis of the anomalies are discussed.

Mangala M., Pai; Latha V., Prabhu; , Prakash; Varsha, Nayak.

290

Malformação ílio-femoral / Iliofemoral arterial malformation  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese Durante uma dissecção de rotina realizada em um cadáver do sexo masculino com 65 anos de idade foi constatada malformação arterial iliofemoral. A aorta abdominal estava consideravelmente deslocada lateralmente e também bifurcava em nível mais alto. A artéria ilíaca comum dividia-se uma vértebra acim [...] a do nível normal e a artéria femoral dava origem à artéria femoral profunda aproximadamente l,2 cm abaixo do ligamento inguinal, o que é consideravelmente proximal ao seu nível normal. Aqui nós apresentamos uma breve revisão de literatura e base embriológica dessas anomalias. Abstract in english During routine dissection, an Iliofemoral arterial malformation was noticed in a 65 year old male cadaver. The abdominal aorta was considerably laterally displaced and also bifurcated higher up. The common iliac artery divided one vertebral level higher and the femoral artery gave the profunda femor [...] is artery about 1.2 cm below the inguinal ligament, which is considerably proximal to its usual level of origin. A brief review of literature and embryological basis of the anomalies are discussed.

Mangala M., Pai; Latha V., Prabhu; , Prakash; Varsha, Nayak.

2006-12-01

291

Nervio Femoral Accesorio: Una Variación del Plexo Lumbar / Accessory Femoral Nerve: a Variation of Lumbar Plexus  

Scientific Electronic Library Online (English)

Full Text Available SciELO Chile | Language: Spanish Abstract in spanish Variaciones en el origen de los ramos del plexo lumbar son observadas comúnmente durante las disecciones. Entre ellas se pueden mencionar: ausencia del nervio iliohipogástrico, presencia de un nervio obturador accesorio, bifurcación del nervio femoral, entre otras, destacándose la presencia de un ne [...] rvio accesorio del nervio femoral. Durante una disección de rutina, en un cadáver fijado en formaldehido 10%, de un individuo adulto, Chileno, de sexo masculino, se observó la presencia unilateral de este nervio femoral accesorio originado del ramo anterior del nervio femoral, el cual estaba formado por dos ramos, describiendo sus características de origen, trayecto y distribución. Las variaciones anatómicas del plexo lumbar deben ser consideradas en el momento de efectuar cirugías en la región, evitando daños al nervio mencionado u otros, durante la disección quirúrgica. Abstract in english Variations in the origin of the branches of the lumbar plexus are commonly observed during dissections. Among them may be mentioned: absence of iliohypogastric nerve, the presence of an accessory obturator nerve, femoral nerve bifurcation, highlighting the presence of a accessory femoral nerve. Duri [...] ng routine dissection in a cadaver fixed in 10% formaldehyde, an adult individual, Chilean, male, unilateral accessory femoral nerve was observed, originating from the anterior branch of femoral nerve, which consisted of two branches.The characteristics of origin, course and distribution are described. Anatomical variations of the lumbar plexus must always be considered at the time of surgery in the mentioned sector avoiding nerve damage, during surgical dissection.

E, Olave; J. J, Cabezas; A, Soto; O, Binvignat.

1479-14-01

292

Nervio Femoral Accesorio: Una Variación del Plexo Lumbar / Accessory Femoral Nerve: a Variation of Lumbar Plexus  

Scientific Electronic Library Online (English)

Full Text Available SciELO Chile | Language: Spanish Abstract in spanish Variaciones en el origen de los ramos del plexo lumbar son observadas comúnmente durante las disecciones. Entre ellas se pueden mencionar: ausencia del nervio iliohipogástrico, presencia de un nervio obturador accesorio, bifurcación del nervio femoral, entre otras, destacándose la presencia de un ne [...] rvio accesorio del nervio femoral. Durante una disección de rutina, en un cadáver fijado en formaldehido 10%, de un individuo adulto, Chileno, de sexo masculino, se observó la presencia unilateral de este nervio femoral accesorio originado del ramo anterior del nervio femoral, el cual estaba formado por dos ramos, describiendo sus características de origen, trayecto y distribución. Las variaciones anatómicas del plexo lumbar deben ser consideradas en el momento de efectuar cirugías en la región, evitando daños al nervio mencionado u otros, durante la disección quirúrgica. Abstract in english Variations in the origin of the branches of the lumbar plexus are commonly observed during dissections. Among them may be mentioned: absence of iliohypogastric nerve, the presence of an accessory obturator nerve, femoral nerve bifurcation, highlighting the presence of a accessory femoral nerve. Duri [...] ng routine dissection in a cadaver fixed in 10% formaldehyde, an adult individual, Chilean, male, unilateral accessory femoral nerve was observed, originating from the anterior branch of femoral nerve, which consisted of two branches.The characteristics of origin, course and distribution are described. Anatomical variations of the lumbar plexus must always be considered at the time of surgery in the mentioned sector avoiding nerve damage, during surgical dissection.

E, Olave; J. J, Cabezas; A, Soto; O, Binvignat.

293

Sequential changes in the femoral head after intracapsular fracture of the femoral neck. MRI findings  

International Nuclear Information System (INIS)

Authors obtained T1-weighted MRI images of the femoral head after fracture of the femoral neck and classified the signals into four patterns to investigate the sequential changes of the femoral head. The T1-weighted MRI images obtained initially after femoral neck fracture showed a normal pattern in 10 of the 15 hip joints studied. MRI images obtained subsequently still showed the normal signal pattern in eight of the 10 hip joints which had shown the normal pattern in the first MRI, while two of the 10 joints subsequently showed a band pattern. The joint with the homogeneous pattern in the first MRI subsequently showed a band pattern. Of the three joints with an inhomogeneous pattern in the first MRI, two joints showed a subsequent band pattern, and the other a normal pattern. The joints which showed a band pattern continued to show a similar band pattern. Eventually, all hip joints studied showed a normal or band pattern within six months after intracapsular fracture of the femoral neck. The joints which showed a band pattern in the first MRI continued to show a similar band pattern in the subsequent MRI, without any change. Collapse occurred in one hip joint which showed an extensive band pattern. Plain X-rays showed collapse of one of the joints with a band pattern in the MRI image. It was therefore suggested that necrosis may be present histologically in the femoral head after fracture of the femoral neck even when no abnormalities are present in plain X-rays. Baormalities are present in plain X-rays. Based on the above results, it is considered necessary to follow-up patients with femoral neck fracture with MRI for at least six months until the normal or band pattern is observed. (K.H.)

294

Aneurisma da veia femoral simulando uma hérnia inguinal Femoral vein aneurysm simulating an inguinal hernia  

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INTRODUÇÃO: Somente seis casos de aneurismas da veia femoral simulando hérnia inguinal foram descritos na literatura. RELATO DO CASO: Um caso de aneurisma da veia femoral comum direita que simulava uma hérnia inguinal é descrito em jovem de 19 anos de idade com uma massa dolorosa de consistência mole na região inguinal direita de seis meses de duração. Durante a consulta médica, o paciente morreu durante em episódio de convulsão generalizada. Na necropsia, tromboembolismo pulmonar...

Victor Assad Buffara-Jr; Júlio Cezar Uili Coelho; Mateus Martinelli de Oliveira

2009-01-01

295

Novel femoral artery terminology: Integrating anatomy and clinical procedures leading to standardized intuitive nomenclature.  

Science.gov (United States)

The objective of this study is to investigate the terminology of the femoral artery and recommended alternative terminology that satisfies both anatomy and clinical arenas.The femoral artery (FA) is often defined as the continuation of the external iliac artery. Specifically, when the external iliac artery reaches directly beneath the inguinal ligament, it becomes the FA. Currently, Terminologia Anatomica (TA) records the profunda femoris or deep femoral as a terminal branch. Clinicians often use superficial femoral artery (SFA) rather than FA and profunda or deep FA. SFA is actually very deep and well protected for most of its journey. On observation, the terminology in current use is not intuitive. The objective of this study was to investigate the terminology associated with the anatomical and clinical anatomical interpretations of the FA and its terminal branches and to suggest a more appropriate terminology that addresses the points of view of the macro anatomist, as well as that of the clinician. Literature search was conducted regarding the nomenclature of the FA and its terminal branches. Dissection of 89 embalmed cadavers (49F, 40M, ages 47-89) was conducted to analyze the morphology of the FA and its branches. Perusal of the literature revealed a difference in terminology between anatomical and clinical textbooks/atlases/journals regarding the FA and its terminal branch. Our dissections suggested that the FA may be better defined vis-à-vis its relationship to the anterior and posterior compartments of the thigh. A difference in terminology exists between the anatomical and clinical arenas. A need for a standardized terminology is necessary because clinicians and their publishers have not adopted TA. This study suggests that the current FA be considered the common FA and the continuation of the FA, the SFA be renamed the anterior FA and the current profunda (the deep FA) be renamed the posterior FA, respectively. The proposed terminology mirrors the lower limb anterior/posterior tibial artery terminology. Clin. Anat. 27:1085-1088, 2014. © 2014 Wiley Periodicals, Inc. PMID:24677146

Benninger, Brion

2014-10-01

296

Glioblastoma Located In Posterior Fossa  

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Full Text Available A 63-year-old woman operated eight months ago for glioblastoma (GB located in posterior fossa was admitted to emergency room for stuporous, nausea, vomiting and headache. CT and MR showed recurrence of posterior fossa cysticnecrotic tumour without any other intracranial contrast enhancing lesion. Tumour was removed near totally. Perseverative cerebrospinal fluid (CSF fistula from the incision was occurred and  contaminated by multidrug resistant Acinetobacter baumannii. Two months after the tumour removal she was expired because of the septicaemia. GB located in posterior fossa is uncommon in both adults and children;and it appears as two different subsets: de novo (primary type and secondary  glioblastomas. Although our patient’s immunohistochemical findings werenot enough to demonstrate the tumour subset, we have thought that her tumour wasde novo because of no other brain involvement, staining with GFAP, vimentin, and  nearly absent p53 mutation.

Bulent Bakar

2013-01-01

297

Posterior Cortical Atrophy: Case Report  

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Full Text Available Posterior cortical atrophy is a rare, slowly progressive dementia characterized by the development of early visual spatial and visual perceptual deficits, often accompanied by features of Balint’s or Gerstmann’s syndromes and transcortical sensory aphasia. Here we present an ambidextrous case who displayed left temporo-parieto-occipital hypoperfusion in single photon emission computerized tomography manifested by right sided neglect, Gerstmann’s syndrome, some features of Balint’s syndrome. The clinical presentation indicated bilateral posterior hemispheric involvement, but only left sided hypoperfusion in the temporo-parieto-occipital region was observed. Briefly, our patient compiled dominant and non-dominant hemisphere functions in the left hemisphere. As far as we know, this is the first report of an ambidextrous patient with posterior cortical atrophy. (Archives of Neuropsychiatry 2008; 45: 60-3

Görsev Gülmen YENER

2008-08-01

298

Pre-operative and postoperative scintimetry after femoral neck fracture.  

Science.gov (United States)

In 22 patients with femoral neck fractures 99mTc-MDP scintimetry was performed before operation and again shortly after operation; in 17 of these patients the investigation was repeated after four months. Six patients with increased uptake in the femoral head before operation and eight with decreased uptake had similar results at the first postoperative investigation. Of eight patients with an intermediate uptake before operation, two showed increased and six decreased femoral head uptake after operation. It is concluded that for the patients in the group with intermediate femoral head uptake before operation, the operative procedure probably influenced the postoperative blood supply of the femoral head. PMID:6229544

Strömqvist, B; Hansson, L I; Ljung, P; Ohlin, P; Roos, H

1984-01-01

299

Immunohistological analysis of extracted anterior cruciate ligament graft impinged against posterior cruciate ligament  

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Full Text Available Abstract A young female athlete suffered from the residual instability of the knee after anterior cruciate ligament (ACL reconstruction with hamstring autograft. The 3-dimensional (3-D CT scan showed the "high noon" positioning of the primary femoral bone tunnel. The revision surgery with anatomic double-bundle technique was performed two years after the primary surgery and the femoral tunnels were created with the assistance of the 3-D fluoroscopy-based navigation. An arthroscopic examination confirmed the ACL graft impingement against posterior cruciate ligament (PCL when the knee was deeply flexed. The histological analysis of the resected primary ACL graft showed local inflammatory infiltration, enhanced synovial coverage and vascularization at the impinged site. The enhanced expression of vascular endothelial growth factor (VEGF at the impinged area when compared with non-impinged area was observed on immunohistochemical analysis. Abnormal mechanical stress by the impingement against PCL might have induced chronic inflammation and VEGF overexpression.

Kato So

2011-11-01

300

Contribution to the method for determining femoral neck axis  

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Full Text Available Introduction. Femoral neck axis plotting is of great significance in measuring parameters that define femoral head-neck junction sphericity in the group of patients with the femoroacetabular impingement. Literature methods of femoral neck axis determination have weaknesses associated with the risk of obtaining inaccurate values of certain parameters. Objective. Method of plotting of the femoral neck axis by two parallel lines that belong to the medial quarter of the femoral neck is proposed. Method was tested on the anatomic specimens and the respective radiograms. Methods. A total of 31 anatomic specimens of the proximal femur and respective radiographs were used, on which three axes of the femoral neck were plotted; accordingly, alpha angle value was determined and tested with corresponding parametric tests, with the measurement error of less than 5% and the strength of the applied tests of 80%. Results. Alpha angle values obtained by plotting femoral neck axis using the literature and methods we have proposed were not significantly different in our series, and, in more than a half of the specimens, the two axes overlapped each other. Conclusion. The advantage of the proposed method does not depend on the position of the femoral head rotation center in relation to the femoral neck, which favors proposed method for measuring the angles of femoral head sphericity in patients with the femoral head translation. Disadvantage of the study is a small sample size for valid conclusions about the applicability of this method in clinical practice.

An?elkovi? Zoran

2014-01-01

 
 
 
 
301

Coverage of Femoral Head at Weight-Bearing Interface of the Hip Joint in Children: An MRI Analysis  

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Full Text Available Objective: To analyze the features of coverage of femoral head at weight-bearing interface of the hip joints in children. Material and Methods: MRI scans of the hips were performed in 95 normal children aged from 1 to 8 years. Radial scans of the hip joints were performed using FFE sequence. Review the morphological features of weight-bearing interface of the acetabulum and the femoral head. Total covering angle (TCA, acetabular covering angle (ACA and labral covering angle (LCA were measured, inter-group comparison and correlation analysis were done. Result: The acetabulum and the femoral head had congruent articulating surface at each weight-bearing position. There was no statistical TCA difference at each position. Average ACA increased, while average LCA decreased from anterior to posterior. TCA correlated with LCA, ACA negatively correlated with LCA. Conclusion: TCA is a good index in indicating stability of the hip joint. Cartilage ossifies slower at posterior than anterior positions. Cartilage acetabulum and the labrum serve as complementary structures that contribute in total stabilizing of the hip joint in development.

Si-Hui Zeng

2013-06-01

302

Arthroscopic posterior cruciate ligament reconstruction in a skeletally immature patient: a new technique with case report.  

Science.gov (United States)

Pediatric intrasubstance posterior cruciate ligament (PCL) injuries are rare but present a significant treatment challenge. Untreated instability may lead to further knee injury, including meniscal or chondral damage. Surgical intervention risks damage to the physis, growth arrest, and angular deformity. We present the case of a skeletally immature 11-year-old boy with a high-grade intrasubstance PCL injury reconstructed using an all-arthroscopic tibial inlay technique modified to minimize risk of physeal injury. The femoral tunnels were placed entirely within the epiphysis, and the tibial physis was minimally crossed with a small drill hole and suture material. At 17 months' follow up, the patient had returned to full activity, including sports. He had a grade 1 posterior drawer and no posterior sag. Radiographs showed no degenerative changes. Both the proximal tibial and distal femoral physes were widely patent with no angular deformity. The patient had a 1-cm leg length discrepancy, with the operative limb being longer. This technical note with a case report describes a novel physeal-sparing reconstruction of the PCL in a pediatric patient with open physes. PMID:20362839

Bovid, Karen M; Salata, Michael J; Vander Have, Kelly L; Sekiya, Jon K

2010-04-01

303

A very rare case with neglected hip dislocation coexisted with posterior acetabular lip fracture  

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Full Text Available Neglected hip dislocation is a rare situation among children. The coexistence of acetabulum fracture is less common. The result of treatment depends on the time of diagnosis. Early treatment is mandatory in such cases. Seven years old female brought to our outpatient clinic with the complaints of right hip pain and walking difficulty. Her parents said that she had fallen from a horse one month ago. X-ray and CT showed a posterior dislocation of her right hip and a fracture on her right posterior acetabular lip. We performed an open reduction via posterior approach. Because the hip was unstable we fixed the femoral head to the acetabulum by a Kirshner wire. Pelvipedal cast was applied after the operation for 6 weeks. After 6 months avascular necrosis (AVN developed on her right femoral head, the range of motion (ROM of the hip was restricted and she had minimal pain on her right hip. J Clin Exp Invest 2011;2(2:228-31

Samet Karabulut

2011-06-01

304

Posterior hindfoot arthroscopy: a review.  

Science.gov (United States)

In recent years, minimally invasive surgery has developed and progressed the standard of care in orthopaedics and sports medicine. In particular, the use of posterior hindfoot arthroscopy in the treatment of posterior ankle and hindfoot injury is increasing rapidly as a means of reducing pain, infection rates, and blood loss postoperatively compared with traditional open procedures. In athletes, hindfoot arthroscopy has been used effectively in expediting rehabilitation and ultimately in minimizing the time lost from competition at previous levels. Van Dijk et al were the first to describe the original 2-portal technique, which remains the most commonly used by surgeons today and forms the basis for this review. The current evidence in the literature supports the use of 2-portal hindfoot arthroscopy as a safe, primary treatment strategy for symptoms of posterior ankle impingement, including resection of os trigonum, treatment of flexor hallucis longus and peroneal tendon injury, treatment of osteochondral lesions of the ankle, and the resection of subtalar coalitions. In this review, we present where possible an evidence-based literature review on the arthroscopic treatment of posterior ankle and hindfoot abnormalities. Causes, diagnosis, surgical technique, outcomes, and complications are each discussed in turn. PMID:23868522

Smyth, Niall A; Zwiers, Ruben; Wiegerinck, Johannes I; Hannon, Charles P; Murawski, Christopher D; van Dijk, C Niek; Kennedy, John G

2014-01-01

305

Prolapsed Giant Posterior Cervical Leiomyoma  

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Full Text Available Introduction Leiomyoma of uterus is the most common tumor in women in reproductive age. They are asymptomatic in 50% of cases.1 Cervical fibroids accounts for 0.4% of leiomyomas.2 We hereby present a case of prolapsed giant posterior cervical fibroid which required surgical intervention.

Ramya.R

2013-09-01

306

Hematomas na fossa craniana posterior / Haematomata in the posterior fossa  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: Portuguese Abstract in portuguese São relatados 6 casos de hematomas sub-tentorias (um de hematoma subdural crônico, quatro de hematomas intra-cerebelares, um de hematoma extra-dural). Salientando a pequena freqüência dos hematomas da fossa craniana posterior, o autor mostra a necessidade de vários exames complementares para o diagn [...] óstico exato, indispensável para a aplicação de terapêutica cirúrgica adequada. Abstract in english Six cases of sub-tentorial haematomata (one chronic sub-dural, four intra-cerebellar, one extra-dural) are reported. Emphasizing the relative rarity of haematomata in the posterior cranial fossa, the author claims the necessity of complementary examinations for proper diagnosis, indispensable for ad [...] equate surgical treatment.

Mário S., Cademartori.

307

Atrofia cortical posterior Posterior cortical atrophy. Report of five cases  

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Full Text Available Posterior cortical atrophy (PCA is a neurodegenerative syndrome, usually due to Alzheimer's disease. The first symptoms are progressive impairment of visuo spatial (Balint's and Gertsmann's syndromes or visuo perceptive (visual agnosia, alexia function. Episodic memory and executive function are spared until later stages. We report two males aged 51 and 55years and three females aged 50, 54 and 56 years, with posterior cortical atrophy. Ophthalmologic study was normal in all. Presenting signs and symptoms were visual ataxia, simultagnosia, agraphia, acalculia, spatial disorientation and unilateral neglect (Balint's and Gerstmann's syndromes. Apperceptive visual agnosia, aphasia, apraxia and alexia were also observed. One female had cortical blindness. Structural images were inconclusive, but PET scan and SPECT disclosed functional impairments in occipitotemporal or occipitoparietal areas.

Carolina Delgado D

2009-11-01

308

Atrofia cortical posterior / Posterior cortical atrophy. Report of five cases  

Scientific Electronic Library Online (English)

Full Text Available SciELO Chile | Language: Spanish Abstract in spanish [...] Abstract in english Posterior cortical atrophy (PCA) is a neurodegenerative syndrome, usually due to Alzheimer's disease. The first symptoms are progressive impairment of visuo spatial (Balint's and Gertsmann's syndromes) or visuo perceptive (visual agnosia, alexia) function. Episodic memory and executive function are [...] spared until later stages. We report two males aged 51 and 55years and three females aged 50, 54 and 56 years, with posterior cortical atrophy. Ophthalmologic study was normal in all. Presenting signs and symptoms were visual ataxia, simultagnosia, agraphia, acalculia, spatial disorientation and unilateral neglect (Balint's and Gerstmann's syndromes). Apperceptive visual agnosia, aphasia, apraxia and alexia were also observed. One female had cortical blindness. Structural images were inconclusive, but PET scan and SPECT disclosed functional impairments in occipitotemporal or occipitoparietal areas.

Carolina, Delgado D; Archibaldo, Donoso S.

309

Spontaneous stress fractures of the femoral neck  

International Nuclear Information System (INIS)

The diagnosis of spontaneous stress fractures of the femoral neck, a form of insufficiency stress fracture, can be missed easily. Patients present with unremitting hip pain without a history of significant trauma or unusual increase in daily activity. The initial radiographic features include osteoporosis, minor alterations of trabecular alignment, minimal extracortical or endosteal reaction, and lucent fracture lines. Initial scintigraphic examinations performed in three of four patients showed focal increased radionuclide uptake in two and no focal abnormality in one. Emphasis is placed on the paucity of early findings. Evaluation of patients with persistent hip pain requires a high degree of clinical suspicion and close follow-up; the sequelae of undetected spontaneous fractures are subcapital fracture with displacement, angular deformity, and a vascular necrosis of the femoral head

310

Femoral corrective osteotomy for malunited supracondylar femoral fracture after TKA in a patient with rheumatoid arthritis.  

Science.gov (United States)

This article presents a case of femoral corrective osteotomy for malunited supracondylar femoral fracture after total knee arthroplasty (TKA) in a patient with rheumatoid arthritis. The patient underwent 1-stage bilateral TKA and 2-stage bilateral total hip arthroplasty 17 years prior at our institution. Her fall 10 years before led to a supracondylar femoral fracture that was treated nonoperatively for 3 months and led to malunion. Complaints of mild right knee pain and remarkable varus deformity were observed. On examination, the right knee was not swollen and tender. Range of motion (ROM) of the right knee was 0° to 130°. The patient needed crutches to ambulate. Knee score and function scores, according to the Knee Society clinical rating system, were 65 and 25 points, respectively. Radiographs after malunion showed remarkable varus knee and the femorotibial angle was 197°. At the time of surgery, the components were stable and bone union was completed. Valgus corrective osteotomy of the femur was performed using a retrograde intramedullary nail, with satisfactory results at 10-year follow-up. The patient is able to walk without a cane and has 0° to 130° ROM. Knee and function scores were 88 and 80 points, respectively. Radiographs showed complete bone union and the femorotibial angle was 179° with no loosening of the prostheses. Femoral corrective osteotomy is recommended for malunited supracondylar femoral fracture after TKA. PMID:21162502

Saito, Shu; Tokuhashi, Yasuaki; Ishii, Takao; Mori, Sei; Hosaka, Kunihiro; Ishigami, Hitoshi

2010-12-01

311

First MRI results of the therapeutic course of avascular femoral head necrosis after femoral core decompression  

International Nuclear Information System (INIS)

The vascular femoral head necrosis is a serious illness, especially when appearing in patients aged 30 to 50 years. Many etiologic factors cause a femoral head necrosis such as, for example, high-dose steroids, abuse of alcohol, defect of bone marrow and trauma of the hip. Often the X-ray photograph leads to the diagnosis in the second stage (ARCO 1992) or in the third stage, when the femoral head has begun to collapse. The stage IIc and III shows an evident enhancement in contrast media in MRI. Contrast enhancement is demonstrated by STIR, FATSAT, T1-weighted and dynamic screening sequence. The characteristics of the contrast media enhancement argue for an active concomitant process of destruction and regeneration. This stage has the best chances for a drug or a surgical therapy. The evaluation of the signal intensity by the dynamic screening sequence is considered as an objective contribution for the staging of the femoral head necrosis. This enables one to differentiate between the curable stage IIc and the stage III, showing the beginning of breakdown of the femoral head. (orig.)

312

Radiofrequency ablation of two femoral head chondroblastomas  

International Nuclear Information System (INIS)

Chondroblastoma is a rare benign cartilaginous bone tumor. Surgical resection is the treatment of choice for pain relief and prevention of further growth. Open surgical techniques are associated with complications, particularly when the tumors are located in deep anatomical sites. The authors performed RF ablation in two cases of subarticular femoral head chondroblastomas and emphasize its positive impact. The clinical course, the radiological findings and the post treatment results are discussed

313

Radiofrequency ablation of two femoral head chondroblastomas  

Energy Technology Data Exchange (ETDEWEB)

Chondroblastoma is a rare benign cartilaginous bone tumor. Surgical resection is the treatment of choice for pain relief and prevention of further growth. Open surgical techniques are associated with complications, particularly when the tumors are located in deep anatomical sites. The authors performed RF ablation in two cases of subarticular femoral head chondroblastomas and emphasize its positive impact. The clinical course, the radiological findings and the post treatment results are discussed.

Petsas, Theodore [Department of Radiology, University of Patras (Greece); Megas, Panagiotis [Department of Orthopaedic Surgery, University of Patras (Greece)]. E-mail: panmegas@med.upatras.gr; Papathanassiou, Zafiria [Department of Radiology, University of Patras (Greece)

2007-07-15

314

Acute appendicitis in a femoral hernia  

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INTRODUCTION Acute appendicitis in a femoral hernia is an uncommon condition that can be serious. Complications are more frequent if the diagnosis is delayed and surgery is not performed on time. CASE REPORT We present a 71-year-old man with a painful swollen mass. The patient presented with fatigue and loss of appetite, while body temperature was normal. The abdomen was not painful, and peristaltic was normal. All laboratory findings were normal. After anamnesis and physical examination, the...

Zdravkovi? Darko; Maširevi? Radivoj; Bilanovi? Dragoljub; Maširevi? Vesna; Zdravkovi? Marija; Milini? Nikola

2007-01-01

315

Fracture of femoral total hip replacement components  

International Nuclear Information System (INIS)

The biomechanical factors responsible for fatigue fracture of femoral total hip component stems were studied by laboratory loading simulations using implants which were instrumented with strain gauges. Stress levels were low when the prosthesis was rigidly fixed in acrylic along its entire length. Significantly higher stresses were recorded in stems which were loose in the acrylic or which were fixed in their distal portion only

316

An aid to femoral nail removal.  

Science.gov (United States)

We describe a novel technique to aid the removal of a proximally inserted femoral nail by using a guide wire and the starter reamer. By reaming through the scar tissue, a cylindrical track is created and the threaded top end of the nail is exposed. The soft tissue dissection is therefore limited to the absolute minimum with no further damage to the hip abductors. PMID:12623257

Ciampolini, J; Eyres, K S

2003-03-01

317

Stent fractures after superficial femoral artery stenting  

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Stent fracture is one of the major factors compromising implanted stent patency due to its consequences including in-stent restenosis, thrombosis, perforation, and migration. Stent fracture can occur from stress (extrinsic or intrinsic) and biomechanical forces at different implantation sites. We report on 2 cases of stent fractures and pertinent literature. One patient, a 75-year-old male, presented with recurrence of claudication 14 months after superficial femoral artery stenting; a femora...

Park, Jae Young; Jeon, Yong Sun; Cho, Soon Gu; Jin, Chan Ik; Kim, Kyung Rae; Shin, Woo Young; Kim, Jang Yong; Hong, Kee Chun

2012-01-01

318

Radiofrequency catheter ablation of posterior paraseptal accessory pathway with atresia of the coronary sinus ostium.  

Science.gov (United States)

A 42-year-old man was referred to our hospital for an electrophysiologic study because of recurrent episodes of palpitation. On coronary angiogram, an anomalous atresia of the coronary sinus (CS) ostium was discovered. The ablation catheter was inserted from the right femoral artery to the accessory pathway (AP) of posterior paraseptal area. The earliest retrograde atrial activation was recorded in the 5-6 o'clock region of the mitral annulus. Radiofrequency energy was delivered to this site, resulting in elimination of the AP. After this application, there was persistent ventriculoatrial dissociation and led to successful ablation of the AP. PMID:21895728

Yoshida, Susumu; Yokoe, Hiroshi; Murakawa, Kousuke; Takagi, Masahiko; Yuasa, Fumio; Kamihata, Hiroshi; Iwasaka, Toshiji

2012-04-01

319

Malformação ílio-femoral Iliofemoral arterial malformation  

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Full Text Available Durante uma dissecção de rotina realizada em um cadáver do sexo masculino com 65 anos de idade foi constatada malformação arterial iliofemoral. A aorta abdominal estava consideravelmente deslocada lateralmente e também bifurcava em nível mais alto. A artéria ilíaca comum dividia-se uma vértebra acima do nível normal e a artéria femoral dava origem à artéria femoral profunda aproximadamente l,2 cm abaixo do ligamento inguinal, o que é consideravelmente proximal ao seu nível normal. Aqui nós apresentamos uma breve revisão de literatura e base embriológica dessas anomalias.During routine dissection, an Iliofemoral arterial malformation was noticed in a 65 year old male cadaver. The abdominal aorta was considerably laterally displaced and also bifurcated higher up. The common iliac artery divided one vertebral level higher and the femoral artery gave the profunda femoris artery about 1.2 cm below the inguinal ligament, which is considerably proximal to its usual level of origin. A brief review of literature and embryological basis of the anomalies are discussed.

Mangala M. Pai

2006-12-01

320

Unusual occipital condyles of the skull: an osteological study with clinical implications / Côndilos occipitais incomuns no crânio e suas implicações clínicas  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in portuguese CONTEXTO: Os côndilos occipitais do crânio se articulam com as facetas superiores da vértebra atlas e formam uma importante junção entre o crânio e a coluna vertebral. As características morfológicas dos côndilos occipitais são relevantes em estudos biomecânicos, anatômicos e clínicos. OBJETIVO: Des [...] crever o perfil anatômico de côndilos occipitais incomuns observados em uma amostra óssea cadavérica. RELATO DE CASO: O estudo osteológico aqui apresentado mostra a detalhada descrição morfológica de côndilos occipitais incomuns com superfícies desproporcionais e serradas, e também com sulcos longitudinais e transversais à esquerda e à direita, respectivamente. O estudo do caso também discute a importância clínica dessas anomalias. O conhecimento anatômico preciso dos côndilos occipitais é importante para qualquer procedimento cirúrgico como, por exemplo, a ressecção de côndilos occipitais. Abstract in english CONTEXT: The occipital condyles of the skull articulate with the superior articular facets of the atlas vertebra and form an important junction between the cranium and the vertebral column. The morphological features of occipital condyles are relevant in biomechanical, anatomical and clinical studie [...] s. OBJECTIVE: To describe the anatomical profile of unusual occipital condyles detected in a bone specimen. CASE REPORT: The present osteological study provides a detailed morphological description of unusual occipital condyles showing uneven and serrated surfaces and also displaying longitudinal and transverse grooves on the left and right sides respectively. The case study also discusses the clinical importance of such anomalies. Precise anatomical knowledge of the occipital condyles is important for any craniovertebral operative procedures such as resection of the occipital condyles.

Srijit, Das; Rajesh, Suri; Vijay, Kapur.

 
 
 
 
321

Comparative endurance testing of the Biomet Matthews Nail and the Dynamic Compression Screw, in simulated condylar and supracondylar femoral fractures  

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Full Text Available Abstract Background The dynamic compression screw is a plate and screws implant used to treat fractures of the distal femur. The Biomet Matthews Nail is a new retrograde intramedullary nail designed as an alternative surgical option to treat these fractures. The objective of this study was to assess the comparative endurance of both devices. Method The dynamic compression screw (DCS and Biomet Matthews Nail (BMN were implanted into composite femurs, which were subsequently cyclically loaded using a materials testing machine. Simulated fractures were applied to each femur prior to the application of load. Either a Y type fracture or a transverse osteotomy was prepared on each composite femur using a jig to enable consistent positioning of cuts. Results The Biomet Matthews Nail demonstrated a greater endurance limit load over the dynamic compression screw in both fracture configurations. Conclusion The distal locking screws pass through the Biomet Matthews Nail in a unique "cruciate" orientation. This allows for greater purchase in the bone of the femoral condyle and potentially improves the stability of the fracture fixation. As these fractures are usually in weak osteoporotic bone, the Biomet Matthews Nail represents a favourable surgical option in these patients.

Davies Benjamin M

2008-01-01

322

Posterior approach to the shoulder  

International Nuclear Information System (INIS)

The purpose of this study was to describe a modified posterior approach to the shoulder and to present their clinical application in 12 cadaver specimens and a prospective series of 11 patients with glenoid fractures from 1994 to 2003. In the proposed approach Deltoid is reflected superiorly without detachment, approaching the interval between Infraspinatus and Teres Minor muscles exposing the glenoid. Witch this technique the Axilar bundle was 26,5 mm to the posterior glenoid rim. The patients had low surgical times (54 min), low bleeding (77 cc), and no nerve complications. All had good and excellent results in the UCLA score in the first 30 postoperative days. We consider this approach safe, it allows an excellent exposure of the glenoid fractures, and facilitates the functional recovery to the patients

323

Osificación del ligamento longitudinal posterior  

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Full Text Available La osificación del ligamento longitudinal posterior es una de las principales causas de neuropatía en Japón y en países de Oriente Medio; su incidencia es infrecuente en Latinoamérica y su presentación clínica es variable. El tratamiento quirúrgico consiste en descompresión medular, anterior o posterior, y en fusión en caso necesario; el pronóstico es reservado, ya que depende de la extensión de la neuropatía y del tipo de osificación. Se comunica el caso de un paciente no oriental, a quien se le practicó (en el Hospital Regional de Alta Especialidad de Puebla, ISSSTE una laminoplastia cervical en C3, C4, C5 y C6, con injerto óseo de la cresta iliaca; también se realiza una discusión de la bibliografía médica.

Luis Manuel Malpica Ram\\u00EDrez

2012-01-01

324

Anterior and posterior ankle impingement.  

Science.gov (United States)

Anterior ankle impingement is characterized by anterior ankle pain on activity. Recurrent (hyper) dorsiflexion is often the cause. Typically, there is pain on palpation at the anteromedial or anterolateral joint line. Some swelling or limitation in dorsiflexion are present. Plain radiographs can disclose the cause of the impingement. In the case of spurs or osteophytes, the diagnosis is anterior bony impingement. In the absence of spurs or osteophytes, the diagnosis is anterior soft tissue impingement. In patients with anteromedial impingement, plain radiographs ae often falsely negative. An oblique view (anteromedial impingement view = AMI view) is recommended in these patients. Arthroscopic management with removal of the offending tissue provides good to excellent long-term (5-8 years) results in 83% of patients with grade 0 and grade I lesions. Long-term results are good/excellent in 50% of patients with grade II lesions (osteophytes secondary to arthritis with joint space narrowing). In posterior ankle impingement, patients experience hindfoot pain when the ankle is forcedly plantarflexed. Trauma or overuse can be the cause. The trauma mechanism is hyperplantarflexion or a combined inversion plantarflexion injury. Overuse injuries typically occur in ballet dancers and downhill runners, who report pain on palpation at the posterolateral aspect of the talus. On plain radiographs, an os trigonum or hypertrophic posterior or talar process can be detected. Surgical management involves removal of the os trigonum, scar tissue, or hypertrophic posterior talar process. In the case of combined posterior bony impingement and flexor hallucis longus tendinopathy, a release of the flexor hallucis longus is performed simultaneously. Endoscopic management is associated with a low morbidity, a short recovery time, and provides good/excellent results at 2-5 years follow-up in 80% of patients. PMID:16971256

Niek van Dijk, C

2006-09-01

325

Posterior asymmetry and idiopathic scoliosis  

CERN Document Server

Study design Are there neuro-anatomical abnormalities associated with idiopathic scoliosis (IS)? Posterior Basicranium (PBA) reflects cerebellum growth and contains vestibular organs, two structures suspected to be involved in scoliosis. Objective The aim of this study was to compare posterior basicranium asymmetry (PBA) in Idiopathic scoliosis (IS) and normal subjects. Method: To measure the shape of PBA in 3D, we defined an intra-cranial frame of reference based on CNS and guided by embryology of the neural tube. Measurements concerned three directions of space referred to a specific intra cranial referential. Data acquisition was performed with T2 MRI (G.E. Excite 1.5T, mode Fiesta). We explored a scoliosis group of 76 women and 20 men with a mean age of 17, 2 and a control group of 26 women and 16 men, with a mean age of 27, 7. Results: IS revealed a significant asymmetry of PBA (Pr>|t|<.0001) in 3 directions of space compared to the control group. This asymmetry was more pronounced in antero-posterior...

Rousie, D L; Berthoz, A

2009-01-01

326

Ender Nail Applications in Femoral Diaphysis Fractures  

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Full Text Available Aim: Although the femoral shaft fractures are treated conservatively for up to 6 years in children, surgical treatment should be considered in patients with femoral shaft fractures in school age or in those who have multiple long-bone fracture or organ injury. But it is a controversial issue which surgical treatment is ideal. Material and Method: Twenty-nine femoral fractures of 26 patients whose surgical treatment of femoral shaft fractures were made with Ender nails were prospectively evaluated. Under general anesthesia, 4,5 mm of 2 Ender nails were performed from the metaphysis to all of the patients. The patients were evaluated according to the type of the fracture, duration of the union, the discrepancy of shortening-length, the rotation, limitation of the joint movement, the complications such as refractures and the criterions of Flynn in terms of the clinical outcomes. Results: The mean age of the patients was 9.2 years (4-14. The type of the fracture was Winquist Hansen type 2 and 3. The mean duration of the followup was 18 months (13-38. While the etiology of the fractures was the traffic accidents in twenty of the patients, gunshot wounds and falling from height were in the others. The mean duration of the union was 6.5 (5-8 weeks in all patients. The discrepancy of shortening-length was an average of 6 mm (2-20, the difference of the rotation was an average of 3 degree (2-7, and the angulation of varus-valgus was an average of 4 degrees (2-9 in the femurs which were treated in the patients. The limitation of the movement in the knee joint was of an average 5 degrees (3-10 as the flexion and extension. None of the patients developed refractures. Excellent result in 20 fractures , good result in 7 fractures and bad result in 2 fractures were observed according to the criterions of Flynn. Discussion: Ender nail should be considered first for the possibility of early return to school, the low risk of refracture and the price advantage in the surgical treatment of femoral shaft fractures in children aged 5 and above

Albert Çakar

2012-10-01

327

MR evaluation of femoral neck version and tibial torsion  

Energy Technology Data Exchange (ETDEWEB)

Abnormalities of femoral neck version have been associated with a number of hip abnormalities in children, including slipped capital femoral epiphysis, proximal femoral focal deficiency, coxa vara, a deep acetabulum and, rarely, developmental dysplasia of the hip. Orthopedic surgeons also are interested in quantifying the femoral neck anteversion or retroversion in children especially to plan derotational osteotomies. Historically, the angle of femoral version and tibial torsion has been measured with the use of radiography and later by CT. Both methods carry with them the risks associated with ionizing radiation. Techniques that utilize MR are used less often because of the associated lengthy imaging times. This article describes a technique using MRI to determine femoral neck version and tibial torsion with total scan times of approximately 10 min. (orig.)

Koenig, James Karl; Dwek, Jerry R. [University of California, San Diego, Children' s Hospital and Health Center, Department of Radiology, San Diego, CA (United States); Pring, Maya E. [Rady Children' s Hospital, Department of Pediatric Orthopedic Surgery, San Diego, CA (United States)

2012-01-15

328

MR evaluation of femoral neck version and tibial torsion  

International Nuclear Information System (INIS)

Abnormalities of femoral neck version have been associated with a number of hip abnormalities in children, including slipped capital femoral epiphysis, proximal femoral focal deficiency, coxa vara, a deep acetabulum and, rarely, developmental dysplasia of the hip. Orthopedic surgeons also are interested in quantifying the femoral neck anteversion or retroversion in children especially to plan derotational osteotomies. Historically, the angle of femoral version and tibial torsion has been measured with the use of radiography and later by CT. Both methods carry with them the risks associated with ionizing radiation. Techniques that utilize MR are used less often because of the associated lengthy imaging times. This article describes a technique using MRI to determine femoral neck version and tibial torsion with total scan times of approximately 10 min. (orig.)

329

Ipsilateral femoral neck and shaft fractures: An overlooked association  

International Nuclear Information System (INIS)

A total of 304 patients with injuries to the femoral shaft and ipsilateral hip presented between 1984 and 1990. Some 253 of them suffered fractures of the femoral shaft and dislocated hips or fractures of the acetabulum, and 51 of these sustained fractures of the femoral shaft and neck or trochanteric region. All of the trochanteric injuries were demonstrated on the initial radiographs. However, in 11 of the patients with combined femoral shaft and neck fractures, the diagnosis was delayed by as much as 4 weeks. This delay related to the fact that these fractures tended not to separate in the initial evaluation period and that there was external rotation of the proximal femoral fragment due to the femoral shaft fracture. (orig./GDG)

330

Structural variation of the distal condyles of the third metacarpal and third metatarsal bones in the horse  

International Nuclear Information System (INIS)

This study examined 3-dimensional (3D) distribution of sectors with contrasting density in the equine third metacarpal (McIII) and third metatarsal (MtIII) bones with a view to explaining the aetiology of distal condylar fractures. Macroradiography and computed tomographic (CT) imaging were used in the nondestructive study of bones obtained from horses, most of which were Thoroughbreds in race training. Distal condylar regions of McIII and MtIII were also studied in microradiographs of 100 mu m thick mediolateral sections cut perpendicular to the dorsal and palmar/plantar articular surfaces. Qualitative and quantitative results from all methods used (radiography, CTand microradiographic stereology) demonstrated densification (sclerosis) of subchondral bone located in the palmar/plantar regions of the medial and lateral condyles of both McIII and MtIII, Substantial density gradients between the denser condyles and the subchondral bone of the sagittal groove were shown to equate with anatomical differences in loading intensity during locomotion. It is hypothesised that such differences in bone density results in stress concentration at the palmar/plantar aspect of the condylar grooves, which may predispose to fracture

331

Posterior scleritis associated with systemic tuberculosis  

Directory of Open Access Journals (Sweden)

Full Text Available Infective isolated posterior scleritis is rare. We report a case of isolated posterior scleritis associated with histopathologically documented systemic tuberculosis, a hitherto unreported association. The patient responded well to a combination of oral corticosteroids with antituberculosis therapy.

Gupta Amit

2003-01-01

332

Femoral head vitality in femoral neck fracture after hook-pin internal fixation.  

Science.gov (United States)

Femoral head vitality was evaluated by tetracycline labeling and 99mTc-MDP scintimetry in 317 femoral neck fractures before and after internal fixation with two hook-pins. The preoperative vitality was about the same as that observed by others using comparable methods. The postoperative vitality was reduced in five of 81 undisplaced fractures and in 76 of 236 displaced fractures. These data would predict a rate of avascular healing complications of 7% in undisplaced and 32% in displaced fractures treated with hook-pins. PMID:6238740

Strömqvist, B; Hansson, L I

1984-12-01

333

Femoral nerve palsy secondary to iliopsoas haemorrhage in patients with haemophilia: results from biceps femoral transfer  

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Full Text Available Hemophilia causes injuries of peripheral nerves secondary to compressions by hematoma. In general, these injuries recover spontaneously after the cause of the compression is solved. A case of a 16-year-old adolescent with injury of the left femoral nerve, causing loss of the extension of the knee is described herein. During the evolution there was no recovery. For this reason a tendinous transfer of the femoral biceps was practiced. This technique was described formerly for the correction of poliomyelitis. Excellent results were obtained with complete recovery of the extension and force 4+/5.

Marcela Piña-Quintero

2009-12-01

334

Femoral Osteolysis Around the Unrevised Stem During Isolated Acetabular Revision  

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Many surgeons treat progressive femoral osteolysis in association with a well-fixed stem with bone grafting but in uncontained proximal defects the graft could get into the joint, raising a question regarding whether the osteolysis can be treated by simple débridement without bone grafting. We investigated whether the curetted proximal osteolysis around an unrevised femoral component progressed in size and whether this lesion would have a deleterious effect on fixation of the femoral compone...

Min, Byung-woo; Song, Kwang-soon; Cho, Chul-hyun; Bae, Ki-cheor; Lee, Kyung-jae

2009-01-01

335

Biophysical stimulation in osteonecrosis of the femoral head  

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Osteonecrosis of the femoral head is the endpoint of a disease process that results from insufficient blood flow and bone-tissue necrosis, leading to joint instability, collapse of the femoral head, arthritis of the joint, and total hip replacement. Pain is the most frequent clinical symptom. Both bone tissue and cartilage suffer when osteonecrosis of the femoral head develops. Stimulation with pulsed electromagnetic fields (PEMFs) has been shown to be useful for enhancing bone repair and for...

Massari Leo; Fini Milena; Setti Stefania; Traina GianCarlo

2009-01-01

336

Detection of Femoral Artery Calcification by Bone Scintigraphy  

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Scintigraphy with technetium-99m methylene diphosphonate (MDP) was performed in a 76-year-old male with prostatic cancer. Tc-99m MDP bone scintigraphy showed a linear markedly increased accumulation of radioactivity in both femoral arteries. Radiopharmaceutical uptake in femoral arteries was confirmed with a colour Doppler ultrasonography as femoral artery calcification. This increased uptake of Tc-99m MDP in the patient is strongly related to the calcium deposition. Tc-99m MDP scintigraphy d...

Uslu, Hatice M. D.; Varoglu, Erhan M. D.; Yildirim, Mustafa M. D.; Polat, Pinar M. D.

2003-01-01

337

MRI morphometry, cartilage damage and impaired function in the follow-up after slipped capital femoral epiphysis  

Energy Technology Data Exchange (ETDEWEB)

To assess rotation deficits, asphericity of the femoral head and localisation of cartilage damage in the follow-up after slipped capital femoral epiphysis (SCFE). Magnetic resonance imaging studies were obtained in adult patients with a history of SCFE. A total of 35 hips after SCFE in 26 patients (mean age 24.1 {+-} 6.5, mean follow-up 11.9 {+-} 6.1 years) were evaluated. The control group comprised 20 healthy hips from 10 young adults with an average age of 23.9 {+-} 3.7 years. The MR protocol included a T1-weighted sequence with a 3D volumetric interpolated breath-hold sequence and a radial 2D proton density-weighted sequence around the femoral neck. Images were evaluated for alpha angle and cartilage damage in five positions around the femoral head. Hip function was evaluated at the time of MRI and correlated with MRI results. Mann-Whitney U test and Spearman's correlation coefficient were used for statistical analysis. In the hips after SCFE alpha angles were significantly increased in the anterosuperior (74.1 {+-} 18.8 ) and superior (72.5 {+-} 21.5 ) positions and decreased in the posterior position (25.0 {+-} 7.2 ). Cartilage damage was dominant in the anterosuperior and superior positions. Impaired rotation significantly correlated with increased anterosuperior, superior and posterosuperior alpha angles. The data support an anterosuperior and superior cam-type deformity of the femoral head-neck junction in the follow-up after SCFE. MRI after SCFE can be used to assess anterosuperior and superior alpha angles, since the anterior alpha angle by itself may underestimate asphericity and is not associated with rotation deficits. (orig.)

Miese, Falk R.; Holstein, Arne; Kroepil, Patric; Moedder, Ulrich; Fuerst, Guenther [University Hospital Duesseldorf, Institute of Radiology, MNR Clinic, Duesseldorf (Germany); Zilkens, Christoph; Bittersohl, Bernd; Jaeger, Marcus; Krauspe, Ruediger [University Hospital Duesseldorf, Department of Orthopaedics, Duesseldorf (Germany); Mamisch, Tallal C. [University Bern, Department of Orthopaedic Surgery, Bern (Switzerland)

2010-06-15

338

Tomographic index as auxiliary criteria for surgery indication in fracture dislocation of acetabulum posterior wall  

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Full Text Available Abstract There are situations which the tomographic exam is done on the affected hip or situations where the contralateral hip presents abnormalities that make it impossible to compare. In this study we aimed to evaluate a tomographic index that does not require comparison between the both hips. Twenty two patients with unilateral acetabular fracture dislocation with fracture of posterior wall were studied. We established the relationship between the remaining posterior wall and the femoral head diameter (head/wall index-H/W index. We evaluated 45 two-dimensional computed tomography scan in normal hips and established the H/W index. In 45 normal hips we simulated a posterior wall fracture with involvement of 25% and 30% of the posterior wall and calculated the H/W index. We divided into five groups with five different H/W index (fractured group with non surgical treatment; fractured group; normal group; normal group with simulated fracture of 25% and; 30% of the posterior wall. 2.4 was the lowest limit of confidence interval of the group with 25% of the posterior wall fracture. When we analyzed the confidence interval of the 30% fracture group the upper limit of the confidence interval was 2.7, close to the lower limit of the surgical group that was 2.9. Thus, we suggest the 2.4 the H/W index limit as an auxiliary criteria to indicate whether or not to operate. H/W index is helpful to decide whether or not surgery indication in the fracture dislocation of the posterior wall of the acetabulum.

Fujiki Edison N

2012-06-01

339

20 CFR Appendix 3 to Part 220 - Railroad Retirement Board Occupational Disability Standards  

Science.gov (United States)

...Necrosis of femoral condyle or tibial...Necrosis of femoral condyle or tibial...Patellar fracture nonunion with...Recommended. Supracondylar fracture...knee: patello femoral joint0...DPatellar fracture nonunion with...degrees)DSupracondylar...

2010-04-01

340

Common femoral artery anatomy: A guide to safe puncture  

International Nuclear Information System (INIS)

A three-part study is being done to define the common femoral artery anatomy as a guide to accurate, safe puncture. In the first phase, punctures were made in the common femoral artery of 11 cadavers. Dyed plasma and contrast media were injected to create a ''hematoma.'' The planes of extension, especially into the retroperitoneum, were assessed by radiography and dissection. In the second phase, over 100 cadavers are being dissected to define common femoral artery relationships. In the third phase, over 400 angiograms have been obtained with external markers in place to define the relationship of the common femoral artery to palpable and fluoroscopic landmarks

 
 
 
 
341

Risk factor analysis for early femoral failure in metal-on-metal hip resurfacing arthroplasty: the effect of bone density and body mass index  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background The importance of appropriately selecting patients based on factors such as bone mineral density, body mass index, age, gender, and femoral component size has been demonstrated in many studies as an aid in decreasing the rate of revisions and improving the outcomes for patients after hip resurfacing arthroplasty (HRA; however, there are few published studies quantitatively specifying the potential risk factors that affect early femoral component failures. Therefore, the purpose of this study was to investigate the specific causes of early femoral component failures in hip resurfacing separately and more carefully in order to develop strategies to prevent these failures, rather than excluding groups of patients from this surgical procedure. Methods This retrospective study included 373 metal-on-metal HRAs performed by a single surgeon using the vascular sparing posterior minimally invasive surgical approach. The average length of follow-up was 30 ± 6 months. In order to understand the causes of early femoral failure rate, a multivariable logistic regression model was generated in order to analyze the effects of bone mineral density (T-score, gender, diagnosis, body mass index, femoral implant fixation type, age, and femoral component size. Results The average post-operative Harris hip score was 92 ± 11 points and the average post-operative UCLA score was 7 ± 2 points. There were three revisions due to femoral neck fracture and two for femoral component loosening. These occurred in two female and three male patients. In the multi-variable regression model, only T-score and body mass index showed significant effects on the failure rate of femoral components. Patients with a lower T-score and a higher body mass index had a significantly increased risk of early femoral component failure. Conclusion We recommend that dual energy x-ray absorptiometry scan T-score tests should be routinely performed on all hip resurfacing patients pre-operatively. If a patient has a low T-score (? -1.5, consideration should be given to additional precautions or treatments to alleviate his or her risk, especially when the patient has a higher body mass index (? 29 kg/m2.

Gross Thomas P

2012-01-01

342

Distrofia polimorfa posterior y LASIK / Posterior polymorphous dystrophy and LASIK  

Scientific Electronic Library Online (English)

Full Text Available SciELO Spain | Language: Spanish Abstract in spanish Objetivo/Método: Mujer hipermétrope de 50 años desea información sobre cirugía refractiva. En la córnea se aprecia vesículas y bandas en la membrana de Descement y endotelio catalogándose de distrofia polimorfa posterior (DPP). El recuento endotelial resulta bajo por lo que se le contraindica cualqu [...] ier cirugía refractiva corneal. Resultados/Conclusiones: La presencia de vesículas y bandas a nivel de la membrana de Descement y endotelio es característico de una DPP. En estos casos resulta obligatorio realizar una microscopía especular previa a una cirugía refractiva con láser excimer. Un recuento de células endoteliales bajo puede constituir una contraindicación para el LASIK hipermetrópico en casos de DDP por el posible riesgo de descompensación endotelial. Abstract in english Objective/Method: A 50-year-old hyperopic woman requested information about refractive surgery. Vesicle and band lesions at Descemet’s membrane and endothelium were suggestive of posterior polymorphous dystrophy (PPD). Lower than normal endothelial cell densities were detected. A corneal refractive [...] procedure was not recommended in this case. Results/Conclusions: The presence of vesicles and bands at Descemet’s membrane and endothelium is suggestive of PPD. Specular microscopy is mandatory in such patients, although corneal decompensation is not evident. A low endothelial cell count may be a contraindication for a hyperopic LASIK procedure in cases of PPD because of the possible risk of corneal decompensation.

V., Huerva; A.J., Mateo.

343

Distrofia polimorfa posterior y LASIK Posterior polymorphous dystrophy and LASIK  

Directory of Open Access Journals (Sweden)

Full Text Available Objetivo/Método: Mujer hipermétrope de 50 años desea información sobre cirugía refractiva. En la córnea se aprecia vesículas y bandas en la membrana de Descement y endotelio catalogándose de distrofia polimorfa posterior (DPP. El recuento endotelial resulta bajo por lo que se le contraindica cualquier cirugía refractiva corneal. Resultados/Conclusiones: La presencia de vesículas y bandas a nivel de la membrana de Descement y endotelio es característico de una DPP. En estos casos resulta obligatorio realizar una microscopía especular previa a una cirugía refractiva con láser excimer. Un recuento de células endoteliales bajo puede constituir una contraindicación para el LASIK hipermetrópico en casos de DDP por el posible riesgo de descompensación endotelial.Objective/Method: A 50-year-old hyperopic woman requested information about refractive surgery. Vesicle and band lesions at Descemet’s membrane and endothelium were suggestive of posterior polymorphous dystrophy (PPD. Lower than normal endothelial cell densities were detected. A corneal refractive procedure was not recommended in this case. Results/Conclusions: The presence of vesicles and bands at Descemet’s membrane and endothelium is suggestive of PPD. Specular microscopy is mandatory in such patients, although corneal decompensation is not evident. A low endothelial cell count may be a contraindication for a hyperopic LASIK procedure in cases of PPD because of the possible risk of corneal decompensation.

V. Huerva

2008-10-01

344

Veia gástrica posterior: hipertensão porta Posterior gastric vein: portal hipertension  

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Full Text Available A veia gástrica posterior não é muito citada nos livros de anatomia e nos trabalhos sobre hipertensão porta. Estudou-se sua anatomia, freqüência e desembocadura. Ela foi encontrada em 54% dos casos e, em 100%, desembocava na veia esplênica. Discute-se a vantagem ou não de sua ligadura ou preservação no tratamento cirúrgico da hipertensão porta.The posterior gastric vein has not been mentioned very often neither in anatomy textbooks nor in portal hypertension papers. The authors studied the anatomy, frequency and confluence of this vein because is a huge variety in the presentation of esophageal varices. Twenty-six adult preserved corpses (twenty females and six males had a wide abdominal incision allowing the dissection of the portal system, identifying the frequency and confluence of its tributaries, notably the posterior gastric vein. The portal vein, in all cases, was formed by the confluence of the superior mesenteric vein with the splenic vein and had a mean length of 6.4 cm. The splenic vein had a mean length of 6.5 cm. The left gastric vein was tributary of the portal vein in 50% of the cases and in 30% of the cases in the splenic vein. The right gastric vein had it's confluence to portal vein in 30 % of the cases and to the splenic vein in 4 %. The inferior mesenteric vein was tributary of the splenic vein in 54% of the cases and in the superior mesenteric vein in 46%. The left gastro-omental vein had its confluence to the splenic vein in 50% of the cases and to the inferior polar vein in 34 %. The middle colic vein had its confluence to superior mesenteric vein in 42% of the cases, to inferior mesenteric vein in 12% and to splenic vein in 8%. The posterior gastric vein was found in 54% of the corpses, and in all cases it was a tributary of the splenic vein, in retropancreatic position, coming from the esophageal-gastric junction. These findings agree with previous papers describing a prevalence of 60% of posterior gastric vein in patients submitted to surgery in portal hypertension, and in all cases, this vein was tributary of the splenic vein. The identification of this vein may influence the treatment, because if left untied during cases of portal-azigos disconnection, they may predispose to postoperative bleeding, but in cases of splenorenal anastomosis may preserve its patency in cases of anastomosis occlusion, or can lead again to postoperative bleeding feeding the esophageal varices. To ligate or not this vein will depends on the surgeon 's experience and common sense. Regarding to previous papers and to this data presented here, the authors believe that the prevalence of this vein is between 50 and 60% in the population.

Alcino Lázaro da Silva

1999-10-01

345

21 CFR 888.3570 - Knee joint femoral (hemi-knee) metallic uncemented prosthesis.  

Science.gov (United States)

...femoral (hemi-knee) metallic uncemented prosthesis. 888.3570 Section 888.3570...femoral (hemi-knee) metallic uncemented prosthesis. (a) Identification. A knee...femoral (hemi-knee) metallic uncemented prosthesis is a device made of alloys,...

2010-04-01

346

21 CFR 888.3400 - Hip joint femoral (hemi-hip) metallic resurfacing prosthesis.  

Science.gov (United States)

...femoral (hemi-hip) metallic resurfacing prosthesis. 888.3400 Section 888.3400...femoral (hemi-hip) metallic resurfacing prosthesis. (a) Identification. A hip...femoral (hemi-hip) metallic resurfacing prosthesis is a device intended to be...

2010-04-01

347

To study the role of dynamic magnetic resonance imaging in assessing the femoral head vascularity in intracapsular femoral neck fractures  

Energy Technology Data Exchange (ETDEWEB)

Intracapsular femoral neck fractures remain unsolved fractures even after improvement in techniques of diagnosis and internal fixation. Individuals who sustain displaced femoral neck fractures are at high risk of developing avascular necrosis and non-union. Although several methods for predicting the viability of femoral head have been reported, they are not effective or widely used because of unreliability, potential complications and technical difficulties. Dynamic MRI was introduced in the recent past as a simple, non-invasive technique to predict the femoral head viability after the femoral neck fractures. In this study role of dynamic MRI was studied in 30 patients with 31 intracapsular femoral neck fractures. Fractures were divided in to three types according to dynamic curve patterns on MRI evaluation and were followed up for 6 months to 2 years to observe the final outcome. Sensitivity, Specificity and the Accuracy of dynamic MRI in predicting vascularity after femoral neck fracture are 87%, 88% and 87%, respectively. Type A or Type B curve pattern is a positive factor to successful osteosynthesis with p value <0.0001 (Chi-square test). This is a statistically significant value. From this finding it can be suggested that the reliability of dynamic curves A and B in predicting maintained vascularity of femoral head is high. This investigation can be used to predict the vascularity of femoral head after intracapsular femoral neck fractures. There was a good correlation between the outcomes of fractures and dynamic MRI curves done within 48 h of injury. This signifies the role of dynamic MRI in predicting the vascularity of femoral head as early as 48 h. A treatment algorithm can be suggested on the basis of dynamic MRI curves. The fractures with Type C dynamic curve should be considered as fractures with poor vascularity of femoral head and measures to enhance the vascularity of femoral head along with rigid internal fixation should be undertaken to promote revascularization process and better healing of fractures. Patients with these fractures should be on longer non-weight bearing ambulation than other patients. To conclude, the dynamic MRI seems to be reliable, non-invasive, sensitive, specific and accurate method of assessing the femoral head vascularity after intracapsular femoral neck fractures as early as 48 h of injury and to predict the outcome of fractures and may be used as a guideline for management of intracapsular femoral neck fractures.

Kaushik, Abhishek, E-mail: abhiortho27@gmail.co [Department of Orthopedics, 513, Thermal Colony, Sector-22, Faridabad 121005, Haryana (India); Sankaran, Balu; Varghese, Mathew [Department of Orthopedics, St Stephen' s Hospital, Tis hazari, Delhi, New Delhi 110054 (India)

2010-09-15

348

To study the role of dynamic magnetic resonance imaging in assessing the femoral head vascularity in intracapsular femoral neck fractures  

International Nuclear Information System (INIS)

Intracapsular femoral neck fractures remain unsolved fractures even after improvement in techniques of diagnosis and internal fixation. Individuals who sustain displaced femoral neck fractures are at high risk of developing avascular necrosis and non-union. Although several methods for predicting the viability of femoral head have been reported, they are not effective or widely used because of unreliability, potential complications and technical difficulties. Dynamic MRI was introduced in the recent past as a simple, non-invasive technique to predict the femoral head viability after the femoral neck fractures. In this study role of dynamic MRI was studied in 30 patients with 31 intracapsular femoral neck fractures. Fractures were divided in to three types according to dynamic curve patterns on MRI evaluation and were followed up for 6 months to 2 years to observe the final outcome. Sensitivity, Specificity and the Accuracy of dynamic MRI in predicting vascularity after femoral neck fracture are 87%, 88% and 87%, respectively. Type A or Type B curve pattern is a positive factor to successful osteosynthesis with p value <0.0001 (Chi-square test). This is a statistically significant value. From this finding it can be suggested that the reliability of dynamic curves A and B in predicting maintained vascularity of femoral head is high. This investigation can be used to predict the vascularity of femoral head after intracapsular femoral neck fractures. There was a good correlation between the outcomes of fractures and dynamic MRI curves done within 48 h of injury. This signifies the role of dynamic MRI in predicting the vascularity of femoral head as early as 48 h. A treatment algorithm can be suggested on the basis of dynamic MRI curves. The fractures with Type C dynamic curve should be considered as fractures with poor vascularity of femoral head and measures to enhance the vascularity of femoral head along with rigid internal fixation should be undertaken to promote revascularization process and better healing of fractures. Patients with these fractures should be on longer non-weight bearing ambulation than other patients. To conclude, the dynamic MRI seems to be reliable, non-invasive, sensitive, specific and accurate method of assessing the femoral head vascularity after intracapsular femoral neck fractures as early as 48 h of injury and to predict the outcome of fractures and may be used as a guideline for management of intracapsular femoral neck fractures.

349

Approaches to a posterior polar cataract  

Science.gov (United States)

Posterior polar cataracts present special challenges to the cataract surgeon. These are often associated with weakness/dehiscence of the posterior capsule and thus have a higher rate of intraoperative posterior capsule rupture. The surgeon needs to adhere to special surgical strategies to minimize the risk of a posterior capsule rupture. These include, adhering to the principles of closed chamber technique, avoiding hydrodissection – instead performing ‘inside-out’ hydrodelineation and using modest to low phaco parameters and reducing these stepwise. This article provides important pearls on how to approach a posterior polar cataract. PMID:23960968

Vasavada, Abhay R.; Vasavada, Viraj A.; Raj, Shetal M.

2011-01-01

350

Ruptured true superficial femoral artery aneurysm / Aneurisma verdadeiro roto de arteria femoral superficial  

Scientific Electronic Library Online (English)

Full Text Available SciELO Brazil | Language: English Abstract in portuguese Os aneurismas de artéria femoral são raros e ocorrem geralmente em pacientes idosos. Estão frequentemente associados a outros aneurismas, tanto periféricos como de aorta abdominal. O presente relato refere-se a um jovem portador de aneurisma de artéria femoral superficial (AFS), cuja apresentação cl [...] ínica foi a ruptura. O paciente foi submetido ao tratamento convencional, com ressecção do aneurisma e interposição de veia safena magna ipsilateral. A revisão da literatura corrobora a raridade do caso Abstract in english Femoral artery aneurysms are rare and generally affect elderly patients. They are often diagnosed in combination with aneurysms in other locations, such as peripheral and aortic aneurysms. This case report describes a young patient whose superficial femoral artery (SFA) had a clinical presentation s [...] uggestive of a ruptured aneurysm. The patient underwent standard treatment, with aneurysmectomy and interposition of the ipsilateral saphenous vein. A review of the literature confirms the rarity of this case

Ani Loize, Arendt; Robinson de Menezes do, Amaral; Mariana Sesterhenn, Vieira; Rafael de Nogueira, Ribeiro; Rodrigo, Argenta.

2013-12-01

351

Extramedullary skeletal traction for intramedullary femoral nailing.  

Science.gov (United States)

The through-and-through forms of femoral skeletal traction that are often used during intramedullary nailing for femur fractures can present two problems: (a) impingement with the intramedullary nail, requiring repositioning of the traction pin intraoperatively under radiographic control, to a position that may not optimally control the fracture; and (b) the risk of contaminating the intramedullary canal that will soon contain the metallic fixation device, especially when placed in the emergency room or at the bedside. Two new forms of extramedullary skeletal femoral traction are presented. The pullout strength and optimal positioning of these devices on the distal femur were evaluated. The first form of extramedullary traction evaluated was the large AO/ASIF pinless clamp. The second form of extramedullary traction, the extramedullary skeletal clamp, was based on a modification of the Gardner-Wells tong. These two forms of skeletal traction were compared with standard tensioned Kirschner wire (K-wire) through-and-through traction. Six fresh-frozen distal femora from donors (average age 29 years) were used to test the three femoral traction devices. Five of these specimens were skeletally mature. A total of 38 pullout tests were conducted. The pullout strength of the tested devices was in the following descending order: (a) tensioned K-wire; (b) extramedullary skeletal clamp (in the optimal metadiaphyseal position, 77% the strength of the K-wire); and (c) large ASIF pinless clamp (in the optimal metaphyseal position, 46% the strength of the K-wire). The mode of failure for each device was cut out through or from the bone.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7996324

Simonian, P T; Routt, M L; Harrington, R M; Swiontkowski, M F

1994-10-01

352

Displaced fatigue fractures of the femoral shaft.  

Science.gov (United States)

For this study, all displaced fatigue fractures of the femoral shaft treated during a 20-year period at a national military hospital were analyzed. Ten previously healthy male recruits sustained displaced femoral shaft fatigue fractures, the incidence being 1.5 per 100,000 person-years in military service. The median age of the patients was 19 years (range, 18-20 years). None had any previous fatigue fractures. The median body mass index was normal. Before the fracture displacement, nine recruits experienced thigh or knee pain for 1 to 6 weeks. Six of the 10 fractures were located in the distal third of the diaphysis. Only one fracture occurred in the proximal third. Six fractures showed a noncomminuted, oblique, or oblique-transverse configuration. Five fractures were treated using an intramedullary nail, four fractures with a dynamic compression plate, and one with a dynamic condylar screw-plate. The bone at the site of fracture proved to be abnormally brittle. In six patients this resulted in additional comminution intraoperatively. Two reoperations were necessary to exchange a nail and a screw because of technical faults. The median time to solid bony union was 3.5 months (range, 3-5 months). The recruits returned to light duty military service 6 weeks postoperatively, on the average. Two were exempted from military service for 2 years. Displacement is a rare, highly undesirable consequence of fatigue osteopathy of the femoral shaft among young recruits during basic military training. Preventive methods should focus on early, effective detection of developing fatigue fractures to avoid a displaced fracture, with subsequent prolonged morbidity and possible complications. Gentle handling of the bone during the fracture fixation procedure is imperative because of the extraordinary brittleness of the fracture fragments. PMID:12671509

Salminen, Sari T; Pihlajamäki, Harri K; Visuri, Tuomo I; Böstman, Ole M

2003-04-01

353

Proximal femoral degeneration in growing broiler fowl.  

Science.gov (United States)

The pathologies in proximal femora of broilers with lameness attributed to disorders of the proximal femur, including so-called 'femoral head necrosis', are described. Samples were collected from a variety of flocks, farms and production systems. Ten 'normal' broilers were also examined. Birds were identified by a characteristic lameness whereby they used a wing for support during locomotion and hip flexion (i.e. whilst sitting down). The appearance of the proximal femora at post mortem was used to place 67 proximal femora in three categories: (a) gross disintegration of the epiphysis, physis and/or metaphysis (43 samples); (b) epiphysiolysis-separation of the cartilaginous epiphysis from the underlying femoral metaphysis (growth plate) (17 samples) and (c) apparently normal (seven samples). Samples from each category were collected for mycoplasmology, virology and bacteriology. All the samples were negative for Mycoplasma, and there was no correlation between pathology and the presence or absence of viruses, but bacteria were cultured from about half the proximal femora and most of these femora showed histological evidence of bacterial infection. Although bacterial culture was negative, evidence of bacterial infections was seen in tissue sections from a further 15 proximal femora. Serial sections were required to find the foci on bacterial lesions. 'Femoral head necrosis' was not considered appropriate to describe the pathologies seen and the term proximal femoral degeneration (PFD) was adopted. Histological examination showed that PFD was most frequently due to a bacterial chondritis and osteomyelitis, with frequent involvement of surrounding tissues. Non-lame controls all had non-bacterial pathologies in the proximal femur which were also seen in many of the lame birds and may have provided a foci for the establishment of bacterial infections. The non-bacterial pathologies when severe were considered the cause of non-infectious PFD which would cause lameness in some cases. Epiphysiolysis was either a post or peri-mortem artefact, traumatic in origin, or could be attributed to underlying growth plate (physeal) pathology which in some cases was due to bacterial infection. PMID:18671021

Thorp, B H; Whitehead, C C; Dick, L; Bradbury, J M; Jones, R C; Wood, A

1993-06-01

354

Posterior cerebral artery territory infarctions.  

Science.gov (United States)

Infarctions in the territory of the posterior cerebral artery (PCA) occur in about 5-10% of all ischemic strokes. The PCA can be divided into 'deep' (P1 and P2 segments) and 'superficial' (P3 and P4) segments. Occlusion of paramedian perforating arteries arising from P1 causes rostral midbrain infarction with or without thalamic lesion. The classical clinical triad after thalamomesencephalic infarcts is hypersomnolence, cognitive deficits and vertical oculomotor paresis. Two main arterial groups arise from P2: infarction in the territory of the thalamogeniculate arteries causes severe contralateral hypesthesia and ataxia, whereas infarction in the territory of the posterior choroidal arteries results in sectoranopia with involvement of the lateral geniculate body. After superficial PCA infarcts, visual field defects and somatosensory deficits are the most frequent signs. Additionally, disorders of reading may be seen after unilateral left infarction and disorientation for place and visual neglect after right lesion. After bilateral PCA infarcts, amnesia, cortical blindness (the patient cannot see but pretend he can) may occur. Acute thrombolysis is as useful after PCA infarctions as after anterior circulation strokes. Mortality after PCA strokes is low, but long-term behavioral and cognitive deficits are underestimated. PMID:22377879

Cereda, Carlo; Carrera, Emmanuel

2012-01-01

355

Anterior Hip Subluxation due to Lumbar Degenerative Kyphosis and Posterior Pelvic Tilt.  

Science.gov (United States)

Nontraumatic anterior subluxation and dislocation of the hip joint are extremely rare. A 58-year-old woman presented to our outpatient clinic with left hip pain with a duration of 15 years. There was no history of trauma or other diseases. Her hip pain usually occurred only on walking and not at rest. Physical examinations demonstrated no tenderness in the hip joint. The range of motion of both hip joints was almost normal. Laxity of other joints was not observed. The bone mineral density of the lumbar spine and proximal femur confirmed a diagnosis of osteoporosis. A plain radiograph showed osteoarthritic changes of the hip joints, severe posterior pelvic tilt, and superior displacement of both femoral heads, especially in a standing position. Three-dimensional computed tomography (3DCT) revealed anterior subluxation of both femoral heads. Seven years after the initial visit, both hip joints showed progression to severe osteoarthritis. Although the exact cause remains unclear, lumbar kyphosis, posterior pelvic tilt, and a decrease in acetabular coverage may have influenced the current case. We should be aware of these factors when we examine patients with hip osteoarthritis. PMID:24592346

Tsuchie, Hiroyuki; Yamada, Shin; Tazawa, Hiroshi; Kijima, Hiroaki; Shimada, Yoichi

2014-01-01

356

Correlation of intra-articular osseous measurements with posterior cruciate ligament length on MRI scans.  

LENUS (Irish Health Repository)

Six patients with a clinical diagnosis of chronic posterior cruciate ligament (PCL) rupture, based on a positive posterior drawer test, had a normal appearance of the PCL on an MRI scan. It is postulated that the PCL had been ruptured but healed in a lengthened state. 12 volunteers with no history of knee trauma underwent an MRI scan of the knee. In this control group (n = 12), there was a close correlation between the lateral femoral condylar width in the sagittal plane and the PCL length, with a ratio of 2:1 (95% confidence interval (CI) = 1.817-2.095). In the clinically abnormal group (n = 6), the ratio was 1.49:1 (95% CI = 1.206-1.782) (p< 0.0005). In conclusion, the ratio of the lateral femoral condylar width in the sagittal plane to the PCL length is a useful index for diagnosing PCL attenuation and lengthening in the presence of a normal morphological MR appearance.

Orakzai, S H

2010-01-01

357

The effect of femoral component malrotation on patellar biomechanics.  

Science.gov (United States)

Patellofemoral complications are among the important reasons for revision knee arthroplasty. Femoral component malposition has been implicated in patellofemoral maltracking, which is associated with anterior knee pain, subluxation, fracture, wear, and aseptic loosening. Rotating-platform mobile bearings compensate for malrotation between the tibial and femoral components and may, therefore, reduce any associated patellofemoral maltracking. To test this hypothesis, we developed a dynamic model of quadriceps-driven open-kinetic-chain extension in a knee implanted with arthroplasty components. The model was validated using tibiofemoral and patellofemoral kinematics and forces measured in cadaver knees. Knee kinematics and patellofemoral forces were measured after simulating malrotation (+/-3 degrees ) of the femoral component. Rotational alignment of the femoral component affected tibial rotation near full extension and tibial adduction at higher flexion angles. External rotation of the femoral component increased patellofemoral lateral tilt, lateral shift, and lateral shear forces. Up to 21 degrees of bearing rotation relative to the tibia was noted in the rotating-bearing condition. However, the rotating bearing had minimal effect in reducing the patellofemoral maltracking or shear induced by femoral component rotation. The rotating platform does not appear to be forgiving of malalignment of the extensor mechanism resulting from femoral component malrotation. These results support the value of improving existing methodologies for accurate femoral component alignment in total knee arthroplasty. PMID:19019376

Kessler, Oliver; Patil, Shantanu; Colwell, Clifford W; D'Lima, Darryl D

2008-12-01

358

Normal neurodynamic responses of the femoral slump test.  

Science.gov (United States)

Femoral slump test is a neurodynamic testing, which could be used to assess the mechanosensitivity of the femoral component of the nervous system. Although Trainor and Pinnington reported the diagnosis accuracy of the femoral slump test, the neurodynamic responses of the femoral slump test have never been studied. The purposes of this study were to evaluate whether maneuvers that changed the nerve tension altered the responses of the femoral slump test and if these responses were influenced by gender and leg dominance; and to identify the correlations between flexibility and measured hip extension angle. Thirty-two asymptomatic subjects (16 males, 16 females) were recruited. The femoral slump test was performed in trunk slump and neutral positions, and cervical extension was used as the structure differential technique. Hip extension angle and visual analog scale (VAS) of thigh pain was measured during the test. Our results showed the decrease of nerve tension significantly increased hip extension ROM (P  0.05). These findings indicated that femoral slump test resulted in normal neurodynamic responses in individuals free of lower extremity problems, and these responses were independent of the influence of muscle flexibility or gender. Future research should emphasize the use of femoral slump test in patient groups such as low back and anterior knee pain. PMID:22056894

Lai, Weng-Hang; Shih, Yi-Fen; Lin, Pei-Ling; Chen, Wen-Yin; Ma, Hsiao-Li

2012-04-01

359

Femoral neck fractures: A Changing Paradigm.  

Science.gov (United States)

Surgical interventions consisting of internal fixation (IF) or total hip replacement (THR) are required to restore patient mobility after hip fractures. Conventionally, this decision was based solely upon the degree of fracture displacement. However, in the last ten years, there has been a move to incorporate patient characteristics into the decision making process. Research demonstrating that joint replacement renders superior functional results when compared with IF, in the treatment of displaced femoral neck fractures, has swayed the pendulum in favour of THR. However, a high risk of dislocation has always been the concern. Fortunately, there are newer technologies and alternative surgical approaches that can help reduce the risk of dislocation. The authors propose an algorithm for the treatment of femoral neck fractures: if minimally displaced, in the absence of hip joint arthritis, IF should be performed; if arthritis is present, or the fracture is displaced, then THR is preferred. Cite this article: Bone Joint J 2014;96-B(11 Suppl A):43-7. PMID:25381407

Su, E P; Su, S L

2014-11-01

360

Distal femoral fractures and LISS stabilization.  

Science.gov (United States)

In recent years, the technique of surgical stabilization in the distal femur has changed. This change decreased the number of non unions and the need for bone grafting. Minimally invasive surgical techniques with a submuscular plate placement have replaced the emphasis on anatomical reduction in the shaft area. Reconstruction of complex articular injuries has been simplified by more direct visualization of the articular surface with the lateral peripatellar approach. Problems remaining are surgical technique and implant considerations. The Less Invasive Stabilization System (LISS) simplifies the surgical technique for percutaneous plate osteosynthesis. An insertion guide is used to insert monocortical, self-tapping screws through a stab incision. A thread in the plate provides the angular stability for the anchoring of these screws. In extra-articular fractures and simple intra-articular fractures, the distal femoral nail permits intram