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1

Osteoarthritis of the patella, lateral femoral condyle and posterior medial femoral condyle correlate with range of motion.  

UK PubMed Central (United Kingdom)

PURPOSE: The type of osteoarthritis and the degree of severity which causes restriction of knee range of motion (ROM) is still largely unknown. The objective of this study was to analyse the location and the degree of cartilage degeneration that affect knee range of motion and the connection, if any, between femorotibial angle (FTA) and knee ROM restriction. METHODS: Four hundreds and fifty-six knees in 230 subjects with knee osteoarthritis undergoing knee arthroplasty were included. Articular surface was divided into eight sections, and cartilage degeneration was evaluated macroscopically during the operation. Cartilage degeneration was classified into four grades based on the degree of exposure of subchondral bone. A Pearson correlation was conducted between FTA and knee flexion angle to determine whether high a degree of FTA caused knee flexion restriction. A logistic regression analysis was also conducted to detect the locations and levels of cartilage degeneration causing knee flexion restriction. RESULTS: No correlation was found between FTA and flexion angle (r = -0.08). Flexion angle was not restricted with increasing FTA. Logistic regression analysis showed significant correlation between restricted knee ROM and levels of knee cartilage degeneration in the patella (odds ratio (OR) = 1.77; P = 0.01), the lateral femoral condyle (OR = 1.62; P = 0.03) and the posterior medial femoral condyle (OR = 1.80; P = 0.03). CONCLUSION: For clinical relevance, soft tissue release and osteophyte resection around the patella, lateral femoral condyle and posterior medial femoral condyle might be indicated to obtain a higher degree of knee flexion angle. LEVEL OF EVIDENCE: Case-control study, Level III.

Suzuki T; Motojima S; Saito S; Ishii T; Ryu K; Ryu J; Tokuhashi Y

2013-04-01

2

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

3

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

UK PubMed Central (United Kingdom)

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 S; Huang T; Watanabe A; Iranpour-Boroujeni T; Yoshioka H

2010-02-01

4

Focal femoral condyle resurfacing.  

UK PubMed Central (United Kingdom)

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.

Brennan SA; Devitt BM; O'Neill CJ; Nicholson P

2013-03-01

5

Impaction fracture of the medial femoral condyle.  

Science.gov (United States)

The patient was a 20-year-old man who sustained a noncontact left knee hyperextension injury while playing soccer. In reviewing left knee radiographs that had previously been interpreted as normal, the physical therapist noted an abnormally deep depression of the medial condylopatellar sulcus, which was concerning for a possible impacted osteochondral fracture. After discussing the radiographic findings with a radiologist, the physical therapist ordered magnetic resonance imaging, which revealed a focal indentation of the anterior portion of the medial femoral condyle with adjacent bone marrow edema that was consistent with an impaction fracture of the medial femoral condyle. PMID:23812292

Mabry, Lance M; Ross, Michael D; Abbott, Jessica L

2013-06-29

6

Impaction fracture of the medial femoral condyle.  

UK PubMed Central (United Kingdom)

The patient was a 20-year-old man who sustained a noncontact left knee hyperextension injury while playing soccer. In reviewing left knee radiographs that had previously been interpreted as normal, the physical therapist noted an abnormally deep depression of the medial condylopatellar sulcus, which was concerning for a possible impacted osteochondral fracture. After discussing the radiographic findings with a radiologist, the physical therapist ordered magnetic resonance imaging, which revealed a focal indentation of the anterior portion of the medial femoral condyle with adjacent bone marrow edema that was consistent with an impaction fracture of the medial femoral condyle.

Mabry LM; Ross MD; Abbott JL

2013-01-01

7

Subchondral impaction fractures of the non-weight-bearing portion of the lateral femoral condyle.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To document the first report of intra-articular, non-weight-bearing, impaction fractures of the lateral femoral condyle. MATERIALS & METHODS: Institutional Review Board and Regional Ethics Committee approval for this study was obtained and patient informed consent deemed unnecessary. We prospectively documented all potential cases of non-weight-bearing posterior subchondral impaction fractures of the femoral condyles diagnosed on magnetic resonance imaging (MRI) of the knee performed at our institution between January 2006 and December 2011. The cases were reviewed and discussed by three experienced musculoskeletal radiologists and only cases satisfying pre-defined MRI criteria were included. RESULTS: Sixteen cases of intra-articular impaction fractures in a posterior, non-weight-bearing area of the lateral femoral condyle were diagnosed in patients with a mean age of 40. Eight were associated with recreational sports activities and 4 with repeated kneeling. There were no fractures documented in the non-weight-bearing aspect of the medial femoral condyles. Proposed underlying mechanisms for development of this type of fracture are presented. CONCLUSION: Awareness, along with a high level of suspicion, that non-specific knee pain, especially in patients involved in athletic activities, could be due to intra-articular impaction fractures of the non-weight-bearing posterior aspect of the lateral femoral condyle is essential and MRI is the mainstay of diagnosis.

Depasquale R; Fotiadou A; Kumar DS; Lalam R; Tins B; Tyrrell PN; Singh J; Cassar-Pullicino VN

2013-02-01

8

Posterior femoral condylar offset after total knee replacement in the risk of knee flexion contracture.  

UK PubMed Central (United Kingdom)

The aim of this study was to clarify the risk of knee flexion contracture associated with a posterior femoral condylar offset after total knee replacement (TKR). Radiographs from 100 healthy Japanese volunteers were included in the study. We evaluated femoral component posterior offset in various implants and compared them with the normal Japanese knee. Posterior offset of the femoral condyle is up to a maximum of 4.7 times greater than that of the healthy Japanese knee in all knee implants. Excess posterior offset of the femoral condyle in TKR prostheses may cause knee joint flexion contracture due to the relative shortening of the posterior soft tissue.

Onodera T; Majima T; Nishiike O; Kasahara Y; Takahashi D

2013-08-01

9

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

UK PubMed Central (United Kingdom)

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. Cite this article: Bone Joint J 2013;95-B:1165-71.

Arastu MH; Kokke MC; Duffy PJ; Korley RE; Buckley RE

2013-09-01

10

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; Ishii Y; Sasaki S

2003-01-01

11

Patellar tendon-lateral femoral condyle friction syndrome: MR imaging in 42 patients  

International Nuclear Information System (INIS)

Objective: To demonstrate the MR imaging findings that occur between the posterior inferolateral patellar tendon and the lateral femoral condyle in patients with chronic anterior and or lateral knee pain. Patients and design: A retrospective review of the MR images in 42 patients who presented with chronic anterior or lateral knee pain was performed by two musculoskeletal radiologists. In 15 patients, post-contrast images were available. Results: Sagittal and axial imaging planes best demonstrated the patellar tendon and its relationship with the lateral femoral condyle. In 40 patients, there was obliteration of the fat planes and abnormal signal intensity in the lateral soft tissues of the inferior patellofemoral joint. Enhancement after administration of gadolinium was noted in all cases in which contrast was administered. Eighteen patients showed cystic changes in the soft tissues adjacent to the lateral femoral condyle in addition to fat plane obliteration. In two patients, only cystic changes were noted in the lateral soft tissues. Abnormal patellar alignment was noted in 37 patients. Patellar tendon pathology was seen in nine patients. Conclusion: In evaluating anterior knee symptoms, MR imaging allows identification of changes that may be related to patellar tendon-lateral femoral condyle friction syndrome and that should be distinguished from other causes of anterior or lateral knee pain. (orig.)

2001-01-01

12

[Ischemic necrosis of femoral condyles in systemic lupus erythematosus  

UK PubMed Central (United Kingdom)

Avascular necrosis (AN) of bone is a complication of systemic lupus erythematosus (SLE). In the present paper we describe two patients with SLE who presented an AN of femoral condyles 18 months and 2 years respectively after the diagnosis of the disease. In the second case, together with the destructive change of the symptomatic knee, X-ray films showed an initial involvement, still asymptomatic, of the contralateral knee.

Caldore M; Ravelli A; Viola S; Beluffi G; Martini A

1989-01-01

13

In vivo determination of posterior femoral rollback for subjects having a NexGen posterior cruciate-retaining total knee arthroplasty.  

UK PubMed Central (United Kingdom)

This study determines the in vivo kinematics during a deep-knee bend activity for subjects implanted with a posterior cruciate-retaining total knee arthroplasty having asymmetric geometries. Of 20 subjects, 19 experienced posterior femoral rollback (PFR) of the lateral condyle (average -3.9 mm), and 13 subjects experienced PFR of the medial condyle (average -3.1 mm). As a result of the lateral condyle rolling further posterior than the medial condyle, on average, subjects experienced 1.4 degrees of normal axial rotation. Of 20 subjects, 10 experienced normal axial rotation, whereas 10 experienced an opposite rotation pattern. Condylar lift-off occurred predominantly with the lateral condyle. Contrary to previous in vivo studies, the subjects in this study experienced consistent PFR of the posterior cruciate-retaining total knee arthroplasty. It can be hypothesized that having asymmetric femoral condyles may lead to PFR with increasing knee flexion.

Bertin KC; Komistek RD; Dennis DA; Hoff WA; Anderson DT; Langer T

2002-12-01

14

Cutaneous angiosome territory of the medial femoral condyle osteocutaneous flap.  

UK PubMed Central (United Kingdom)

PURPOSE: The medial femoral condyle flap is used for treatment of nonunions with or without intercalary bone loss. Most reported uses have been without a skin segment, but this flap can provide a skin component supplied by the saphenous artery branch (SAB) of the descending genicular artery (DGA) pedicle. Experience with this flap suggests that an additional distinct, reliable, more-distal, DGA-cutaneous branch can be found at condyle level, capable of supporting skin without using the SAB. This cadaver study evaluated SAB and DGA-cutaneous branch angiosome territories. A clinical case series assesses the DGA-cutaneous branch's clinical utility. METHODS: The DGA and SAB were isolated in 12 cadaveric legs, divided, and separately cannulated. Red dye and methylene blue were selectively injected into each vessel manually. Skin perfusion was measured and photographed. RESULTS: In all specimens, the DGA was present, originating 14.2 cm proximal to the joint line, and demonstrated a distinct cutaneous branch at condyle level. This vessel provided an average perfusion area of 70 cm(2), centered over the medial knee. The SAB was identified in 11 specimens (92%), with an average perfusion area of 361 cm(2) along the medial aspect of the distal thigh and proximal leg. The DGA communicating branch was present and used for perfusion of the skin paddle in 17 of 20 cases. The SAB was present in 18 of 20 cases, used with DGA-communicating branch in 4 cases, and the sole source of skin perfusion in 1 case. In 2 remaining cases, neither the SAB nor DGA communicating branch was adequate for perfusion of a skin segment. CONCLUSIONS: The medial femoral condyle flap can be harvested with a large skin paddle based on the SAB. A smaller skin segment can be harvested using the more distal DGA-communicating branch at condyle level. CLINICAL RELEVANCE: Improved understanding of the skin island associated with the DGA's saphenous and cutaneous branches can provide a rapid, reliable method of skin-segment harvest.

Iorio ML; Masden DL; Higgins JP

2012-05-01

15

Bilateral osteochondritis dissecans of the femoral condyles in both knees: a report of two sibling cases.  

Science.gov (United States)

Osteochondritis dissecans (OCD) of both femoral condyles is very rare, with no previously reported cases of bilateral OCD of both knees in two siblings. We report on a brother and sister with both femoral condyle OCD with a description of surgical technique and clinical results. Fixation using headless compressive screws, osteochondral autologous transplantation and autologous chondrocyte implantation were all successful. PMID:23741705

Jeong, Jae-Hoon; Mascarenhas, Randy; Yoon, Hang Seob

2013-05-29

16

Bilateral osteochondritis dissecans of the femoral condyles in both knees: a report of two sibling cases.  

UK PubMed Central (United Kingdom)

Osteochondritis dissecans (OCD) of both femoral condyles is very rare, with no previously reported cases of bilateral OCD of both knees in two siblings. We report on a brother and sister with both femoral condyle OCD with a description of surgical technique and clinical results. Fixation using headless compressive screws, osteochondral autologous transplantation and autologous chondrocyte implantation were all successful.

Jeong JH; Mascarenhas R; Yoon HS

2013-06-01

17

Bilateral osteochondrosis of lateral femoral condyles: case report and literature review.  

Science.gov (United States)

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. PMID:23090377

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

2012-10-01

18

Bilateral osteochondrosis of lateral femoral condyles: case report and literature review.  

UK PubMed Central (United Kingdom)

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.

Bica BE; Ruiz DG; Paranhos FF; de Abreu AV; de Azevedo MN

2012-10-01

19

Do fresh osteochondral allografts successfully treat femoral condyle lesions?  

UK PubMed Central (United Kingdom)

BACKGROUND: Fresh osteochondral allograft transplantation is an increasingly common treatment option for chondral and osteochondral lesions in the knee, but the long-term outcome is unknown. QUESTIONS/PURPOSES: We determined (1) pain and function, (2) frequency and types of reoperations, (3) survivorship at a median of 13.5 years, and (4) predictors of osteochondral allograft failure in the distal femur. METHODS: We evaluated 122 patients (129 knees) who underwent osteochondral allograft transplantation of the femoral condyle. Mean age was 33 years and 53% were male. Clinical evaluation included the modified Merle d'Aubigné-Postel (18-point), IKDC, and Knee Society function (KS-F) scores. We defined graft failure as revision osteochondral allografting or conversion to arthroplasty. We determined whether patient characteristics or attributes of the graft influenced failure. Minimum followup was 2.4 years (median, 13.5 years); 91% had more than 10 years of followup. RESULTS: Mean modified Merle d'Aubigné-Postel score improved from 12.1 to 16, mean IKDC pain score from 7.0 to 3.8, mean IKDC function score from 3.4 to 7.2, and mean KS-F score from 65.6 to 82.5. Sixty-one knees (47%) underwent reoperations. Thirty-one knees (24%) failed at a mean of 7.2 years. Survivorship was 82% at 10 years, 74% at 15 years, and 66% at 20 years. Age of more than 30 years at time of surgery and having two or more previous surgeries for the operated knee were associated with allograft failure. CONCLUSIONS: Followup of femoral condyle osteochondral allografting demonstrated durable improvement in pain and function, with graft survivorship of 82% at 10 years.

Levy YD; Görtz S; Pulido PA; McCauley JC; Bugbee WD

2013-01-01

20

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

 
 
 
 
21

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

International Nuclear Information System (INIS)

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.)

2004-01-01

22

Rollback of the femoral condyle in anatomical double-bundle anterior cruciate ligament reconstruction.  

UK PubMed Central (United Kingdom)

PURPOSE: The purpose of this study was to evaluate rollback of the femoral condyle in anatomical double-bundle anterior cruciate ligament reconstruction (ACL). METHODS: Twenty-two subjects who underwent anatomical double-bundle ACL reconstruction were included in this study. More than 6 months after surgery, lateral radiographic imaging of the knee was performed with active full knee flexion. The most posterior tibiofemoral contact point was measured for evaluation of femoral rollback (rollback ratio). Flexion angle was also measured using the same radiograph, and the correlation between rollback and flexion angle was analyzed. As a control, radiographs of the healthy contralateral knees were evaluated. For clinical evaluation, side-to-side difference in anterior tibial translation (ATT) and pivot shift test were analyzed approximately 1 year after surgery. RESULTS: The rollback ratios of the operated knees and the healthy contralateral knees were 28.7 ± 6.6 and 29.7 ± 6.7%, respectively, from the posterior edge of the tibia. No significant difference in rollback was observed. The flexion angles of the operated knees and the healthy contralateral knees were 136 ± 11° and 140 ± 9°, respectively. No significant difference in knee flexion angle was observed. Significant correlation between femoral rollback and knee flexion angle was observed. The side-to-side difference in ATT was 0.7 mm, and no cases of positive pivot shift were observed. CONCLUSION: Anatomical double-bundle ACL reconstruction can restore normal femoral rollback in active full knee flexion. For clinical relevance, knees with anatomical double-bundle ACL reconstruction can flex with normal kinematics at the end of knee flexion angle. LEVEL OF EVIDENCE: III.

Iriuchishima T; Shirakura K; Horaguchi T; Morimoto Y; Fu FH

2012-05-01

23

Dynamic scintigraphic study of the reflex sympathetic dystrophy syndrome and of osteonecrosis of the femoral condyle  

International Nuclear Information System (INIS)

Bone scintigraphy associated with a dynamic study is being increasingly used in order to improve the specificity of the method. This dynamic study is performed with the injection of a bone seeker 99mTc-methylene diphosphonate. The method is found to be valuable for early identification of patients with suspected reflex sympathetic distrophy syndrome and with osteonecrosis of the femoral condyle.

1985-01-01

24

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 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.

2004-01-01

25

Meniscoplasty for stable osteochondritis dissecans of the lateral femoral condyle combined with a discoid lateral meniscus: a case report  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Introduction Osteochondritis dissecans of the lateral femoral condyle is relatively rare, and it is reported to often be combined with a discoid lateral meniscus. Given the potential for healing, conservative management is indicated for stable osteochondritis dissecans in patients who are skeletally immature. However, patients with osteochondritis dissecans of the lateral femoral condyle combined with a discoid lateral meniscus often have persistent symptoms despite conservative management. Case presentation We present the case of a seven-year-old Korean girl who had osteochondritis dissecans of the lateral femoral condyle combined with a discoid lateral meniscus, which healed after meniscoplasty for the symptomatic lateral discoid meniscus without surgical intervention for the osteochondritis dissecans. In addition, healing of the osteochondritis dissecans lesion was confirmed by an MRI scan five months after the operation. Conclusions Meniscoplasty can be recommended for symptomatic stable juvenile osteochondritis dissecans of the lateral femoral condyle combined with a discoid lateral meniscus when conservative treatment fails.

Lim Hong-Chul; Bae Ji-Hoon

2011-01-01

26

Secondary collapse of lateral femoral condyle following bone bruise: a case report.  

UK PubMed Central (United Kingdom)

The term bone bruise, in modern medicine, is still a relatively young one, which followed the advent of MRI. Resolution takes between 12 and 24 weeks, however clinical significance is unknown. We present the case of an 18-year-old male who developed bone bruising of his lateral femoral condyle, associated with meniscal injury and anterior cruciate ligament rupture, following a fall from a push bike. A subsequent injury then led to collapse of his lateral femoral condyle following initial resolution of his symptoms. This was managed operatively performing bony and soft tissue stabilisation. This case highlights the issues associated with proven bone bruising and associated soft-tissue injuries in the knee, which cannot be considered innocuous injuries. We also raise the question as to whether patients should undergo a period of protected weightbearing when a bone bruise is recognised on MRI.

Vannet N; Kempshall P; Davies J

2009-10-01

27

Secondary collapse of lateral femoral condyle following bone bruise: a case report.  

Science.gov (United States)

The term bone bruise, in modern medicine, is still a relatively young one, which followed the advent of MRI. Resolution takes between 12 and 24 weeks, however clinical significance is unknown. We present the case of an 18-year-old male who developed bone bruising of his lateral femoral condyle, associated with meniscal injury and anterior cruciate ligament rupture, following a fall from a push bike. A subsequent injury then led to collapse of his lateral femoral condyle following initial resolution of his symptoms. This was managed operatively performing bony and soft tissue stabilisation. This case highlights the issues associated with proven bone bruising and associated soft-tissue injuries in the knee, which cannot be considered innocuous injuries. We also raise the question as to whether patients should undergo a period of protected weightbearing when a bone bruise is recognised on MRI. PMID:19999886

Vannet, Nicola; Kempshall, Peter; Davies, Jonathan

2009-10-01

28

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

International Nuclear Information System (INIS)

[en] 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.)

2003-01-01

29

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

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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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Posterior tilting of the tibial component decreases femoral rollback in posterior-substituting knee replacement: a computer simulation study.  

UK PubMed Central (United Kingdom)

Posterior tilting of the tibial component is thought to increase the range of motion in posterior cruciate-retaining total knee replacement, but its effect on implant motion in posterior cruciate-substituting total knee replacement is unknown. This issue has become of interest recently because manufacturers have introduced instrumentation that produces a posteriorly tilted tibial cut for both implant types. The purpose of this study was to investigate how motion of posterior cruciate-substituting total knee replacement is affected when the tibial component is installed with posterior tilt. Sagittal plane implant motions were predicted from prosthesis geometry with use of a computer simulation in which the femoral condyles were assumed to sit in the bottoms of the tibial condylar wells when the knee was in extension. Rollback of the femoral component was produced by a cam-spine mechanism at higher angles of flexion. The simulations revealed that even small degrees of posterior tilt reduced rollback by limiting the interaction between the cam and spine. Tilting the component posteriorly by 5 degrees caused the cam to contact the spine at a knee flexion angle that was 18 degrees higher than with the untilted component. The results suggest that posterior tilting of the tibial component in posterior cruciate-substituting knee replacement may not produce the same beneficial effects that have been reported for the tilting of tibial components in posterior cruciate-retaining knee replacement.

Piazza SJ; Delp SL; Stulberg SD; Stern SH

1998-03-01

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

UK PubMed Central (United Kingdom)

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.

Touraine S; Lagadec M; Petrover D; Genah I; Parlier-Cuau C; Bousson V; Laredo JD

2013-09-01

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Necrosis of the femoral condyles in a four-week-old foal: clinical, imaging and histopathological features.  

UK PubMed Central (United Kingdom)

A 4-week-old Thoroughbred filly foal with a history of sepsis was evaluated for right hindlimb lameness. Bilateral femoropatellar and femorotibial joint effusions were detected. Ultrasonography and radiography of the right stifle revealed signs of joint collapse and periarticular swelling. Computed tomography revealed abnormalities in the bone density of the medial femoral condyle of the right hindlimb and lateral femoral condyle of the left hindlimb. Euthanasia was recommended based on the severity of the lesions. Gross and microscopic examinations revealed extensive separation of the articular-epiphyseal cartilage complex from the subchondral bone of the femoral condyles. The histological features suggest an ischaemic aetiology; comparisons are made with lesions of osteochondrosis and avascular necrosis of bone.

Haggett EF; Foote AK; Head MJ; McGladdery AJ; Powell SE

2012-02-01

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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; Matsumoto Tomoyuki; Kubo Seiji; Matsushita Takehiko; Ishida Kazunari; Hoshino Yuichi; Nishimoto Koji; Kurosaka Masahiro; Kuroda Ryosuke

2012-01-01

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Medial femoral condyle morphometrics and subchondral bone density patterns in Thoroughbred racehorses.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To characterize medial femoral condyle (MFC) morphometrics and subchondral bone density patterns in Thoroughbred racehorses and to determine whether these variables differ between left and right limbs. SAMPLE: Stifle joints harvested from 6 Thoroughbred racehorses euthanized for reasons other than hind limb lameness. PROCEDURES: The distal portion of the left and right femurs of each cadaver was scanned via CT. Hounsfield units were converted to dipotassium phosphate equivalent densities through use of a phantom on each specimen. Medial femoral condyle width, length, height, and curvature; subchondral bone plate densities; and subchondral trabecular bone densities were analyzed in multiple sections in 5 frontal planes and 3 sagittal planes and were compared between left and right MFCs. RESULTS: MFC width, length, and height did not differ between left and right limbs. Regions of interest in the right caudoaxial subchondral bone plate and subchondral trabecular bone were significantly denser than their corresponding left regions of interest in the frontal and sagittal planes. A concavity in the otherwise convex articular surface of the cranial aspect of the MFC was identified in 11 of 12 specimens. CONCLUSIONS AND CLINICAL RELEVANCE: A disparity was identified between left and right subchondral bone density patterns at the caudoaxial aspect of the MFC, which could be attributable to the repetitive asymmetric cyclic loading that North American Thoroughbred racehorses undergo as they race in a counterclockwise direction. The uneven region at the cranial aspect of the MFC could be associated with the development of subchondral bone cysts in horses.

Walker WT; Kawcak CE; Hill AE

2013-05-01

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Medial femoral condyle fracture as a complication of antegrade intramedullary nailing.  

UK PubMed Central (United Kingdom)

A 49-year-old man suffered a closed oblique fracture of the middle third of his left femur. Closed reduction and internal fixation by intramedullary (IM) nailing were performed. Per-operative fluoroscopic imaging and initial postoperative X-rays were judged normal and the patient followed the usual rehabilitation protocol. At 3-month follow-up the patient still demonstrated poor knee function and pain. A plain X-ray and a CT scan of the left knee revealed a displaced fracture of the medial femoral condyle. Analysis of the postoperative imaging suggests that the fracture occurred during the insertion of the IM nail. The nail possibly hit the Steinmann traction pin in the distal femur causing the medial condyle fracture. The patient was reoperated; open reduction and internal plate and screw fixation were performed with satisfactory clinical progress postoperatively. The description and illustration of this case is intended to make trauma surgeons aware of this rare but serious complication of IM femoral nailing.

Neumayer F; Löcherbach C; McManus J; Chevalley F

2013-09-01

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

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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 st...

Fujita Norifumi; Matsumoto Tomoyuki; Kubo Seiji; Matsushita Takehiko; Ishida Kazunari; Hoshino Yuichi; Nishimoto Koji

37

Is femoral tunnel length correlated with the intercondylar notch and femoral condyle geometry after double-bundle anterior cruciate ligament reconstruction using the transportal technique? An in vivo computed tomography analysis.  

UK PubMed Central (United Kingdom)

PURPOSE: To analyze femoral tunnel geometry using computed tomography (CT) imaging and evaluate the anatomic factors affecting femoral tunnel length after anterior cruciate ligament (ACL) reconstruction by the transportal technique. METHODS: Twenty-nine patients underwent an anatomic double-bundle ACL reconstruction with a femoral tunnel drill by the transportal technique. CT imaging with OsiriX software (version 3.8; Pixmeo, Geneva, Switzerland) was used to measure femoral tunnel length (anteromedial [AM], posterolateral [PL], and central), femoral tunnel divergent angle, and femoral condyle size and intercondylar notch size parameters. Correlations between femoral tunnel length and femoral condyle size and intercondylar notch size parameters were analyzed. RESULTS: The mean AM, PL, and central femoral tunnel lengths were 33.3 ± 3.9 mm, 33.6 ± 3.6 mm, and 34.3 ± 3.2 mm, respectively. A femoral tunnel length of less than 30 mm developed in 7 cases (24.1%) in the AM aspect and 4 cases (13.8%) in the PL aspect. The mean femoral tunnel divergent angle was 14.4° ± 4.1°. A positive correlation was found between AM, not PL or central, femoral tunnel length and medial femoral condyle anteroposterior (AP) distance (P = .01, r = 0.46), lateral femoral condyle AP distance (P = .01, r = 0.43), medial-to-lateral epicondylar distance (P = .03, r = 0.39), middle notch width (P = .009, r = 0.47), notch height (P = .001, r = 0.57), and notch area (P < .001, r = 0.58). CONCLUSIONS: After double-bundle ACL reconstruction with the transportal technique through the accessory anteromedial portal, the AM and PL femoral tunnels showed mean tunnel length greater than 30 mm and a divergent angle. However, a femoral tunnel length of less than 30 mm developed in some cases. AM femoral tunnel length was correlated with femoral condyle size (medial femoral condyle AP distance, lateral femoral condyle AP distance, and medial-to-lateral epicondylar distance) and intercondylar notch size (notch width, notch height, and notch area). LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Wang JH; Kim JG; Ahn JH; Lim HC; Hoshino Y; Fu FH

2012-08-01

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The retrograde nail for distal femoral fractures in the elderly: high failure rate of the condyle screw and nut.  

Science.gov (United States)

Displaced distal femoral fractures in elderly patients benefit from surgical fixation. We describe the use of a retrograde femoral nail to treat these fractures. The implant has a special condyle screw and nut that allows for manual compression of the fracture when there is an additional inter-condylar split. We present our results when using this implant to treat 16 patients over a 13-month period. The mean patient age was 78 years (range, 65-96 years). All 16 patients were available at the time of final follow up and proceeded to union at an average time of 11 weeks (range, 10-14 weeks). Twenty-six condyle screw and nuts were used. Ten out of 26 condyle screws in 10 out of 16 patients failed by disengaging at a mean time of 10 weeks (range, 8-12 weeks). Our union rate was unaffected by the nut and bolt disengaging. This would suggest that the condylar compression generated by the nut and bolt may not be critical for union. PMID:16499912

Singh, S K; El-Gendy, K A; Chikkamuniyappa, C; Houshian, S

2006-02-24

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Applications of the Medial Femoral Condyle Free Flap for Foot and Ankle Reconstruction.  

UK PubMed Central (United Kingdom)

BACKGROUND: Avascular necrosis (AVN) or persistent nonunion occurs in situations of poor vascular supply. Some specific situations that plague the foot and ankle surgeon are talus nonunion, talus AVN, navicular AVN, and failed ankle arthrodesis with bone loss. The medial femoral condyle (MFC) flap has emerged as a popular source of vascularized corticocancelous bone. We present a series of cases demonstrating the versatility of the MFC flap in complex foot and ankle pathology. METHODS: A retrospective review was completed of all MFC flaps used in the foot and ankle over the past 5 years. Five patients were identified (average age 48). Surgical indications included talar AVN and ankle arthritis, talar nonunion, and navicular AVN. All patients had undergone conventional bone grafting techniques, which failed, prior to being treated with a MFC free flap; this series of patients did not possess significant medical comorbidities. Fixation techniques included compression screw fixation, plate osteosynthesis, or fine wire external fixation. The average follow-up was 20 months (range 8 to 40 months). RESULTS: There was a 100% flap success rate with no returns to the operating room for thrombosis. The volume of the bone flaps was 5.6 cm(3) (range 1 cm(3) to 12 cm(3)). The average follow-up time was 20 months (range 8 to 40 months). All cases resulted in union, and full weight bearing status was achieved at a mean of 23.8 weeks (range 10 to 52 weeks) postoperatively. CONCLUSIONS: Vascularized bone transfer in the form of the MFC free flap was a valuable method for foot and ankle reconstruction. The MFC flap provided an alternative for those defects that were smaller then 3 cm in length. In our experience, for small bone defects requiring vascularized bone, the MFC flap is currently the ideal donor location supplanting the iliac crest. LEVEL OF EVIDENCE: Level IV, retrospective case series.

Haddock NT; Alosh H; Easley ME; Levin LS; Wapner KL

2013-06-01

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Posterior femoral cutaneous nerve neuropathy and somatosensory evoked potentials.  

Science.gov (United States)

Isolated posterior femoral cutaneous nerve (PFCN) entrapment has only rarely been described in the literature and never documented electrophysiologically. We report an unusual occurrence of such an injury and use somatosensory evoked potentials (SSEP) to explore the extent of the lesion. A 40-year-old woman had localized numbness of the right posterior thigh after a left putamenal hemorrhage four years before this study. She made a complete recovery from her stroke within four months; however, she continued to experience decreased sensation in the right posterior thigh. Normal sural and peroneal nerve latencies, velocities, and amplitudes were obtained in the right leg. Electromyographic examination of right leg and related para spinal musculature was unremarkable. SSEP were then performed with CZ'-FZ (10-20 system) electrode placement. Normal sural, lateral femoral cutaneous, and posterior tibial responses were obtained bilaterally. Response differences consistent with an isolated right PFCN neuropathy were observed. The perfectly symmetric SSEP responses for the sural, lateral femoral cutaneous, and posterior tibial nerves obviate a central, and substantiate a peripheral, cause for the altered right PFCN evoked response. PMID:2827603

Dumitru, D; Marquis, S

1988-01-01

 
 
 
 
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Posterior femoral cutaneous nerve neuropathy and somatosensory evoked potentials.  

UK PubMed Central (United Kingdom)

Isolated posterior femoral cutaneous nerve (PFCN) entrapment has only rarely been described in the literature and never documented electrophysiologically. We report an unusual occurrence of such an injury and use somatosensory evoked potentials (SSEP) to explore the extent of the lesion. A 40-year-old woman had localized numbness of the right posterior thigh after a left putamenal hemorrhage four years before this study. She made a complete recovery from her stroke within four months; however, she continued to experience decreased sensation in the right posterior thigh. Normal sural and peroneal nerve latencies, velocities, and amplitudes were obtained in the right leg. Electromyographic examination of right leg and related para spinal musculature was unremarkable. SSEP were then performed with CZ'-FZ (10-20 system) electrode placement. Normal sural, lateral femoral cutaneous, and posterior tibial responses were obtained bilaterally. Response differences consistent with an isolated right PFCN neuropathy were observed. The perfectly symmetric SSEP responses for the sural, lateral femoral cutaneous, and posterior tibial nerves obviate a central, and substantiate a peripheral, cause for the altered right PFCN evoked response.

Dumitru D; Marquis S

1988-01-01

42

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 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.

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

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  

Directory of Open Access Journals (Sweden)

Full Text Available 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.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

2012-01-01

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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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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...

Nakayama, Hiroshi; Yagi, Masayoshi; Yoshiya, Shinichi

45

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

Science.gov (United States)

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

2009-09-08

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

UK PubMed Central (United Kingdom)

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.

Ochiai N; Sasho T; Tahara M; Watanabe A; Matsuki K; Yamaguchi S; Miyake Y; Nakaguchi T; Wada Y; Moriya H

2010-08-01

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Medial femoral condyle fracture after cementless unicompartmental knee replacement: a rare complication.  

UK PubMed Central (United Kingdom)

This case report describes a rare complication of unicompartmental knee arthroplasty. Femoral fracture after TKR is a serious and relatively common problem, but to the best of our knowledge, only one case of femoral condylar fracture after UKA has been reported thus far.

Akan B; Yildirim T; Karaguven D

2013-08-01

48

Posterior femoral cutaneous nerve mononeuropathy: a case report.  

Science.gov (United States)

Isolated posterior femoral cutaneous nerve (PFCN) lesions are rare, with only six cases reported in the modern literature and one case documented with a nerve conduction study. A 25-year-old woman had sensory loss in the posterolateral thigh after two right gluteal intramuscular injections. Nerve conduction studies using Dumitru's technique showed a 9microV response on the asymptomatic side, but no response on the symptomatic side, and no abnormalities on needle examination of the back and lower extremities. Although a single case does not prove the validity of a technique, this case provides the rare opportunity to demonstrate the utility of Dumitru's technique. PMID:10943764

Tong, H C; Haig, A

2000-08-01

49

Posterior femoral cutaneous nerve mononeuropathy: a case report.  

UK PubMed Central (United Kingdom)

Isolated posterior femoral cutaneous nerve (PFCN) lesions are rare, with only six cases reported in the modern literature and one case documented with a nerve conduction study. A 25-year-old woman had sensory loss in the posterolateral thigh after two right gluteal intramuscular injections. Nerve conduction studies using Dumitru's technique showed a 9microV response on the asymptomatic side, but no response on the symptomatic side, and no abnormalities on needle examination of the back and lower extremities. Although a single case does not prove the validity of a technique, this case provides the rare opportunity to demonstrate the utility of Dumitru's technique.

Tong HC; Haig A

2000-08-01

50

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

Directory of Open Access Journals (Sweden)

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; Yagi Masayoshi; Yoshiya Shinichi

2009-01-01

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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.

Yokota Masashi; Yasuda Kazunori; Kitamura Nobuto; Arakaki Kazunobu; Onodera Shin; Kurokawa Takayuki; Gong Jian-Ping

2011-01-01

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Femoral rollback after cruciate-retaining and stabilizing total knee arthroplasty.  

Science.gov (United States)

Limited data comparing the kinematics of posterior cruciate ligament-retaining or substituting total knee arthroplasty with its own intact knee under identical loadings is available. In the current study, posterior femoral translation of the lateral and medial femoral condyles under unloaded conditions was examined for intact, cruciate-retaining, cruciate ligament-deficient cruciate-retaining and posterior-substituting knee arthroplasties. Cruciate-retaining and substituting total knee arthroplasties behaved similarly to the cruciate-deficient cruciate-retaining total knee arthroplasty between 0 degrees and 30 degrees flexion. Beyond 30 degrees, the posterior cruciate-retaining arthroplasty showed a significant increase in posterior translation of both femoral condyles. The posterior cruciate-substituting arthroplasty only showed a significant increase in posterior femoral translation after 90 degrees. At 120 degrees, both arthroplasties restored approximately 80% of that of the native knee. Posterior translation of the lateral femoral condyle was greater than that observed in the medial condyle for all knees, indicating the presence of internal tibial rotation during knee flexion. The data showed that the posterior cruciate ligament is an important structure in posterior cruciate-retaining total knee arthroplasty and proper balancing is imperative to the success of the implant. The cam-spine engagement is valuable in restoring posterior femoral translation in posterior cruciate-substituting total knee arthroplasty. PMID:12771821

Most, Ephrat; Zayontz, Shay; Li, Guoan; Otterberg, Erik; Sabbag, Kenneth; Rubash, Harry E

2003-05-01

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Effect of posterior femoral condylar offset and posterior tibial slope on maximal flexion angle of the knee in posterior cruciate ligament sacrificing total knee arthroplasty.  

UK PubMed Central (United Kingdom)

PURPOSE: To evaluate the effect of femoral condylar offset and posterior tibial slope on maximal flexion angle of the knee in posterior cruciate ligament (PCL)-sacrificing total knee arthroplasty (TKA, Medial-Pivot Knee System). MATERIALS AND METHODS: Forty-five knees in 35 patients who could be followed up more than 1 year after PCL-sacrificing TKA were evaluated retrospectively. We measured and analyzed the preoperative and postoperative maximal flexion angle, posterior femoral condylar offset difference, posterior femoral condylar offset ratio difference, and tibial slope. RESULTS: The mean maximal flexion angle after TKA was 118.44°±9.8° and significantly related to postoperative tibial slope (11.78°±6.2°) in correlation analysis (R=0.451, p=0.002). There was no statistical relationship between the postoperative maximal flexion angle and the posterior femoral condylar offset difference (3.24±3.862 mm, R=0.105, p=0.493) and posterior femoral condylar offset ratio difference (0.039±0.029 mm, R=-0.163, p=0.284). CONCLUSIONS: The maximal flexion angle of the knee after PCL-sacrificing TKA was significantly related to the postoperative tibial slope. Therefore, posterior tibial slope can be considered as a factor that affects maximal flexion angle after PCL-sacrificing TKA.

Kim JH

2013-06-01

54

Serial contrast-enhanced MRI of the condyle and posterior disk attachment for assessing temporomandibular joint disorders  

International Nuclear Information System (INIS)

The purpose of this study was to determine the usefulness of serial contrast-enhanced magnetic resonance imaging (SCE-MRI) in assessing temporomandibular joint disorders (TMDs). SCE-MRI was performed for 114 patients with TMD. As controls, 50 asymptomatic joints of patients with unilateral symptoms were examined. Peak signal intensity ratio (pSIR) was calculated referring to signal intensity of precontrast images of the condyle (CON) and posterior disk attachment (PDA). Relationships among pSIR, existence of disease, stage of disk displacement, and clinical stages of disease were studied. Mean pSIRs of CON and PDA were significantly higher in affected joints (CON: 1.41±054; PDA 0.97±0.64) than in asymptomatic groups (CON: 1.01±0.42; PDA: 0.60±0.45). Mean pSIRs of CON and PDA were significantly higher in patients with disk displacement without reduction (CON: 1.49±0.58; PDA: 1.07±0.66) than in patients with disk displacement with reduction (CON: 1.25±0.41, PDA: 0.75±0.55). Mean pSIR of CON was significantly lower in stage IIIa (1.17±0.43) than in stage IIIb (1.45±0.56) or IV (1.57±0.53). The pSIR obtained by SCE-MRI reflects clinical symptoms and offers potential diagnostic value in determining clinical stages and in follow-up for patients with TMDs. (author)

2006-01-01

55

Evaluation and comparison of cartilage repair tissue of the patella and medial femoral condyle by using morphological MRI and biochemical zonal T2 mapping  

International Nuclear Information System (INIS)

The objective of this study was to use advanced MR techniques to evaluate and compare cartilage repair tissue after matrix-associated autologous chondrocyte transplantation (MACT) in the patella and medial femoral condyle (MFC). Thirty-four patients treated with MACT underwent 3-T MRI of the knee. Patients were treated on either patella (n = 17) or MFC (n = 17) cartilage and were matched by age and postoperative interval. For morphological evaluation, the MR observation of cartilage repair tissue (MOCART) score was used, with a 3D-True-FISP sequence. For biochemical assessment, T2 mapping was prepared by using a multiecho spin-echo approach with particular attention to the cartilage zonal structure. Statistical evaluation was done by analyses of variance. The MOCART score showed no significant differences between the patella and MFC (p ? 0.05). With regard to biochemical T2 relaxation, higher T2 values were found throughout the MFC (p

2009-01-01

56

Bilateral Combined Discoid Lateral Menisci and Lateral Femoral Condyle Osteochondritis Dissecans Lesions in a Division I Varsity Athlete: A Case Report.  

UK PubMed Central (United Kingdom)

Discoid menisci can be a source of pain for patients, and pose treatment challenges to the treating surgeon. Additional associated intra-articular pathology, specifically osteochondral defects, can further complicate the clinical picture. The incidence of lateral discoid meniscus is variable based on the population, with a range of 0.4 to 17%, with bilateral involvement in up to 19% of these cases. Osteochondritis dissecans (OCD) is exceedingly rare, with an incidence of 0.015% in one study; however, some authors have suggested a correlation between the development of OCD and the presence of an unstable or torn lateral discoid meniscus. We present a case, the first to our knowledge, of bilateral lateral femoral condyle OCD in the presence of bilateral, asymptomatic, complete lateral discoid menisci.

Kilcoyne KG; Dickens JF; Rue JP; Keblish DJ

2012-05-01

57

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 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. RESULTA (more) DOS: 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 the 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: (more) 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.

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

2012-10-01

58

Femoral rollback of cruciate-retaining and posterior-stabilized total knee replacements: in vivo fluoroscopic analysis during activities of daily living.  

Science.gov (United States)

Restoration of the physiological flexor/extensor mechanism at the knee in terms of appropriate muscular lever arms, proper required quadriceps force, and suitable patellofemoral compressive force, is fundamental for the success of total knee replacement. Therefore, measurements of anteroposterior translation of the femoral component over the tibial base-plate against joint flexion during daily living activities are essential for the assessment of the in vivo performance of current prosthesis designs. Patients treated with posterior stabilized and cruciate retaining prostheses with excellent clinical scores were evaluated during stair climbing, sitting and rising from a chair, and step up and down, using a three-dimensional pose reconstruction technique based on videofluoroscopy. The posterior stabilized patients experienced a fairly consistent and physiological rollback specific of each motor task, demonstrating proper function of the spine-cam mechanism. Rollback was somehow inconsistent among subjects in the cruciate retaining group, accompanied with a smaller range of knee flexion. In this group, more posterior locations of the condyles correlated significantly with higher clinical and functional scores. Articular surface conformity restores physiological rollback in the presence of a spine-cam mechanism, but not coherently in the presence of the posterior cruciate ligament. PMID:17019683

Fantozzi, Silvia; Catani, Fabio; Ensini, Andrea; Leardini, Alberto; Giannini, Sandro

2006-12-01

59

Femoral rollback of cruciate-retaining and posterior-stabilized total knee replacements: in vivo fluoroscopic analysis during activities of daily living.  

UK PubMed Central (United Kingdom)

Restoration of the physiological flexor/extensor mechanism at the knee in terms of appropriate muscular lever arms, proper required quadriceps force, and suitable patellofemoral compressive force, is fundamental for the success of total knee replacement. Therefore, measurements of anteroposterior translation of the femoral component over the tibial base-plate against joint flexion during daily living activities are essential for the assessment of the in vivo performance of current prosthesis designs. Patients treated with posterior stabilized and cruciate retaining prostheses with excellent clinical scores were evaluated during stair climbing, sitting and rising from a chair, and step up and down, using a three-dimensional pose reconstruction technique based on videofluoroscopy. The posterior stabilized patients experienced a fairly consistent and physiological rollback specific of each motor task, demonstrating proper function of the spine-cam mechanism. Rollback was somehow inconsistent among subjects in the cruciate retaining group, accompanied with a smaller range of knee flexion. In this group, more posterior locations of the condyles correlated significantly with higher clinical and functional scores. Articular surface conformity restores physiological rollback in the presence of a spine-cam mechanism, but not coherently in the presence of the posterior cruciate ligament.

Fantozzi S; Catani F; Ensini A; Leardini A; Giannini S

2006-12-01

60

Biomechanics of posterior-substituting total knee arthroplasty: an in vitro study.  

UK PubMed Central (United Kingdom)

The cam-spine system in posterior-substituting total knee arthroplasty was designed to improve posterior stability and to increase posterior femoral translation (rollback). Little is known on its effectiveness in the restoration of femoral rollback under functional loads. In the current study, the effect of cam-spine engagement on knee motion under simulated muscle loads was investigated using knees from cadavers. The translations of the lateral and medial femoral condyles of the knee before and after total knee arthroplasty were compared from 0 degrees to 120 degrees flexion. Cam-spine contact forces were measured under the same muscle loads. The posterior translations of both femoral condyles in the total knee arthroplasty were significantly lower than that of the native knee beyond full extension. Cam-spine engagement occurred between 60 degrees and 90 degrees flexion followed by an increase in posterior translation of both femoral condyles. However, the resultant femoral translation of the total knee arthroplasty was still lower than that of the native knee from 90 degrees to 120 degrees flexion. Knee motion after cam-spine engagement was independent of muscle loads, indicating the importance of the cam-spine mechanism at high flexion angles. Decreased posterior translation of both femoral condyles after total knee arthroplasty may be a limiting factor at high flexion.

Li G; Most E; Otterberg E; Sabbag K; Zayontz S; Johnson T; Rubash H

2002-11-01

 
 
 
 
61

Observations of femoral rollback in cruciate-retaining knee arthroplasty.  

UK PubMed Central (United Kingdom)

The current study evaluated kinematics of the knee during a stair-climbing activity after total knee arthroplasty. All patients received a posterior cruciate ligament retaining prosthesis of the same design, having an anatomically shaped femoral component and an unconstrained tibial insert. All patients had the same surgical technique done by two experienced surgeons. Patients had some posterior femoral rollback and screw-home type axial rotations during weightbearing activities. However, patients treated by different surgeons had different patterns of tibiofemoral motions. In Group 1, rollback occurred early in the flexion range and was maintained until 80 degrees flexion. In Group 2, the lateral condyle had rollback in early flexion, but both condyles translated forward as flexion increased to 80 degrees. An anatomic femoral component seems to be necessary to produce consistent early femoral rollback. However, soft tissue balance can have a significant effect on the kinematics of sagittally unconstrained posterior cruciate retaining total knee arthroplasty, because it may vary among surgeons.

Nozaki H; Banks SA; Suguro T; Hodge WA

2002-11-01

62

Commonly used ACL autograft areas do not correlate with the size of the ACL footprint or the femoral condyle.  

UK PubMed Central (United Kingdom)

PURPOSE: The purpose of this study was to reveal the correlation between the size of the native anterior cruciate ligament (ACL) footprint and the area of commonly used autografts using cadaveric knees. METHODS: Twenty-Four non-paired human cadaver knees were used. The size of the femoral and tibial ACL footprints, length of Blumensaat's line, and the height and area of the lateral wall of the femoral intercondylar notch were photographed and measured with Image J software (National Institution of Health). Simulating an semitendinosus tendon (ST) graft, the ST was cut in half. The bigger half was regarded as the antero-medial (AM) bundle, and the remaining half was regarded as the postero-lateral (PL) bundle. Simulating an semitendinosus and gracilis (ST-G) graft, the bigger half of the ST and G was regarded as the AM bundle, and the smaller half of the ST was regarded as the PL bundle. Each graft diameter was measured, and the graft area was calculated. Simulating a bone-patella tendon-bone (BPTB) graft, a 10-mm wide BPTB graft was harvested and the area calculated. RESULTS: The sizes of the native femoral and tibial ACL footprints were 72.3 ± 24.4 and 134.1 ± 32.4 mm(2), respectively. The length of Blumensaat's line, and the height and area of the lateral wall of the femoral intercondylar notch were 29.5 ± 2.5 mm, 17.7 ± 2.3 mm, and 400.9 ± 62.6 mm(2), respectively. The average areas of the ST, ST-G, and BPTB graft were 52.7 ± 6.3, 64.7 ± 7.6, and 37.1 ± 7.5 mm(2). Both the height and the area of the lateral wall of the femoral intercondylar notch were significantly correlated with the femoral size of the ACL footprint (p = 0.007 and 0.008, respectively). However, no significant correlation was observed between ACL footprint size and autograft size. No significant correlation was observed between autograft size and the size of the lateral wall of the femoral intercondylar notch. CONCLUSION: In ACL reconstruction, if the reconstructed ACL size is determined by the harvested autograft size alone, native ACL size and anatomy are unlikely to be reproduced.

Iriuchishima T; Ryu K; Yorifuji H; Aizawa S; Fu FH

2013-07-01

63

Influence of the anterior-posterior femoral translation on the range of motion in cruciate-retaining total knee arthroplasty.  

UK PubMed Central (United Kingdom)

PURPOSE: The purpose of this study is to evaluate the post-operative range of motion (ROM) of the knee related to the anterior-posterior femoral translation on the tibia observed during surgery in cruciate-retaining total knee arthroplasty (TKA) using a navigation system. Our hypothesis is that the intraoperative anterior-posterior femoral translation is correlated with the post-operative ROM in patients undergoing cruciate-retaining TKA. METHODS: The subjects were 20 patients involving 23 joints. The passive maximum ROM was measured before and 1 year after surgery. In addition, we evaluated the intraoperative anterior-posterior femoral translation that was measured after inserting a tensor device from 10° to 120° of knee flexion. The starting point of the anterior-posterior femoral translation was defined as when the femur started to move posteriorly. The anterior-posterior femoral translation 120 was set as the amount of femoral movement from 10° to 120°. RESULTS: The subjects were divided into those with an increased or maintained ROM (group A) and those with a decreased ROM (group B). There were no significant differences between the two groups in terms of the age or pre-operative ROM. The starting point of the anterior-posterior femoral translation was significantly earlier in group B (58.0 ± 5.7° for group A, 48.7 ± 3.2° for group B) (P < 0.05). Regarding the anterior-posterior femoral translation 120, Group B showed a larger amount of femoral movement posteriorly than group A (13.0 ± 6.5 mm for group A, 19.0 ± 6.2 mm for group B) (P < 0.05). CONCLUSIONS: The present study shows that intraoperative anterior-posterior femoral translation has a significant correlation with the post-operative ROM in patients undergoing cruciate-retaining TKA. If the starting point of the anterior-posterior femoral translation is early and the anterior-posterior femoral translation 120 is large, there is likely to be a decrease in the post-operative ROM. LEVEL OF EVIDENCE: III.

Yanagisawa S; Sato N; Ohsawa T; Saito K; Shimizu M; Takagishi K

2013-06-01

64

A Validation Study for Estimation of Femoral Anteversion Using the Posterior Lesser Trochanter Line: An Analysis of Computed Tomography Measurement.  

UK PubMed Central (United Kingdom)

The aim of this study was to introduce a simple and reliable intraoperative reference guide to reproduce the normal femoral anteversion during total hip arthroplasty (THA). We hypothesized that the posterior lesser trochanter line (PLTL) could be a useful guide for estimating femoral anteversion during THA. We conducted a study of 56 men (112 hips) to evaluate the relationship between the PLTL and the femoral anteversion using computed tomography scans. The mean femoral anteversion was 9.0°±8.1° (range, -16.2° to 32.9°). The PLTL angle correlated (r(2)=0.12, P<0.05) with the femoral anteversion. We found a constant relationship between the PLTL and femoral anteversion, and the PLTL may be used as a guide for estimating the femoral stem anteversion during femoral stem fixation.

Yun HH; Yoon JR; Yang JH; Song SY; Park SB; Lee JW

2013-03-01

65

Value of magnetic resonance imaging in the mid-term follow-up of osteochondritis dissecans of the femoral condyle and talus  

International Nuclear Information System (INIS)

Purpose: Definition of the prognostic value of clinical and morphological findings in the mid-term follow-up of OCD of the femoral condyle and talus. Demonstration of the consolidation of OCD on MRI depending on different therapies. Materials and Methods: 76 patients were examined before and at an average of 30 months after conservative or surgical therapy using T1 and T2 weighted SE and 3D-FISP sequences and contrast enhanced studies. Six clinical (age, gender, site, duration and severity of symptoms, therapy) and six morphological (size, signal intensity, fragmentation, contrast enhancement, condition of cartilage, staging) data were registered on first MRI and correlated with the degree of consolidation of OCD (partial and complete remission, no change and progression) on control MRI. Results: Patients under 17 years showed partial or complete remissions in 73%, those of 17 years or older in 33%. Conservatively treated patients had a higher remission rate (54%) than those treated with different surgical techniques (drilling 50%, refixation 43%, abrasio 38%). Small OCDs had a higher remission rate than large lesions (63% vs. 33%). OCDs covered with intact cartilage healed better than lesions with chondral defects (61% vs. 26%). Contrast enhancing fragments had a better prognosis than non-enhancing lesions (100% vs. 40%). Conclusions: Prognosis of OCD can be better estimated when size of OCD, condition of cartilage and enhancement of contrast agent is graduated with MRI and patient age is registered. The consequences for therapy planning are great. (orig.)

1999-01-01

66

Quantitative analysis of the resorption and osteoconduction of a macroporous calcium phosphate bone cement for the repair of a critical size defect in the femoral condyle.  

UK PubMed Central (United Kingdom)

Clinical orthopaedic use of calcium phosphate cement has been limited due to its slow resorption rate, but a new macroporous alpha-tricalcium phosphate (alpha-TCP) bone cement has been designed to accelerate resorption and to increase bone ingrowth. To assess its clinical potential, the in vivo behaviour of alpha-TCP was evaluated in a critical-size defect drilled in the femoral condyles of 36 adult female New Zealand rabbits. Macroporous or standard cement was injected immediately after preparation of the defect. The foaming agent was albumen, which gave up to 75% porosity. The rabbits were divided into three groups and the lesions examined histopathologically at 1, 4 and 12 weeks. No inflammatory reaction was detected at any time period following implantation with either macroporous or standard cement. At 12 weeks, the area of the implanted macroporous cement was approximately 35% of the initial lesion size. Bone growth and revascularisation was observed inside the central pores of the macroporous cement, not only at the margins, as was found with standard calcium phosphate cement. The results indicated that both cements were osteoconductive, biocompatible and biodegradable but their different physicochemical and biological properties had a marked influence on their post-implant behaviour.

Miño-Fariña N; Muñoz-Guzón F; López-Peña M; Ginebra MP; Del Valle-Fresno S; Ayala D; González-Cantalapiedra A

2009-02-01

67

Evaluation and comparison of cartilage repair tissue of the patella and medial femoral condyle by using morphological MRI and biochemical zonal T2 mapping  

Energy Technology Data Exchange (ETDEWEB)

The objective of this study was to use advanced MR techniques to evaluate and compare cartilage repair tissue after matrix-associated autologous chondrocyte transplantation (MACT) in the patella and medial femoral condyle (MFC). Thirty-four patients treated with MACT underwent 3-T MRI of the knee. Patients were treated on either patella (n = 17) or MFC (n = 17) cartilage and were matched by age and postoperative interval. For morphological evaluation, the MR observation of cartilage repair tissue (MOCART) score was used, with a 3D-True-FISP sequence. For biochemical assessment, T2 mapping was prepared by using a multiecho spin-echo approach with particular attention to the cartilage zonal structure. Statistical evaluation was done by analyses of variance. The MOCART score showed no significant differences between the patella and MFC (p {>=} 0.05). With regard to biochemical T2 relaxation, higher T2 values were found throughout the MFC (p < 0.05). The zonal increase in T2 values from deep to superficial was significant for control cartilage (p < 0.001) and cartilage repair tissue (p < 0.05), with an earlier onset in the repair tissue of the patella. The assessment of cartilage repair tissue of the patella and MFC afforded comparable morphological results, whereas biochemical T2 values showed differences, possibly due to dissimilar biomechanical loading conditions. (orig.)

Welsch, Goetz H. [Medical University of Vienna, MR Center - High field MR, Department of Radiology, Vienna (Austria); University of Erlangen, Department of Trauma and Orthopaedic Surgery, Erlangen (Germany); Mamisch, Tallal C. [University of Berne, Department of Orthopaedic Surgery, Berne (Switzerland); Quirbach, Sebastian; Trattnig, Siegfried [Medical University of Vienna, MR Center - High field MR, Department of Radiology, Vienna (Austria); Zak, Lukas; Marlovits, Stefan [Medical University of Vienna, Center of Joints and Cartilage, Department of Trauma Surgery, Vienna (Austria)

2009-05-15

68

High-resolution magnetic resonance-guided posterior femoral cutaneous nerve blocks.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To assess the feasibility, technical success, and effectiveness of high-resolution magnetic resonance (MR)-guided posterior femoral cutaneous nerve (PFCN) blocks. MATERIALS AND METHODS: A retrospective analysis of 12 posterior femoral cutaneous nerve blocks in 8 patients [6 (75%) female, 2 (25%) male; mean age, 47 years; range, 42-84 years] with chronic perineal pain suggesting PFCN neuropathy was performed. Procedures were performed with a clinical wide-bore 1.5-T MR imaging system. High-resolution MR imaging was utilized for visualization and targeting of the PFCN. Commercially available, MR-compatible 20-G needles were used for drug delivery. Variables assessed were technical success (defined as injectant surrounding the targeted PFCN on post-intervention MR images) effectiveness, (defined as post-interventional regional anesthesia of the target area innervation downstream from the posterior femoral cutaneous nerve block), rate of complications, and length of procedure time. RESULTS: MR-guided PFCN injections were technically successful in 12/12 cases (100%) with uniform perineural distribution of the injectant. All blocks were effective and resulted in post-interventional regional anesthesia of the expected areas (12/12, 100%). No complications occurred during the procedure or during follow-up. The average total procedure time was 45 min (30-70) min. CONCLUSIONS: Our initial results demonstrate that this technique of selective MR-guided PFCN blocks is feasible and suggest high technical success and effectiveness. Larger studies are needed to confirm our initial results.

Fritz J; Bizzell C; Kathuria S; Flammang AJ; Williams EH; Belzberg AJ; Carrino JA; Chhabra A

2013-04-01

69

Optimisation of the posterior stabilised tibial post for greater femoral rollback after total knee arthroplasty--a finite element analysis.  

Science.gov (United States)

Femoral rollback after total knee arthroplasty (TKA) is necessary for flexion beyond 90-100 degrees. Femoral rollback in posterior cruciate substituting TKA occurs as a result of the interaction between the femoral cam and tibial post. The geometric design of the cam post mechanism determines the kinematics of rollback. The purpose of this study is to optimise the design of the femoral cam-tibial post articulation through finite element analysis and suggest various design parameters that would optimise femoral rollback. Modifications to the tibial post geometry without changing the relative post position or slope are made. Results are characterised in terms femoral rollback and pressure distribution at the tibial post. Small design modifications to the tibial post are seen to produce large changes in femoral rollback with relatively small accompanying increases in contact pressures at the tibial post. PMID:18594821

Chandran, Nagarajan; Amirouche, Farid; Gonzalez, Mark H; Hilton, Kevin M; Barmada, Riad; Goldstein, Wayne

2008-07-02

70

Optimisation of the posterior stabilised tibial post for greater femoral rollback after total knee arthroplasty--a finite element analysis.  

UK PubMed Central (United Kingdom)

Femoral rollback after total knee arthroplasty (TKA) is necessary for flexion beyond 90-100 degrees. Femoral rollback in posterior cruciate substituting TKA occurs as a result of the interaction between the femoral cam and tibial post. The geometric design of the cam post mechanism determines the kinematics of rollback. The purpose of this study is to optimise the design of the femoral cam-tibial post articulation through finite element analysis and suggest various design parameters that would optimise femoral rollback. Modifications to the tibial post geometry without changing the relative post position or slope are made. Results are characterised in terms femoral rollback and pressure distribution at the tibial post. Small design modifications to the tibial post are seen to produce large changes in femoral rollback with relatively small accompanying increases in contact pressures at the tibial post.

Chandran N; Amirouche F; Gonzalez MH; Hilton KM; Barmada R; Goldstein W

2009-06-01

71

Short-term effect of zoledronic acid upon fracture resistance of the mandibular condyle and femoral head in an animal model.  

UK PubMed Central (United Kingdom)

OBJECTIVE: The aim of this study was to compare the effects in terms of resistance to fracture of the mandibular condyle and femoral head following different doses of zoledronic acid in an animal model. STUDY DESIGN: A total of 80 adult male Sprague-Dawley rats were included in a prospective randomized study. The animals were randomly divided into four groups of 20 rats each. Group 1 (control) received sterile saline solution, while groups 2, 3 and 4 received a accumulated dose of 0.2 mg, 0.4 mg and 0.6 mg of zoledronic acid, respectively. The animals were sacrificed 28 days after the last dose, and the right hemimandible and the right femur were removed. The fracture strength was measured (in Newtons) with a universal test machine using a 1 kN load connected to a metal rod with one end angled at 30 degrees. The cross-head speed was 1 mm/min. Later, the specimens were observed under a scanning electron microscope with backscattered electron imaging (SEM-BSE). At last, chemical analysis and elemental mapping of the mineral bone composition were generated using a microanalytical system based on energy-dispersive and X-ray spectrometry (EDX). RESULTS: A total of 160 fracture tests were performed. The fracture resistance increased in mandible and femur with a higher accumulated dose of zoledronic acid. Statistically significant differences were recorded versus the controls with all the studies groups. The chemical analysis in mandible showed a significantly increased of calcium and phosphorous to compare the control with all of the study groups; however, in femur no statistically significant differences between the four study groups were observed. CONCLUSIONS: The administration of bisphosphonates increases the fracture resistance in mandible and femur.

Camacho-Alonso F; López-Jornet P; Vicente-Hernández A

2013-05-01

72

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

UK PubMed Central (United Kingdom)

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. © 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 31:1757-1764, 2013.

Chen H; Chevrier A; Hoemann CD; Sun J; Picard G; Buschmann MD

2013-11-01

73

Free inferior gluteal flap harvest with sparing of the posterior femoral cutaneous nerve.  

Science.gov (United States)

The free inferior gluteal flap is a major secondary choice of autologous tissue for breast reconstruction if the TRAM flap is not an option. Loss of posterior thigh and popliteal sensibility is a frequent sequela of harvesting the free inferior gluteal musculocutaneous flap and the inferior gluteal artery perforator (I-GAP) flap. The posterior femoral cutaneous nerve of the thigh lies directly on the deep surface of the gluteus maximus muscle, having a very close anatomic relationship with the inferior gluteal artery. The purpose of this study was to gain a better understanding of the anatomy of the posterior femoral cutaneous nerve (PFCN), its branches, and their relationship with the inferior gluteal artery (IGA). Eighteen fresh human pelvic halves were dissected for examination during harvesting of the inferior gluteal myocutaneous free flap, to determine if a nerve-sparing approach was possible and how this information might impact on I-GAP flap harvest. Seventeen of 18 pelvic halves had at least some of the PFCN branches intact after isolation of the IGA pedicle and flap elevation. Three of 18 of the pelvic halves had the entire PFCN and its branches intact after flap elevation. One of 18 pelvic halves required complete transection of the PFCN and its branches in order to isolate the IGA pedicle. In 94.5 percent of the pelvic halve dissections, it was possible to maintain at least a portion of the PFCN intact after isolation of the inferior gluteal artery pedicle while harvesting the free inferior gluteal myocutaneous flap. These findings support a nerve-sparing approach to inferior gluteal myocutaneous flap elevation to minimize the sequela of posterior thigh anesthesia. These data also emphasize the intimate relationship of the PFCN and the gluteal artery and the real possibility of injury to the PFCN during I-GAP harvest. PMID:17048132

Zenn, Michael R; Millard, John A

2006-10-01

74

Free inferior gluteal flap harvest with sparing of the posterior femoral cutaneous nerve.  

UK PubMed Central (United Kingdom)

The free inferior gluteal flap is a major secondary choice of autologous tissue for breast reconstruction if the TRAM flap is not an option. Loss of posterior thigh and popliteal sensibility is a frequent sequela of harvesting the free inferior gluteal musculocutaneous flap and the inferior gluteal artery perforator (I-GAP) flap. The posterior femoral cutaneous nerve of the thigh lies directly on the deep surface of the gluteus maximus muscle, having a very close anatomic relationship with the inferior gluteal artery. The purpose of this study was to gain a better understanding of the anatomy of the posterior femoral cutaneous nerve (PFCN), its branches, and their relationship with the inferior gluteal artery (IGA). Eighteen fresh human pelvic halves were dissected for examination during harvesting of the inferior gluteal myocutaneous free flap, to determine if a nerve-sparing approach was possible and how this information might impact on I-GAP flap harvest. Seventeen of 18 pelvic halves had at least some of the PFCN branches intact after isolation of the IGA pedicle and flap elevation. Three of 18 of the pelvic halves had the entire PFCN and its branches intact after flap elevation. One of 18 pelvic halves required complete transection of the PFCN and its branches in order to isolate the IGA pedicle. In 94.5 percent of the pelvic halve dissections, it was possible to maintain at least a portion of the PFCN intact after isolation of the inferior gluteal artery pedicle while harvesting the free inferior gluteal myocutaneous flap. These findings support a nerve-sparing approach to inferior gluteal myocutaneous flap elevation to minimize the sequela of posterior thigh anesthesia. These data also emphasize the intimate relationship of the PFCN and the gluteal artery and the real possibility of injury to the PFCN during I-GAP harvest.

Zenn MR; Millard JA

2006-10-01

75

Posterior sloping angle as a predictor of contralateral slip in slipped capital femoral epiphysis.  

UK PubMed Central (United Kingdom)

BACKGROUND: Slipped capital femoral epiphysis is a condition with potentially severe complications. Controversy remains as to when to undertake prophylactic pinning. We aimed to assess the utility of the posterior sloping angle as a predictor for contralateral slip in a large, multi-ethnic cohort including Polynesian children with a high incidence of slipped capital femoral epiphysis. METHODS: All patients presenting to our hospital between 2000 and 2009 were identified and records were reviewed to determine demographic data and determine whether they subsequently developed a contralateral slip. The presenting radiographs were reviewed and the posterior sloping angle was measured. Patients with bilateral slips at presentation and those without initial radiographs were excluded. RESULTS: Records and radiographs of 132 patients were analyzed for the posterior sloping angle in the unaffected hip. Forty-two patients who had subsequently developed a contralateral slip had a mean posterior sloping angle (and standard deviation) of 17.2° ± 5.6°, which was significantly higher (p < 0.001) than that of 10.8° ± 4.2° for the ninety patients who had had a unilateral slip. Children who had developed a subsequent contralateral slip were significantly younger (11.1 years) than those who had developed a unilateral slip (12.2 years) (p < 0.001). If a posterior sloping angle of 14° were used as an indication for prophylactic fixation in this population, thirty-five (83.3%) of forty-two contralateral slips would have been prevented, and nineteen (21.1%) of ninety hips would have been pinned unnecessarily. The number needed to treat to prevent one subsequent contralateral slip is 1.79. CONCLUSIONS: To our knowledge, this is the largest study to date that confirms that the posterior sloping angle is a reliable predictor of contralateral slip and can be used to guide prophylactic pinning. The posterior sloping angle is applicable in the high-risk Polynesian population and could be useful in preventing future slips in populations that are difficult to follow up.

Phillips PM; Phadnis J; Willoughby R; Hunt L

2013-01-01

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

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 bo...

Ayman I Tharwat

77

Treatment of femoral neck fractures with bipolar hemiarthroplasty using a modified minimally invasive posterior approach in patients with neurological disorders.  

Science.gov (United States)

Bipolar hemiarthroplasty is a useful treatment for displaced femoral neck fractures in elderly patients. Although uncommon, dislocation is problematic, particularly in older patients, and those with neurologic disorders are at an increased risk for this complication. Recently, a modified posterior approach to the hip intended to enhance hip joint stability by preserving the short external rotators was described. Therefore, the dislocation rate was compared after bipolar hemiarthroplasty using the modified or standard minimally invasive posterior approach.A retrospective analysis was performed of 67 patients older than 65 years with displaced femoral neck fractures and neurological disorders who underwent bipolar hemiarthroplasty using the modified and standard approaches in 28 and 39 hips, respectively. Follow-up averaged 19.3 months. Dislocation rates for the treatment and control groups were 0% and 7.7%, respectively (Pbipolar hemiarthroplasty via the modified, short external rotator-sparing approach for treating displaced femoral neck fractures in elderly patients with neurological disorders. PMID:22588403

Han, Suk-Ku; Kim, Yong-Sik; Kang, Soo-Hwan

2012-05-01

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Radiographic landmarks for femoral tunnel placement in medial patellofemoral ligament reconstruction.  

UK PubMed Central (United Kingdom)

BACKGROUND: Reconstruction of the medial patellofemoral ligament has recently become popular for restoring patellofemoral stability. Femoral insertion site anatomy of the medial patellofemoral ligament has been described. This anatomical insertion has been inferred to be the isometric point in medial patellofemoral ligament reconstruction, but data about radiographic landmarks for a postoperative or intraoperative control are missing. PURPOSE: To determine the radiographic landmarks for control of postoperative and intraoperative femoral medial patellofemoral ligament insertion. STUDY DESIGN: Descriptive laboratory study. METHODS: Eight fresh-frozen human knees were dissected, and the medial patellofemoral ligament was exposed. After identification of the femoral medial patellofemoral ligament insertion site, the insertion center was marked with a lead ball of 2-mm diameter. Straight lateral radiographs were taken, and posterior-anterior as well as proximal-distal position were evaluated. RESULTS: Six of 8 insertion points were anterior to a line representing an extension of the posterior cortex, 1 point was touching this line, and 1 point was posterior to it. All points were situated distal to the posterior origin of the medial femoral condyle and proximal to the most posterior point of the Blumensaat line. CONCLUSION: A reproducible anatomical and radiographic point, 1 mm anterior to the posterior cortex extension line, 2.5 mm distal to the posterior origin of the medial femoral condyle, and proximal to the level of the posterior point of the Blumensaat line on a lateral radiograph with both posterior condyles projected in the same plane, shows the mean femoral medial patellofemoral ligament center. CLINICAL RELEVANCE: This radiographic point may be useful both intraoperatively and postoperatively.

Schöttle PB; Schmeling A; Rosenstiel N; Weiler A

2007-05-01

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A non-randomized controlled clinical trial on autologous chondrocyte implantation (ACI) in cartilage defects of the medial femoral condyle with or without high tibial osteotomy in patients with varus deformity of less than 5°.  

UK PubMed Central (United Kingdom)

PURPOSE: High tibial osteotomy (HTO) is a recommended concomitant surgery when treating cartilage lesions of the medial femoral condyle (MFC). Varus deformities of 5° and more were considered an indication for HTO in patients with cartilage defects. This study compares clinical outcome in patients with ACI and concomitant varus deformity of <5° with or without additional HTO. METHODS: 43 patients with isolated cartilage defect of the MFC and varus deformity between 1° and 5° (mean age 39.14 ± 8.35 years; mean varus deformity 2.84 ± 1.19°) were included (follow-up 71.88 ± 23.99 months). Group A (n = 19) was treated with ACI and additional HTO; group B (n = 24) received ACI only. Survival rate in terms of absence of the need of reintervention was defined as main outcome parameter. In the subgroup without reintervention, functional outcome (KOOS and WOMAC) was evaluated. RESULTS: Overall rate of reintervention was 12 (27.9 %). Survival was significantly higher in group A (group A 89.5 %, group B 58.33 %; p = 0.023). Although a trend for better clinical outcome was observed for group A in the subgroup without reintervention, this observation lacked statistical significance (KOOS(symptoms) group A 73.23, group B 59.64; p = 0.274). CONCLUSION: While there is general consensus for treating varus deformities of >5° in patients with cartilage lesions of the medial femoral condyle, HTO also leads to a reduced rate of reinterventions and longer survival rates in patients with varus deformities of <5°.

Bode G; Schmal H; Pestka JM; Ogon P; Südkamp NP; Niemeyer P

2013-01-01

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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 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 (more) 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 later (more) al 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.

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

2011-10-01

 
 
 
 
81

Inhibition of micturition reflex by activation of somatic afferents in posterior femoral cutaneous nerve.  

UK PubMed Central (United Kingdom)

This study determined if activation of somatic afferents in posterior femoral cutaneous nerve (PFCN) could modulate the micturition reflex recorded under isovolumetric conditions in ?-chloralose anaesthetized cats. PFCN stimulation inhibited reflex bladder activity and significantly (P <0.05) increased bladder capacity during slow infusion of saline or 0.25% acetic acid (AA). The optimal frequency for PFCN stimulation-induced bladder inhibition was between 3 and 10 Hz, and a minimal stimulation intensity of half of the threshold for inducing anal twitching was required. Bilateral pudendal nerve transection eliminated PFCN stimulation-induced anal twitching but did not change the stimulation-induced bladder inhibition, excluding the involvement of pudendal afferent or efferent axons in PFCN afferent inhibition.Mechanical or electrical stimulation on the skin surface in the PFCN dermatome also inhibited bladder activity. Prolonged (2 × 30 min) PFCN stimulation induced a post-stimulation inhibition that persists for at least 2 h. This study revealed a new cutaneous-bladder reflex activated by PFCN afferents. Although the mechanisms and physiological functions of this cutaneous-bladder reflex need to be further studied, our data raise the possibility that stimulation of PFCN afferents might be useful clinically for the treatment of overactive bladder symptoms.

Tai C; Shen B; Mally AD; Zhang F; Zhao S; Wang J; Roppolo JR; de Groat WC

2012-10-01

82

Inhibition of micturition reflex by activation of somatic afferents in posterior femoral cutaneous nerve.  

Science.gov (United States)

This study determined if activation of somatic afferents in posterior femoral cutaneous nerve (PFCN) could modulate the micturition reflex recorded under isovolumetric conditions in ?-chloralose anaesthetized cats. PFCN stimulation inhibited reflex bladder activity and significantly (P PFCN stimulation-induced bladder inhibition was between 3 and 10 Hz, and a minimal stimulation intensity of half of the threshold for inducing anal twitching was required. Bilateral pudendal nerve transection eliminated PFCN stimulation-induced anal twitching but did not change the stimulation-induced bladder inhibition, excluding the involvement of pudendal afferent or efferent axons in PFCN afferent inhibition.Mechanical or electrical stimulation on the skin surface in the PFCN dermatome also inhibited bladder activity. Prolonged (2 × 30 min) PFCN stimulation induced a post-stimulation inhibition that persists for at least 2 h. This study revealed a new cutaneous-bladder reflex activated by PFCN afferents. Although the mechanisms and physiological functions of this cutaneous-bladder reflex need to be further studied, our data raise the possibility that stimulation of PFCN afferents might be useful clinically for the treatment of overactive bladder symptoms. PMID:22869011

Tai, Changfeng; Shen, Bing; Mally, Abhijith D; Zhang, Fan; Zhao, Shouguo; Wang, Jicheng; Roppolo, James R; de Groat, William C

2012-08-06

83

Joint line position in revision total knee arthroplasty: the role of posterior femoral off-set stems.  

UK PubMed Central (United Kingdom)

BACKGROUND: Elevation of the joint line frequently occurs in revision total knee arthroplasty (RTKA) because of a wider flexion space than extension space. One solution to balance this flexion-extension space involves the introduction of couplers between the stem and femoral components, and the use of posteriorly offset femoral stems that we hypothesized would improve gap balancing and facilitate joint line restoration. METHODS: We retrospectively reviewed a selected series of 43 RTKA. Postoperative joint line height was subtracted from intended height using postoperative lateral radiographs. The value was negative if the joint line position was lowered, and positive if raised. RESULTS: Forty knees were followed for a mean of 3.5years. Mean postoperative joint line position change from intended position was 1.5mm (range -2.5-7.5mm). In 28 knees (70%), the joint line position was restored to within ±2mm of the intended position; in eight knees (20%), from 2-4mm; and in four knees (10%), >4mm. Joint line position was raised in 32 knees (80%) and lowered in eight (20%). In the offset stem knees, the intended joint line position was 0.9mm (range -1.2-3.4mm) as compared with 3.2mm (range -2.5-7.5mm) for the straight stem knees. CONCLUSIONS: A coupler system between the femoral stem and femoral component restored the joint line in 70% of cases. The posterior offset stem provided increased posterior condylar offset, addressed the wider flexion space, provided better positioning of the stem, and restored the joint line. LEVEL OF EVIDENCE: Therapeutic Study Level IV.

Innocenti M; Matassi F; Carulli C; Soderi S; Villano M; Civinini R

2013-06-01

84

Treatment of femoral neck fractures with bipolar hemiarthroplasty using a modified minimally invasive posterior approach in patients with neurological disorders.  

UK PubMed Central (United Kingdom)

Bipolar hemiarthroplasty is a useful treatment for displaced femoral neck fractures in elderly patients. Although uncommon, dislocation is problematic, particularly in older patients, and those with neurologic disorders are at an increased risk for this complication. Recently, a modified posterior approach to the hip intended to enhance hip joint stability by preserving the short external rotators was described. Therefore, the dislocation rate was compared after bipolar hemiarthroplasty using the modified or standard minimally invasive posterior approach.A retrospective analysis was performed of 67 patients older than 65 years with displaced femoral neck fractures and neurological disorders who underwent bipolar hemiarthroplasty using the modified and standard approaches in 28 and 39 hips, respectively. Follow-up averaged 19.3 months. Dislocation rates for the treatment and control groups were 0% and 7.7%, respectively (P<.01). No significant difference existed in postoperative bleeding, operative time, or length of hospital stay between groups. These data suggest a lower dislocation rate after bipolar hemiarthroplasty via the modified, short external rotator-sparing approach for treating displaced femoral neck fractures in elderly patients with neurological disorders.

Han SK; Kim YS; Kang SH

2012-05-01

85

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?cartilage repair, with better outcome in TR versus MFC defects in rabbits. Meniscal degeneration is associated with cartilage damage. © 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 31:1757-1764, 2013. PMID:23843172

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

2013-07-10

86

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

Directory of Open Access Journals (Sweden)

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

2011-01-01

87

Abordagem simplificada do nervo ciático por via posterior, no ponto médio do sulco glúteo-femoral, com uso de neuroestimulador  

Directory of Open Access Journals (Sweden)

Full Text Available JUSTIFICATIVA E OBJETIVOS: O bloqueio do nervo ciático pode ser realizado por várias abordagens com vantagens e desvantagens. O nervo ciático é o maior nervo do corpo humano em diâmetro e comprimento. É a continuação do fascículo superior do plexo sacral (L4, L5, S1, S2 e S3). Sai da pelve através do forâmen isquiático maior, passando por baixo do músculo piriforme, desce entre o trocânter maior do fêmur e a tuberosidade isquiática, e ao longo do dorso da coxa, anterior aos músculos bíceps femoral e semitendinoso, até o terço inferior da coxa, onde se divide em dois grandes ramos denominados nervos tibial e fibular comum. Torna-se superficial na borda inferior do músculo glúteo máximo. Baseados nesta descrição anatômica, desenvolvemos uma abordagem posterior, tendo como vantagens a fácil identificação da anatomia de superfície, superficialidade do nervo nesta localização, provocando menor desconforto ao paciente que outras abordagens e podendo utilizar agulha de 5 cm. MÉTODO: Foram estudados 17 pacientes, estado físico ASA I, II ou III, com idades entre 21 e 79 anos, peso de 55 a 90 kg, submetidos a cirurgias em perna ou pé. Após monitorização, o paciente foi posicionado em decúbito ventral e realizado bloqueio no ponto médio do sulco glúteo-femoral (dobra da pele entre a nádega e região posterior da coxa), com auxílio de neuroestimulador, utilizando lidocaína a 1% sem adrenalina (300 mg). Avaliou-se latência, tempo de execução do bloqueio, anestesia dos nervos tibial, fibular comum e cutâneo posterior da coxa. Quando necessário, foi também realizado o bloqueio do nervo safeno com 5 ml de lidocaína a 1%. RESULTADOS: Obteve-se anestesia adequada em todos os casos com o volume e concentração usados. Em nenhum paciente ocorreu anestesia do nervo cutâneo posterior da coxa. O tempo de execução do bloqueio foi de 8,58 ± 5,71 min. A latência foi de 5,88 ± 1,6 min. A duração sensitiva e motora do bloqueio foi de 4,05 ± 1,1 e 2,9 ± 0,8 horas, respectivamente. CONCLUSÕES: Essa nova abordagem é eficaz e de fácil execução. Não está indicada se o bloqueio do nervo cutâneo posterior da coxa for necessário.

Fonseca Neuber Martins; Ferreira Fernando Xavier; Ruzi Roberto Araújo; Pereira Gulherme Carnaval Souza

2002-01-01

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

UK PubMed Central (United Kingdom)

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. Clin. Anat., 2013. © 2013 Wiley Periodicals, Inc.

Tubbs RS; Lingo PR; Mortazavi MM; Cohen-Gadol AA

2013-01-01

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

DEFF Research Database (Denmark)

BACKGROUND AND PURPOSE: Preoperative posterior tilt in undisplaced (Garden I-II) femoral neck fractures is thought to influence rates of reoperation. However, an exact method for its measurement has not yet been presented. We designed a new measurement for posterior tilt on preoperative lateral radiographs and investigated its association with later reoperation. PATIENTS AND METHODS: A consecutive series of 113 patients, > or = 60 years of age with undisplaced (Garden I-II) femoral neck fractures treated with two parallel implants, was assessed regarding patient characteristics, radiographs, and rate of reoperation within the first year. In a subgroup of 50 randomly selected patients, reliability tests for measurement of posterior tilt were performed. RESULTS: Intra- and interclass coefficients for the new measurement were > or = 0.94. 23% (26/113) of patients were reoperated and increased posterior tilt was an accurate predictor of failure (p = 0.002). 14/25 of posteriorly tilted fractures > or = 20 degrees were reoperated, as compared to 12/88 of fractures with less tilt (p or = 20 degrees was the only significant predictor of reoperation (p < 0.001). INTERPRETATION: The new measurement for posterior tilt appears to be reliable and able to predict reoperation in patients with undisplaced (Garden I-II) femoral neck fractures.

Palm, Henrik; Gosvig, Kasper

2009-01-01

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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  

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; Luiz Fernando Machado Soares; Matheus Braga Jacques Gonçalves; Leonardo Lanziotti Costa; Lincoln Paiva Costa; Rodrigo Rosa Lessa; Marcelo Lobo Pereira

2011-01-01

91

Abordagem simplificada do nervo ciático por via posterior, no ponto médio do sulco glúteo-femoral, com uso de neuroestimulador Abordaje simplificado del nervio ciático por vía posterior, en el punto medio del sulco glúteo-femoral, con uso de neuroestimulador Simplified sciatic nerve approach by the posterior route at the median gluteus-femoral sulcus region, with a neurostimulator  

Directory of Open Access Journals (Sweden)

Full Text Available JUSTIFICATIVA E OBJETIVOS: O bloqueio do nervo ciático pode ser realizado por várias abordagens com vantagens e desvantagens. O nervo ciático é o maior nervo do corpo humano em diâmetro e comprimento. É a continuação do fascículo superior do plexo sacral (L4, L5, S1, S2 e S3). Sai da pelve através do forâmen isquiático maior, passando por baixo do músculo piriforme, desce entre o trocânter maior do fêmur e a tuberosidade isquiática, e ao longo do dorso da coxa, anterior aos músculos bíceps femoral e semitendinoso, até o terço inferior da coxa, onde se divide em dois grandes ramos denominados nervos tibial e fibular comum. Torna-se superficial na borda inferior do músculo glúteo máximo. Baseados nesta descrição anatômica, desenvolvemos uma abordagem posterior, tendo como vantagens a fácil identificação da anatomia de superfície, superficialidade do nervo nesta localização, provocando menor desconforto ao paciente que outras abordagens e podendo utilizar agulha de 5 cm. MÉTODO: Foram estudados 17 pacientes, estado físico ASA I, II ou III, com idades entre 21 e 79 anos, peso de 55 a 90 kg, submetidos a cirurgias em perna ou pé. Após monitorização, o paciente foi posicionado em decúbito ventral e realizado bloqueio no ponto médio do sulco glúteo-femoral (dobra da pele entre a nádega e região posterior da coxa), com auxílio de neuroestimulador, utilizando lidocaína a 1% sem adrenalina (300 mg). Avaliou-se latência, tempo de execução do bloqueio, anestesia dos nervos tibial, fibular comum e cutâneo posterior da coxa. Quando necessário, foi também realizado o bloqueio do nervo safeno com 5 ml de lidocaína a 1%. RESULTADOS: Obteve-se anestesia adequada em todos os casos com o volume e concentração usados. Em nenhum paciente ocorreu anestesia do nervo cutâneo posterior da coxa. O tempo de execução do bloqueio foi de 8,58 ± 5,71 min. A latência foi de 5,88 ± 1,6 min. A duração sensitiva e motora do bloqueio foi de 4,05 ± 1,1 e 2,9 ± 0,8 horas, respectivamente. CONCLUSÕES: Essa nova abordagem é eficaz e de fácil execução. Não está indicada se o bloqueio do nervo cutâneo posterior da coxa for necessário.JUSTIFICATIVA Y OBJETIVOS: El bloqueo del nervio ciático puede ser realizado por varios abordajes con ventajas y desventajas. El nervio ciático es el mayor nervio del cuerpo humano en diámetro y largura. Es la continuación del fascículo superior del plexo sacral (L4, L5, S1, S2 y S3). Sale de la pelvis a través del Fuerone isquiático mayor, pasando por bajo del músculo piriforme, baja entre el trocanter mayor del femur y la tuberosidad isquiática, y al largo del dorso del muslo, anterior a los músculos bíceps femoral y semitendinoso, hasta el tercero inferior del muslo, donde se divide en dos grandes ramos denominados nervios tibial y fibular común. Se torna superficial en la borda inferior del músculo glúteo máximo. Baseados en esta descripción anatómica, desenvolvemos un abordaje posterior, teniendo como ventajas la identificación fácil de la anatomía de superficie, superficialidad del nervio en esta localización, provocando menor incomodidad al paciente que otros abordajes y pudiendo utilizar aguja de 5 cm. MÉTODO: Fueron estudiados 17 pacientes, estado físico ASA I, II ó III, con edades entre 21 y 79 años, peso de 55 a 90 kg, sometidos a cirugías en piernas o pies. Después de monitorización, el paciente fue posicionado en decúbito ventral y realizado bloqueo en el punto medio del sulco glúteo femoral (dobla de la piel entre la nalga y la región posterior del muslo), con auxilio de neuroestimulador, utilizando lidocaína a 1% sin adrenalina (300 mg). Se evaluó la latencia, tiempo de ejecución del bloqueo, anestesia de los nervios tibial, fibular común y cutáneo posterior del muslo. Cuando necesario, fue también realizado el bloqueo del nervio safeno con 5 ml de lidocaína a 1%. RESULTADOS: Se obtuvo anestesia adecuada en todos los casos con el volumen y concentración usados. En ningún paciente ocurrió

Neuber Martins Fonseca; Fernando Xavier Ferreira; Roberto Araújo Ruzi; Gulherme Carnaval Souza Pereira

2002-01-01

92

Abordagem simplificada do nervo ciático por via posterior, no ponto médio do sulco glúteo-femoral, com uso de neuroestimulador/ Simplified sciatic nerve approach by the posterior route at the median gluteus-femoral sulcus region, with a neurostimulator/ Abordaje simplificado del nervio ciático por vía posterior, en el punto medio del sulco glúteo-femoral, con uso de neuroestimulador  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese JUSTIFICATIVA E OBJETIVOS: O bloqueio do nervo ciático pode ser realizado por várias abordagens com vantagens e desvantagens. O nervo ciático é o maior nervo do corpo humano em diâmetro e comprimento. É a continuação do fascículo superior do plexo sacral (L4, L5, S1, S2 e S3). Sai da pelve através do forâmen isquiático maior, passando por baixo do músculo piriforme, desce entre o trocânter maior do fêmur e a tuberosidade isquiática, e ao longo do dorso da (more) coxa, anterior aos músculos bíceps femoral e semitendinoso, até o terço inferior da coxa, onde se divide em dois grandes ramos denominados nervos tibial e fibular comum. Torna-se superficial na borda inferior do músculo glúteo máximo. Baseados nesta descrição anatômica, desenvolvemos uma abordagem posterior, tendo como vantagens a fácil identificação da anatomia de superfície, superficialidade do nervo nesta localização, provocando menor desconforto ao paciente que outras abordagens e podendo utilizar agulha de 5 cm. MÉTODO: Foram estudados 17 pacientes, estado físico ASA I, II ou III, com idades entre 21 e 79 anos, peso de 55 a 90 kg, submetidos a cirurgias em perna ou pé. Após monitorização, o paciente foi posicionado em decúbito ventral e realizado bloqueio no ponto médio do sulco glúteo-femoral (dobra da pele entre a nádega e região posterior da coxa), com auxílio de neuroestimulador, utilizando lidocaína a 1% sem adrenalina (300 mg). Avaliou-se latência, tempo de execução do bloqueio, anestesia dos nervos tibial, fibular comum e cutâneo posterior da coxa. Quando necessário, foi também realizado o bloqueio do nervo safeno com 5 ml de lidocaína a 1%. RESULTADOS: Obteve-se anestesia adequada em todos os casos com o volume e concentração usados. Em nenhum paciente ocorreu anestesia do nervo cutâneo posterior da coxa. O tempo de execução do bloqueio foi de 8,58 ± 5,71 min. A latência foi de 5,88 ± 1,6 min. A duração sensitiva e motora do bloqueio foi de 4,05 ± 1,1 e 2,9 ± 0,8 horas, respectivamente. CONCLUSÕES: Essa nova abordagem é eficaz e de fácil execução. Não está indicada se o bloqueio do nervo cutâneo posterior da coxa for necessário. Abstract in spanish JUSTIFICATIVA Y OBJETIVOS: El bloqueo del nervio ciático puede ser realizado por varios abordajes con ventajas y desventajas. El nervio ciático es el mayor nervio del cuerpo humano en diámetro y largura. Es la continuación del fascículo superior del plexo sacral (L4, L5, S1, S2 y S3). Sale de la pelvis a través del Fuerone isquiático mayor, pasando por bajo del músculo piriforme, baja entre el trocanter mayor del femur y la tuberosidad isquiática, y al largo del (more) dorso del muslo, anterior a los músculos bíceps femoral y semitendinoso, hasta el tercero inferior del muslo, donde se divide en dos grandes ramos denominados nervios tibial y fibular común. Se torna superficial en la borda inferior del músculo glúteo máximo. Baseados en esta descripción anatómica, desenvolvemos un abordaje posterior, teniendo como ventajas la identificación fácil de la anatomía de superficie, superficialidad del nervio en esta localización, provocando menor incomodidad al paciente que otros abordajes y pudiendo utilizar aguja de 5 cm. MÉTODO: Fueron estudiados 17 pacientes, estado físico ASA I, II ó III, con edades entre 21 y 79 años, peso de 55 a 90 kg, sometidos a cirugías en piernas o pies. Después de monitorización, el paciente fue posicionado en decúbito ventral y realizado bloqueo en el punto medio del sulco glúteo femoral (dobla de la piel entre la nalga y la región posterior del muslo), con auxilio de neuroestimulador, utilizando lidocaína a 1% sin adrenalina (300 mg). Se evaluó la latencia, tiempo de ejecución del bloqueo, anestesia de los nervios tibial, fibular común y cutáneo posterior del muslo. Cuando necesario, fue también realizado el bloqueo del nervio safeno con 5 ml de lidocaína a 1%. RESULTADOS: Se obtuvo anestesia adecuada en todos los casos con el vol

Fonseca, Neuber Martins; Ferreira, Fernando Xavier; Ruzi, Roberto Araújo; Pereira, Gulherme Carnaval Souza

2002-11-01

93

Kinematic analysis of kneeling in cruciate-retaining and posterior-stabilized total knee arthroplasties.  

Science.gov (United States)

Kneeling is an important function of the knee for many activities of daily living. In this study, we evaluated the in vivo kinematics of kneeling after total knee arthroplasty (TKA) using radiographic based image-matching techniques. Kneeling from 90 to 120 degrees of knee flexion produced a posterior femoral rollback after both cruciate-retaining and posterior-stabilized TKA. It could be assumed that the posterior cruciate ligament and the post-cam mechanism were functioning. The posterior-stabilized TKA design had contact regions located far posterior on the tibial insert in comparison to the cruciate-retaining TKA. Specifically, the lateral femoral condyle in posterior-stabilized TKA translated to the posterior edge of the tibial surface, although there was no finding of subluxation. After posterior-stabilized TKA, the contact position of the post-cam translated to the posterior medial corner of the post with external rotation of the femoral component. Because edge loading can induce accelerated polyethylene wear, the configuration of the post-cam mechanism should be designed to provide a larger contact area when the femoral component rotates. PMID:17960655

Hamai, Satoshi; Miura, Hiromasa; Higaki, Hidehiko; Matsuda, Shuichi; Shimoto, Takeshi; Sasaki, Kousuke; Yoshizumi, Masaaki; Okazaki, Ken; Tsukamoto, Nobuaki; Iwamoto, Yukihide

2008-04-01

94

Internal fixation of femoral neck fractures with posterior comminution: a biomechanical comparison of DHS® and Intertan nail®.  

UK PubMed Central (United Kingdom)

BACKGROUND AND PURPOSE: Internal fixation is a therapeutic mainstay for treatment of undisplaced femoral neck fractures and fractures without posterior comminution. The best treatment for unstable and comminuted fractures, however, remains controversial, especially in older patients. The present study was designed to assess the utility of the Intertan Nail® (IT) for stabilization of comminuted Pauwels type III fractures compared to dynamic hips screw (DHS). METHODS: Randomized on the basis of bone mineral density, 32 human femurs were assigned to four groups. Pauwels type III fractures were osteomized with a custom-made saw guide. In 16 specimens the posteromedial support was removed and all femurs were instrumented with an IT or a DHS. All constructs were tested with nondestructive axial loading to 700N, cyclical compression to 1,400N (10,000 cycles), and loading to failure. Outcome measures included number of survived cycles, mechanical stiffness, head displacement and load to failure. RESULTS: Postoperative mechanical stiffness and stiffness after cyclical loading were significantly reduced in all constructs regardless of the presence of a comminution defect (p = 0.02). Specimens stabilized with the IT had a lower construct displacement (IT, 8.5 ± 0.5 mm vs. DHS, 14.5 ± 2.2 mm; p = 0.007) and sustained higher failure loads (IT, 4929 ± 419 N vs. DHS, 3505 ± 453 N; p = 0.036) than the DHS constructs. INTERPRETATION: In comminuted Pauwels type III fractures, the fixation with the IT provided sufficient postoperative mechanical strength, comparable rate of femoral head displacement, and a similar tolerance of physiological loads compared to fractures without comminution. The absence of the posteromedial support in comminuted fractures tended to reduce the failure load regardless of the fixation method.

Rupprecht M; Grossterlinden L; Sellenschloh K; Hoffmann M; Püschel K; Morlock M; Rueger JM; Lehmann W

2011-11-01

95

Value of magnetic resonance imaging in the mid-term follow-up of osteochondritis dissecans of the femoral condyle and talus; Die Bedeutung der Magnetresonanztomographie fuer die Verlaufskontrolle der Osteochondrosis dissecans am Knie- und Sprunggelenk  

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Purpose: Definition of the prognostic value of clinical and morphological findings in the mid-term follow-up of OCD of the femoral condyle and talus. Demonstration of the consolidation of OCD on MRI depending on different therapies. Materials and Methods: 76 patients were examined before and at an average of 30 months after conservative or surgical therapy using T{sub 1} and T{sub 2} weighted SE and 3D-FISP sequences and contrast enhanced studies. Six clinical (age, gender, site, duration and severity of symptoms, therapy) and six morphological (size, signal intensity, fragmentation, contrast enhancement, condition of cartilage, staging) data were registered on first MRI and correlated with the degree of consolidation of OCD (partial and complete remission, no change and progression) on control MRI. Results: Patients under 17 years showed partial or complete remissions in 73%, those of 17 years or older in 33%. Conservatively treated patients had a higher remission rate (54%) than those treated with different surgical techniques (drilling 50%, refixation 43%, abrasio 38%). Small OCDs had a higher remission rate than large lesions (63% vs. 33%). OCDs covered with intact cartilage healed better than lesions with chondral defects (61% vs. 26%). Contrast enhancing fragments had a better prognosis than non-enhancing lesions (100% vs. 40%). Conclusions: Prognosis of OCD can be better estimated when size of OCD, condition of cartilage and enhancement of contrast agent is graduated with MRI and patient age is registered. The consequences for therapy planning are great. (orig.) [German] Ziel: Bewertung von MRT-Befunden und klinischen Daten als Prognoseparameter fuer den mittelfristigen Heilungsverlauf der Osteochondrosis dissecans (OCD) an Knie- und Sprunggelenk. Zudem wird die Konsolidierung der OCD unter verschiedenen Therapieformen untersucht. Material und Methoden: 76 Patienten wurden vor und durchschnittlich 30 Monaten nach konservativer bzw. chirurgischer Therapie einer OCD MR-tomographisch untersucht (T{sub 1}-gewichtete SE-Sequenz ohne und mit Kontrastmittel, T{sub 2}-gewichtete SE-Sequenz, FISP-3D-Sequenz). Klinische Daten (Alter, Geschlecht, Lokalisation, Anamnesedauer, Symptomatik und Art der Therapie) und MRT-Befunde (Groesse, Signal, Sinterung, Kontrastmittelaufnahme, Knorpelzustand, Stadium) wurden mit dem im Kontroll-MRT erkennbaren Heilungszustand (partielle bzw. komplette Remission Konstanz, Progression) korreliert. Ergebnisse: Bei Patienten unter 17 Jahren wurde eine partielle bzw. komplette Remission in 73%, bei Patienten ueber 17 Jahren in 33% registriert. Die konservative Behandlung fuehrte zu einer etwas hoeheren Remissionsrate (54%) als die chirurgischen Therapieformen (Bohrung 50%, Refixation 43%, Abrasio 38%). Kleine OCDs heilten besser als grosse (63% vs. 33%), Herde mit intaktem Knorpel besser (61%) als jene mit Knorpeldefekten (26%) und nach Kontrastmittelgabe anreichernde Fragmente wesentlich haeufiger (100%) als nicht anreichernde (40%). Schlussfolgerung: Wichtigster klinischer Parameter fuer die Prognose der OCD ist das Alter. Unter den MRT-Kriterien stehen die Groesse des Defekts, der Zustand des Knorpelbelags und die Kontrastmittelaufnahme im Fragment an der Spitze. Die Konsequenzen dieser Befunde fuer die Therapieplanung sind betraechtlich. (orig.)

Bachmann, G.; Rominger, M.; Rau, W.S. [Giessen Univ. (Germany). Abt. Diagnostische Radiologie; Juergensen, I. [Giessen Univ. (Germany). Orthopaedische Klinik

1999-11-01

96

Growth regulation of the rat mandibular condyle and femoral head by transforming growth factor-{beta}1, fibroblast growth factor-2 and insulin-like growth factor-I.  

Digital Repository Infrastructure Vision for European Research (DRIVER)

The mandibular condyle is a major growth site and is known to adapt to functional factors. Numerous studies have been performed on the effects of growth factors on the metabolism of primary cartilages, but only a few investigations have examined their action on primary and secondary cartilages. Ther...

Delatte, Myriam L; Von den Hoff, Johannes W; Nottet, Servaas J A M; De Clerck, Hugo; Kuijpers-Jagtman, Anne M

97

Bifid mandibular condyle.  

UK PubMed Central (United Kingdom)

A 20-year-old young male patient presented with limited mouth opening and cosmetic disfigurement since childhood. On examination, marked mandibular hypoplasia resulting in a convex facial profile was noted. Further radiographic investigation using orthopantomograph and CT scan with three-dimensional reconstruction revealed bifid mandibular condyle of the right side.

Katti G; Najmuddin M; Fatima S; Unnithan J

2012-01-01

98

Bifid mandibular condyle.  

Science.gov (United States)

A 20-year-old young male patient presented with limited mouth opening and cosmetic disfigurement since childhood. On examination, marked mandibular hypoplasia resulting in a convex facial profile was noted. Further radiographic investigation using orthopantomograph and CT scan with three-dimensional reconstruction revealed bifid mandibular condyle of the right side. PMID:23131544

Katti, Girish; Najmuddin, Mohammed; Fatima, Syeda; Unnithan, Jayesh

2012-11-02

99

The blood supply to the femoral head after posterior fracture/dislocation of the hip, assessed by CT angiography.  

Science.gov (United States)

The femoral head receives blood supply mainly from the deep branch of the medial femoral circumflex artery (MFCA). In previous studies we have performed anatomical dissections of 16 specimens and subsequently visualised the arteries supplying the femoral head in 55 healthy individuals. In this further radiological study we compared the arterial supply of the femoral head in 35 patients (34 men and one woman, mean age 37.1 years (16 to 64)) with a fracture/dislocation of the hip with a historical control group of 55 hips. Using CT angiography, we identified the three main arteries supplying the femoral head: the deep branch and the postero-inferior nutrient artery both arising from the MFCA, and the piriformis branch of the inferior gluteal artery. It was possible to visualise changes in blood flow after fracture/dislocation. Our results suggest that blood flow is present after reduction of the dislocated hip. The deep branch of the MFCA was patent and contrast-enhanced in 32 patients, and the diameter of this branch was significantly larger in the fracture/dislocation group than in the control group (p = 0.022). In a subgroup of ten patients with avascular necrosis (AVN) of the femoral head, we found a contrast-enhanced deep branch of the MFCA in eight hips. Two patients with no blood flow in any of the three main arteries supplying the femoral head developed AVN. Cite this article: Bone Joint J 2013;95-B:1453-7. PMID:24151262

Zlotorowicz, M; Czubak, J; Caban, A; Kozinski, P; Boguslawska-Walecka, R

2013-11-01

100

[Accuracy of rotational positioning of the femoral component using the tibial-cut-first technique].  

UK PubMed Central (United Kingdom)

AIM: Problems with the patellofemoral joint are still one of the most common difficulties after total knee arthroplasty. One of the main reasons for these problems seems to be the rotatory malposition of the femoral component. We examined the rotation of the femoral component and the symmetry of the flexion gap of knee prostheses implanted using the tibial-cut-first technique. METHOD: The radiographs of 58 consecutive patients who underwent primary LCS total knee arthroplasty in 2008 were examined retrospectively. The rotation of the femoral component was determined intraoperatively using the femoral positioner and depended on the amount of tibial resection and the tension of the collateral ligaments. The position was then checked by means of three anatomic landmarks: the epicondylar axis, the posterior condyles and the Whiteside line. We used Kanekasu's technique for the radiographs. With this technique it was possible to ascertain the rotation of the femoral component after total knee arthroplasty easily and with a low level of radiation. It was also possible to determine the opening of the flexion gap. RESULTS: The radiographs showed a slight external rotation of the femoral component of 1.31°. The opening of the flexion gap was increased laterally, but only by 1.5°. CONCLUSION: In this study, determination of femoral rotation using the tibial-cut-first technique resulted in a slight external rotation of the femoral component. Furthermore, it is possible to create an almost symmetrical flexion gap with this method.

Classen T; Wegner A; Müller RD; von Knoch M

2011-12-01

 
 
 
 
101

Correlation between the Condyle Position and Intra-Extraarticular Clinical Findings of Temporomandibular Dysfunction  

Science.gov (United States)

Objectives: To investigate the relationship between different clinical findings and condyle position. Methods: Tenderness on masseter (MM), temporal (TM), lateral pyterigoid (LPM), medial pyterigoid (MPM) and posterior cervical (PSM) muscles, limitation, deviation and deflection in opening of mouth, clicking, crepitating, tenderness on lateral palpation of temporomandibular joint (TMJ) area for each side of 85 patients were evaluated. Each side of patients was categorized into the clinical findings: no sign and/or symptom of temporomandibular dysfunctions (TMDs), only extraarticular findings and only intraarticular findings, extra and intraarticular findings. Condyle positions of 170 TMJs were determined the narrowest anterior (a) and posterior interarticular distance (p) on mid-sagittal MRIs of condyles and expressed as p/a ratio and these ratio were transformed into logarithmic base e. Spearman’s Correlation was used to investigate the relationship between the condyle position and the clinical findings. The difference between the condyle positions of different groups was tested by T test. Reliability statistic was used to determine intra-observer concordance of two measurements of condylar position. Results: A significant relationship was found between the condyle position and tenderness of PSM. There was no significant difference between the groups in aspect of the condyle position. Occlusion and condyle position correlated with significantly. Conclusions: The inclination of the upper cervical spine and craniocervical angulations can cause the signs and symptoms of TMD and condyle position is not main cause of TMDs alone but it may be effective together with other possible etiological factors synergistically.

Sener, Sevgi; Akgunlu, Faruk

2011-01-01

102

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.

1977-01-01

103

Anatomical analysis of the medial patellofemoral ligament of the knee, especially the femoral attachment.  

UK PubMed Central (United Kingdom)

The purpose of this study was to investigate the anatomical morphology and measurement of the medial patellofemoral ligament (MPFL), especially the femoral attachment. A total of 20 knee specimens were dissected and the total length, width, thickness, inclination, as well as the attachment points of the MPFL were measured. The MPFL was well-developed in seven knees, moderate in ten knees and wispy in three knees. Total length of the MPFL was 58.8 +/- 4.7 mm. The width and thickness was 12.0 +/- 3.1 mm and 0.44 +/- 0.19 mm at the middle point. The long axis of the MPFL inclined at 15.9 +/- 5.6 degrees proximally. The center of the patellar attachment was located at 27 +/- 10% from the upper end of the patella in the longitudinal patellar height. The femoral attachment was superoposterior to the medial femoral epicondyle and just distal to the adductor tubercle. The center of the anterior edge of the femoral attachment was 9.5 +/- 1.8 mm proximally and 5.0 +/- 1.7 mm posteriorly from the center of the medial femoral epicondyle. The femoral attachment was located at 61 +/- 4% of anteroposterior length of the medial femoral condyle from the anterior edge.

Nomura E; Inoue M; Osada N

2005-10-01

104

Anatomical analysis of the medial patellofemoral ligament of the knee, especially the femoral attachment.  

Science.gov (United States)

The purpose of this study was to investigate the anatomical morphology and measurement of the medial patellofemoral ligament (MPFL), especially the femoral attachment. A total of 20 knee specimens were dissected and the total length, width, thickness, inclination, as well as the attachment points of the MPFL were measured. The MPFL was well-developed in seven knees, moderate in ten knees and wispy in three knees. Total length of the MPFL was 58.8 +/- 4.7 mm. The width and thickness was 12.0 +/- 3.1 mm and 0.44 +/- 0.19 mm at the middle point. The long axis of the MPFL inclined at 15.9 +/- 5.6 degrees proximally. The center of the patellar attachment was located at 27 +/- 10% from the upper end of the patella in the longitudinal patellar height. The femoral attachment was superoposterior to the medial femoral epicondyle and just distal to the adductor tubercle. The center of the anterior edge of the femoral attachment was 9.5 +/- 1.8 mm proximally and 5.0 +/- 1.7 mm posteriorly from the center of the medial femoral epicondyle. The femoral attachment was located at 61 +/- 4% of anteroposterior length of the medial femoral condyle from the anterior edge. PMID:15895206

Nomura, Eiki; Inoue, Motoyasu; Osada, Natsuya

2005-05-13

105

Calcaneal plate fixation of distal femoral fractures.  

UK PubMed Central (United Kingdom)

Open reduction and internal fixation constitute the standard of care for management of displaced distal femoral condylar fractures. The techniques most commonly used include conventional and locked plating with the primary goal of articular surface congruency. However, a specific implant for the isolated medial femoral condyle fracture is lacking. We report the use of a calcaneal plate as a novel technique for managing medial and lateral femoral condylar fractures.

Hohman DW; Affonso J; Budny J; Anders MJ

2012-03-01

106

Calcaneal plate fixation of distal femoral fractures.  

Science.gov (United States)

Open reduction and internal fixation constitute the standard of care for management of displaced distal femoral condylar fractures. The techniques most commonly used include conventional and locked plating with the primary goal of articular surface congruency. However, a specific implant for the isolated medial femoral condyle fracture is lacking. We report the use of a calcaneal plate as a novel technique for managing medial and lateral femoral condylar fractures. PMID:22530211

Hohman, D W; Affonso, J; Budny, J; Anders, M J

2012-03-01

107

Biomechanical analysis of posterior cruciate ligament retaining high-flexion total knee arthroplasty.  

UK PubMed Central (United Kingdom)

BACKGROUND: High-flexion knee replacements have been developed to accommodate a large range of flexion (>120 degrees ) after total knee arthroplasty. Both posterior cruciate ligament retaining and sacrificing high-flexion knee designs have been marketed. The main objective of this study was to evaluate the biomechanical performance of a cruciate-retaining high-flexion knee replacement. Furthermore, the mechanical behaviour of this high-flexion knee replacement was compared to both a cruciate-retaining conventional and a posterior-stabilized high-flexion knee replacement. METHODS: A finite element prosthetic knee model was developed to analyze the mechanical performance of the knee designs evaluated in this study. Polyethylene stresses and the amount of femoral rollback were studied during a squatting movement (flexion femoral contact stress (74.7 MPa) than the cruciate-retaining conventional design (96.5 MPa). The posterior-stabilized high-flexion design showed the lowest peak tibio-femoral contact stress at the condylar articulation (54.2 MPa), although the post was loaded higher (77.4 MPa). The knee designs analyzed in this study produced a similar amount of femoral rollback during normal knee flexion (flexion > 120 degrees), whereas the cruciate-retaining designs showed a paradoxical anterior movement of the femoral condyles during high-flexion (flexion>120 degrees). INTERPRETATION: The current study demonstrates a cruciate-retaining high-flexion knee replacement produces a lower prosthetic load than a conventional cruciate-retaining replacement during deep knee flexion. Compared to a posterior-stabilized high-flexion design, the cruciate-retaining high-flexion design demonstrated an equivalent prosthetic loading along with an inferior amount of femoral rollback in the high-flexion range. Posterior cruciate ligament balancing is an important surgical aim for high-flexion knee arthroplasty.

Zelle J; Van der Zanden AC; De Waal Malefijt M; Verdonschot N

2009-12-01

108

Posterior occipitocervical fixation under skull-femoral traction for the treatment of basilar impression in a child with Klippel-Feil syndrome.  

UK PubMed Central (United Kingdom)

We present the case of a 15-year-old boy with symptoms due to Klippel-Feil syndrome. Radiographs and CT scans demonstrated basilar impression, occipitalisation of C1 and fusion of C2/C3. MRI showed ventral compression of the medullocervical junction. Skull traction was undertaken pre-operatively to determine whether the basilar impression could be safely reduced. During traction, the C3/C4 junction migrated 12 mm caudally and spasticity resolved. Peri-operative skull-femoral traction enabled posterior occipitocervical fixation without decompression. Following surgery, cervical alignment was restored and spasticity remained absent. One year after surgery he was not limited in his activities. The surgical strategy for patients with basilar impression and congenital anomalies remains controversial. The anterior approach with decompression is often recommended for patients with ventral compression of the medullocervical region, but such procedures are technically demanding and carry a significant risk of complications. Our surgical strategy was an alternative solution. Prior to a posterior cervical fixation, without decompression, skull traction was used to confirm that the deformity was reducible and effective in resolving associated myelopathy.

Dokai T; Nagashima H; Nanjo Y; Tanida A; Teshima R

2011-11-01

109

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

UK PubMed Central (United Kingdom)

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. © 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 31:1772-1779, 2013.

Orth P; Meyer HL; Goebel L; Eldracher M; Ong MF; Cucchiarini M; Madry H

2013-11-01

110

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. © 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 31:1772-1779, 2013. PMID:23813860

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

2013-06-27

111

Relationship between the condyle and adjacent structures in double temporomandibular joint view using panorama  

Energy Technology Data Exchange (ETDEWEB)

To investigate the ability of double TMJ view by multifunctional panorama to view the bony components and the space of the temporomandibular joint. Ten dry skulls fitted with resin shims over the caricular surface of the condyle were used to reproduce the temporomandibular joint space. Fine metal wires were attached to the three portions of contours of the condylar head and the articular eminence. With 10 dry skulls and 20 cases having TMJ dysfunction, double TMJ views by multifunctional panorama (Planmeca 2002 Proline CC) and transcranial views were taken, analyzed from the anatomical view point, and compared statistically in view of the widths of the posterior joint space and the condylar head. In double TMJ view, the supero-anterior part of the condyle represented the lateral 1/3, the most superior part represented center portion, and the posterior part medial 1/3 of the condyle. In maximum mouth opening, no other structures were statistically with the condyle in double TMJ view. In double TMJ view, petrous bone was moderately superimposed with the superior part of the condyle. The tendency of reduction in the posterior joint space appeared in the side of TMJ dysfunction compared with the normal side. The posterior joint spaces in double TMJ view were statistically wider (p<0.05) than those in transcranial view. The correlation coefficient was 0.5179 between the widths of the posterior joint spaces in two radiographic views. Double TMJ view can be substituted for transcracial view in evaluating the TMJ dysfunction.

Lee, Chang Yul; Kim, Jae Duk [Chosun Univ. Dental School, Gwangju (Korea, Republic of)

2001-12-15

112

[The role of the posterior tibial slope on rupture of the anterior cruciate ligament].  

UK PubMed Central (United Kingdom)

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 degrees : 4.5 degrees) as well as statistically significantly lesser posterior tibial slope (p < 0.05) on medial tibial condyle (5.9 degrees : 6.6 degrees) 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 L; Blagojevi? Z; Kadija M; Stankovi? G; Djuleji? V; Milovanovi? D; Filipovi? B

2012-10-01

113

Relationship between the condyle and adjacent structures in double temporomandibular joint view using panorama  

International Nuclear Information System (INIS)

To investigate the ability of double TMJ view by multifunctional panorama to view the bony components and the space of the temporomandibular joint. Ten dry skulls fitted with resin shims over the caricular surface of the condyle were used to reproduce the temporomandibular joint space. Fine metal wires were attached to the three portions of contours of the condylar head and the articular eminence. With 10 dry skulls and 20 cases having TMJ dysfunction, double TMJ views by multifunctional panorama (Planmeca 2002 Proline CC) and transcranial views were taken, analyzed from the anatomical view point, and compared statistically in view of the widths of the posterior joint space and the condylar head. In double TMJ view, the supero-anterior part of the condyle represented the lateral 1/3, the most superior part represented center portion, and the posterior part medial 1/3 of the condyle. In maximum mouth opening, no other structures were statistically with the condyle in double TMJ view. In double TMJ view, petrous bone was moderately superimposed with the superior part of the condyle. The tendency of reduction in the posterior joint space appeared in the side of TMJ dysfunction compared with the normal side. The posterior joint spaces in double TMJ view were statistically wider (p

2001-01-01

114

A geometric morphometric analysis of the medial tibial condyle of african hominids.  

UK PubMed Central (United Kingdom)

Although the hominid knee has been heavily scrutinized, shape variation of the medial tibial condyle has yet to be described. Humans, chimpanzees, and gorillas differ in the shape of their medial femoral condyles and in their capacity for external and internal rotation of the tibia relative to the femur. I hypothesize that these differences should be reflected in the shape of the medial tibial condyle of these hominids. Here I use geometric morphometric techniques to uncover shape differences between the medial tibial condyles of humans, chimpanzees, and gorillas. Humans are distinguished from the other two species by having a much more oval-shaped medial tibial condyle, while those of chimpanzees and gorillas are more triangular in outline. Gorillas (especially males) are distinguished by having more concavely-curved condyles (mediolateral direction), which is interpreted as an effect of heavy loading through the medial compartment of the knee in conjunction with differences in the degree of arboreality. Anat Rec, 296:1518-1525, 2013. © 2013 Wiley Periodicals, Inc.

Sylvester AD

2013-10-01

115

Internal fixation of garden I and II femoral neck fractures: posterior tilt did not influence the reoperation rate in 382 consecutive hips followed for a minimum of 5 years.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To analyze factors influencing the reoperation rate due to fracture healing complications after internal fixation of Garden I and II femoral neck fractures with special reference to a new validated method assessing the preoperative posterior tilt on lateral radiographs. DESIGN: Prospective cohort study. SETTING: Level II trauma center. PATIENTS: A consecutive cohort of 382 hips in 379 patients who underwent internal fixation for a Garden I or II femoral neck fracture. INTERVENTION: The posterior tilt in preoperative radiographs was analyzed with a new validated method. A Cox regression analysis was used to evaluate factors associated with reoperation due to fracture healing complications. Age, gender, cognitive function, ASA classification, time to surgery, and the posterior tilt were tested as independent factors in the model. MAIN OUTCOME MEASURES: Reoperation rate due to fracture healing complications with a minimal follow-up of 5 years. Reoperation data were validated against the National Board of Health and Welfare's national registry using unique Swedish personal identification numbers. RESULTS: The overall reoperation rate was 19% (72 of 382 hips) and the reoperation rate due to fracture healing complications was 12% (45 of 382 hips). The posterior tilt had no influence on the risk for reoperation due to fracture healing complication, nor had the age, gender, cognitive function, ASA classification, or the time to surgery. CONCLUSIONS: Preoperative posterior tilt measurement on lateral radiographs cannot be used as a discriminator for fracture healing complications in Garden I and II femoral neck fractures. LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Lapidus LJ; Charalampidis A; Rundgren J; Enocson A

2013-07-01

116

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

117

Transpharyngeal radiography of mandibular condyle  

International Nuclear Information System (INIS)

Transpharyngeal examination of the mandibular condyle was compared with transcranial and transmaxillary examinations in 22 patients with mandibular pain/dysfunction. All projections were supplementary and a combination of at least two methods seemed preferable. When a single examination was used, underestimation of abnormalities was evident. In demonstrating condylar destruction, the transpharyngeal examination seemed to be superior to the more commonly used transcranial, but inferior to the transmaxillary examination. (orig.).

1985-01-01

118

Saw tooth patello - Femoral arthritis  

International Nuclear Information System (INIS)

Four patients with an unusual form of patello-femoral arthritis are described. The characteristic feature of the condition is an erosive 'saw tooth' pattern characteristically seen on both sides of the joint. Radiologically, this pattern is best seen on the skyline view. The other principal features are a lamellar-like pattern on slightly oblique lateral views, a smooth supra patellar erosion of the femur seen on the lateral view and cortical ridging of the lateral femoral condyle seen 'en face' on the AP projection. A possible mechanism to account for the radiological features is proposed. Anbarasu, A., Loughran, C.F. (2000). Clinical Radiology 55, 767-769.

2000-01-01

119

Bifid mandibular condyle: CT and MRI appearance.  

UK PubMed Central (United Kingdom)

Bifid mandibular condyle (BMC) is a rare asymptomatic morphological alteration with no predilection for age group or gender. Its morphology varies from a shallow groove to two condylar heads with separate necks, oriented mediolaterally or anteroposteriorly. This report describes an unusual case of bilateral mediolateral bifid condyle in a 24-year-old female patient with the main complaint of mouth-opening limitation. MRI and CT findings revealed bilateral bifid condyle.

Tutar O; Bas A; Gülsen G; Bayraktarov E

2012-01-01

120

A radiographic study of mandibular condyle shape and position in an asymptomatic population  

International Nuclear Information System (INIS)

This study was designed to observe mandibular condyle shape and position in an asymptomatic population. Using Accurad-200 head holder (Denar Corp.) for transcranial radiography of the temporomandibular joint region, transcranial radiographs were taken at the centric occlusion and 1 inch mouth opening in 73 males and females who were asymptomatic for TMJ disturbances, had no severe carious or missing teeth, and no history of prosthodontic or orthodontic treatments. Mandibular condyles were classified morphologically at the centric occlusion and evaluated in positional relationship with mandibular fossa and articular eminence at the centric occlusion and 1 inch mouth opening. The results were as follows: 1. In the morphologic classification of mandibular condyle, the convex shape was more prevalent in an asymptomatic population (90.4%), the locally concave shape and wedge were 5.5%, 4.1%. 2. At the centric occlusion, the means of joint space were 3.43 mm superiorly, 2.17 mm anteriorly, and 2.61 mm posteriorly. 3. At the centric occlusion, the mandibular condyles were placed slightly anterior to the center of their fossa. 4. At the 1 inch mouth opening, the mandibular condyles were placed anterior to the articular eminence more than posterior to or below top of the articular eminence.

1988-01-01

 
 
 
 
121

A radiographic study of mandibular condyle shape and position in an asymptomatic population  

Energy Technology Data Exchange (ETDEWEB)

This study was designed to observe mandibular condyle shape and position in an asymptomatic population. Using Accurad-200 head holder (Denar Corp.) for transcranial radiography of the temporomandibular joint region, transcranial radiographs were taken at the centric occlusion and 1 inch mouth opening in 73 males and females who were asymptomatic for TMJ disturbances, had no severe carious or missing teeth, and no history of prosthodontic or orthodontic treatments. Mandibular condyles were classified morphologically at the centric occlusion and evaluated in positional relationship with mandibular fossa and articular eminence at the centric occlusion and 1 inch mouth opening. The results were as follows: 1. In the morphologic classification of mandibular condyle, the convex shape was more prevalent in an asymptomatic population (90.4%), the locally concave shape and wedge were 5.5%, 4.1%. 2. At the centric occlusion, the means of joint space were 3.43 mm superiorly, 2.17 mm anteriorly, and 2.61 mm posteriorly. 3. At the centric occlusion, the mandibular condyles were placed slightly anterior to the center of their fossa. 4. At the 1 inch mouth opening, the mandibular condyles were placed anterior to the articular eminence more than posterior to or below top of the articular eminence.

Lee, Sang Hoon; Lee, Sang Rae [Dept. of Oral Radiology, College of Dentistry, Kyunghee University, Seoul (Korea, Republic of)

1988-11-15

122

In vivo kinematics for fixed and mobile-bearing posterior stabilized knee prostheses.  

Science.gov (United States)

This is the first in vivo kinematic study to compare mobile-bearing with fixed-bearing prostheses in patients who had total knee arthroplasties. Femorotibial contact positions for 40 patients implanted with either a fixed-bearing or mobile-bearing prosthesis were analyzed using videofluoroscopy. Femorotibial contact paths were determined using a computer automated model-fitting technique. Nineteen of 20 patients in each group experienced posterior femoral rollback of their lateral condyles, with a mean of 3.6 and 3.7 mm for fixed-bearing and mobile-bearing prostheses respectively. Eighteen patients who had mobile-bearing prostheses and 17 patients with fixed-bearing knee prostheses experienced a normal pattern of axial rotation of 7.3 degrees and 4.1 degrees respectively. Eleven of 20 (55%) patients who had mobile-bearing prostheses implanted and eight of 20 (40%) patients who had fixed-bearing prostheses implanted did not experience femoral condylar lift-off. The remaining knees had condylar lift-off less than 2.4 mm for fixed-bearing prostheses and 1.7 mm for mobile-bearing prostheses, respectively. Patients who had mobile-bearing prostheses implanted experienced greater axial rotation and less condylar lift-off than patients who had fixed-bearing prostheses implanted. Both cruciate ligaments are sacrificed for the mobile and fixed-bearing total knee replacements. The results from the current study showed that, in both groups, the majority of patients experienced kinematics similar to those of a normal knee. However, the extent of lateral femoral condyle posterior rollback and the extent of axial rotation were less. PMID:15043113

Ranawat, Chitranjan S; Komistek, Richard D; Rodriguez, Jose A; Dennis, Douglas A; Anderle, Matt

2004-01-01

123

In vivo comparison of knee kinematics for subjects having either a posterior stabilized or cruciate retaining high-flexion total knee arthroplasty.  

Science.gov (United States)

The objective of this study was to determine the in vivo kinematics for subjects having either a fixed posterior stabilized (PS) or cruciate retaining (CR) high-flexion total knee arthroplasty (TKA). Three-dimensional kinematics from full extension to maximum flexion were determined for 30 subjects (15 PS, 15 CR) using fluoroscopy. On average, the PS subjects demonstrated 112 degrees of weight-bearing (WB) flexion, -6.4 mm of posterior femoral rollback, and 2.9 degrees of axial rotation. The CR subjects averaged 117 degrees of WB flexion, -4.9 mm of posterior femoral rollback, and 4.8 degrees of axial rotation. Posterior femoral rollback of the lateral condyle occurred for all PS TKAs and in 93% of the CR TKAs. Only 2 subjects in each group experienced greater than 1.0 mm of condylar lift-off. Subjects in both TKA groups demonstrated excellent WB ranges of motion and kinematic patterns similar to the normal knee, but less in magnitude. PMID:18534487

Cates, Hal E; Komistek, Richard D; Mahfouz, Mohamed R; Schmidt, Monica A; Anderle, Matthew

2008-03-14

124

In vivo comparison of knee kinematics for subjects having either a posterior stabilized or cruciate retaining high-flexion total knee arthroplasty.  

UK PubMed Central (United Kingdom)

The objective of this study was to determine the in vivo kinematics for subjects having either a fixed posterior stabilized (PS) or cruciate retaining (CR) high-flexion total knee arthroplasty (TKA). Three-dimensional kinematics from full extension to maximum flexion were determined for 30 subjects (15 PS, 15 CR) using fluoroscopy. On average, the PS subjects demonstrated 112 degrees of weight-bearing (WB) flexion, -6.4 mm of posterior femoral rollback, and 2.9 degrees of axial rotation. The CR subjects averaged 117 degrees of WB flexion, -4.9 mm of posterior femoral rollback, and 4.8 degrees of axial rotation. Posterior femoral rollback of the lateral condyle occurred for all PS TKAs and in 93% of the CR TKAs. Only 2 subjects in each group experienced greater than 1.0 mm of condylar lift-off. Subjects in both TKA groups demonstrated excellent WB ranges of motion and kinematic patterns similar to the normal knee, but less in magnitude.

Cates HE; Komistek RD; Mahfouz MR; Schmidt MA; Anderle M

2008-10-01

125

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

2012-01-01

126

Hyperplastic conditions of the mandibular condyles  

Energy Technology Data Exchange (ETDEWEB)

To evaluate the clinical and radiographic features of unilateral hyperplastic mandibular condyles for some useful preliminary diagnostic recommendations. Clinical records, radiographs and histologic diagnoses of 35 cases with asymmetric mandibular condyles due to apparent unilateral condylar hyperplasia were evaluated retrospectively. Among 35 cases, 28 were true hyperplastic conditions of condyles whereas the remaining 7 were unilateral internal derangement occurring on the short side. 17 of the 28 hyperplastic condyles showed a mass or irregular radiographic shadow with histologic diagnosis including osteochondroma and osteoma. Only 5 of these cases showed facial asymmetry. 2 out of ths 17 cases showed hyperplastic round shaped irregular condyles consistent with ankylosis and their histologic diagnoses were osteochondromas. 11 of the 28 cases showed smooth enlargement of condylar head with elongation of the neck causing facial asymmetry, but histologic diagnoses were not available because the surgical operation conserved the condyles. The hyperplastic conditions of the mandibular condyles include not only true hyperplasia, osteochondroma, osteoma, and ankylosis, but also unilateral internal derangement occurring on the short side.

Nah, Kyung Soo [Pusan National University College of Medicine, Busan (Korea, Republic of)

2003-12-15

127

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

2010-01-01

128

Eosinophilic granuloma of the mandibular condyle  

Energy Technology Data Exchange (ETDEWEB)

The present study reports a case of eosinophilic granuloma of the mandibular condyle. Eosinophilic granulomas on the mandibular condyle are very rare, but there are several common clinical and radiographic presentations. The clinical presentations involve swelling on preauricular area, limitation of opening, TMJ pain, etc. The radiographic presentations involve radiolucent lytic condylar lesion with or without pathologic fracture. Sometimes new bone formations are observed. The purpose of the article is to add new cases to the literatures.

Huh, Kyung Hoe; Yi, Won Jin; Oh, Sung Won; Lee, Sam Sun [Department of Oral and Maxillofacial Radiology, and Dental Research Institute, School of Dentistry, Seoul National University, Seoul (Korea, Republic of); Choi, Mun Kyung [Department of Oral and Maxillofacial Surgery, College of Medicine, Inje University Sanggye Paik Hospital, Seoul (Korea, Republic of)

2008-03-15

129

Eosinophilic granuloma of the mandibular condyle  

International Nuclear Information System (INIS)

[en] The present study reports a case of eosinophilic granuloma of the mandibular condyle. Eosinophilic granulomas on the mandibular condyle are very rare, but there are several common clinical and radiographic presentations. The clinical presentations involve swelling on preauricular area, limitation of opening, TMJ pain, etc. The radiographic presentations involve radiolucent lytic condylar lesion with or without pathologic fracture. Sometimes new bone formations are observed. The purpose of the article is to add new cases to the literatures.

2008-01-01

130

Radiographic landmarks for tunnel positioning in posterior cruciate ligament reconstructions.  

UK PubMed Central (United Kingdom)

BACKGROUND: Consistent radiographic guidelines for tunnel placement in single- or double-bundle posterior cruciate ligament (PCL) reconstructions are not well defined. Quantitative guidelines reporting the location of the individual PCL bundle attachments would aid in intraoperative tunnel placement and postoperative assessment of a PCL reconstruction. HYPOTHESIS: Consistent and reproducible measurements in relation to radiographic landmarks for the entire PCL and its individual bundle attachments are achievable. STUDY DESIGN: Controlled laboratory study. METHODS: The femoral and tibial PCL bundle attachment centers of 20 nonpaired fresh-frozen cadaveric knees were labeled using radio-opaque spheres and the attachment areas were labeled using barium sulfate. Anteroposterior (AP) and lateral radiographs of the femur and tibia were obtained, and measurements of the distances between the PCL bundle centers and landmarks were acquired. RESULTS: On the AP femur view, the anterolateral bundle (ALB) and posteromedial bundle (PMB) centers were 34.1 ± 3.0 mm and 29.2 ± 3.0 mm lateral to the most medial border of the medial femoral condyle, respectively. The lateral femur images revealed that the ALB center was 17.4 ± 1.7 mm and the PMB center was 23.9 ± 2.7 mm posteroproximal to a line perpendicular to the Blumensaat line that intersected the anterior margin of the medial femoral condyle cortex. Anteroposterior tibia images revealed that the ALB and PMB centers were located 0.2 ± 2.1 mm proximal and 4.9 ± 2.9 mm distal to the proximal joint line, respectively. The PCL attachment center was 1.6 ± 2.5 mm distal to the proximal joint line. On the lateral tibia view, the ALB center was 8.4 ± 1.8 mm, the PCL attachment center was 5.5 ± 1.7 mm, and the PMB center was 2.5 ± 1.5 mm superior to the champagne glass drop-off of the posterior tibia. CONCLUSION: Radiographic measurements from several clinically relevant views of the femur and tibia were reproducible with regard to the anatomic locations of the ALB and PMB centers. The measurements from the lateral femur and tibia views provided the most clinically pertinent radiographic measurements intraoperatively. CLINICAL RELEVANCE: This study established a set of clinically relevant radiographic guidelines for anatomic reconstruction of the PCL. The parameters set forth in this study can be used in both the intraoperative and postoperative settings for both single- and double-bundle PCL reconstructions.

Johannsen AM; Anderson CJ; Wijdicks CA; Engebretsen L; LaPrade RF

2013-01-01

131

Radionuclide evaluation of spontaneous femoral osteonecrosis  

Energy Technology Data Exchange (ETDEWEB)

Spontaneous osteonecrosis of the femoral condyle in 40 knees was followed by sequential radiographs and three-phase bone scans using /sup 99//sup m/Tc-methylene diphosphonate. The characteristic bone scan appearance of focal increased uptake by the medial femoral condyle in blood flow, blood pool, and delayed images helped to make the specific diagnosis in 11 knees that had no characteristic radiographic findings at the time of presentation. The three phases of the bone scan demonstrated a pattern that was useful in determining the activity of the process. There was a gradual loss of hyperemia as healing progressed. Late bone scans were normal or showed nonspecific findings. Radionuclide bone scans were able to confirm or exclude this disease and were superior to radiographs in demonstrating the disease in the acute phase.

Greyson, N.D. (St. Michael' s Hospital, Toronto, Ontario, Canada); Lotem, M.M.; Gross, A.E.; Houpt, J.B.

1982-03-01

132

MPR realignment increases accuracy when measuring femoral neck anteversion angle.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To compare two methods of measuring femoral neck anteversion angle (FNA): A 2D method used at Odense University Hospital until 2010, and a method labeled 3D-OUH. The latter method makes corrections to compensate for errors introduced by the individual placement of patients in the CT scanner. MATERIALS AND METHODS: Twenty-six CT-examined patients were included: nine men and 17 women. The right side FNA was measured twice with each method by one observer, measuring intraobserver variability. Both methods are based on the following anatomy: femoral head center, center at the level of lesser trochanter and posterior apex of the femoral condyles. The 3D-OUH method corrects for the individual orientation of femur by realigning it prior to measurement, in accordance to Murphy et al.'s original definition of FNA. The intercondylar notch center of the knee and center at lesser trochanter was used in the realignment. RESULTS: The 2D method significantly overestimated FNA compared to 3D-OUH by 4.2° (95 % CI: 2.8°; 5.6°), p?

Olesen TH; Torfing T; Overgaard S

2013-08-01

133

The relationship between peak knee extension at heel-strike of walking and the location of thickest femoral cartilage in ACL reconstructed and healthy contralateral knees.  

UK PubMed Central (United Kingdom)

Reports that knee cartilage health is sensitive to kinematic changes, combined with reports of extension loss following ACL reconstruction, underscores the importance of restoring ambulatory knee extension in the context of preventing premature osteoarthritis. The purpose of this study was to test the relationship between individual variations in peak knee extension at heel-strike of walking and the anterior-posterior location of thickest cartilage in the medial and lateral femoral condyles of healthy contralateral and ACL reconstructed knees. In vivo gait analysis and knee MR images were collected from 29 subjects approximately 2 years after unilateral ACL reconstruction. Knee extension was measured at heel-strike of walking and 3-D femoral cartilage thickness models were reconstructed from MR images. The ACL reconstructed knees had significantly reduced knee extension (-1.5±4.2°) relative to the contralateral knees (-4.6±3.4°) at heel-strike of walking but did not have side-to-side differences in the anterior-posterior location or magnitude of thickest medial and lateral femoral cartilage. The anterior-posterior location of the thickest medial femoral cartilage was correlated with knee extension at heel-strike in both the healthy contralateral (R(2)=0.356, p<0.001) and reconstructed (R(2)=0.234, p=0.008) knees. These results suggest that ACL reconstruction can impair terminal extension at periods of ambulatory loading known to be related to cartilage morphology in healthy joints. The fact that the femoral cartilage thickness distribution had not changed at 2 years post-op, even in the subset of subjects with extension loss, suggests that loads may be shifted to thinner cartilage regions, which could have important implications on long-term joint health.

Scanlan SF; Favre J; Andriacchi TP

2013-03-01

134

Estimation of pretraumatic femoral antetorsion in bilateral femoral shaft fractures  

International Nuclear Information System (INIS)

To describe a system for measurement of the pretraumatic femoral antetorsion angle post-bilateral femoral shaft fracture with the use of new imaging software which allows segmentation and three dimensional (3D) reconstruction of DICOM (digital imaging and communications in medicine) images. This case involved a 20-year-old patient with bilateral femoral shaft fractures. Following initial clinical examination, CT scans of both femurs were performed. Subsequently, the DICOM datasets were uploaded to the new software tool. Following segmentation and 3D reconstruction, pretraumatic femoral antetorsion angles were determined. Femoral antetorsion was described and assessed in two ways by referring to the intersection of the posterior condylar plane and (1) a line drawn between the center of the femoral head and femoral neck, (2) a line drawn between the centers of the femoral head and greater trochanter. Using these definitions, values for femoral antetorsion were found to be, respectively, 20 at the right fracture site and 19 on the left site, and 33 bilaterally. The investigators describe in this current technical report the use of new imaging software which enables the calculation of femoral AV following reduction of virtual fracture fragments which are created from standard DICOM images. We believe that this 3D reconstruction method of measuring the antetorsion angle can be integrated into a regular treatment algorithm and may potentially optimize clinical outcomes. (orig.)

2009-01-01

135

Estimation of pretraumatic femoral antetorsion in bilateral femoral shaft fractures  

Energy Technology Data Exchange (ETDEWEB)

To describe a system for measurement of the pretraumatic femoral antetorsion angle post-bilateral femoral shaft fracture with the use of new imaging software which allows segmentation and three dimensional (3D) reconstruction of DICOM (digital imaging and communications in medicine) images. This case involved a 20-year-old patient with bilateral femoral shaft fractures. Following initial clinical examination, CT scans of both femurs were performed. Subsequently, the DICOM datasets were uploaded to the new software tool. Following segmentation and 3D reconstruction, pretraumatic femoral antetorsion angles were determined. Femoral antetorsion was described and assessed in two ways by referring to the intersection of the posterior condylar plane and (1) a line drawn between the center of the femoral head and femoral neck, (2) a line drawn between the centers of the femoral head and greater trochanter. Using these definitions, values for femoral antetorsion were found to be, respectively, 20 at the right fracture site and 19 on the left site, and 33 bilaterally. The investigators describe in this current technical report the use of new imaging software which enables the calculation of femoral AV following reduction of virtual fracture fragments which are created from standard DICOM images. We believe that this 3D reconstruction method of measuring the antetorsion angle can be integrated into a regular treatment algorithm and may potentially optimize clinical outcomes. (orig.)

Citak, Musa; Jagodzinski, Michael; Krettek, Christian; Huefner, Tobias [Hannover Medical School, Trauma Department, Hannover (Germany); Citak, Mustafa [BG-University Hospital Bergmannsheil, Department of Surgery, Bochum (Germany); Kendoff, Daniel; O' Loughlin, Padhraig F. [Hospital for Special Surgery, Orthopaedic Department, New York, NY (United States); Tavassol, Frank [Hannover Medical School, Department of Oral and Maxillofacial Surgery, Hannover (Germany)

2009-12-15

136

Saw tooth patello--femoral arthritis.  

UK PubMed Central (United Kingdom)

Four patients with an unusual form of patello-femoral arthritis are described. The characteristic feature of the condition is an erosive 'saw tooth' pattern characteristically seen on both sides of the joint. Radiologically, this pattern is best seen on the skyline view. The other principal features are a lamellar-like pattern on slightly oblique lateral views, a smooth supra patellar erosion of the femur seen on the lateral view and cortical ridging of the lateral femoral condyle seen 'en face' on the AP projection. A possible mechanism to account for the radiological features is proposed. Anbarasu, A., Loughran, C. F. (2000). Clinical Radiology55, 767-769.

Anbarasu A; Loughran CF

2000-10-01

137

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

Energy Technology Data Exchange (ETDEWEB)

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 (r{sub LRD} = 0.70, p < 0.01; r{sub APD} = 0.56, p < 0.01; r{sub rat} = 0.28, p < 0.01) while the AA (mean, 27 {+-} 7 ) decreased significantly (r{sub 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.)

Karlo, Christoph A. [University Children' s Hospital Zurich, Department of Diagnostic Imaging, Zurich (Switzerland); University Hospital Zurich, Institute of Diagnostic and Interventional Radiology, Zurich (Switzerland); Stolzmann, Paul [University Hospital Zurich, Institute of Diagnostic and Interventional Radiology, Zurich (Switzerland); Habernig, Sandra; Kellenberger, Christian J. [University Children' s Hospital Zurich, Department of Diagnostic Imaging, Zurich (Switzerland); Mueller, Lukas [University of Zurich, Clinics for Orthodontics and Paediatric Dentistry, Zurich (Switzerland); Saurenmann, Traudel [University Children' s Hospital Zurich, Department of Rheumatology, Zurich (Switzerland)

2010-10-15

138

Bloqueio do nervo isquiático por abordagem posterior simplificada no ponto médio do sulco glúteo-femoral: estudo com diferentes volumes de lidocaína a 1% Bloqueo del nervio isquiático por abordaje posterior simplificado en el punto medio del surco glúteo-femoral: estudio con diferentes volúmenes de lidocaína a 1% Simplified posterior sciatic nerve block at mid gluteofemoral dulcus: comparison of different 1% lidocaine volumes  

Directory of Open Access Journals (Sweden)

Full Text Available JUSTIFICATIVA E OBJETIVOS: O bloqueio do nervo isquiático por via subglútea foi descrito com sucesso em estudo anterior, sendo mais uma opção entre as várias abordagens possíveis. O nervo isquiático torna-se superficial na borda inferior do músculo glúteo máximo, permitindo seu acesso com fácil localização, pouco desconforto e baixo risco de punção acidental de grandes vasos. O objetivo deste estudo foi avaliar o bloqueio do nervo isquiático por esta abordagem simplificada com diferentes volumes de lidocaína a 1%. MÉTODO: Foram estudados 40 pacientes com intervenções cirúrgicas na perna ou no pé distribuídos em dois grupos. Após monitorização, eles foram posicionados em decúbito ventral e realizado bloqueio no ponto médio do sulco glúteo-femoral, com auxílio de neuroestimulador e agulha de 5 cm eletricamente isolada, utilizando 300 mg (G1) ou 200 mg (G2) de lidocaína a 1% sem adrenalina. RESULTADOS: Obteve-se anestesia adequada em todos os casos com o volume e a concentração usados. O tempo de execução do bloqueio foi de 8,6 ± 5,7 min (G1) e 5,6 ± 5,7 min (G2). A latência foi de 5,98 ± 1,4 min (G1) e 6,7 ± 2,9 min (G2). A duração sensitiva e motora do bloqueio foi de 243 ± 37 min e 152 ± 30 min (G1) e 235 ± 39 min e 149 ± 59 min (G2), respectivamente. Não foram observadas diferenças estatísticas significativas entre os grupos estudados. CONCLUSÕES: Essa abordagem é eficaz e de fácil execução, podendo a dose total de anestésico ser reduzida sem comprometimento da qualidade.JUSTIFICATIVA Y OBJETIVOS: El bloqueo del nervio isquiático por vía subglútea fue descrito con éxito en estudio anterior, siendo una opción más entre los varios abordajes posibles. El nervio isquiático se hace superficial en el borde inferior del músculo glúteo máximo, permitiendo su acceso con fácil ubicación, poca incomodidad y bajo riesgo de punción accidental de grandes vasos. El objetivo de este estudio fue el de evaluar el bloqueo del nervio isquiático por este abordaje simplificado con diferentes volúmenes de lidocaína a 1%. MÉTODO: Se estudiaron 40 pacientes con intervenciones quirúrgicas en la pierna o en el pie, distribuidos en dos grupos. Después de la monitorización, fueron colocados en decúbito ventral y realizado el bloqueo en el punto medio del surco glúteo-femoral, con auxilio de neuroestimulador y aguja de 5 cm, eléctricamente aislada, utilizando 300 mg (G1) o 200 mg (G2) de lidocaína a 1% sin adrenalina. RESULTADOS: Se obtuvo anestesia adecuada en todos los casos con el volumen y la concentración utilizados. El tiempo de ejecución del bloqueo fue de 8,6 ± 5,7 min (G1) y 5,6 ± 5,7 min (G2). La latencia fue de 5,98 ± 1,4 min (G1) y 6,7 ± 2,9 min (G2). La duración sensitiva y motora del bloqueo fue de 243 ± 37 min y 152 ± 30 min (G1) y 235 ± 39 min y 149 ± 59 min (G2), respectivamente. No se observaron diferencias estadísticas significativas entre los grupos estudiados. CONCLUSIONES: Ese abordaje es eficaz y de fácil ejecución, pudiendo la dosis total de anestésico ser reducida sin el comprometimiento de la calidad.BACKGROUND AND OBJECTIVES: Subgluteus sciatic nerve block has been successfully described in a previous study and is one more option among several possible approaches. The sciatic nerve becomes superficial at inferior gluteus maximus muscle where it is easily located and accessed with minor discomfort and low risk of accidental great vessels puncture. Our study aimed at evaluating this simplified sciatic nerve block approach with different 1% lidocaine volumes. METHODS: Participated in this study 40 patients submitted to leg or foot procedures, who were distributed in two groups. Patients were placed in the prone position after monitoring and blockade was induced at mid gluteofemoral sulcus with the aid of neurostimulator and with beveled insulated 5 cm needle, with 300 mg (G1) or 200 mg (G2) of 1% plain lidocaine. RESULT

Neuber Martins Fonseca; Beatriz Lemos Mandim; Roberto Araújo Ruzi; Fabiana Rosa Tavares

2006-01-01

139

Saw tooth patello - Femoral arthritis  

Energy Technology Data Exchange (ETDEWEB)

Four patients with an unusual form of patello-femoral arthritis are described. The characteristic feature of the condition is an erosive 'saw tooth' pattern characteristically seen on both sides of the joint. Radiologically, this pattern is best seen on the skyline view. The other principal features are a lamellar-like pattern on slightly oblique lateral views, a smooth supra patellar erosion of the femur seen on the lateral view and cortical ridging of the lateral femoral condyle seen 'en face' on the AP projection. A possible mechanism to account for the radiological features is proposed. Anbarasu, A., Loughran, C.F. (2000). Clinical Radiology 55, 767-769.

Anbarasu, A.; Loughran, C.F

2000-10-01

140

Biomechanical study of the Delta plate and the TriLock Delta condyle trauma plate.  

UK PubMed Central (United Kingdom)

PURPOSE: The aim of this study was to evaluate in mandibular condylar process fractures the biomechanical stability of osteosynthesis using the Delta plate and the TriLock Delta condyle trauma plate and to compare these with 2 4-hole miniplates. MATERIALS AND METHODS: The condyles of 120 porcine mandibles were fractured at a defined location. After anatomic reduction, the fractures were fixed with a Delta plate, a TriLock Delta condyle trauma plate, or 2 4-hole miniplates (40 per group). Each group was subjected to linear loadings in 4 different directions with a universal mechanical testing machine (TIRA Test 2720). Yield load and yield displacement were measured for the 2 Delta plates and the 2 miniplates. Means were derived and compared for statistical significance using the Kruskal-Wallis test with a confidence level of 95% (P < .05). RESULTS: None of the plates broke. In 4 cases using the double miniplate and in 2 cases using the Delta plate, osteosynthesis screw loosening was registered. In lateral-to-medial and anterior-to-posterior directions, the 2 miniplates tolerated the highest loads. From medial to lateral and from posterior to anterior, the TriLock Delta condyle trauma plate resisted the highest loads. However, there was a statistically significant difference among all osteosynthesis systems only for medial-to-lateral loads. Statistical analysis for displacement showed significant differences among all plates in the 4 directions. CONCLUSIONS: This biomechanical study indicates that for rigid internal fixation of condylar fractures of the mandible, similar to 2 miniplates, the 2 Delta plates (Delta plate with gliding holes and TriLock Delta plate) fulfill the principles of a functional and stable osteosynthesis. Both are able to resist physiologic strains. The locking plate (TriLock Delta condyle trauma plate) has the advantages of greater primary stability and decreased likelihood of screw loosening.

Haim D; Müller A; Leonhardt H; Nowak A; Richter G; Lauer G

2011-10-01

 
 
 
 
141

Bloqueio do nervo isquiático por abordagem posterior simplificada no ponto médio do sulco glúteo-femoral: estudo com diferentes volumes de lidocaína a 1%  

Directory of Open Access Journals (Sweden)

Full Text Available JUSTIFICATIVA E OBJETIVOS: O bloqueio do nervo isquiático por via subglútea foi descrito com sucesso em estudo anterior, sendo mais uma opção entre as várias abordagens possíveis. O nervo isquiático torna-se superficial na borda inferior do músculo glúteo máximo, permitindo seu acesso com fácil localização, pouco desconforto e baixo risco de punção acidental de grandes vasos. O objetivo deste estudo foi avaliar o bloqueio do nervo isquiático por esta abordagem simplificada com diferentes volumes de lidocaína a 1%. MÉTODO: Foram estudados 40 pacientes com intervenções cirúrgicas na perna ou no pé distribuídos em dois grupos. Após monitorização, eles foram posicionados em decúbito ventral e realizado bloqueio no ponto médio do sulco glúteo-femoral, com auxílio de neuroestimulador e agulha de 5 cm eletricamente isolada, utilizando 300 mg (G1) ou 200 mg (G2) de lidocaína a 1% sem adrenalina. RESULTADOS: Obteve-se anestesia adequada em todos os casos com o volume e a concentração usados. O tempo de execução do bloqueio foi de 8,6 ? 5,7 min (G1) e 5,6 ? 5,7 min (G2). A latência foi de 5,98 ? 1,4 min (G1) e 6,7 ? 2,9 min (G2). A duração sensitiva e motora do bloqueio foi de 243 ? 37 min e 152 ? 30 min (G1) e 235 ? 39 min e 149 ? 59 min (G2), respectivamente. Não foram observadas diferenças estatísticas significativas entre os grupos estudados. CONCLUSÕES: Essa abordagem é eficaz e de fácil execução, podendo a dose total de anestésico ser reduzida sem comprometimento da qualidade.

Fonseca Neuber Martins; Mandim Beatriz Lemos; Ruzi Roberto Araújo; Tavares Fabiana Rosa

2006-01-01

142

Accessory mandibular condyle at the coronoid process.  

Science.gov (United States)

Coronoid process hyperplasia is a rare cause of mandibular hypomobility. It can result from temporalis muscle hyperactivity, trauma, and neoplasia, but often is idiopathic. Enlargement of the coronoid process leading to pseudojoint formation with the zygomatic arch is known as Jacob's disease. It results most commonly from an osteochondroma of the coronoid process. This is the first reported case of a non-neoplastic accessory mandibular condyle located at the coronoid process articulating with the zygoma. PMID:22075815

Peacock, Zachary S; Resnick, Cory M; Faquin, William C; Kaban, Leonard B

2011-11-01

143

Accessory mandibular condyle at the coronoid process.  

UK PubMed Central (United Kingdom)

Coronoid process hyperplasia is a rare cause of mandibular hypomobility. It can result from temporalis muscle hyperactivity, trauma, and neoplasia, but often is idiopathic. Enlargement of the coronoid process leading to pseudojoint formation with the zygomatic arch is known as Jacob's disease. It results most commonly from an osteochondroma of the coronoid process. This is the first reported case of a non-neoplastic accessory mandibular condyle located at the coronoid process articulating with the zygoma.

Peacock ZS; Resnick CM; Faquin WC; Kaban LB

2011-11-01

144

Femoral anteversion.  

UK PubMed Central (United Kingdom)

Biplane roentgenography, axial roentgenography, and fluoroscopy are the usual roentgenographic methods of measuring femoral anteversion. These methods use a strict geometrical definition of anteversion. The computerized tomography method of measuring anteversion that was developed recently, and is now widely used, does not adhere to the accepted definition of anteversion and has not been tested for accuracy in a large series. In the present study, the widely used computerized-tomography method of measuring anteversion was tested on thirty-two femoral specimens. With that method, anteversion was consistently underestimated by an average of 10 degrees compared with direct measurements and was reproducible only to within +/- 3.6 degrees. Therefore, a new method of measuring anteversion using computerized tomography was developed. It was shown to be accurate to +/- 1 degree, as tested on the same specimens. This study demonstrated geometrically why the currently practiced computerized-tomography method of selecting the points that are used to define the axis of the femoral neck is not consistent with geometrical definitions of anteversion. A more accurate method for both defining the axis of the femoral neck and measuring femoral anteversion is described and recommended for clinical use.

Murphy SB; Simon SR; Kijewski PK; Wilkinson RH; Griscom NT

1987-10-01

145

Three-dimensional topographical variation of femoral cartilage T2 in healthy volunteer knees.  

UK PubMed Central (United Kingdom)

OBJECTIVE: Quantitative knee cartilage T2 assessment on limited two-dimensional midsagittal or midcoronal planes may be insufficient to assess variations in normal cartilage composition. The purpose of this work was to reveal characteristic 3D distribution of T2 values in femoral cartilage in healthy volunteer knees. MATERIALS AND METHODS: Sixteen volunteers were enrolled in this study. One knee joint in each volunteer was imaged using a 3D fast image employing steady-state acquisition cycled phases (FIESTA-C) sequence for modeling distal femoral morphology, as well as a sagittal T2 mapping of cartilage. 3D distribution of cartilage T2 values was generated for the femoral condyles. At each medial and lateral condyle, four regions of interest (ROI) were manually defined based on the cartilage covered by the 3D surface model of the medial and lateral menisci. RESULTS: The 3D maps showed a relatively inhomogeneous distribution of cartilage T2 on the medial and lateral condyles. Cartilage T2 values in the internal half of the weight-bearing zone were significantly higher than those in all other zones on both lateral and medial condyles. CONCLUSIONS: Analysis of 3D distribution of femoral cartilage T2 may be valuable in determining the site-specific normal range of cartilage T2 in the healthy knee joint.

Shiomi T; Nishii T; Nakata K; Tamura S; Tanaka H; Yamazaki Y; Murase K; Yoshikawa H; Sugano N

2013-03-01

146

Mandibular condyle position in cone beam computed tomography  

Energy Technology Data Exchange (ETDEWEB)

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.

Hwang, Hyoung Joo; Kim, Gyu Tae; Choi, Yong Suk; Hwang, Eui Hwan [Kyung Hee Univ. School of Dentistry, Seoul (Korea, Republic of)

2006-06-15

147

Clinical and kinematic outcomes of a rotating platform posterior stabilized total knee system.  

Science.gov (United States)

Early post-operative clinical outcomes were analyzed for subjects having a rotating platform (RP) posterior stabilized (PS) total knee arthroplasty (TKA); a subset of which underwent in vivo kinematics and produced kinematic results that compare well with subjects in previous fluoroscopic studies that were deemed excellent in nature. In total, 153 subjects (180 knees) were enrolled in the prospective clinical study. TKAs were performed by three surgeons at three North American centers. Ten subjects were randomly chosen and evaluated under fluoroscopic surveillance. Average active flexion increased from 113.3 (SD=16.6) degrees before surgery to 118.3 (SD=9.9) degrees 12-months post-operatively. American Knee Society (AKS) function score increased from an average of 57.6 (SD=18.8) points pre-operatively to 85.3 (SD=16.6) points 12-months post-operatively. For the kinematic subset, post-operative weight-bearing flexion was 115.9 (SD=8.4),while subjects achieved an average posterior femoral rollback of their lateral condyle of -5.4mm. The average femorotibial axial rotation from full extension to maximum weight-bearing flexion was 3.9 degrees (SD=3.9). Certain kinematic parameters were deemed statistically significant when determining early post-operative clinical success. PMID:23142442

Komistek, Richard D; Murphy, Jeffrey A; O'Dell, Tammy L

2012-11-08

148

Clinical and kinematic outcomes of a rotating platform posterior stabilized total knee system.  

UK PubMed Central (United Kingdom)

Early post-operative clinical outcomes were analyzed for subjects having a rotating platform (RP) posterior stabilized (PS) total knee arthroplasty (TKA); a subset of which underwent in vivo kinematics and produced kinematic results that compare well with subjects in previous fluoroscopic studies that were deemed excellent in nature. In total, 153 subjects (180 knees) were enrolled in the prospective clinical study. TKAs were performed by three surgeons at three North American centers. Ten subjects were randomly chosen and evaluated under fluoroscopic surveillance. Average active flexion increased from 113.3 (SD=16.6) degrees before surgery to 118.3 (SD=9.9) degrees 12-months post-operatively. American Knee Society (AKS) function score increased from an average of 57.6 (SD=18.8) points pre-operatively to 85.3 (SD=16.6) points 12-months post-operatively. For the kinematic subset, post-operative weight-bearing flexion was 115.9 (SD=8.4),while subjects achieved an average posterior femoral rollback of their lateral condyle of -5.4mm. The average femorotibial axial rotation from full extension to maximum weight-bearing flexion was 3.9 degrees (SD=3.9). Certain kinematic parameters were deemed statistically significant when determining early post-operative clinical success.

Komistek RD; Murphy JA; O'Dell TL

2013-04-01

149

In vivo ultrasound-assisted tissue-engineered mandibular condyle: a pilot study in rabbits.  

UK PubMed Central (United Kingdom)

CONTEXT: Tissue engineering of mandibular articular condyles encounters many challenges, especially restoring adequate mechanical strength that is correlated to matrix production by the tissue-engineered mandibular condyles (TEMCs). Low-intensity pulsed ultrasound (LIPUS) has been shown to enhance cell expansion, differentiation, and matrix production by different cells. OBJECTIVE: This study evaluated effect of daily LIPUS treatment (in vitro and in a pilot in vivo study) for 4 weeks on matrix production and functional integration of the TEMCs in rabbits. METHODS: Bone marrow stromal cells were isolated from the femoral bones of skeletally mature New Zealand rabbits, expanded, and differentiated into chondrogenic and osteogenic lineages. Animals employed in the in vivo study were divided into four groups: (1) TEMCs and LIPUS treatment; (2) TEMCs without LIPUS treatment; (3) empty scaffold and LIPUS treatment, and (4) empty scaffolds without LIPUS treatment. RESULTS: In vitro results showed that LIPUS enhanced chondrogenic and osteogenic differentiation of bone marrow stromal cells. The in vivo study showed that LIPUS led to better structural formation (namely, new osteogenic and chondrogenic tissue formation) and integration of the newly formed tissues and original condylar bone than those without LIPUS treatment. LIPUS resulted in a small amount of tissue regeneration in the empty scaffolds, whereas empty scaffolds without LIPUS treatment showed no signs of repair. CONCLUSIONS: The preliminary results of this pilot study suggest that LIPUS can enhance TEMCs both in vitro and in vivo.

El-Bialy T; Uludag H; Jomha N; Badylak SF

2010-12-01

150

Bilateral condyle fracture of tibial insert in mobile bearing total knee arthroplasty.  

UK PubMed Central (United Kingdom)

We report a case of polyethylene insert breakage in a 45-year-old man after 3.5years of cruciate retaining type mobile bearing total knee arthroplasty (TKA). Interstingly, both condyles of the polyethylene insert have fractured. The visual assessment done by stereoscopic microscope in the investigation report suggested that the fracture propagation was a result of cyclic loading and that the fracture was from the articular surface as a result of tibio-femoral and anteroposterior shear loading. The initial flexion-extension gap mismatch and/or specific Asian habits like kneeling or deep knee bending could have been the possible factors for over-stress for the insert causing this complication. After replacement of the broken insert and modification for daily activity preventing deep knee flexion, the patient obtained complete relief of previous symptoms. It remains unclear whether insert breakage was secondary to polyethylene insufficient design or to the polyethylene material fracture propagation.

Yoon JR; Jeong HI; Oh KJ; Yang JH

2013-01-01

151

Bilateral bifid mandibular condyles diagnosed with three-dimensional reconstruction.  

UK PubMed Central (United Kingdom)

Bifid mandibular condyles (BMCs) are rare anomalies. The overwhelming majority of prior reports described their predominantly unilateral occurrence diagnosed by panoramic radiography. We present an even rarer case of bilateral BMC initially identified by panoramic radiography and confirmed with colour-enhanced three-dimensional CT. These images substantiate the theory that the secondary condyles arise from the neck of the mandible (Lopez-Lopez et al. Bifid condyle: review of the literature of the last 10 years and report of two cases. Cianio 2010; 28: 136-140).

Tanner JM; Friedlander AH; Chang TI

2012-12-01

152

Bilateral bifid mandibular condyles diagnosed with three-dimensional reconstruction.  

Science.gov (United States)

Bifid mandibular condyles (BMCs) are rare anomalies. The overwhelming majority of prior reports described their predominantly unilateral occurrence diagnosed by panoramic radiography. We present an even rarer case of bilateral BMC initially identified by panoramic radiography and confirmed with colour-enhanced three-dimensional CT. These images substantiate the theory that the secondary condyles arise from the neck of the mandible (Lopez-Lopez et al. Bifid condyle: review of the literature of the last 10 years and report of two cases. Cianio 2010; 28: 136-140). PMID:22241877

Tanner, J M; Friedlander, A H; Chang, T I

2012-01-12

153

Posterior cruciate ligament removal contributes to abnormal knee motion during posterior stabilized total knee arthroplasty.  

UK PubMed Central (United Kingdom)

Abnormal anterior translation of the femur on the tibia has been observed in mid flexion (20-60 degrees ) following posterior stabilized total knee arthroplasty. The underlying biomechanical causes of this abnormal motion remain unknown. The purpose of this study was to isolate the effects of posterior cruciate ligament removal on knee motion after total knee arthroplasty. We posed two questions: Does removing the posterior cruciate ligament introduce abnormal anterior femoral translation? Does implanting a posterior stabilized prosthesis change the kinematics from the cruciate deficient case? Using a navigation system, we measured passive knee kinematics of ten male osteoarthritic patients during surgery after initial exposure, after removing the anterior cruciate ligament, after removing the posterior cruciate ligament, and after implanting the prosthesis. Passively flexing and extending the knee, we calculated anterior femoral translation and the flexion angle at which femoral rollback began. Removing the posterior cruciate ligament doubled anterior translation (from 5.1 +/- 4.3 mm to 10.4 +/- 5.1 mm) and increased the flexion angle at which femoral rollback began (from 31.2 +/- 9.6 degrees to 49.3 +/- 7.3 degrees). Implanting the prosthesis increased the amount of anterior translation (to 16.1 +/- 4.4 mm), and did not change the flexion angle at which femoral rollback began. Abnormal anterior translation was observed in low and mid flexion (0-60 degrees) after removing the posterior cruciate ligament, and normal motion was not restored by the posterior stabilized prosthesis.

Cromie MJ; Siston RA; Giori NJ; Delp SL

2008-11-01

154

Posterior cruciate ligament removal contributes to abnormal knee motion during posterior stabilized total knee arthroplasty.  

Science.gov (United States)

Abnormal anterior translation of the femur on the tibia has been observed in mid flexion (20-60 degrees ) following posterior stabilized total knee arthroplasty. The underlying biomechanical causes of this abnormal motion remain unknown. The purpose of this study was to isolate the effects of posterior cruciate ligament removal on knee motion after total knee arthroplasty. We posed two questions: Does removing the posterior cruciate ligament introduce abnormal anterior femoral translation? Does implanting a posterior stabilized prosthesis change the kinematics from the cruciate deficient case? Using a navigation system, we measured passive knee kinematics of ten male osteoarthritic patients during surgery after initial exposure, after removing the anterior cruciate ligament, after removing the posterior cruciate ligament, and after implanting the prosthesis. Passively flexing and extending the knee, we calculated anterior femoral translation and the flexion angle at which femoral rollback began. Removing the posterior cruciate ligament doubled anterior translation (from 5.1 +/- 4.3 mm to 10.4 +/- 5.1 mm) and increased the flexion angle at which femoral rollback began (from 31.2 +/- 9.6 degrees to 49.3 +/- 7.3 degrees). Implanting the prosthesis increased the amount of anterior translation (to 16.1 +/- 4.4 mm), and did not change the flexion angle at which femoral rollback began. Abnormal anterior translation was observed in low and mid flexion (0-60 degrees) after removing the posterior cruciate ligament, and normal motion was not restored by the posterior stabilized prosthesis. PMID:18464260

Cromie, Melinda J; Siston, Robert A; Giori, Nicholas J; Delp, Scott L

2008-11-01

155

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; Nilson Roberto Severino; Osmar Pedro Arbix Camargo; Tatsuo Aihara; Victor Marques de Oliveira; Roger Avakian

2012-01-01

156

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 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 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 (more) 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 PCL lesions, instability and pain were operated on by arthroscopy and evaluated according to the International Knee Documentation Committee (IKDC) and Lysholm scales. Posterior (more) 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.

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

2012-02-01

157

MR Imaging of a Posterior Root Tear of the Medial Meniscus: Diagnostic Accuracy of Various Tear Configurations and Associated Knee Abnormalities  

International Nuclear Information System (INIS)

[en] To evaluate the diagnostic accuracy of the various tear configurations in a medial meniscal posterior horn root tear and assess whether any correlation exists with other associated knee abnormalities in MR imaging. A retrospective review of 146 preoperative knee MR images were performed by one experienced musculoskeletal radiologist. The tear configuration and other abnormalities were evaluated. Sensitivity, specificity, and diagnostic accuracy of each configuration in the medial meniscal posterior horn root tear were calculated. A total of 48 medial meniscal posterior horn root tears including 38 full-thickness radial, 7 partial-thickness radial, and 3 complex tears were confirmed during arthroscopy. Overall, the sensitivity, specificity, and accuracy for the detection of medial meniscal posterior horn root tear were 92% (44/48), 99% (97/98), and 97% (141/146), respectively. For each tear configuration, sensitivity, specificity, and accuracy were 82% (31/38), 97% (105/108), and 93% (136/146) for full-thickness radial tears, respectively, and 43% (3/7), 94% (131/139), and 91% (134/146) for partial-thickness radial tears, respectively. The incidence of degenerative joint disease was 85% (41/48) for the tear group, revealing a strong association. In patients with a root tear and with degenerative joint disease, the incidence of high grade cartilage defects involving the medial femoral condyle was at 80% (33/41), compared to 56% (23/41) for the presence of medial meniscal extrusion. In contrast, a similar comparison of incidence for patients with no root tears but with degenerative joint disease was at 68% (17/25) and 26% (8/31), respectively. MR imaging is very sensitive for the detection of medial meniscal root tears, but has reduced the accuracy with regard to each tear configuration. Medial meniscal root tears showed a strong association with degenerative joint disease. High grade cartilage defects of the medial femoral condyle and medial meniscal extrusions also reveal a strong association with medial meniscal root tears

2010-01-01

158

Femoral tunnel length in primary anterior cruciate ligament reconstruction using an accessory medial portal.  

UK PubMed Central (United Kingdom)

PURPOSE: The purpose of this study was to evaluate tunnel length during independent femoral tunnel drilling using an accessory medial portal with the knee in maximal hyperflexion, and correlate the tunnel length and flexion angle with anthropometric data. METHODS: During a 1-year period, 106 consecutive patients undergoing primary anterior cruciate ligament (ACL) reconstruction were included in the study. All patients underwent independent femoral tunnel drilling using an accessory medial portal with maximal knee hyperflexion. Tunnel length and maximal intraoperative knee flexion angles were measured. Additionally, height, weight, and body mass index (BMI), plus the width and depth of the lateral femoral condyle (LFC), were recorded to correlate with tunnel length and knee flexion angles. RESULTS: Average tunnel length was 37.0 ± 3.3 mm (range, 26 to 45), with all but one tunnel greater than 30 mm. Average knee flexion angle was 134.4 ± 5.0° (range, 122° to 147°). Height (r = 0.5, P < .001) and weight (r = 0.33, P = .001), but not BMI (r = 0.14, P = .17), correlated positively with tunnel length. Width (r = 0.46, P < .001) and depth (r = 0.38, P < .001) of the LFC also correlated positively with tunnel length. Knee flexion angle was not correlated with tunnel length (r = -0.09, P = .39) or width (r = -0.04, P = .7) and depth (r = -0.01, P = .91) of the LFC. Knee flexion angle was negatively correlated with weight (r = -0.44, P < .001) and BMI (r = -0.46, P < .001). CONCLUSIONS: Using an accessory medial portal for independent femoral tunnel drilling, with maximal knee hyperflexion, in ACL reconstruction consistently produced tunnel lengths greater than 30 mm with no posterior wall fractures. Tunnel lengths tend to be longer with increasing patient height, mass, and larger LFC dimensions. Maximum knee flexion angle achieved intraoperatively tends to be less for patients with increasing weight and BMI. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Tompkins M; Milewski MD; Carson EW; Brockmeier SF; Hamann JC; Hart JM; Miller MD

2013-02-01

159

The patella in total knee replacement: technical aspects on the femoral side.  

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The influence of femoral component positioning on patellar tracking is critical. The various possibilities of modifying the position of the femoral component relative to the distal femoral epiphysis are analyzed, and the ideal positioning in the medio-lateral, antero-posterior, and proximal-distal d...

Poilvache, Pascal

160

Theoretical risk of anterior femoral cortex notching in total knee arthroplasty using a navigation system.  

UK PubMed Central (United Kingdom)

Two important requirements for navigation systems in total knee arthroplasty (TKA), perpendicular cut from the distal femoral condyle to the femoral mechanical axis and prevention of notching of the anterior femoral cortex, might be difficult to meet simultaneously. The potential risk of notching was investigated using three-dimensional (3D) computed tomography data of 50 entire lower extremities of 50 female Japanese candidates for TKA and a 3D template system. Navigation systems for TKA carry the potentially higher risk of notching of the anterior femoral cortex (34% to 51%) than conventional technique (11%) (P<0.001). More anterior setting of the reference point for navigation systems on the distal femur and more external setting of the femoral component were risk factors for notching (P<0.001).

Minoda Y; Watanabe K; Iwaki H; Takahashi S; Fukui M; Nakamura H

2013-10-01

 
 
 
 
161

Postoperative femoral component rotation and femoral anteversion after total knee arthroplasty in patients with distal femoral deformity.  

UK PubMed Central (United Kingdom)

We asked whether total knee arthroplasty (TKA) in patients with distal femoral deformity (DFD) would change femoral component rotation (FCR) and investigated the correlation between DFD and femoral anteversion (FA). 75 patients were divided into two groups according to the preoperative posterior condylar angle (PCA); group A without DFD (PCA<7°), group B with DFD (PCA>7°). We evaluated the different angles on the CT scan: (1) PCA, (2) angle between the line which is perpendicular to the Whiteside's line and PCL (WLP), and (3) FA. The mean FCRs were external rotation of 0.21°+2.75° in group A and internal rotation of 4.48°+2.51° in group B (P=0.001). The mean preoperative and postoperative FAs were similar in group A but were significantly different in group B (P=0.035). DFD resulted in excessive internal rotation of the femoral component. There was a secondary decrease in FA in patients with DFD.

Lim HC; Bae JH; Kim SJ

2013-08-01

162

Bone changes of mandibular condyle using cone beam computed tomography  

Energy Technology Data Exchange (ETDEWEB)

To assess bone changes of mandibular condyle using cone beam computed tomography (CBCT) in temporomandibualr disorder (TMD) patients. 314 temporomandibular joints (TMJs) images of 163 TMD patients were examined at the Department of Oral and Maxillofacial Radiology, Chonbuk National University. The images were obtained by PSR9000N (Asahi Roentgen Co., Japan) and reconstructed by using Asahivision software (Asahi Roentgen Co., Japan). The CBCT images were examined three times with four weeks interval by three radiologists. Bone changes of mandibular condyle such as flattening, sclerosis, erosion and osteophyte formation were observed in sagittal, axial, coronal and 3 dimensional images of the mandibular condyle. The statistical analysis was performed using SPSS 12.0. Intra-and interobserver agreement were performed by 3 radiologists without the knowledge of clinical information. Osteopathy (2.9%) was found more frequently on anterior surface of the mandibular condyle. Erosion (31.8%) was found more frequently on anterior surface of the mandibular condyle. The intraobserver agreement was good to excellent (k=0.78{sub 0}.84), but interobserver agreement was fair (k=0.45). CBCT can provide high qualified images of bone changes of the TMJ with axial, coronal and 3 dimensional images.

Lee, Ji Un; Kim, Hyung Seop; Song, Ju Seop; Kim, Kyoung A; Koh, Kwang Joon [Chonbuk National Univ., Chonju (Korea, Republic of)

2007-09-15

163

Osteochondroma of mandibular condyle: A clinic-radiographic correlation.  

UK PubMed Central (United Kingdom)

Osteochondroma (OC) of temporo mandibular joint is a rare, slow growing, benign tumor that causes a progressive enlargement of the condyle, usually resulting in facial asymmetry, temporo mandibular joint (TMJ) dysfunction, limited mouth opening and malocclusion. Pain is rarely associated with this tumor. OC is composed of cartilaginous and osseous tissues. Radiographically, there is unilaterally enlarged condyle usually with an exophytic outgrowth of the tumor from the condylar head. We present a rare case of osteochondroma of right mandibular condyle in a 45-year-old male who reported with painless swelling over TMJ area and progressive limited mouth opening. Panoramic radiograph and computed tomography (CT) was performed for better evaluation of the pathological condition. This paper describes the clinico-radiographic features and differential diagnosis of OC.

More CB; Gupta S

2013-07-01

164

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

Energy Technology Data Exchange (ETDEWEB)

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

165

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

International Nuclear Information System (INIS)

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.

1995-01-01

166

Ultrasonographic evaluation of the femoral cartilage thickness in patients with systemic lupus erythematosus.  

UK PubMed Central (United Kingdom)

Systemic lupus erythematosus (SLE) is a multisystem chronic inflammatory disease with a broad spectrum of clinical and serological manifestations. Although articular involvement is known in SLE, articular cartilage has not been studied before. Therefore, in this study, we have evaluated the femoral cartilage by using ultrasonography. Twenty-nine SLE patients (5 M, 24 F) with a mean age of 37.93 ± 10.66 years and mean disease duration of 3.69 ± 3.24 years and 29 age-, gender- and body mass index-matched healthy subjects were enrolled. Demographic and clinical characteristics of the patients were recorded. The thickness of the femoral articular cartilage was measured by using a 7- to 12-MHz linear probe. Three mid-point measurements were taken from each knee; from right lateral condyle, right intercondylar area (RIA), right medial condyle (RMC), left medial condyle, left intercondylar area (LIA) and left lateral condyle (LLC). Although SLE patients had thicker femoral cartilage values than those of the control group at all measurement sites, the differences were not statistically significant (all p > 0.05). Twenty-two patients (75.9 %) were using corticosteroids, and when those patients were compared with their healthy controls, the difference reached statistical significance at RIA (p = 0.022), LIA (p = 0.059) and LLC (p = 0.029). We found that SLE patients seem to have thicker femoral cartilage values and that this increase could be related with corticosteroid treatment. In addition to studies that have shown the favorable effects of corticosteroids on chondrogenesis, further studies are needed to clarify the scenario in SLE patients.

Kaya A; Kara M; Tiftik T; Tezcan ME; Öztürk MA; Ak?nc? A; Özçakar L

2013-04-01

167

TMJ tissue engineering : From the disc to condyle  

Digital Repository Infrastructure Vision for European Research (DRIVER)

The field of TMJ tissue engineering is blossoming, a field that was onnce far behind orthopaedic tissue engineering is rapidly gaining ground. Both TMJ disc and TMJ condyle tissue engineering efforts present unique challenges and will ultimiately be necessary to regenerate TMJs for patients sufferin...

Detamore, Michael S.

168

Occipital condyle fracture and ligament injury: imaging by CT  

Energy Technology Data Exchange (ETDEWEB)

The true incidence of fracture of the occipital condyles is unknown. It may be associated with instability at the craniocervical joint. CT is the modality of choice for the demonstration of these fractures, but its use for imaging of the associated ligament injury has not been reported. In order to demonstrate normal anatomy, occipital condyle fracture and ligament injury, and to estimate the incidence of this lesion, 21 children and young adults with high-energy blunt craniocervical injury were examined prospectively. Thin-slice, axial, contiguous, CT was performed from the base of C2 to above the foramen magnum. Bone and soft tissue windows and coronal, sagittal, and curvilinear 2D reconstructions were performed. Five occipital condyle fractures were identified in four patients (19 %), with demonstration of alar ligament injury in two cases and local hematoma in one. In four, artifacts or rotation precluded assessment of ligaments. In all remaining cases normal bone and ligament anatomy was demonstrated. Fracture of the occipital condyles following craniocervical injury is not uncommon in children and young adults. Normal bone and ligament anatomy and pathology can be safely and clearly demonstrated in seriously injured patients and others using this CT technique. Increased awareness of this entity and a low threshold for performing CT should avoid the potentially serious consequences of a missed diagnosis. (orig.). With 8 figs., 2 tabs.

Bloom, A.I. [Department of Radiology, Hadassah University Hospital, Jerusalem (Israel); Neeman, Z. [Department of Radiology, Hadassah University Hospital, Jerusalem (Israel); Floman, Y. [Department of Orthopedic Surgery, Hadassah University Hospital, Jerusalem (Israel); Gomori, J. [Department of Radiology, Hadassah University Hospital, Jerusalem (Israel); Bar-Ziv, J. [Department of Radiology, Hadassah University Hospital, Jerusalem (Israel)

1996-11-01

169

Oligo[poly(ethylene glycol)fumarate] hydrogel enhances osteochondral repair in porcine femoral condyle defects.  

UK PubMed Central (United Kingdom)

BACKGROUND: Management of osteochondritis dissecans remains a challenge. Use of oligo[poly(ethylene glycol)fumarate] (OPF) hydrogel scaffold alone has been reported in osteochondral defect repair in small animal models. However, preclinical evaluation of usage of this scaffold alone as a treatment strategy is limited. QUESTIONS/PURPOSES: We therefore (1) determined in vitro pore size and mechanical stiffness of freeze-dried and rehydrated freeze-dried OPF hydrogels, respectively; (2) assessed in vivo gross defect filling percentage and histologic findings in defects implanted with rehydrated freeze-dried hydrogels for 2 and 4 months in a porcine model; (3) analyzed highly magnified histologic sections for different types of cartilage repair tissues, subchondral bone, and scaffold; and (4) assessed neotissue filling percentage, cartilage phenotype, and Wakitani scores. METHODS: We measured pore size of freeze-dried OPF hydrogel scaffolds and mechanical stiffness of fresh and rehydrated forms. Twenty-four osteochondral defects from 12 eight-month-old micropigs were equally divided into scaffold and control (no scaffold) groups. Gross and histologic examination, one-way ANOVA, and one-way Mann-Whitney U test were performed at 2 and 4 months postoperatively. RESULTS: Pore sizes ranged from 20 to 433 ?m in diameter. Rehydrated freeze-dried scaffolds had mechanical stiffness of 1 MPa. The scaffold itself increased percentage of neotissue filling at both 2 and 4 months to 58% and 54%, respectively, with hyaline cartilage making up 39% of neotissue at 4 months. CONCLUSIONS: Rehydrated freeze-dried OPF hydrogel can enhance formation of hyaline-fibrocartilaginous mixed repair tissue of osteochondral defects in a porcine model. CLINICAL RELEVANCE: Rehydrated freeze-dried OPF hydrogel alone implanted into cartilage defects is insufficient to generate a homogeneously hyaline cartilage repair tissue, but its spacer effect can be enhanced by other tissue-regenerating mediators.

Hui JH; Ren X; Afizah MH; Chian KS; Mikos AG

2013-04-01

170

Anatomical posterior cruciate ligament transplantation: a biomechanical analysis.  

UK PubMed Central (United Kingdom)

BACKGROUND: Although current techniques of posterior cruciate ligament reconstruction may successfully stabilize the posterior cruciate ligament-deficient knee, no studies have demonstrated restoration of intact-knee kinematics. HYPOTHESIS: Posterior cruciate ligament transplantation will successfully restore posterior stability and kinematics to the posterior cruciate ligament-deficient knee. STUDY DESIGN: Controlled laboratory study. METHODS: Seven pairs (donor/recipient) of size-matched cadaveric knees underwent a novel technique for posterior cruciate ligament transplantation. The grafts were fixed at the femoral origin and tibial insertion using an inlay technique with rigid fixation. The knees were tested in the intact (intact group), posterior cruciate ligament-deficient (deficient group), and posterior cruciate ligament-transplanted (transplant group) states. A 3-dimensional electromagnetic tracking system during an active knee extension and passive knee flexion maneuver was used to quantify kinematics, specifically looking at femoral rollback. KT ligament arthrometry was used to quantify posterior stability at the quadriceps neutral angle (70 degrees ). RESULTS: For femoral rollback, the intact versus deficient groups was significantly different (P = .045) as was deficient versus transplant groups (P = .008) but not intact versus transplant groups. Similar differences were noted with the measurements of posterior stability (P < .001). Total posterior laxity between the intact versus deficient groups was significantly different (means, 1.32 mm vs 11.1 mm; P < .0001), as was deficient versus transplant groups (means, 11.1 mm vs 2.04 mm; P < .126) but not intact versus transplant groups. CONCLUSION: In a posterior cruciate ligament-deficient cadaveric model, we demonstrated the technical feasibility and efficacy of posterior cruciate ligament transplantation for restoring femoral rollback and posterior stability at the quadriceps neutral angle. CLINICAL RELEVANCE: Future studies in posterior cruciate ligament reconstruction should not only address stability but also restoration of normal knee kinematics in assessing the success of a given technique.

Davis DK; Goltz DH; Fithian DC; D'Lima D

2006-07-01

171

Topographical analysis of the femoral components of ex vivo total knee replacements.  

Science.gov (United States)

With greater numbers of primary knee replacements now performed in younger patients there is a demand for improved performance. Surface roughness of the femoral component has been proposed as a causative mechanism for premature prosthesis failure. Nineteen retrieved total knee replacements were analysed using a non-contacting profilometer to measure the femoral component surface roughness. The Hood technique was used to analyse the wear and surface damage of the matching ultra-high molecular weight polyethylene (UHMWPE) tibial components. All femoral components were shown to be up to 11× rougher after their time in vivo while 95 % showed a change in skewness, further indicating wear. This increase in roughness occurred relatively soon after implantation (within 1 year) and remained unchanged thereafter. Mostly, this roughness was more apparent on the lateral condyle than the medial. This increased femoral surface roughness likely led to damage of the UHMWPE tibial component and increased Hood scores. PMID:23160912

Scholes, Susan C; Kennard, Emma; Gangadharan, Rajkumar; Weir, David; Holland, Jim; Deehan, David; Joyce, Thomas J

2012-11-17

172

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

Directory of Open Access Journals (Sweden)

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; Scarvell Jennifer M; Buirski Graham; Woods Kevin R; Smith Paul N

2012-01-01

173

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

UK PubMed Central (United Kingdom)

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.

Kodama Y; Tanaka R; Kurokawa A; Ohnuki H; Sultana S; Hayashi T; Iizuka T; Takagi R

2013-08-01

174

SEXUAL DIMORPHISM OF MAXIMUM FEMORAL LENGTH  

Directory of Open Access Journals (Sweden)

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; Singel T C; Akbari V J; Dangar K P; Tank K C; Patel M P

2011-01-01

175

Characterization of initial microfracture defects in human condyles.  

Science.gov (United States)

Microfracture (MFX) is a cartilage repair technique that depends on cell migration from marrow-rich trabecular bone cavities into the cartilage lesion. This study tested the hypothesis that MFX awls with distinct geometry generate different hole shapes and variable bone marrow access in condyles with Grade III to IV lesions. Lateral and medial condyles from total knee arthroplasty (N = 24 male and female patients, 66 ± 9 years) were systematically microfractured ex vivo to 2 and 4 mm deep and the bone holes analyzed by micro-computed tomography. Subchondral bone in lesional condyles showed different degrees of sclerosis up to 2 mm deep ("porous," sclerotic, extremely dense). MFX holes ranged from 1.1 to 2.0 mm in diameter, and retained the awl shape with evidence of slight bone elastic rebound and bone compaction lining the holes that were increased by wider awl diameter and deeper MFX. Marrow access was significantly diminished by sclerosis for all three awls, with an average marrow access varying from 70% (nonlesional bone) to 40% (extremely dense bone). This study revealed that subchondral bone sclerosis can reach a critical limit beyond which MFX creates bone compaction and fissures instead of marrow access. PMID:23529699

Hoemann, Caroline D; Gosselin, Yoann; Chen, Hongmei; Sun, Jun; Hurtig, Mark B; Carli, Alberto; Stanish, William D

2013-03-25

176

Combined autologous chondrocyte implantation (ACI) with supra-condylar femoral varus osteotomy, following lateral growth-plate damage in an adolescent knee: 8-year follow-up  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract We report the 8-year clinical and radiographic outcome of an adolescent patient with a large osteochondral defect of the lateral femoral condyle, and ipsilateral genu valgum secondary to an epiphyseal injury, managed with autologous chondrocyte implantation (ACI) and supracondylar re-alignment femoral osteotomy. Long-term clinical success was achieved using this method, illustrating the effective use of re-alignment osteotomy in correcting mal-alignment of the knee, protecting the ACI graft site and providing the optimum environment for cartilage repair and regeneration. This is the first report of the combined use of ACI and femoral osteotomy for such a case.

Vijayan Sridhar; Bentley George

2011-01-01

177

Increased femoral cartilage thickness in patients with Klinefelter syndrome.  

Science.gov (United States)

The objective of this study was to determine femoral cartilage thickness (FCT) in patients with Klinefelter syndrome (KS), which is the most common sex chromosome disorder in men with varying degrees of androgen deficiency. This cross-sectional controlled study was conducted in a tertiary care center. Participants were 33 male patients (mean age = 36.2 years) with KS and 35 aged-matched healthy male controls (mean age = 32.9 years). Femoral condyle cartilage was measured by ultrasonography at three locations in each knee. Total testosterone, estradiol, sex hormone binding globulin, free androgen index, bioavailable testosterone, and albumin levels were measured. Femoral cartilage of patients at right and left knee lateral (3.03 and 2.99 mm), mid (3.81 and 3.74 mm), and medial (3.01 and 3.20 mm) were statistically thicker than in controls (right and left knee lateral 2.29 and 2.36 mm, mid 2.64 and 2.53 mm, medial 2.39 and 2.32 mm, respectively, p < .001). There was no significant correlation between FCT and sex hormones. In conclusion, patients with KS had thicker femoral cartilage. Relatively low testosterone levels in these patients and altered estrogen metabolism may hypothetically explain increased cartilage thickness in these patients. PMID:22954555

Inci, Mehmet; Akgul, Ozgur; Baydilli, Numan; Ekmekcioglu, Oguz; Ozgöçmen, Salih

2012-09-06

178

Increased femoral cartilage thickness in patients with Klinefelter syndrome.  

UK PubMed Central (United Kingdom)

The objective of this study was to determine femoral cartilage thickness (FCT) in patients with Klinefelter syndrome (KS), which is the most common sex chromosome disorder in men with varying degrees of androgen deficiency. This cross-sectional controlled study was conducted in a tertiary care center. Participants were 33 male patients (mean age = 36.2 years) with KS and 35 aged-matched healthy male controls (mean age = 32.9 years). Femoral condyle cartilage was measured by ultrasonography at three locations in each knee. Total testosterone, estradiol, sex hormone binding globulin, free androgen index, bioavailable testosterone, and albumin levels were measured. Femoral cartilage of patients at right and left knee lateral (3.03 and 2.99 mm), mid (3.81 and 3.74 mm), and medial (3.01 and 3.20 mm) were statistically thicker than in controls (right and left knee lateral 2.29 and 2.36 mm, mid 2.64 and 2.53 mm, medial 2.39 and 2.32 mm, respectively, p < .001). There was no significant correlation between FCT and sex hormones. In conclusion, patients with KS had thicker femoral cartilage. Relatively low testosterone levels in these patients and altered estrogen metabolism may hypothetically explain increased cartilage thickness in these patients.

Inci M; Akgul O; Baydilli N; Ekmekcioglu O; Ozgöçmen S

2013-01-01

179

Magnetic resonance imaging findings of true bifid mandibular condyle with duplicated mandibular fossa.  

UK PubMed Central (United Kingdom)

Bifid mandibular condyle (BMC) is a rare asymptomatic morphological alteration with no predilection for age group or gender. Its morphology varies from a shallow groove to two condylar heads with separate necks, oriented mediolaterally or anteroposteriorly. This report describes an unusual case of anteroposterior bifid condyle in a 39-year-old female patient with the main complaint of mouth-opening limitation and a deviation of the mandible to the left side. Magnetic resonance imaging (MRI) findings revealed a bifid condyle on the left side and duplicated mandibular fossa, with the articular disc over the anterior head. The MRI images in the open-mouth position revealed minimal movement of the condyle. Despite the increased number of mediolateral bifid mandibular condyle cases described in the literature, none of previously reported cases of BMC included an anteroposterior bifid condyle case with two distinct mandibular fossa.

Melo SL; Melo DP; Oenning AC; Haiter-Neto F; Almeida SM; Campos PS

2012-07-01

180

Detection of bifid mandibular condyle by panoramic radiography and cone beam computed tomography  

Scientific Electronic Library Online (English)

Full Text Available Abstract in english AIM: To compare panoramic radiography and cone beam computed tomography (CBCT) in the diagnosis of bifid mandibular condyle. METHODS: The sample consisted of 350 individuals who underwent panoramic radiography and CBCT. In the panoramic radiographs and CBCT images, the presence or absence of bifid mandibular condyle was determined. RESULTS: Presence of bifid mandibular condyle was detected in four cases (1.1%). In all cases, the relation of one condylar process to the oth (more) er was mediolateral and history of trauma was reported. None of the individuals had symptoms. In two cases, panoramic radiography did not reveal the presence of bifid mandibular condyle. CONCLUSIONS: Initial screening for bifid mandibular condyle can be performed by panoramic radiography; however, CBCT images can reveal morphological changes and the exact orientation of the condyle heads.

Neves, Frederico Sampaio; Ramírez-Sotelo, Laura Ricardina; Roque-Torres, Gina; Barbosa, Gabriella Lopes Resende; Haiter-Neto, Francisco; Freitas, Deborah Queiroz de

2013-03-01

 
 
 
 
181

Less femoral lift-off and better femoral alignment in TKA using computer-assisted surgery.  

UK PubMed Central (United Kingdom)

PURPOSE: A comparison has been made between navigation-assisted and conventional measured resection total knee arthroplasty (TKA), under the hypothesis that navigation assistance would improve the precision and consistency of component alignment and femoral component rotation. METHODS: The following radiographic parameters were measured: mechanical femorotibial angle, coronal and sagittal component angle, and femoral component rotation. Femoral condylar lift-off was checked by axial radiographs, and thresholds for outliers were set at 1.0 mm. RESULTS: Clinical results obtained using Knee Society and Hospital for Special Surgery systems were not statistically different. The mean mechanical femorotibial angle was 2.2° (SD: 0.9) in the conventional group and 1.7° (SD: 0.7) in navigation group (p = 0.001). The mean coronal femoral component angle was 89.2° (SD: 2.2) in conventional group and 90.4° (SD: 1.8) in navigation group (p = 0.006). The mean transepicondylar-posterior condylar axis angle was 1.7° (SD: 0.9) in conventional group and 1.2° (SD: 0.5) in navigation group (p = 0.008). Femoral condylar lift-off greater than 1 mm occurred more frequently (p = 0.000) in conventional group. CONCLUSION: Coronal plane stability and precision of femoral component rotation were impacted by navigation system. The use of a navigation system with measured resection TKA can help optimize coronal stability and parallel component position. LEVEL OF EVIDENCE: Retrospective case control study, Level IV.

Kim SH; Lee HJ; Jung HJ; Lee JS; Kim KS

2013-10-01

182

Posttraumatic bifid and trifid mandibular condyle with bilateral temporomandibular joint ankylosis.  

UK PubMed Central (United Kingdom)

Trifid mandibular condyle is an exceedingly rare entity with only 5 cases reported to date. The etiology of the disorder is unknown, though like bifid mandibular condyle, a correlation with prior trauma is usually seen. We present a case of a 6-year-old child who presented with severe restriction of movements at the temporomandibular joint, with a history of trauma 2 years back. Imaging revealed bilateral temporomandibular joint ankylosis with trifid and bifid mandibular condyles.

Jha A; Khalid M; Sahoo B

2013-03-01

183

Posttraumatic bifid and trifid mandibular condyle with bilateral temporomandibular joint ankylosis.  

Science.gov (United States)

Trifid mandibular condyle is an exceedingly rare entity with only 5 cases reported to date. The etiology of the disorder is unknown, though like bifid mandibular condyle, a correlation with prior trauma is usually seen. We present a case of a 6-year-old child who presented with severe restriction of movements at the temporomandibular joint, with a history of trauma 2 years back. Imaging revealed bilateral temporomandibular joint ankylosis with trifid and bifid mandibular condyles. PMID:23524825

Jha, Abhishek; Khalid, Mohd; Sahoo, Biswajit

2013-03-01

184

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

2008-01-01

185

Foramen magnum meningiomas: To drill or not to drill the occipital condyle? A series of 12 patients.  

UK PubMed Central (United Kingdom)

BACKGROUND: Despite the development of microsurgery and cranial base techniques, the surgical management of Foramen Magnum Meningiomas (FMM) continues to be a technical challenge to neurosurgeons. Controversy concerning the utility of systematic condyle drilling for approaching FMM has been raised. Our aim was to describe the surgical technique, analyze its safety, and the postoperative outcome in 12 consecutive FMM patients. METHODS: From 1986 to 2011, 12 patients with FMM underwent operations in the Department of Neurosurgery at Servidores do Estado Hospital and in a private clinic. All patients were operated using a standard suboccipital craniectomy, preserving the occipital condyle, opening of the Foramen Magnum, and ipsilateral removal of the posterior arch of C1. RESULTS: There was no operative mortality, nine patients achieved Glasgow Outcome Scale 4 or 5. Condylar resection was not deemed necessary in any case. Gross total resection was achieved in nine patients. After surgery, four patients developed lower cranial nerve weakness. There was no significant postoperative complication in the remaining patients. The average follow-up is 8.2 years. CONCLUSION: The vast majority of FMM can be safely removed with a retrocondylar lateral suboccipital approach without condylar resection, using meticulous microsurgical techniques.

Lynch JC; Temponi V; Emmerich JC; Pereira CE; Gonçalves MB

2013-01-01

186

Foramen magnum meningiomas: To drill or not to drill the occipital condyle? A series of 12 patients  

Science.gov (United States)

Background: Despite the development of microsurgery and cranial base techniques, the surgical management of Foramen Magnum Meningiomas (FMM) continues to be a technical challenge to neurosurgeons. Controversy concerning the utility of systematic condyle drilling for approaching FMM has been raised. Our aim was to describe the surgical technique, analyze its safety, and the postoperative outcome in 12 consecutive FMM patients. Methods: From 1986 to 2011, 12 patients with FMM underwent operations in the Department of Neurosurgery at Servidores do Estado Hospital and in a private clinic. All patients were operated using a standard suboccipital craniectomy, preserving the occipital condyle, opening of the Foramen Magnum, and ipsilateral removal of the posterior arch of C1. Results: There was no operative mortality, nine patients achieved Glasgow Outcome Scale 4 or 5. Condylar resection was not deemed necessary in any case. Gross total resection was achieved in nine patients. After surgery, four patients developed lower cranial nerve weakness. There was no significant postoperative complication in the remaining patients. The average follow-up is 8.2 years. Conclusion The vast majority of FMM can be safely removed with a retrocondylar lateral suboccipital approach without condylar resection, using meticulous microsurgical techniques.

Lynch, Jose Carlos; Temponi, Vicente; Emmerich, Joao Claudio; Pereira, Celestino Esteves; Goncalves, Mariangela Barbi

2013-01-01

187

Posterior acetabular arc angle of unstable posterior hip fracture-dislocation.  

UK PubMed Central (United Kingdom)

PURPOSE: Posterior hip fracture-dislocation needs stability evaluation. A previous study in the normal acetabulum has shown that the coronal posterior acetabular arc angle (PAAA) could be used to assess an unstable posterior hip fracture. Our study was designed to assess PAAA of unstable posterior hip fracture-dislocation and whether posterior acetabular wall fracture involves the superior acetabular dome. METHODS: Using coronal computed tomography (CT) of the acetabulum and 3D reconstruction of the lateral pelvis, we measured coronal, vertical PAAA and posterior acetabular wall depth of 21 unstable posterior hip fracture-dislocations and of 50 % normal contralateral acetabula. Posterior acetabular wall fracture was assessed to determine whether the fracture involved the superior acetabular dome and then defined as a high or low wall fracture using vertical PAAA in reference to the centroacetabulo-greater sciatic notch line. RESULTS: The coronal PAAA of unstable posterior hip fracture-dislocations and of 50 % of the posterior acetabular wall of normal the contralateral acetabulum were 54.48° (9.09°) and 57.43° (5.88°) and corresponded to 15.06 (4.39) and 15.61 (2.01) mm of the posterior acetabular wall without significant difference (p?>?0.05). The vertical PAAA of unstable posterior hip fracture-dislocation was 101.67° (20.44°). There were 16 high posterior acetabular wall fractures with 35.00 (16.18) vertical PAAA involving the acetabular dome and 5 low wall fractures. High posterior wall fractures resulted in four avascular necroses of the femoral head, three sciatic nerve injuries and one osteoarthritic hip. CONCLUSION: Coronal and vertical PAAA of unstable posterior hip fracture-dislocations were 54.48° and 101.67°. Vertical PAAA assesses high or low posterior acetabular wall fracture by referring to the centroacetabulo-greater sciatic notch line. High posterior wall fracture seems to be the most frequent and is involved with many complications.

Harnroongroj T; Riansuwan K; Sudjai N; Harnroongroj T

2013-09-01

188

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  

Scientific Electronic Library Online (English)

Full Text Available 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 arteria femoral posterior a cateterismo diagnóstico o terapéutico. Resultados: Se incluyeron 100 pacientes en el grupo de compresión con compresor (grupo uno) y 112 d (more) e forma manual (grupo dos). La falla para lograr hemostasia se presentó en 48% del grupo uno vs 19.7% en el grupo dos (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 4 (more) 8% of patients in group 1 and 19.7% in group two (p

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

2012-06-01

189

Femoral fractures in children.  

UK PubMed Central (United Kingdom)

PURPOSE OF REVIEW: Femoral fractures in children are the commonest children's fracture requiring hospitalization. They consume disproportionate amounts of healthcare resource. Advances in operative management have resulted in improved clinical and health economic outcomes. RECENT FINDINGS: This article describes 21st-century management of femoral fractures concentrating on recent advances. There is a clear trend to increased operative management in all femoral fractures with improved outcomes in the proximal femur and shaft. Crucially, advances in the treatment of both have led to a reduction in the rate of avascular necrosis of the femoral head. SUMMARY: Units treating paediatric fractures need access to specialist surgeons and equipment to treat the full range of femoral fractures and improve outcomes.

Brousil J; Hunter JB

2013-02-01

190

[Locked posterior dislocation of the hip: a case report].  

Science.gov (United States)

Impaction fractures of the femoral head occurring after anterior or posterior hip dislocations are well described. However, locked posterior hip dislocation resulting in sinking of the posterior acetabular rim into the femoral head has hitherto been undescribed. A 26-year-old male patient presented with complaints of severe pain in the left thigh and marked limitation in the movements of the left hip two weeks after an in-car crash. He could only walk with crutches. Shortly after the accident, he was examined at another center with physical examination and plain radiographies and was given bed rest and medications for pain relief. Computed tomography demonstrated the locked posterior hip by the impact of the posterior acetabular rim against the femoral head. At surgery, the posterior acetabular rim was embedded in the anteromedial surface of the femoral head resulting in an osteochondral impaction fracture with a penetration depth of 12 mm. Due to wide destruction to the cartilage surface, an uncemented bipolar hemiarthroplasty was performed. After 28 months of follow-up, he had no complaints and hip movements were painless with full range of motion. PMID:17483654

Esenkaya, Irfan; Elmali, Nurzat

2007-01-01

191

Osteonecrosis of the femoral head extending into the femoral neck.  

UK PubMed Central (United Kingdom)

Osteonecrosis of the femoral head (ONFH) is an ischemic disorder that can lead to femoral head collapse and secondary osteoarthritis. Although the condition is usually limited to the femoral head, we report a rare case of biopsy-proven ONFH extending into the femoral neck, which required hip replacement surgery. We emphasize the imaging features of this condition and briefly discuss its potential relevance.

Sakamoto Y; Yamamoto T; Motomura G; Sakamoto A; Yamaguchi R; Iwasaki K; Zhao G; Karasuyama K; Iwamoto Y

2013-03-01

192

[Distal femoral bypass under local anaesthesia].  

UK PubMed Central (United Kingdom)

INTRODUCTION: The aim of this article is to present our experience in performing distal femoral bypass under local anaesthesia for high risk patients. MATERIAL AND METHODS: Lower limb revascularisation surgery under local anaesthesia was performed on 8 patients in our centre between January and May 2010. The common characteristics of the patients were, advanced age, chronic ischaemic heart disease on antiplatelet treatment, and chronic obstructive pulmonary disease (COPD). RESULTS: All 8 patients (100%) tolerated the procedure well without having to resort to sedation or invasive anaesthetic procedures. The receiving artery was the posterior tibial in 6 cases (75%) and the popliteal and peroneal in 1 (12%). Early patency of the graft was achieved 7 patients and 1 had early thrombosis with a supracondylar amputation. The technique used was femoral-popliteal in 1 case, femoral-posterior tibial in 6 cases, and popliteal-peroneal in 1 case. The saphenous vein was the graft used, inverted in 1 patient (12%), and in situ in 7 (88%) with a 3mm BARD™ valvotomy. There were no post-operative complications as regards haemorrhage, infections or death. A minor amputation was performed on 3 patients (37%), and after a mean of 3 months (1-4 months) follow-up, 7 cases were free of major amputation. CONCLUSIONS: Revascularisation of the distal zone of the lower limbs can be safely and effectively performed using local anaesthesia, avoiding the risks of general anaesthesia and without the need to stop antiplatelet treatment. Anatomical problems (obesity) may limit the procedure.

Taboada Martín R; Glenn-Ray López V; Gutiérrez García F; Cassinello Martínez N

2012-08-01

193

ACL footprint size is correlated with the height and area of the lateral wall of femoral intercondylar notch.  

UK PubMed Central (United Kingdom)

PURPOSE: The purpose of this study was to reveal the correlation between the size of the native anterior cruciate ligament (ACL) footprint and the size of the lateral wall of femoral intercondylar notch. METHODS: Eighteen non-paired human cadaver knees were used. All soft tissues around the knee were resected except the ACL. The ACL was cut in the middle, and the femoral bone was cut at the most proximal point of the femoral notch. The ACL was carefully dissected, and the periphery of the ACL insertion site was outlined on both the femoral and tibial sides. An accurate lateral view of the femoral condyle and the tibial plateau was photographed with a digital camera, and the images were downloaded to a personal computer. The size of the femoral and tibial ACL footprints, length of Blumensaat's line, and the height and area of the lateral wall of femoral intercondylar notch were measured with Image J software (National Institution of Health). RESULTS: The sizes of the native femoral and tibial ACL footprints were 84 ± 25.3 and 144.7 ± 35.9 mm(2), respectively. The length of Blumensaat's line and the height and area of the lateral wall of femoral intercondylar notch were 29.4 ± 2.8 mm, 17.1 ± 2.7 mm, and 392.4 ± 86 mm(2), respectively. Both the height and the area of the lateral wall of femoral intercondylar notch were significantly correlated with the size of the ACL footprint on both the femoral and tibial sides. CONCLUSION: For clinical relevance, the height and area of the lateral wall of femoral intercondylar notch can be a predictor of native ACL size prior to surgery. However, the length of Blumensaat's line showed no significant correlation with native ACL size.

Iriuchishima T; Shirakura K; Yorifuji H; Aizawa S; Murakami T; Fu FH

2013-04-01

194

The posterior cruciate ligament in total knee arthroplasty.  

UK PubMed Central (United Kingdom)

The purpose of this study was to answer 2 questions: Does the posterior cruciate ligament (PCL) produce femoral rollback in a single-design, cruciate-sparing total knee arthroplasty (TKA)? Does the PCL prevent posterior tibial displacement when it is retained after a single-design, cruciate-sparing TKA? Knee kinematics and limits of motion were measured with the knees in the following states: (1) intact knee, (2) anterior cruciate-deficient knee, (3) PCL-retaining total knee of a single design (TKA), (4) PCL-retaining TKA with PCL cut, and (5) PCL-substituting TKA. Femoral rollback was then calculated from the above data. The results showed that the PCL was able to prevent posterior translation and maintain femoral rollback when it was preserved during TKA. Therefore, the PCL can be functional after TKA, in a single-design, cruciate-sparing TKA. When the PCL was cut, significant changes in knee kinematics were observed.

Sorger JI; Federle D; Kirk PG; Grood E; Cochran J; Levy M

1997-12-01

195

Slipped Capital Femoral Epiphysis  

Science.gov (United States)

... occurred through the growth plate. (Courtesy of John Killian, MD, Birmingham, AL) The condition is diagnosed based ... head through the growth plate. (Courtesy of John Killian, MD, Birmingham, AL) Fixing the femoral head with ...

196

Modular neck femoral stems.  

UK PubMed Central (United Kingdom)

Following the recall of modular neck hip stems in July 2012, research into femoral modularity will intensify over the next few years. This review aims to provide surgeons with an up-to-date summary of the clinically relevant evidence. The development of femoral modularity, and a classification system, is described. The theoretical rationale for modularity is summarised and the clinical outcomes are explored. The review also examines the clinically relevant problems reported following the use of femoral stems with a modular neck. Joint replacement registries in the United Kingdom and Australia have provided data on the failure rates of modular devices but cannot identify the mechanism of failure. This information is needed to determine whether modular neck femoral stems will be used in the future, and how we should monitor patients who already have them implanted. Cite this article: Bone Joint J 2013;95-B:1011-21.

Krishnan H; Krishnan SP; Blunn G; Skinner JA; Hart AJ

2013-08-01

197

Endoscopic approach to the ramus/condyle unit: Clinical applications.  

UK PubMed Central (United Kingdom)

PURPOSE: The purpose of this report is to describe use of an endoscopic technique for exposure of the mandibular ramus/condyle unit (RCU) to facilitate reconstructive jaw procedures. PATIENTS AND METHODS: This is a retrospective evaluation of 10 patients with diagnoses of idiopathic condylar resorption (n = 2), subcondylar fracture (n = 5), mandibular prognathism (n = 1), condylar hyperplasia (n = 1), and mandibular asymmetry (n = 1), who underwent endoscopic exposure of the RCU. RESULTS: All 10 patients had successful reconstruction of the RCU using the endoscopic approach. The procedures performed included the following: condylectomy (n = 5 sides), costochondral graft reconstruction (n = 4 sides), reduction of subcondylar fracture (n = 5 sides), and mandibular ramus osteotomy (n = 4 sides). Mean operating time was 84 minutes. No patients had marginal mandibular nerve weakness or other complications. CONCLUSION: This case series demonstrates the feasibility of endoscopic access to the RCU. The procedures can be performed with no increase in operative time and with minimal morbidity.

Troulis MJ; Kaban LB

2001-05-01

198

Rib reconstruction of the absent mandibular condyle in children.  

Science.gov (United States)

Objectives To describe pediatric costochondral graft reconstruction of the absent mandibular condyle and to report the short-term and long-term outcomes and complications associated with performing this procedure in young children. Study Design Case series with a retrospective chart review. Setting Pediatric otolaryngology clinic and tertiary children's hospital in a metropolitan area. Subjects and Methods All children treated for an absent mandibular condyle with a costochondral graft at Children's Hospitals and Clinics of Minnesota were identified from 2002 through 2011, and a retrospective chart review was performed. Results Ten patients aged 3 to 11 years were identified. The most common diagnosis, in 8 of 10 patients, was oculo-auriculo-vertebral syndrome. Three of the patients had a tracheostomy, of which 1 was decannulated following condylar reconstruction. Functional improvement, defined as improved symmetry, chewing, or better oral opening, was observed in 8 of 10 patients. Five patients have required no further surgeries to date, with a mean follow-up time of 3.9 years. Severe overgrowth of the graft was noted in 1 case, and partial or complete resorption of the graft was also noted in 3 cases. Overgrowth occurred after 5.7 years, whereas resorption occurred after an average of 2.5 years. Conclusions Costochondral grafts are an excellent surgical treatment option for children with severe mandibular malformations. Short-term results show particular improvement in function and mandibular alignment. The mean follow-up time with no revision surgery was substantial and indicates that rib grafting is a good addition to the armamentarium of treatment for this patient population. PMID:23585152

Goerke, Derek; Sampson, Daniel E; Tibesar, Robert J; Sidman, James D

2013-04-12

199

Rib reconstruction of the absent mandibular condyle in children.  

UK PubMed Central (United Kingdom)

Objectives To describe pediatric costochondral graft reconstruction of the absent mandibular condyle and to report the short-term and long-term outcomes and complications associated with performing this procedure in young children. Study Design Case series with a retrospective chart review. Setting Pediatric otolaryngology clinic and tertiary children's hospital in a metropolitan area. Subjects and Methods All children treated for an absent mandibular condyle with a costochondral graft at Children's Hospitals and Clinics of Minnesota were identified from 2002 through 2011, and a retrospective chart review was performed. Results Ten patients aged 3 to 11 years were identified. The most common diagnosis, in 8 of 10 patients, was oculo-auriculo-vertebral syndrome. Three of the patients had a tracheostomy, of which 1 was decannulated following condylar reconstruction. Functional improvement, defined as improved symmetry, chewing, or better oral opening, was observed in 8 of 10 patients. Five patients have required no further surgeries to date, with a mean follow-up time of 3.9 years. Severe overgrowth of the graft was noted in 1 case, and partial or complete resorption of the graft was also noted in 3 cases. Overgrowth occurred after 5.7 years, whereas resorption occurred after an average of 2.5 years. Conclusions Costochondral grafts are an excellent surgical treatment option for children with severe mandibular malformations. Short-term results show particular improvement in function and mandibular alignment. The mean follow-up time with no revision surgery was substantial and indicates that rib grafting is a good addition to the armamentarium of treatment for this patient population.

Goerke D; Sampson DE; Tibesar RJ; Sidman JD

2013-09-01

200

The heterogeneity in femoral neck structure and strength.  

Science.gov (United States)

Most measures of femoral neck strength derived using dual-energy X-ray absorptiometry or computed tomography (CT) assume the femoral neck is a cylinder with a single cortical thickness. We hypothesized that these simplifications introduce errors in estimating strength and that detailed analyses will identify new parameters that more accurately predict femoral neck strength. High-resolution CT data were used to evaluate 457 cross-sectional slices along the femoral neck of 12 postmortem specimens. Cortical morphology was measured in each cross-section. The distribution of cortical thicknesses was evaluated to determine whether the mean or median better estimated central tendency. Finite-element models were used to calculate the stresses in each cross-section resulting from the peak hip joint forces created during a sideways fall. The relationship between cortical morphology and peak bone stress along the femoral neck was analyzed using multivariate regression analysis. In all cross-sections, cortical thicknesses were non-normally distributed and skewed toward smaller thicknesses (p central tendency of cortical thickness was best estimated by the median, not the mean. Stress increased as the median cortical thickness decreased along the femoral neck. The median, not mean, cortical thickness combined with anterior-posterior diameter best predicted peak bone stress generated during a sideways fall (R(2) = 0.66, p < 0.001). Heterogeneity in the structure of the femoral neck determines the diversity of its strength. The median cortical thickness best predicted peak femoral neck stress and is likely to be a relevant predictor of femoral neck fragility. PMID:23197364

Kersh, Mariana E; Pandy, Marcus G; Bui, Quang M; Jones, Anthony C; Arns, Christoph H; Knackstedt, Mark A; Seeman, Ego; Zebaze, Roger Md

2013-05-01

 
 
 
 
201

The heterogeneity in femoral neck structure and strength.  

UK PubMed Central (United Kingdom)

Most measures of femoral neck strength derived using dual-energy X-ray absorptiometry or computed tomography (CT) assume the femoral neck is a cylinder with a single cortical thickness. We hypothesized that these simplifications introduce errors in estimating strength and that detailed analyses will identify new parameters that more accurately predict femoral neck strength. High-resolution CT data were used to evaluate 457 cross-sectional slices along the femoral neck of 12 postmortem specimens. Cortical morphology was measured in each cross-section. The distribution of cortical thicknesses was evaluated to determine whether the mean or median better estimated central tendency. Finite-element models were used to calculate the stresses in each cross-section resulting from the peak hip joint forces created during a sideways fall. The relationship between cortical morphology and peak bone stress along the femoral neck was analyzed using multivariate regression analysis. In all cross-sections, cortical thicknesses were non-normally distributed and skewed toward smaller thicknesses (p < 0.0001). The central tendency of cortical thickness was best estimated by the median, not the mean. Stress increased as the median cortical thickness decreased along the femoral neck. The median, not mean, cortical thickness combined with anterior-posterior diameter best predicted peak bone stress generated during a sideways fall (R(2) = 0.66, p < 0.001). Heterogeneity in the structure of the femoral neck determines the diversity of its strength. The median cortical thickness best predicted peak femoral neck stress and is likely to be a relevant predictor of femoral neck fragility.

Kersh ME; Pandy MG; Bui QM; Jones AC; Arns CH; Knackstedt MA; Seeman E; Zebaze RM

2013-05-01

202

Subchondral bone density distribution in the human femoral head  

International Nuclear Information System (INIS)

[en] 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 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

2012-01-01

203

[Giant cell tumor of temporal bone and mandibular condyle: a case report].  

UK PubMed Central (United Kingdom)

Giant cell tumor of bone (GCTB) seldom occurs in the head or face. This article reported a case that GCTB occurred simultaneously in the temporal bone and mandibular condyle, and analyzed their clinical and pathological features.

Li HT; Wang WJ; Zhu GD; Lai RQ

2010-08-01

204

Ossifying fibroma affecting the mandibular condyle: report of an uncommon case.  

UK PubMed Central (United Kingdom)

We describe the surgical management of an uncommon case of ossifying fibroma affecting the mandibular condyle. A condylectomy was performed with an immediate temporomandibular joint reconstruction by a total temporomandibular joint prosthesis.

Zavattero E; Garzino-Demo P; Berrone S

2013-07-01

205

Computed tomographic evaluation of femoral component rotation in total knee arthroplasty  

Science.gov (United States)

Background: Optimal femoral component rotational alignment in total knee arthroplasty (TKA) is crucial to establish a balanced knee reconstruction. Unbalanced knees can lead to instability, patellofemoral problems, persistent pain, stiffness, and generally poorer outcomes including early failure. Intraoperative techniques to achieve this optimal femoral component rotation include the use of the transepicondylar axis (TEA), the posterior-condylar-cut-parallel-to-the-tibial-cut (PCCPTC) technique and the anteroposterior axis technique (Whiteside's line). The purpose of this study was to compare the PCCPTC technique to the TEA technique using computed tomography (CT) scans to assess femoral component rotational alignment. Materials and Methods: This study used postoperative CT scans to compare the degree of femoral component rotation obtained with the use of PCCPTC technique and the TEA. The femoral component rotation of 30 TKA was measured on postoperative CT scans the angle of deviation between the two lines radiographic trans-epicondylar axis (rTEA) and femoral prosthesis posterior condylar line (FPPCL) was determined. This angle represented the rotation of the femoral component relative to the true rTEA. Results: The degree of rotation measured 2.67 ± 1.11 degrees in the PCCPTC group and 5.60 ± 1.64 degrees in the TEA group. Conclusion: The use of the TEA technique for determining rotational alignment in TKR results in excessive external rotation of the femoral component compared to the PCCPTC technique.

Vaidya, Shrinand V; Gadhiya, Rajesh M; Bagaria, Vaibhav; Ranawat, Amar S; Ranawat, Chitranjan S

2013-01-01

206

Femoral graft bending angle and femoral tunnel geometry of transportal and outside-in techniques in anterior cruciate ligament reconstruction: an in vivo 3-dimensional computed tomography analysis.  

UK PubMed Central (United Kingdom)

PURPOSE: To compare femoral graft bending angles and femoral tunnel geometries between the transportal (TP) and outside-in (OI) techniques after anatomic double-bundle (DB) anterior cruciate ligament (ACL) reconstruction. METHODS: Thirty-nine patients underwent DB ACL reconstruction with the TP and OI techniques. They were randomized on the day of surgery to either the TP group (group I, 21 cases) or the OI group (group II, 18 cases). Femoral graft bending angle, femoral tunnel geometry, posterior wall breakage, and tunnel communication were assessed by computed tomography imaging with OsiriX imaging software (Pixmeo, Geneva, Switzerland). RESULTS: The mean anteromedial (AM) and posterolateral (PL) femoral graft bending angles of group II (97.3° ± 8.3° and 97.4° ± 8.6°, respectively) were significantly more acute than those of group I (108.2° ± 8.4° and 109.9° ± 8.8°, respectively) (P < .001). The mean AM femoral tunnel length of group II (34.3 ± 3.9 mm) was significantly longer than that of group I (31.9 ± 2.7 mm) (P = .02). However, the mean PL femoral tunnel lengths did not differ between groups. In 7 cases-4 cases (19.0%) in group I and 3 cases (16.6%) in group II-the femoral tunnel communication was found around the intra-articular aperture. Posterior wall breakage was observed in 5 cases (23.8%), which were all in AM femoral tunnels of group I. CONCLUSIONS: The OI technique resulted in more acute femoral graft bending angles (difference of 10.9° and 12.5° for AM and PL, respectively) and longer mean AM femoral tunnel lengths (difference of 2.4 mm) than the TP technique after anatomic DB ACL reconstruction, even though these small differences might be unlikely to be of clinical significance. Femoral tunnel communication was found in both groups, and posterior wall breakage was observed in AM femoral tunnels with the TP technique. LEVEL OF EVIDENCE: Level I, prospective randomized trial.

Kim JG; Wang JH; Lim HC; Ahn JH

2012-11-01

207

Ultrasonographic measurement of the distal femoral cartilage thickness in patients with unilateral transtibial amputation.  

UK PubMed Central (United Kingdom)

BACKGROUND: Lower limb amputation sometimes predisposes to degenerative secondary disorders. OBJECTIVES: To evaluate the distal femoral cartilage thicknesses of patients with unilateral transtibial amputations using ultrasound and to investigate the relationship between cartilage thickness and disease-related parameters. STUDY DESIGN: Cross-sectional study. METHODS: Twenty-four unilateral transtibial amputees (mean age: 46.4 ± 8.5 years, range: 28-60 years) were evaluated. Duration of prosthesis use (years) and daily walking time with prosthesis (hours) were recorded. Functional status was assessed by gate velocity (m/s), and 6-min walking distance (m) with prosthesis. Ultrasound was used to measure distal femoral cartilage thicknesses bilaterally at medial/lateral condyles and the intercondylar areas. The percentages of cartilage loss (of the amputee-side in comparison with the nonamputee-side) were calculated. RESULTS: Compared to the nonamputee-sides, distal femoral cartilage was significantly thinner at lateral condyles and the intercondylar areas on the amputee-sides (p < 0.05). Significant positive correlations were detected between the percentage of cartilage loss (at all three sites of measurement) and gate velocity, 6-min walking distance, and daily walking time with prosthesis (all p < 0.05). CONCLUSIONS: Future prospective controlled studies are warranted to determine the principles of optimum prosthetic use regarding its possible effects on the femoral cartilage of amputee patients. CLINICAL RELEVANCE: The correlations between the cartilage loss in the amputee extremity with faster gait and longer daily prosthetic use suggest that abnormal gait patterns might increase the loading on the amputated extremity.

Akkaya N; Akkaya S; Özçakar L; Demirkan F; Kiter E; Konukcu S; Ardic F

2013-08-01

208

Detection of bifid mandibular condyle using computed tomography.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To determine the frequency and characteristics of bifid mandibular condyle (BMC) using computed tomography (CT) evaluation. STUDY DESIGN: A retrospective study was carried out using the CT records of 550 patients referred to the Medical School of Erciyes University (Kayseri, Turkey) between 2007 and 2010. T-tests were used to compare frequency of BMC between the left and right sides and between female and male patients. Statistical analysis was performed using SPSS software and a chi-squared test. RESULTS: Of the 550 Patients, 10 patients (1.82%) were found to have BMCs. Five patients were female (50%) and five were male (50%). Of these 10 patients, 7 (70%) had unilateral and 3 (30%) had bilateral BMCs. As a result, a total of 13 BMCs were found in 10 patients. No statistically significant differences were found between either the right- and left-sided BMCs or between female and male patients (p >.05). CONCLUSIONS: To our knowledge, this is the first retrospective study investigating the prevalence and characteristics of BMC using computed tomography. Although BMC is an uncommon anomaly, it may be a more frequent condition in the Turkish population. Further studies and research on the orientation of duplicated condylar heads should be carried out.

Sahman H; Sisman Y; Sekerci AE; Tarim-Ertas E; Tokmak T; Tuna IS

2012-11-01

209

Intra-operative femoral condylar stress during arthroscopy: an in vivo biomechanical assessment.  

UK PubMed Central (United Kingdom)

PURPOSE: Excessive varus and valgus stress forces during arthroscopy might exceed minimal compressive strength of cancellous bone. In extreme cases, this could lead to post-arthroscopic osteonecrosis. It was our purpose to measure the valgus and varus stress forces during arthroscopy and draw conclusions on the development of osteonecrosis. METHODS: On 24 consecutive patients undergoing arthroscopy, the maximum varus and valgus stress forces (N) were measured in vivo using a strain gauge mounted to a leg holder. The forces (N) and contact stresses (kPa) on the femoral condyles were calculated based on the measured acting lateral force at the femur fixation based on the lever principle. RESULTS: The maximum contact stress during varus on the medial condyle was significantly lower in patients with intact meniscus (mean ± standard error of the mean: 243 ± 29 kPa) than in patients with meniscus-deficient knees (520 ± 61 kPa; P < 0.01). A similar finding was obtained for the maximum contact stress during valgus on the lateral condyle: 630 ± 72 kPa in patients with intact meniscus compared to 2,173 ± 159 kPa in patients with meniscus-deficient knees (P < 0.01). In 19 patients (79%), the maximum contact stress was higher during valgus than during varus. The maximum contact stress on the lateral condyle during valgus was significantly higher for more experienced surgeons (P = 0.01). CONCLUSION: The maximum contact stresses in knees with intact menisci did not exceed the critical threshold of the compressive strength in cancellous bone. However, the maximum contact stresses in meniscus-deficient knees were frequently higher than the threshold. However, these stresses were much lower than those during daily activities and therefore unlikely to lead to post-arthroscopic osteonecrosis. LEVEL OF EVIDENCE: Diagnostic study, Level II.

Schmid RB; Wirz D; Göpfert B; Arnold MP; Friederich NF; Hirschmann MT

2011-05-01

210

Total hip arthroplasty in an adult with proximal femoral focal deficiency.  

Science.gov (United States)

A 40-year-old woman with isolated unilateral proximal femoral focal deficiency presented with 2 years of gradually increasing left hip pain that interfered with her activities of daily living. A total hip arthroplasty was performed through a posterior approach. At 12 months, she had minimal discomfort about the hip, a markedly increased level of activity, and improved gait, and she required no ambulatory aids. This procedure is cautiously recommended for use in selected patients with proximal femoral focal deficiency. PMID:9590650

Köse, N; Campbell, R; Loredo, R; Wammack, L A; Mabrey, J D

1998-04-01

211

Total hip arthroplasty in an adult with proximal femoral focal deficiency.  

UK PubMed Central (United Kingdom)

A 40-year-old woman with isolated unilateral proximal femoral focal deficiency presented with 2 years of gradually increasing left hip pain that interfered with her activities of daily living. A total hip arthroplasty was performed through a posterior approach. At 12 months, she had minimal discomfort about the hip, a markedly increased level of activity, and improved gait, and she required no ambulatory aids. This procedure is cautiously recommended for use in selected patients with proximal femoral focal deficiency.

Köse N; Campbell R; Loredo R; Wammack LA; Mabrey JD

1998-04-01

212

Subchondral bone density distribution in the human femoral head  

Energy Technology Data Exchange (ETDEWEB)

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

213

Ectopic mandibular third molar leading to osteomyelitis of condyle: a case report with literature review.  

UK PubMed Central (United Kingdom)

BACKGROUND: A tooth is said to be ectopic if it is malpositioned either due to congenital factors or displaced due to pathological lesions. The incidence of osteomyelitis of condyle has a rare occurrence, very few cases have been reported, either their etiology is unknown or is due to hematogenous spread or a tuberculous focus. This particular case may be a rare of its kind, as recent literature did not reveal any case where an ectopic mandibular third molar led to osteomyelitis of the condyle. CASE REPORT: This report presents a unique case where an ectopically placed mandibular third molar led to extraoral sinus and scar formation below the ear lobule with osteomyelitis of the mandibular condyle and proposes various indications for its removal along with literature review. DISCUSSION: Ectopic eruption of a tooth into the dental environment is common, whereas ectopic eruption of tooth in other sites is rare. The exact etiology of ectopic eruption of mandibular third molar in condyle is a rare occurrence and to the best of our knowledge, only 14 cases have been reported in the literature. Management of such cases should be meticulously planned after ruling out various local as well as systemic factors as an underlying cause for osteomyelitis and on the basis of the position and type of ectopic tooth and related potential trauma which could be caused by surgical intervention with less morbidity. CONCLUSION: This particular case may be the unique of its kind, as recent literature did not reveal any case where an ectopic mandibular third molar led to osteomyelitis of the condyle. Diagnosis and management in such cases deserve very special attention to rule out various local and systemic causes which can cause osteomyelitis to affect very unusual site like mandibular condyle. The aim of surgical intervention should be to cause minimum morbidity without affecting the functional efficiency of the mandibular condyle. In this report, we also have proposed the indications for surgical intervention to remove ectopically erupted teeth.

Lambade P; Lambade D; Dolas RS; Virani N

2013-06-01

214

Nontraumatic bifid mandibular condyles in asymptomatic and symptomatic temporomandibular joint subjects.  

UK PubMed Central (United Kingdom)

PURPOSE: 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. MATERIALS AND METHODS: 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. RESULTS: 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). CONCLUSION: 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 BH; Jung YH

2013-03-01

215

Radiation induced femoral palsy  

International Nuclear Information System (INIS)

We report four cases of femoral palsy due to compressive fibrosis, after pelvic radiation therapy. Three patients had Hodgkin's disease, and one testicular seminoma. Prominent clinical features include major groin induration and underlying swelling. Unlike what is usually seen in tumoral relapse, little or no pain is associated with these neuropathies. The femoral post-radic palsy develops earlier and faster than brachial plexus palsy of same aetiology. In one case, progressive aggravation led to surgical neurolysis which resulted in dramatic and long lasting improvement. The principal preventive and therapeutic managements are discussed: since compressive fibrosis is related to the use of isolated and massive electron beam therapy, various association of cobalt and electron beam therapy are designed to best prevent the side effects of each of these methods. The early treatment of developing fibrosis by D. penicillamine is discussed

1982-01-01

216

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

Energy Technology Data Exchange (ETDEWEB)

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.

Oh, Jong Hwa; Kim, Jae Duk; Kim, Jin Soo [Department of Oral and Maxillofacial Radiology, College of Dentistry, Chosun University, Seoul (Korea, Republic of)

2008-06-15

217

In vivo quantitative ultrasound image analysis of femoral subchondral bone in knee osteoarthritis.  

Science.gov (United States)

A potential of quantitative noninvasive knee ultrasonography (US) for detecting changes in femoral subchondral bone related to knee osteoarthritis (OA) was investigated. Thirty-nine patients referred to a knee arthroscopy underwent dynamic noninvasive US examination of the knee joint. The subchondral bone was semiautomatically segmented from representative US images of femoral medial and lateral condyles and intercondylar notch area. Subsequently, the normalized mean gray-level intensity profile, starting from the cartilage-bone interface and extending to the subchondral bone depth of -1.7?mm, was calculated. The obtained profile was divided into 5 depth levels and the mean of each level, as well as the slope of the profile within the first two levels, was calculated. The US quantitative data were compared with the arthroscopic Noyes' grading and radiographic Kellgren-Lawrence (K-L) grading. Qualitatively, an increase in relative subchondral bone US gray-level values was observed as OA progressed. Statistically significant correlations were observed between normalized US mean intensity or intensity slope especially in subchondral bone depth level 2 and K-L grading (r = 0.600, P resp.) or femoral arthroscopic scoring (r = 0.332, P = 0.039; r = 0.335, P = 0.037, resp.). This novel quantitative noninvasive US analysis technique is promising for detection of femoral subchondral bone changes in knee OA. PMID:23781150

Podlipská, Jana; Koski, Juhani M; Pulkkinen, Pasi; Saarakkala, Simo

2013-05-27

218

In vivo quantitative ultrasound image analysis of femoral subchondral bone in knee osteoarthritis.  

UK PubMed Central (United Kingdom)

A potential of quantitative noninvasive knee ultrasonography (US) for detecting changes in femoral subchondral bone related to knee osteoarthritis (OA) was investigated. Thirty-nine patients referred to a knee arthroscopy underwent dynamic noninvasive US examination of the knee joint. The subchondral bone was semiautomatically segmented from representative US images of femoral medial and lateral condyles and intercondylar notch area. Subsequently, the normalized mean gray-level intensity profile, starting from the cartilage-bone interface and extending to the subchondral bone depth of -1.7?mm, was calculated. The obtained profile was divided into 5 depth levels and the mean of each level, as well as the slope of the profile within the first two levels, was calculated. The US quantitative data were compared with the arthroscopic Noyes' grading and radiographic Kellgren-Lawrence (K-L) grading. Qualitatively, an increase in relative subchondral bone US gray-level values was observed as OA progressed. Statistically significant correlations were observed between normalized US mean intensity or intensity slope especially in subchondral bone depth level 2 and K-L grading (r = 0.600, P < 0.001; r = 0.486, P = 0.006, resp.) or femoral arthroscopic scoring (r = 0.332, P = 0.039; r = 0.335, P = 0.037, resp.). This novel quantitative noninvasive US analysis technique is promising for detection of femoral subchondral bone changes in knee OA.

Podlipská J; Koski JM; Pulkkinen P; Saarakkala S

2013-01-01

219

Complications of posterior sagittal anorectoplasty.  

Science.gov (United States)

From 1982 to 1985, 23 patients underwent posterior sagittal anorectoplasty procedures: 12 as primary treatment for congenital anorectal malformations, 9 for treatment of fecal incontinence following a prior pull-through procedure, and 2 for treatment of fecal incontinence following trauma. Six patients (26%) developed seven complications specifically related to the procedure. One patient with a cloacal anomaly had partial dehiscence of the sacroperineal incision following total reconstruction. This resulted in retraction of vaginal and anal openings, which, however, have remained separate and patent. Two patients developed temporary femoral nerve palsies, unilateral in one patient lasting one week, and bilateral in one patient lasting four months. Four patients developed leaks from the suture line of the tailored ectatic rectum, which was pulled through to the perineum. In one male patient, the suture line was placed anteriorly, resulting in a rectourethral fistula, which required a repeat posterior sagittal dissection. One male, who had a redo procedure, developed a posterior diverticulum comparable to a large anal crypt. This was repaired prior to closure of the colostomy. One seven-year-old girl developed multiple rectocutaneous fistulae, which closed with conservative management in five months. One male infant developed a single supralevator rectocutaneous fistula, which closed after rediversion of feces with a colostomy and has remained so after colostomy closure. The majority of the complications encountered were probably preventable if careful attention to certain details of technique had been observed: careful padding of the groin areas when patients are prone, especially in older patients.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3723300

Nakayama, D K; Templeton, J M; Ziegler, M M; O'Neill, J A; Walker, A B

1986-06-01

220

Complications of posterior sagittal anorectoplasty.  

UK PubMed Central (United Kingdom)

From 1982 to 1985, 23 patients underwent posterior sagittal anorectoplasty procedures: 12 as primary treatment for congenital anorectal malformations, 9 for treatment of fecal incontinence following a prior pull-through procedure, and 2 for treatment of fecal incontinence following trauma. Six patients (26%) developed seven complications specifically related to the procedure. One patient with a cloacal anomaly had partial dehiscence of the sacroperineal incision following total reconstruction. This resulted in retraction of vaginal and anal openings, which, however, have remained separate and patent. Two patients developed temporary femoral nerve palsies, unilateral in one patient lasting one week, and bilateral in one patient lasting four months. Four patients developed leaks from the suture line of the tailored ectatic rectum, which was pulled through to the perineum. In one male patient, the suture line was placed anteriorly, resulting in a rectourethral fistula, which required a repeat posterior sagittal dissection. One male, who had a redo procedure, developed a posterior diverticulum comparable to a large anal crypt. This was repaired prior to closure of the colostomy. One seven-year-old girl developed multiple rectocutaneous fistulae, which closed with conservative management in five months. One male infant developed a single supralevator rectocutaneous fistula, which closed after rediversion of feces with a colostomy and has remained so after colostomy closure. The majority of the complications encountered were probably preventable if careful attention to certain details of technique had been observed: careful padding of the groin areas when patients are prone, especially in older patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Nakayama DK; Templeton JM Jr; Ziegler MM; O'Neill JA; Walker AB

1986-06-01

 
 
 
 
221

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  

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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; Sílvia Regina Arruda de Moraes; Luciano Carvalho Suruagy; Tetsuo Tashiro; Helena Medeiros Costa

2004-01-01

222

Dislocation of the mandibular condyle into the middle cranial fossa: a case report.  

UK PubMed Central (United Kingdom)

INTRODUCTION: A 32-year-old woman was admitted to our hospital following a motor vehicle accident. Her chief complaint was severe limited mouth opening and unilateral open bite on the left. METHODS: Axial and coronal CT scans showed penetration of right condyle into the middle cranium through the fractured roof of glenoid fossa. A craniotomy exactly above the glenoid fossa was done. RESULTS: The condyle was reduced and the glenoid fossa was reconstructed. CONCLUSION: On postoperative follow-up at 6 months, the patient had no complaint, but there was a small deviation to the affected side on opening.

Vaezi T; Rajaei SA; Hosseini Abrishami M; Erfanian Taghvaei M

2013-02-01

223

Dental abrasion as a factor in remodeling of the mandibular condyle.  

UK PubMed Central (United Kingdom)

Skulls of 100 male and female subjects of various ages and with unimpaired dental arches were examined with respect to the morphological features of the mandibular condyle. A certain number of typical shapes were distinguished. Dental abrasion was also assessed and three parameters were calculated: (1) total abrasion index; (2) working:balancing abrasion ratio, and (3) frontal abrasion index. These data were then related to condylar shape and subject age. The results show that abrasion influences changes in condyle shape due to bone remodeling. The forces applied on this bone segment are distributed over functional areas that vary both in extent and in their different characteristics.

Mongini F

1975-01-01

224

Disc-condyle Relationships during Class II Treatment with the Functional Mandibular Advancer (FMA).  

UK PubMed Central (United Kingdom)

OBJECTIVE: The objective of this study was to verify the effects of treatment to correct Class II malocclusion with the Functional Mandibular Advancer (FMA) on the relative positions of the articular disc and mandibular condyle. In particular, we aimed to find out whether the disc-condyle relationship changed between baseline and post-treatment, in temporomandibular joints initially exhibiting a physiological relationship and alternatively, in temporomandibular joints initially presenting anterior displacement of the articular disc. PATIENTS AND METHODS: Treatment progress in 15 patients was monitored at defined points in time by manual structural analysis (MSA) and magnetic resonance (MR) imaging. The disc-condyle relationship was assessed by examining the parasagittal MR images made up of three slices each (lateral, central, medial) taken in habitual intercuspation and maximum-open mouth position. The MR images were metrically analyzed to determine the sagittal positional relationship of the articular disc and mandibular condyle using two methods on the central slices of the images taken in closed-mouth position. MSA was used in particular to determine the disc-condyle relationships and to metrically record the extent of active movement of the mandible during mouth opening, protrusion, laterotrusion, and retrusion. RESULTS: Comparison of baseline and post-treatment findings revealed that none of the joints exhibited a treatment-induced deterioration in the disc-condyle relationship, while the relationship improved in five joints. After categorization of the joints according to groups according to disc position, metric analysis of the MR images showed significantly-improved post-treatment disc positions in the joints that had initially exhibited anterior disc displacement. Post-treatment findings for maximum-open mouth position, protrusion, and laterotrusion corresponded to the baseline values recorded before bite-jumping, and the extent of maximum active retrusion increased significantly. CONCLUSIONS: Functional jaw orthopedics for correction of skeletal Class II with the rigid fixed FMA leads to side-effects reflected in the disc-condyle relationship in the temporomandibular joints: no adverse effects were observed in joints presenting an initial physiological disc-condyle relationship, whereas the disc position may improve in joints with initial partial or total anterior disc displacement. In comparison with the baseline findings, we observed no post-treatment restriction in the extent of maximum mouth opening, protrusion, and left and right laterotrusion. Maximum active retrusion increased due to the treatment. MR imaging and MSA only partly cover the same aspects of temporomandibular joint diagnostics.

Kinzinger G; Gülden N; Roth A; Diedrich P

2006-09-01

225

Femoral neck stress fracture.  

UK PubMed Central (United Kingdom)

The patient was a 19-year-old woman who recently completed a military basic training program. She was evaluated by a physical therapist in a direct-access capacity for a chief complaint of anterior right hip pain that limited her ability to run. Due to the limited sensitivity of radiographs, magnetic resonance imaging of the right hip was obtained, which revealed a stress fracture of the right distal femoral neck.J Orthop Sports Phys Ther 2013;43(4):275. doi:10.2519/jospt.2013.0407.

Konetsky M; Miller J; Tripp C

2013-04-01

226

Knee arthroscopy - series (image)  

Science.gov (United States)

The knee is a complex joint made up of the distal end of the femur (femoral condyles) and the ... between the femur and the tibia in the knee joint. The anterior cruciate ligament, the posterior cruciate ...

227

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; J. Andonegui; L. Berástegui; N. Arruti

2011-01-01

228

Escleritis posterior bilateral/ Bilateral posterior scleritis  

Scientific Electronic Library Online (English)

Full Text Available 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 (more) 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 m (more) ultidisciplinary approach and the collaboration of ophthalmologists with neurologists, internists or rheumatologists. This article describes a case of idiopathic bilateral posterior scleritis.

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

2011-08-01

229

Late presentation of fractures of the lateral condyle of the humerus in children  

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Background: The current controversy regarding the management of fractures of the lateral condyle of the humerus presenting between 3 to 12 weeks prompted us to evaluate our results of open reduction and internal fixation of such fractures. Patients and Methods: Twenty-one patients ope...

Khare Ghanshyam; Saraf Shyam

230

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

Scientific Electronic Library Online (English)

Full Text Available 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 morfológicas. A anquilose de articulação temporomandibular é uma patologia incapacitante com envolvimento do côndilo mandibular, fossa articular e base do crânio. A associa (more) ção 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 morphological 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 temp (more) oromandibular 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.

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

2007-01-01

231

Polyethylene post failure in posterior stabilized total knee arthroplasty.  

Science.gov (United States)

Posterior-stabilized (PS) prostheses have been used extensively in total knee arthroplasty (TKA), with excellent long-term results. The key feature of these prostheses is the femoral cam and tibial post mechanism that limits posterior displacement and produces femoral rollback. Although articular-surface polyethylene wear of the tibial component has not been a significant clinical problem, tibial post wear has been reported. In distinction to chronic post wear, little information exists about catastrophic post failure. We present the case of a 56-year-old woman who presented 63 months after TKA with a PS prosthesis with acute fracture of the polyethylene post. The evaluation and treatment of this patient, including the previously unreported use of computed tomography arthrography to diagnose this rare problem, is reviewed. PMID:15284990

Clarke, Henry D; Math, Kevin R; Scuderi, Giles R

2004-08-01

232

Bipolar hemiarthroplasty for femoral neck fracture using the direct anterior approach  

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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 observ...

Tomonori Baba; Katsuo Shitoto; Kazuo Kaneko

233

Adaptation of canine femoral head articular cartilage to long distance running exercise in young beagles.  

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OBJECTIVE--To study the effects of long term (one year), long distance (up to 40 km/day) running on the metabolism of articular cartilage the biosynthesis of proteoglycans was examined by in vitro labelling of anterior (weight bearing) and posterior (less weight bearing) areas of the femoral head fr...

Lammi, M J; Häkkinen, T P; Parkkinen, J J; Hyttinen, M M; Jortikka, M; Helminen, H J; Tammi, M I

234

Pin fixation in treatment of dislocated lateral condyle of the humerus in pediatric population  

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Full Text Available Introduction Fractures of lateral condyle represent 17% of all pediatric fractures of the distal humerus, and in current pediatric orthopedics there is still no agreement regarding optimal treatment modalities. We presented a treatment protocol for pediatric dislocated fractures of the lateral condyle of the humerus used at the Pediatric Surgery Clinic in Novi Sad. Material and methods Over the study period (1991-2000) a total of 48 patients with dislocated fractures of the lateral condyle of the humerus were hospitalized at the Pediatric Surgery Clinic. Orthopedic reduction and percutaneous pin fixation under radiological supervision was done in 15 patients, while 33 patients needed surgical reduction and pin fixation. Results Satisfactory results were obtained in 42 patients (91.3%), out of which 29 patients (63.1%) presented with excellent resuls. Good results were obtained in 8 patients (17.4%), and fair results in 5 patients (10.8%). Unsatisfactory results were present in 4 patients (8.7%). Two patients were lost to follow-up. Discussion Dislocation fractures of the lateral condyle represent high risk for development of complications. Adequate diagnosis and treatment represent basic conditions for successful post-interventional result. Orthopedic reduction with percutaneous pin fixation is recommended for fractures that may be anatomically reduced. In cases of unsatisfactory results of reduction, as well as in cases with completely dislocated and rotated fragments, surgical reduction and pin fixation is necessary. Conclusions Satisfactory results in 91.3% of cases, and long-term experience suggest that the recommended therapeutic option is adequate in treatment of dislocated fractures of the lateral condyle of the humerus in pediatric population.

Gajdobranski ?or?e R.; Mari? Dušan M.; Tati? Milanka R.; Živkovi? Dragana 1; Mikov Aleksandra; Nedeljkovi? Miroslav

2004-01-01

235

Cóndilo Mandibular Bífido: Un Desafío Diagnóstico/ Bífid Mandibular Condyle: a Diagnostic Challenge  

Scientific Electronic Library Online (English)

Full Text Available Abstract in spanish El cóndilo mandibular bífido es una condición rara, observada frecuentemente como hallazgo radiográfico, caracterizada por la división de la cabeza de la mandíbula. Su prevalencia varía entre 0,0018% a 0,3%, donde múltiples causas han sido sugeridas en la literatura para justificar su desarrollo, sin embargo no hay concordancia entre los estudios acerca del factor causal principal. El objetivo de este artículo es relatar un caso de cóndilo mandibular bífido obs (more) ervado en una mujer de 21 años de edad, el cual fue revelado por una radiografía panorámica donde se observó hipoplasia del cóndilo mandibular izquierdo, con presencia de una aparente calcificación en la región de la articulación temporomandibular izquierda; otros exámenes convencionales fueron realizados (radiografía postero-anterior, con apoyo frente-nasion en boca abierta, transcraniana y panorámica), sin embargo, apenas en la tomografía computarizada de haz cónico, fue posible obtener el diagnóstico de cóndilo mandibular bífido. Abstract in english The mandibular bifid condyle is a rare condition, frequently observed in routine X-rays, characterized by division of the mandible head. According to the literature, the prevalence varies from 0.018% to 0.3%. Several causes have been suggested to justify the development of bifid mandibular condyle, however there is no agreement between studies about the main causative factor. The aim of this paper is to report a case of mandibular bifid condyle in a 21-years-old girl. The (more) panoramic radiograph showed hypoplasia of the left mandibular condyle, with an apparent presence of calcification in the left temporomandibular joint. Other conventional extraoral radiographs were performed (postero-anterior with fronto-nasal support, open mouth; panoramic and trascranial radiographs), however, only in the cone beam computed tomography ir was possible to obtain the diagnosis of mandibular bifid condyle.

Sampaio Neves, Frederico; Ramirez-Sotelo, Laura Ricardina; Queiroz de Freitas, Deborah; Haiter-Neto, Francisco; Bóscolo, Frab Norberto

2012-01-01

236

Retention of the posterior cruciate in total knee arthroplasty.  

UK PubMed Central (United Kingdom)

Retention of the posterior cruciate ligament in total knee arthroplasty is discussed in biomechanical and clinical terms and the implications for design, kinematics, function, and prosthesis longevity considered. The specific roles of passive range of motion, femoral rollback, stresses on the implant-bone-prosthesis cement system, and wear are examined. The authors argue that the posterior cruciate ligament improves passive range of motion, the mechanical efficiency of the knee musculature and thus improved stairclimbing efficiency, reduces stress at the cement-bone-implant interfaces, and has little or no impact on the polyethylene wear problems.

Andriacchi TP; Galante JO

1988-01-01

237

Posterior malleolus fracture.  

Science.gov (United States)

Posterior malleolus fractures are a common component of ankle fractures. The morphology is variable; these fractures range from small posterolateral avulsion injuries to large displaced fracture fragments. The integrity of the posterior malleolus and its ligamentous attachment is important for tibiotalar load transfer, posterior talar stability, and rotatory ankle stability. Fixation of posterior malleolus fractures in the setting of rotational ankle injuries has certain benefits, such as restoring articular congruity and rotatory ankle stability, as well as preventing posterior talar translation, but current indications are unclear. Fragment size as a percentage of the anteroposterior dimension of the articular surface is often cited as an indication for fixation, although several factors may contribute to the decision, such as articular impaction, comminution, and syndesmotic stability. Outcome studies show that, in patients with ankle fractures, the presence of a posterior malleolus fracture negatively affects prognosis. Notable variability is evident in surgeon practice. PMID:23281469

Irwin, Todd A; Lien, John; Kadakia, Anish R

2013-01-01

238

Posterior malleolus fracture.  

UK PubMed Central (United Kingdom)

Posterior malleolus fractures are a common component of ankle fractures. The morphology is variable; these fractures range from small posterolateral avulsion injuries to large displaced fracture fragments. The integrity of the posterior malleolus and its ligamentous attachment is important for tibiotalar load transfer, posterior talar stability, and rotatory ankle stability. Fixation of posterior malleolus fractures in the setting of rotational ankle injuries has certain benefits, such as restoring articular congruity and rotatory ankle stability, as well as preventing posterior talar translation, but current indications are unclear. Fragment size as a percentage of the anteroposterior dimension of the articular surface is often cited as an indication for fixation, although several factors may contribute to the decision, such as articular impaction, comminution, and syndesmotic stability. Outcome studies show that, in patients with ankle fractures, the presence of a posterior malleolus fracture negatively affects prognosis. Notable variability is evident in surgeon practice.

Irwin TA; Lien J; Kadakia AR

2013-01-01

239

[Posterior cerebral encephalopathy].  

UK PubMed Central (United Kingdom)

Posterior reversible encephalopathy (PRE) is a recent syndrome characterized by headache, vomiting, seizures, visual loss, altered mental status with or without motor or sensitive deficit. Neuroimaging demonstrates symmetrical posterior cortical and subcortical lesions. The aetiology remains uncertain but vascular hypotheses is the most retained. We report a case of a 21 year old man with posterior cerebral encephalopathy, the toxic hypo these remains the most probable.

Boughammoura-Bouatay A; Chebel S; Fitouri F; Hizem Y; Frih-Ayed M

2005-02-01

240

[Posterior cerebral encephalopathy].  

Science.gov (United States)

Posterior reversible encephalopathy (PRE) is a recent syndrome characterized by headache, vomiting, seizures, visual loss, altered mental status with or without motor or sensitive deficit. Neuroimaging demonstrates symmetrical posterior cortical and subcortical lesions. The aetiology remains uncertain but vascular hypotheses is the most retained. We report a case of a 21 year old man with posterior cerebral encephalopathy, the toxic hypo these remains the most probable. PMID:15969236

Boughammoura-Bouatay, Amel; Chebel, Saber; Fitouri, Fitouri; Hizem, Yosr; Frih-Ayed, Mahbouba

2005-02-01

 
 
 
 
241

Femoral nerve palsy. An unusual complication of anterior lumbar interbody fusion.  

UK PubMed Central (United Kingdom)

SUMMARY OF BACKGROUND DATA: Compression neuropathy of the femoral nerve has been reported as an uncommon complication of bleeding into the iliopsoas muscle. OBJECTIVE: The authors detected anatomic reasons of direct injury to the femoral nerve at the lower lumbar level. METHODS: Keeping the hip in extension during the course of carrying out anterior fusion on a previously failed posterior fusion was considered another causative factor of femoral nerve injury. Anatomical dissection confirmed the likelihood of this injury being produced in this situation. RESULTS: Femoral nerve traction and compression can occur after prolonged compression of the nerve within the psoas muscle stretched between an immobile lower lumbar spine and the lesser trochanter when the hip is kept in extension. In the patients described no other reasons for direct or indirect injury were identified. CONCLUSION: Although uncommon, the complication should be kept in mind. It can be avoided by intraoperative hip flexion.

Papastefanou SL; Stevens K; Mulholland RC

1994-12-01

242

A provisionally unique syndrome with features including "molar tooth" sign and "femoral hypoplasia".  

UK PubMed Central (United Kingdom)

A provisionally unique syndrome with features including "molar tooth" sign and "femoral hypoplasia": The femoral-facial syndrome (FH-UFS) is a rare syndrome of uncertain inheritance comprising hypoplastic femora, microretrognathia, and peculiar facies. We describe a new case with facial dysmorphism, broad chest and widely spaced nipples, shorter right lower limb with femoral hypoplasia and unilateral fibular hemimelia, bilateral absence of 5th metatarsal and toe, and bilateral talipes equinovarus. In addition, a complete agenesis of corpus callosum, cerebellar vermis hypoplasia with molar tooth sign and Dandy-Walker malformation were present. Posterior fossa abnormalities in FH-UFS have not been described in the literature until now, thus extending the clinical spectrum of this entity. Other syndromes characterized by femoral hypoplasia and/or molar tooth sign are also discussed.

Caglayan AO; Gumus H; Yikilmaz A; Gumus GO; Per H

2009-01-01

243

[Analysis of the contraction induced by isoproterenol in isolated cerebral and femoral arteries of cat  

UK PubMed Central (United Kingdom)

The vasoconstrictor responses induced by isoproterenol in cylindrical segments of posterior communicating and femoral arteries of the cat were analyzed. For this purpose, dose-response curves for isoproterenol before and after addition of propranolol (5 X 10(-9) to 10(-6) M) or phentolamine (10(-6) M) to the bath were determined. Propranolol did not significantly change the contraction induced by isoproterenol in cerebral and femoral arteries. Phentolamine reduced the contractile responses of cerebral arteries evoked by all concentrations of isoproterenol. However phentolamine shifted the dose-response curve to isoproterenol in femoral arteries to the right, the pA2 value for this antagonist being 6.74. These results indicate that the alfa adrenoceptors are involved in the contraction caused by isoproterenol in femoral arteries, whereas in brain arteries other receptors or mechanisms are also likely involved.

Salaices M; Marín J

1982-06-01

244

The first 100 fully porous-coated femoral components in hip resurfacing.  

UK PubMed Central (United Kingdom)

UNLABELLED: Uncemented fixation of implants to bone is a proven technology in traditional hip arthroplasty surgery. However, cement fixation is currently the standard method for the femoral component in hip resurfacing. The purpose of this study was to evaluate the performance of uncemented fixation of the femoral component in the first 100 fully porous-coated metal-on-metal hip resurfacing arthroplasties at a minimum follow-up of 2 years. MATERIALS AND METHODS: From March to October 2007, 100 consecutive uncemented metal-on-metal hip resurfacing arthroplasties in 95 patients (74 males and 21 females) were implanted by the same surgeon, using bone ingrowth technology for both femoral and acetabular components. The posterior minimally invasive approach was utilized in all cases. The primary diagnosis was osteoarthritis in 72% of cases, but other diagnoses were not excluded for the purposes of this study. The mean femoral component size was 51 ± 4 millimeters, and patients were not excluded for small component size. RESULTS: The mean follow-up was 2.9 ± 0.2 years. The mean pre-operative Harris hip score was 57 ± 13 and improved to 96 ± 6 at the final follow-up visit. The mean UCLA activity score was 8 ± 2. There were two failures (2%): one femoral neck fracture at 2 months and one femoral component loosening at 12 months postoperatively. CONCLUSION: The study demonstrated that fully porous-coated femoral resurfacing components have equivalent results to those reported for cemented femoral components at short-term follow-up. This suggests that the femoral head can reliably achieve bone ingrowth into a fully porous-coated femoral component. This encourages us to continue utilizing this bone ingrowth technique as an alternative to cement in this young and active patient group. Long-term follow-up will be needed.

Gross TP; Liu F

2011-01-01

245

[On the posterior infarct  

UK PubMed Central (United Kingdom)

The article deals with infarctions in the territory of the posterior cerebral arteries. For a better understanding of pathoanatomical and pathogenetical factors influencing posterior cerebral infarctions embryological, orthological and pathological data on the posterior cerebral artery and on its leptomeningeal anastomoses to other cerebral arteries were reported in the first two chapters. Chapter 3 includes a review of findings on the predilection sites for occlusions of the posterior cerebral artery, on the relative incidence and also on pathogenetical factors of posterior cerebral infarctions. The few papers especially dealing with the posterior cerebral infarctions in the CCT were indicated likewise. Chapter 4 contains our own findings on 180 patients with posterior cerebral infarctions, who were all examined with CCT (the slices were done parallel to the fronto-occipital line); data on age, sex and hemispheric distribution of the sample and on combinations with other cerebral infarctions were reported. 159 posterior cerebral infarctions (of 144 patients including 15 with bilateral infarctions) could be described "anatomically". As to the maximum infarction areas referred to 8 defined slice levels, differences to the findings reported so far in the literature were observed; they comprise the (ventro-) lateral borders of the infarction areas including the longitudinal fibre projections (e.g. the optic radiation), the cranial extension of the posterior cerebral infarctions and the splenial as well as thalamic lesions. The posterior cerebral infarctions were classified as uni-territorial, bi-territorial and subtotal subtypes. Among the uni-territorial posterior cerebral infarctions calcarine infarctions outweighed those in the territory of the posterior temporal (temporo-occipital) artery and of the parieto-occipital artery by a ratio of 2:1:1. The overlap areas of the uni-territorial posterior cerebral infarctions are shown in figures. The second, less frequent bi-territorial subtype is a combination of infarctions in the territories of the calcarine and the parieto-occipital arteries. The calcarine, the medio-basal and the subtotal subtype occurred in about 23% of the "anatomically" evaluated posterior cerebral infarctions. At length, thalamic and splenial infarctions associated with any of the subtypes were observed in about a quarter of all posterior cerebral infarctions. As to the subtotal posterior cerebral infarctions additional thalamic and splenial infarctions can be expected in about 40%.

Hebel N; von Cramon DY

1987-02-01

246

Posttraumatic chronic patellar dislocation treated by distal femoral osteotomy and medial patellofemoral ligament reconstruction.  

Science.gov (United States)

Chronic patellar dislocation is a rare condition where the patella remains dislocated throughout knee range of motion during flexion and extension. In adults, the delayed presentation of this condition is often due to symptoms caused by the onset of severe secondary osteoarthritis. To the authors' knowledge, all of the cases reported in the literature have been treated by patellofemoral or total knee replacements depending on patient age and the extent of the arthritis. This article describes a rare case of a 22-year-old woman who sustained a traumatic chronic patellar dislocation for 5 months. Clinical examination revealed a valgus deformity of the left leg secondary to childhood injury and that the patella lay lateral to the lateral femoral condyle throughout flexion and extension. Radiographs of the knee revealed patellar dislocation. Long-leg radiographs of the left leg showed an anatomic tibiofemoral angle of 17° valgus. The anatomical (74°) and mechanical (80°) lateral distal femoral angles were abnormal, whereas the medial proximal tibial angle (87°) was normal, confirming that the valgus deformity was due to the abnormal distal femur. The authors performed a distal femoral osteotomy to correct the valgus deformity. Medial patellofemoral ligament reconstruction using a hamstring autograft was performed to stabilize the patella. PMID:23127463

Purushothaman, Balaji; Agarwal, Amit; Dawson, Matt

2012-11-01

247

Posttraumatic chronic patellar dislocation treated by distal femoral osteotomy and medial patellofemoral ligament reconstruction.  

UK PubMed Central (United Kingdom)

Chronic patellar dislocation is a rare condition where the patella remains dislocated throughout knee range of motion during flexion and extension. In adults, the delayed presentation of this condition is often due to symptoms caused by the onset of severe secondary osteoarthritis. To the authors' knowledge, all of the cases reported in the literature have been treated by patellofemoral or total knee replacements depending on patient age and the extent of the arthritis. This article describes a rare case of a 22-year-old woman who sustained a traumatic chronic patellar dislocation for 5 months. Clinical examination revealed a valgus deformity of the left leg secondary to childhood injury and that the patella lay lateral to the lateral femoral condyle throughout flexion and extension. Radiographs of the knee revealed patellar dislocation. Long-leg radiographs of the left leg showed an anatomic tibiofemoral angle of 17° valgus. The anatomical (74°) and mechanical (80°) lateral distal femoral angles were abnormal, whereas the medial proximal tibial angle (87°) was normal, confirming that the valgus deformity was due to the abnormal distal femur. The authors performed a distal femoral osteotomy to correct the valgus deformity. Medial patellofemoral ligament reconstruction using a hamstring autograft was performed to stabilize the patella.

Purushothaman B; Agarwal A; Dawson M

2012-11-01

248

Posterior labrocapsular periosteal sleeve avulsion complicating locked posterior shoulder dislocation  

Energy Technology Data Exchange (ETDEWEB)

This case presents the imaging features of a posterior shoulder dislocation complicated by a rare but surgically relevant lesion of the posterior labrum. Due to the attachment of the posterior capsule to the posterior portion of the labrum, which in itself is attached to the posterior scapular periosteum, stripping of the labrum by the posterior capsule resulted in a posterior labrocapsular periosteal sleeve avulsion. (orig.) With 4 figs., 5 refs.

Simons, P. [Department of Radiology, Onze Lieve Vrouwe Hospital, Aalst (Belgium)]|[Department of Radiology, Leiden University Medical Centre, Leiden (Netherlands); Joekes, E.; Bloem, J.L. [Department of Radiology, Leiden University Medical Centre, Leiden (Netherlands); Nelissen, R.G.H.H. [Department of Orthopaedic Surgery, Leiden University Medical Centre (Netherlands)

1998-10-01

249

Posterior labrocapsular periosteal sleeve avulsion complicating locked posterior shoulder dislocation  

International Nuclear Information System (INIS)

This case presents the imaging features of a posterior shoulder dislocation complicated by a rare but surgically relevant lesion of the posterior labrum. Due to the attachment of the posterior capsule to the posterior portion of the labrum, which in itself is attached to the posterior scapular periosteum, stripping of the labrum by the posterior capsule resulted in a posterior labrocapsular periosteal sleeve avulsion. (orig.)

1998-01-01

250

Study of corrosion in femoral implant/ Estudio de corrosión en implante femoral  

Scientific Electronic Library Online (English)

Full Text Available Abstract in spanish Las condiciones en las que tienen que actuar los bioimplantes en el cuerpo humano son muy severas, ya que entran en contacto con un medio el cual tiene predisposición a producir corrosión en los metales de estos dispositivos. En condiciones normales, los fluidos extracelulares del cuerpo humano, se pueden considerar como una disolución acuosa de oxigeno, diversos complejos de sales y glucosa. Se trata, de un medio electrolítico que contiene iones cloruro y conduce ele (more) ctrones, lo que facilita que puedan producirse fenómenos electroquímicos de corrosión, que interfieren con el funcionamiento óptimo del implante o perturban la interrelación del implante con el hueso. El objetivo del trabajo es el estudio de un componente femoral y cabeza del componente femoral extraído de paciente femenina, quien posterior a fractura del cuello femoral izquierdo (1997), resultó intervenida, practicándosele artroplastia total de cadera izquierda, cementada. En el momento de la extracción del implante, se observó in situ corrosión generalizada que fue analizada por microscopia óptica, microscopia electrónica de barrido analítica (MEB-EDX) y espectroscopia infrarroja con transformada de Fourier, confirmándose el proceso de corrosión por los fluidos celulares del cuerpo humano debido a la presencia de compuestos orgánicos e inorgánicos presentes. Abstract in english Bioimplants are subject to severe conditions in the human body as they must coexist with tissue environment that makes their metallic parts susceptible to corrosion. Extracellular tissue fluids constitute an oxygenated aqueous solution containing different salts and glucose, an electron-conducting medium of chloride ions that elicits electrochemical corrosion phenomena and interferes with the optimum performance of implants by disturbing their interrelation with bone tiss (more) ue. The intense wear and tear of implants may require surgical removal and replacement. This paper reports on the corrosion sustained by a femoral prosthesis that had been implanted in a female patient during total cemented arthroplasty due to a left femoral neck fracture in 1997. Generalized in situ corrosion was observed upon implant retrieval, prompting analysis by both optic and electron microscopy (SEM), as well as by infrared spectroscopy with a Fourier transform. The analysis confirmed the ongoing corrosion process brought about by the contact of the prosthetic component with organic and inorganic compounds in the cellular fluids.

Figueroa de Gil, Yelitza; López, Glorys; Palomo, Carlos; Prin, José Luis; Albornoz, Alberto

2007-11-01

251

Estudio de corrosión en implante femoral Study of corrosion in femoral implant  

Directory of Open Access Journals (Sweden)

Full Text Available Las condiciones en las que tienen que actuar los bioimplantes en el cuerpo humano son muy severas, ya que entran en contacto con un medio el cual tiene predisposición a producir corrosión en los metales de estos dispositivos. En condiciones normales, los fluidos extracelulares del cuerpo humano, se pueden considerar como una disolución acuosa de oxigeno, diversos complejos de sales y glucosa. Se trata, de un medio electrolítico que contiene iones cloruro y conduce electrones, lo que facilita que puedan producirse fenómenos electroquímicos de corrosión, que interfieren con el funcionamiento óptimo del implante o perturban la interrelación del implante con el hueso. El objetivo del trabajo es el estudio de un componente femoral y cabeza del componente femoral extraído de paciente femenina, quien posterior a fractura del cuello femoral izquierdo (1997), resultó intervenida, practicándosele artroplastia total de cadera izquierda, cementada. En el momento de la extracción del implante, se observó in situ corrosión generalizada que fue analizada por microscopia óptica, microscopia electrónica de barrido analítica (MEB-EDX) y espectroscopia infrarroja con transformada de Fourier, confirmándose el proceso de corrosión por los fluidos celulares del cuerpo humano debido a la presencia de compuestos orgánicos e inorgánicos presentes.Bioimplants are subject to severe conditions in the human body as they must coexist with tissue environment that makes their metallic parts susceptible to corrosion. Extracellular tissue fluids constitute an oxygenated aqueous solution containing different salts and glucose, an electron-conducting medium of chloride ions that elicits electrochemical corrosion phenomena and interferes with the optimum performance of implants by disturbing their interrelation with bone tissue. The intense wear and tear of implants may require surgical removal and replacement. This paper reports on the corrosion sustained by a femoral prosthesis that had been implanted in a female patient during total cemented arthroplasty due to a left femoral neck fracture in 1997. Generalized in situ corrosion was observed upon implant retrieval, prompting analysis by both optic and electron microscopy (SEM), as well as by infrared spectroscopy with a Fourier transform. The analysis confirmed the ongoing corrosion process brought about by the contact of the prosthetic component with organic and inorganic compounds in the cellular fluids.

Yelitza Figueroa de Gil; Glorys López; Carlos Palomo; José Luis Prin; Alberto Albornoz

2007-01-01

252

Precision of a novel computed tomographic method for quantification of femoral varus in dogs and an assessment of the effect of femoral malpositioning.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To assess the precision of a novel protocol for determination of femoral varus angle (FVA) using computed tomography (CT) in dogs, and to quantify the effect of femoral rotational and sagittal plane malpositioning on measured FVA. STUDY DESIGN: Cross-sectional study. SAMPLE POPULATION: Femora (n?=?66) from dogs that had pelvic limb CT examination for patellar instability (26) or other reasons (10). METHODS: Three observers measured FVA of each of 66 femora on three separate occasions. Standardized orientation of a volume rendered image was achieved by superimposition of the caudal and distal aspects of the femoral condyles on a lateral projection, definition of a sagittal plane axis, and finally rotation through 90° to yield a cranial projection. Intra- and inter-observer variability were estimated using the intra-class correlation coefficient. The effect of variation in rotational and sagittal plane orientation on measured FVA was subsequently quantified using 6 femora with FVAs between -0.4° and 19°. RESULTS: Intra-class correlation coefficients for the 3 observers, indicating intra-observer variation, were 0.982, 0.937, and 0.974. The intra-class correlation coefficient of the means of the results from each observer, indicating inter-observer variation, was 0.976. Consistent linear variations in measured FVA occurred as a result of rotational malpositioning in all 6 tested femora, and as a result of sagittal plane malpositioning in femora with FVAs???7.9°. CONCLUSIONS: The reported protocol for the measurement of FVA in dogs is repeatable and reproducible. Small variations in femoral orientation, as might be expected with conventional radiography, lead to clinically significant alterations in measured FVA.

Oxley B; Gemmill TJ; Pink J; Clarke S; Parry A; Baines S; Malcolm McKee W

2013-08-01

253

Neck reconstruction (AIIMS Box Technique) in the management of large femoral neck defects.  

UK PubMed Central (United Kingdom)

Large femoral neck defects are frequently associated with neglected femoral neck fractures, sequelae of infection, and failed fixation devices. The AIIMS box technique of neck reconstruction has the objectives of femoral head preservation and restoration of hip function in such cases. 32 patients (age range 20-56, average 38 years) with large femoral neck defects were treated from January 1990 to May 1997 and were followed up for a minimum of 10 years (range 10 to 17 years). The neck defect was converted into a box using osteal flaps (base from greater trochanter, anterior wall from head, quadratus femoris muscle pedicle graft posteriorly), which was filled with cancellous bone autograft, and stabilized with cancellous screws. Union occurred in all patients in a mean time of 16 weeks (range 12-20 weeks). One patient developed avascular necrosis (AVN) of femoral head. 8 out of 32 results were classified as excellent, 22 good and 2 fair. Good functional mobility was seen in all but two patients. Complications included coxa vara in two patients, and fixation problems in four patients. Large femoral neck defects can be managed successfully by this technique with preservation of the viability of the femoral head, and therefore the procedure should be considered in appropriate cases, particularly in young adults.

Garg B; Upendra BN; Jayaswal A

2011-01-01

254

One-stage anatomic double-bundle anterior and posterior cruciate ligament reconstruction using the autogenous hamstring tendons.  

UK PubMed Central (United Kingdom)

This is the first report of an anatomic double-bundle ACL and PCL reconstruction procedure with the autogenous hamstring tendons. We prepare two pairs of the doubled tendon grafts, to which a polyester tape and an Endobutton-CL are attached using our original technique at the tibial and femoral ends, respectively. Under arthroscopic and fluoroscopic observations, two tibial tunnels for PCL reconstruction are created so that they pass through the posteromedial and anterolateral bundle attachments, respectively. Then, we create two tibial tunnels for anatomic double-bundle ACL reconstruction so that each tunnel axis is aimed at a targeted point on the femoral condyle. Using the outside-in technique, two femoral tunnels for PCL reconstruction are created so that the tunnel outlets are located at the center of the anterolateral and posteromedial bundle attachments. Then, two femoral tunnels for anatomic double-bundle ACL reconstruction are created with the trans-tibial tunnel technique. After the two grafts have been placed for PCL reconstruction, the two grafts are placed for ACL reconstruction. After all the femoral graft ends are fixed, the knee joint is reduced to the full extension position, and then, the four tibial tape portions are simultaneously fixed with the turn-buckle stapling technique.

Yasuda K; Kitamura N; Kondo E; Hayashi R; Inoue M

2009-07-01

255

One-stage anatomic double-bundle anterior and posterior cruciate ligament reconstruction using the autogenous hamstring tendons.  

Science.gov (United States)

This is the first report of an anatomic double-bundle ACL and PCL reconstruction procedure with the autogenous hamstring tendons. We prepare two pairs of the doubled tendon grafts, to which a polyester tape and an Endobutton-CL are attached using our original technique at the tibial and femoral ends, respectively. Under arthroscopic and fluoroscopic observations, two tibial tunnels for PCL reconstruction are created so that they pass through the posteromedial and anterolateral bundle attachments, respectively. Then, we create two tibial tunnels for anatomic double-bundle ACL reconstruction so that each tunnel axis is aimed at a targeted point on the femoral condyle. Using the outside-in technique, two femoral tunnels for PCL reconstruction are created so that the tunnel outlets are located at the center of the anterolateral and posteromedial bundle attachments. Then, two femoral tunnels for anatomic double-bundle ACL reconstruction are created with the trans-tibial tunnel technique. After the two grafts have been placed for PCL reconstruction, the two grafts are placed for ACL reconstruction. After all the femoral graft ends are fixed, the knee joint is reduced to the full extension position, and then, the four tibial tape portions are simultaneously fixed with the turn-buckle stapling technique. PMID:19399478

Yasuda, Kazunori; Kitamura, Nobuto; Kondo, Eiji; Hayashi, Riku; Inoue, Masayuki

2009-04-28

256

Radiographic and histopathologic study of morphologic changes in the mandibular condyle of ovariectomized cynomolgus monkey  

International Nuclear Information System (INIS)

The objective of this study was to investigate the micro structural and histomorphometrical changes in mandibular condyles in ovariectomized cynomolgus monkeys. The experimental animals were female cynomolgus monkeys (n=24) with a mean age of 10 years, range 9-15 years. The animals were divided into 2 groups: an experimental group to be ovariectomized (OVX group) and a control sham operated group (Sham group). The animals in each group were housed under the environmental condition outlined in the appropriate guidelines from the National Institutes of Health U.S.A. Two years post-operatively, the animals were killed and the maxillo-facial bones were dissected and fixed with 10% buffered formalin. The bone mineral density (BMD) of the mandibular condyle was determined by densitometric analysis of the lateral oblique transcranial projection radiograph. Bone X-ray microanalysis on the mandibular condyle was performed using micro computed tomography (?CT). The following parameters were examined in cancellous bone: bone volume (BV/TV), trabecular thickness and number, trabecular separation, structure model index (SMI), number of node struts, and total strut length of tissue volume. Further, cortical bone volume was additionally examined. The condyles were immersed in Plank-Rychlo's solution for demineralization, embedded in paraffin, and used for standard light microscopic observation. Thickness of the cartilage was measured and the unit number of hypertrophic cartilage cells was counted on each coronal section. Densitometric analysis of lateral oblique transcranial projection radiograph showed that BMD of the mandibular condyle did not significantly decrease in the OVX group in comparison with the Sham group. However, CT analysis did show that BV/TV of the cancellous bone, trabecular thickness and number, SMI, number of node struts, and total strut length of tissue volume in the OVX group were significantly lower than those found in the Sham group. Further, trabecular separation in the OVX group was significantly higher than that in the Sham group. However, cortical bone volumes were similar in those two groups. Histomorphometrical analysis on condylar cartilage showed that both thickness of the hypertrophy stratum and unit number of hypertrophic cartilage cells were lower in the OVX group than in the Sham group. Bone loss and trabecular fragmentation in the monkey condyle could be induced with ovariectomy. The changes occurred only in cancellous bone, but not in cortical bone. (author)

2006-01-01

257

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 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 grupo de nuestros pacientes, seleccionados y aleatorizados, que recibieron un tratamiento conservador de fracturas del proceso condilar. Se evaluaron las intervenciones terap? (more) ?uticas 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 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 fol (more) low 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, co

Wassouf, A.; Verdeja, R.; Grätz, K.W.

2005-04-01

258

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 treatmen

A. Wassouf; R. Verdeja; K.W. Grätz

2005-01-01

259

Posterior fossa epidural hematoma  

International Nuclear Information System (INIS)

[en] CT demonstrated posterior fossa epidural hematoma in three patients with head trauma in whom this diagnosis was not clinically apparent. No patient was in stupor or coma and no patient experienced a lucid interval. Only one patient had signs referable to the posterior fossa. Two patients had occipital skull fracture disclosed by plain radiographs. CT revealed a unilateral biconvex hematoma in two cases, and a bilateral hematoma with supratentorial extension in the third. All patients underwent suboccipital craniectomy and recovered. Therapeutic success in these cases was facilitated by early CT and the rapid disclosure of the unsuspected posterior fossa lesions. CT showing contiguous hematoma below and above the tentorium cerebelli after posterior head trauma is highly suggestive of epidural hematoma arising from the posterior fossa. (orig.)

1983-01-01

260

Multifocal posterior necrotizing retinitis.  

UK PubMed Central (United Kingdom)

PURPOSE: To describe the clinical features of an acute, inflammatory, and progressive retinal necrosis that affects primarily the posterior pole. DESIGN: Retrospective, interventional case series. METHODS: Twenty-seven eyes of 24 patients diagnosed with and treated for acute retinal necrosis (ARN) were categorized into two groups according to the predominant location of retinitis at presentation: either in the peripheral retina or in the posterior pole. Clinical features, disease progression, visual outcomes, and complications of these two groups were compared. RESULTS: Fifteen eyes demonstrated the known peripheral retinitis pattern, and 12 eyes exhibited a pattern of retinitis that affected mainly the posterior pole. Eyes with peripheral retinitis showed focal, well-demarcated areas of retinal necrosis in the periphery with rapid circumferential progression and rare involvement of the posterior pole. All eyes with posterior pole retinitis had multifocal deep lesions posterior to the vortex veins at presentation, and half of these eyes had lesions in the macula. These lesions progressed to patches of confluent retinitis in both the periphery and the posterior pole. There was no significant difference between the two groups in the incidence of anterior chamber and vitreous cells, vascular sheathing, retinal hemorrhages, or optic disk edema. Patients with posterior retinitis involvement seemed to have a worse visual outcome during the first two years after diagnosis. The Cox proportional hazards model suggested a higher incidence of retinal detachment in patients with posterior retinitis (P = .07). CONCLUSIONS: The authors report a pattern of herpetic retinitis that affects predominantly the posterior pole and may have a worse visual prognosis and a higher rate of retinal detachment.

Margolis R; Brasil OF; Lowder CY; Smith SD; Moshfeghi DM; Sears JE; Kaiser PK

2007-06-01

 
 
 
 
261

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  

Directory of Open Access Journals (Sweden)

Full Text Available 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 meses 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.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 months 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

2009-01-01

262

Atypical femoral fractures  

Science.gov (United States)

Summary Bisphosphonates (BPs) represent the most widely used therapy for osteoporosis. Recently, a relationship between long-term treatment with BPs and a subset of atypical femoral fractures (AFFs) from below the lesser trochanter to the sovracondilar line has been described. Many etiopathogenetic theories have been invoked to explain AFFs: reduced bone turnover and increased osteoblast bone apposition with accumulation of microdamage and decreased bone toughness with subsequent increased risk of micro-cracks and duration fractures, collagen fiber cross-linking and vascularization impairment. Based on published studies, a task force of the American Society for Bone and Mineral Research has redacted the diagnostic criteria of AFFs by classifying them according to their major and minor criteria. The treatment for displaced AFFs is osteosynthesis, but there is a lack of evidence for undisplaced AFFs and the duration of fracture treatment. BPs have a proven efficacy in osteoporotic fracture reduction as well as in the treatment of other bone diseases caused by the downregulation of osteoclast activity. BPs have an excellent benefit-to-risk ratio; however, minor adverse events, such as AFFs, occur in a variable percentage of patients treated over a long period of time.

Giannini, Sandro; Chiarello, Eugenio; Tedesco, Giuseppe; Cadossi, Matteo; Luciani, Deianira; Mazzotti, Antonio; Donati, Davide Maria

2013-01-01

263

Atypical femoral fractures.  

UK PubMed Central (United Kingdom)

Bisphosphonates (BPs) represent the most widely used therapy for osteoporosis. Recently, a relationship between long-term treatment with BPs and a subset of atypical femoral fractures (AFFs) from below the lesser trochanter to the sovracondilar line has been described. Many etiopathogenetic theories have been invoked to explain AFFs: reduced bone turnover and increased osteoblast bone apposition with accumulation of microdamage and decreased bone toughness with subsequent increased risk of micro-cracks and duration fractures, collagen fiber cross-linking and vascularization impairment. Based on published studies, a task force of the American Society for Bone and Mineral Research has redacted the diagnostic criteria of AFFs by classifying them according to their major and minor criteria. The treatment for displaced AFFs is osteosynthesis, but there is a lack of evidence for undisplaced AFFs and the duration of fracture treatment. BPs have a proven efficacy in osteoporotic fracture reduction as well as in the treatment of other bone diseases caused by the downregulation of osteoclast activity. BPs have an excellent benefit-to-risk ratio; however, minor adverse events, such as AFFs, occur in a variable percentage of patients treated over a long period of time.

Giannini S; Chiarello E; Tedesco G; Cadossi M; Luciani D; Mazzotti A; Donati DM

2013-01-01

264

Atypical femoral fractures.  

Science.gov (United States)

Bisphosphonates (BPs) represent the most widely used therapy for osteoporosis. Recently, a relationship between long-term treatment with BPs and a subset of atypical femoral fractures (AFFs) from below the lesser trochanter to the sovracondilar line has been described. Many etiopathogenetic theories have been invoked to explain AFFs: reduced bone turnover and increased osteoblast bone apposition with accumulation of microdamage and decreased bone toughness with subsequent increased risk of micro-cracks and duration fractures, collagen fiber cross-linking and vascularization impairment. Based on published studies, a task force of the American Society for Bone and Mineral Research has redacted the diagnostic criteria of AFFs by classifying them according to their major and minor criteria. The treatment for displaced AFFs is osteosynthesis, but there is a lack of evidence for undisplaced AFFs and the duration of fracture treatment. BPs have a proven efficacy in osteoporotic fracture reduction as well as in the treatment of other bone diseases caused by the downregulation of osteoclast activity. BPs have an excellent benefit-to-risk ratio; however, minor adverse events, such as AFFs, occur in a variable percentage of patients treated over a long period of time. PMID:23858308

Giannini, Sandro; Chiarello, Eugenio; Tedesco, Giuseppe; Cadossi, Matteo; Luciani, Deianira; Mazzotti, Antonio; Donati, Davide Maria

2013-01-01

265

[Distal femoral fractures  

UK PubMed Central (United Kingdom)

Techniques of operative treatment of supra- and intercondylar fractures have changed in recent years. These changes refer to reduction techniques and implant selection. Operative approach concepts, which remained unchanged for several decades were critically evaluated and modified to a minimal invasive osteosynthesis [MIO]. This included for intraarticular fractures a trans-articular joint reconstruction and a retrograde plate osteosynthesis (TARPO). This technique result in better operative visualization and management of intraarticular comminution, saver fracture healing and better functional outcome. For extraarticular fractures a minimally invasive percutaneous plate osteosynthesis (MIPPO) via stab incisions only or retrograde intramedullary nailing is available. Beside that new strategies and techniques for the avoidance of axial malalignment, rotational deformities and leg length discrepancies are described, as well as a new plate generation (LISS: less invasive stabilization system), which behaves more like an internal fixator. The complex nature of combined fractures and soft tissue injuries of the distal femur and proximal tibia needs special attention and specific management. Distal femoral and proximal tibial fractures in young patients are usually caused by a high energy trauma. They are complicated by a high rate of systemic and local injuries to cartilage, ligaments and skin. The patients in this group with severe injuries need a detailed treatment algorithm, because the surgeon's individual skill, enthusiasm and wishful thinking frequently led to unsatisfactory results. A decision making scheme is presented specifically addressing timing and treatment modalities.

Krettek C; Schandelmaier P; Richter M; Tscherne H

1998-01-01

266

[Distal femoral fractures].  

Science.gov (United States)

Techniques of operative treatment of supra- and intercondylar fractures have changed in recent years. These changes refer to reduction techniques and implant selection. Operative approach concepts, which remained unchanged for several decades were critically evaluated and modified to a minimal invasive osteosynthesis [MIO]. This included for intraarticular fractures a trans-articular joint reconstruction and a retrograde plate osteosynthesis (TARPO). This technique result in better operative visualization and management of intraarticular comminution, saver fracture healing and better functional outcome. For extraarticular fractures a minimally invasive percutaneous plate osteosynthesis (MIPPO) via stab incisions only or retrograde intramedullary nailing is available. Beside that new strategies and techniques for the avoidance of axial malalignment, rotational deformities and leg length discrepancies are described, as well as a new plate generation (LISS: less invasive stabilization system), which behaves more like an internal fixator. The complex nature of combined fractures and soft tissue injuries of the distal femur and proximal tibia needs special attention and specific management. Distal femoral and proximal tibial fractures in young patients are usually caused by a high energy trauma. They are complicated by a high rate of systemic and local injuries to cartilage, ligaments and skin. The patients in this group with severe injuries need a detailed treatment algorithm, because the surgeon's individual skill, enthusiasm and wishful thinking frequently led to unsatisfactory results. A decision making scheme is presented specifically addressing timing and treatment modalities. PMID:9887674

Krettek, C; Schandelmaier, P; Richter, M; Tscherne, H

1998-01-01

267

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

2007-01-01

268

MR imaging of posterior cruciate ligament injury  

Energy Technology Data Exchange (ETDEWEB)

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.

Cho, Young Ja; Park, Yang Hee; Lee, Jee Yean; Jee, Keum Nahn; Lee, Kyung Hee [National Police Hospital, Seoul (Korea, Republic of)

1994-11-15

269

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

1994-01-01

270

Femoral sizing in total knee arthroplasty is rotation dependant.  

UK PubMed Central (United Kingdom)

PURPOSE: The mismatch between the medio-lateral (ML) and the antero-posterior (AP) size of femoral components in total knee arthroplasty (TKA) has been linked to gender, ethnicity, morphotype and height differences in patients. The hypothesis of this study was that the AP size measurement of a femoral component increases with more external rotation in posterior referencing TKA. METHODS: During a 2-year period, 201 patients were included in this prospective study. The AP distance of the distal femur was measured with an AP sizer of the Vanguard (Biomet, Warsaw, US) knee system. This AP sizer allows to dial in external rotation by 1° increments and to determine the femoral size with an anterior boom. AP size was noted at 0°, 3° and 5° of external rotation and then compared for ML matching. RESULTS: Antero-posterior and corresponding ML sizes match perfectly for the Vanguard at 0° of external rotation and a central boom position on the anterior femoral surface. Then, the anterior boom was positioned on the antero-lateral cortex and the AP size increased a mean (SD) 1 (0.5) mm. With 3° of external rotation, the AP size increased a mean (SD) 2.3 (0.4) mm and for 5° a mean (SD) 3.8 (0.3) mm (P < 0.05). This increase in AP size resulted in ML overhang of 2.2 (1.2) mm for 3° and 4.8 (2.6) mm for 5° (P < 0.05). CONCLUSIONS: Antero-posterior size measurement of the distal femur is determined by the anatomy of the anterior surface with a higher antero-lateral cortex and the amount of external rotation that is dialled in during surgery. Since these parameters vary case per case, the availability of narrow components offers more surgical options to the surgeon and its importance extends beyond the gender aspect allowing different amounts of external rotation to be used without ML overhang. LEVEL OF EVIDENCE: II.

Koninckx A; Deltour A; Thienpont E

2013-10-01

271

Computerized navigation for treatment of slipped femoral capital epiphysis.  

UK PubMed Central (United Kingdom)

In situ pinning with a single screw is the treatment of choice for symptomatic slipped capital femoral epiphysis (SCFE). Some technical features are critical and include proper screw entry point, screw direction in relation to the epiphysis, and the length of screw. These are complicated by the deformity created as a result of the posterior slip of the epiphysis. Fluoroscopic based computerized navigation system can increase precision in screw placement while performing the surgical task, and markedly reduce radiation. By using real fluoroscopy-based navigation, the screw can be placed with only two fluoroscopic images. Entry point, length, and precise direction can all be easily determined through this technique.

Weil Y; Pearle A; Liebergall M; Simanovsky N; Porat S; Moshieff R

2006-09-01

272

Biomechanical analysis of titanium plate systems in mandibular condyle fractures: a systematized literature review.  

UK PubMed Central (United Kingdom)

PURPOSE: To conduct a systematized review of the literature about the main methodologies used to evaluate the biomechanical fixation systems with titanium plates in fractures of the mandibular condyle. METHODS: A systematized review of literature was performed in the electronic databases PubMed, EMBASE, LILACS and MEDLINE without restriction of the publication date. The eligibility criteria were laboratory studies involving mandibular condyle fractures, studies using titanium plates, biomechanical studies, in vitro and computational studies involving the finite element method (FEM). RESULTS: Eleven articles that met the eligibility criteria were selected, including seven articles involving in vitro studies and four studies with biomechanical analysis by using FEM. CONCLUSION: Although few articles have used the finite element method, the results of in vitro studies were similar to those found in computational studies, regarding to the stable use of two titanium miniplates.

Costa FW; Bezerra MF; Ribeiro TR; Pouchain EC; Sabóia Vde P; Soares EC

2012-06-01

273

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

International Nuclear Information System (INIS)

[en] 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)

2007-01-01

274

Bilateral Bifid Mandibular Condyle: A Case Report Proceso Condilar Bífido Bilateral: Reporte de Caso  

Directory of Open Access Journals (Sweden)

Full Text Available The bifid mandibular condyle is an exceedingly rare anomaly, frequently diagnosed as an incidental finding in a panoramic radiograph. Its etiology and pathogenesis are unknown, though the most acceptable theory suggests that trauma is at the origin of the condition. This article reports a new case of bilateral bifid condyle in a 21-year-old female with history of trauma in childhood.El proceso condilar bífido es una anomalía muy rara. Se diagnostica como un hallazgo accidental en una radiografía panorámica. Su etiología y patogenia son desconocidas, aunque la teoría más aceptada sugiere que el trauma está en el origen de esta condición. Este artículo presenta un nuevo caso de proceso condilar bífido bilateral en una mujer de 21 años de edad con antecedentes de trauma en la infancia.

Suzana Lubambo de Melo; Joanna Martins Novais Barbosa; Aline Carvalho Peixoto; Thiago de Santana Santos; Marleny Gerbi

2011-01-01

275

Effect of alendronate on endochondral ossification in mandibular condyles of growing rats  

Directory of Open Access Journals (Sweden)

Full Text Available The replacement of the calcified cartilage by bone tissue during the endochondral ossification of the mandibular condyle is dependent of the resorbing activity of osteoclats. After partial resorption, calcified cartilage septa are covered by a primary bone matrix secreted by osteoblasts. Osteoadherin (OSAD) is a small proteoglycan present in bone matrix but absent in cartilage during the endochondral ossification. The aim of this study was to analyze the effect of alendronate, a drug known to inhibit bone resorption by osteoclasts, on the endochondral ossification of the mandibular condyle of young rats, by evaluating the distribution of osteoclasts and the presence of OSAD in the bone matrix deposited. Wistar newborn rats (n=45) received daily injections of alendronate (n=27) or sterile saline solution as control (n=18) from the day of birth until the ages of 4, 14 and 30 days. At the days mentioned, the mandibular condyles were collected and processed for transmission electron microscopy analysis. Specimens were also submitted to tartrate resistant acid phosphatase (TRAP) histochemistry and ultrastructural immunodetection of OSAD. Alendronate treatment did not impede the recruitment and fusion of osteoclasts at the ossification zone during condyle growth, but they presented inactivated phenotype. The trabeculae at the ossification area consisted of cartilage matrix covered by a layer of primary bone matrix that was immunopositive to OSAD at all time points studied. Apparently, alendronate impeded the removal of calcified cartilage and maturation of bone trabeculae in the mandibular ramus, while in controls they occurred normally. These findings highlight for giving attention to the potential side-effects of bisphosphonates administered to young patients once it may represent a risk of disturbing maxillofacial development.

V. Bradaschia-Correa; F.A.C. Barrence; L.B. Ferreira; L.F. Massa; V.E. Arana-Chavez

2012-01-01

276

Aneurysmal bone cyst of the mandibular condyle with condylar neck fracture  

International Nuclear Information System (INIS)

Aneurysmal bone cyst (ABC) is relatively rare, non-neoplastic expansible lesion of bone. The case of a 15-year-old male with a ABC of the left mandibular condyle is presented. Panoramic radiograph showed a unilocular radiolucency with thinned coritces and a subcondylar fracture which was due to the trauma. Computed tomography (CT) revealed expansible lesion which had similar attenuation soft tissue. The patient was treated surgically including iliac crestal bone graft.

2009-01-01

277

Bifid mandibular condyle with temporomandibular joint ankylosis: report of two cases and review of literature  

International Nuclear Information System (INIS)

Bifid mandibular condyle is an uncommon entity with a controversial etiology. It can be developmental or acquired and rarely may be associated with temporomandibular joint (TMJ) ankylosis. Although the patient may be asymptomatic, the radiologist should be aware of this entity and its clinical implications. We report two cases of BMC, one developmental and the other secondary to trauma. Both were diagnosed using computed tomography, which additionally revealed the associated ankylosis of TMJ in both the patients. (orig.)

2009-01-01

278

Bifid mandibular condyle with temporomandibular joint ankylosis: report of two cases and review of literature  

Energy Technology Data Exchange (ETDEWEB)

Bifid mandibular condyle is an uncommon entity with a controversial etiology. It can be developmental or acquired and rarely may be associated with temporomandibular joint (TMJ) ankylosis. Although the patient may be asymptomatic, the radiologist should be aware of this entity and its clinical implications. We report two cases of BMC, one developmental and the other secondary to trauma. Both were diagnosed using computed tomography, which additionally revealed the associated ankylosis of TMJ in both the patients. (orig.)

Gulati, Ajay; Virmani, V.; Ramanathan, S.; Khandelwal, N. [Postgraduate Institute of Medical Education and Research, PGIMER, Department of Radiodiagnosis and Imaging, Chandigarh (India); Verma, L. [Gian Sagar Dental College and Hospital, Department of Pedodontics, Patiala (India)

2009-10-15

279

Cóndilo bífido: A propósito de un caso/ Bifid condyle: Case report  

Scientific Electronic Library Online (English)

Full Text Available Abstract in spanish En este artículo, a propósito de un caso clínico, se presenta el cóndilo bífido como una rara alteración mandibular con muchas incógnitas. Su diagnóstico suele ser un hallazgo casual en radiografías panorámicas de rutina. El número de casos relatados en literatura ha experimentado en los últimos años un crecimiento debido al aumento de pruebas radiológicas que se realizan. Se discute sobre las diferentes teorías existentes con respecto a la etiología de es (more) te proceso. En lo referente a la relevancia clínica del cóndilo bífido señalamos que la gran mayoría son asintomáticos. Es importante realizar un buen diagnóstico diferencial de éste proceso con otras lesiones que producen alteraciones morfológicas condilares, la prueba de elección es la tomografía computerizada. El tratamiento conservador suele ser efectivo en los casos con clínica de disfunción articular leve, la cirugía tan sólo suele indicarse en casos de anquilosis condilar, normalmente éstos casos son secundarios a traumatismos. Abstract in english The double headed mandible condyle is a rare alteration that is frequently diagnosticated as an incidental finding in a panoramic radiograph. The different theories about its etiology are explained in this article. Symptoms described with bifid condyles vary from case to case, but in most instances are absent. Computer tomography is the ideal imaging method to evaluate the condyle morphology and to role out any degenerative process to achieve the differential diagnosis. T (more) reatment is conservative for symptomatic patients with TMJ disorders, surgical treatment is described in literature in TMJ ankylosis that develops in bifid condyles secondary to trauma.

Corchero Martín, Guadalupe; Gonzalez Terán, Tomás; García Reija, María Fe; Sánchez Santolino, Sergio; Saiz Bustillo, Ramón

2005-07-01

280

[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

 
 
 
 
281

Is there added risk in resurfacing a femoral head with cysts?  

UK PubMed Central (United Kingdom)

BACKGROUND: Femoral head cysts have been identified as a risk factor for early femoral failures after metal-on-metal hip resurfacing arthroplasty (HRA) based on limited scientific data. However, we routinely performed HRA if less than 1/3 of the femoral head appeared destroyed by cysts on the preoperative radiograph. This study was undertaken to analyze whether there was an added risk of early femoral failures in HRA when femoral head cysts were present. METHODS: This retrospective case-control study included 939 MOM HRAs operated by a single surgeon with use of the posterior minimally invasive surgical (MIS) approach between November 2005 and January 2009. Patients with all diagnoses except osteonecrosis were included. Among them, 117 HRAs had femoral head cysts ? 1 cm identified in surgery. All cysts were treated with bone grafting using acetabular reamings packed into the cavitary defect (instead of filling the cysts with cement). The control group, which had no cyst observed at the time of surgery, was randomly selected from our database using computer algorithms to match those cases in the study group for the parameters of surgical date, age, gender, body mass index, diagnosis, femoral fixation method, and the size of the femoral component. RESULTS: The minimum follow-up was 24 months for both groups. The early femoral failure rate in the study group was 3/117 (2.6%) and 0/117 in the control group; there was no statistical difference between these two groups (P = 0.08). In the study group, there were two femoral neck fractures (revised): both occurred in patients having a cyst size of 1 cm3; and there was one femoral component loosening at 3-year follow up in a patient having a cyst size of 2 cm(3). CONCLUSION: Although the risk of early femoral failures among the group with cysts appeared higher than the group without cysts, we could not demonstrate a significant statistical difference between the two groups. It is possible that bone grafting cysts rather than cementing them may account for the low failure rate, and that this technique may minimize the risk of resurfacing a femoral head with cysts.

Gross TP; Liu F

2011-01-01

282

CAD-CAM-generated hydroxyapatite scaffold to replace the mandibular condyle in sheep: preliminary results.  

UK PubMed Central (United Kingdom)

In this study, rapid CAD-CAM prototyping of pure hydroxyapatite to replace temporomandibular joint condyles was tested in sheep. Three adult animals were implanted with CAD-CAM-designed porous hydroxyapatite scaffolds as condyle substitutes. The desired scaffold shape was achieved by subtractive automated milling machining (block reduction). Custom-made surgical guides were created by direct metal laser sintering and were used to export the virtual planning of the bone cut lines into the surgical environment. Using the same technique, fixation plates were created and applied to the scaffold pre-operatively to firmly secure the condyles to the bone and to assure primary stability of the hydroxyapatite scaffolds during masticatory function. Four months post-surgery, the sheep were sacrificed. The hydroxyapatite scaffolds were explanted, and histological specimens were prepared. Different histological tissues penetrating the scaffold macropores, the sequence of bone remodeling, new apposition of bone and/or cartilage as a consequence of the different functional anatomic role, and osseointegration at the interface between the scaffold and bone were documented. This animal model was found to be appropriate for testing CAD-CAM customization and the biomechanical properties of porous, pure hydroxyapatite scaffolds used as joint prostheses.

Ciocca L; Donati D; Fantini M; Landi E; Piattelli A; Iezzi G; Tampieri A; Spadari A; Romagnoli N; Scotti R

2013-08-01

283

In vivo kinematic comparison of posterior cruciate-retaining and posterior stabilized total knee arthroplasties under passive and weight-bearing conditions.  

Science.gov (United States)

An in vivo comparison of flexion kinematics for posterior cruciate-retaining (PCR) and posterior stabilized (PS) total knee arthroplasty (TKA) was performed. Twenty patients who underwent bilateral paired TKAs were included in this prospective study. Both PCR and PS prostheses were from the same TKA series with comparable surface geometries, and all were implanted by a single surgeon. Of these 20 patients, 3-dimensional kinematics during flexion could be analyzed using a computer model fitting technique in 18 patients. The follow-up period ranged from 18 to 53 months. In the PCR TKA, an anterior femoral translation from 30 degrees to 60 degrees of flexion was observed in the weight-bearing condition. In contrast, flexion kinematics for the PS TKA was characterized by the maintenance of a constant contact position under weight-bearing conditions and posterior femoral rollback in passive flexion. PMID:16139716

Yoshiya, Shinichi; Matsui, Nobuzo; Komistek, Richard D; Dennis, Douglas A; Mahfouz, Mohamed; Kurosaka, Masahiro

2005-09-01

284

The intact posterior cruciate ligament not only controls posterior displacement but also maintains the flexion gap.  

UK PubMed Central (United Kingdom)

BACKGROUND: The PCL is a strong stabilizer of the knee and provides posterior stability to the tibia. However, sagittal alignment of the PCL with the knee at 90° flexion suggests the PCL might play a role not only in posterior stabilization but also in maintaining the flexion gap. QUESTIONS/PURPOSES: We determined whether the intact PCL helps maintain the flexion gap. METHODS: We examined axial radiographs and gravity sag views of 17 patients with chronic isolated unilateral PCL injury. The flexion gap was defined as the mean value of the medial and lateral distances between the femoral and tibial bones on the axial radiograph. Increase in the flexion gap and posterior laxity were determined by comparing the patients' injured and contralateral uninjured knees. RESULTS: The flexion gap of PCL injured knees (median, 7.5 mm; range, 5.3-11.5 mm; medial median, 6.2 mm; medial range, 3.7-8.3 mm; lateral median, 7.9 mm; lateral range, 5.3-11.5 mm) was larger than that seen in uninjured knees (median, 5.0 mm; range, 4.0-7.6 mm; medial median, 4.6 mm; medial range 3.4-7.1 mm; lateral median, 5.6; lateral range, 4.5-11.2 mm). The increment in the medial distance was similar to that in the lateral distance. Posterior laxity of injured knees was 9.1 (median); 5.4 to 15.2 (range) mm greater than that of uninjured knees. We found no correlation between posterior laxity and the flexion gap increment. CONCLUSIONS: Our data suggest the intact PCL controls posterior displacement and maintains the flexion gap.

Matsui Y; Kadoya Y; Horibe S

2013-04-01

285

[Efficacy of preoperative Halo-femoral traction in the treatment of rigid idiopathic scoliosis].  

UK PubMed Central (United Kingdom)

OBJECTIVE: To evaluate the efficacy of preoperative Halo-femoral traction in the treatment of rigid idiopathic scoliosis. METHODS: Sixteen patients with rigid idiopathic scoliosis treated with Halo-femoral traction before posterior spine fusion from July 2003 through May 2006 were studied retrospectively. There were 4 male and 12 female, with a mean age of 16 years (range, 12-20 years). The coronal Cobb angles of coronal major curve and the thoracic kyphosis (T(5)-T(12)) were 111 degrees and 64 degrees, respectively. All the patients underwent preoperative Halo-femoral traction. After the maximum weight traction for 2-3 weeks, a posterior instrumentation and fusion was performed. The correction rate of coronal major curve on preoperative side bending film, on supine film after Halo-femoral traction and after surgery was compared. RESULTS: The maximum traction weight averaged 19 kg. All patients had an at least 12-month follow-up. One patient experienced transient brachial plexus palsy and complete recovery was achieved after reducing the traction weight. No neurologic complication, death and respiratory failure occurred after surgery. In comparison to the correction rate of 18.7% on preoperative side bending film, the correction rate of coronal major curve after Halo-femoral traction increased by 13.2% (P < 0.05). The postoperative correction rate of coronal major curve and thoracic kyphosis was 48.6% and 51.9%, respectively. At the final follow-up, the coronal and sagittal correction loss averaged 2.0% and 5.8%, respectively. CONCLUSIONS: Preoperative Halo-femoral traction combined with intraoperative posterior spinal release can significantly enhance the correction rate for rigid idiopathic scoliosis. However, the traction complications should be worthy of vigilance.

Zhu ZZ; Qiu Y; Wang B; Yu Y; Qian BP; Zhu F; Ma WW; Sun X

2010-04-01

286

Heterogeneity of bone microstructure in the femoral head in patients with osteoporosis: An ex vivo HR-pQCT study.  

UK PubMed Central (United Kingdom)

INTRODUCTION: Trabecular bone in the femoral head has a complicated and heterogeneous structure with few studies having analyzed heterogeneity in this structure quantitatively. We analyze trabecular bone microstructure in the femoral head with osteoporosis (OP) using high resolution peripheral quantitative CT (HR-pQCT) to investigate its regional characteristics. METHODS: Fifteen femoral heads extracted from female OP patients with femoral neck fracture (85±7, 67-94years) were scanned by HR-pQCT at 41?mvoxel size. The femoral head was segmented into 15 regions (3 longitudinal regions: superior, center, and inferior, and 5 axial subregions: center, medial, lateral, anterior, posterior). Of these 15 regions, five were excluded due to overlap with the fracture site, leaving a total of 10 regions of cancellous bone microstructures to be quantitatively assessed using the following parameters: bone volume fraction, trabecular thickness, number, separation, connectivity density, structure model index, and degree and orientation of anisotropy. These parameters were compared among each region. RESULTS: Trabecular bone at the center, superior, and supero-posterior regions of the femoral head had higher bone volume, trabecular number, thickness, narrower bone marrow spaces, higher connectivity and anisotropy, and more plate-like structure. This plate-like structure ran supero-inferiorly and antero-posteriorly at the superior and center regions. Bone volume at the anterior, posterior, and medial regions was almost half of the central and superior regions. CONCLUSION: Significant heterogeneity of the trabecular bone microstructure in the OP femoral head was showed quantitatively in this study. These data offer new insight into bone microstructural anatomy and may prove to provide useful information on clinical medicine such as hip surgeries.

Chiba K; Burghardt AJ; Osaki M; Majumdar S

2013-09-01

287

Extension block secondary to partial anterior cruciate ligament tear on the femoral attachment of the posterolateral bundle.  

UK PubMed Central (United Kingdom)

PURPOSE: The purpose of this investigation was to prove that a partial tear of the anterior cruciate ligament (ACL) at the femoral attachment of the posterolateral bundle can result in mechanical knee locking and trigger the injury mechanism of an isolated ACL injury. TYPE OF STUDY: Case series. METHODS: From February 1993 through June 1999, 19 cases of knee locking with observation of a torn ACL, confirmed under arthroscopy, were investigated. Patients' ages ranged from 22 to 54 years. The causes of injury were sporting activities in 14 patients (8 skiing, 4 soccer, and 2 badminton); slipping and falling in 2 cases; a pedestrian car accident in 2 cases; and an unknown low-velocity injury in 1 case. RESULTS: On physical examination, each patient indicated that the chief complaint was knee pain; all had a locked knee at 5 degree to 20 degree of full extension and 4 cases showed a locked knee at full flexion. Of the 19 cases, Lachman testing was positive in 3. With respect to intra-articular injuries, 3 patients had a tear in the medial meniscus and 1 had a tear in the lateral meniscus. The average time span between arthroscopy examinations was 3 months with a range of 1 to 10 months. Arthroscopic diagnosis and treatment were performed and meniscal tear was ruled out as the cause of locking in all patients. CONCLUSIONS: The mechanisms of injury for isolated ACL were knee hyperextension and internal rotation of lower extremity brought on especially by a low-velocity injury. The partial ACL tears were found on the femoral attachment site of the posterolateral bundle. The torn segment of the ACL was interposed between the lateral femoral condyle and the lateral tibial condyle and acted as a mechanical obstruction, giving rise to the locking symptom. In all 19 cases, the torn portion of the ACL was excised under arthroscopy and the locked knees were treated properly.

Chun CH; Lee BC; Yang JH

2002-03-01

288

A Complication During Femoral Broaching in Total Hip Arthroplasty: A Case Report  

Science.gov (United States)

Press-fit component fixation is one of the primary goals in uncemented total hip arthroplasty. When aiming at proximal load transfer, the stem size has to be selected with regard to the shape of the proximal femoral canal. This can be challenging in patients with ‘champagne flute’ femurs with a relatively narrow diaphysis, especially when a long stem femoral component is used. The present case report describes a complication during femoral broaching for a primary uncemented femoral component. Because of the narrow diaphysis, the distal portion of the broach got caught in the narrow canal and it became impossible to remove the broach with conventional techniques. Via a second distal incision, the femur was split from the distal tip of the broach to approximately 5 cm distal of the femoral neck cut along the posterior aspects of the femur. This loosened the broach enough to allow for an uncomplicated removal. The longitudinal split was secured with cables before a similar size primary implant was press fitted into the femoral canal.

Waldstein, Wenzel; Boettner, Friedrich

2013-01-01

289

Ceramic femoral head retrieval data.  

UK PubMed Central (United Kingdom)

In the 1970s it was first realized that the properties of alumina ceramics could be exploited to provide better implants for orthopaedic applications. Applications depend on the fact that ceramics provided wear characteristics suitable for bearing surfaces in total hip replacement. Resultant orthopaedic use had more than 20 years' clinical success. To date more than 2.5 million alumina femoral heads have been implanted. Published reports of fracture rates of the alumina heads range between 0% for ceramics manufactured after 1990 and 13.4% for ceramics manufactured before 1990. These high fracture rates were caused by materials manufactured by companies that are not on the market today. These old aluminas had a low density, had a very coarse microstructure, and were not in compliance with specifications that are valid today. Materials scientists have substantially improved the mechanical strength of alumina. There are three generations of medical grade aluminas. The latest generation is an alumina that is hot isostatic pressed, laser marked, and proof tested. This material has been on the market since 1994. The fracture rates of the most commonly used ceramics have been analyzed by various groups, and are based on .5 million femoral heads to 1.5 million femoral heads. The fracture rate of ceramic Biolox femoral heads are 0.026 % for first generation alumina, 0.014% for second generation alumina, and 0.004% for femoral heads manufactured after 1994. Analyzing the clinical experience of more than 20 years, it can be concluded that all the improvements have produced reliable ceramic femoral heads.

Willmann G

2000-10-01

290

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.

Hoorie Bashizade; Dariush Goodarzipour; Nilofar Mofidi

2013-01-01

291

Patello-femoral and tibio-femoral contact forces during kicking type of activity  

Energy Technology Data Exchange (ETDEWEB)

In this paper patello-femoral and tibia-femoral contact forces during kicking type of activity is presented by means of a dynamic model of the knee joint which includes tibio-femoral and patello-femoral articulations, and the major ligaments of the joint. The model shows that the patella can be subjected to very large transient patello-femoral contact forces during a strenuous lower limb activity such as kicking even under conditions of small knee-flexion angles.

Engin, A.E. [Univ. of South Alabama, Mobile, AL (United States); Tumer, S.T. [Middle East Technical Univ., Ankara (Turkey)

1996-12-31

292

Spondylolisthesis and Posterior Instability  

International Nuclear Information System (INIS)

We present the case of a patient with a spondylolisthesis of L5 on S1 due to spondylolysis at the level L5/S1. The vertebral slip was fixed and no anterior instability was found. Using functional magnetic resonance imaging (MRI) in an upright MRI scanner, posterior instability at the level of the spondylolytic defect of L5 was demonstrated. A structure, probably the hypertrophic ligament flava, arising from the spondylolytic defect was displaced toward the L5 nerve root, and a bilateral contact of the displaced structure with the L5 nerve root was shown in extension of the spine. To our knowledge, this is the first case described of posterior instability in patients with spondylolisthesis. The clinical implications of posterior instability are unknown; however, it is thought that this disorder is common and that it can only be diagnosed using upright MRI.

2009-01-01

293

FEMALE POSTERIOR WALL PROSTHESIS  

UK PubMed Central (United Kingdom)

A prosthesis comprising a flattened lobe (100), a neck (110) and a handle (120) sized and shaped to shield the posterior vaginal wall from frictional contact during coitus. This self-retaining prosthesis comprises a means to retain the flattened lobe (100) within the vagina and a means to prevent the handle (120) from entering the vagina during insertion of the prosthesis or during coitus. This prosthesis decreases the volume of the vagina and decreases the area of the vaginal opening providing a non-surgical, cost-effective solution to tightening a woman's vagina. The posterior vaginal wall prosthesis enables women who have larger vaginas to use tampons.

MAURETTE NEIL LUKE

294

An anatomic study of the distal femoral epiphysis.  

UK PubMed Central (United Kingdom)

BACKGROUND: The anatomy of the undulating distal femoral physis may be relevant to growth disturbance after physeal fractures and screw fixation about the physis. The surface anatomy of this physis has not been well described. METHODS: We performed an anatomic study on 26 cadaveric distal femoral epiphyses in specimens 3 to 18 years of age. High-resolution 3-dimensional surface scans were obtained and analyzed to determine the heights, approximate surface areas, and locations of the major undulations. RESULTS: Gross examination revealed lateral and anteromedial peripheral notches at the metaphyseal-epiphyseal junction, which deepen with advancing skeletal maturity. Within the epiphysis, there are 3 major undulations: a central ridge, lateral ridge, and medial peak, with mean heights of 5.5 mm (range, 2.9 to 9.8 mm), 2.5 mm (1.0 to 5.7 mm), and 2.9 mm (0.9 to 4.7 mm), respectively. The normalized height and surface area of each undulation decreased with increasing age, most dramatically in the central ridge. With respect to a line connecting the medial and lateral aspects of the physis, we found that the central peak passes more superior with younger age, and tends to be more posteriorly located. The lowest point of the physis is located either anteromedial or posterolateral. CONCLUSIONS: The central ridge, lateral ridge, and medial peak are the 3 major undulations in the distal femoral physis. The central ridge has the greatest height and most dramatic decrease in relative size with increasing age, suggesting structural importance. This anatomic data can guide metaphyseal and epiphyseal screw fixation. CLINICAL RELEVANCE: This study provides quantitative data on the topographic anatomy of the distal femoral physis, which can guide screw placement about the physis. These data may help identify fractures patterns with a greater risk of growth disturbance and key radiographic landmarks for guiding fracture reduction.

Liu RW; Armstrong DG; Levine AD; Gilmore A; Thompson GH; Cooperman DR

2013-10-01

295

Reproducibility of radiographic assessment of femoral implant position after hip resurfacing arthroplasty: a pilot study.  

Science.gov (United States)

To determine whether femoral implant position can be reproducibly measured on plain digital radiographs, we prospectively studied 40 patients after hip resurfacing arthroplasty. Three observers performed double blinded randomized analysis of calibrated digital radiographs meeting strict quality criteria. The implant stem-shaft angle and femoral anteversion angle were measured by the trapezoid method of axis determination using OsiriX software. The upper and lower offset and the anterior and posterior offset were measured. The statistical analysis was performed using Pearson correlation tests (intra-observer reproducibility) and Fisher F tests (inter-observer reproducibility). Intra-observer reproducibility was very good for all parameters and all observers. Inter-observer reproducibility was excellent except for superior offset measurement. Thus, this study validates a radiographic method for assessing the femoral implant position in hip resurfacing. We believe this could be useful for future studies on hip resurfacing devices. PMID:23558663

Pailhé, Régis; Reina, Nicolas; Ancelin, David; Cavaignac, Etienne; Maubisson, Laurent; Sharma, Akash; Chiron, Philippe

2013-04-01

296

Reproducibility of radiographic assessment of femoral implant position after hip resurfacing arthroplasty: a pilot study.  

UK PubMed Central (United Kingdom)

To determine whether femoral implant position can be reproducibly measured on plain digital radiographs, we prospectively studied 40 patients after hip resurfacing arthroplasty. Three observers performed double blinded randomized analysis of calibrated digital radiographs meeting strict quality criteria. The implant stem-shaft angle and femoral anteversion angle were measured by the trapezoid method of axis determination using OsiriX software. The upper and lower offset and the anterior and posterior offset were measured. The statistical analysis was performed using Pearson correlation tests (intra-observer reproducibility) and Fisher F tests (inter-observer reproducibility). Intra-observer reproducibility was very good for all parameters and all observers. Inter-observer reproducibility was excellent except for superior offset measurement. Thus, this study validates a radiographic method for assessing the femoral implant position in hip resurfacing. We believe this could be useful for future studies on hip resurfacing devices.

Pailhé R; Reina N; Ancelin D; Cavaignac E; Maubisson L; Sharma A; Chiron P

2013-04-01

297

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

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese A tomografia computadorizada (TC) tem sido cada vez mais utilizada para exames de pacientes portadores de traumas craniofaciais. Essa técnica tem apresentado vantagens no exame da articulação temporomandibular, sendo também empregada com sucesso no diagnóstico de fraturas de côndilo. Com o propósito de verificar se a reconstrução em 3 dimensões de imagens de TC (3D-TC) acrescenta informação visual às interpretações baseadas em imagens de 2D-TC, o presente t (more) rabalho avaliou qualitativamente exames realizados segundo ambas as técnicas em 18 pacientes portadores de fraturas por trauma do côndilo mandibular. Os resultados indicaram que a 2D-TC e a 3D-TC apresentaram informações similares para o diagnóstico dessas fraturas. Contudo, as imagens reconstruídas em 3D-TC forneceram indicações mais precisas quanto à posição anatômica da fratura, deslocamento dos fragmentos ósseos e presença de cominução nas fraturas. Estes resultados, aliados à possibilidade de refinamento e manipulação em vários ângulos das imagens em 3D, sublinham sua aplicabilidade no planejamento e acompanhamento cirúrgico daquelas fraturas. Concluiu-se que a técnica de 3D-CT apresentou informações suplementares para um diagnóstico mais preciso das fraturas de côndilo mandibular. Abstract in english 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 (more) 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; Antunes, José Leopoldo Ferreira; Cavalcanti, Marcelo Gusmão Paraiso

2003-01-01

298

[Chronic posterior shoulder dislocation  

UK PubMed Central (United Kingdom)

The posterior dislocation of the shoulder is frequently unrecognized for many days, months or even years after the initial accident. After the presentation of its clinical and radiological features, as the different ways of its treatment, some cases will illustrate this entity, too frequently missed or wrongly treated.

Perrenoud A; Imhoff A

1992-01-01

299

Posterior shape models.  

UK PubMed Central (United Kingdom)

We present a method to compute the conditional distribution of a statistical shape model given partial data. The result is a "posterior shape model", which is again a statistical shape model of the same form as the original model. This allows its direct use in the variety of algorithms that include prior knowledge about the variability of a class of shapes with a statistical shape model. Posterior shape models then provide a statistically sound yet easy method to integrate partial data into these algorithms. Usually, shape models represent a complete organ, for instance in our experiments the femur bone, modeled by a multivariate normal distribution. But because in many application certain parts of the shape are known a priori, it is of great interest to model the posterior distribution of the whole shape given the known parts. These could be isolated landmark points or larger portions of the shape, like the healthy part of a pathological or damaged organ. However, because for most shape models the dimensionality of the data is much higher than the number of examples, the normal distribution is singular, and the conditional distribution not readily available. In this paper, we present two main contributions: First, we show how the posterior model can be efficiently computed as a statistical shape model in standard form and used in any shape model algorithm. We complement this paper with a freely available implementation of our algorithms. Second, we show that most common approaches put forth in the literature to overcome this are equivalent to probabilistic principal component analysis (PPCA), and Gaussian Process regression. To illustrate the use of posterior shape models, we apply them on two problems from medical image analysis: model-based image segmentation incorporating prior knowledge from landmarks, and the prediction of anatomically correct knee shapes for trochlear dysplasia patients, which constitutes a novel medical application. Our experiments confirm that the use of conditional shape models for image segmentation improves the overall segmentation accuracy and robustness.

Albrecht T; Lüthi M; Gerig T; Vetter T

2013-06-01

300

[Changes in the posterior vertical dimension of the face. Etiopathogenic factors, architectural criteria and therapeutic aspects  

UK PubMed Central (United Kingdom)

The ramus of the mandible appears with the cephalic hominisation phenomenous during phylogenesis and determines the vertical posterior height of the face. Among the three skeletal units that form it, the condylar one is responsible of this height and of the level of the posterior part of the occlusal plane. So, all congenital, constitutional or acquired diseases concerning this unit, give a change of the vertical posterior height of the face. The excess troubles ar essentially represented by the condylar hyperplasia, usually unilateral and treated by condylectomy. The vertical posterior insufficiency may be unilateral or bilateral. The former looks like a mandibular asymmetry whereas the latter looks like an anterior vertical excess with or without a Class II malocclusion. If the condyle is absent or T.M.J. destroyed like in ankylosis, the authors use the costo-chondral graft to repair it. But in condylar hypoplasia, they use a vertical osteotomy of the ramus for lengthening the ramus. The three-dimensional architectural analysis is very useful for studying the vertical posterior height of the face and his changes.

Mercier J; Gordeeff A; Delaire J

1989-01-01

 
 
 
 
301

Attachments of separate small bundles of human posterior cruciate ligament: an anatomic study.  

UK PubMed Central (United Kingdom)

PURPOSE: To date, there is no consensus on the detailed anatomy of the posterior cruciate ligament (PCL) and the most appropriate PCL reconstruction method. The purpose of this study is the detailed observation of separate small PCL bundles for better comprehension of detailed PCL anatomy to facilitate the design of anatomic PCL reconstruction. METHODS: Twelve cadaveric knees were used in this study. PCL was divided into anterolateral and posteromedial (PM) sections and then separated into about 20 small bundles of 1 mm in diameter while maintaining preservation of their attachment sites marked with fine coloured marker pens. The positional relationship between the femoral and tibial attachments of each small bundle was investigated. RESULTS: The small bundles of tibial and femoral attachments showed a topographical correlation. The anterior-posterior aligned bundles in the tibia corresponded to the bundles aligned in a low-high direction in flexion in the femur. The femoral attachment pattern was relatively similar in each specimen. However, the tibial attachment showed two patterns of small bundle footprint location: a parabolic type (6 of 12) and a transverse type (6 of 12). The posterior portion of the PM bundle was separately attached to the medial and lateral portions in the tibial attachment. CONCLUSION: Small bundles of PCL showed a relatively layered arrangement between tibial and femoral attachments. Therefore, anatomic PCL reconstruction cannot be completed simply performed merely with straight bundles and circular bone tunnels.

Hatsushika D; Nimura A; Mochizuki T; Yamaguchi K; Muneta T; Akita K

2013-05-01

302

In vivo determination of total knee arthroplasty kinematics: a multicenter analysis of an asymmetrical posterior cruciate retaining total knee arthroplasty.  

Science.gov (United States)

The objective of this study was to determine if consistent posterior femoral rollback of an asymmetrical posterior cruciate retaining (PCR) total knee arthroplasty was mostly influenced by the implant design, surgical technique, or presence of a well-functioning posterior cruciate ligament (PCL). Three-dimensional femorotibial kinematics was determined for 80 subjects implanted by 3 surgeons, and each subject was evaluated under fluoroscopic surveillance during a deep knee bend. All subjects in this present study having an intact PCL had a well-functioning PCR knee and experienced normal kinematic patterns, although less in magnitude than the normal knee. In addition, a surprising finding was that, on average, subjects without a PCL still achieved posterior femoral rollback from full extension to maximum knee flexion. The findings in this study revealed that implant design did contribute to the normal kinematics demonstrated by subjects having this asymmetrical PCR total knee arthroplasty. PMID:18165027

Komistek, Richard D; Mahfouz, Mohamed R; Bertin, Kim C; Rosenberg, Aaron; Kennedy, William

2007-09-24

303

In vivo determination of total knee arthroplasty kinematics: a multicenter analysis of an asymmetrical posterior cruciate retaining total knee arthroplasty.  

UK PubMed Central (United Kingdom)

The objective of this study was to determine if consistent posterior femoral rollback of an asymmetrical posterior cruciate retaining (PCR) total knee arthroplasty was mostly influenced by the implant design, surgical technique, or presence of a well-functioning posterior cruciate ligament (PCL). Three-dimensional femorotibial kinematics was determined for 80 subjects implanted by 3 surgeons, and each subject was evaluated under fluoroscopic surveillance during a deep knee bend. All subjects in this present study having an intact PCL had a well-functioning PCR knee and experienced normal kinematic patterns, although less in magnitude than the normal knee. In addition, a surprising finding was that, on average, subjects without a PCL still achieved posterior femoral rollback from full extension to maximum knee flexion. The findings in this study revealed that implant design did contribute to the normal kinematics demonstrated by subjects having this asymmetrical PCR total knee arthroplasty.

Komistek RD; Mahfouz MR; Bertin KC; Rosenberg A; Kennedy W

2008-01-01

304

The correlation between mineralization degree and bone tissue stiffness in the porcine mandibular condyle.  

Science.gov (United States)

The aim of this study was to correlate the local tissue mineral density (TMD) with the bone tissue stiffness. It was hypothesized that these variables are positively correlated. Cancellous and cortical bone samples were derived from ten mandibular condyles taken from 5 young and 5 adult female pigs. The bone tissue stiffness was assessed in three directions using nanoindentation. At each of three tested sides 5 indents were made over the width of 5 single bone elements, resulting in a total number of 1500 indents. MicroCT was used to determine the local TMD at the indented sites. The TMD and the bone tissue stiffness were higher in bone from the adult animals than from the young ones, but did not differ between cancellous and cortical bone. In the adult group, both the TMD and the bone tissue stiffness were higher in the center than at the surface of the bone elements. The mean TMD, thus ignoring the local mineral distribution, had a coefficient of determination (R (2)) with the mean bone tissue stiffness of 0.55, p < 0.05, whereas the correlation between local bone tissue stiffness and the concomitant TMD appeared to be weak (R (2) 0.07, p < 0.001). It was concluded that the mineralization degree plays a larger role in bone tissue stiffness in cancellous than in cortical bone. Our data based on bone from the mandibular condyle suggest that the mineralization degree is not a decisive determinant of the local bone tissue stiffness. PMID:23624768

Willems, Nop M B K; Mulder, Lars; den Toonder, Jaap M J; Zentner, Andrej; Langenbach, Geerling E J

2013-04-28

305

The correlation between mineralization degree and bone tissue stiffness in the porcine mandibular condyle.  

UK PubMed Central (United Kingdom)

The aim of this study was to correlate the local tissue mineral density (TMD) with the bone tissue stiffness. It was hypothesized that these variables are positively correlated. Cancellous and cortical bone samples were derived from ten mandibular condyles taken from 5 young and 5 adult female pigs. The bone tissue stiffness was assessed in three directions using nanoindentation. At each of three tested sides 5 indents were made over the width of 5 single bone elements, resulting in a total number of 1500 indents. MicroCT was used to determine the local TMD at the indented sites. The TMD and the bone tissue stiffness were higher in bone from the adult animals than from the young ones, but did not differ between cancellous and cortical bone. In the adult group, both the TMD and the bone tissue stiffness were higher in the center than at the surface of the bone elements. The mean TMD, thus ignoring the local mineral distribution, had a coefficient of determination (R (2)) with the mean bone tissue stiffness of 0.55, p < 0.05, whereas the correlation between local bone tissue stiffness and the concomitant TMD appeared to be weak (R (2) 0.07, p < 0.001). It was concluded that the mineralization degree plays a larger role in bone tissue stiffness in cancellous than in cortical bone. Our data based on bone from the mandibular condyle suggest that the mineralization degree is not a decisive determinant of the local bone tissue stiffness.

Willems NM; Mulder L; den Toonder JM; Zentner A; Langenbach GE

2013-04-01

306

Femoral neuropathy after renal transplantation.  

UK PubMed Central (United Kingdom)

Two cases of postoperative femoral neuropathy have been encountered in 135 renal transplant patients operated upon at Groote Schuur Hospital since 1967. It is thought that the lesions were due to anoxia secondary to compression of the nerve by a self-retaining retractor blade. Electromyographic studies were useful in assessing the severity and prognosis of the lesion. A prolonged convalescence may occur with a varying degree of residual neurological deficit.

Pontin AR; Donaldson RA; Jacobson JE

1978-03-01

307

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

Scientific Electronic Library Online (English)

Full Text Available 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 aparelho ortodôntico fixo (fase II). Trinta e dois adolescentes consecutivos passaram pela fase I e 23 complet (more) aram 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<0,05) e T1 a T4 (p<0,05) ocorreram mudanças em 39,1% e 43,4% das cabeças das mandíbulas. Não ocorreram mudanças significantes no IDC de T1 a T3, T3 a T4 e T1 a T4 (p=1,000; 86,6%, 76,2% e 76,2% concordância). Após a fase I, não houve praticamente mudanças na morfologia da cabeça da mandíbula. Ao final da fase II, um leve aplainamento foi observado em algumas cabeças das mandíbulas. Pode ser concluído que não ocorreram mudanças significantes no IDC após ambas as fases de tratamento. 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 (more) (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<0.05) and T1 to T4 (p<0.05), changes occurred in 39.1% and 43.4% of the condyles. No significant changes in CDI occurred from T1 to T3, T3 to T4 and T1 to T4 (p=1.000; 86.6%, 76.2% and 76.2% concordance). After phase I, there were practically no changes in condyle morphology. At the end of phase II, a mild flattening was observed in some condyles. It may be concluded that no significant changes occurred in CDI after both treatment phases.

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

2013-07-01

308

FEMALE POSTERIOR WALL PROSTHESIS  

UK PubMed Central (United Kingdom)

A prosthesis comprising a pancake-shaped body (100), a neck (110) and a flared flattened handle (120) sized and shaped to shield the posterior vaginal wall (610) from frictional contact during coitus. This self-retaining prosthesis comprises a means to retain the pancake-shaped body (100) within the vagina and a means to prevent the flared flattened handle (120) from entering the vagina during insertion of the prosthesis or during coitus. This prosthesis decreases the volume of the vagina and decreases the area of the vaginal opening providing a non-surgical, cost-effective solution to tightening a woman's vagina. The posterior vaginal wall prosthesis enables women who have larger vaginas to use tampons.

MAURETTE NEIL L

309

FEMALE POSTERIOR WALL PROSTHESIS  

UK PubMed Central (United Kingdom)

A prosthesis comprising a pancake-shaped body (100), a neck (110) and a flared flattened handle (120) sized and shaped to shield the posterior vaginal wall (610) from frictional contact during coitus. This self-retaining prosthesis comprises a means to retain the pancake-shaped body (100) within the vagina and a means to prevent the flared flattened handle (120) from entering the vagina during insertion of the prosthesis or during coitus. This prosthesis decreases the volume of the vagina and decreases the area of the vaginal opening providing a non-surgical, cost-effective solution to tightening a woman's vagina. The posterior vaginal wall prosthesis enables women who have larger vaginas to use tampons

MAURETTE NEIL L

310

POSTERIOR CRUCIATE LIGAMENT  

Directory of Open Access Journals (Sweden)

Full Text Available M agnetic Resonance imaging of posterior cruciate ligament (PCL) was done in sagittal and coronal views. Axialimages were obtained as the need arises. Seventy two patients without any prior history of systemic and local illness wereincluded in the study. The examination was conducted in those with acute history of trauma. Study was conducted atLahore Medical Imaging (PVT) Limited, Lahore. Ten patients were volunteers as control to study the normal anatomyof posterior cruciate ligament (PCL) as seen on MRI. We found that MRI can be valuable for evaluating the acutelyinjured knee when operative repair for the PCL is being considered. This is also invaluable as the clinical and arthroscopicassessment of PCL injury can be difficult in acute injury.

MUSTANSAR MAHMOOD WARRIACH

2002-01-01

311

Metaphyseal bone collapse mimicking slipped capital femoral epiphysis in severe renal osteodystrophy.  

UK PubMed Central (United Kingdom)

CONTEXT: Slipped capital femoral epiphysis is a well-recognized skeletal complication of renal osteodystrophy in adolescence, which is distinct from idiopathic slipped capital femoral epiphysis in its etiology. OBJECTIVE: We report a case of severe mixed-type renal osteodystrophy with metaphyseal bone collapse that mimicked slipped capital femoral epiphyses. METHODS: Case history, laboratory and radiological evaluation, and bone biopsies are discussed. RESULTS: A 14-yr-old girl presented with left hip pain showing bilateral metaphyseal bone collapse accompanied with posterior-inferior displacement of capital femoral epiphyses after 2.5 yr of GH treatment. Blood chemistry, showing high levels of alkaline phosphatase and PTH, and a transiliac bone biopsy, indicating severe osteomalacia with osteitis fibrosa, along with serial computed tomography images of the hips from the presymptomatic stage, led to accurate diagnosis and successful treatment by administration of high-dose vitamin D. CONCLUSION: This case emphasizes the importance of controlling hyperparathyroidism well in children with chronic renal insufficiency, particularly at adolescence before initiating GH treatment. When children with renal insufficiency present with displacement of capital femoral epiphysis, it is necessary to evaluate the serum levels of alkaline phosphatase and PTH and metaphyseal bone quality below the physis.

Takao M; Hashimoto J; Sakai T; Nishii T; Sugano N; Yoshikawa H

2012-11-01

312

Reversible Posterior Leukoencephalopathy Syndrome  

Directory of Open Access Journals (Sweden)

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; Yetkin OZER

2005-01-01

313

Posterior relaxing retinotomy.  

Science.gov (United States)

Three patients with retinal detachments complicated by proliferative vitreoretinopathy underwent posteriorly located relaxing retinotomy to facilitate retinal reattachment. Six months postoperatively the retina remained attached in all cases, with an improvement in visual acuity in two cases (light perception to hand motion and 20/200 to 20/60) and a drop of one line in visual acuity in the third (20/20 to 20/25). PMID:2812694

Gremillion, C M; Peyman, G A

1989-09-01

314

Posterior relaxing retinotomy.  

UK PubMed Central (United Kingdom)

Three patients with retinal detachments complicated by proliferative vitreoretinopathy underwent posteriorly located relaxing retinotomy to facilitate retinal reattachment. Six months postoperatively the retina remained attached in all cases, with an improvement in visual acuity in two cases (light perception to hand motion and 20/200 to 20/60) and a drop of one line in visual acuity in the third (20/20 to 20/25).

Gremillion CM Jr; Peyman GA

1989-09-01

315

Posterior cruciate ligament (PCL) injury  

Science.gov (United States)

Cruciate ligament injury - posterior; PCL injury; Knee injury - posterior cruciate ligament (PCL); Hyperextended knee ... a physical examination to check for signs of PCL injury. This includes moving the knee joint in ...

316

Human posterior subcapsular cataracts.  

Science.gov (United States)

Clinically and pathologically there are two kinds of posterior subcapsular cataracts: vacuolar-lacy and solid plaque. Vacuolar opacities occur in senile, diabetic, retinitis pigmentosa, steroid, and secondary cataracts (Elschnig pearls). Plaque opacities occur in congenital polar, myotonic dystrophy, and Turner syndrome (chromosome XO) cataracts. The vacuolar opacities tend to be more superficial (closer to the posterior capsule), whereas the plaque opacities are generally slightly deeper (more cortical). The vacuolar opacities show cellular proliferation of aberrantly migrated lens epithelial cells in the posterior pole which have added damage to the cataract by secretion of basement membrane, intra- and extra-cellular filaments, and release of cytolytic lysozymes causing liquefaction and necrosis. The plaque opacities are acellular. Both types of cataracts show breakdown of lens fibres into rounded up disorganized globules and some membranous whorls. The liquefied vacuolar opacity is more readily removed by extracapsular cataract extraction, but the retention of nucleated lens epithelial cells in the vacuolar type of opacity is the source of a secondary cataract or Hirchberg-Elschnig pearls which require a discussion or membranectomy to clear the visual axis. This article will review the salient features in the histopathology (light and electron microscopy) and morphology of PSC and amalgamate the findings reported by several investigators (Eshagian and Streeten, 1975; Eshagian, March, Goossens, and Rafferty, 1978, 1978; Eshagian, Rafferty, and Goossens, 1980, 1981; Eshagian, Rafferty, Goossens, and March, 1979; 1980; Streeten and Eshagian, 1978). PMID:6964282

Eshagian, J

1982-01-01

317

Human posterior subcapsular cataracts.  

UK PubMed Central (United Kingdom)

Clinically and pathologically there are two kinds of posterior subcapsular cataracts: vacuolar-lacy and solid plaque. Vacuolar opacities occur in senile, diabetic, retinitis pigmentosa, steroid, and secondary cataracts (Elschnig pearls). Plaque opacities occur in congenital polar, myotonic dystrophy, and Turner syndrome (chromosome XO) cataracts. The vacuolar opacities tend to be more superficial (closer to the posterior capsule), whereas the plaque opacities are generally slightly deeper (more cortical). The vacuolar opacities show cellular proliferation of aberrantly migrated lens epithelial cells in the posterior pole which have added damage to the cataract by secretion of basement membrane, intra- and extra-cellular filaments, and release of cytolytic lysozymes causing liquefaction and necrosis. The plaque opacities are acellular. Both types of cataracts show breakdown of lens fibres into rounded up disorganized globules and some membranous whorls. The liquefied vacuolar opacity is more readily removed by extracapsular cataract extraction, but the retention of nucleated lens epithelial cells in the vacuolar type of opacity is the source of a secondary cataract or Hirchberg-Elschnig pearls which require a discussion or membranectomy to clear the visual axis. This article will review the salient features in the histopathology (light and electron microscopy) and morphology of PSC and amalgamate the findings reported by several investigators (Eshagian and Streeten, 1975; Eshagian, March, Goossens, and Rafferty, 1978, 1978; Eshagian, Rafferty, and Goossens, 1980, 1981; Eshagian, Rafferty, Goossens, and March, 1979; 1980; Streeten and Eshagian, 1978).

Eshagian J

1982-01-01

318

Posterior subtalar dislocation.  

UK PubMed Central (United Kingdom)

A subtalar dislocation of the foot is an uncommon injury, and cases of posterior subtalar dislocation are even rarer. This injury is characterized by a simultaneous dislocation of talocalcaneal and talonavicular joints while tibiotalar and calcaneocuboid articulations remain intact. Subtalar dislocation is commonly accompanied by fractures of the malleoli, talus, or fifth metatarsal and by a rotational component of the subtalar joint. Subtalar dislocation can occur in any direction and produces significant deformity. This article presents a case of pure posterior subtalar dislocation in an 80-year-old man who presented with pain and deformity in his left ankle following a motorcycle accident. Radiographs demonstrated dislocation of both the talonavicular and talocalcaneal joints. The calcaneus was displaced posteriorly without medial or lateral displacement. No rotational component of the calcaneus was noted, suggesting the trauma was in pure hyperplantar flexion. We hypothesize that pure hyperplantar flexion could lead to a progressive subtalar ligament weakening that may result in a complete ligament rupture if the plantar flexion force is prolonged. This could be observed in the presence of good bone quality and if the force is applied distally at the navicular bone.

Camarda L; Martorana U; D'Arienzo M

2009-07-01

319

Slipped capital femoral epiphysis in dogs.  

Science.gov (United States)

In a retrospective review of 43 femoral fractures, three dogs had separation of the femoral capital epiphysis from the metaphysis in the absence of trauma. Two of these dogs also had evidence of pathology in the contralateral femoral neck including, in one dog, displacement of the capital epiphysis in relation to the metaphysis without actual separation. The case histories, radiographic features and histopathological findings of these cases were reviewed and compared with previous cases of slipped capital femoral epiphysis (SCFE) reported in dogs and also with SCFE in children. Pre-slip, acute, chronic and acute-on-chronic slips were Identified. Based on the cases reviewed, the authors advise internal fixation of stable slipped epiphyses in dogs. This may also be appropriate for unstable separations, although resorption of the femoral neck may preclude stable fixation and necessitate femoral head and neck excision. PMID:15600271

Moores, A P; Owen, M R; Fews, D; Coe, R J; Brown, P J; Butterworth, S J

2004-12-01

320

Slipped capital femoral epiphysis in dogs.  

UK PubMed Central (United Kingdom)

In a retrospective review of 43 femoral fractures, three dogs had separation of the femoral capital epiphysis from the metaphysis in the absence of trauma. Two of these dogs also had evidence of pathology in the contralateral femoral neck including, in one dog, displacement of the capital epiphysis in relation to the metaphysis without actual separation. The case histories, radiographic features and histopathological findings of these cases were reviewed and compared with previous cases of slipped capital femoral epiphysis (SCFE) reported in dogs and also with SCFE in children. Pre-slip, acute, chronic and acute-on-chronic slips were Identified. Based on the cases reviewed, the authors advise internal fixation of stable slipped epiphyses in dogs. This may also be appropriate for unstable separations, although resorption of the femoral neck may preclude stable fixation and necessitate femoral head and neck excision.

Moores AP; Owen MR; Fews D; Coe RJ; Brown PJ; Butterworth SJ

2004-12-01

 
 
 
 
321

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

Scientific Electronic Library Online (English)

Full Text Available 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 su (more) bcapital 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.

Tompkins, M; Mkandawire, NC; Harrison, J

2010-01-01

322

Superselective intra-arterial DSA in patients with femoral head necrosis and femoral neck fracture  

International Nuclear Information System (INIS)

[en] The prospective study includes 25 patients without pathology of the femoral head for the evaluation of the normal femoral head perfusion. In addition 34 patients with femoral head necrosis underwent i.a. DSA preoperatively before pedicled pelvic bone grafting. 15 patients after pelvic bone graft operation and 7 patients with medial femoral head fracture were also examined via superselective DSA. In cases with femoral head necrosis a rarefaction or interruption of the rami nutricii proximales, or an occlusion of the medial circumflex femoral artery were observed. Patients with medial femoral neck fracture showed an interruption of the rami nutricii proximales of the femoral head. Postoperative DSA - after pedicled pelvic bone graft - revealed a regular arterial graft perfusion in 82%. (orig.)

1991-01-01

323

Effect of tibial slope or posterior cruciate ligament release on knee kinematics.  

Science.gov (United States)

An experimental study using fresh human cadaver knees was designed to evaluate the effect of partial posterior cruciate ligament release or posterior tibial slope on knee kinematics after total knee arthroplasty. Varus and valgus laxity, rotational laxity, anteroposterior laxity, femoral rollback, and maximum flexion angle were evaluated in a normal knee, an ideal total knee arthroplasty, and a total knee arthroplasty in which the ligaments were made to be too tight in flexion. The total knee arthroplasty specimens then were subjected to either partial posterior cruciate ligament release or increased posterior tibial slope, and the tests were repeated. Posterior tibial slope increased varus and valgus laxity, anteroposterior laxity, and rotational laxity in the knee that had flexion tightness. Posterior cruciate ligament release corrected only anteroposterior tightness, and had no effect on the abnormal collateral ligament tightness. Increased posterior tibial slope significantly improved varus and valgus laxity and rotational laxity in the knee that was tight in flexion more than with release of the posterior cruciate ligament. Therefore increasing posterior tibial slope is preferable for a knee that is tight in flexion during total knee arthroplasty. PMID:15346073

Jojima, Hiroshi; Whiteside, Leo A; Ogata, Kosuke

2004-09-01

324

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

325

Stress distribution on the mandibular condyle and the distraction area in distraction osteogenesis by finite element analysis.  

UK PubMed Central (United Kingdom)

PURPOSE: Many 3-dimensional (3-D) finite element analysis (FEA) models based on the virtual simulation have been constructed to explore the stress distribution during distraction osteogenesis (DO). The aim of this study is to achieve a better understanding of the biomechanical feature of mandible during DO procedure. MATERIALS AND METHODS: Using CT image data of a goat mandible that already has been elongated for 10 mm, an anatomical 3D model was reconstructed. This model was imported into MSC.Patran for monitoring mechanical parameters, including Von-Mises stress, max-principal stress, and mix-principal stress, on the distraction area and the mandibular condyle. RESULTS: The computed result showed special stress distribution on 9 slopes of the condyle and 3 cross-sections of the distraction area. From 0.8 MP to 17.2 MP, a dramatic increase in Von-Mises stress was discovered on the right side of the condyle compared with the left side. From 22.6 MP to 0.9 MP on the distraction area, Von-Mises stress decreased from the central zone to the peripheral zone gradually. CONCLUSIONS: During the process of mandibular DO, the special stress distribution may be an important factor on the physiopathological change of the mandibular condyle and the generation of new bone in the distraction area. The correlations between the value of the stress and physiopathological changes during DO process should be clarified in future research.

Li P; Long J; Tang W; Li J; Liang R; Tian DW

2013-05-01

326

Dislocation of a fractured mandibular condyle into the middle cranial fossa: a case treated by an extracranial approach.  

UK PubMed Central (United Kingdom)

INTRODUCTION: Penetration of the mandibular condyle into the middle cranial fossa is a rare complication usually due to blunt traumas to the chin. Particular anatomical and dynamic conditions can lead to the intracranial dislocation of the condyle in spite of the fracture of the condylar neck that usually prevents this event from dissipating the kinetic force of the impact. DISCUSSION: We report the case of a 10-year-old female patient suffering from symphyseal and bilateral condilar fracture with intrusion of the left condyle into the middle cranial fossa. The diagnosis of intracranial dislocation was initially missed because of the nonspecific symptomatology and insufficient radiologic data provided by conventional investigations (plain X-rays and panoramic views). The persistence of the limitation of the mouth opening and the worsening of the preauricular pain with irradiation to the temporal region led us to perform further radiological investigations (computed tomography scan and magnetic resonance imaging) that revealed the intracranial complication. A successful removal of the displaced condyle was carried out through an extracranial approach, and at a 3-year follow-up temporomandibular joint function is satisfactory. CONCLUSION: The case is reported to emphasize the need for careful radiological investigation in case of condylar fractures and the effectiveness of the extracranial route to surgically treat these rare complications.

Taglialatela Scafati C; Aliberti F; Scotto di Clemente S; Taglialatela Scafati S; Facciuto E; Cinalli G

2008-09-01

327

Prosthetic rehabilitation of a patient with unilateral dislocated condyle fracture after treatment with a mandibular repositioning splint: a clinical report.  

UK PubMed Central (United Kingdom)

This clinical report describes the use of a mandibular repositioning splint and the subsequent prosthodontic treatment of a unilateral dislocated condyle fracture for a patient whose injury resulted in significant mandibular deviation and malocclusion. The use of a mandibular repositioning splint considerably reduced the mandibular deviation, and a stable mandibular position was maintained with the definitive prosthesis.

Noh K; Choi W; Pae A; Kwon KR

2013-06-01

328

Late presentation of fractures of the lateral condyle of the humerus in children  

Directory of Open Access Journals (Sweden)

Full Text Available Background: The current controversy regarding the management of fractures of the lateral condyle of the humerus presenting between 3 to 12 weeks prompted us to evaluate our results of open reduction and internal fixation of such fractures. Patients and Methods: Twenty-one patients operated between March 1995 and February 2001 qualified for this study. Five patients presented between 3-4 weeks, nine between 5-8 weeks and seven between 9-12 weeks post injury. Ten fractures were classified as stage II and eleven as stage III (Jacob et al. criteria). The mean age was 8 years (range: 4-14 years). All patients underwent surgery (open reduction and internal fixation with K-wires/screw, with or without bone grafting). The results were assessed by the modified criteria of Agarwal et al. after an average follow-up of 2.3 years. Results: Excellent to good results were observed in all the five patients presenting at 3-4 weeks post injury. In the patients presenting at 5-8 weeks, the results were excellent in one, good in four, fair in three, and poor in one patient. The fracture united in all cases; however, malunion was observed in four patients. The fractures that were operated at 9-12 weeks showed good results in one case, fair result in three cases, and poor result in three cases. Avascular necrosis of the lateral condyle in one patient, premature fusion in two patients, pin tract infection in three patients, and gross restriction of elbow movements in three patients were the major complications in this group. Accurate reduction was difficult as a result of new bone formation and remodeling at the fracture surfaces. Multiple incisions over the common extensor aponeurosis and bone graft supplementation were helpful for achieving acceptable reduction. Conclusion: Open reduction and internal fixation is recommended in all cases of displaced fractures of the lateral condyle of the humerus presenting at up to 12 weeks post injury. However, the results become poorer with increase in duration after injury and the grade of displacement. To avoid complications it is important to carry out careful dissection of the soft tissue attachments and to mobilize the fragment without the use of force.

Khare Ghanshyam; Saraf Shyam

2011-01-01

329

Surgical treatment on displaced and dislocated sagittal fractures of the mandibular condyle.  

UK PubMed Central (United Kingdom)

PURPOSE: The purpose of this study was to evaluate the effect of surgical treatment on displaced and dislocated sagittal fractures of the mandibular condyle (SFMC). PATIENTS AND METHODS: Twenty-four patients with 28 displaced and dislocated SFMCs were distinguished into type M, type C, and type L fractures according the location of the fracture line. The fractured fragment was reduced and fixated with two 0.6-mm 4-hole micro-plates via a preauricular temporal incision. The fragment was extirpated when it was too small to be fixated. The postoperative position and profile of the fragment was examined by orthopantomogram radiograph or computed tomography (CT). The function of the temporal and zygomatic branches of the facial nerve was inspected. The occluding relation was surveyed, the interincisal distance at maximum mouth opening was measured, and the deviation from the midline during mouth opening was recorded. RESULTS: Twenty-three condyles (82%) suffered dislocated fractures with the condylar fragment out of the glenoid fossa. Five condyles (18%) were displaced, but not dislocated. There were 2 (7%) type M, 19 (68%) type C (3 comminuted), and 7 (25%) type L fractures (1 comminuted), respectively. Twenty-one (75%) fractured fragments received free-graft procedures with 2 micro-plates. Four (14%) fragments were reduced and fixated without being dissected free of their attachments. Three (11%) fragments were extirpated. There were no permanent facial never branch injuries. Micro-plate removal was necessary because of postoperative infection and necrosis of the fractured fragment in 1 condylar process. No other patients could be found with obvious postoperative bone resorption. The average postoperative maximum mouth opening and deviation at 6 months were improved significantly. The postoperative occlusion was good in 22 cases. CONCLUSIONS: Access with the preauricular incision, and the dislocated and displaced fragment can be reduced and fixated to its normal position easily. Free-graft procedure is a suitable surgical treatment if the fractured fragment cannot be reduced without dissection free of the pterygoid muscle attachment. Although most fractured fragments in SFMCs have to be dissected free, there are no obvious complications in dislocated and displaced SFMCs after surgical treatment.

Jing J; Han Y; Song Y; Wan Y

2011-06-01

330

The effects of severe femoral bone loss on the flexion extension joint space in revision total knee arthroplasty: a cadaveric analysis and clinical consequences.  

Science.gov (United States)

Five revision total knee arthroplasties (TKAs) involving severe femoral bone loss were performed in 1994. Each had sufficiently severe femoral bone loss in which collateral ligament origins and posterior capsular attachments were violated. A paradoxical phenomenon was observed in each case. Unlike primary TKAs, in which larger distal femoral bone resection leads to laxity of the knee joint in extension, these cases with severe distal femoral bone loss, after initial component selection, developed the opposite situation, a flexion contracture. It was hypothesized that femoral bone loss involving collateral ligament origins would permit distraction of the tibia below the femur with the knee held in flexion, but when the knee was brought to full extension, intact posterior structures would maintain a normal tibial position. To investigate this hypothesis, six fresh-frozen cadaveric lower limbs were tested in full extension and 45 degrees and 90 degrees of flexion after release of the femoral attachments of the collateral ligaments and the posterior capsule from the femur. Joint space changes were measured via a motion tracking device. Results showed that with loss of collateral attachments, 17.2+/-8.9 mm of joint space is created in 90 degrees of flexion, whereas the joint space in full extension is conserved (1.5+/-1.7 mm). With additional loss of the posterior capsule, the joint space at 90 degrees of flexion increased to 26.2+/-6.1 mm, with minimal changes in the extension gap (3.4+/-0.8 mm). Distal femoral bone loss was associated with an increase in the flexion gap compared to the extension gap. PMID:11284594

Krackow, K A; Mihalko, W M

2001-02-01

331

The effects of severe femoral bone loss on the flexion extension joint space in revision total knee arthroplasty: a cadaveric analysis and clinical consequences.  

UK PubMed Central (United Kingdom)

Five revision total knee arthroplasties (TKAs) involving severe femoral bone loss were performed in 1994. Each had sufficiently severe femoral bone loss in which collateral ligament origins and posterior capsular attachments were violated. A paradoxical phenomenon was observed in each case. Unlike primary TKAs, in which larger distal femoral bone resection leads to laxity of the knee joint in extension, these cases with severe distal femoral bone loss, after initial component selection, developed the opposite situation, a flexion contracture. It was hypothesized that femoral bone loss involving collateral ligament origins would permit distraction of the tibia below the femur with the knee held in flexion, but when the knee was brought to full extension, intact posterior structures would maintain a normal tibial position. To investigate this hypothesis, six fresh-frozen cadaveric lower limbs were tested in full extension and 45 degrees and 90 degrees of flexion after release of the femoral attachments of the collateral ligaments and the posterior capsule from the femur. Joint space changes were measured via a motion tracking device. Results showed that with loss of collateral attachments, 17.2+/-8.9 mm of joint space is created in 90 degrees of flexion, whereas the joint space in full extension is conserved (1.5+/-1.7 mm). With additional loss of the posterior capsule, the joint space at 90 degrees of flexion increased to 26.2+/-6.1 mm, with minimal changes in the extension gap (3.4+/-0.8 mm). Distal femoral bone loss was associated with an increase in the flexion gap compared to the extension gap.

Krackow KA; Mihalko WM

2001-02-01

332

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 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.

2001-01-01

333

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

334

Movement patterns of the C-stem femoral component: an RSA study of 33 primary total hip arthroplasties followed for two years.  

Science.gov (United States)

We used roentgen stereophotogrammetric analysis to follow 33 C-stem femoral components for two years after primary total hip arthroplasty. All components migrated distally and posteriorly within the cement mantle. The mean distal migration was 1.35 mm (sd 0.62) at two years and the mean posterior migration was 1.35 mm (sd 0.69) at two years. All the femoral components rotated into retroversion with a mean rotation at two years of 1.9 degrees (sd 1.1). For all other directions, the prosthesis was stable up to two years. Compared with other tapered prostheses, the distal migration of the C-stem is the same, but posterior rotation and posterior migration are greater. PMID:16189306

Sundberg, M; Besjakov, J; von Schewelow, T; Carlsson, A

2005-10-01

335

Movement patterns of the C-stem femoral component: an RSA study of 33 primary total hip arthroplasties followed for two years.  

UK PubMed Central (United Kingdom)

We used roentgen stereophotogrammetric analysis to follow 33 C-stem femoral components for two years after primary total hip arthroplasty. All components migrated distally and posteriorly within the cement mantle. The mean distal migration was 1.35 mm (sd 0.62) at two years and the mean posterior migration was 1.35 mm (sd 0.69) at two years. All the femoral components rotated into retroversion with a mean rotation at two years of 1.9 degrees (sd 1.1). For all other directions, the prosthesis was stable up to two years. Compared with other tapered prostheses, the distal migration of the C-stem is the same, but posterior rotation and posterior migration are greater.

Sundberg M; Besjakov J; von Schewelow T; Carlsson A

2005-10-01

336

Effect of the interaction between periodontitis and type 1 diabetes mellitus on alveolar bone, mandibular condyle and tibia.  

UK PubMed Central (United Kingdom)

Abstract Objective. This study examined the effect of the interaction between periodontitis and type 1 diabetes mellitus on alveolar bone, mandibular condyle and tibia in animal models. Materials and methods. Rats were divided into normal, periodontitis, diabetic and diabetic with periodontitis groups. After injection of streptozotocin to induce diabetes, periodontitis was induced by ligation of both lower-side first molars for 30 days. Alveolar bone loss and trabecular bone volume fraction (BVF) of the mandibular condyle and tibia were estimated via hematoxylin and eosin staining and micro-computed tomography, respectively. Osteoclastogenesis of bone marrow cells isolated from tibia and femur was assayed using tartrate-resistant acid phosphatase staining. Results. The cemento-enamel junction to the alveolar bone crest distance and ratio of periodontal ligament area in the diabetic with periodontitis group were significantly increased compared to those of the periodontitis group. Mandibular condyle BVF did not differ among groups. The BVF of tibia in the diabetic and diabetic with periodontitis groups was lower than that of the normal and periodontitis groups. Osteoclastogenesis of bone marrow cells in the diabetic groups was higher than that in the non-diabetic groups. However, the BVF of tibia and osteoclastogenesis in the diabetic with periodontitis group were not significantly different than those in the diabetic group. Conclusions. Type 1 diabetes mellitus aggravates alveolar bone loss induced by periodontitis, but periodontitis does not alter the mandibular condyle and tibia bone loss induced by diabetes. Alveolar bone, mandibular condyle and tibia may have different responses to bone loss stimuli in the diabetic environment.

Kim JH; Lee DE; Gunawardhana KS; Choi SH; Woo GH; Cha JH; Bak EJ; Yoo YJ

2013-08-01

337

Assessment of osteoarthrosis of the temporomandibular joint associated with avascular necrosis of the condyle on magnetic resonance imaging  

Energy Technology Data Exchange (ETDEWEB)

Osteoarthrosis associated with findings of avascular necrosis of the mandibular condyle on magnetic resonance imaging was clinically evaluated. The subjects consisted of 5 female unilateral cases, with an average age of 55.4 years who had a mean duration of illness of 15.2 months. The symptoms were a mean interincisal opening distance of 32.8 mm with arthralgia in mild to moderate degree, and joint noise (crepitation) in all joints. MRI documented decreasing signal intensity of the condyle with 2 joints in high degree and 3 joints in moderate, as well as variable low signal density of the articular eminence, associated with concomitant anterior disk displacement. X-ray showed deformity of the condyle and eminence. The operative findings disclosed disk rupture and comparatively smooth cartilage with minimum remodeling of the condylar surface; however, avascular evidence was suggested when corticotomy was performed. 4 joints underwent diskectomy, condylar shaving, auricular cartilage grafts and corticotomy of the condyle. Arthroscopic corticotomy was applied for 1 joint with mild symptoms. Postoperative symptoms improved to mean opening distance of 41.4 mm and disappeared arthralgia in 4 joints. The surgical outcome was excellent in 3 joints and good in 2 joints. Follow-up MRI in 2 cases disclosed increasing signal intensity, which suggested recovery of condylar vascularity following corticotomy. It is suggested that the low-signal intensity on MRI in osteoarthrosis might indicate avascular lesions of the condyle, secondary to degenerative change. Histological investigations are required to evaluate avascular necrosis of the temporomandibular joints. (author).

Segami, Natsuki; Murakami, Ken-ichiro; Hosaka, Hideo; Moriya, Yoshiyuki; Miyaki, Katsuaki; Chen, Wen-Hsi; Iizuka, Tadahiko (Kyoto Univ. (Japan). Faculty of Medicine)

1993-02-01

338

Assessment of osteoarthrosis of the temporomandibular joint associated with avascular necrosis of the condyle on magnetic resonance imaging  

International Nuclear Information System (INIS)

Osteoarthrosis associated with findings of avascular necrosis of the mandibular condyle on magnetic resonance imaging was clinically evaluated. The subjects consisted of 5 female unilateral cases, with an average age of 55.4 years who had a mean duration of illness of 15.2 months. The symptoms were a mean interincisal opening distance of 32.8 mm with arthralgia in mild to moderate degree, and joint noise (crepitation) in all joints. MRI documented decreasing signal intensity of the condyle with 2 joints in high degree and 3 joints in moderate, as well as variable low signal density of the articular eminence, associated with concomitant anterior disk displacement. X-ray showed deformity of the condyle and eminence. The operative findings disclosed disk rupture and comparatively smooth cartilage with minimum remodeling of the condylar surface; however, avascular evidence was suggested when corticotomy was performed. 4 joints underwent diskectomy, condylar shaving, auricular cartilage grafts and corticotomy of the condyle. Arthroscopic corticotomy was applied for 1 joint with mild symptoms. Postoperative symptoms improved to mean opening distance of 41.4 mm and disappeared arthralgia in 4 joints. The surgical outcome was excellent in 3 joints and good in 2 joints. Follow-up MRI in 2 cases disclosed increasing signal intensity, which suggested recovery of condylar vascularity following corticotomy. It is suggested that the low-signal intensity on MRI in osteoarthrosis might indicate avascular lesions of the condyle, secondary to degenerative change. Histological investigations are required to evaluate avascular necrosis of the temporomandibular joints. (author)

1993-01-01

339

Bilateral variation of iliacus muscle and splitting of femoral nerve  

Directory of Open Access Journals (Sweden)

Full Text Available Awareness in the variations of psoas major muscle and iliacus muscle is useful guide for both in studies ofhuman anatomy and in clinical practice today. It is of significant practical importance for the surgeons andradiologist, to know the form, degree of severity and range of such changes. Images of posterior abdominopelvicwall with such variations may lead to confusion in interpretation. The knowledge of relations of this variationwith neighboring nerves, blood vessels and other structures are important for an accurate diagnosis and toprevent further surgical complications during routine surgery. In our routine dissections with the purposeof preparation of the teaching and museum specimens, it was observed that in one of the elderly Indian malecadaver showed bilateral variant slip of iliacus muscle having two bellies; in addition the femoral nerve alsoshowed variation in its course.

Rao TR; Vanishree; Kanyan PS; Rao S

2008-01-01

340

Femoral neck cross-sectional geometry and exercise loading.  

UK PubMed Central (United Kingdom)

The aim of this study was to examine the association between different types of exercise loading and femoral neck cross-sectional geometry. Our data comprised proximal femur magnetic resonance (MR) images obtained from 91 female athletes and their 20 age-matched controls. The athletes were categorized according to typical training activity - high impact (high and triple jumping), odd impact (racket and soccer playing), high magnitude (power lifting), repetitive low impact (endurance running) and repetitive non-impact (swimming). Segmented MR images at two locations, narrowest cross-section of the femoral neck (narrowFN) and the cross-section at insertion of articular capsule (distalFN), were investigated to detect between group differences in shape, curvature and buckling ratio derived using image and signal analysis tools. The narrowFN results indicated that the high-impact group had weaker antero-superior (33% larger buckling ratio than controls) but stronger inferior weight-bearing region (32% smaller than controls), while the odd-impact group had stronger superior, posterior and anterior region (21% smaller buckling ratio than controls). The distalFN results indicated that the high-impact group had stronger inferior region (37% smaller buckling ratio), but the odd-impact group had stronger superior region (22% smaller buckling ratio) than the controls. Overall, the results point towards odd-impact exercise loading, with inherently varying directions of impact, associated with more robust cross-sectional geometry along the femoral neck. In conclusion, our one-dimensional polar treatment for geometrical traits and intuitive presentation of differences in trends between exercise groups and controls provides a basis for analysis with high angular accuracy.

Narra N; Nikander R; Viik J; Hyttinen J; Sievänen H

2013-07-01

 
 
 
 
341

The natural history of a posteriorly dislocated total hip replacement.  

UK PubMed Central (United Kingdom)

A retrospective review was conducted to delineate the natural history of the posteriorly dislocated total hip replacement. A total of 1,036 consecutive total hip replacements were performed between 1989 and 1992. Forty (3.9%) were known to have dislocated posteriorly. Twenty-four of these dislocations occurred after primary replacements, and 16 occurred after revision. Eighty-five percent of the dislocations occurred within 2 months and were reduced closed. No statistical differences were noted between these 2 groups with respect to height, weight, sex, age, and femoral and acetabular anteversion. Nonunion of the greater trochanter, modular femoral neck length, and operative approach appeared to affect hip stability. Twenty-three of the 40 dislocated hips (57.5%) redislocated. Sixteen of the 40 hips (40%) required reoperation for recurrent dislocation. Thirteen of the 16 revisions (81.3%) were successful. A dislocated total hip replacement that has been rendered stable does not preclude one from having a successful total hip replacement, and it does not appear to affect survivorship at intermediate follow-up.

Li E; Meding JB; Ritter MA; Keating EM; Faris PM

1999-12-01

342

Unusual presentation of a femoral stress fracture.  

UK PubMed Central (United Kingdom)

Stress fractures are common injuries in sports medicine. Among these fractures, femoral neck stress fractures frequently have a benign course, especially when it happens in the medial aspect of the neck. This case report describes a stress fracture of the medial aspect of the femoral neck that developed a complete fracture and underwent surgical fixation.

Ejnisman L; Wajnsztejn A; Queiroz RD; Ejnisman B

2013-01-01

343

Posterior lateral choroidal artery in antero-posterior angiographic projection  

Energy Technology Data Exchange (ETDEWEB)

Opacification of the lateral posterior choroidal artery in antero-posterior projection was analysed in 282 left-sided brachial angiograms. In 40.5% of cases the artery was sufficiently opacified to evaluate its course. The authors report the time intervals for filling of the artery in normal angiograms. The pattern described may serve as a basis for the evaluation of the displacement of the lateral posterior choroidal artery by midline tumours.

Agnoli, A.L.; Fontana, H.J.; Zierski, J.

1982-10-01

344

Compression hemostat via femoral artery  

UK PubMed Central (United Kingdom)

The utility model relates to a hemostat by compression of the femoral artery, belonging to the technical field of a medical device. The hemostat by compression of the femoral artery comprises a pressure plate (1), a pressurized airbag (2), a hemostatic plate (3), a fixation belt (4) and an inflatable airbag (5), and is characterized in that one end of the pressure plate (1) is connected with the fixation belt (4) with the upper surface provided with a nylon fused filament, and the other end is provided with a via hole (6) adapted to the fixation belt (4) the pressurized airbag (2) is fixed to the bottom surface of the pressure plate (1), the hemostatic plate (3) is fixed to the bottom surface of the pressurized airbag (2), and the inflatable airbag (5) is communicated with the pressurized airbag (2) through a hose. The utility model has the advantages that the structure is simple, the use is convenient, artificial hemostasis by compression can be replaced, and the pressure of the hemostatic plate can be adjusted, thereby symptoms such as bleeding, hematoma, and the like caused by human body fatigue are avoided.

TINGGUI LIU; YANPING CHEN

345

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

Energy Technology Data Exchange (ETDEWEB)

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

346

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

International Nuclear Information System (INIS)

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.)

2000-01-01

347

Knee kinematics in anterior cruciate ligament-substituting arthroplasty with or without the posterior cruciate ligament.  

UK PubMed Central (United Kingdom)

Few studies have compared functional kinematics in knees using identical prostheses with or without the posterior cruciate ligament (PCL). This study contrasted in vivo knee kinematics with an anterior cruciate ligament-substituting arthroplasty with and without PCL retention. We hypothesized that knees without PCLs would exhibit less femoral posterior translation, and consequently less maximum knee flexion. Fifty-six knees were studied using dynamic radiography at least one year post-surgery, with twenty-seven knees retaining the PCL and twenty-nine knees having the PCL sacrificed. Consistent with our hypothesis, PCL-sacrificing knees showed more anterior femoral condylar positions. Contrary to our hypothesis, PCL-sacrificing knees demonstrated greater knee flexion during kneeling (122° versus 115°). Contracted PCLs in severely deformed knees likely were the cause of limited flexion in some retaining knees.

Watanabe T; Ishizuki M; Muneta T; Banks SA

2013-04-01

348

Extension malunion of the femoral component after retrograde nailing: no sequelae at 6 years.  

UK PubMed Central (United Kingdom)

OBJECTIVES: Supracondylar femoral fracture is a complex complication after total knee arthroplasty (TKA). One potential complication of retrograde locked nailing is malunion in extension of the femoral prosthetic component--produced by an overly posterior nail entry point in the intercondylar notch. The aim of this study was to determine the repercussion of this deformity on the midterm radiological and functional outcomes of TKA. DESIGN: Retrospective review. METHODS: From 2001 to 2006, 30 patients were treated for supracondylar femoral fracture above TKA with a retrograde locked nail. In 7 patients (6 women and 1 man) with a mean age of 78.8 years (range, 74-84 years), more than 10 degrees of hyperextension (mean of 18.5 degrees) of the femoral component on the sagittal plane was observed without any significant misalignment on the coronal plane. Functional outcomes were assessed using the Knee Society Score. RESULTS: After a mean follow-up of 68.5 months (range, 48-111 months), all patients' fractures with a hyperextension of the femoral component had consolidated with no clinical or radiological signs of TKA loosening. These patients presented "good" functional outcomes at final follow-up. CONCLUSIONS: These results should be interpreted with caution. However, isolated hyperextension of the femoral component of a TKA after placing a retrograde nail for a periprosthetic fracture does not seem to significantly affect the functional or radiological outcomes at ?6-years follow-up. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Pelfort X; Torres-Claramunt R; Hinarejos P; Leal J; Gil-González S; Puig L

2013-03-01

349

[Posterior reversible encephalopathy syndrome].  

Science.gov (United States)

INTRODUCTION: Reversible Posterior Leukoencephalopathy Syndrome was introduced into clinical practice in 1996 in order to describe unique syndrome, clinically expressed during hypertensive and uremic encephalopathy, eclampsia and during immunosuppressive therapy [1]. First clinical investigations showed that leucoencephalopathy is major characteristic of the syndrome, but further investigations showed no significant destruction in white cerebral tissue [2, 3, 4]. In majority of cases changes are localise in posterior irrigation area of the brain and in the most severe cases anterior region is also involved. Taking into consideration all above mentioned facts, the suggested term was Posterior Reversible Encephalopathy Syndrome (PRES) for the syndrome clinically expressed by neurological manifestations derived from cortical and subcortical changes localised in posterior regions of cerebral hemispheres, cerebral trunk and cerebellum [5]. CASE REPORT: Patient, aged 53 years, was re-hospitalized in Cardiovascular Institute "Dediwe" two months after successful aorto-coronary bypass performed in June 2001 due to the chest bone infection. During the treatment of the infection (according to the antibiogram) in September 2001, patient in evening hours developed headache and blurred vision. The recorded blood pressure was 210/120 mmHg so antihypertensive treatment was applied (Nifedipin and Furosemid). After this therapy there was no improvement and intensive headache with fatigue and loss of vision developed. Neurological examination revealed cortical blindness and left hemiparesis. Manitol (20%, 60 ccm every 3 hours) and i.v. Nytroglicerin (high blood pressure). Brain CT revealed oedema of parieto-occipital regions of both hemispheres, more emphasized on the right. (Figure 1a, b, c). There was no sign of focal ischemia even in deeper sections (Figure 1d, e, f). Following three days enormous high blood pressure values were registered. On the fourth day the significant clinical improvement occurred with lowering of blood pressure, better mental state and better vision. There was no sign of left hemiparesis on the 7th day. On the 9th day there were no symptoms or sign of disease. Control brain CT (15th day) was normal. ETHIOPATHOGENESIS: Most common causes of PRES are hypertensive encephalopathy [6-8], pre-eclampsia/eclampsia [9-12] cyclosporin A administration [13-22] and uremic encephalopathy [23]. There are several theories about the mechanism for PRES in hypertensive encephalopathy (reversible vasospasm and hyperperfusion) and administration of cyclosporin A (neurotoxic effect). CLINICAL PICTURE: Most common symptoms are headache, nausea, vomiting, confusion, behavioural changes, changes of conciousness (from somnolencia to stupor), vision disturbances (blurred vision, haemianopsia, cortical blindness) and epileptic manifestations (mostly focal attacks with secondary generalisation). Mental functions are characterised with decreased activity and reactivity, confusion, loss of concentration and mild type of amnesia. Lethargy is often initial sign, sometimes accompanied with phases of agitation. Stupor and coma rarely occurred. DIAGNOSIS: In patients with hypertensive encephalopathy and eclampsia high blod pressure is registered. Neurological examination revealed vision changes and damages of mental function as well as increased reflex activity. Today, brain MRI and CT are considered the most important diagnostic method for the diagnosis and follow-up of patients with PRES [6]. Brain MRI better detects smaller focal parenhim abnormalities than brain CT. The most often neuroradiological finding is relatively symmetrical oedema of white cerebral tissue in parieto-occipital regions of both cerebral hemispheres. Gray cerebral tissue is sometimes involved, usually in mild form of disease. Diagnosis of this "cortical" form of PRES is possible by MR FLAIR (Fluid-Attenuated Inversion Recovery) technique [5]. TREATMENT: Therapeutic strategy depends on the cause of PRES and clinical picture. Most important are blood pres

Petrovi?, Branko; Kosti?, Vladimir; Sterni?, Nadezda; Kolar, Jovo; Tasi?, Nebojsa

350

Accessory thymus in posterior mediastinum  

Directory of Open Access Journals (Sweden)

Full Text Available Presence of thymus in the normal position as well as in the posterior mediastinum is an unusual phenomenon. We report here a case of posterior mediastinal mass in a 20-month old male child who presented with dysphagia and dry cough. Investigations revealed it to be a solid posterior mediastinal mass, suspected to be either lymphoma or a neuroblastoma. Excision of the mass followed by histopathologic examination revealed the mass to be a normal thymus. This case indicates that a benign mass, an accessory thymus, though rare, can be located in the posterior mediastinum and cause symptoms similar to solid mediastinal tumors.

Bhatnagar Sushmita; Pradhan Rohit; Shastri Pankaj; Shenoy Pradeep

2008-01-01

351

Synthetic implants for the repair of osteochondral defects of the medial femoral condyle: a biomechanical and histological evaluation in the rabbit knee.  

UK PubMed Central (United Kingdom)

Polyurethane-coated and uncoated polytetrafluoroethylene (PTFE) (Teflon) and polyester (Dacron) felts were used for repair of full-thickness cartilage defects in the rabbit knee. At 3 months the indentation characteristics and the histological appearance of the repairs were compared with those of a sham-operation, natural repair, and periosteal grafting. Joint compressive load-displacement and indentation characteristics of the cartilage adjacent to the defect were normal for all alternatives. All the repair sites had a higher compliance than had normal cartilage-bone, but synthetic grafting had values closer to normal than periosteal grafting. The adjacent cartilage appeared macroscopically normal, except with periosteal grafting and coated PTFE implants where it showed surface irregularities in some cases. With periosteal and uncoated synthetic implants the defects were completely filled, but not in the natural repair sites. Most of the coated implants failed by separation within the implant. On histological examination, ingrowth of trabecular bone from the base of the defect into the synthetic material was seen in all the specimens. The neocartilage 'score' was equally low with all the repairs reaching only one-third of the maximum points. All the repairs were associated with synovitis. Further, some of the knees with the synthetic materials repair had debris particles in the synovium. We conclude that none of the biological resurfacing techniques described achieved normal articular cartilage characteristics at 3 months, although the compliance of the repair site was closer to normal with synthetic than with periosteal grafting.

Messner K; Gillquist J

1993-06-01

352

Effects of posterior pelvic tilt on anterior instability in total hip arthroplasty: a parametric experimental modeling evaluation.  

UK PubMed Central (United Kingdom)

BACKGROUND: Anterior dislocation is one of the concerns of patients with posterior pelvic tilt undergoing total hip arthroplasty. This study aimed to evaluate the magnitude of posterior pelvic tilt constituting a risk for anterior dislocation by measuring the range of motion until impingement and dislocation under various pelvic tilt. METHODS: Using a jig mounted prosthetic hip model, the ranges of external rotation at extension and internal rotation at flexion until reaching dislocation were tested. The site of impingement prior to dislocation was also recorded. Posterior pelvic tilt and the cup version were changed with 10° increments from 0° to 40° and from 10° retroversion to 30° anteversion, respectively. Effects of increasing femoral offset were also tested. We defined a required range of motion as having 30° external rotation at extension and 40° internal rotation at 90° flexion. FINDINGS: External rotation decreased in a posterior pelvic tilt-dependent manner. In the case with more than 20° posterior pelvic tilt, available external rotation extended beyond required range with the cup anteversion of 20°. Decreasing cup anteversion improved external rotation, however, internal rotation decreased simultaneously. In the case with posterior pelvic tilt more than 20°, only cup anteversion with 0° or 10° satisfied the required range of motion. A +4 mm horizontal offset improved external rotation by 10° with delaying bony impingement. INTERPRETATION: More than 20° of posterior pelvic tilt may cause anterior instability and diminish the optimal range of cup version. Increasing the femoral offset improved external rotation without reducing internal rotation.

Sato T; Nakashima Y; Matsushita A; Fujii M; Iwamoto Y

2013-02-01

353

Posterior Cricoid Region Fluoroscopic Findings: The Posterior Cricoid Plication  

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The region posterior to the cricoid cartilage is challenging to assess fluoroscopically. The purpose of this investigation is to critically evaluate the posterior cricoid (PC) region on fluoroscopy and describe patterns of common findings. This was a case control study. All fluoroscopic swallowing s...

Allen, Jacqui E.; White, Cheryl J.; Leonard, Rebecca J.; Belafsky, Peter C.

354

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  

Directory of Open Access Journals (Sweden)

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; Marco Martins Amatuzzi; Alexandre Pagotto Pacheco; Fabio Janson Angelini; Osmar Campos Jr

2007-01-01

355

Femoral neck stress fractures in military personnel.  

UK PubMed Central (United Kingdom)

INTRODUCTION: Stress fractures are common during military training but femoral neck stress fractures are uncommon and sometimes pose diagnostic and therapeutic challenges. An incomplete stress fracture with excellent prognosis, if left unprotected, can lead to displaced femoral neck fracture with almost 63% complication rate even with best of the treatment. The aim of this study was to analyze various aspects of the femoral neck stress fracture so that early diagnosis can be made to prevent devastating complications like osteonecrosis and non-union. METHODS: The four year army hospital record of 16 patients with femoral neck stress fracture were studied. Their demographic profile, type of fracture, presentation delay, on set of clinical symptoms and complication of femoral neck stress fracture were critically analyzed. RESULTS: The mean age of the patient was 19.94 years. Total 74% of them developed first symptoms of stress fracture between four to seven weeks of training. There was 3.4 weeks delay from the clinical onset of symptoms to the diagnosis of stress fracture. The type of femoral neck stress fracture were compression (31.25%), tension (18.75%) and displaced (50%). Out of eight displaced type of fractures, 5 (62.5%) had developed complications (3 osteonecrosis and 2 nonunion). CONCLUSIONS: Femoral neck stress fracture occurs in initial four to seven weeks of training. The high index of suspicion in initial period of training can help to detect and decreases significant morbidity.

Joshi A; Kc BR; Shah BC; Chand P; Thapa BB; Kayastha N

2009-04-01

356

Femoral neck fracture following hardware removal.  

UK PubMed Central (United Kingdom)

It is uncommon for femoral neck fractures to occur after proximal femoral hardware removal because age, osteoporosis, and technical error are often noted as the causes for this type of fracture. However, excessive alcohol consumption and failure to comply with protected weight bearing for 6 weeks increases the risk of femoral neck fractures.This article describes a case of a 57-year-old man with a high-energy ipsilateral inter-trochanteric hip fracture, comminuted distal third femoral shaft fracture, and displaced lateral tibial plateau fracture. Cephalomedullary fixation was used to fix the ipsilateral femur fractures after medical stabilization and evaluation of the patient. The patient healed clinically and radiographically at 6 months. Despite conservative treatment for painful proximal h