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Sample records for acetabular labral tears

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

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

    2013-09-15

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

  2. Delamination Cysts: A Predictor of Acetabular Cartilage Delamination in Hips with a Labral Tear

    OpenAIRE

    Gdalevitch, Marie; Smith, Karen; Tanzer, Michael

    2008-01-01

    The treatment and prognosis of labral tears of the hip depend primarily on whether there is concomitant injury of the adjacent acetabular articular cartilage. We asked whether a delamination cyst on the preoperative plain radiographs correlated with delamination of the acetabular articular cartilage at the time of hip arthroscopy. We reviewed the preoperative radiographs of 125 consecutive hips that had a labral tear at hip arthroscopy for the presence of a delamination cyst. A delamination c...

  3. Delamination cysts: a predictor of acetabular cartilage delamination in hips with a labral tear.

    Science.gov (United States)

    Gdalevitch, Marie; Smith, Karen; Tanzer, Michael

    2009-04-01

    The treatment and prognosis of labral tears of the hip depend primarily on whether there is concomitant injury of the adjacent acetabular articular cartilage. We asked whether a delamination cyst on the preoperative plain radiographs correlated with delamination of the acetabular articular cartilage at the time of hip arthroscopy. We reviewed the preoperative radiographs of 125 consecutive hips that had a labral tear at hip arthroscopy for the presence of a delamination cyst. A delamination cyst was defined as an acetabular subchondral cyst either directly adjacent to a lateral acetabular cyst or in relation to a subchondral crack in the anterosuperior portion of the acetabulum. All patients with acetabular cartilage delamination at arthroscopy were identified. There were 16 patients with delamination cysts on radiographs and 15 patients with cartilage delamination at arthroscopy. A delamination cyst on the preoperative anteroposterior and/or frog lateral radiographs of the hip accurately predicted acetabular cartilage delamination, especially in hips with labral tears not caused by a major trauma. A delamination cyst is a previously unrecognized and novel radiographic sign that can preoperatively identify acetabular cartilage delamination in patients with labral tears, thereby facilitating the selection of the appropriate surgery and determining prognosis. Level II, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.

  4. Similar Prevalence of Acetabular Labral Tear in Professional Ballet Dancers and Sporting Participants.

    Science.gov (United States)

    Mayes, Susan; Ferris, April-Rose; Smith, Peter; Garnham, Andrew; Cook, Jill

    2016-07-01

    To compare the prevalence of acetabular labral tear in male and female professional ballet dancers with age-matched and sex-matched sporting participants and to determine the relationship to clinical findings and cartilage defects. Case-control study. Clinical and radiology practices. Forty-nine (98 hips) male and female professional ballet dancers (current and retired) with median age 30 years (range: 19-64 years) and 49 (98 hips) age-matched and sex-matched sporting participants. Group (ballet or sports), sex, age, hip cartilage defects, history of hip pain, Hip and Groin Outcome Score, passive hip internal rotation (IR), and external rotation range of movement (ROM). Labral tear identified with 3T magnetic resonance imaging (MRI). Labral tears were identified in 51% of all 196 hips. The prevalence did not differ significantly between the ballet and sporting participants (P = 0.41) or between sexes (P = 0.34). Labral tear was not significantly associated with clinical measures, such as pain and function scores or rotation ROM (P > 0.01 for all). Pain provocation test using IR at 90° of hip flexion had excellent specificity [96%, 95% confidence intervals (CIs), 0.77%-0.998%] but poor sensitivity (50%, 95% CI, 0.26%-0.74%) for identifying labral tear in participants reporting hip pain. Older age and cartilage defect presence were independently associated with an increased risk of labral tear (both P ballet dancers was similar to a sporting population. Labral tears were not associated with clinical findings but were related to cartilage defects, independent of aging. Caution is required when interpreting MRI findings as labral tear may not be the source of the ballet dancer's symptoms.

  5. 3.0 T conventional hip MR and hip MR arthrography for the acetabular labral tears confirmed by arthroscopy

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

    2014-10-15

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

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

    Science.gov (United States)

    Khoo-Summers, Lynnette; Bloom, Nancy J

    2015-08-01

    Dancers are at risk for developing groin pain that is due to acetabular labral tears. Although surgical management of labral tears has been reported extensively, conservative management has been poorly described. This case report describes the examination, diagnosis, and treatment of groin pain in a professional ballet dancer with a suspected acetabular labral tear. Treatment focused on decreasing anterior hip joint stresses and improving the precision of hip motion through correction of alignment and movement impairments noted during functional activities and dance. Successful outcomes included a reduction in pain and return to professional ballet dancing. Copyright © 2015 Elsevier Ltd. All rights reserved.

  7. Cross-sectional area of the labrum: role in the diagnosis of anterior acetabular labral tears

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    Kantarci, Fatih; Ozpeynirci, Yigit; Gulsen, Fatih; Ozbayrak, Mustafa; Mihmanli, Ismail; Cantasdemir, Murat [Istanbul University, Department of Radiology, Cerrahpasa Medical Faculty, Istanbul (Turkey); Unlu, Mehmetcan; Botanlioglu, Huseyin; Inan, Muharrem [Department of Orthopedic Surgery, Istanbul (Turkey)

    2012-06-15

    To investigate the utility of ultrasound cross-sectional area (CSA) measurements for diagnosing acetabular labral (AL) tears. The study included qualitative/quantitative ultrasound examinations of 55 hips in 52 patients with a presumed diagnosis of AL tear and 56 hips in 28 healthy volunteers. MR arthrography examinations were available only for the patients and were reviewed for the presence of AL thickening and tear. The CSA of the anterior labrum was significantly larger in patients with an AL tear on MR arthrography than those in healthy volunteers (P < 0.01). The CSA cut-off value in determining labral thickening that maximises accuracy was 34.7 mm{sup 2}, and sensitivity, specificity and accuracy were 86.7%, 74.1% and 77.5%. Direct signs of AL tear on ultrasound had sensitivity, specificity and accuracy of 34.9%, 91.7% and 47.3%. The CSA cut-off value that maximises the accuracy of the AL tear was 40.6 mm{sup 2}, and sensitivity, specificity and accuracy were 58.1%, 91.2% and 78.4%. Ultrasound detects the thickened labrum frequently observed in MR arthrography studies, especially in patients with dysplastic hips. Although specificity of the method of detecting AL tears is high, sensitivity is low, with an overlap between subjects with AL tear and controls. circle Labral degeneration is frequent in dysplastic hips circle Thickened labra are frequently observed on MR arthrograms circle Labral thickening can be depicted by quantitative ultrasound measurements circle The sensitivity is low with overlap between subjects with AL tear and controls. (orig.)

  8. Myofascial treatment for patients with acetabular labral tears: a single-subject research design study.

    Science.gov (United States)

    Cashman, Glenn E; Mortenson, W Ben; Gilbart, Michael K

    2014-08-01

    Single-subject research design using 4 consecutive patients. To assess whether treatment using soft tissue therapy (ART or Active Release Technique), stretching, and strengthening of the hip abductors, hip external rotators, and tensor fascia latae muscles reduces pain and improves self-reported hip function in patients with acetabular labral tears who also have posterolateral hip pain of suspected myofascial origin. Acetabular labral tears cause pain in some but not all patients. Pain commonly presents anteriorly but may also present posteriorly and laterally. The standard of care is arthroscopic repair, which helps many but not all patients. It is possible that these patients may present with extra-articular contributions to their pain, such as myofascial pain, making their clinical presentation more complex. No previous study has assessed soft tissue therapy as a treatment option for this subset of patients. This A-B-A design used repeated measures of the Hip Outcome Score and visual analog scale for pain. Four patients were treated for 6 to 8 weeks, using a combination of soft tissue therapy, stretching, and strengthening for the hip abductors, external rotators, and tensor fascia latae. Data were assessed visually, statistically, and by comparing mean differences before and after intervention. All 4 patients experienced both statistically significant and clinically meaningful improvement in posterolateral hip pain and hip-related function. Three patients also experienced reduction in anteromedial hip pain. Myofascial hip pain may contribute to hip-related symptoms and disability in patients with acetabular labral tears and posterolateral hip pain. These patients may benefit from soft tissue therapy combined with stretching and strengthening exercises targeting the hip abductors, tensor fascia latae, and hip external rotator muscles. Level of Evidence Therapy, level 4.

  9. Efficacy of MR arthrography in the diagnosis of the acetabular labral tear

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    Chun, Kwang Jin; Kwon, Soon Tae; Hwang, Deuk Soo; Chung, Yon Su; Paek, Chung Ho; Kim, Young Min; Lee, Won Sok [Chungnam National Univ. College of Medicine, Taejon (Korea, Republic of)

    1999-08-01

    To determine the accuracy of magnetic resonance (MR) arthrography in the detection and staging of lesions of the acetabular labrum. Fifteen hips of 14 patients with chronic hip pain and clinical suspicion of labral lesions were examined with direct or indirect MR arthrography and underwent subsequent arthroscopic evaluation. The study population consisted of six women and eight men aged between 40 and 59 years. Nine arthrograms were obtained intra-articular administration of gadolinium solution, and six involved articular motion exercise after intravenous administration of gadolinium solution. In 14 cases a phased-array pelvic coil was used, and a shoulder coil in one. Fat-suppressed T1-weighted images were obtained in the coronal, oblique coronal and oblique axial planes, and T1- and T2-weighted images were obtained in the axial plane. Labral lesions were graded according to the Czerny classification and evaluated on the basis of presence or absence of a tear and location (anteroinferior, anterosuperior, superior, posterosuperior, posteroinferior). The findings were than correlated with the arthroscopic findings. After direct and indirect MR arthography, the findings-based on the Czerny classification-were as follows : stage IA:3; IB:1; IIA:8; IIB:1; IIIA:4; IIIB:0. MR arthrography also showed that seven cases were located in the anterosuperior portion of the labrum, seven in the superior portion, and three in the posteroinferior portion. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MR arthrography for diagnosis of the labral tear was 92%, 75%, and 88%, respectively. In this preliminary study, MR arthrography appears to be a promising imaging modality for accurate diagnosis and useful for screening patients with chronic hip pain.

  10. Hip Labral Tear

    Science.gov (United States)

    ... sports as ice hockey, soccer, football, golf and ballet are at higher risk of developing a hip labral tear. Structural abnormalities of the hip also ... of a hip labral tear may be: Trauma. Injury to or dislocation of the hip joint — which can occur during car accidents or ...

  11. Achados em ressonância magnética artrográfica de indivíduos com lesão do labrum acetabular Magnetic resonance arthrographic findings in subjects with acetabular labral tears

    Directory of Open Access Journals (Sweden)

    André Luiz Almeida Pizzolatti

    2011-01-01

    Full Text Available OBJETIVO: Descrever os achados em artro RM de sujeitos com suspeita de lesão do labrum acetabular. MÉTODO: Foram analisadas 108 artro RM de quadris em 2007/2008. Dois radiologistas independentemente analisaram as imagens e foi considerada a resposta comum entre eles. Com base em seus pareceres observou-se o local e estadiamento das lesões labrais e condrais, as alterações anatômicas, e a presença de tendinite e bursite trocantérica. RESULTADO: As lesões labrais grau I ocorreram em 41% dos casos, grau II em 31%, e grau III em 29%. O IFA tipo cam foi frequente em 36% dos casos, tipo pincer em 11%, e IFA misto em 13%, nestes casos 57% apresentaram lesão labral grau III, A lesão condral grau I foi observada em 51% acetábulos, as de grau II em 13%, e grau III em 18%. CONCLUSÃO: As alterações morfológicas que provocam IFA do tipo cam foram as mais prevalentes. Em relação ao grau de lesão labral e condral foram predominantes as lesões grau I independente da presença ou do tipo de IFA, exceto em IFAs mistos onde houve predomínio de lesão labral grau III. Não foi observada uma relação entre o grau de lesão labral e condral.OBJECTIVE: To describe the MR arthrographic findings in subjects with suspected acetabular labral tears of the hip. METHOD: 108 hip MRa results were analyzed in 2007-2008. Two radiologists independently interpreted the images, and the consensual answers between them were considered for analysis. Based on their opinions, information was obtained on the location, staging of the chondral and labral lesions, anatomic alterations, and the presence of trochanteric bursitis and tendonitis. RESULTS: 1st degree labral lesions occurred in 41% of cases, 2nd degree in 31%, and 3rd degree in 29%. The cam type FAI was common in 36% of cases, pincer FAI in 11%, and mixed cam-pincer FAI in 13%; in these cases 57% had grade III labral lesions. 1st degree chondral lesions were observed in 51% of acetabulum, 2nd degree in 13

  12. Diagnostic Accuracy of Imaging Modalities and Injection Techniques for the Diagnosis of Femoroacetabular Impingement/Labral Tear A Systematic Review With Meta-analysis

    DEFF Research Database (Denmark)

    Reiman, Michael P.; Thorborg, Kristian; Goode, Adam P.

    2017-01-01

    Background: Diagnosing femoroacetabular impingement/acetabular labral tear (FAI/ALT) and subsequently making a decision regarding surgery are based primarily on diagnostic imaging and intra-articular hip joint injection techniques of unknown accuracy. Purpose: Summarize and evaluate the diagnosti...

  13. Recurrent Labral Tearing on Magnetic Resonance Imaging Is Not Predictive of Diminished Participation Among National Football League Athletes.

    Science.gov (United States)

    Knapik, Derrick M; Gebhart, Jeremy J; Sheehan, Joseph; Tanenbaum, Joseph E; Salata, Michael J; Voos, James E

    2018-01-01

    To investigate the prevalence of shoulder labral repair and utility of magnetic resonance imaging (MRI) in determining the risks of recurrent labral tearing and impact on future participation in the National Football League (NFL). Athletes invited to the NFL Combine between 2012 and 2015 were retrospectively reviewed. Athletes with a history of labral repair and MRI of the operative shoulder at the Combine were included in the study for further analysis, excluding athletes without a history of labral repair, labral repair without MRI at the Combine, additional procedure to the operative shoulder, or athletes still undergoing rehabilitation at the time of the Combine after labral repair. All MRIs were reviewed to determine initial labral repair location, the presence of recurrent tearing, and any concomitant shoulder pathology. Prospective information on future NFL participation in regard to draft status, games played, and games started in the athlete's first NFL season after the Combine was compared between athletes with a history of labral repair with and without recurrent tearing versus all other athletes participating in the Combine. A total of 132 (10.1%) athletes underwent 146 shoulder labral repair procedures before the NFL Combine, of whom 32% (n = 39 athletes, n = 46 shoulders) had recurrent labral tears on MRI. Athletes with recurrent tears were more likely to have undergone bilateral labral repairs (P = .048) and possess concomitant shoulder pathology (P < .001). Recurrent labral tearing was significantly more common in the posterior labrum in athletes with a history of posterior labral repairs (P = .032). Prospective participation in the NFL in terms of games played (P = .38) or started (P = .98) was not significantly reduced in athletes with a history of labral repair compared with those without repair. Participation was not diminished in athletes with recurrent labral tears compared with those with intact repairs or those with evidence of

  14. Diagnosis of lesions of the acetabular labrum, of the labral-chondral transition zone, and of the cartilage in femoroacetabular impingement: Correlation between direct magnetic resonance arthrography and hip arthroscopy.

    Science.gov (United States)

    Crespo Rodríguez, A M; de Lucas Villarrubia, J C; Pastrana Ledesma, M A; Millán Santos, I; Padrón, M

    2015-01-01

    To determine the sensitivity and accuracy of direct MR arthrography in the diagnosis of intra-articular lesions associated with femoroacetabular impingement. We used direct MR arthrography to study 51 patients with femoroacetabular impingement who underwent arthroscopic hip surgery. Surgery demonstrated 37 labral tears, 44 lesions in the labral-chondral transitional zone, and 40 lesions of the articular cartilage. We correlated the findings at preoperative direct MR arthrography with those of hip arthroscopy and calculated the sensitivity, specificity, positive predictive value, negative predictive value, and validity index for direct MR arthrography. The sensitivity and specificity of MR arthrography were 94.5% and 100%, respectively, for diagnosing labral tears, 100% and 87.5%, respectively, for diagnosing lesions of the labral-chondral transition zone, and 92.5% and 54.5%, respectively, for diagnosing lesions of the articular cartilage. The negative predictive value of MR arthrography for lesions of the labral-chondral transitional zone was 100%. MR arthrography accurately defined extensive lesions of the cartilage and the secondary osseous changes (the main factor in poor prognosis), although its diagnostic performance was not so good in small chondral lesions. In patients with femoroacetabular impingement, direct MR arthrography can adequately detect and characterize lesions of the acetabular labrum and of the labral-chondral transitional zone as well as extensive lesions of the articular cartilage and secondary osseous changes. Copyright © 2013 SERAM. Published by Elsevier España, S.L.U. All rights reserved.

  15. Femoroacetabular impingement negates the acetabular labral seal during pivoting maneuvers but not gait.

    Science.gov (United States)

    Dwyer, Maureen K; Jones, Hugh L; Field, Richard E; McCarthy, Joseph C; Noble, Philip C

    2015-02-01

    Experimental disruption of the labrum has been shown to compromise its sealing function and alter cartilage lubrication. However, it is not known whether pathological changes to the labrum secondary to femoroacetabular impingement (FAI) have a similar impact on labral function. Does damage to the labrum occurring in association with abnormal femoral morphology affect the labral seal? Using 10 fresh cadaveric specimens (mean age 50 years, ±8), we measured the capacity of the central compartment of the hip (the iliofemoral joint) to maintain a seal during fluid infusion, which may help elucidate the function of the labrum during weightbearing. Specimens with and without abnormal femoral morphology (six normal-appearing specimens and four whose geometry suggested cam-type FAI) were tested in postures observed during functional activities, including simulations of normal gait, stooping, and pivoting. Each specimen with FAI morphology exhibited secondary damage of the labrum and the adjacent chondral surface, whereas specimens of normal morphology were undamaged. Average peak central compartment pressure was reduced during pivoting for specimens with the presence of labral damage secondary to FAI. When placed in pivoting positions, hips with FAI maintained lower fluid pressures within the central compartment compared with intact specimens (15±3 versus 42±8 kPa, respectively; effect size: 1.08 [-0.36 to 2.31]; p=0.007). No differences in peak pressure were observed between groups (FAI versus normal) for postures simulating either gait (21±6 versus 22±4 kPa; p=0.902) or stooping (9±2 versus 8±3 kPa; p=0.775) with the numbers available. The acetabular seal, quantified by the maximum intraarticular pressure, was reduced during pivoting; however, the seal was maintained during simulated gait and stooping. Because degeneration is progressive with repetitive impingement, loss of the labral seal starts to be seen during pivoting and may progress from there, but in this

  16. recurrent traumatic posterior hip dislocation in labral avulsion

    African Journals Online (AJOL)

    dislocation who had acetabular labrum avulsion, with torn short external rotators, who benefitted from surgical repair of the labrum, with plate augmentation. Clinicians should be wary of post traumatic labral tears as a rare cause of recurrent posterior hip dislocation in the absence of acetabular fractures. They are amenable ...

  17. Nonoperative Management of Labral Tears of the Hip in Adolescent Athletes: Description of Sports Participation, Interventions, Comorbidity, and Outcomes.

    Science.gov (United States)

    Cianci, Andrea; Sugimoto, Dai; Stracciolini, Andrea; Yen, Yi-Meng; Kocher, Mininder S; dʼHemecourt, Pierre A

    2017-08-16

    Hip injury among young athletes is increasing, especially hip labral tears. Some tears may require surgical intervention, especially if they are associated with boney pathology such as femoroacetabular impingement (FAI). A protocol for nonoperative treatment of the hip labral tears is not well established. To identify current nonoperative treatment options, comorbidities, sports participation, and outcomes of adolescent athletes who were diagnosed with hip labral tears. Retrospective chart review. A regional tertiary level medical and academic institution. Physically active 8- to 20-year-old males and females who were diagnosed with hip labral tears in 2010 to 2013. Nonoperative treatment interventions including physical therapy (PT), intraarticular injection (IAI), the type of sports participation, and comorbidity were extracted. Descriptive statistics and χ tests were used with a priori alpha level sports participated were dance (18.4%), soccer (14.5%), and gymnastics (7.9%). The most common comorbidity was FAI, which was observed in 46 individuals (60.5%). Although there was no difference in a proportion of FAI cases between sexes, a greater proportion of surgical cases were observed among hip labrum-injured athletes with FAI compared with those without FAI (P = 0.032). Adolescent athletes with hip labral tears often receive PT, IAI, and a combination of both, as nonoperative treatment options in this study cohort. The adolescent athletes who sustained hip labral tears with comorbidity of FAI had significantly greater proportion of surgical cases after nonoperative treatments.

  18. Magnetic resonance imaging and clinical features of glenoid labral flap tears

    Energy Technology Data Exchange (ETDEWEB)

    Stewart, Jessica K.; Vinson, Emily N. [Duke University Hospital, Department of Radiology, Durham, NC (United States); Taylor, Dean C. [Duke University Hospital, Department of Orthopaedic Surgery, Durham, NC (United States)

    2017-08-15

    Displaced flaps of glenoid labral tissue are an uncommonly encountered finding on MRI of the shoulder, and are of unclear clinical significance. The purpose of this study is to describe the imaging characteristics of displaced glenoid labral flaps, evaluate for any common concomitant injuries, and identify the typical clinical presentation and management of patients with this lesion. This retrospective, observational study was approved by the institutional review board. Nineteen patients with flap-type tears of the labrum on preoperative MRI were identified. Each examination was retrospectively reviewed by two radiologists for size, location, and signal intensity of the displaced flap of tissue, in addition to any co-existing labrum or cartilage pathological conditions and clinical information. All displaced flaps extended from the inferior margin of the glenoid into the axillary recess. The average size of the visualized flap was 10.9 by 6.0 by 2.6 mm. Seventy percent of the flaps had signal intensity isointense to labrum and hypointense to hyaline cartilage on T2-weighted images. All 19 patients had concomitant labral pathological conditions and 63% had cartilage defects, visualized on MRI. Clinical evidence of shoulder instability was seen in 83% of patients, and 67% were managed surgically. Glenoid labral flap tears have distinct imaging characteristics that may aid in their identification. Their presence should prompt careful evaluation of the glenoid articular cartilage. Recognition of a labral flap tear may have clinical importance, as 83% of patients with this finding demonstrated clinical evidence of shoulder instability, often requiring surgical intervention. (orig.)

  19. Factors Associated with the Risk of Articular Surface Perforation during Anchor Placement for Arthroscopic Acetabular Labral Repair.

    Science.gov (United States)

    Yoo, Jun-Il; Ha, Yong-Chan; Hwang, Sun-Chul; Oh, Jin-Young; Chang, Eui-Chan; Lee, Young-Kyun; Koo, Kyung-Hoi

    2017-12-01

    The purpose of this study was to evaluate factors associated with the risk of articular surface perforation during anchor placement for arthroscopic acetabular labral repair using follow-up computed tomographic arthrography (CTA). Forty-six patients (29 males and 17 females) underwent arthroscopic labral repair using 142 suture anchors (55 large anchors and 87 small anchors). The patients were followed with CTA 1 year postoperatively. Anchor position was assessed by the insertion angle and the distance of the suture anchor tip from the articular cartilage. The incidence of malposition of suture anchors was assessed in follow-up CTA. The location and incidence of malposition were compared between two groups divided according to the diameter of suture anchor. The mean insertion angle and distance were significantly different between the groups. Of the 142 anchors, 15 (11%) were placed in the cartilage-bone transitional zone. Articular involvement was most common at the 3 o'clock position of the suture anchor (six out of 33 anchors, 18.2%). Both the insertion angle and distance showed small values in the articular involvement group. The radiographic analysis of the placement of suture anchors after arthroscopic labral refixation based on follow-up CTA demonstrates that articular involvement of anchors is related to the location on the acetabular rim (clock position) and anchor diameter.

  20. The MR arthrographic anatomy of the biceps labral insertion and its morphological significance with labral tears in patients with shoulder instability

    Energy Technology Data Exchange (ETDEWEB)

    Jakanani, G.C., E-mail: gcjakanani@gmail.com [Leicester Royal Infirmary, Leicester (United Kingdom); Botchu, R., E-mail: drrajeshb@gmail.com [Leicester Royal Infirmary, Leicester (United Kingdom); Rennie, W.J., E-mail: winston.rennie@gmail.com [Leicester Royal Infirmary, Leicester (United Kingdom)

    2012-11-15

    Introduction: Most of the fibres of the long head of biceps tendon attach on the superior labrum just posterior to the supraglenoid tubercle. Aim: Our hypothesis was that posteriorly attached biceps tendons predispose to posterior superior labral tears and SLAP lesions. Methods and materials: A prospective analysis of all MR shoulder arthrograms for shoulder instability referred from the shoulder specialist clinics, performed during a one year period were reviewed by two independent observers who were blinded to clinical history. The biceps attachment was classified into four groups according to the method described in an earlier cadaveric study into four groups; posterior-type 1, predominantly posterior-type 2, equal contributions to both anterior and posterior labrum-type 3 and predominantly anterior labral attachment-type 4. Data was analysed using Kappa statistics and Fischer's exact test. Results: 48 patients (33 males and 15 females) were included in this study with a mean age of 32 years. Majority, 22 patients (46%) had a type 1 attachment of the biceps on the superior labrum. There was moderate intra-observer and good interobserver agreement with a Kappa of 0.58 and 0.63 respectively. There was a significant association between a type 2 attachment and posterior tears (p {<=} 0.04) and also between a type 2 attachment and SLAP tears (p {<=} 0.04). Conclusion: Our results suggest that variation in anatomy of biceps origin influences the type of labral tears that occur in patients with shoulder instability. The importance of these findings could influence selection of individuals in throwing sports like cricket and baseball.

  1. Hip arthroscopy in patients less than 25 years of age in the treatment of labral tears: aetiology and clinical outcomes.

    Science.gov (United States)

    Bayley, Gillian; Poitras, Stephane; Parker, Gillian; Beaulé, Paul E

    2017-09-19

    Hip arthroscopy has evolved into a well-established and rapidly growing field of orthopedic surgery for the management of labral tears. The purpose of this study was to review clinical outcomes of patients less than 25 years of age undergoing hip arthroscopy for treatment of a labral tear. From 2005 to 2013, 82 hips in 76 patients with mean age of 20.4 (16-25 range) underwent hip arthroscopy for treatment of labral-chondral damage. The Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) and hip disability and osteoarthritis outcome score (HOOS) were recorded at latest follow-up. 36 of 86 hips (42%) had isolated labral pathology with no associated bony pathology (normal alpha and centre-edge angle; no retroversion). Beck score (intraoperative cartilage damage) of 3 or more was significantly associated with an alpha angle of more than 55 degrees (odds ratio [OR], 3.6; confidence interval [CI], 1.2-11.0) and presence of femeroacetabular impingement (OR, 4.5; CI, 1.3-15.2). HOOS pain, sports/recreation, and quality of life significantly improved from preoperative to one year after surgery (parthroscopy with subsequent periacetabular osteotomy (PAO); 1 had only a periacetabular osteotomy (PAO). Complications included 2 lateral femoral cutaneous nerve deficits and 1 deep vein thrombosis. Labral tears in patients less than 25 years of age occurs commonly without bony deformities, with those with normal head/neck contour demonstrating significantly less early cartilage damage than those with bony pathology. Hip arthroscopy in young patients can improve function and quality of life with minimal morbidity.

  2. Acetabular paralabral cyst: an uncommon cause of sciatica

    Energy Technology Data Exchange (ETDEWEB)

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

    2003-02-01

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

  3. Acetabular All-Suture Anchor for Labral Repair: Incidence of Intraoperative Failure due to Pullout.

    Science.gov (United States)

    Byrd, J W Thomas; Jones, Kay S; Loring, Cynthia L; Sparks, Stephanie L

    2018-01-17

    To report on the incidence and features of intraoperative anchor pullout in a consecutive series of patients undergoing arthroscopic labral repair of the hip. Over an 18-month period, 434 consecutive cases underwent labral repair by a single surgeon with a particular anchor system. The following data were recorded: (1) age and gender of all cases; (2) number of anchors used; (3) number of cases in which intraoperative anchor failure occurred; (4) number of anchors that failed; and (5) age and gender of those cases in which anchor failure occurred. Failures were reported for 3-month intervals. One patient underwent repair with an alternative anchor system during this time period and was excluded. Mean age was 34.2 (14-71) years with 180 males and 254 females. A total of 2,007 anchors were used, averaging 4.6 per case (1-8). Thirty-three anchors pulled out among 30 patients, representing a 1.6% incidence among all anchors. Mean age among pullouts was 37.8 (17-54) years with 11 males and 19 females. There was no difference compared with patient population in which no anchor pulled: mean 33.9 (14-71) years (P = .085) with 169 males and 235 females (P = .578). Pullouts were evenly distributed over the 3-month intervals (4, 4, 6, 6, 5, 8). Pullout was mostly due to failure to securely imbed the anchor in bone. Only 2 were known to pull out in the presence of being securely seated in bone. These data support that the security of this particular all-suture anchor at implantation is exceptionally reliable for a single experienced surgeon, and there is no demonstrable learning curve. LEVEL OF EVIDENCE: Level IV, retrospective review of a case series. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  4. Treatment of Ulnar Collateral Ligament Injuries and Superior Labral Tears by Major League Baseball Team Physicians.

    Science.gov (United States)

    Erickson, Brandon J; Harris, Joshua D; Fillingham, Yale A; Cvetanovich, Gregory L; Bush-Joseph, Charles A; Bach, Bernard R; Romeo, Anthony A; Verma, Nikhil N

    2016-07-01

    To determine practice patterns of Major League Baseball (MLB) team orthopaedic surgeons in addressing the controversial topics of ulnar collateral ligament (UCL) tears, type II SLAP tears, and partial-thickness rotator cuff tear. Seventy-four MLB team orthopaedic surgeons were surveyed via an online survey system. A 14-question survey was used to assess surgeon experience, technique, and graft choice for UCL reconstruction (UCLR), treatment of type II SLAP tears, and other common pathologic conditions. Thirty team orthopaedic surgeons (41%) responded (mean experience as team physicians: 9.37 ± 6.33 years). Seventeen (56.7%) surgeons use the docking technique for UCLR whereas 20% use the modified Jobe technique. Nineteen (63.3%) use palmaris longus autograft in UCLR. Overall, 28 (93.3%) do not routinely perform elbow arthroscopy or perform an obligatory transposition of the ulnar nerve in patients without preoperative ulnar nerve symptoms. Twenty-eight (93.3%) would repair a type II SLAP tear, whereas only 1 (3.3%) would debride the tear. No surgeon would perform a concomitant biceps tenodesis, either open or arthroscopic. Most MLB team orthopaedic surgeons perform a UCLR using the docking technique with a palmaris longus autograft without concomitant elbow arthroscopy or obligatory transposition of the ulnar nerve. The overwhelming majority of these surgeons would also treat an operative type II SLAP tear with a SLAP repair. The number of UCLRs and SLAP repairs performed on MLB pitchers has significantly increased over the past 10 years. To properly treat these conditions in elite, college, and recreational athletes, it is important to understand how the surgeons who take care of the most elite-level athletes treat them, and how they are able to reproducibly attain excellent outcomes. This study shows how these common shoulder and elbow injuries are treated by those surgeons who care for the most elite overhead-throwing athletes in the world. Copyright © 2016

  5. Magnetic resonance imaging with gadolinium arthrography to assess acetabular cartilage delamination.

    Science.gov (United States)

    Zaragoza, Edward; Lattanzio, Pierre-Jean; Beaule, Paul E

    2009-01-01

    Recent reports have demonstrated magnetic resonance imaging (MRI) as a promising technique in detecting articular cartilage lesions of the hip joint. The purpose of our study was to evaluate the diagnostic performance of MRI with gadolinium arthrography in detecting acetabular cartilage delamination in patients with pre-arthritic hip pain. 46 patients (48 hips) underwent surgical dislocation of the hip. Mean age was 38.8 (range 17-56). There were 26 males and 20 females. All patients had Magnetic Resonance Imaging with gadolinium arthrography (MRA) before undergoing open hip surgery where the acetabular cartilage was inspected. Acetabular cartilage delamination on MRA was seen on sagittal images as a linear intra-articular filling defect of low signal intensity >1mm in thickness on T1 weighted images and surrounded by contrast. On MRA all hips had a labral tear confirmed at surgery. At surgery 30 hips had evidence of acetabular cartilage delamination, 4 hips had ulceration and 14 had no articular cartilage damage. The majority of labral tears and cartilage damage were located in the antero-superior quadrant. The sensitivity and specificity of MRA detection of cartilage delamination confirmed at surgery were 97% and 84%, respectively. The positive and negative predictive values of the MRA finding were 90% and 94%, respectively. The presence of the acetabular cartilage delamination represents an early stage of articular cartilage degeneration. When evaluating a young adult with hip pain, labral tears in association with cartilage delamination should be considered. MRA represents an effective diagnostic tool.

  6. Acetabular Chondral Lesions in Hip Arthroscopy: Relationships Between Grade, Topography, and Demographics.

    Science.gov (United States)

    Suarez-Ahedo, Carlos; Gui, Chengcheng; Rabe, Stephanie M; Chandrasekaran, Sivashankar; Lodhia, Parth; Domb, Benjamin G

    2017-09-01

    Hip pain remains a challenge given the multiple factors that can cause damage to the articular cartilage, such as traumatic injury, metabolic damage, and morphologic variations such as femoroacetabular impingement (FAI) and that can contribute to progression of osteoarthritis. However, a direct relationship between patient characteristics, the extent of acetabular chondral damage, and topologic characteristics of chondral lesions has not been established. To compare the grade of acetabular chondral damage, measured in terms of acetabular labrum articular disruption (ALAD) classification, to the size and position of the chondral lesions, matching patients' demographic factors such as age and body mass index (BMI). Cross-sectional study; Level of evidence, 3. This study included all hip arthroscopies performed by the corresponding author from August 7, 2008, to November 19, 2014, in which acetabular chondral lesions were intraoperatively identified and measured in terms of ALAD grade, clockface location, and size. Bivariate analyses and multiple logistic regression were used to identify the demographic factors, characteristics of the acetabular chondral lesion, and other anatomic characteristics that were related to the ALAD grade of the acetabular chondral lesion. Acetabular chondral lesions were measured in 1502 patients during the study period. Multivariate analysis showed that higher ALAD grade of acetabular chondral damage was significantly related to male sex, more advanced age, the area of the acetabular chondral lesion, anterior extension of the acetabular chondral lesion within the anterosuperior quadrant, labral detachment from the acetabular cartilage, and posterior extension of the labral tear. Higher grades of acetabular chondral damage were related to male sex, increased age, height, weight, BMI, and the size of the lesion. Chondral lesions were generally found in the anterosuperior region of the acetabulum, consistent with labral lesions and the

  7. Evaluation of Labral Pathology and Hip Articular Cartilage in Patients with Femoroacetabular Impingement (FAI): Comparison of Multidetector CT Arthrography and MR Arthrography.

    Science.gov (United States)

    Sahin, Murat; Calisir, Cuneyt; Omeroglu, Hakan; Inan, Ulukan; Mutlu, Fezan; Kaya, Tamer

    2014-01-01

    To compare the multidetector computed tomography (MDCT) arthrography (CTa) and magnetic resonance (MR) arthrography (MRa) findings with surgical findings in patients with femoroacetabular impingement (FAI) and to evaluate the diagnostic performance of these methods. Labral pathology and articular cartilage were prospectively evaluated with MRa and CTa in 14 hips of 14 patients. The findings were evaluated by two musculoskeletal radiologists with 10 and 20 years of experience, respectively. Sensitivity, specificity, accuracy, and positive predictive value were determined using surgical findings as the standard of reference. While the disagreement between observers was recorded in two cases of labral tearing with MRa, there was a complete consensus with CTa. Disagreement between observers was found in four cases of femoral cartilage loss with both MRa and CTa. Disagreement was also recorded in only one case of acetabular cartilage loss with both methods. The percent sensitivity, specificity, and accuracy for correctly assessing the labral tearing were as follows for MRa/CTa, respectively: 100/100, 50/100, 86/100 (p0.05) and for femoral cartilage assessment were 100/75, 90/70, 86/71 (p>0.05). Inter-observer reliability value showed excellent agreement for labral tearing with CTa (κ=1.0). Inter-observer agreement was substantial to excellent with regard to acetabular cartilage assessment with MRa and CTa (κ=0.76 for MRa and κ=0.86 for CTa). Inter-observer reliability with CTa is excellent for labral tearing assessment. CTa seems to have an equal sensitivity and a higher specificity than MRa for the detection of labral pathology. MRa is better, but not statistically significantly, in demonstrating acetabular and femoral cartilage pathology.

  8. MRI appearance in the early stage of Legg-Calvé-Perthes disease to predict lateral pillar classification: A retrospective analysis of the labral horizontalization.

    Science.gov (United States)

    Shirai, Yasuhiro; Wakabayashi, Kenjiro; Wada, Ikuo; Tsuboi, Yoshiaki; Ha, Myongsu; Otsuka, Takanobu

    2017-11-17

    The Herring lateral pillar classification is widely used for the classification of Legg-Calvé-Perthes disease, but is not applied at the early stage of Legg-Calvé-Perthes disease because it is typically applied at the late fragmentation stage. The purpose of this study was to investigate the correlation between the early appearance on magnetic resonance imaging of the acetabular labrum and lateral pillar involvement in Legg-Calvé-Perthes disease. Non-contrast magnetic resonance images of 26 hips in 25 children with early-stage Legg-Calvé-Perthes disease were retrospectively reviewed. The extent of labral horizontalization was quantitatively evaluated with a new method, the labral angle, on T2*-weighted magnetic resonance images. A small labral angle indicates strong labral horizontalization. Calculation of the teardrop distance and acetabular head index on radiographs was modified for application to magnetic resonance imaging, and the extent of cartilaginous lateral subluxation (cartilaginous tear drop distance) and cartilaginous lateral extrusion (cartilaginous acetabular head index) were evaluated. The outcome measure was the lateral pillar classification. There were statistically significant correlations between the labral angle and the cartilaginous tear drop distance (p = 0.002, ɤ = -0.58) and the cartilaginous acetabular head index (p early stage of Legg-Calvé-Perthes disease correlated with strong cartilaginous lateral subluxation and extrusion, and with increased lateral pillar collapse at the maximum fragmentation stage. Our finding suggests that a quantitative evaluation of labral horizontalization using magnetic resonance imaging in the early-stage of Legg-Calvé-Perthes disease can predict the later lateral pillar classification. Copyright © 2017 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

  9. Anteroinferior acetabular rim damage due to femoroacetabular impingement.

    Science.gov (United States)

    Tibor, Lisa M; Ganz, Reinhold; Leunig, Michael

    2013-12-01

    The most common location of labral tears and chondral damage in the hip is the anterosuperior region of the acetabulum, which is associated with pain in flexion and rotation. We describe a case series of patients with labral tears, ganglion formation, and chondromalacia isolated to the anteroinferior acetabulum. Clinically, patients had pain in extension and internal rotation. Isolated anteroinferior labral hypertrophy and ganglion were first observed in a patient with coxa valga. We retrospectively reviewed clinical and radiographic records and identified nine hips in seven patients with isolated anteroinferior damage. One patient with bilateral valgus femoral head tilt after slipped capital femoral epiphysis (SCFE) had impingement of the anteromedial metaphysis on the acetabulum from 3 to 6 o'clock. Five of seven had valgus neck-shaft angles and all had acetabular anteversion with damage isolated to the anteroinferior acetabular rim. Series on the diagnostic efficacy of MR arthrogram have noted anteroinferior damage adjacent to superior acetabular rim lesions. However, these do not describe isolated anteroinferior rim damage. In addition, available case series of patients with valgus SCFE do not describe a location of impingement or intraarticular damage. In this small case series of patients with isolated anteroinferior chondrolabral damage, there are two potential causative mechanisms: (1) primary anteroinferior impingement with femoral extension and internal rotation and (2) posterior extraarticular ischiotrochanteric impingement causing secondary anterior instability of the femur. The pathoanatomy appears to be multifactorial, necessitating an individualized treatment approach.

  10. Hip arthroscopy: intra-articular saucerization of the acetabular cotyloid fossa.

    Science.gov (United States)

    Brannon, James K

    2012-02-17

    Hip arthroscopy is increasingly recognized as a treatment option for patients with hip pain and labral tears. When emphasis is placed on labral tears as a primary clinical finding in the peripheral compartment, a broader view of the pathophysiology of these tears may be missed. Therefore, it is imperative to gain arthroscopic surgical access to the central compartment and determine if its contents affect the congruency of the hip joint. Abnormal bone and fibro-fatty tissue in the cotyloid fossa decrease the space available for the ligamentum teres, leading to lateral subluxation of the femoral head and rim loading of the acetabulum at the chondrolabral junction. Rim loading of the acetabulum may induce articular-sided labral tears due to hip incongruency. Although these labral tears may require refixation, the congruency of the hip joint should be restored to the best extent possible. Arthroscopic intra-articular saucerization and debridement of space-occupying lesions in the cotyloid fossa increase the space available for the ligamentum teres, improve the congruency of the hip joint, and mitigate against acetabular rim loading. This article describes a case of arthroscopic intra-articular saucerization of the cotyloid fossa in a 25-year-old man with chronic hip pain. Copyright 2012, SLACK Incorporated.

  11. Return to Play and Prior Performance in Major League Baseball Pitchers After Repair of Superior Labral Anterior-Posterior Tears.

    Science.gov (United States)

    Smith, Ryan; Lombardo, Daniel J; Petersen-Fitts, Graysen R; Frank, Charles; Tenbrunsel, Troy; Curtis, Gannon; Whaley, James; Sabesan, Vani J

    2016-12-01

    The published return-to-play (RTP) rates for Major League Baseball (MLB) pitchers who have undergone surgical repair of superior labrum anterior-posterior (SLAP) tears vary widely and are generally accepted to be lower in the subset of competitive throwers. The efficacy of surgical treatment for MLB players is largely unknown. To examine the RTP rate and performance of MLB pitchers who have undergone SLAP tear repair between 2003 and 2010. Descriptive epidemiological study. A retrospective review of MLB pitchers undergoing SLAP repair was performed using the MLB disabled list. Data collected included the following player statistics: earned run average (ERA), walks plus hits per inning pitched (WHIP), and innings pitched (IP). The mean values for performance variables both before and after surgery were compared. A definition of return to prior performance (RTPP) was established as an ERA within 2.00 and WHIP within 0.500 of preoperative values. Twenty-four MLB players met inclusion criteria, of which 62.5% were able to RTP at the MLB level after SLAP repair surgery. Of those able to RTP, 86.7% were able to RTPP. However, the overall rate of RTPP, including those unable to RTP, was 54.2%. Mean performance analysis of the RTP group revealed a statistically significant decrease in IP for MLB pitchers throwing a mean 101.8 innings before injury and 65.53 innings after injury (P = .004). Of those pitchers able to RTP, chances of a full recovery were good (86.7%). Our results indicate the need for future research aimed at proper surgical selection of who will return to play, as they will likely achieve full recovery. We believe this information can help surgeons advise high-level overhead-throwing athletes about expected outcomes for surgical treatment of SLAP tears.

  12. Labral injuries of the hip in rowers.

    Science.gov (United States)

    Boykin, Robert E; McFeely, Eric D; Ackerman, Kathryn E; Yen, Yi-Meng; Nasreddine, Adam; Kocher, Mininder S

    2013-08-01

    Injuries of the hip in the adolescent and young adult athlete are receiving more attention with advances in the understanding of femoroacetabular impingement (FAI), labral pathology, and hip arthroscopy. Labral tears have not been well characterized in rowers. The purposes of this study were (1) to describe the clinical presentation of labral pathology in rowers; (2) to describe the MRI and radiographic findings of labral pathology in rowers; and (3) to determine the likelihood that a rower with labral injury, treated arthroscopically, will return to sport. We conducted a review from August 2003 to August 2010 to identify all rowers with MRI-confirmed intraarticular pathology of the hip presenting to our institution. Baseline demographics, symptoms and physical findings, and location of the labral tear with associated pathology, management, and early followup were recorded. The review yielded a total of 21 hips (18 rowers, three with bilateral labral pathology) with a mean patient age of 18.5 years (range, 14-23 years). Most of the rowers (85%) were female and the series included prep school (44%) and collegiate rowers (56%). Eighteen of the 21 hips (85%) eventually underwent arthroscopic surgery at our institution. A large majority of patients had isolated groin pain (71%) and physical findings consistent with impingement (81%). There was no single, dominant location for the labral tears on MRI. Among the 18 patients who had surgery, 10 (56%) returned to rowing, six (33%) never returned, and return data were not available for two (11%) at a mean of 8 months (range, 3-25 months) after surgery. The repetitive motions of the hip required for rowing may be a factor leading to intraarticular labral injuries in the athletes. Underlying anatomic abnormalities of the hip such as FAI may predispose certain patients to these injuries. However, many patients treated arthroscopically did not return to sport at a mean of 8 months after surgery.

  13. Arthroscopic repair of delaminated acetabular articular cartilage in femoroacetabular impingement.

    Science.gov (United States)

    Sekiya, Jon K; Martin, RobRoy L; Lesniak, Bryson P

    2009-09-01

    Lesions to articular cartilage can be difficult to treat and directly impact surgical outcome in hip arthroscopy. This article describes a direct cartilage suture repair technique for a young, active individual with full-thickness acetabular cartilage delamination. Lesions of this type are commonly seen with femoroacetabular impingement. A 17-year-old boy presented with bilateral hip pain greater in the right than left. Arthroscopic intervention for the right hip included direct cartilage repair for the cartilage lesion, osteoplasty for femoroacetabular impingement, repair for an anterior labral tear, capsular plication for iliofemoral ligament laxity, and psoas lengthening. Twelve weeks postoperatively, a standard capsular plication, osteoplasty, and chondroplasty were performed on the left hip. At follow-up, the patient reported feeling 95% normal. He noted that the right and left hips were essentially the same. Symptoms consisted of stiffness after prolonged sitting and mild pain following sports. The patient reported being pain free 90% of the time, with pain 2/10 at worst. He scored a 96 on the modified Harris Hip Score, 93 on the Hip Outcome Score Activities of Daily Living subscale, and 81 on the Hip Outcome Score Sports subscale. Overall, the patient was satisfied with the outcome. The direct cartilage repair, in addition to osteoplasty, anterior superior labral repair, iliofemoral capsular plication, and psoas lengthening, produced an excellent outcome in this young, active patient.

  14. The prevalence of hip labral and chondral lesions identified by method of detection during periacetabular osteotomy: arthroscopy versus arthrotomy.

    Science.gov (United States)

    Redmond, John M; Gupta, Asheesh; Stake, Chris E; Domb, Benjamin G

    2014-03-01

    Periacetabular osteotomy (PAO) has become an accepted treatment option for patients with severe hip dysplasia. In addition to correcting acetabular architecture, consideration has been given to concomitant joint evaluation and treatment of coexisting intra-articular pathologic conditions, which can be identified with hip arthroscopy or through an open arthrotomy. The purpose of this systematic review was to evaluate the prevalence of intra-articular pathologic conditions identified arthroscopically compared with that of those identified with open arthrotomy. A systematic review of the literature was performed by a search of PubMed using the words "periacetabular osteotomy," "Bernese osteotomy," and "Ganz osteotomy." Two reviewers searched for relevant articles that met established inclusion criteria, which follow: (1) they were in the English language, (2) they contained data on patients who underwent periacetabular osteotomy, (3) the study patients underwent concomitant arthroscopy or arthrotomy, and (4) the studies contained data on the intra-articular findings at the time of osteotomy. Exclusion criteria included review articles, technique articles, articles reporting on the same patient population, and articles without reported patient data. After review of 361 references and abstracts, 8 articles met the inclusion criteria. A total of 775 patients who had undergone PAO were included in the 8 articles. Three articles inspected all joints at the time of PAO and accounted for 345 PAOs. Arthrotomy was used to evaluate 151 hips, and 31 (21%) labral tears were identified. Arthroscopy was used to evaluate 194 hips, and 162 (84%) labral tears were identified. The difference in prevalence is statistically significant (P hips. The prevalence of intra-articular damage, including labral injuries and pathologic conditions of cartilage, at the time of PAO is substantial. Labral tears and chondral injury appear to be better recognized with concomitant arthroscopy when

  15. Acetabular osteochondroplasty and simultaneous reorientation: background and validation of concept.

    Science.gov (United States)

    Anderson, Lucas A; Crofoot, Carmen D; Erickson, Jill; Morton, David A; Peters, Christopher L

    2010-05-12

    Most hips with femoroacetabular impingement (FAI) have combinations of femoral and acetabular abnormalities, including acetabular deficiency in some cases. Other impinging hips have large acetabular hyaline cartilage lesions that, when treated by resection, lead to acetabular deficiency and the need for a subsequent reorientation to improve coverage. Ideally, large cartilage lesions could be identified preoperatively and treated with 1 procedure. Therefore, a single operative approach that allows for both femoral and acetabular osteochondroplasty where needed, as well as simultaneous acetabular reorientation, is advantageous. We hypothesized that the addition of traction and dry arthroscopy via the Smith-Petersen approach at the time of periacetabular osteotomy could allow for the diagnosis and treatment of intra-articular labral and hyaline cartilage lesions and simultaneous acetabular reorientation. To validate this concept, we performed the procedure on cadaveric hips and subsequently treated a series of patients successfully (4 hips with limited anterior debridement and dry arthroscopy and 1 hip with a simultaneous periacetabular osteotomy). There were no intra- or postoperative complications in the series of 5 hips. The addition of traction and dry arthroscopy can permit the diagnosis and treatment of intra-articular lesions in reorienting periacetabular osteotomy. This enables the surgeon to address both acetabular cartilage and labral lesions, as well as idealizing acetabular orientation and coverage in 1 setting with less morbidity. Copyright 2010, SLACK Incorporated.

  16. Hip arthroscopy in patients with recurrent pain following Bernese periacetabular osteotomy for acetabular dysplasia: operative findings and clinical outcomes.

    Science.gov (United States)

    Cvetanovich, Gregory L; Heyworth, Benton E; Murray, Kerri; Yen, Yi-Meng; Kocher, Mininder S; Millis, Michael B

    2015-10-01

    To report the operative findings and outcomes of hip arthroscopy for recurrent pain following periacetabular osteotomy (PAO) for acetabular dysplasia. A departmental database was used to identify patients who underwent hip arthroscopy following PAO between 2000 and 2009. Demographic data, arthroscopic findings, functional outcome scores and patient satisfaction were analysed. Of 556 PAO patients, 17 hips in 16 patients (3.1%) underwent post-PAO hip arthroscopy. Mean age at PAO was 23.8 years, and mean age at arthroscopy was 27.0 years. Common hip arthroscopy findings included labral tears (13 hips, 81.3%), significant (≥grade 2) chondral changes (12 hips, 75%), cam impingement (7 hips, 43.8%) and pincer impingement (6 hips, 37.5%). At mean follow-up 2.8 years after arthroscopy, additional procedures had been performed in six hips (37.5%), including total hip arthroplasty in one hip. Post-PAO arthroscopy questionnaire revealed 85.7% of patients with improved hip pain, 57.1% improved hip stiffness and 57.1% improved hip function. There was no significant difference in functional outcome measures. Common post-PAO hip arthroscopy findings include labral tears, chondral changes and femoroacetabular impingement. Many patients reported subjective hip improvement from post-PAO arthroscopy, but hip outcome scores were unchanged and one-third of patients had further surgery.

  17. Minimum 2-Year Outcomes of Hip Arthroscopic Surgery in Patients With Acetabular Overcoverage and Profunda Acetabulae Compared With Matched Controls With Normal Acetabular Coverage.

    Science.gov (United States)

    Chandrasekaran, Sivashankar; Darwish, Nader; Chaharbakhshi, Edwin O; Suarez-Ahedo, Carlos; Lodhia, Parth; Domb, Benjamin G

    2017-09-01

    Advancements in instrumentation and techniques have extended the scope of hip arthroscopic surgery to treat complex osseous deformities that were previously best addressed with an open approach. Global pincer-type femoroacetabular impingement is an example of an abnormality requiring osseous correction with a technically challenging access point. To report on the patterns of clinical presentation and intra-articular derangements, radiological associations, and minimum 2-year outcomes after hip arthroscopic surgery in patients with a lateral center edge angle (LCEA) >40° and profunda acetabulae in comparison with matched controls with normal acetabular coverage. Cohort study; Level of evidence, 3. Data were collected on all patients undergoing hip arthroscopic surgery during the study period from April 2008 to April 2013. All patients who had undergone hip arthroscopic surgery for symptomatic labral tears not responsive to a minimum of 3 months of physical therapy with both an LCEA >40° and profunda acetabulae, as defined by the ilioischial line lateral to the medial border of the teardrop, and without a history of hip surgery or hip conditions were included. This group was matched in a 1-to-1 ratio with a control group that had also undergone the arthroscopic management of symptomatic labral tears refractory to a minimum of 3 months of physical therapy with an LCEA between 25° and 40° according to age within 3 years, sex, body mass index category, Tönnis grade, labral treatment, and capsular treatment. Range of motion, impingement signs, and radiographic indices of coverage and version were recorded for each group. Four patient-reported outcome (PRO) scores, the visual analog scale (VAS) for pain, patient satisfaction, revision hip arthroscopic surgery, and conversion to total hip arthroplasty (THA) were also recorded. Thirty-nine patients met the inclusion criteria for the study (overcoverage) group, of which 36 (92.3%) patients had a minimum 2-year follow

  18. Osteocondroma acetabular Acetabular osteochondroma

    Directory of Open Access Journals (Sweden)

    Reynaldo Jesus Garcia

    2005-01-01

    Full Text Available Apresentamos o relato de um caso de osteocondroma solitário acetabular, tumor ósseo comum em diversas regiões do esqueleto porém raro nesta localização. O tratamento realizado foi a ressecção do tumor por uma via posterior ao quadril e o paciente evoluiu com resolução do quadro clínico.This is a case report of a patient with a intra-articular hip osteochondroma, an extremely rare location for this kind of lesion. The patient was treated with resection of the lesion and presented a very good evolution with total recovery of the hip movements.

  19. The role of the acetabular labrum in hip dysplasia. A literature overview

    DEFF Research Database (Denmark)

    Hartig-Andreasen, Charlotte; Søballe, Kjeld; Troelsen, Anders

    2013-01-01

    A periacetabular osteotomy (PAO) is the preferred joint preserving treatment for young adults with symptomatic hip dysplasia and no osteoarthritis. In symptomatic dysplasia of the hip, there is labral pathology in up to 90% of cases. However, no consensus exists as to whether a labral tear should...

  20. High frequency of labral pathology in dysplastic hips with a CE angle between 20-25

    DEFF Research Database (Denmark)

    Jakobsen, Stig Storgaard; Hartig-Andreasen, Charlotte; Mikkelsen, Lone Rømer

    to investigate the degree of labral pathology in symptomatic patients with CE between 20 and 25 compared with patients with CE age 34.1 years (range 14.5- 58.9 years) consecutively scheduled for PAO due to symptomatic DDH were enrolled......Background: Hip dysplasia becomes symptomatic due to labral pathology and secondary muscular pain. A CE angle pathologic and defined as dysplasia in PAO centres in Denmark. However, it is debated whether a CE angle between 20 and 25 is borderline. Purpose / Aim of Study: We aimed...... of osteoarthritis 0 or 1. All patients had a magnetic resonance arthrography (MRA) performed. The MRA was assessed for labral pathology in terms of degeneration, hypertrophic changes, tears and paralabral cysts. Labral lesions were graded according to the Czerny classification. Findings / Results: In the group...

  1. Comparison of MR-arthrography and MDCT-arthrography for detection of labral and articular cartilage hip pathology

    Energy Technology Data Exchange (ETDEWEB)

    Perdikakis, Evangelos; Karantanas, Apostolos [University Hospital, University of Crete, Department of Radiology, Heraklion (Greece); Karachalios, Theofilos [University of Thessaly, Department of Orthopaedic Surgery, Larissa (Greece); Katonis, Pavlos [University of Crete, Department of Orthopaedics, Heraklion (Greece)

    2011-11-15

    To compare the diagnostic ability of MR arthrography (MRa) and MDCT arthrography (CTa) in depicting surgically proven hip labral tears and articular cartilage degradation. Labral pathology and articular cartilage were prospectively evaluated with MRa and CTa in 14 hips of 10 patients. The findings were evaluated by two independent observers (a musculoskeletal fellow and one senior musculoskeletal radiologist). Sensitivity, specificity, accuracy, and positive predictive value were determined using arthroscopic and open surgery findings as the standard of reference. Interobserver agreement was recorded. All images were assessed for the presence of a labral tear (according to Czerny classification) and for cartilage erosion using a 3 point scale for both methods: 1 = complete visualization-sharp edges, 2 = blurred edges fissuring-partial defects, 3 = exposed bone. The same classification was applied surgically. Disagreement between the senior observer and the fellow observer was recorded in three cases of labral tearing with MRa and six with CTa. Disagreement was also found in four cases of cartilage erosion with both MRa and CTa. The percent sensitivity, specificity, accuracy, and positive predictive value for correctly assessing the labral tear were as follows for MRa/CTa, respectively: 100/15, 50/13, 90/14, and 90/13 (P < 0.05). The same values for cartilage assessment were 63/66, 33/40, 50/57 and 55/66 (P > 0.05). Interobserver reproducibility with MRa is very good for labral tearing assessment. MRa is better for assessing labral tears. CTa shows better, but not statistically significant, demonstration of the articular cartilage. (orig.)

  2. MR imaging findings of acetabular dysplasia in adults

    Energy Technology Data Exchange (ETDEWEB)

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

    2006-06-15

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

  3. The use of ultrasound in the assessment of the glenoid labrum of the glenohumeral joint. Part II: Examples of labral pathologies

    Directory of Open Access Journals (Sweden)

    Wojciech Krzyżanowski

    2012-09-01

    Full Text Available Labral pathologies of the glenohumeral joint are most commonly caused by trauma. The majority of lesions affect the anterior part of labrum, resulting from much higher frequency of anterior shoulder dislocations over posterior ones. Another subgroup of labral lesions, not directly related to joint instability, are SLAP tears. Other findings include degenerative changes of labrum and paralabral cysts. Diagnostic imaging is crucial for making a decision regarding operative treatment. Apart from a standard X-ray examination, the imaging mainly relies on magnetic resonance or computed tomography arthrography. Based on their own experience, the authors propose the use of ultrasound in the assessment of labral tears of the glenohumeral joint. Different signs indicating labral pathology may be discovered and assessed during ultrasound examination. They include permanent displacement of the labrum onto the glenoid, labral instability during dynamic examination, lack of the labrum in the anatomical position, hypoechoic zone at the base of the labrum >2 mm in width, residual or swollen labrum as well as paralabral cyst(s. The most frequent appearance of labral pathology is displacement of the anteroinferior labrum onto the external aspect of the glenoid typically seen after anterior shoulder dislocation. The another most important US feature is labral instability while dynamically examined. The swelling or reduced size of the labrum usually indicates degeneration. This article presents sonographic images of selected labral pathologies.

  4. [Femoroacetabular impingement: association between the over-coverage and acetabular cartilage delamination areas].

    Science.gov (United States)

    Camacho-Alvarez, D; Mardones-Peterman, R

    2013-01-01

    Femoroacetabular impingement (FAI), it is a clinical syndrome relatively recently recognized as source of hip mechanic pain and early osteoarthritis. Two types of FAI have been described, based on the bone morphology and pattern of chondral and labral damage; the cam type is frequently associated with chondral delamination; and the pincer type is associated with a contre-coup injury of the posteroinferior acetabulum. A close relationship between the zone of acetabular overcoverage or retroversion and the area of acetabular chondral delamination has been observed. To evaluate the relationship between the acetabular overcoverage or retroversion zone, and the cartilage delamination area; and if by treating the overcoverage zone, the cartilage delamination area itself is also treated. A prospective evaluation was conducted on 16 patients (17 hips) with FAI and chondral delamination treated with acetabular trimming and labral reinsertion, and femoral bump resection. All cases had chondral delamination in the anterosuperior acetabular area, corresponding to the overcoverage or retroversion zone. In the 16 patients (94% of the hips) after the acetabular overcoverage bone resection, the remaining cartilage was stable and without delamination. Only one case (6%) required microfractures to treat the exposed subchondral bone after delaminated cartilage debridement. The acetabular chondral delamination area has a very close relationship with the acetabular overcoverage zone, meaning that the delamination area can be treated by trimming the overcoverage zone. Copyright © 2012 SECOT. Published by Elsevier Espana. All rights reserved.

  5. Femoroacetabular impingement: treatment of the acetabular side.

    Science.gov (United States)

    Leunig, Michael; Huff, Thomas W; Ganz, Reinhold

    2009-01-01

    Over the past decade, femoroacetabular impingement (FAI) has become an increasingly recognized pathomechanism that may explain why some hips that were previously considered to have normal morphology fail early in life. Subtle morphologic alterations in the acetabulum or femur, as well as the degree of hypermobility or impact on the hip, affect the potential for joint damage. The most frequent location of FAI is the anterosuperior acetabular rim, and the most critical motion is internal rotation of the hip in flexion. Because medication, activity restrictions, and physical therapy are rarely successful in treating symptoms caused by FAI, surgery has become a mainstay of treatment. Acetabular causes of FAI, called pincer FAI, can be treated by improving hip clearance. Independent of whether local or global overcoverage is present, rim reduction should be combined with labral preservation whenever possible.

  6. Magnetic resonance appearance of posterosuperior labral peel back during humeral abduction and external rotation

    Energy Technology Data Exchange (ETDEWEB)

    Borrero, Camilo G.; Casagranda, Bethany U.; Towers, Jeffrey D. [Department of Radiology, Pittsburgh, PA (United States); Bradley, James P. [Department of Orthopedics, Pittsburgh, PA (United States)

    2010-01-15

    To describe the magnetic resonance appearance of posterosuperior labral peel back and determine the reliability of MR in the abducted and externally rotated (ABER) position for the prospective diagnosis of arthroscopically proven cases of posterosuperior labral peel back. After approval by the institutional review board (IRB) of the University of Pittsburgh Medical Center, USA, databases of patients who underwent arthroscopy over a 2-year period for one of three clinical diagnoses [suspected type 2 superior labrum anterior to posterior (SLAP) tears, posterior instability, or multidirectional instability] were reviewed after anonymization by an honest broker. Sixty-three cases were selected by the following inclusion criteria: operative report documenting labral peel back in the ABER position, age <40 years, and preceding MR arthrogram evaluations with images in the ABER position (n = 34). Inclusion criteria for the control group differed from those for the case group insofar as the operative note documented the absence of posterosuperior labral peel back (n = 29). Cases and controls were randomized in one list and evaluated independently by two fellowship-trained musculoskeletal radiologists unaware of the surgical results and using a three-point grading system (0 = posterosuperior labrum normally positioned lateral/craniad to glenoid articular plane in ABER; 1 = posterosuperior labral tissue flush with the glenoid articular plane in ABER; 2 = posterosuperior labral tissue identified medial/caudal to glenoid articular plane in ABER). Only one image in ABER showing abnormal posterosuperior labral position was required for a grade of 1 or 2 to be assigned. Sensitivity, specificity, and positive and negative predictive value were calculated as well as the level of agreement between readers (kappa). Both readers assigned a grade of 2 to 25 of 34 patients with surgically proven labral peel back. Of the patients with surgically proven SLAP tears with peel back in ABER

  7. Acetabular Fracture

    Directory of Open Access Journals (Sweden)

    Chad Correa

    2017-09-01

    Full Text Available History of present illness: A 77-year-old female presented to her primary care physician (PCP with right hip pain after a mechanical fall. She did not lose consciousness or have any other traumatic injuries. She was unable to ambulate post-fall, so X-rays were ordered by her PCP. Her X-rays were concerning for a right acetabular fracture (see purple arrows, so the patient was referred to the emergency department where a computed tomography (CT scan was ordered. Significant findings: The non-contrast CT images show a minimally displaced comminuted fracture of the right acetabulum involving the acetabular roof, medial and anterior walls (red arrows, with associated obturator muscle hematoma (blue oval. Discussion: Acetabular fractures are quite rare. There are 37 pelvic fractures per 100,000 people in the United States annually, and only 10% of these involve the acetabulum. They occur more frequently in the elderly totaling an estimated 4,000 per year. High-energy trauma is the primary cause of acetabular fractures in younger individuals and these fractures are commonly associated with other fractures and pelvic ring disruptions. Fractures secondary to moderate or minimal trauma are increasingly of concern in patients of advanced age.1 Classification of acetabular fractures can be challenging. However, the approach can be simplified by remembering the three basic types of acetabular fractures (column, transverse, and wall and their corresponding radiologic views. First, column fractures should be evaluated with coronally oriented CT images. This type of fracture demonstrates a coronal fracture line running caudad to craniad, essentially breaking the acetabulum into two halves: a front half and a back half. Secondly, transverse fractures should be evaluated by sagittally oriented CT images. By definition, a transverse fracture separates the acetabulum into superior and inferior halves with the fracture line extending from anterior to posterior

  8. Labral reconstruction: when to perform and how

    Directory of Open Access Journals (Sweden)

    Brian J White

    2015-07-01

    Full Text Available Over the past decade, the understanding of the anatomy and function of the hip joint has continuously evolved, and surgical treatment options for the hip have significantly progressed. Originally, surgical treatment of the hip primarily involved resection of damaged tissue. Procedures that maintain and preserve proper hip anatomy, such as labral repair and femoroacetabular impingement (FAI correction, have shown superior results, in terms of pain reduction, increased function, and ability to return to activities. Labral reconstruction is a treatment option that uses a graft to reconstruct the native labrum. The technique and outcomes of labral reconstruction have been described relatively recently, and labral reconstruction is a cutting edge procedure that has shown promising early outcomes. The aim of this article is to review the current literature on hip labral reconstruction. We will review the indications for labral reconstruction, surgical technique and graft options, and surgical outcomes that have been described to date. Labral reconstruction provides an alternative treatment option for challenging intra-articular hip problems. Labral reconstruction restores the original anatomy of the hip and has the potential to preserve the longevity of the hip joint. This technique is an important tool in the orthopaedic surgeon’s arsenal for hip joint treatment and preservation.

  9. Acetabular Fracture

    OpenAIRE

    Correa, Chad; Lahham, Sari

    2017-01-01

    History of present illness: A 77-year-old female presented to her primary care physician (PCP) with right hip pain after a mechanical fall. She did not lose consciousness or have any other traumatic injuries. She was unable to ambulate post-fall, so X-rays were ordered by her PCP. Her X-rays were concerning for a right acetabular fracture (see purple arrows), so the patient was referred to the emergency department where a computed tomography (CT) scan was ordered. Significant findings:...

  10. Indirect magnetic resonance arthrography of the shoulder; a reliable diagnostic tool for investigation of suspected labral pathology

    Energy Technology Data Exchange (ETDEWEB)

    Fallahi, Farshid [North Cumbria University Hospitals NHS Trust, Carlisle (United Kingdom); North Cumbria University Hospitals, Department of Radiology, Carlisle (United Kingdom); Green, Nick; Gadde, Sarat; Jeavons, Lisa; Armstrong, Patrick; Jonker, Leon [North Cumbria University Hospitals NHS Trust, Carlisle (United Kingdom)

    2013-09-15

    Indirect magnetic resonance arthrography (I-MRA) confers significant logistical advantages over direct MRA and does not require articular injection. In this study, we determined the diagnostic performance of I-MRA in relation to conventional MRI and arthroscopy or surgery in detecting tears of the glenoid labrum, including Bankart lesions and superior labral antero-posterior (SLAP) tears in a standard clinical setting. Ninety-one symptomatic patients underwent conventional MRI and I-MRA of the affected shoulder, followed by either arthroscopy or open surgery. The scans were interpreted independently by two experienced radiology consultants with a special interest in musculoskeletal radiology. Using the surgical findings as the standard of reference, sensitivity, specificity, and diagnostic accuracy of conventional non-contrast MRI and I-MRA in the detection of labral tears were calculated. The sensitivity of I-MRA was 95 and 97 %, respectively, for two radiologists as opposed to 79 and 83 % for conventional MRI. For both radiologists, the specificity of I-MRA, as well as MRI, was 91 % for detection of labral tears of all types. Accuracy of diagnosis was 93 and 95 %, respectively, for two radiologists with indirect MRA, compared to 84 and 86 % with non-contrast MRI. This retrospective study shows that I-MRA is a highly accurate and sensitive method for the detection of labral tears. The data obtained supports the use of I-MRA as standard practice in patients with shoulder instability due to suspected labral pathology where further investigative imaging is indicated. (orig.)

  11. Labral Resection or Preservation During FAI Treatment? A Systematic Review.

    Science.gov (United States)

    Tibor, Lisa M; Leunig, Michael

    2012-10-01

    Open and arthroscopic treatment of femoroacetabular impingement and resultant labral pathology has increased significantly over the past decade. Although the functional importance of the labrum and the labral seal has been established in biomechanical studies, good clinical results have been reported for both labral debridement and labral refixation. The purpose of this paper is to summarize existing literature on the surgical treatment of labral pathology to provide treatment recommendations and direct future research. A systematic review was performed with the following research question in mind: Does preservation of the hip labrum improve outcomes as compared to labral debridement for the treatment of labral pathology? The MEDLINE database was searched for level I, II, or III articles in English or German comparing labral debridement to labral refixation. Five studies were included in the analysis. Good short-term results were reported for both groups. Three out of five papers report improved outcomes after labral refixation as compared to labral debridement. In short-term follow-up, labral refixation appears to have slightly better outcomes than labral debridement. Studies with prospectively defined cohorts and longer follow-up are, however, necessary to provide definitive recommendations for labral treatment.

  12. Labral and cartilage abnormalities in young patients with hip pain: accuracy of 3-Tesla indirect MR arthrography

    Energy Technology Data Exchange (ETDEWEB)

    Petchprapa, Catherine N.; Rybak, Leon D. [NYU Langone Medical Center-Hospital for Joint Diseases, Department of Radiology, New York, NY (United States); Dunham, Kevin S.; Recht, Michael P. [NYU Langone Medical Center, Department of Radiology, New York, NY (United States); Lattanzi, Riccardo [NYU Langone Medical Center, The Bernard and Irene Schwartz Center for Biomedical Imaging, New York, NY (United States)

    2015-01-15

    Assess the diagnostic accuracy of 3-T indirect magnetic resonance arthrography (iMRA) for hip cartilage and labral pathology detection using arthroscopy as the reference standard and compare it to the published performance of direct magnetic resonance arthrography (dMRA). Between 2009 and 2011, 290 patients suspected of having femoroacetabular impingement underwent iMRA. Our study group consisted of 41 of these patients (17 males, mean age 35 years; 24 females, mean age 33 years) who did not have a prior history of hip surgery and who subsequently underwent arthroscopy. Two experienced musculoskeletal radiologists separately evaluated the randomized and anonymized studies for the presence and quadrant location of labral and cartilage pathology. These recorded data were compared to arthroscopic reports. Forty-one patients had labral pathology, 34 patients had acetabular and 5 patients had femoral cartilage pathology at arthroscopy. Sensitivity, specificity, accuracy, negative- and positive-predictive values for labral lesion detection were respectively 98, 99, 99, 99 and 98 %; for acetabular cartilage lesion detection they were 69, 98, 89, 87 and 95 %; for femoral cartilage lesion detection they were 69, 95, 93 and 39 %. Sensitivities of iMRA by quadrant (anteroinferior, anterosuperior, posteroinferior, posterosuperior) for the labrum were 100.0, 95.0, NA and 85.7 %, for acetabular cartilage were NA, 58.8, NA and 39.5 % and for femoral cartilage were 50.0, 33.3, 75.0 and 75.0 %. NA indicates results not available because of the absence of findings in those quadrants. Specificities of iMRA by quadrant (anteroinferior, anterosuperior, posteroinferior, posterosuperior) for the labrum (95.0, 100.0, 95.1, 67.5 %), acetabular (100.0, 85.7, 92.6, 79.5 %) and femoral cartilage (100.0, 94.7, 96.2, 85.9 %). iMRA at 3 T is accurate in detecting labral pathology suggesting that it is a viable alternative to dMRA. (orig.)

  13. Diagnostic performance of direct traction MR arthrography of the hip: detection of chondral and labral lesions with arthroscopic comparison

    Energy Technology Data Exchange (ETDEWEB)

    Schmaranzer, Florian; Klauser, Andrea; Henninger, Benjamin [Medical University Innsbruck, Department of Radiology, Innsbruck (Austria); Kogler, Michael; Schmaranzer, Ehrenfried [District Hospital St. Johann in Tyrol, Department of Radiology, St. Johann in Tyrol (Austria); Forstner, Thomas [Johannes Keppler University, Department for Applied Systems Research and Statistics, Linz (Austria); Reichkendler, Markus [District Hospital St. Johann in Tyrol, Department of Orthopedic Surgery, St. Johann in Tyrol (Austria)

    2015-06-01

    To assess diagnostic performance of traction MR arthrography of the hip in detection and grading of chondral and labral lesions with arthroscopic comparison. Seventy-five MR arthrograms obtained ± traction of 73 consecutive patients (mean age, 34.5 years; range, 14-54 years) who underwent arthroscopy were included. Traction technique included weight-adapted traction (15-23 kg), a supporting plate for the contralateral leg, and intra-articular injection of 18-27 ml (local anaesthetic and contrast agent). Patients reported on neuropraxia and on pain. Two blinded readers independently assessed femoroacetabular cartilage and labrum lesions which were correlated with arthroscopy. Interobserver agreement was calculated using κ values. Joint distraction ± traction was evaluated in consensus. No procedure had to be stopped. There were no cases of neuropraxia. Accuracy for detection of labral lesions was 92 %/93 %, 91 %/83 % for acetabular lesions, and 92 %/88 % for femoral cartilage lesions for reader 1/reader 2, respectively. Interobserver agreement was moderate (κ = 0.58) for grading of labrum lesions and substantial (κ = 0.7, κ = 0.68) for grading of acetabular and femoral cartilage lesions. Joint distraction was achieved in 72/75 and 14/75 hips with/without traction, respectively. Traction MR arthrography safely enabled accurate detection and grading of labral and chondral lesions. (orig.)

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

    Energy Technology Data Exchange (ETDEWEB)

    Chun, K.A. [The Catholic University of Korea Uijongbu St. Mary' s Hospital, Department of Radiology, Uijongbu, Kyunggi-Do 480-130 (Korea); University of Iowa Hospitals and Clinics, Department of Radiology, Iowa City (United States); Morcuende, J. [University of Iowa Hospitals and Clinics, Department of Orthopaedic Surgery, Iowa City (United States); El-Khoury, G.Y. [University of Iowa Hospitals and Clinics, Department of Radiology, Iowa City (United States)

    2004-12-01

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

  15. Diagnostic performance of direct traction MR arthrography of the hip: detection of chondral and labral lesions with arthroscopic comparison.

    Science.gov (United States)

    Schmaranzer, Florian; Klauser, Andrea; Kogler, Michael; Henninger, Benjamin; Forstner, Thomas; Reichkendler, Markus; Schmaranzer, Ehrenfried

    2015-06-01

    To assess diagnostic performance of traction MR arthrography of the hip in detection and grading of chondral and labral lesions with arthroscopic comparison. Seventy-five MR arthrograms obtained ± traction of 73 consecutive patients (mean age, 34.5 years; range, 14-54 years) who underwent arthroscopy were included. Traction technique included weight-adapted traction (15-23 kg), a supporting plate for the contralateral leg, and intra-articular injection of 18-27 ml (local anaesthetic and contrast agent). Patients reported on neuropraxia and on pain. Two blinded readers independently assessed femoroacetabular cartilage and labrum lesions which were correlated with arthroscopy. Interobserver agreement was calculated using κ values. Joint distraction ± traction was evaluated in consensus. No procedure had to be stopped. There were no cases of neuropraxia. Accuracy for detection of labral lesions was 92 %/93 %, 91 %/83 % for acetabular lesions, and 92 %/88 % for femoral cartilage lesions for reader 1/reader 2, respectively. Interobserver agreement was moderate (κ = 0.58) for grading of labrum lesions and substantial (κ = 0.7, κ = 0.68) for grading of acetabular and femoral cartilage lesions. Joint distraction was achieved in 72/75 and 14/75 hips with/without traction, respectively. Traction MR arthrography safely enabled accurate detection and grading of labral and chondral lesions. • The used traction technique was well tolerated by most patients. • The used traction technique almost consistently achieved separation of cartilage layers. • Traction MR arthrography enabled accurate detection of chondral and labral lesions.

  16. Loosening After Acetabular Revision

    DEFF Research Database (Denmark)

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

    2014-01-01

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

  17. Rotator cuff tears in children and adolescents: experience at a large pediatric hospital

    Energy Technology Data Exchange (ETDEWEB)

    Zbojniewicz, Andrew M.; Emery, Kathleen H. [University of Cincinnati College of Medicine, Department of Radiology, Cincinnati Children' s Hospital Medical Center, Cincinnati, OH (United States); Maeder, Matthew E. [University of Cincinnati College of Medicine, Department of Radiology, Cincinnati Children' s Hospital Medical Center, Cincinnati, OH (United States); Lenox Hill Hospital, Department of Radiology, New York, NY (United States); Salisbury, Shelia R. [University of Cincinnati College of Medicine, Division of Biostatistics and Epidemiology, Cincinnati Children' s Hospital Medical Center, Cincinnati, OH (United States)

    2014-06-15

    Prior literature, limited to small case series and case reports, suggests that rotator cuff tears are rare in adolescents. However, we have identified rotator cuff tears in numerous children and adolescents who have undergone shoulder MRI evaluation. The purpose of this study is to describe the prevalence and characteristics of rotator cuff tears in children and adolescents referred for MRI evaluation of the shoulder at a large pediatric hospital and to correlate the presence of rotator cuff tears with concurrent labral pathology, skeletal maturity and patient activity and outcomes. We reviewed reports from 455 consecutive non-contrast MRI and magnetic resonance arthrogram examinations of the shoulder performed during a 2-year period, and following exclusions we yielded 205 examinations in 201 patients (ages 8-18 years; 75 girls, 126 boys). Rotator cuff tears were classified by tendon involved, tear thickness (partial or full), surface and location of tear (when partial) and presence of delamination. We recorded concurrent labral pathology when present. Physeal patency of the proximal humerus was considered open, closing or closed. Statistical analysis was performed to evaluate for a relationship between rotator cuff tears and degree of physeal patency. We obtained patient activity at the time of injury, surgical reports and outcomes from clinical records when available. Twenty-five (12.2%) rotator cuff tears were identified in 17 boys and 7 girls (ages 10-18 years; one patient had bilateral tears). The supraspinatus tendon was most frequently involved (56%). There were 2 full-thickness and 23 partial-thickness tears with articular-side partial-thickness tears most frequent (78%). Insertional partial-thickness tears were more common (78%) than critical zone tears (22%) and 10 (43%) partial-thickness tears were delamination tears. Nine (36%) patients with rotator cuff tears had concurrent labral pathology. There was no statistically significant relationship between

  18. Isolated Acetabuloplasty and Labral Repair for Combined-Type Femoroacetabular Impingement: Are We Doing Too Much?

    Science.gov (United States)

    Tjong, Vehniah K; Gombera, Mustafa M; Kahlenberg, Cynthia A; Patel, Ronak M; Han, Brian; Deshmane, Prashant; Terry, Michael A

    2017-04-01

    To evaluate patient outcomes after isolated arthroscopic volumetric acetabular osteoplasty and labral repair for the treatment of patients with combined femoroacetabular impingement (FAI) lesions. A review of a prospectively collected registry identified 86 patients (106 hips) with an average age of 38.1 years (range, 17-59 years) with combined-type FAI that underwent isolated acetabular osteoplasty and labral repair. Preoperative α-angle, degree of radiographic degenerative changes, and presence of a crossover sign were recorded. Clinical outcomes were assessed with the modified Harris Hip Score (mHHS), International Hip Outcome Tool-12 (iHOT-12), Hip Outcome Score Sport-Specific Subscale (HOS-SSS), and patient satisfaction score (out of 10) at a minimum 2-year follow-up. Clinical follow-up was obtained at a mean follow-up of 37.2 months (range, 27.9-79.2 months). Patients with Tönnis grade 0 and I findings had significantly higher mHHS (83.5 vs 71.5, P = .01), HOS-SSS (81.3 vs 59.9, P = .02), and iHOT-12 scores (71.1 vs 58.8, P = .04) compared to patients with Tonnis grade II changes. However, patient satisfaction scores (8.0 vs 7.2, P = .45) were no different. No significant difference was noted between unilateral and bilateral hip patient outcome scores. Patient age and preoperative α-angles did not correlate with any outcome scores (all R(2) effect on postoperative outcomes. Level IV, therapeutic case series. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  19. Arthroscopy of the hip in children and adolescents

    National Research Council Canada - National Science Library

    Roy, Dennis R

    2009-01-01

    Intra-articular abnormalities of the hip, such as labral tears, loose bodies, chondral lesions, ligamentum teres tears and femoral acetabular impingement are increasingly being recognized in the pediatric age group...

  20. Classification of normal labral variants and labral injuries; Klassifikation von Normvarianten des Labrums und Labrumverletzungen

    Energy Technology Data Exchange (ETDEWEB)

    Waldt, S. [Klinikum rechts der Isar, Technische Universitaet Muenchen, Institut fuer diagnostische und interventionelle Radiologie, Muenchen (Germany); Bruegel, M. [Radiologie am Stiglmaierplatz, Muenchen (Germany)

    2015-03-01

    The glenoid labrum is an important stabilizer of the glenohumeral joint. Labral injuries affect the stability of the shoulder joint to varying degrees depending on the localization, the extension and the structures involved. Because of the complex anatomy and the high variability of the glenoid labrum, in-depth knowledge concerning normal variations and labral injury patterns is required as well as high-resolution imaging with intra-articular contrast in order to discriminate anatomical variants from pathological findings. Therefore, magnetic resonance (MR) and alternatively computed tomography (CT) arthrography have become established as the imaging methods of choice. In this review MR arthrographic findings of normal labral variants and different labral injury patterns are portrayed. (orig.) [German] Das Labrum glenoidale ist ein wichtiger Stabilisator des Glenohumeralgelenks. Verletzungen des Labrums beeintraechtigen in Abhaengigkeit von der Lokalisation, der Ausdehnung und den beteiligten Strukturen die Stabilitaet des Schultergelenks in unterschiedlichem Masse. Die komplexe Anatomie und die hohe anatomische Variabilitaet erfordern detaillierte Kenntnisse und eine hochaufgeloeste bildgebende Darstellung mit intraartikulaerer Kontrastmittelgabe, um pathologische Befunde von Normvarianten zu unterscheiden. Die MR-Arthrographie, alternativ auch die CT-Arthrographie, haben sich als bildgebende Verfahren der Wahl etabliert. In dieser Uebersichtsarbeit werden MR-arthrographische Befunde von Normvarianten und labralen Verletzungsmustern gegenuebergestellt. (orig.)

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

    LENUS (Irish Health Repository)

    Baker, J F

    2010-06-01

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

  2. Patient and disease characteristics associated with hip arthroscopy failure in acetabular dysplasia.

    Science.gov (United States)

    Ross, James R; Clohisy, John C; Baca, Geneva; Sink, Ernest

    2014-09-01

    The purpose of this study was to define the clinical and disease characteristics in patients who fail hip arthroscopy and require periacetabular osteotomy. Thirty patients (30 hips) who underwent a PAO, following a failed hip arthroscopy were identified from a multicenter database. Eighty-seven percent were female and the average age was 27.3 years. The average LCE angle was 14.7°, acetabular inclination 16.3°, and ACE angle 16.8°. Labral abnormalities and acetabular chondral disease were noted at PAO surgery in 60 and 56%, respectively. The average clinical scores prior to the PAO were mHHS 53.5, WOMAC 56.9, and UCLA 5.4. Failed hip arthroscopy and the need for PAO are most commonly observed in young female patients with mild to moderate dysplasia, major functional limitations and associated intra-articular abnormalities. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. Estudio de la función del rodete acetabular en la biomecánica de la cadera: estudio cadavérico de la repercusión de la lesión y la reparación del rodete acetabular en la cinética articular de la cadera

    OpenAIRE

    Tey Pons, Marc

    2015-01-01

    Trabajo experimental en espécimen de cadera para valorar la repercusión de la lesión labral, parcial o completa, en la distribución de cargas de la superficie acetabular, así como el papel de la reconstrucción labral por reanclaje al reborde acetabular en la misma. Este trabajo implica el diseño y desarrollo previo de una bancada de prueba, el uso de tecnología de sensores piezoeléctricos para medir la presión intraarticular y la medición dinámica de las mismas en cinco especímenes anatómicos...

  4. The diagnostic performance of non-contrast 3-Tesla magnetic resonance imaging (3-T MRI) versus 1.5-Tesla magnetic resonance arthrography (1.5-T MRA) in femoro-acetabular impingement.

    Science.gov (United States)

    Crespo-Rodríguez, Ana M; De Lucas-Villarrubia, Jose C; Pastrana-Ledesma, Miguel; Hualde-Juvera, Ana; Méndez-Alonso, Santiago; Padron, Mario

    2017-03-01

    The aim of this study was to evaluate the diagnostic accuracy of 3-T non-contrast MRI versus 1.5-T MRA for assessing labrum and articular cartilage lesions in patients with clinical suspicion of femoro-acetabular impingement (FAI). Fifty patients (thirty men and twenty women, mean age 42.5 years) underwent 1.5-T MRA, 3-T MRI and arthroscopy on the same hip. An optimized high-resolution proton density spin echo pulse sequence was included in the 3-T non-contrast MRI protocol. The 3-T non-contrast MRI identified forty-two of the forty-three arthroscopically proven tears at the labral-chondral transitional zone (sensitivity, 97.7%; specificity, 100%; positive predictive value (PPV), 100%; negative predictive value (NPV), 87.5%; accuracy 98%). With 1.5-T MRA, forty-four tears were diagnosed. However, there was one false positive (sensitivity, 100%; specificity, 85.7%; PPV, 97.7%; NPV, 100%; accuracy 98%). Agreement between arthroscopy and MRI, whether 3-T non-contrast MRI or 1.5-T MRA, as to the degree of chondral lesion in the acetabulum was reached in half of the patients and in the femur in 76% of patients. Non-invasive assessment of the hip is possible with 3-T MR magnet. 3-T non-contrast MRI could replace MRA as the workhorse technique for assessing hip internal damage. MRA would then be reserved for young adults with a strong clinical suspicion of FAI but normal findings on 3-T non-contrast MRI. When compared with 1.5-T MRA, optimized sequences with 3-T non-contrast MRI help in detecting normal variants and in diagnosing articular cartilage lesions. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

  5. Glenoid labral repair in Major League Baseball pitchers.

    Science.gov (United States)

    Ricchetti, E T; Weidner, Z; Lawrence, J T R; Sennett, B J; Huffman, G R

    2010-04-01

    Little is known about outcomes of glenoid labral repair in Major League Baseball (MLB) pitchers. We hypothesized that following repair, pitching performance would not be significantly different from an uninjured cohort. Fifty-one pitchers were identified who pitched in at least one MLB game prior to undergoing isolated glenoid labral repair. For the three years prior to and following surgery, demographic and performance variables were analyzed for an association with labral injury and repair, and compared to a control cohort of MLB pitchers without history of repair. Following surgery, 72.5% of pitchers returned to MLB at a mean of 13.1 months with no significant change in performance. Starting pitchers had a higher risk of labral injury requiring repair (p< or =0.05). Pitchers that returned to play averaged more innings pitched in the seasons prior to surgery and had a higher body mass index than those that did not return to play (p< or =0.05). Approximately 70% of MLB pitchers undergoing labral repair can be expected to return to competition postoperatively with no significant change in performance. Starting pitchers are more likely to undergo repair, but pitchers with greater preoperative innings pitched per season have a greater likelihood of returning to play. Copyright Georg Thieme Verlag KG Stuttgart . New York.

  6. Acetabular fracture types vary with different acetabular version

    National Research Council Canada - National Science Library

    Werner, Clément M. L; Copeland, Carol E; Ruckstuhl, Thomas; Stromberg, Jeff; Turen, Clifford H; Bouaicha, Samy

    2012-01-01

    .... While several investigations figured out what role femoral position during impact plays in distinct fracture patterns, no data exists on the influence of acetabular version on the fracture type...

  7. Hip Arthroscopic Surgery With Labral Preservation and Capsular Plication in Patients With Borderline Hip Dysplasia: Minimum 5-Year Patient-Reported Outcomes.

    Science.gov (United States)

    Domb, Benjamin G; Chaharbakhshi, Edwin O; Perets, Itay; Yuen, Leslie C; Walsh, John P; Ashberg, Lyall

    2018-02-01

    standard for treating true acetabular dysplasia, hip arthroscopy may provide a safe and durable means of managing intra-articular abnormalities in the setting of borderline acetabular dysplasia at midterm follow-up. These procedures should be performed by surgeons with expertise in advanced arthroscopic techniques, using strict patient selection criteria, with emphasis on labral preservation and capsular plication.

  8. Diagnostic accuracy of clinical tests for the diagnosis of hip femoroacetabular impingement/labral tear

    DEFF Research Database (Denmark)

    Reiman, M P; Goode, A P; Cook, C E

    2015-01-01

    surgical decision-making. OBJECTIVE: Summarise/evaluate the current diagnostic accuracy of various clinical tests germane to hip FAI/ALT pathology. METHODS: A computer-assisted literature search of MEDLINE, CINAHL and EMBASE databases using keywords related to diagnostic accuracy of the hip joint, as well...... screening accuracy. CONCLUSIONS: Few hip physical examination tests for diagnosing FAI/ALT have been investigated in enough studies of substantial quality to direct clinical decision-making. Further high-quality studies across a wider spectrum of hip pathology patients are recommended to discern...... the confirmed clinical utility of these tests. TRIALS REGISTRATION NUMBER: PROSPERO Registration # CRD42014010144....

  9. Outcome of porous tantalum acetabular components for Paprosky type 3 and 4 acetabular defects.

    Science.gov (United States)

    Batuyong, Eldridge D; Brock, Hugh S; Thiruvengadam, Nikhil; Maloney, William J; Goodman, Stuart B; Huddleston, James I

    2014-06-01

    Porous tantalum acetabular implants provide a potential solution for dealing with significant acetabular bone loss. This study reviews 24 acetabular revisions using tantalum implants for Paprosky type 3 and 4 defects. The mean Harris Hip Score improved from 35 ± 19 (range, 4-71) to 88 ± 14 (range, 41-100), p tantalum acetabular components show promising short-term results. Copyright © 2014 Elsevier Inc. All rights reserved.

  10. Superior dislocation hip with anterior column acetabular

    African Journals Online (AJOL)

    abp

    2012-06-21

    Jun 21, 2012 ... Abstract. Superior variety of anterior dislocation of the hip is a rare injury. Its occurrence with acetabular fractures has been documented infrequently. We report a case of superior dislocation of the hip with anterior column acetabular fracture. Open reduction of the hip and internal fixation of the fracture was ...

  11. Do Ligamentum Teres Tears Portend Inferior Outcomes in Patients With Borderline Dysplasia Undergoing Hip Arthroscopic Surgery? A Match-Controlled Study With a Minimum 2-Year Follow-up.

    Science.gov (United States)

    Chaharbakhshi, Edwin O; Perets, Itay; Ashberg, Lyall; Mu, Brian; Lenkeit, Christopher; Domb, Benjamin G

    2017-09-01

    Arthroscopic surgery in borderline dysplastic hips remains controversial, but the role of the ligamentum teres (LT) has not been studied in this setting. Borderline dysplastic patients with LT tears have worse short-term outcomes than those without LT tears. Cohort study; Level of evidence, 3. Data were prospectively collected on patients who underwent arthroscopic surgery between February 2008 and April 2014. The inclusion criteria were borderline dysplasia (lateral center-edge angle [LCEA], 18°-25°) and labral tears; arthroscopic treatments including labral preservation and capsular plication; and preoperative patient-reported outcome scores including the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sport-Specific Subscale, and visual analog scale for pain. Patients were excluded for preoperative Tönnis osteoarthritis grade >0, workers' compensation claims, previous ipsilateral hip surgery and conditions, or frank dysplasia (LCEA arthroscopic surgery with labral treatment and capsular plication, LT tears may indicate advanced instability and portend slightly inferior outcomes when compared with a match-controlled group. Borderline dysplastic patients with LT tears may have increased propensities toward revision arthroscopic surgery and conversion to THA. LT tears in these patients may warrant consideration for additional procedures including periacetabular osteotomy and LT reconstruction.

  12. The "flying swan" technique: a novel method for anterior labral repair using a tensioned suture bridge.

    Science.gov (United States)

    Alexander, Susan; Wallace, Andrew L

    2014-02-01

    Arthroscopic labral repair is an effective technique for most cases of traumatic shoulder instability. However, patients with anterior labroligamentous periosteal sleeve avulsion lesions frequently have multiple episodes of subluxation or dislocation and a high recurrence rate after surgery, even with modern methods of labral repair. One reason may be failure of biological healing of the labrum due to an inadequate "footprint" of contact between the capsulolabral tissue and the glenoid bone. We have developed a technique that facilitates a tensioned suture bridge between suture anchors that may improve the results of labral repair in patients with anterior labroligamentous periosteal sleeve avulsion lesions.

  13. Return to Play and Outcomes in Baseball Players After Superior Labral Anterior-Posterior Repairs.

    Science.gov (United States)

    Gilliam, Brad D; Douglas, Lonnie; Fleisig, Glenn S; Aune, Kyle T; Mason, Kylie A; Dugas, Jeffrey R; Cain, E Lyle; Ostrander, Roger V; Andrews, James R

    2017-09-01

    Few studies have documented the outcomes of superior labral anterior-posterior (SLAP) repairs in baseball players. Furthermore, the results of these previous studies varied widely and were based on small numbers of patients. Hypothesis/Purpose: The purpose was to report return-to-play (RTP) rates and validated subjective outcome scores for baseball players after SLAP repair. It was hypothesized that RTP rates and outcomes would be significantly different between pitchers and nonpitchers, as well as among baseball levels. Case series; Level of evidence, 4. A series of 216 baseball players was identified who had isolated SLAP repair or SLAP repair with debridement of partial-thickness (<25%) rotator cuff tear at our surgical centers. Patients were contacted by phone a minimum of 2 years after surgery and asked questions about their ability to RTP. Patients were also asked questions to complete the Western Ontario Shoulder Instability Index (WOSI), Veteran's RAND 12-Item Health Survey (VR-12), and Kerlan-Jobe Orthopaedic Clinic (KJOC) questionnaires. Statistical equivalence in RTP rate, VR-12, and WOSI scores was determined between players with and without concomitant rotator cuff debridement using 2 one-sided tests and risk difference measures. Differences in RTP were tested among baseball levels (high school, college, professional) and positions (pitcher vs nonpitcher) using chi-square analyses ( P < .05). Differences in outcomes scores were compared using t tests and analyses of variance ( P < .05). Of the 216 baseball players, 133 were reached by phone for follow-up interview (mean, 78 months; range, 27-146 months). Overall, 62% successfully returned to play. There were no differences in RTP rates or subjective outcomes among baseball levels or between procedures. RTP rates were 59% for pitchers and 76% for nonpitchers ( P = .060). Subjectively, the percentage of patients who felt the same or better at follow-up compared to preinjury was significantly higher among

  14. CT classification of acetabular fractures

    Energy Technology Data Exchange (ETDEWEB)

    Marincek, B.; Porcellini, B.; Robotti, G.

    1984-05-01

    The contribution of computed tomography (CT) in classifying acetabular fractures was analysed retrospectively in 33 cases. CT and plain radiography classification agreed in 27 cases (82%). CT revealed more extensive fractures in 6 patients (thereof 5 patients with associated fractures). In 10 patients (thereof 9 patients with associated fractures) CT showed intraarticular fragments; radiographically intraarticular fragments were seen only in 2 patients and suspected in 4. CT is of considerable aid in defining the fracture pattern. It should be used mainly in patients with radiographically difficult interpretable associated fractures in order to assess preoperatively the weight-bearing part of the acetabulum, the degree of displacement and the presence of intraarticular fragments.

  15. Acetabular Fractures in the Elderly

    Directory of Open Access Journals (Sweden)

    Joshua L. Gary

    2015-01-01

    Full Text Available As the population ages, the incidence of osteoporotic fractures, including those of the pelvis and acetabulum, continues to rise. Treatment of the elder patients with an acetabular fracture is much more controversial than the treatment of younger patients with similar injuries, where prevention of posttraumatic arthritis and total hip replacement remains optimal to limit need for revision arthroplasty. Arthroplasty for fractures of the proximal femur is commonplace in an older population and is a mainstay of treatment to promote early mobilization and weight-bearing. However, even with acute total hip arthroplasty for a geriatric acetabular fracture, most surgeons do not permit immediate weight-bearing postoperatively. Therefore, controversy regarding optimal treatment of these challenging fractures persists. Four treatment options have emerged: nonoperative treatment with early mobilization, open reduction and internal fixation (ORIF, limited open reduction and percutaneous screw fixation, and acute total hip arthroplasty. The exact indications and benefits of each treatment remain unknown. This article serves as a review of these four treatments and the data existing to support them.

  16. Acetabular roof arc angles and anatomic biomechanical superior acetabular weight bearing area

    Directory of Open Access Journals (Sweden)

    Thossart Harnroongroj

    2014-01-01

    Full Text Available Background: Acetabular fracture involves whether superior articular weight bearing area and stability of the hip are assessed by acetabular roof arc angles comprising medial, anterior and posterior. Many previous studies, based on clinical, biomechanics and anatomic superior articular surface of acetabulum showed different degrees of the angles. Anatomic biomechanical superior acetabular weight bearing area (ABSAWBA of the femoral head can be identified as radiographic subchondral bone density at superior acetabular dome. The fracture passes through ABSAWBA creating traumatic hip arthritis. Therefore, acetabular roof arc angles of ABSAWBA were studied in order to find out that the most appropriate degrees of recommended acetabular roof arc angles in the previous studies had no ABSAWBA involvement. Materials and Methods: ABSAWBA of femoral head was identified 68 acetabular fractures and 13 isolated pelvic fractures without unstable pelvic ring injury were enrolled. Acetabular roof arc angle was measured on anteroposterior, obturator and iliac oblique view radiographs of normal contralateral acetabulum using programmatic automation controller digital system and measurement tools. Results: Average medial, anterior and posterior acetabular roof arc angles of the ABSAWBA of 94 normal acetabulum were 39.09 (7.41, 42.49 (8.15 and 55.26 (10.08 degrees, respectively. Conclusions: Less than 39°, 42° and 55° of medial, anterior and posterior acetabular roof arc angles involve ABSAWBA of the femoral head. Application of the study results showed that 45°, 45° and 62° from the previous studies are the most appropriate medial, anterior and posterior acetabular roof arc angles without involvement of the ABSAWBA respectively.

  17. CUSTOMIZED ACETABULAR COMPONENTS IN REVISION HIP ARTHROPLASTY

    Directory of Open Access Journals (Sweden)

    G. M. Kavalersky

    2016-01-01

    Full Text Available In recent years, there is a trend of increasing demand for revision hip arthroplasty. Among these patients there are many with complex acetabular defects, including patients with pelvic discontinuity. To ensure stability for revised acetabular components in such cases becomes a challenging or unachievable task. Such defects give indications for printing customized tri-flange acetabular component. The authors analysed own experience of creating and applying custom made acetabular components in 3 patients with complex acetabular defects. Material and methods. Among the patients there were 2 women and 1 man. Average age was 60,3±19,4 years (38 to 78 years. Two patients had III B defects with pelvic discontinuity and one patient had III A defect by Paprosky classification. As the first step, the authors in collaboration with engineers printed a plaster full size pelvic 3D model, as the second step a customized tri-flange acetabular component was designed and printed. Harris Hip Score was evaluated preoperatively and 3 months postoperatively. Results. Average follow-up period was 5,3±2,5 months (3 to 8 months. The authors observed no cases of implant loosening, dislocation or deep periprosthetic infection. Average Harris Hip Score before surgery was 27,13 and after surgery – 74,1 indicating a significant improvement in 3 months postoperatively. Conclusion. Indications for use of individual acetabular components in reported patients correspond to indications formulated by Berasi et al. The authors obtained encouraging early follow-up outcomes that correspond to data of other authors. In one patient certain difficulties were reported due to insufficient pelvic distraction. Component’s flanges prevented achieving adequate pelvic distraction. Nevertheless, good primary stability was achieved. Modern software and 3D metal printers can significantly reduce the production cost of customized acetabular components. Application of this technology can be

  18. Magnetic resonance imaging evaluation of the labrum to predict acetabular development in developmental dysplasia of the hip: A STROBE compliant study.

    Science.gov (United States)

    Shirai, Yasuhiro; Wakabayashi, Kenjiro; Wada, Ikuo; Tsuboi, Yoshiaki; Ha, Myongsu; Otsuka, Takanobu

    2017-05-01

    Recently, more attention has been paid to the role of the acetabular labrum. Therefore, we designed a retrospective cohort study of patients with residual hip dysplasia (RHD) who underwent magnetic resonance imaging (MRI). The objective of this study was to investigate an association between the MRI appearance of the labrum before school age and the natural history of RHD.We retrospectively investigated 45 hips of 40 patients who underwent MRI at about 3 and 4 years of age for RHD and were conservatively followed up with until 6 years of age or older. We evaluated the extent of eversion with a new method that measures the β angle (MRI β angle) using landmarks of the Graf method on MRI T2*-weighted images. The outcome measure was the Severin classification at the final follow-up. We compared the radiographic and MRI parameters at approximately 3 and 4 years of age between the good and poor outcome groups. The Student t test or one-way analysis of variance was used to compare the quantitative variables between groups. The Chi-square test was used to perform a ratio comparison.Although there was a significant difference in the center-edge (CE) angle, there was no significant difference in the acetabular index and the ratio of the presence of femoral head necrosis and the break in Shenton line between the good and poor groups. The MRI β angle was significantly greater in the poor outcome group than in the normal and good outcome groups. The cut-off value of the MRI β angle to differentiate the good and poor outcome groups was 65°, and its specificity and sensitivity were 92% and 53%, respectively.There was labral eversion on MRI scans in patients with RHD. Acetabular development before adolescence was poorer with greater labral eversion on MRI scans. The specificity for poor acetabular development was high when the MRI β angle was 65° or more. The MRI β angle has the potential to predict acetabular development.

  19. Streaming tearing mode

    Science.gov (United States)

    Shigeta, M.; Sato, T.; Dasgupta, B.

    1985-01-01

    The magnetohydrodynamic stability of streaming tearing mode is investigated numerically. A bulk plasma flow parallel to the antiparallel magnetic field lines and localized in the neutral sheet excites a streaming tearing mode more strongly than the usual tearing mode, particularly for the wavelength of the order of the neutral sheet width (or smaller), which is stable for the usual tearing mode. Interestingly, examination of the eigenfunctions of the velocity perturbation and the magnetic field perturbation indicates that the streaming tearing mode carries more energy in terms of the kinetic energy rather than the magnetic energy. This suggests that the streaming tearing mode instability can be a more feasible mechanism of plasma acceleration than the usual tearing mode instability.

  20. Concurrent criterion-related validity of physical examination tests for hip labral lesions: a systematic review.

    Science.gov (United States)

    Leibold, M Rebecca; Huijbregts, Peter A; Jensen, Richard

    2008-01-01

    Hip injuries are prevalent, especially within the athletic population. Of the hip injuries in this population, some 18-55% are lesions to the labrum of the hip. Clinical diagnosis of hip labral lesions is difficult because data on prevalence are varied. In addition, data on the prevalence of internal and external risk factors are absent as are data on the correlation of these risk factors with labral lesions, making it difficult to gauge the diagnostic utility. The mechanism of injury is often unknown or not specific to labral lesions. Internal risk factors may remain hidden to physical therapists because in most jurisdictions, ordering imaging tests is not within their scope of practice. Anterior inguinal pain seems highly sensitive for the diagnosis of patients with labral lesions but can hardly be considered specific; data on other pain-related and mechanical symptoms clearly have little diagnostic utility, making these data collected during the patient history almost irrelevant to diagnosis. By way of a comprehensive literature review and narrative and systematic analysis of the methodological quality of the retrieved diagnostic utility studies, this paper aimed to determine a diagnostic physical examination test or test cluster based on current best evidence for the diagnosis of hip labral lesions. Current best evidence indicates that a negative finding for the flexion-adduction-internal rotation test, the flexion-internal rotation test, the impingement provocation test, the flexion-adduction-axial compression test, the Fitzgerald test, or a combination of these tests provides the clinician with the greatest evidence-based confidence that a hip labral lesion is absent. Currently, research has produced no tests with sufficient specificity to help confidently rule in a diagnosis of hip labral lesion. Suggestions for future research are provided.

  1. Failure of cement-in-shell acetabular liner exchange.

    Science.gov (United States)

    Blakey, Caroline M; Biant, Leela C; Kavanagh, Thomas G; Field, Richard E

    2010-01-01

    Cement-in-shell acetabular liner exchange is a revision surgery option for cases of total hip arthroplasty (THA) with polyethylene wear where direct liner exchange is not possible. A replacement liner is cemented into a well fixed uncemented acetabular shell, avoiding the morbidity associated with acetabular shell component revision. We present a case of dissociation of an acetabular liner at the cement-liner interface, three years following liner exchange without radiographic evidence to indicate the diagnosis.

  2. SLAP Lesion with Supraglenoid Labral Cyst causing Suprascapular Nerve Compression: A case report

    Directory of Open Access Journals (Sweden)

    Bryan Y Tan

    2012-11-01

    Full Text Available We present a case of left suprascapular nerve palsy in a 39-year-old female secondary to compression from a large ganglion cyst. She presented with a two month history of left posterior shoulder pain which affected her work and disturbed her sleep. Clinical examination revealed a positive O’Brien’s test. Supraspinatus and infraspinatus strength was mildly weakened. A magnetic resonance imaging (MRI scan of the left shoulder revealed a superior labral anterior to posterior (SLAP lesion with a large supraglenoid labral cyst extending posteriorly to the spinoglenoid notch, resulting in compression of the suprascapular nerve. Arthroscopy revealed the SLAP lesion with a haemorrhagic labral cyst at the posterosuperior aspect. Arthroscopic decompression of the cyst and SLAP repair with two suture anchors was performed. At 22 months postoperative follow-up, the patient’s left shoulder remained asymptomatic with full range of motion and full strength.

  3. [Two key describers of the sacro-acetabular relationships: the angles of sacral and acetabular incidence].

    Science.gov (United States)

    Tardieu, C; Hecquet, J; Boulay, C; Montigny, J-P; Legaye, J; Gagey, O; Marty, C; Duval-Beaupère, G

    2008-06-01

    Implantation of total hip arthroplasties raises several important questions concerning the relationship between the orientation of the lumbosacral joint and the acetabular-femoral joint; in other words, between the position of the patients trunk and the orientation of the acetabula. To elucidate better these complex relationships, we conducted a morphometry study on a sample of 51 dry pelves: pelv 26 female and 25 male specimens. Three-dimensional coordinates of 47 homologous points were recorded for each pelvis. Data were then processed with De-Visu, a graphic visualization software. Seven parameters were compared: sacral slope, sacral incidence, and five parameters quantifying the three-dimensional orientation of the acetabula. The graphic modelization enabled an integral 3-D visualization of each pelvis. The sagittal view enabled simultaneous visualization of the sacrum, the sacroiliac joints, the acetabula, and their alignments, as well as the variability of their spatial relation. The position reference chosen to simulate the upright position aligned the anterior iliac spines and the superior pubic point. This position was found pertinent because the mean value of the sacral slope (41.8) and the sacral incidence (54) were not different from published series. The sacral slope was the most strongly correlated with the acetabular parameters. It exhibited a positive correlation with sagittal acetabular slope (r=0.59) and acetabular inclination (r=0.59). It exhibited a negative correlation with acetabular anteversion (R=0.45). The correlation with the sagittal acetabular slope was very strong for anteversion (r=0.92), and rose with acetabular inclination (r=-0.66). The angle formed by the two acetabular axes was highly variable (37). The correlation between this angle and inclination was very high in males (r=-0.88) and non-significant in females. There was however a very strong correlation with anteversion in females (r=-0.74) which was non-significant in males

  4. Iatrogenic tracheal tear.

    LENUS (Irish Health Repository)

    Dias, A

    2010-10-01

    Large post intubation tracheal tears are usually detected intra-operatively due to unstable signs namely impaired ventilation and mediastinal emphysema and often require surgical management. Smaller tracheal tears are often missed during anaesthesia and recognized during the postoperative period. Conservative management should be considered in these latter cases.

  5. Meniscus Tears (For Teens)

    Science.gov (United States)

    ... surgery. A torn meniscus is a common sports injury, particularly in contact sports like football and hockey. Meniscus tears can range from minor ... knee while playing a contact sport, such as football, hockey, or rugby, where ... along with other knee injuries such as ligament tears. Can I Prevent a ...

  6. Idiopathic Bilateral Bloody Tearing

    Directory of Open Access Journals (Sweden)

    Emrullah Beyazyıldız

    2015-01-01

    Full Text Available Bloody tear is a rare and distinct clinic phenomenon. We report a case presenting with the complaint of recurrent episodes of bilateral bloody tearing. A 16-year-old girl presented to our clinic with complaint of bloody tearing in both eyes for 3 months. Bloody tearing was not associated with her menses. A blood-stained discharge from the punctum was not observed during the compression of both nasolacrimal ducts. Nasolacrimal passage was not obstructed. Imaging studies such as dacryocystography and gradient-echo magnetic resonance imaging (MRI of nasolacrimal canal were normal. Intranasal endoscopic evaluation was normal. We collected samples from bloody tears two times and pathological examination was performed. Pathological analysis showed lots of squamous cells and no endometrial cells; dysplastic cells were found. Further evaluations for underlying causes were unremarkable. No abnormalities were found in ophthalmologic, radiologic, and pathologic investigations. This condition is likely a rare abnormality and the least recognized aetiology for the idiopathic phenomenon.

  7. Antimicrobial compounds in tears.

    Science.gov (United States)

    McDermott, Alison M

    2013-12-01

    The tear film coats the cornea and conjunctiva and serves several important functions. It provides lubrication, prevents drying of the ocular surface epithelia, helps provide a smooth surface for refracting light, supplies oxygen and is an important component of the innate defense system of the eye providing protection against a range of potential pathogens. This review describes both classic antimicrobial compounds found in tears such as lysozyme and some more recently identified such as members of the cationic antimicrobial peptide family and surfactant protein-D as well as potential new candidate molecules that may contribute to antimicrobial protection. As is readily evident from the literature review herein, tears, like all mucosal fluids, contain a plethora of molecules with known antimicrobial effects. That all of these are active in vivo is debatable as many are present in low concentrations, may be influenced by other tear components such as the ionic environment, and antimicrobial action may be only one of several activities ascribed to the molecule. However, there are many studies showing synergistic/additive interactions between several of the tear antimicrobials and it is highly likely that cooperativity between molecules is the primary way tears are able to afford significant antimicrobial protection to the ocular surface in vivo. In addition to effects on pathogen growth and survival some tear components prevent epithelial cell invasion and promote the epithelial expression of innate defense molecules. Given the protective role of tears a number of scenarios can be envisaged that may affect the amount and/or activity of tear antimicrobials and hence compromise tear immunity. Two such situations, dry eye disease and contact lens wear, are discussed here. Copyright © 2013 Elsevier Ltd. All rights reserved.

  8. Arthroscopic labral repair versus labral debridement in patients with femoroacetabular impingement: a minimum 2.5 year follow-up study.

    Science.gov (United States)

    Cetinkaya, Sarper; Toker, Berkin; Ozden, Vahit E; Dikmen, Goksel; Taser, Omer

    2016-01-01

    To compare the clinical results of labral repair with labral debridement in patients undergoing arthroscopy for femoroacetabular impingement. Between July 2008 and December 2011, 67 patients (73 hips) underwent arthroscopic treatment for femoroacetabular impingement. The repair group consisted of 33 patients; 18 hips with pincer only, 1 with CAM only and 15 with combined impingement. The debridement group contained 34 patients; 6 with pincer only, 5 with CAM only and 28 with combined type. The mean age in the repair group was 33.5 years (range, 30-61) and in the debridement group was 39.5 years (range, 18-59 y). At the time of last follow-up, patient's hip function was evaluated with ROM of the hip; daily Hip Outcome scores (dHOS) and Visual Analogue Score (VAS). The mean follow-up was 45.2 month in the repair group and 47.2 month in debridement group. Daily hip outcome scores were significantly improved from preoperatively to last follow-up in both groups (p<0.05). However, there were no statistical significant difference in dHOS between repair and debridement groups (p>0.05) at last follow-up. 2 patients in the repair group and 1 patient in the debridement group had undergone total hip replacement at an average of 16 months (range, 4-32 m) after arthroscopic treatment. Hip joint instability occurred in 1 patient in the repair group due to aggressive capsular resection. This was treated by a periacetabular osteotomy. No difference in hip functional outcomes was observed between labral debridement and labral repair in arthroscopic treatment of femoroacetabular impingement.

  9. Acetabular fractures in children and adolescents

    NARCIS (Netherlands)

    Heeg, M; de Ridder, VA; Tornetta, P; de Lange, S; Klasen, HJ

    A retrospective study of 29 acetabular fractures in children 2 to 16 years of age with an average followup of 14 years is presented. Nineteen patients had an additional dislocation of the femoral head and 14 patients had an associated neurologic injury. Surgical treatment was performed in 16

  10. Rapidly progressive osteoarthritis after arthroscopic labral repair in patients with hip dysplasia.

    Science.gov (United States)

    Matsuda, Dean K; Khatod, Monti

    2012-11-01

    Recent reports of poor clinical outcomes after arthroscopic surgery in hips with marked dysplasia have emerged. Arthroscopic resection of the hypertrophic labrum in cases of dysplasia, especially in the absence of periacetabular osteotomy (PAO), has been implicated. Some patients will refuse PAO because it is a major open procedure, opting for a less invasive arthroscopic procedure. We present the cases of 2 young adults with marked dysplasia who had rapidly progressive osteoarthrosis despite arthroscopic labral repair. Though perhaps beneficial as an isolated procedure in borderline or mild dysplasia cases, arthroscopic hip surgery, even labral repair, may best be performed with PAO in cases with more severe dysplasia. Albeit attractive as a less invasive labral-preserving surgery, arthroscopic labral repair not only may fail to provide symptomatic improvement but may compromise or preclude a later PAO if rapidly progressive osteoarthrosis ensues. Hip arthroscopy may best be performed concurrently with or after PAO but not proceeding PAO in patients requiring both procedures. Copyright © 2012 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  11. Outcome after arthroscopic labral surgery in patients previously treated with periacetabular osteotomy

    DEFF Research Database (Denmark)

    Hartig-Andreasen, Charlotte; Nielsen, Torsten G; Lund, Bent

    2017-01-01

    at Aarhus University Hospital, 43 hips were included (median age: 36.1 yrs, range 16.3-56.9 yrs). Indications were unacceptable pain, a positive FABER and impingement test and signs of labral damage on MR-arthrography. Outcomes were evaluated with mHHS and HOS. Failure was defined as conversion to a THR...

  12. Predictors of Poor Clinical Outcome After Arthroscopic Labral Preservation, Capsular Plication, and Cam Osteoplasty in the Setting of Borderline Hip Dysplasia.

    Science.gov (United States)

    Hatakeyama, Akihisa; Utsunomiya, Hajime; Nishikino, Shoichi; Kanezaki, Shiho; Matsuda, Dean K; Sakai, Akinori; Uchida, Soshi

    2018-01-01

    Borderline developmental dysplasia of the hip (BDDH) is frequently diagnosed concurrently with cam impingement. While hip arthroscopy has advanced the treatment of hip joint pathology, including femoroacetabular impingement (FAI), arthroscopic treatment for FAI in the setting of BDDH remains a challenge amid a subset of patients. The risk factors of poor clinical results after hip arthroscopic labral preservation and FAI corrections in the setting of BDDH patients have not been well established. Pre- and intraoperative findings can predict the poor clinical outcomes after hip arthroscopic surgery for FAI in the setting of BDDH. Case control study; Level of evidence, 3. Of patients with BDDH (defined as lateral center edge [LCE] angle between 20° and 25°) who underwent arthroscopic procedures for FAI between 2009 and 2014, 45 met inclusion criteria (45 hips: 15 males and 30 females). Their mean age was 31.4 years (range, 12-65 years), and the mean LCE angle was 23.2°. Clinical and radiographic follow-up evaluations up to a minimum of 2 years after surgery were performed for all patients. Failure of the procedure was defined as conversion to subsequent surgery or having a Tönnis osteoarthritis grade of 2, and success was defined as patients who did not need subsequent surgery. Univariate analysis and Cox hazard proportional analysis were performed for both cohorts. Of 45 patients, 11 (24%) had revision surgery (endoscopic shelf acetabuloplasty for 5 patients, total hip arthroplasty for 2, and revision hip arthroscopy for 2) or advanced to Tönnis grade ≥2 osteoarthritis and thus constituted the failure group. In the success group, modified Harris Hip Score (median, pre- vs postoperative: 72.1 vs 100, Parthroscopic labral preservation, capsular plication, and cam osteoplasty in the setting of BDDH are age ≥42 years old, broken Shenton line, osteoarthritis, Tönnis angle ≥15°, and VCA angle ≤17° on preoperative radiographs. Intraoperative predictors of

  13. [Operative outcomes of complex acetabular fractures and its influence factors].

    Science.gov (United States)

    Dong, Changchao; Wu, Gang; Wang, Guanglin; Yang, Tianfu; Fang, Yue; Liu, Lei; Xue, Jianli

    2009-04-01

    To evaluate the results of operative treatment of complex acetabular fractures and to investigate its influence factors. From June 2000 to August 2006, 54 patients with complex acetabular fractures were treated, including 44 males and 10 females aged 20-75 years old (average 39.1 years old). Fractures were due to traffic accident in 40 cases, falling from high places in 8 cases and crush by heavy objects in 6 cases. All cases were fresh and close fractures and the time from injury to operation was 5-72 days. There were 5 cases of posterior column and posterior wall fracture, 25 of transverse and posterior wall fracture, 2 of T-type fracture, and 22 of double column fracture. During operation, Kocker-Lagenbach approach was used in 23 cases, anterior ilioinguinal approach was applied for 3 cases and the combination of anterior and posterior approaches was performed on 28 cases. AO reconstructive plate and screw internal fixation were used in all the cases. Fifty-two cases were followed up for 12-74 months (average 31.3 months). Anatomical reduction was achieved in 23 cases, satisfactory reduction in 19 cases, poor reduction in 10 cases, and the excellent and good rate reached 80.77%. During operation, 1 case suffered from a tear in the external iliac vein and healed after vein repair; 2 cases had sciatic nerve injury and took mecobalamin as oral administration, one of them fully recovered, and the other had incomplete recovery at 18-month follow-up. At the final follow-up, there were 6 cases of severe heterotopic ossification, one of them received heterotopic bone resection and the rest 5 patients received conservative treatment; there were 9 cases of traumatic osteoarthritis, one of them received total hip replacement and the rest 8 patients received conservative treatment; there were 5 cases of avascular necrosis of the femoral head, two of them received total hip replacement, 1 received no further treatment because the femoral head didn't collapse, and the rest 2

  14. Computed tomography of the acetabular fractures

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Ho Young; Suh, Jin Suck; Park, Chang Yun; Lee, Kil Woo [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    1986-04-15

    In a retrospective study of 21 patients, in whom the acetabular fractures were suspected on initial radiographs, we compared and analysed the computed tomographic findings and plain radiographic findings. The results were as follow: 1. In patients with multiple trauma, no further change in position was required during CT examinations. 2. CT showed intraarticular loose bodies, which were invisible on plain radiographs. 3. CT was useful in detecting the fractures of acetabular rims, medial wall of acetabulum, and femoral head. 4. CT permitted better evaluation of shape, extent, and degree of separation of fracture fragments. 5. CT was helpful in detecting the associated fractures and soft tissue injuries. 6. CT also demonstrated the adequacy of reduction, the position of metallic fixation devices, and the presence or absence of remaining intraarticular osseous fragments after surgery.

  15. Surgical treatment of displaced acetabular fractures

    Directory of Open Access Journals (Sweden)

    Milenković Saša

    2011-01-01

    Full Text Available Introduction. Acetabular fractures are severe injuries, generally caused by high-energy trauma, most frequently from traffic accidents or falls from heights. Fractures of the extremities, head injuries, chest, abdomen and pelvic ring injuries are most commonly associated injuries. Objective. The purpose of this study was to evaluate the results of open reduction and internal fixation of acetabular fractures. The open anatomical reduction of the articular surface combined with a rigid internal fixation and early mobilisation have become the standard treatment of these injuries. Methods. We conducted a retrospective analysis of 22 patients of average age 43.13 years. The patients were treated by open reduction and internal fixation at the Orthopaedic Clinic of Niš from 2005-2009. The follow-up was 12 to 60 months, with the average of 21.18 months after surgery. Results. All injured patients were operated on between 4 and 11 days (5.7 days on the average. According to the classification by Judet and Letournel, 15 (68.18% patients had an elementary acetabular fracture, whereas 7 (31.82% patients had associated fracture. A satisfactory postoperative reduction implying less than 2 mm of displacement was achieved in 19 (86.36% patients. The radiological status of the hip joint, determined according to Matta score, was excellent in 15 (68.18% patients, good in 4 (18.18% patients and moderate in 3 (13.63% patients. According to Merle d’Aubigné Scale, the final functional results of the treatment of all operated patients were excellent in 12 (54.54% patients, good in 7 (31.81% patients and moderate in 3 (13.63% patients. Conclusion. Surgical treatment of dislocated acetabular fractures requires an open reduction and a stable internal fixation. Excellent and good results can be expected only if anatomical reduction and stable internal fixation are achieved.

  16. Plain film analysis of acetabular fracture

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Chang Soo; Han, Sang Suk; Yoon, Eu Giene; Cha, Seong Sook; Eun, Tchoong Kie; Chung, Duck Hwan [Inje Medical College Paik Hospital, Pusan (Korea, Republic of)

    1986-02-15

    Acetabular fracture can result in severe limitation of the motion of the hip joint, which supports total weight of human body. Because of different methods of surgical approach according to fracture type, precise interpretation of X-ray films of acetabular fracture is required. We reviewed 38 cases of simple X-ray films showing acetabular fracture. The results were as follows: 1. Almost 60% of the cases-were in their 2nd and 3rd decades. 2. Twenty cases were male, and 18 cases were female. 3. The most common cause of the injury was traffic accident (33 cases, 86.8%), followed by fall down (4 cases, 10.5%), and slip down (1 case, 2.7%). 4. Elementary fractures were 21 cases (55.3%), and associated fractures were 17 cases (44.7%). 5. Among elementary fractures, posterior wall fractures were 9 cases (23.7%), followed by anterior column fractures (8 cases, 21.1%), anterior wall fractures (4 cases, 10.5%). 6. Among associated fractures, T-shaped fractures were 8 cases (21.1%), followed by both column fractures (6 cases, 15.8%), anterior and hemitransverse fractures (3 cases, 7.8%). 7. Other pelvic bone fractures associated with the acetabular fracture were as follows: fractures of contralateral pubic rami (6 cases, 15.8%) contralateral iliac bone (1 case, 2.6%) and ipsilateral iliac bone (1 case, 2.6%). 8. Injuries of other organs adjacent to the acetabulum were as follows: rupture of the bladder (3 cases, 7.9%), urethra (2 cases, 5.3%) and uterus (1 cases, 2.6%)

  17. Studies on lipid artificial tears

    OpenAIRE

    Torrent Burgués, Juan

    2017-01-01

    Report-review sobre llàgrima artificial, llàgrima lipídica. The use of artificial tears is related with dry eye problems or ocular irritations. It exist different types of artificial tears. One type of them is the lipid artificial tears which tray to repair or improve the lipid layer present in the outermostpart of the tear film. Several lipid artificial tears are present in the market and commercialised by several companies. In the composition of some of these lipid tears occurs as a prin...

  18. Validation of a Dry Model for Assessing the Performance of Arthroscopic Hip Labral Repair.

    Science.gov (United States)

    Phillips, Lisa; Cheung, Jeffrey J H; Whelan, Daniel B; Murnaghan, Michael Lucas; Chahal, Jas; Theodoropoulos, John; Ogilvie-Harris, Darrell; Macniven, Ian; Dwyer, Tim

    2017-07-01

    Arthroscopic hip labral repair is a technically challenging and demanding surgical technique with a steep learning curve. Arthroscopic simulation allows trainees to develop these skills in a safe environment. The purpose of this study was to evaluate the use of a combination of assessment ratings for the performance of arthroscopic hip labral repair on a dry model. Cross-sectional study; Level of evidence, 3. A total of 47 participants including orthopaedic surgery residents (n = 37), sports medicine fellows (n = 5), and staff surgeons (n = 5) performed arthroscopic hip labral repair on a dry model. Prior arthroscopic experience was noted. Participants were evaluated by 2 orthopaedic surgeons using a task-specific checklist, the Arthroscopic Surgical Skill Evaluation Tool (ASSET), task completion time, and a final global rating scale. All procedures were video-recorded and scored by an orthopaedic fellow blinded to the level of training of each participant. The internal consistency/reliability (Cronbach alpha) using the total ASSET score for the procedure was high (intraclass correlation coefficient > 0.9). One-way analysis of variance for the total ASSET score demonstrated a difference between participants based on the level of training ( F3,43 = 27.8, P arthroscopic procedures ( r = 0.52-0.73, P 0.9). The results of this study demonstrate that the use of dry models to assess the performance of arthroscopic hip labral repair by trainees is both valid and reliable. Further research will be required to demonstrate a correlation with performance on cadaveric specimens or in the operating room.

  19. The “Labral Bridge”: A Novel Technique for Arthroscopic Anatomic Knotless Bankart Repair

    Science.gov (United States)

    Ostermann, Roman C.; Hofbauer, Marcus; Platzer, Patrick; Moen, Todd C.

    2015-01-01

    Arthroscopic Bankart repair with suture anchors is widely considered a mainstay for surgical treatment of anterior shoulder instability after recurrent anterior shoulder dislocations. Traditionally, the displaced capsulolabral complex is restored and firmly attached to the glenoid by placing multiple suture anchors individually from a 5- to 3-o'clock position. A variety of different techniques using different anchor designs and materials have been described. Knotless anchors are widely used nowadays for shoulder instability repair, providing a fast and secure way of labral fixation with favorable long-term outcomes. However, these techniques result in a concentrated point load of the reduced labrum to the glenoid at each suture anchor. We describe a technique, developed by the first author, using a 1.5-mm LabralTape (Arthrex, Naples, FL) in combination with knotless suture anchors (3.5-mm PEEK [polyether ether ketone] PushLock anchors; Arthrex), for hybrid fixation of the labrum. The LabralTape is used to secure the torn labrum to the glenoid between each suture anchor, thus potentially providing a more even pressure distribution. PMID:26052499

  20. Functional evaluation of repairs to circumferential labral lesions of the glenoid - Case series

    Directory of Open Access Journals (Sweden)

    Alexandre Tadeu do Nascimento

    Full Text Available ABSTRACT OBJECTIVE: To evaluate the clinical results among patients undergoing arthroscopic repair of circumferential labral lesions. METHODS: This was a retrospective study on 10 patients who underwent arthroscopic repair to circumferential labral lesions of the shoulder, between September 2012 and September 2015. The patients were evaluated by means of the Carter-Rowe score, DASH score, UCLA score, visual analog scale (VAS for pain and Short-Form 36 (SF36. The average age at surgery was 29.6 years. The mean follow-up was 27.44 months (range: 12-41.3. RESULTS: The mean score was 16 points for DASH; 32 points for UCLA, among which six patients (60% had excellent results, three (30% good and one (10% poor; 1.8 points for VAS, among which nine patients (90% had minor pain and one (10% moderate pain; 79.47 for SF-36; and 92.5 for Carter-Rowe, among which nine patients (90% had excellent results and one (10% good. Joint degeneration was present in one case (10%, of grade 1. We did not observe any significant complications, except for grade 1 glenohumeral arthrosis, which one patient developed after the operation. CONCLUSION: Arthroscopic repair of circumferential labral lesions of the shoulder through use of absorbable anchors is effective, with improvements in all scores applied, and it presents low complication rates. Cases associated with glenohumeral dislocation have lower long-term residual pain.

  1. Acetabular paralabral cyst causing compression of the sciatic nerve

    Directory of Open Access Journals (Sweden)

    Caoimhe Byrne, MB BCh BAO

    2017-12-01

    Full Text Available Acetabular paralabral cysts are common. They vary in their clinical presentation and may be asymptomatic or cause pain and restriction at the hip joint. In rare instances they may cause symptoms by compressing local neurovascular structures. We report a case of symptomatic compression of the sciatic nerve by a posteriorly displaced acetabular paralabral cyst.

  2. Superior dislocation hip with anterior column acetabular fracture ...

    African Journals Online (AJOL)

    Superior variety of anterior dislocation of the hip is a rare injury. Its occurrence with acetabular fractures has been documented infrequently. We report a case of superior dislocation of the hip with anterior column acetabular fracture. Open reduction of the hip and internal fixation of the fracture was carried out using a twin ...

  3. Management of acetabular fractures in the geriatric patient

    Directory of Open Access Journals (Sweden)

    Hanschen Marc

    2017-01-01

    Full Text Available Introduction: Open reduction and internal fixation (ORIF is standard care for most acetabular fractures. With increasing numbers of acetabular fractures in the elderly, the risk of revision surgery and conversion to total hip replacement (THR is increasing. Alarmingly, about 20–25% of acetabular fractures in the elderly following ORIF needed revision and conversion to delayed THR. Methods: Recently, prognostic factors have been identified, which correlate with an increased risk of worse outcomes following ORIF of acetabular fractures in the elderly patient. Patient risk factors include, for example, age, comorbidities, and degree of osteoporosis. Injury risk factors mainly include the fracture pattern. Results: The concept of primary THR following acetabular fractures is an alternative to ORIF, especially in the elderly patient. Satisfactory outcomes have been reported in different studies for primary THR following acetabular fractures in the elderly. The surgeon should be aware of strict selection criteria in order to achieve these satisfactory outcomes. Therefore, an individualized treatment plan has to be defined for elderly patients following acetabular fractures. Discussion: Here, the advantages and disadvantages of ORIF versus THR following acetabular fractures in the elderly are discussed.

  4. early experience of operative treatment of pelvic and acetabular ...

    African Journals Online (AJOL)

    Background: There is a large number of patients who sustain pelvic and acetabular fractures in Kenya. A number of these patients have undergone internal fixation at our institution but there is no local data to show the results of such treatment. Objective: To review early post-operative results of pelvic and acetabular fracture ...

  5. Probability Theory Without Tears!

    Indian Academy of Sciences (India)

    Home; Journals; Resonance – Journal of Science Education; Volume 1; Issue 2. Probability Theory Without Tears! S Ramasubramanian. Book Review Volume 1 Issue 2 February 1996 pp 115-116. Fulltext. Click here to view fulltext PDF. Permanent link: http://www.ias.ac.in/article/fulltext/reso/001/02/0115-0116 ...

  6. Tears of Wine

    Science.gov (United States)

    Rathore, Prerana; Sharma, Vivek

    `Tears of wine' refer to the rows of wine-drops that spontaneously emerge within a glass of strong wine. Evaporation-driven Marangoni flows near the meniscus of water-alcohol mixtures drive liquid upward forming a thin liquid film, and a rim or ridge forms near the moving contact line. Eventually the rim undergoes an instability forming drops, that roll back into bulk reservoir forming so called tears or legs of wine. Most studies in literature argue the evaporation of more volatile, lower surface tension component (alcohol) results in a concentration-dependent surface tension gradient that drives the climbing flow within the thin film. Though it is well-known that evaporative cooling can create temperature gradients that could provide additional contribution to the climbing flows, the role of thermocapillary flows is less well-understood. Furthermore, the patterns, flows and instabilities that occur near the rim, and determine the size and periodicity of tears, are not well-studied. Using experiments and theory, we visualize and analyze the formation and growth of tears of wine. The sliding drops, released from the rim towards the bulk reservoir, show oscillations and a cascade of fascinating flows that are analyzed for the first time.

  7. Normal Percentile Reference Curves and Correlation of Acetabular Index and Acetabular Depth Ratio in Children.

    Science.gov (United States)

    Novais, Eduardo N; Pan, Zhaoxing; Autruong, Patrick T; Meyers, Mariana L; Chang, Frank M

    2018-03-01

    Radiographic surveillance of the hip is vital in the diagnosis and treatment of developmental dysplasia of the hip (DDH) in children. The acetabular index (AI) and the acetabular depth ratio (ADR) are radiographic parameters for evaluation of acetabular morphology. Normal reference curves for these parameters that allow for serial evaluation of acetabular development in a manner that is independent of age are necessary and clinically useful. The purpose of this study was (1) to establish normal values of AI and ADR in the normally developing pediatric hip up to age 14, (2) to generate percentile reference curves of both parameters, (3) to determine the extent of correlation between AI and ADR, and (4) to assess intrarater and interrater reliability of AI measurement. We identified 1734 patients who underwent anterior-posterior pelvic radiography between 2004 and 2014. A total of 1152 patients (age range, 0.15 to 13.97 y; 2304 hips) were identified as radiographically normal in the radiology report, signed by the attending pediatric radiologist on the basis of the absence of structural deformity of the hip and previously established reference values for DDH assessment. A review of the medical records confirmed that patients had no diagnosis of DDH or any other orthopaedic hip pathology. The AI and ADR were measured in all radiographs. Normal values and fully parametric percentile curves were generated from birth to skeletal maturity. Correlation between AI and ADR was assessed using linear regression analysis. Normal AI decreased, and ADR increased, with age. Percentile curves were generated for AI and ADR. Using the provided equations, measured values can be converted to age-appropriate percentile and Z-score. The 2 parameters exhibited strong correlation (Pearson correlation=-0.789, Ppercentile and Z-score. Using the presented method during surveillance of the pathologic hip, change in acetabular development can now be assessed in a manner that is independent of

  8. The role of the transverse acetabular ligament for acetabular component orientation in total hip replacement: an analysis of acetabular component position and range of movement using navigation software

    National Research Council Canada - National Science Library

    Kalteis, T; Sendtner, E; Beverland, D; Archbold, P A; Hube, R; Schuster, T; Renkawitz, T; Grifka, J

    2011-01-01

    .... In order to assess the influence of alignment on impingement, the range of movement was calculated for that defined by the TAL and the posterior labrum and compared with a standard acetabular component position (abduction 45°/anteversion 15...

  9. Neurologic Injury in Operatively Treated Acetabular Fractures.

    Science.gov (United States)

    Bogdan, Yelena; Tornetta, Paul; Jones, Clifford; Gilde, Alex K; Schemitsch, Emil; Vicente, Milena; Horwitz, Daniel; Sanders, David; Firoozabadi, Reza; Leighton, Ross; de Dios Robinson, Juan; Marcantonio, Andrew; Hamilton, Benjamin

    2015-10-01

    The purpose of this study is to evaluate a series of operatively treated acetabular fractures with neurologic injury and to track sensory and motor recovery. Operatively treated acetabular fractures with neurologic injury from 8 trauma centers were reviewed. Patients were followed for at least 6 months or to neurologic recovery. Functional outcome was documented at 3 months, 6 months, and final follow-up. Outcomes included motor and sensory recovery, brace use, development of chronic regional pain syndrome, and return to work. One hundred thirty-seven patients (101 males and 36 females), average age 42 (17-87) years, met the criteria. Mechanism of injury included MVC (67%), fall (11%), and other (22%). The most common fracture types were transverse + posterior wall (33%), posterior wall (23%), and both-column (23%). Deficits were identified as preoperative in 57%, iatrogenic in 19% (immediately after surgery), and those that developed postoperatively in 24%. A total of 187 nerve deficits associated with the following root levels were identified: 7 in L2-3, 18 in L4, 114 in L5, and 48 in S1. Full recovery occurred in 54 (29%), partial recovery in 69 (37%), and 64 (34%) had no recovery. Forty-three percent of S1 deficits and 29% of L5 deficits had no recovery. Fifty-five percent of iatrogenic injuries did not recover. Forty-eight patients wore a brace at the final follow-up, all for an L5 root level deficit. Although 60% (42/70) returned to work, chronic regional pain syndrome was seen to develop in 19% (18/94). Peripheral neurologic injury in operatively treated acetabular fractures occurs most commonly in the sciatic nerve distribution, with L5 root level deficits having only a 26% chance of full recovery. Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

  10. Conservatively treated acetabular fractures: A retrospective analysis

    Directory of Open Access Journals (Sweden)

    Narender Kumar Magu

    2012-01-01

    Full Text Available Background: There are a few studies reporting the long term outcome of conservatively treated acetabular fractures. The present study aims to evaluate the quality of reduction, and radiological and functional outcome in displaced acetabular fractures treated conservatively. Materials and Methods: Sixty-nine patients (55 men and 14 women with 71 displaced acetabular fractures (mean age 38.6 years managed conservatively were retrospectively evaluated. There were 11 posterior wall, 5 posterior column, 6 anterior column, 13 transverse, 2 posterior column with posterior wall, 9 transverse with posterior wall, 6 T-shaped, 1 anterior column with posterior hemi-transverse, and 18 both-column fractures. The follow-up radiographs were graded according to the criteria developed by Matta J. Functional outcome was assessed using Harris hip score and Merle d′Aubigne and Postel score at final followup. Average follow-up was 4.34 years (range 2-11 years. Results: Patients with congruent reduction (n=45 had good or excellent functional outcome. Radiologic outcome in incongruent reduction (n=26 was good or excellent in 6 and fair or poor in 20 hips. The functional outcome in patients with incongruent reduction was good or excellent in 16 and satisfactory or poor in 10 hips. Good to excellent radiologic and functional outcome was achieved in all patients with posterior wall fractures including four having more than 50% of broken wall. Good to excellent functional outcome was observed in 88.8% of both-column fractures with secondary congruence despite medial subluxation. Conclusions: Nonoperative treatment of acetabular fractures can give good radiological and functional outcome in congruent reduction. Posterior wall fractures with a congruous joint without subluxation on computed tomography axial section, posterior column, anterior column, infratectal transverse or T-shaped, and both-column fractures may be managed conservatively. Small osteochondral fragments

  11. Total hip arthroplasty with cementless cup after acetabular fracture

    Directory of Open Access Journals (Sweden)

    Marcelo Alfonso Lugones

    2012-12-01

    Full Text Available Background Acetabular fractures are a common cause of degenerative hip arthritis. The incidence of post-traumatic osteoarthritis has been reported between 12% and 57% and avascular necrosis of the femoral head may occur in 2% to 40% after posterior fracture dislocation. The fracture is often caused by major trauma in road accidents, at work or during sports, and patients usually present for total hip replacement (THR at an earlier age than the general arthritic population. We describe and analyze our patients with uncemented acetabular reconstruction in post-traumatic arthritis and compare them with THR in non-traumatic arthritis. Methods We retrospectively evaluated 19 patients who underwent uncemented acetabular reconstruction due to post-traumatic arthritis secondary to acetabular fracture. Results The average age at the time of arthroplasty was 52.2 years (19-83. The age at the time of fracture was 47.9 years (16-81. The average time between the acetabular fracture and THR was 52.4 months (4-360. The average follow-up was 4.25 years. No acetabular component loosening or infections were seen in either group. The Harris Hip Score at an average follow-up of 4.25 years was 89.3 (57-99. The follow-up in the control group with non-traumatic arthritis was 4.9 years, and the Harris Hip Score was 94.1 points (78-100. There were no significant difference in the Harris Hip Score between groups (p = 0.24. Conclusion Uncemented acetabular reconstruction in post-traumatic arthritis secondary to acetabular fracture is a more difficult procedure than routine arthroplasty in patient with non-traumatic arthritis. In the short-term there are no clinical or radiographic differences in THR with uncemented acetabular cups in post-traumatic arthritis patients compared to patients with non-traumatic arthritis.

  12. High-energy pediatric pelvic and acetabular fractures.

    Science.gov (United States)

    Amorosa, Louis F; Kloen, Peter; Helfet, David L

    2014-10-01

    Pediatric pelvic and acetabular fractures are rare injuries. They are almost always the result of a high-energy injury mechanism. A full trauma protocol should be instituted, having a high index of suspicion for associated life-threatening injuries. In the past, it was recommended that almost all of these injuries be treated nonoperatively. However, pelvic and acetabular fractures do not all remodel well. Prospective studies are needed to establish optimal treatment guidelines. Until then, in the presence of instability or significant displacement, operative fixation by a pelvic and acetabular fracture specialist should be considered to allow the best possible outcome. Copyright © 2014 Elsevier Inc. All rights reserved.

  13. Magnetic Resonance Imaging Appearance of the Hip Musculature After Arthroscopic Labral-Level Iliopsoas Tenotomies

    Science.gov (United States)

    Walczak, Brian E.; Blankenbaker, Donna G.; Tuite, Michael R.; Keene, James S.

    2017-01-01

    Background: Iliopsoas (IP) muscle atrophy is a known consequence of open IP tenotomy, but the severity of IP muscle atrophy that occurs after arthroscopic labral-level IP tenotomies has not been documented. Purpose: To document the severity of muscle atrophy that occurs in the iliacus, psoas, and adjacent hip musculature after arthroscopic labral-level IP tenotomy. Study Design: Case series; Level of evidence, 4. Methods: Twenty-eight patients who had magnetic resonance arthrograms (MRAs) obtained prior to and 3 months to 5 years after arthroscopic labral-level IP tenotomies are the basis of this report. The pre- and postoperative MRAs of each patient were examined in consensus by 2 musculoskeletal radiologists who graded the postoperative muscle atrophy from 0 (no fatty infiltration) to 4 (>75% fatty infiltration) and noted any compensatory muscle hypertrophy or abnormal IP tendon morphology. Patients also were assessed with the Byrd 100-point modified Harris Hip Scoring system (MHHS) preoperatively and at the time of their postoperative MRA. Results: Postoperative MRAs were obtained on average 1.7 years (range, 3 months to 5 years) after hip arthroscopy. None of the patients had muscle atrophy on their preoperative MRAs. In contrast, 89% of patients had iliacus and psoas muscle atrophy on their postoperative MRAs, but only 2 (7%) developed grade 4 atrophy, and the majority (64%) had either grade 1 (n = 15) or no atrophy (n = 3). In addition, there were no significant differences in the MHHS of the patients with mild (grades 0-1), moderate (grades 2-3), or severe (grade 4) postoperative atrophy. Postoperative MRAs also demonstrated low-grade atrophy (grades 1-2) in the quadratus femoris (n = 5) and rectus femoris (n = 1) muscles, and 16 patients (57%) had distortion of the tendon, but none had a gap in their tendon. Conclusion: A majority of patients (89%) developed IP muscle atrophy after arthroscopic labral-level IP tenotomies, and although this percentage was

  14. Cemented total hip arthroplasty following acetabular fracture.

    Science.gov (United States)

    Scott, C E H; MacDonald, D; Moran, M; White, T O; Patton, J T; Keating, J F

    2017-10-01

    To evaluate the outcomes of cemented total hip arthroplasty (THA) following a fracture of the acetabulum, with evaluation of risk factors and comparison with a patient group with no history of fracture. Between 1992 and 2016, 49 patients (33 male) with mean age of 57 years (25 to 87) underwent cemented THA at a mean of 6.5 years (0.1 to 25) following acetabular fracture. A total of 38 had undergone surgical fixation and 11 had been treated non-operatively; 13 patients died at a mean of 10.2 years after THA (0.6 to 19). Patients were assessed pre-operatively, at one year and at final follow-up (mean 9.1 years, 0.5 to 23) using the Oxford Hip Score (OHS). Implant survivorship was assessed. An age and gender-matched cohort of THAs performed for non-traumatic osteoarthritis (OA) or avascular necrosis (AVN) (n = 98) were used to compare complications and patient-reported outcome measures (PROMs). The mean time from fracture to THA was significantly shorter for patients with AVN (2.2 years) or protrusio (2.2 years) than those with post-traumatic OA (9.4 years) or infection (8.0 years) (p = 0.03). Nine contained and four uncontained defects were managed with autograft (n = 11), bulk allograft (n = 1), or trabecular metal augment (n = 1). Initial fracture management (open reduction and internal fixation or non-operative), timing of THA (>// 10 mm) were significantly higher following acetabular fracture compared with atraumatic OA/AVN and OHSs were inferior: one-year OHS (35.7 v ersus 40.2, p = 0.026); and final follow-up OHS (33.6 v ersus 40.9, p = 0.008). Cemented THA is a reasonable option for the sequelae of acetabular fracture. Higher complication rates and poorer PROMs, compared with patients undergoing THA for atraumatic causes, reflects the complex nature of these cases. Cite this article: Bone Joint J 2017;99-B:1399-1408. ©2017 The British Editorial Society of Bone & Joint Surgery.

  15. Predictors of postoperative outcome for acetabular fractures.

    Science.gov (United States)

    Meena, U K; Tripathy, S K; Sen, R K; Aggarwal, S; Behera, P

    2013-12-01

    The outcomes of surgically treated acetabular fractures are dependent on many factors. The purpose of this retrospective study is to evaluate these factors in a group of patients operated on by a single surgeon in one institute. One hundred and eighteen patients, treated surgically for their displaced acetabular fracture and who had completed two years follow-up, were evaluated clinically with Modified Postel Merle d'Aubigné score and radiologically with Matta's radiological outcome grading. The effect of age (≤ 55 or >55 years), gender, fracture displacement (≤ 20mm or >20mm), hip dislocation, delay in surgery (≤ 2 weeks or >2 weeks), associated injury and length of follow-up (≤ 5 years or >5 years) on the functional outcome was evaluated. There were 99 (83.9%) males and 19 (16.1%) females with mean age of 38.75 years (16 to 65 years). The mean duration of follow-up was 3.95 years (range 2 to 14 years). The mean Modified Postel Merle d'Aubigné score was 15.7 ± 2.2 (range, 8 to 18). The clinical outcome was excellent in 27 (22.9%), good in 52 (44.2%), fair in 20 (16.9%), and poor in 19 (16.1%, 10 patients who underwent THR for secondary arthritis were considered as poor outcome) patients. The Modified Postel Merle d'Aubigné score was significantly affected by quality of reduction (P=0.0001), presence of associated injuries (P=0.0001), initial fracture displacement of >20mm (P=0.018), joint dislocation (P=0.015) and delay in surgery (P=0.001). However, age, gender, fracture type and length of follow-up did not have any effects on the clinical outcome. Poor reduction, associated injuries, fracture displacement of >20mm, joint dislocation and late surgery definitely carry poor prognosis in predicting the outcome of surgically treated acetabular fractures. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  16. Is there evidence for accelerated polyethylene wear in uncemented compared to cemented acetabular components? A systematic review of the literature

    NARCIS (Netherlands)

    van der Veen, Hugo; van Jonbergen, H.P.W.; Poolman, R.W.; Bulstra, S.K.; van Raay, J.J.A.M.

    Joint arthroplasty registries show an increased rate of aseptic loosening in uncemented acetabular components as compared to cemented acetabular components. Since loosening is associated with particulate wear debris, we postulated that uncemented acetabular components demonstrate a higher

  17. Bridging Suture Repair for Acetabular Chondral Carpet Delamination.

    Science.gov (United States)

    Kaya, Mitsunori; Hirose, Toshiaki; Yamashita, Toshihiko

    2015-08-01

    Acetabular chondral carpet delamination is a frequent finding at hip arthroscopy. The cartilage is macroscopically normal but deboned from the subchondral bone, without a disruption at the chondrolabral junction. Arthroscopic anatomic repair of delaminated cartilage is challenging. We propose that a combination of microfracture and use of stitches to press the delaminated cartilage against the subchondral bone using a suture limb offers an effective method to provide an environment for cartilage repair. This article describes the technique of bridging suture repair for carpet delamination in detail; the technique enables the surgeon to stabilize the delaminated acetabular cartilage. Intra-articular soft anchors and an acetabular rim knotless anchor footprint provide a stable repair for delaminated cartilage. This technique is especially helpful in cases with acetabular cartilage carpet delamination.

  18. The shape of acetabular cartilage optimizes hip contact stress distribution

    Science.gov (United States)

    Daniel, Matej; Iglič, Aleš; Kralj-Iglič, Veronika

    2005-01-01

    The biomechanical role of the horseshoe geometry of the acetabular cartilage is described using a three-dimensional mathematical model. It is shown that the acetabular fossa contributes to a more uniform articular contact stress distribution and a consequent decrease in the peak contact stress. Based on the results it is suggested that the characteristic horseshoe shape of the articular cartilage in the human acetabulum optimizes the contact stress distribution in the hip joint. PMID:16011547

  19. A simple technique to remove well-fixed acetabular components in revision of total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Xiaoqi Zhang, MD

    2017-12-01

    Full Text Available Removing well-fixed acetabular components can be a challenge for orthopaedic surgeons in revision of total hip arthroplasty. Acetabular bone loss, fracture, and other complications occurred in extracting implants may result in instability and fail of revision. Thus, instruments are developed to avoid such complications. We report a simple technique by drilling a tunnel on the superolateral quadrant of acetabulum and using an offset staff to remove acetabular components without many matching units. The procedure of removing well-fixed acetabular components is a simple, efficient, inexpensive, bone stock preserving technique. Keywords: Total hip arthroplasty, Acetabular revision, Removing acetabular components

  20. [BIOMECHANICS STUDY ON ACETABULAR POSTERIOR WALL FRACTURE].

    Science.gov (United States)

    Tang, Yang; Hu Xiaopeng; Lu, Xiongwei; Zhang, Yuntong; Zhang, Chuncai; Wang, Panfeng; Zhao, Xue

    2015-08-01

    To study the experimental biomechanics of acetabular posterior wall fractures so as to provide theoretical basis for its clinical treatment. Six formalin-preserved cadaveric pelvises were divided into groups A and B (n=3). The fracture models of superior-posterior wall and inferior-posterior wall of the acetabulum were created on both hips in group A; fractures were fixed with two interfragmentary screws and a locking reconstruction plate. The fracture models of superior-posterior wall of acetabulum were created on both hips in group B; fractures were fixed with two interfragmentary screws and a locking reconstruction plate at one side, and with acetabular tridimensional memory fixation system (ATMFS) at the other side. The biomechanical testing machine was used to load to 1 500 N at 10 mm/min speed for 30 seconds. The displacement of superior and inferior fracture sites was analyzed with the digital image correlation technology. No fracture or internal fixation breakage occurred during loading and measuring; the displacement valuess of the upper and lower fracture lines were below 2 mm (the clinically tolerable maximum value) in 2 groups. In group A, the displacement values of the upper and lower fracture lines at superior-posterior wall fracture site were significantly higher than those at inferior-posterior wall fracture site (P fracture line were significantly higher than those of lower fracture line (P fracture types. In group B, the displacement values of the upper and lower fracture lines at the side fixed with screws and a locking reconstruction plate were similar to the values at the side fixed with ATMFS, all being close to 2 mm; the displacement values of the upper fracture line were significantly higher than those of lower fracture line (P acetabulum is much greater than that of the inferior-posterior wall of acetabulum and they should be discriminated, which might be the reasons of reduction loss, femoral head subluxation, and traumatic arthritis

  1. The Glenoid Labral Articular Teardrop Lesion: A Chondrolabral Injury With Distinct Magnetic Resonance Imaging Findings.

    Science.gov (United States)

    Lederman, Evan S; Flores, Stephen; Stevens, Christopher; Richardson, Damien; Lund, Pamela

    2018-02-01

    Evaluation and description of a pathognomonic lesion identified on magnetic resonance imaging (MRI) of a chondrolabral injury of the glenohumeral joint. Patients were prospectively identified at the time of MRI by a characteristic teardrop appearance of a pedicled displaced chondrolabral flap in the axillary recess on coronal imaging and retrospectively reviewed. In a sample of 36 patients, there were 30 males (83%), and the average age was 27 years (14-75 years). Twenty-four (67%) were noted to have sustained an instability episode or had findings of instability on physical examination; 19 patients (53%) were playing a sport at the time of injury. The characteristic teardrop lesion measured 3.36 mm (1-9 mm) in the coronal plane, 6.98 mm (2-20 mm) sagittal and 11.78 mm (1-25 mm) longitudinal. The lesion was located in the anterior inferior quadrant of the glenoid. The glenoid labral articular teardrop (GLAT) lesion represents a pathognomonic lesion in the spectrum of chondral labral injury, indicating articular cartilage damage to the glenoid. Level IV, therapeutic case series. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  2. Risk factors for the need of hip arthroscopy following periacetabular osteotomy

    OpenAIRE

    Hartig-Andreasen, Charlotte; Troelsen, Anders; Thillemann, Theis M.; Gelineck, John; S?balle, Kjeld

    2015-01-01

    Despite the frequency of labral tears in symptomatic developmental dysplasia of the hip, no consensus exists regarding the treatment of coexisting dysplasia of the hip and tearing of the acetabular labrum. The purpose of this prospective, MR arthrography (MRA) based 2-year follow-up study was to identify risk factors predicting the need for a hip arthroscopy (HA) after periacetabular osteotomy (PAO). Ninety-nine patients (104 hips) scheduled for PAO were evaluated preoperatively and at 2-year...

  3. Tear Film Lipids

    Science.gov (United States)

    Butovich, Igor A.

    2013-01-01

    Human meibomian gland secretions (MGS, or meibum) are formed from a complex mixture of lipids of different classes such as wax esters, cholesteryl esters, (O-acyl)-ω-hydroxy fatty acids (OAHFA) and their esters, acylglycerols, diacylated diols, free fatty acids, cholesterol, and a smaller amount of other polar and nonpolar lipids, whose chemical nature and the very presence in MGS have been a matter of intense debates. The purpose of this review is to discuss recent results that were obtained using different experimental techniques, estimate limitations of their usability, and discuss their biochemical, biophysical, and physiological implications. To create a lipid map of MGS and tears, the results obtained in the author’s laboratory were integrated with available information on chemical composition of MGS and tears. The most informative approaches that are available today to researchers, such as HPLC-MS, GC-MS, and proton NMR, are discussed in details. A map of the meibomian lipidome (as it is seen in reverse phase liquid chromatography/mass spectrometry experiments) is presented. Directions of future efforts in the area are outlined. PMID:23769846

  4. Hip Arthroscopy with Labral Preservation and Capsular Plication in Patients with Borderline Hip Dysplasia: Minimum 5-year Patient Reported Outcomes

    OpenAIRE

    Ashberg, Lyall; Chaharbakhshi, Edwin; Perets, Itay; Close, Mary; Walsh, John P.; Domb, Benjamin G.

    2017-01-01

    Objectives: Arthroscopic management of hip pathology in patients with hip dysplasia has been controversial, and historically demonstrated mixed results. Studies on patients with borderline dysplasia, emphasizing the importance of the labrum and capsule as secondary stabilizers, have shown favorable outcomes. We predicted that patients with borderline dysplasia, who are undergoing hip arthroscopy for intrarticular pathology and who have commensurate labral preservation and capsular plication, ...

  5. Comparative study of comminuted posterior acetabular wall fracture treated with the Acetabular Tridimensional Memory Fixation System.

    Science.gov (United States)

    Zhang, Yuntong; Zhao, Xue; Tang, Yang; Zhang, Chuncai; Xu, Shuogui; Xie, Yang

    2014-04-01

    Posterior wall fractures are one of the most common acetabular fractures. However, only 30% of these fractures involve a single large fragment, and comminuted acetabular posterior wall fractures pose a particular surgical challenge. The purpose of this study was to compare outcomes between patients who received fixation for comminuted posterior wall fracture using the Acetabular Tridimensional Memory Fixation System (ATMFS) and patients who underwent fixation with conventional screws and buttress plates (Plates group). Between April 2003 and May 2007, 196 consecutive patients who sustained a comminuted posterior wall fracture of acetabulum were treated with ATMFS or conventional screws and buttress plates. Operative time, fluoroscopy time, blood loss, and any intra-operative complications were recorded. Plain AP and lateral radiographs were obtained at all visits (Matta's criteria). Modified Merle d' Aubigne-Postel score, and Mos SF-36 score were compared between groups. Fifty patients were included in the analysis with 26 in the ATMFS group and 24 in the Plates group. The mean follow-up time was 57.5 months, ranging from 31 to 69 months. All patients had fully healed fractures at the final follow-up. There was no difference in clinical outcomes or radiological evaluations between groups. Patients with comminuted posterior wall fractures of the acetabulum treated with the ATMFS or conventional screws and buttress plate techniques achieve a good surgical result. Both techniques are safe, reliable, and practical. Use of the ATMFS technique may reduce blood loss and improve rigid support to marginal bone impaction. The use ATMFS may need additional support when fractures involve the superior roof. Copyright © 2013 Elsevier Ltd. All rights reserved.

  6. Tearing: Breakthrough in Human Emotional Signaling

    Directory of Open Access Journals (Sweden)

    Robert R. Provine

    2009-01-01

    Full Text Available Tearing is not a benign secretory correlate of sadness or other emotional state, but a potent visual cue that adds meaning to human facial expression, the tear effect. Although tearing (lacrimation provides ocular lubrication and is a response to irritation in many animals, emotional tearing may be unique to humans and does not develop until several months after birth. This study provides the first experimental demonstration that tears are a visual signal of sadness by contrasting the perceived sadness of human facial images with tears against copies of those images that had the tears digitally removed. Tear removal produced faces rated as less sad. Anecdotal findings suggest further that tear-removal often produced faces of uncertain emotional valence, perhaps awe, concern, or puzzlement, not just less sad. Tearing signaled sadness and resolved ambiguity. The evolution and development of emotional tearing in humans provide a novel, potent and neglected channel of affective communication.

  7. Análise epidemiológica das fraturas acetabulares Epidemiological analysis on acetabular fractures

    Directory of Open Access Journals (Sweden)

    Maurício Silveira Maia

    2011-01-01

    Full Text Available O objetivo deste trabalho é realizar um estudo epidemiológico das fraturas acetabulares na cidade de Campinas e entorno, tendo em vista poucos trabalhos publicados a respeito deste assunto. Prontuários cedidos pelo Serviço de Arquivamento Médico (SAM do Hospital das Clínicas da Universidade Estadual de Campinas (Unicamp, dos anos de 2004 a 2008 com diagnósticos de fratura acetabular foram analisados por seis observadores que coletaram idade do paciente, sexo, lado acometido da fratura, mecanismo de lesão, material de síntese utilizado, complicações operatórias, fraturas associadas, tempo de internação pré e pós- operatória, tempo de internação total e número de sessões de fisioterapia pré e pós-cirurgia. Foi observado nesta demografia que o lado esquerdo foi o mais acometido; mecanismo de lesão que mais ocasiona esse tipo de fratura são os acidentes automobilísticos; das complicações cirúrgicas, as lesões do ciático tiveram maior ocorrência; o material de síntese mais utilizado são as placas de reconstrução.This aim of this work was to carry out an epidemiological study on acetabular fractures in the city of Campinas and surrounds, in view of the few published papers on this subject. Medical files with a diagnosis of acetabular fracture between the years 2004 and 2008 that were made available by the Medical Archiving Service of Hospital das Clínicas, State University of Campinas (UNICAMP were analyzed by six observers. Data on patients' ages, sex, side affected by the fracture, mechanism of injury, material used for synthesis, complications of the operation, associated fractures, length of hospitalization before and after the surgery, time of total internment and number of physiotherapy sessions before and after the surgery were gathered. It was observed in this population that the left side was more affected; the mechanism of injury that most often caused this type of fracture was automobile accidents

  8. Quantitative analysis of peak torque and power-velocity characteristics of shoulder rotator muscles after arthroscopic labral repair.

    Science.gov (United States)

    Szuba, Łukasz; Markowska, Iga; Czamara, Andrzej; Noga, Henryk

    2016-10-01

    We aimed to use biomechanical testing to assess differences in the power and strength of patients who participated in a short-term, home-based rehabilitation program following arthroscopic labral repair compared with a healthy control group. The functional outcomes of patients who underwent arthroscopic labral repair followed by self-directed short-term rehabilitation at home were compared with age- and body mass index (BMI)-matched healthy controls. Group I included 20 male patients who had undergone arthroscopic labral repair after being diagnosed with recurrent anterior glenohumeral joint instability without bony lesions of the humeral head or glenoid. Postoperatively, they participated in physical therapy for 17±4 appointments, followed by self-guided home-based exercises. Group II included 25 males without injuries. The two groups were matched for age and BMI. The orthopaedic examination, functional tests, and biomechanical measurements were performed under isokinetic conditions at an average of 16±3 months postoperatively. Significant differences were observed in range of shoulder rotation on the operative shoulder compared with the unaffected side and in the dominant arms of the control group. The patients were also found to have significant deficits in biomechanical parameters such as power and peak torque angle. Significant deficits in peak torque, power, and peak torque angle during external and internal shoulder rotation remained up to 16 months after arthroscopic labral repair. Further research is needed to understand the changes in shoulder power assessment after labral repair. Copyright © 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  9. Reconstruction of Acetabular Posterior Wall Fractures

    Science.gov (United States)

    Ahn, Jae-Min; Hur, Jun-Oh; Lee, Jong-Seo; Cheon, Sang-Jin

    2011-01-01

    Background The results after acetabular fracture are primarily related to the quality of the articular reduction. We evaluated the results of internal fixation of posterior wall fractures with using three-step reconstruction. Methods Thirty-three patients (mean age at the time of injury, 47.9 years; 28 males and 5 females) were followed for a minimum of 2 years after surgery. The three-step reconstruction included 1) preservation of soft tissues and reduction of the marginally impacted osteochondral (articular) fragments using screws, 2) filling the impacted cancellous void with a bone graft, and 3) reinforcement with buttress-plating. Clinical evaluation was done according to the criteria of D'aubigne and Postel, while the radiological criteria were those of Matta. The associated injuries and complications were evaluated. Results The clinical results were excellent in 15 (45.5%) patients and they were good in 5 (15.2%), (i.e., satisfactory in 60.7%), while the radiologic results were excellent in 10 (30.3%) and good in 14 (42.4%) (satisfactory in 72.7%). Heterotopic ossification was common, but this did not require excision, even without prophylactic treatment with indomethacin. Deep infection was the worst complication and this was accompanied by a poor outcome. Conclusions This study confirms that three-step reconstruction facilitates accurate and firm reduction of displaced posterior wall fractures of the acetabulum. Therefore, we anticipate less long-term arthrosis in the patients treated this way. PMID:21629471

  10. Diagnostic performance of MR arthrography in the assessment of superior labral anteroposterior lesions of the shoulder.

    Science.gov (United States)

    Waldt, Simone; Burkart, Andreas; Lange, Peter; Imhoff, Andreas B; Rummeny, Ernst J; Woertler, Klaus

    2004-05-01

    The purpose of this study was to evaluate the diagnostic performance of MR arthrography in the assessment of superior labral anteroposterior (SLAP) lesions of the shoulder with emphasis on the classification of SLAP lesions. Two hundred sixty-five MR arthrograms including 68 MR arthrograms of patients with arthroscopically proven SLAP lesions of the shoulder and 197 MR arthrograms of patients with an intact superior labrum and biceps anchor were retrospectively reviewed in random order. MR arthrography was performed using triplanar T1-weighted spin-echo sequences and a coronal oblique T2-weighted fast spin-echo sequence. MR arthrograms were evaluated by two radiologists with agreement by consensus, and the results were compared with arthroscopic findings. Of 68 SLAP lesions, seven (10%) were arthroscopically classified as type I, 41 (60%) as type II (including 20 type II lesions with coexisting Bankart lesions [29%]), 14 (21%) as type III, and six (9%) as type IV. Compared with arthroscopy as the gold standard, MR arthrography showed a sensitivity of 82% and a specificity of 98% for the overall detection of SLAP lesions. MR arthrographic grading and arthroscopic grading were concurrent in 45 (66%) of 68 arthroscopic diagnoses. Of the surgically confirmed SLAP lesions, involvement of the biceps insertion and SLAP type II lesions with coexisting Bankart lesions were assessed correctly in 75% and 95% of cases, respectively. MR arthrography is a highly effective method for the detection of SLAP lesions, but this technique is limited in the classification of different types of SLAP lesions. However, for preoperative planning MR arthrography provides accurate information about the stability of the biceps insertion and the presence of associated anteroinferior labral injuries.

  11. Simple versus horizontal suture anchor repair of Bankart lesions: which better restores labral anatomy?

    Science.gov (United States)

    Hagstrom, Lindsey S; Marzo, John M

    2013-02-01

    The goal of this study was to determine which suture repair technique better restores glenoid labrum height: horizontal sutures or simple sutures. Sixteen cadaveric glenoids, 8 per repair technique, were used to measure native labral height at the 3:00 to 6:00 positions in half-hour increments. A Bankart lesion was then created from 3:00 to 6:30. Height measurements at each time point were again taken after creation of the Bankart lesion. Repair with a 3-mm knotted suture anchor was then performed at 3:30, 4:30, and 5:30 with either a simple or horizontal suture technique, and postrepair heights were measured across all time points. Significant decreases in height, as compared with native height, were observed at 3:30, 4:30, and 5:30 in the simple repair group. Decreases in height of 1.4 mm (P = .044), 2.1 mm (P = .030), and 1.1 (P = .034) were observed at 3:30, 4:30, and 5:30. There was no significant decrease in height at these respective time points in the horizontal repair group. The in vitro horizontal mattress suture technique better restores labral height and anatomy when compared with a simple suture technique in the repair of acute Bankart lesions. Compared with the simple suture technique, horizontal suture repair may provide increased stability to the glenohumeral construct. Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  12. Development of site-specific locking plates for acetabular fractures.

    Science.gov (United States)

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

    2013-05-01

    Site-specific locking plates have gained popularity for the treatment of fractures. However, the clinical use of a site-specific locking plate for acetabular fractures remains untested due to production limits. To design a universal site-specific locking plate for acetabular fractures, the 3-dimensional (3D) photographic records of 171 pelvises were retrospectively studied to generate a universal posterior innominate bone surface. Using 3D photographical processing software, the 3D coordinate system was reset according to bony landmarks and was scaled based on the acetabular diameter to allow a direct comparison between surfaces. The measured surface was separated into measurement units. At each measurement unit, the authors calculated the average z-axis values in all samples and obtained the 3D coordinate values of the point cloud that could be reconstructed into the universal surface. A plate was subsequently designed in 3D photographical processing software, and the orientation and distribution of locking screws was included. To manufacture a plate, the data were entered into Unigraphics NX version 6.0 software (Siemens PLM Software, Co, Ltd, Plano, Texas) and a CNC digital milling machine (FANUC Co, Ltd, Yamanashi, Japan). The resulting locking plate fit excellently with the reduced bone surface intraoperatively. Plate contouring was avoided intraoperatively. Universal 3.5-mm locking screws locked successfully into the plate, and their orientations were consistent with the design. No screw yielded to acetabular penetration. This method of designing a site-specific acetabular locking plate is practical, and the plates are suitable for clinical use. These site-specific locking plates may be an option for the treatment of acetabular fractures, particularly in elderly patients. Copyright 2013, SLACK Incorporated.

  13. Síndrome do conflito femoro-acetabular

    OpenAIRE

    Feteira, Rui André Carriço Fernandes

    2011-01-01

    Introdução. A síndrome do conflito femoro-acetabular é uma patologia recente na comunidade ortopédica. Hoje, é reconhecido que possa constituir uma das causas das osteoartroses ditas idiopáticas no adulto jovem. Objectivos. Com este trabalho, pretende-se elaborar uma revisão completa e actual da definição, epidemiologia, etiologia, etiopatogenia, apresentação clínica, meios complementares de diagnóstico, tratamento e prognóstico da síndrome do conflito femoro-acetabular. Desenvolvimento...

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

    DEFF Research Database (Denmark)

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

    2016-01-01

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

  15. CHOICE OF SURGICAL APPROACH FOR ACETABULAR COMPONENT’S IMPLANTATION USING CURRENT CLASSIFICATION FOR ARTHRITIS FOLLOWING ACETABULAR FRACTURE

    Directory of Open Access Journals (Sweden)

    R. M. Tikhilov

    2011-01-01

    Full Text Available Degenerative-dystrophic changes in hip after treatment of acetabular fracture, over the time, develops about in 60% of affected people. In such cases, total hip replacement is used. Existing classifications (for example AO or Letournel are good for fracture treatment, but not for arthritis following acetabular fracture. The group of patients, with post traumatic arthritis, is heterogeneous with severity of post traumatic anatomic changes. Basis for surgical approach, could be current classification for post traumatic changes – taking into account features of anatomic functional changes in hip and the bone defects of acetabulum. In this article is demonstrated X-ray and clinical basing for current classification.

  16. Acetabular Retroversion, but Not Increased Acetabular Depth or Coverage, in Slipped Capital Femoral Epiphysis: A Matched-Cohort Study.

    Science.gov (United States)

    Hesper, Tobias; Bixby, Sarah D; Kim, Young-Jo; Yen, Yi-Meng; Bowen, Garrett; Miller, Patricia; Millis, Michael B; Novais, Eduardo N

    2017-06-21

    Femoral head overcoverage by a deep and retroverted acetabulum has been postulated as a mechanical factor in slipped capital femoral epiphysis (SCFE). We assessed acetabular depth, coverage, and version in the hips of patients with unilateral SCFE; in the contralateral, uninvolved hips; and in healthy control hips. Thirty-six patients affected by unilateral SCFE were matched to 36 controls on the basis of sex and age. The acetabular depth-width ratio (ADR), the lateral center-edge angle (LCEA), the anterior and posterior acetabular sector angle (ASA), and version (10 mm distal to the highest point of the acetabular dome and at the level of the femoral head center) were assessed on computed tomography (CT). A repeated-measures analysis of variance was used to assess differences among the SCFE, contralateral, and matched-control hips. Pairwise comparisons were conducted using Bonferroni correction for multiple comparisons. The mean coronal ADR was significantly lower in the hips affected by SCFE (311.6) compared with the contralateral hips (336.1) (p = 0.001) but did not differ from that of controls (331.9) (p = 0.08). The mean LCEA was significantly lower in the SCFE hips (29.8°) compared with the contralateral hips (33.7°) (p femoral head center was also observed in the SCFE hips compared with the contralateral hips (13.9° versus 15.5°; p = 0.04) and compared with controls (13.9° versus 16.0°; p = 0.045). No significant difference (p > 0.05) in acetabular measurements was observed between the contralateral and control hips. In SCFE, the acetabulum has reduced version but is not deeper, nor is there acetabular overcoverage. Additional longitudinal studies will clarify whether acetabular retroversion is a primary abnormality influencing the mechanics of SCFE development or an adaptive response to the slip. Our data suggest that the contralateral, uninvolved hip in patients with unilateral SCFE has normal acetabular morphology. Prognostic Level III. See

  17. Acetabular Wall Indices Help to Distinguish Acetabular Coverage in Asymptomatic Adults With Varying Morphologies.

    Science.gov (United States)

    Anderson, Lucas A; Anderson, Mike B; Erickson, Jill A; Chrastil, Jesse; Peters, Christopher L

    2017-04-01

    The anterior wall index (AWI) and posterior wall index (PWI) have been proposed to quantify anterior and posterior acetabular coverage using AP pelvic radiographs. However, these indices have only been reported in symptomatic patients with apparent pathomorphologies (dysplasia, overcoverage, and retroversion) undergoing osteochondroplasty or reorientation osteotomy. (1) What are the ranges for AWI and PWI from measurements obtained on AP pelvic radiographs of asymptomatic senior athletes with well-functioning hips? (2) Is there a difference between the AWI and PWI in asymptomatic athletes with acetabular morphology consistent with acetabular dysplasia, overcoverage, and retroversion when compared with asymptomatic hips that do not meet the radiographic definitions for those morphologies (controls)? Five hundred five athletes (998 asymptomatic native hips) were independently evaluated by two readers on AP pelvic radiographs for AWI and the PWI after excluding hips with prior surgery, inadequate radiographs, or poor function (modified Harris hip score  38°. The mean age of the athletes was 67 years (range, 50-91 years) and 55% were men. Linear generalized estimating equation regression was used to compare each individual diagnosis (DDH, retroversion, overcoverage) with the controls for both AWI and PWI adjusting for age and sex. The mean AWI in the study population was 0.36 (range, -0.02 to 0.91). The mean PWI was 1.13 (range, 0.12-1.74). The mean AWI and PWI in controls (n = 740) was 0.35 (range, -0.02 to 0.91) and 1.13 (range, 0.64-1.70), respectively. There were 25 (3%) with DDH in whom the mean AWI was 0.26 (range, 0.05-0.5) and the mean PWI was 1.03 (range, 0.71-1.3). There were 112 (11%) retroverted hips in whom the mean AWI was 0.42 (range, 0.1-0.89) and PWI was 1.02 (range, 0.61-1.5). There were 121 (12%) overcovered hips in whom the mean AWI was 0.43 (range, -0.18 to 0.85) and PWI was 1.22 (0.12-1.74). The AWI in the control hips was no different than

  18. Acute pulmonary embolism after arthroscopic glenoid labral repair and subacromial decompression: case report and review of the literature.

    Science.gov (United States)

    Yagnatovsky, Michelle; Dai, Amos Z; Zacchilli, Michael; Jazrawi, Laith M

    2018-02-01

    This report describes the case of a 29 year-old female with a history of polycystic ovary syndrome (PCOS) and on combined oral contraceptives who presents with an acute, CT confirmed pulmonary embolus of the right lower lobe, one week following arthroscopic labral repair of the right shoulder. This patient's relevant risk factors including obesity, oral contraceptive use, PCOS, and surgical positioning are discussed. Literature surrounding venous thromboembolism (VTE) following shoulder arthroscopy is also reviewed.

  19. High-energy pediatric pelvic and acetabular fractures

    NARCIS (Netherlands)

    Amorosa, Louis F.; Kloen, Peter; Helfet, David L.

    2014-01-01

    Pediatric pelvic and acetabular fractures are rare injuries. They are almost always the result of a high-energy injury mechanism. A full trauma protocol should be instituted, having a high index of suspicion for associated life-threatening injuries. In the past, it was recommended that almost all of

  20. Acetabular Fracture Fixation in an Adult with Fontan Physiology. A ...

    African Journals Online (AJOL)

    Acetabular Fracture Fixation in an Adult with Fontan Physiology. A Case Report. D Olabumuyi, R Taib, S Nair, C F Chong. Abstract. No Abstract. Nigerian Journal of Orthopaedics and Trauma Vol. 6 (2) 2007: pp. 80-82. Full Text: EMAIL FULL TEXT EMAIL FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT.

  1. Impaction bone grafting and a cemented cup after acetabular fracture

    NARCIS (Netherlands)

    Bronsema, E.; Stroet, M.A. Te; Zengerink, M.; Kampen, A. van; Schreurs, B.W.

    2014-01-01

    PURPOSE: Patients suffering from post traumatic osteoarthritis of the acetabulum often require a total hip arthroplasty at a relatively young age. Long-term data outcome studies for this population are lacking. We report on the long-term outcome of 20 acetabular fractures in 20 patients treated with

  2. Intertrochanteric osteotomy for posttraumatic arthritis after acetabular fractures

    NARCIS (Netherlands)

    Marti, R. K.; Chaldecott, L. R.; Kloen, P.

    2001-01-01

    To evaluate the long-term results of intertrochanteric osteotomies for posttraumatic arthritis after acetabular fractures. Retrospective study of eight patients who underwent a total of ten intertrochanteric osteotomies. Two patients underwent two osteotomies of the same hip. Academic Level I trauma

  3. Arthroscopic suture anchor capsulorrhaphy versus labral-based suture capsulorrhaphy in a cadaveric model.

    Science.gov (United States)

    Gillis, Robert C; Donaldson, Christopher T; Kim, Hyunchul; Love, James M; Dreese, James C

    2012-11-01

    The purpose of this study was to establish whether suture anchor capsulorrhaphy (SAC) is biomechanically superior to suture capsulorrhaphy (SC) in the management of recurrent anterior shoulder instability without a labral avulsion. Twelve matched pairs of shoulders were randomized to either SC or SAC. Specimens were mounted in 60° of abduction and 90° of external rotation. Testing was conducted on an MTS servohydraulic load testing device (MTS, Eden Prairie, MN). A compressive load of 22 N was applied, followed by a 2-N anterior and posterior force to establish a 0 point. Translation with 10-N anterior and posterior loads was recorded for baseline laxity measurement. Arthroscopic capsulorrhaphy was performed with either 3 solitary sutures or 3 suture anchors. Specimens were remounted and returned to the 0 point. Translation was measured with 10-N anterior and posterior loads to determine reduction in translation. Specimens were then loaded to failure to the 0 point at a rate of 0.1 mm/s. Load to failure was significantly greater (P = .02) in the SC group (13.6 ± 1.0 N) versus the SAC group (20.5 ± 2.8 N). No differences were found between SC (2.7 ± 0.7 mm) and SAC (2.3 ± 0.6 mm) when we compared reduction of anterior translation with a 10-N load. The percent reduction of anterior displacement with a 10-N load was similar for the SC (49.9%) and SAC (49.6%) groups. The dominant mode of failure in the study was suture pull-through of the capsular tissue. Our study indicates that labral-based SC and SAC similarly reduce anterior glenohumeral translation at low loading conditions. Load-to-failure studies indicate that SAC exhibits significantly greater resistance to translation at higher loading conditions. Our study suggests that the use of a suture anchor when one is performing a capsulorrhaphy may provide biomechanical advantage at high loading conditions. Our study suggests that when one is performing capsulorrhaphy, the use of a suture anchor may provide

  4. Outcomes of revision arthroscopic type II superior labral anterior posterior repairs.

    Science.gov (United States)

    Park, SangDo; Glousman, Ronald E

    2011-06-01

    Outcomes of arthroscopic type II superior labral anterior posterior (SLAP) repairs have been reported with success. However, published data regarding outcomes of revision arthroscopic type II SLAP repairs are lacking. Outcomes of revision arthroscopic type II SLAP repairs are inferior to those of primary repairs. Case series; Level of evidence, 4. A retrospective chart review was performed to identify patients who had undergone revision arthroscopic type II SLAP repairs at our institution. Patients who underwent concomitant rotator cuff repairs or labral repairs for instability were excluded. Twelve patients were contacted, and the following outcome data were prospectively gathered: American Shoulder and Elbow Surgeons (ASES) score, patient satisfaction level, return to work, return to sports, and physical examination. Demographics and intraoperative report data were also collected from the charts. The mean age at the time of revision arthroscopic type II SLAP repairs was 32.6 years (range, 19-67 years) with a mean follow-up of 50.5 months (range, 8-81 months). There were 5 workers' compensation patients and 6 overhead athletes. Pain was the chief complaint at the time of initial and revision SLAP repairs. The mean ASES score was 72.5, patient satisfaction level was 6.4 (scale of 0-10), mean return to work was at 57.8% of the previous level, and mean return to sports was at 42.2% of the previous level. In overhead athletes, mean return to sports was at 41.3% of the previous level, and none of the 4 baseball players returned to preinjury level. The mean values for all outcome data and range of motion values were lower in workers' compensation patients. There were no reported complications, but 2 patients required additional arthroscopic surgeries. Arthroscopic revision type II SLAP repairs yield worse results than primary repairs as reported in the literature, with workers' compensation patients and overhead athletes doing especially worse. A larger prospective

  5. Association of peripheral vertical meniscal tears with anterior cruciate ligament tears

    Energy Technology Data Exchange (ETDEWEB)

    Vinson, Emily N.; Gage, Jeffrey A.; Lacy, Joe N. [Duke University Medical Center, Department of Radiology, Durham, NC (United States)

    2008-07-15

    The purpose of this article is to describe a type of meniscal tear seen on magnetic resonance (MR) imaging, the peripheral vertical tear, and to determine the prevalence of anterior cruciate ligament (ACL) tears in knees with this type of meniscal tear compared to knees with other types of meniscal tears. Following Institutional Review Board approval, a retrospective review of 200 knee MR examinations with imaging diagnoses of 'meniscal tear' was performed to assess the location and morphology of the meniscal tear, and to assess the status of the ACL. Nineteen peripheral vertical meniscal tears were identified in 17 patients, 14 of whom had acute ACL tears, prior ACL reconstruction, or chronic ACL deficiency. Three peripheral vertical tears were seen in the setting of a normal ACL. Of the 183 examinations with other types of meniscal tears, there were 17 cases with acute ACL tears, prior ACL reconstruction, or chronic ACL deficiency. The difference in the prevalence of ACL tear, reconstruction, or deficiency in knees with meniscal tears of the peripheral vertical type (82.4%) compared with the prevalence of ACL tear, reconstruction, or deficiency in knees with other types of meniscal tears (9.3%) was statistically significant (P < 0.001). The calculated specificity of the presence of peripheral vertical tear morphology in detecting an ACL injury in patients with meniscal tears was 98.2%. Peripheral vertical meniscal tears, particularly when involving the posterior horn, are highly associated with ACL tear, deficiency, or reconstruction. The finding of this type of tear on knee MR imaging should prompt close inspection of the ACL for evidence of acute or chronic injury, and its presence may help make the diagnosis of ACL tear in equivocal cases. (orig.)

  6. Acetabular Fractures in the Senior Population– Epidemiology, Mortality and Treatments

    Directory of Open Access Journals (Sweden)

    Reza Firoozabadi

    2017-03-01

    Full Text Available Background:Management of acetabular fractures in the senior population can be one of the most challenging injuries tomanage. Furthermore, treating surgeons have a paucity of information to guide the treatment in this patient population.The purpose of this study was to determine: (1 demographic and epidemiologic data, (2 mortality rates for nonoperativecompared to operative management at different time points, (3 common fracture configurations, and (4 fracture fixationstrategies in senior patients treated with acetabular fractures.Methods:Retrospective review of prospectively gathered data at a Level I trauma center over a five-year period. 1123acetabular fractures were identified. 156 of them were for patients over the age of 65 (average age of 78.Results:Falls and motor vehicle accidents accounted for the two most common mechanisms of injury. 82% of patientshad significant medical comorbidities. 51 patients (33% died within one year, in which 75% of them died within 90 daysof their acetabular fracture. 84% of the deceased patients, i.e. from the group of 51 patients, had non-operative treatment.For patients treated with traction alone, there was a 79% one-year mortality and 50% mortality rate within 90 days. Withinthe entire cohort, 70% had either an associated both-column (ABC or anterior column/posterior hemitransverse (AC/PHTfracture pattern. Fifty-seven patients (36.5% underwent open reduction and internal fixation using standard reductiontechniques and surgical implants via two main surgical exposures of ilioinguinal (69% and Kocher-Langenbeck (29%.Conclusion:Geriatric patients with acetabular fractures are uncommon accounting for only 14% of all acetabularfractures. Patients who undergo surgery show lower mortality rates. ABC and AC/PHT fracture patterns are the two mostcommon fracture patterns. Routine fixation constructs and implants can be used to manage these challenging fractures.Most patients are unable to return to their homes and

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

    Science.gov (United States)

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

    2016-01-01

    In cementless total hip arthroplasty, imageless computer-assisted navigation is usually used to register the anterior pelvic plane (APP). The accuracy of this method is influenced by the subcutaneous tissues overlying the registration landmarks. On the other hand, the acetabular center axis (ACA) is determined from the acetabular rim. Precise registration of the ACA is possible because of direct palpation using a pointer. Imageless navigation using the ACA usually targets patients with normal acetabular morphology. The aim of this study was to investigate the accuracy of imageless navigation using the ACA instead of the APP in patients with normal or deformed acetabular rims. The intraoperative cup position was compared with that obtained from the postoperative computed tomography (CT) images in 18 cases. The inclination angle derived from the navigation system was 3.4 ± 5.3 degrees smaller and the anteversion angle was 1.4 ± 3.1 degrees larger than those derived from the CT images. The inclination cup angle of the navigation system was significantly inferior to the true value, particularly in cases with large anterior osteophytes.

  8. Acetabular reduction osteotomy using surgical dislocation of the hip joint for treatment of a malunited acetabular fracture

    NARCIS (Netherlands)

    Haverkamp, D.; Luitse, J. S. K.; Eijer, H.

    2004-01-01

    Introduction: Acetabular fractures remain a challenge for the orthopedic and trauma surgeon, with frequently poor outcome in terms of pain and lack of motion and high rate of posttraumatic arthritis especially in badly reconstructed fractures where the anatomy was not restored. Surgical treatment of

  9. Software Simulation of Hot Tearing

    DEFF Research Database (Denmark)

    Andersen, S.; Hansen, P.N.; Hattel, Jesper Henri

    1999-01-01

    . With this additional information, the criteria can, for the first time, be used to their full potential.The purpose of this paper is to first give an introduction to a stress/strain simulation procedure that can be used in any foundry. Then, some results how to predict the hot cracking tendency in a casting are shown......The brittleness of a solidifying alloy in a temperature range near the solidus temperature has been recognised since the fifties as the mechanism responsible for hot tearing. Due to this brittlenes, the metal will crack under even small amounts of strain in that temperature range. We see these hot...... the solidification rate and the strain rate of the hot tear prone areas. But, until recently it was only possible to simulate the solidification rate, so that the criteria could not be used effectively.Today, with new software developments, it is possible to also simulate the strain rate in the hot tear prone areas...

  10. Tear gas: an epidemiological and mechanistic reassessment

    National Research Council Canada - National Science Library

    Rothenberg, Craig; Achanta, Satyanarayana; Svendsen, Erik R; Jordt, Sven‐Eric

    2016-01-01

    Deployments of tear gas and pepper spray have rapidly increased worldwide. Large amounts of tear gas have been used in densely populated cities, including Cairo, Istanbul, Rio de Janeiro, Manama (Bahrain), and Hong Kong...

  11. Acute Medial Plantar Fascia Tear.

    Science.gov (United States)

    Pascoe, Stephanie C; Mazzola, Timothy J

    2016-06-01

    A 32-year-old man who participated in competitive soccer came to physical therapy via direct access for a chief complaint of plantar foot pain. The clinical examination findings and mechanism of injury raised a concern for a plantar fascia tear, so the patient was referred to the physician and magnetic resonance imaging was obtained. The magnetic resonance image confirmed a high-grade, partial-thickness, proximal plantar fascia tear with localized edema at the location of the medial band. J Orthop Sports Phys Ther 2016;46(6):495. doi:10.2519/jospt.2016.0409.

  12. Performance Assessment of Arthroscopic Rotator Cuff Repair and Labral Repair in a Dry Shoulder Simulator.

    Science.gov (United States)

    Dwyer, Tim; Schachar, Rachel; Leroux, Tim; Petrera, Massimo; Cheung, Jeffrey; Greben, Rachel; Henry, Patrick; Ogilvie-Harris, Darrell; Theodoropoulos, John; Chahal, Jaskarndip

    2017-07-01

    To evaluate the use of dry models to assess performance of arthroscopic rotator cuff repair (RCR) and labral repair (LR). Residents, fellows, and sports medicine staff performed an arthroscopic RCR and LR on a dry model. Any prior RCR and LR experience was noted. Staff surgeons assessed participants by use of task-specific checklists, the Arthroscopic Surgical Skill Evaluation Tool (ASSET), and a final overall global rating. All procedures were video recorded and were scored by a fellow blinded to the year of training of each participant. A total of 51 participants and 46 participants performed arthroscopic RCR and LR, respectively, on dry models. The internal consistency or reliability (Cronbach α) using the total ASSET score for the RCR and LR was high (>0.9). One-way analysis of variance for the total ASSET score showed a difference between participants based on year of training (P 0.9) for both procedures. A good correlation was seen between the ASSET score and the year of training, as well as the previous number of sports rotations. The results of this study show evidence of construct validity when using dry models to assess performance of arthroscopic RCR and LR by residents. The results of this study support the use of arthroscopic simulation in the training of residents and fellows learning arthroscopic shoulder surgery. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  13. Aumento acetabular pela técnica de Stahelli modificada Acetabular increase with modified Stahelli technique

    Directory of Open Access Journals (Sweden)

    Sílvio Pereira Coelho

    2000-09-01

    Full Text Available Os autores apresentam neste trabalho um estudo retrospectivo realizado em 18 pacientes submetidos a tratamento cirúrgico de insuficiência acetabular pela osteotomia da pelve seguindo a técnica descrita por Lynn T. Staheli. Enfatizam a modificação da técnica deste autor, com a introdução do enxerto ósseo, retirado da tábua externa do ilíaco, numa fenda aprofundada até cerca da cortical interna do ilíaco. Os pacientes foram acompanhados através de consultas ambulatoriais previamente a cirurgia e pós-operatoriamente com seguimento que variou de 2 meses a 4 anos no serviço de ortopedia infantil do Hospital Independência - Complexo Hospitalar ULBRA/Porto Alegre-RS. O objetivo do trabalho foi avaliar o quadril acometido pré e pós-operatoriamente, demonstrando a evolução e vantagens da variação da técnica de Staheli desenvolvida neste serviço. Observou-se que a cirurgia, se realizada sob técnica adequada e em mãos experientes, torna-se uma fonte válida de tratamento para aquelas patologias que levam a uma insuficiente cobertura da cabeça femoral.The authors present in this paper a retrospective study of eighteen patients treated surgically for insufficiency of the acetabular coverage with the shelf procedure according to Lynn T. Staheli. This study was done at the Service of Pediatric Orthopedics of Hospital Independência - Complexo Hospitalar ULBRA/Porto Alegre-RS. They call attention to the modification of the surgical technique in that the bone graft taken from outer cortex of the iliac bone, is deepened in the slot in the superior rim of the acetabulum. The follow-up ranged from two months to four years. The aim of this paper was to evaluate the affected hip pre and postoperatively showing the results and the advantages of the modified shelf technique. They observed that if the surgery is performed according to the correct technique and by an experienced surgeon, it is a very good alternative to the treatment of those

  14. Acetabular Cup Abduction Angle Determined by Digital Radiographic Software as Compared to CT-Based Measurement

    Directory of Open Access Journals (Sweden)

    Eytan M Debbi

    2014-12-01

    Full Text Available Aim: Measurement of the acetabular cup orientation is critical in patients after total hip arthroplasty (THA. One important measurement is the acetabular abduction angle. The purpose of the present study was to compare the measurements of the acetabular abduction angle using radiographic analysis software with the measurements made by computed tomography (CT analysis software. Methods: CT scans and radiograph exams were performed on 150 patients after THA. The acetabular abduction angle was measured from CT using CT-based image analysis software and from radiographs using the dedicated measurement tools of digital radiographic software. Results: The two measurement systems showed no significant difference in the calculation of the acetabular abduction angle (0.35±5.41°; p=0.425 and a moderate correlation was found between the two methods (r=0.619; p<0.001. Discussion: Digital radiographic software provides an accurate and precise measurement of the acetabular abduction angle.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2015-11-15

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

  16. Modified Harrington Procedure for Acetabular Insuficiency Due to Metastatic Malignant Disease

    Directory of Open Access Journals (Sweden)

    WI Faisham

    2009-05-01

    Full Text Available Extensive peri-acetabular osteolysis caused by malignant disease process is a major surgical challenge as conventional hip arthroplasty is not adequate. We describe a modified use of the Harrington procedure for acetabular insufficiency secondary to metastatic disease in twelve patients. The procedures include application of multiple threaded pins to bridge the acetabular columns, anti-protrusio cage and cemented acetabular cup. Eleven patients were able to walk pain free and achieved a mean Musculoskeletal Tumour Society Functional Score of 80 (range, 68 to 86.

  17. Profile Measurement of Worn Acetabular Cup by Holographic Contouring

    Science.gov (United States)

    Kakunai, Satoshi; Sakamoto, Tohoru; Sakurai, Daisuke; Aota, Yuuki; Shelton, Julia

    Wear in a polyethylene acetabular cup is dependent on the history of the cup, namely on the sterilization treatment, initial mounting situation, the patient's lifestyle and length of time in vivo. Understanding wear patterns is essential in order to prevent inflammation and prosthesis failure. This study describes the profile measurement of a worn acetabular cup by holographic contouring, which can provide non-contact measurement over the entire visual field. Experiments were performed to verify the method, and measurements of cups worn in vivo were carried out. Cup profile was investigated using holograms obtained in three directions and changes in cup profile were evaluated using fringe patterns in which the interval range was adjusted from tens of microns to several millimeters.

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

    Energy Technology Data Exchange (ETDEWEB)

    Kuhlman, J.E.; Fishman, E.K.; Ney, D.R.; Brooker, A.F. Jr.; Magid, D.

    1989-01-01

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

  19. Acetabular Version Increases After Closure of the Triradiate Cartilage Complex.

    Science.gov (United States)

    Albers, Christoph E; Schwarz, Andrea; Hanke, Markus S; Kienle, Karl-Philipp; Werlen, Stefan; Siebenrock, Klaus A

    2017-04-01

    Although the etiology of primary femoroacetabular impingement (FAI) is considered developmental, the underlying pathogenic mechanisms remain poorly understood. In particular, research identifying etiologic factors associated with pincer FAI is limited. Knowledge of the physiologic growth patterns of the acetabulum during skeletal maturation might allow conclusions on deviations from normal development that could contribute to pincer-related pathomorphologies. In a population of healthy children, we asked if there were any differences related to skeletal maturation with regard to (1) acetabular version; (2) acetabular depth/width ratio; and (3) femoral head coverage in the same children as assessed by MRIs obtained 1 year apart. We prospectively compared 129 MRIs in 65 asymptomatic volunteers without a known hip disorder from a mixed primary/high school population (mean age, 12.7 years; range, 7-16 years). All participants underwent two MRI examinations separated by a minimum interval of 1 year. Based on the status of the triradiate cartilage complex (open versus closed [TCC]), all hips were allocated to the following groups: "open-open" = open TCC at both MRIs (n = 45 hips [22 bilateral]); "open-closed" = open TCC at initial and closed TCC at followup MRI (n = 26 hips [13 bilateral]); and "closed-closed" group = closed TCC at both MRIs (n = 58 hips [29 bilateral]). We assessed acetabular version in the axial plane at five different locations (5, 10, 15, 20 mm below the acetabular dome and at the level of the femoral head) as well as three-dimensional (3-D) acetabular depth/width ratio and 3-D femoral head coverage on six radial MRI sequences oriented circumferentially around the femoral neck axis. Using analysis of variance for multigroup comparisons with Bonferroni adjustment for pairwise comparisons, we compared the results between the initial and followup MRI examinations and among the three groups. Acetabular version was increased in hips of

  20. Late sciatic nerve axonotmesis following acetabular reconstruction plate.

    Science.gov (United States)

    Moreta, J; Foruria, X; Labayru, F

    2016-01-01

    Sciatic nerve injuries associated with acetabular fractures can be post-traumatic, perioperative or postoperative. Late postoperative injury is very uncommon and can be due to heterotopic ossifications, muscular scarring, or implant migration. A case is presented of a patient with a previous transverse acetabular fracture treated with a reconstruction plate for the posterior column. After 17 years, she presented with progressive pain and motor deficit in the sciatic territory. Radiological and neurophysiological assessments were performed and the patient underwent surgical decompression of the sciatic nerve. A transection of the nerve was observed that was due to extended compression of one of the screws. At 4 years postoperatively, her pain had substantially diminished and the paresthesias in her leg had resolved. However, her motor symptoms did not improve. This case report could be relevant due to this uncommon delayed sciatic nerve injury due to prolonged hardware impingement. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

  1. Effects of tear size and location on predictions of supraspinatus tear propagation.

    Science.gov (United States)

    Miller, R Matthew; Thunes, James; Musahl, Volker; Maiti, Spandan; Debski, Richard E

    2018-02-08

    Rotator cuff tears remain a significant clinical problem with a high incidence rate and severe clinical burden. Previous computational models developed to study rotator cuff tears have not modeled tissue damage and tear propagation. The objective of this study was to predict tear propagation for various combinations of tear size and location using an experimentally validated finite element model of supraspinatus tendon. It was hypothesized that larger rotator cuff tears propagate at lower loads than smaller tears, and that posterior tears require higher loads to propagate than anterior tears. Using a previously validated computational model of supraspinatus tendon, tears of size 0.5-1.5 cm were introduced to the tendon geometry in the anterior, middle, and posterior tendon thirds. Cohesive elements were assigned subject-specific failure properties and used to model tissue damage and tear propagation. A displacement of 5 mm was applied to the medial tendon edge to induce tear propagation. Model outputs included critical load required to propagate the tear, and principal stress and maximum principal strain at the anterior and posterior tear tips. For all tear sizes, posterior tears required the highest loads to propagate (247-567 N). Anterior tears generally required the least load to propagate (171-280 N). Stress and strain were larger on the articular side (maximum 33.9% articular strain vs 27.8% bursal strain). Overall, larger tears located in the anterior supraspinatus tendon that interrupt the rotator cable are most at risk for tear propagation, and should be carefully followed by clinicians when considering treatment options. Copyright © 2017 Elsevier Ltd. All rights reserved.

  2. Comparison of tear lipid profile among basal, reflex, and flush tear samples.

    Science.gov (United States)

    Rohit, Athira; Stapleton, Fiona; Brown, Simon H J; Mitchell, Todd W; Willcox, Mark D P

    2014-12-01

    To determine whether tear collection by flushing the ocular surface with saline (flush tears) or collection by stimulation (reflex tears) can be used as an alternative to basal tear collection for the identification and quantification of lipids in the tear film. Tear samples were collected from 10 participants with no history of ocular surface disease or contact lens wear. Up to 10 μl of basal, reflex, and flush tear samples were collected from each eye using a microcapillary tube on three occasions with the order of methods randomized and allowing at least 24 hours between each collection method. Lipids were quantified from each tear sample using nano-electrospray ionization tandem mass spectrometry. Total lipids significantly differed in their concentration (pmol/μl) and mole % with each collection technique. Cholesterol esters [mean % (SE)] formed the major component of the total lipidome in basal [54.8% (3.1)], reflex [35.7% (6.4)], and flush [33.0% (3.1)] tear samples. However, the mole % of each lipid class substantially varied with each tear collection method. Nonpolar lipids, including cholesterol, wax esters, and triacylglycerols, dominated the tear lipidome in basal [92.8% (1.9)], reflex [71.8% (7.9)], and flush [83.6% (3.8)] tear samples. However, the mole % of phospholipids in reflex [27.5% (8.1)] and flush [15.8% (3.8)] tear samples was higher (p = 0.005) than that in basal tears [5.4% (2.0)]. Flush or reflex tears did not have similar lipid profiles in either concentration or in mole % to basal tears. It is recommended that basal tears are used for tear lipid analysis as the reflex or flush tears contain very low levels of most lipid components.

  3. Cheating the Acetabular Component Horizontally in Total Hip Arthroplasty.

    Science.gov (United States)

    Eskildsen, Scott M; Moskal, Peter T; Olcott, Christopher W; Del Gaizo, Daniel J

    2016-11-01

    To avoid inadvertent vertical positioning of the acetabular component during total hip arthroplasty (THA), the authors routinely "cheat" component abduction an additional 10° horizontal (goal=30°). This likely increases the incidence of components placed into abduction of less than 30°, the clinical consequences of which are not well studied. The purpose of this study was to determine the clinical and radiographic outcomes in patients undergoing THA with acetabular components positioned in less than 30° of abduction as compared with those with components positioned between 30° and 50°. A retrospective review was performed of consecutive patients undergoing primary THA with horizontally cheated acetabular component position performed by a single surgeon. Patients were grouped into cohorts with either component abduction less than 30° or between 30° and 50°. Demographic data, operative data, and complications were recorded. Harris Hip Scores (HHS) and radiographic analysis were obtained from preoperative and most recent clinic visits. Between September 2004 and September 2010, 320 consecutive THA procedures were performed. A total of 149 hips had component abduction less than 30° (mean, 25.8°; range, 15.7°-29.4°). No components had greater than 50° of abduction. At an average 37-month follow-up, no significant difference in HHS was found between the 2 cohorts (P=.137). The horizontal cohort had no dislocations, component loosening, or osteolysis. By cheating the acetabular component more horizontal, an excessively vertical position was avoided. Component abduction less than 30° yielded equivalent clinical outcomes to component abduction between 30° and 50°. [Orthopedics. 2016; 39(6):e1092-e1096.]. Copyright 2016, SLACK Incorporated.

  4. Multiplanar and 3D CT of acetabular fractures

    Energy Technology Data Exchange (ETDEWEB)

    Haveri, M.; Suramo, I.; Laehde, S. [Oulu Univ., Dept. of Diagnostic Radiology (Finland); Junila, J. [Oulu Univ., Dept. of Orthopaedic Surgery (Finland)

    1998-05-01

    Purpose: To establish a standard protocol for the multiplanar (MPR) and 3D shaded surface display (SSD) reconstruction of CT data on acetabular fractures, and to assess the usefulness of these reformats. Material and Methods: Acetabular fractures in 15 patients were imaged by means of plain radiographs, transaxial CT, MPR reformats, and SSD reformats. Results: The classification of the acetabular fracture was revised in 7/15 cases when the transaxial CT images were read after the plain radiographs. Although the MPR and SSD reformats did not alter the classification, they did add to the degree of confidence in the diagnosis in 9/15 cases. In 2 patients, the MPR and SSD reformats indicated operative instead of conservative treatment. In the MPR reformats, the following views were considered essential in all cases: (a) along the anterior column; (b) along the posterior column; and (c) along both columns and the inferior ramus. In the SSD reformats, the following views were considered essential in all cases: (d) the latero-caudal en face view into the acetabulum; and 180 opposite to this, (e) the medio-cranial view (facing the quadrilateral plate). In 10/15 cases, these views were all that was needed for classification. It was, however, essential to remove the femur from the images before reconstructing the SSD views. Conclusion: Complex acetabular fractures with displacement should be evaluated by means of transaxial CT and additional MPR and SSD reformats. The use of appropriate standard MPR and SSD views shortens the time required to produce the reformats and thereby maximizes the benefit gained. (orig.).

  5. Pelvic Incidence and Acetabular Version in Slipped Capital Femoral Epiphysis.

    Science.gov (United States)

    Gebhart, Jeremy J; Bohl, Michael S; Weinberg, Douglas S; Cooperman, Daniel R; Liu, Raymond W

    2015-09-01

    The etiology of slipped capital femoral epiphysis (SCFE) is multifactorial, but the role of sagittal balance of the pelvis as a contributing factor to its development has not been well studied. Our primary purpose was to determine whether a smaller pelvic incidence (PI), a position-independent anatomic parameter that regulates pelvic orientation, could be a factor that increases shear stress in the epiphyseal growth plate and potentially contributes to the development of SCFE. We also set out to determine whether acetabular retroversion was associated with SCFE. We obtained 14 cadaveric pelvi from the Hamann-Todd Osteological Collection whose femurs showed evidence of post-SCFE deformity. Two hundred age-matched, sex-matched, and race-matched pelvi were used as controls. PI and acetabular version were measured using standardized lateral photographs and goniometers, respectively. T tests were performed to evaluate for differences in measured parameters between groups. The mean PI was 40.6±6.1 degrees for SCFE specimens and 47.4±9.9 degrees for normal specimens (P=0.01). The mean version of SCFE and normal acetabula was 15±7 and 17±6 degrees, respectively (P=0.39). There was also no significant difference in version between SCFE acetabula and the contralateral, uninvolved acetabular of the same specimen (15±7 vs. 17±8 degrees, P=0.33). Specimens with SCFE deformity demonstrated a smaller PI than a large cohort of normal control specimens. We found no significant difference between acetabular version of specimens with and without SCFE deformity. Contralateral or unaffected acetabuli of SCFE specimens were not more retroverted than the affected side of the same specimen. Sagittal balance of the pelvis, and particularly decreased PI, may play an important role in the development of SCFE. The influence of mechanical factors beyond the hip joint in the development of SCFE should be considered by clinicians.

  6. [Biological downsizing : Acetabular defect reconstruction in revision total hip arthroplasty].

    Science.gov (United States)

    Koob, S; Scheidt, S; Randau, T M; Gathen, M; Wimmer, M D; Wirtz, D C; Gravius, S

    2017-02-01

    Periacetabular bony defects remain a great challenge in revision total hip arthroplasty. After assessment and classification of the defect and selection of a suitable implant the primary stable fixation and sufficient biological reconstitution of a sustainable bone stock are essential for long term success in acetabular revision surgery. Biological defect reconstruction aims for the down-sizing of periacetabular defects for later revision surgeries. In the field of biological augmentation several methods are currently available. Autologous transplants feature a profound osseointegrative capacity. However, limitations such as volume restrictions and secondary complications at the donor site have to be considered. Structural allografts show little weight bearing potential in the long term and high failure rates. In clinical practice, the usage of spongious chips implanted via impaction bone grafting technique in combination with antiprotrusio cages for the management of contained defects have shown promising long time results. Nevertheless, when dealing with craniolateral acetabular and dorsal column defects, the additional implantation of macroporous metal implants or augments should be considered since biological augmentation has shown little clinical success in these particular cases. This article provides an overview of the current clinically available biological augmentation methods of peri-acetabular defects. Due to the limitations of autologous and allogeneic bone transplants in terms of size and availability, the emerging field of innovative implantable tissue engineering constructs gains interest and will also be discussed in this article.

  7. Arthroscopic Labral Base Repair in the Hip: 5-Year Minimum Clinical Outcomes.

    Science.gov (United States)

    Domb, Benjamin G; Yuen, Leslie C; Ortiz-Declet, Victor; Litrenta, Jody; Perets, Itay; Chen, Austin W

    2017-10-01

    Arthroscopic labral base repair (LBR) in the hip is a previously described technique designed to restore the native functional anatomy of the labrum by reproducing its seal against the femoral head. LBR has been shown to have good short-term outcomes. Hypothesis/Purpose: The purpose was to evaluate clinical outcomes of an LBR cohort with a minimum 5-year follow-up. It was hypothesized that patients who underwent LBR would continue to have significant improvement from their preoperative scores and maintain scores similar to their 2-year outcomes. Case series; Level of evidence, 4. Data for patients undergoing primary hip arthroscopic surgery with LBR from February 2008 to May 2011 with a minimum 5-year follow-up were prospectively collected and retrospectively reviewed. Patients with preoperative Tonnis osteoarthritis grade ≥2, previous hip conditions (slipped capital femoral epiphysis, avascular necrosis, Legg-Calv-Perthes disease), severe dysplasia (lateral center-edge angle arthroscopic surgery rates were 10.9% (7/64) and 17.2% (11/64). At a minimum 5-year follow-up, arthroscopic LBR continued to be a successful procedure and valid technique based on 3 PROs, the VAS, patient satisfaction, and survivorship. Significantly improved outcome scores were maintained compared with preoperative values and showed no signs of deterioration from the 2-year scores. The long-term survivorship of hip arthroscopic surgery has yet to be determined; however, these midterm results demonstrate the rates of additional procedures (both secondary arthroscopic surgery and conversion to total hip arthroplasty), that may be necessary after 2 years.

  8. Efficacy of labral repair, biceps tenodesis, and diagnostic arthroscopy for SLAP Lesions of the shoulder: a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Mowinckel Petter

    2010-10-01

    Full Text Available Abstract Background Surgery for type II SLAP (superior labral anterior posterior lesions of the shoulder is a promising but unproven treatment. The procedures include labral repair or biceps tenodesis. Retrospective cohort studies have suggested that the benefits of tenodesis include pain relief and improved function, and higher patient satisfaction, which was reported in a prospective non-randomised study. There have been no completed randomised controlled trials of surgery for type II SLAP lesions. The aims of this participant and observer blinded randomised placebo-controlled trial are to compare the short-term (6 months and long-term (2 years efficacy of labral repair, biceps tenodesis, and placebo (diagnostic arthroscopy for alleviating pain and improving function for type II SLAP lesions. Methods/Design A double-blind randomised controlled trial are performed using 120 patients, aged 18 to 60 years, with a history for type II SLAP lesions and clinical signs suggesting type II SLAP lesion, which were documented by MR arthrography and arthroscopy. Exclusion criteria include patients who have previously undergone operations for SLAP lesions or recurrent shoulder dislocations, and ruptures of the rotator cuff or biceps tendon. Outcomes will be assessed at baseline, three, six, 12, and 24 months. Primary outcome measures will be the clinical Rowe Score (1988-version and the Western Ontario Instability Index (WOSI at six and 24 months. Secondary outcome measures will include the Shoulder Instability Questionnaire (SIQ, the generic EuroQol (EQ-5 D and EQ-VAS, return to work and previous sports activity, complications, and the number of reoperations. Discussion The results of this trial will be of international importance and the results will be translatable into clinical practice. Trial Registration [ClinicalTrials.gov NCT00586742

  9. Reduced tear meniscus dynamics in dry eye patients with aqueous tear deficiency.

    Science.gov (United States)

    Yuan, Yimin; Wang, Jianhua; Chen, Qi; Tao, Aizhu; Shen, Meixiao; Shousha, Mohamed Abou

    2010-06-01

    To measure the tear meniscus dynamics in aqueous tear deficiency dry eye patients using optical coherence tomography. Clinical research study of a laboratory technique. Twenty-five aqueous tear deficiency dry eye patients and 30 healthy subjects were recruited. Upper and lower tear menisci of 1 randomly selected eye of each participant were imaged during normal and delayed blinking using optical coherence tomography. Measured parameters included upper tear meniscus height and volume, lower tear meniscus height and volume, the blink outcome defined as the meniscus volume change during blink action, and open eye outcome defined as the meniscus volume change during the open eye period. During normal blinking, both tear meniscus height and volume before blink in dry eye patients were significantly smaller than those in healthy subjects, except for the upper tear meniscus volume. During normal blinking, the blink outcome and open eye outcome of lower tear meniscus were significantly smaller in dry eye patients compared with healthy subjects. During delayed blinking, the upper and lower tear menisci heights and volumes significantly increased in both groups. However, dry eye patients had smaller increases than healthy subjects. During delayed blinking, the open eye outcomes of upper and lower tear menisci were smaller in dry eye patients than healthy subjects. Dry eye patients seem to have reduced tear meniscus dynamics during normal blinking and smaller increases of meniscus volume during delayed blinking. Analysis of tear meniscus dynamics may provide more insight in the altered tear system in dry eye patients. Copyright 2010 Elsevier Inc. All rights reserved.

  10. Arthroscopic osteochondral autologous transplantation for the treatment of osteochondritis dissecans of the femoral head

    Directory of Open Access Journals (Sweden)

    Uchida Soshi

    2017-01-01

    Full Text Available Osteochondritis dissecans (OCD of the femoral head is an unusual cause of hip pain. It can be associated with other intra-articular pathologies including: acetabular labral tears or bone deformities such as Legg-Calve-Perthes Disease (LCPD. In this article, we propose a modern surgical technique using an arthroscopic antegrade and retrograde osteochondral autologous transplantation (OAT procedure for assessing and treating OCD lesions of the femoral head.

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

    Science.gov (United States)

    Harnroongroj, Thos; Riansuwan, Kongkhet; Sudjai, Narumol; Harnroongroj, Thossart

    2013-12-01

    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. 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. 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. 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.

  12. TFOS DEWS II Tear Film Report.

    Science.gov (United States)

    Willcox, Mark D P; Argüeso, Pablo; Georgiev, Georgi A; Holopainen, Juha M; Laurie, Gordon W; Millar, Tom J; Papas, Eric B; Rolland, Jannick P; Schmidt, Tannin A; Stahl, Ulrike; Suarez, Tatiana; Subbaraman, Lakshman N; Uçakhan, Omür Ö; Jones, Lyndon

    2017-07-01

    The members of the Tear Film Subcommittee reviewed the role of the tear film in dry eye disease (DED). The Subcommittee reviewed biophysical and biochemical aspects of tears and how these change in DED. Clinically, DED is characterized by loss of tear volume, more rapid breakup of the tear film and increased evaporation of tears from the ocular surface. The tear film is composed of many substances including lipids, proteins, mucins and electrolytes. All of these contribute to the integrity of the tear film but exactly how they interact is still an area of active research. Tear film osmolarity increases in DED. Changes to other components such as proteins and mucins can be used as biomarkers for DED. The Subcommittee recommended areas for future research to advance our understanding of the tear film and how this changes with DED. The final report was written after review by all Subcommittee members and the entire TFOS DEWS II membership. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Posterior root tears of the lateral meniscus.

    Science.gov (United States)

    Feucht, Matthias J; Salzmann, Gian M; Bode, Gerrit; Pestka, Jan M; Kühle, Jan; Südkamp, Norbert P; Niemeyer, Philipp

    2015-01-01

    To summarize and discuss the current knowledge on posterior lateral meniscus root tears. A comprehensive review of the MEDLINE database was carried out to identify relevant articles using different keywords (e.g. "meniscus root", "root tear", "meniscus avulsion", "radial tear" and "lateral meniscus"). The reference lists of the reviewed articles were searched for additional relevant articles. Posterior lateral meniscus root tears are found in 7-12% of patients with a tear of the anterior cruciate ligament (ACL). Biomechanical studies have found an increase in lateral compartment contact pressure of approximately 50% after creation of a posterior lateral meniscus root tear. There is some evidence that the biomechanical consequences of these injuries are significantly influenced by the presence and integrity of the meniscofemoral ligaments. Clinical studies have found encouraging results after repair of posterior lateral meniscus root tears. Whether root repair can prevent the development of osteoarthritis is currently unknown. A posterior lateral meniscus root tear is a clinical relevant but most likely underrecognized concomitant injury in patients with a tear of the ACL. This article may support clinicians in diagnosing and treating this unique type of meniscus tear. V.

  14. Artificial tears potpourri: a literature review

    Directory of Open Access Journals (Sweden)

    Moshirfar M

    2014-07-01

    Full Text Available Majid Moshirfar,1 Kasey Pierson,2,* Kamalani Hanamaikai,3,* Luis Santiago-Caban,1 Valliammai Muthappan,1 Samuel F Passi11Department of Ophthalmology, John A Moran Eye Center, University of Utah, Salt Lake City, UT, USA; 2University of Arizona College of Medicine, Phoenix, Phoenix, AZ, USA; 3A T Still University, School of Osteopathic Medicine in Arizona, Mesa, AZ, USA *These authors contributed equally to this work Abstract: Numerous brands and types of artificial tears are available on the market for the treatment of dysfunctional tear syndrome. Past literature has focused on comparing the components of these products on patient’s clinical improvement. The wide array of products on the market presents challenges to both clinicians and patients when trying to choose between available tear replacement therapies. Different formulations affect patients based on etiology and severity of disease. In order to provide an unbiased comparison between available tear replacement therapies, we conducted a literature review of existing studies and National Institutes of Health clinical trials on commercially available, brand name artificial tears. Outcomes evaluated in each study, as well as the percent of patients showing clinical and symptomatic improvement, were analyzed. Fifty-one studies evaluating different brands of artificial tears, and their efficacy were identified. Out of the 51 studies, 18 were comparison studies testing brand name artificial tears directly against each other. Nearly all formulations of artificial tears provided significant benefit to patients with dysfunctional tear syndrome, but some proved superior to others. From the study data, a recommended treatment flowchart was derived. Keywords: dry eye, tear film, dysfunctional tear syndrome, ophthalmic lubricant, artificial tears, lipid layer, tear osmolarity, TBUT, Systane®, Refresh®, Blink®, GenTeal®, Soothe®, Lacrisert®, ocular surface inflammatory disease, Sjogren

  15. Acetabular roof stress fracture: a rare cause of hip pain in children ...

    African Journals Online (AJOL)

    Stress fracture of acetabular roof is an unusual cause of hip pain. It is considered as an underdiagnosed entity. People who are more susceptible to experience this fracture are athletes, soldiers and dancers. We present the case of an 11 year old girl with a roof acetabular stress fracture for which the diagnosis and ...

  16. Outcome of peri-acetabular osteotomy for hip dysplasia in teenagers.

    Science.gov (United States)

    Sakamoto, Tetsuya; Naito, Masatoshi; Nakamura, Yoshinari

    2015-11-01

    Peri-acetabular osteotomy, especially curved peri-acetabular osteotomy, is an effective surgical procedure for re-orientating the acetabulum. However, there have been few reports on this procedure in teenagers. The purpose of this study was to investigate the treatment outcomes of curved peri-acetabular osteotomy in teenagers. We retrospectively reviewed 33 hips in 27 teenage patients with acetabular dysplasia who underwent curved peri-acetabular osteotomy between 1995 and 2012. The mean age was 17.0 years (range, 14-19 years). The mean follow-up duration at the most recent physical examination was 33.3 months (range, 24-96 months). All hips were evaluated in terms of the Harris hip score, radiographic measurements, and complications. The mean Harris hip score improved from 80.1 points pre-operatively to 95.4 points post-operatively (p teenagers.

  17. Pelvic Discontinuity Caused by Acetabular Overreaming during Primary Total Hip Arthroplasty

    Directory of Open Access Journals (Sweden)

    Iori Takigami

    2011-01-01

    Full Text Available Intraoperative acetabular fracture is a rare complication of primary total hip arthroplasty (THA, typically occurring during impaction of the cementless acetabular component. Here we report an unusual case of pelvic discontinuity caused by overreaming of the acetabulum during primary THA. Restoration of posterior columnar continuity was achieved with an autologous fibular graft and a reconstruction plate. Wall defects and cavitary defects were reconstructed with metal mesh and femoral head allograft, followed by placement and fixation of a Kerboull-type acetabular reinforcement device. Previous reports of acetabular fracture during THA have indicated that it has a relatively good prognosis without extensive treatment. However, to our knowledge, there has been no report of pelvic discontinuity necessitating acetabular reconstruction surgery as an intraoperative complication of primary THA.

  18. Repeated measurements of dynamic tear distribution on the ocular surface after instillation of artificial tears.

    Science.gov (United States)

    Wang, Jianhua; Aquavella, James; Palakuru, Jayachandra; Chung, Suk

    2006-08-01

    To determine the repeatability of real-time optical coherence tomography (OCT) measurements of tear film thickness (TFT) and variables of tear film menisci. Forty eyes were imaged with a custom-built, real-time OCT to obtain heights, curvatures, and cross-sectional areas of upper and lower tear menisci simultaneously. The central TFT was indirectly determined as the difference between the combined thickness of the central cornea and tear film and the true corneal thickness obtained after instillation of artificial tears. Dynamic tear distribution was determined by OCT imaging immediately and 5, 20, 40, and 60 minutes after tear instillation. Measurements taken after two blinks of one eye at each visit were repeated on the next day. Measurements from the companion eye were made on separate days. There were no significant differences between the two measurements of each variable made on consecutive days. At baseline, upper tear meniscus variables were strongly correlated with the comparable lower meniscus variables. However, there were no significant correlations between TFT and any tear meniscus variable. Immediately after instillation of artificial tears, all measured variables increased significantly. TFT, upper and lower menisci heights, and upper meniscus area remained elevated for at least 5 minutes. In addition there were significant correlations between TFT and the lower tear meniscus height and area. The custom-built OCT showed good repeatability and holds promise in measuring the dynamic distribution of artificial tears on the ocular surface.

  19. Diagnostics of femoroacetabular impingement and labral pathology of the hip: a systematic review of the accuracy and validity of physical tests

    NARCIS (Netherlands)

    Tijssen, M.P.W.; Cingel, R. van; Willemsen, L.; Visser, E. de

    2012-01-01

    PURPOSE: Femoroacetabular impingement (FAI) and labral pathology have been recognized as causative factors for hip pain. The clinical diagnosis is now based on MRI-A (magnetic resonance imaging-arthrogram) because the physical diagnostic tests available are diverse and information on diagnostic

  20. Outcome of alternative approach to displaced acetabular fractures.

    Science.gov (United States)

    Park, K S; Chan, C K; Lee, G W; Ahn, H W; Yoon, T R

    2017-02-01

    Anatomical reduction of displaced acetabular fracture is not without its' limitations and complications. This study is conducted to assess clinical and radiological outcomes as well as complications of treating displaced acetabular fractures with emphasis on anatomical reduction in weight-bearing area, mainly the posterior column, and imperfect reduction of the anterior column is acceptable. However, stability of both columns is mandatory. It was a retrospective study carried out in a Level 1 arthroplasty and trauma centre. 23 patients (17 males, 6 females) with average age of 50.1 years (range, 36-68 years) with displaced acetabular fracture treated with combined incisions and plate-cable systems were included. There were 3 elementary and 18 associated fractures according to Letournel classification. Average follow-up was 23.5 months (range, 12-38.7 months). Mean operation time was 160min (range: 75-320min). Functional scores were evaluated using Harris Hip Score (HHS) whilst reduction was assessed by Matta criteria. Any displacement of reduction, osteoarthritis, heterotopic ossification, and other complications was recorded. 65.2% (15/23) of the patients obtained excellent HHS and 21.7% (5/23) had good HHS. There were 12 anatomical, 6 imperfect, and 5 poor reductions. No displacement was recorded in final follow-up. Complications documented: three lateral femoral cutaneous nerve injuries, two conversions to total hip arthroplasty, three Brooker stage 1 heterotrophic ossification, one pulmonary embolism and one screw irritation. No incidence of wound breakdown, infection and radiological osteoarthritis was reported. Imperfect reduction of the anterior column provided clinical outcomes that are as good as total anatomical reduction. This approach minimizes soft tissue damage and reduces perioperative morbidities. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. Trabecular metal acetabular components in primary total hip arthroplasty

    DEFF Research Database (Denmark)

    Laaksonen, Inari; Lorimer, Michelle; Gromov, Kirill

    2018-01-01

    Background and purpose - Trabecular metal (TM) cups have demonstrated favorable results in acetabular revision and their use in primary total hip arthroplasty (THA) is increasing. Some evidence show that TM cups might decrease periprosthetic infection (PPI) incidence. We compared the survivorship...... of TM cups with that of other uncemented cups in primary THA, and evaluated whether the use of TM cups is associated with a lower risk of PPI. Patients and methods - 10,113 primary THAs with TM cup and 85,596 THAs with other uncemented cups from 2 high-quality national arthroplasty registries were...

  2. [Surgical treatment of acetabular type C1 acetabular fracture by posteroproximal-posteroanterior sequential reduction and internal fixation].

    Science.gov (United States)

    Lan, Shu-Hua; Zhu, Jun-Kun; Huang, Shu-Ming; Ye, Ji-Fei; Wu, Quan-Zhou; Ye, Fang; Lü, Guo-Qiang

    2013-06-01

    To investigate the operative reduction techniques and clinical results of surgical treatment of type C1 (AO/ASIF) acetabular fracture by posteroproximal-posteroanterior sequential reduction and internal fixation. From August 2004 to January 2012, 13 patients with type C1 (AO/ASIF) acetabular fracture were treated by posteroproximal-posteroanterior sequential reduction and internal fixation. Of them, 8 cases were male and 5 cases were female with an average age of 42 years years old (ranged, 18 to 64). Pelvis 3-dimentional CT reconstruction were used to confirmed the classification of fracture, and the operation were performed during from 5 to 20 days with an average of 9.5 days. Operation time, blood loss, complications and reduction were recorded and evaluated. The function of hip joint were accessed at the final follow-up. The operation time ranged from 190 to 290 min with an average of 240 min. The mean blood loss was 1 800 ml (ranged, 1 300 to 3 000 ml). One case had superficial infection and healed after 3 weeks. According to Matta reduction criteria, 8 cases obtained anatomical reduction, 4 cases got satisfied results and 1 cases got unsatisfied results. Eleven cases were followed up with an average of (24.0 +/- 8.0) months, and 2 cases were lost to follow-up. According to revised Mede d'Aubingne and Postel evaluation system, 7 cases got excellent results, 2 good, 1 moderate and 1 poor. Posteroproximal-posteroanterior sequential reduction and internal fixation for the treatment of type C1 (AO/ASIF) acetabular fracture can achieve satisfied surgical proces and operation quality.

  3. Multicenter Analysis of Midterm Clinical Outcomes of Arthroscopic Labral Repair in the Hip: Minimum 5-Year Follow-up.

    Science.gov (United States)

    Hevesi, Mario; Krych, Aaron J; Johnson, Nick R; Redmond, John M; Hartigan, David E; Levy, Bruce A; Domb, Benjamin G

    2018-02-01

    The technique of hip arthroscopic surgery is advancing and becoming more commonly performed. However, most current reported results are limited to short-term follow-up, and therefore, the durability of the procedure is largely unknown. To perform a multicenter analysis of mid-term clinical outcomes of arthroscopic hip labral repair and determine the risk factors for patient outcomes. Cohort study; Level of evidence, 3. Prospectively collected data of primary hip arthroscopic labral repair performed at 4 high-volume centers between 2008 and 2011 were reviewed retrospectively. Patients were assessed preoperatively and postoperatively with the visual analog scale (VAS), modified Harris Hip Score (mHHS), and Hip Outcome Score-Sports-Specific Subscale (HOS-SSS) at a minimum of 5 years' follow-up. Factors including age, body mass index (BMI), Tönnis grade, and cartilage grade were analyzed in relation to outcome scores, and revision rates were determined. Failure was defined as subsequent ipsilateral hip surgery, including revision arthroscopic surgery and open hip surgery. A total of 303 patients (101 male, 202 female) with a mean age of 32.0 years (range, 10.7-58.9 years) were followed for a mean of 5.7 years (range, 5.0-7.9 years). Patients achieved mean improvements in VAS of 3.5 points, mHHS of 20.1 points, and HOS-SSS of 29.3 points. Thirty-seven patients (12.2%) underwent revision arthroscopic surgery, and 12 (4.0%) underwent periacetabular osteotomy, resurfacing, or total hip arthroplasty during the study period. Patients with a BMI >30 kg/m2 had a mean mHHS score 9.5 points lower and a mean HOS-SSS score 15.9 points lower than those with a BMI ≤30 kg/m2 ( P 35 years at surgery had a mean mHHS score 4.5 points lower and a HOS-SSS score 6.7 points lower than those aged ≤35 years ( P = .03). Patients with Tönnis grade 2 radiographs demonstrated a 12.5-point worse mHHS score ( P = .02) and a 23.0-point worse HOS-SSS score ( P arthroscopic labral repair

  4. A review on hot tearing of magnesium alloys

    Directory of Open Access Journals (Sweden)

    Jiangfeng Song

    2016-09-01

    Full Text Available Hot tearing is often a major casting defect in magnesium alloys and has a significant impact on the quality of their casting products. Hot tearing of magnesium alloys is a complex solidification phenomenon which is still not fully understood, it is of great importance to investigate the hot tearing behaviour of magnesium alloys. This review attempts to summarize the investigations on hot tearing of magnesium alloys over the past decades. The hot tearing criteria including recently developed Kou's criterion are summarized and compared. The numeric simulation and assessing methods of hot tearing, factors influencing hot tearing, and hot tearing susceptibility (HTS of magnesium alloys are discussed.

  5. Tear gas: an epidemiological and mechanistic reassessment.

    Science.gov (United States)

    Rothenberg, Craig; Achanta, Satyanarayana; Svendsen, Erik R; Jordt, Sven-Eric

    2016-08-01

    Deployments of tear gas and pepper spray have rapidly increased worldwide. Large amounts of tear gas have been used in densely populated cities, including Cairo, Istanbul, Rio de Janeiro, Manama (Bahrain), and Hong Kong. In the United States, tear gas was used extensively during recent riots in Ferguson, Missouri. Whereas tear gas deployment systems have rapidly improved-with aerial drone systems tested and requested by law enforcement-epidemiological and mechanistic research have lagged behind and have received little attention. Case studies and recent epidemiological studies revealed that tear gas agents can cause lung, cutaneous, and ocular injuries, with individuals affected by chronic morbidities at high risk for complications. Mechanistic studies identified the ion channels TRPV1 and TRPA1 as targets of capsaicin in pepper spray, and of the tear gas agents chloroacetophenone, CS, and CR. TRPV1 and TRPA1 localize to pain-sensing peripheral sensory neurons and have been linked to acute and chronic pain, cough, asthma, lung injury, dermatitis, itch, and neurodegeneration. In animal models, transient receptor potential inhibitors show promising effects as potential countermeasures against tear gas injuries. On the basis of the available data, a reassessment of the health risks of tear gas exposures in the civilian population is advised, and development of new countermeasures is proposed. © 2016 The Authors. Annals of the New York Academy of Sciences published by Wiley Periodicals, Inc. on behalf of New York Academy of Sciences.

  6. Interferometric characterization of tear film dynamics

    Science.gov (United States)

    Primeau, Brian Christopher

    The anterior refracting surface of the eye is the thin tear film that forms on the surface of the cornea. When a contact lens is on worn, the tear film covers the contact lens as it would a bare cornea, and is affected by the contact lens material properties. Tear film irregularity can cause both discomfort and vision quality degradation. Under normal conditions, the tear film is less than 10 microns thick and the thickness and topography change in the time between blinks. In order to both better understand the tear film, and to characterize how contact lenses affect tear film behavior, two interferometers were designed and built to separately measure tear film behavior in vitro and in vivo. An in vitro method of characterizing dynamic fluid layers applied to contact lenses mounted on mechanical substrates has been developed using a phase-shifting Twyman-Green interferometer. This interferometer continuously measures light reflected from the surface of the fluid layer, allowing precision analysis of the dynamic fluid layer. Movies showing this fluid layer behavior can be generated. The fluid behavior on the contact lens surface is measured, allowing quantitative analysis beyond what typical contact angle or visual inspection methods provide. The in vivo interferometer is a similar system, with additional modules included to provide capability for human testing. This tear film measurement allows analysis beyond capabilities of typical fluorescein visual inspection or videokeratometry and provides better sensitivity and resolution than shearing interferometry methods.

  7. Tear exchange and contact lenses: a review.

    Science.gov (United States)

    Muntz, Alex; Subbaraman, Lakshman N; Sorbara, Luigina; Jones, Lyndon

    2015-01-01

    Tear exchange beneath a contact lens facilitates ongoing fluid replenishment between the ocular surface and the lens. This exchange is considerably lower during the wear of soft lenses compared with rigid lenses. As a result, the accumulation of tear film debris and metabolic by-products between the cornea and a soft contact lens increases, potentially leading to complications. Lens design innovations have been proposed, but no substantial improvement in soft lens tear exchange has been reported. Researchers have determined post-lens tear exchange using several methods, notably fluorophotometry. However, due to technological limitations, little remains known about tear hydrodynamics around the lens and, to-date, true tear exchange with contact lenses has not been shown. Further knowledge regarding tear exchange could be vital in aiding better contact lens design, with the prospect of alleviating certain adverse ocular responses. This article reviews the literature to-date on the significance, implications and measurement of tear exchange with contact lenses. Copyright © 2014 Spanish General Council of Optometry. Published by Elsevier Espana. All rights reserved.

  8. Effect of Ramadan Fasting on Tear Proteins

    Directory of Open Access Journals (Sweden)

    Reyhaneh Sariri

    2010-01-01

    Full Text Available Muslims abstain from eating, drinking and smoking from dawn to sunset during the holy month of Ramadan. Prolonged fasting is thought to be among risk factors for many diseases, e.g., cardiovascular, gastrointestinal and various infectious diseases. It could also play a part in several eye diseases, including dry eye syndrome, glaucoma, and cataract. Toxic and oxidative effects due to increased concentrations of some biochemicals as a result of reduction in tear volume thought to play an important role in damaging ocular tissue. Human tear is an important biological fluid similar to blood in many aspects. Tear film is composed of three basic layers i.e. lipid, aqueous and mucin. The tear film covering the ocular surface presents a mechanical and antimicrobial barrier, and endures an optical refractive surface. The aim of this study was to analyze and compare tear protein of volunteers during fasting. Using two reliable analytical methods, i.e. electrophoresis and high performance liquid chromatography (HPLC, we compared tear protein content of sixty volunteers (35 males and 25 females, 23–27 years old during fasting in holly month of Ramadan (FAST: n=62 and one month before Ramadan (CTRL: n=60. The results showed that some identified tear proteins decreased during fasting. On the other hand, the activity of some enzymes such as lysozyme, lactoferrin and alpha amylase also decreased in fasting samples. Electrophoresis results showed that tear protein patterns in FAST (PP<0.005 than in CTRL.

  9. Identification of lactoferrin in bovine tears.

    Science.gov (United States)

    Brown, M H; Brightman, A H; Fenwick, B W; Rider, M A

    1996-09-01

    To determine whether bovine tear film contains the iron-binding glycoprotein, lactoferrin. 40 Adult Hereford, Angus, and Simmental cattle. Protein analysis: pooled bovine tears were used for protein analysis (size exclusion high-performance liquid chromatography [HPLC] fractionation). HPLC was used for tear analysis. A diode array detector was used (215 and 280 microns) for chromatogram analysis and comparisons. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE): protein electrophoresis was performed, using 7.5% running gels with 4% stacking gels. Molecular weight of proteins in the unknown samples was determined as recommended by the manufacturer of the standards. Protein sequencing: amino acid sequencing, using automated Edman degradation of HPLC purified protein, was performed. The sequence obtained was compared with the known protein sequence of bovine lactoferrin. HPLC analysis of whole bovine tears resulted in a consistent chromatogram. Peak collection was performed to recover a protein from the bovine tear film with chromatogram characteristics nearly identical to purified bovine lactoferrin. Silver-stained SDS-PAGE of this peak revealed a band with molecular mass consistent with bovine lactoferrin (estimated mass of 78 kd). The first 13 amino acid residues of this protein were identical to the amino acid sequence of bovine lactoferrin. Analysis of whole bovine tears, using size exclusion HPLC, SDS-PAGE, and amino acid sequencing, provided evidence that bovine tears contain lactoferrin. Lactoferrin probably exerts a bacteriostatic effect in bovine tear film. Locally produced lactoferrin may bathe the ocular surface and sequester iron from potential pathogens.

  10. A novel computer-based method for measuring the acetabular angle on hip radiographs.

    Science.gov (United States)

    Sahin, Seda; Akata, Emin; Sahin, Orcun; Tuncay, Cengiz; Özkan, Hüseyin

    2017-03-01

    The aim of this study was to propose a new computer based method for measuring acetabular angles on hip radiographs and to assess its practicality, sensitivity and reliability for acetabular angle measurement. A total of 314 acetabulum were assessed on 157 pelvic X-ray images. Acetabular angles were measured with both the conventional method (Method 1) and our proposed method (Method 2). All the Acetabular Index (AI) angle, Acetabular Angle (AA) and Acetabular Center (ACM) angle were measured with both methods. The mean AI angle for Method 1 is 11.02° ± 2.7° and the mean AI angle for Method 2 is 10.08° ± 1.88°, the mean AA angle for Method 1 is 39.5° ± 5.3° and the mean AA angle for Method 2 is 39.36° ± 4.68°, the mean ACM angle for Method 1 is 50.5° ± 6.01° and the mean ACM angle for Method 2 is 55.42° ± 12.43°. Our novel automated method appear to be reliable and practical for acetabular angle measurement on hip radiographs. Level III, Diagnostic study. Copyright © 2017 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

  11. Acetabular fractures: what radiologists should know and how 3D CT can aid classification.

    Science.gov (United States)

    Scheinfeld, Meir H; Dym, Akiva A; Spektor, Michael; Avery, Laura L; Dym, R Joshua; Amanatullah, Derek F

    2015-01-01

    Correct recognition, description, and classification of acetabular fractures is essential for efficient patient triage and treatment. Acetabular fractures may result from high-energy trauma or low-energy trauma in the elderly. The most widely used acetabular fracture classification system among radiologists and orthopedic surgeons is the system of Judet and Letournel, which includes five elementary (or elemental) and five associated fractures. The elementary fractures are anterior wall, posterior wall, anterior column, posterior column, and transverse. The associated fractures are all combinations or partial combinations of the elementary fractures and include transverse with posterior wall, T-shaped, associated both column, anterior column or wall with posterior hemitransverse, and posterior column with posterior wall. The most unique fracture is the associated both column fracture, which completely dissociates the acetabular articular surface from the sciatic buttress. Accurate categorization of acetabular fractures is challenging because of the complex three-dimensional (3D) anatomy of the pelvis, the rarity of certain acetabular fracture variants, and confusing nomenclature. Comparing a 3D image of the fractured acetabulum with a standard diagram containing the 10 Judet and Letournel categories of acetabular fracture and using a flowchart algorithm are effective ways of arriving at the correct fracture classification. Online supplemental material is available for this article. (©)RSNA, 2015.

  12. Early results of the use of oblong S-ROM cementless acetabular component

    Directory of Open Access Journals (Sweden)

    Popović Zoran

    2003-01-01

    Full Text Available Massive deficiency of acetabular bone stock is a challenging problem in the increasing number of patients who need a revision of the failed hip arthroplasty. Oblong acetabular cup has been presented as an alternative reconstruction technique for hips with extensive acetabular bone loss. The aim of this study was to present our results with the use of a bilobed acetabular component inserted during revisional surgery, to define indications, and to introduce this method into our orthopaedic practice. Seven patients underwent revisional hip arthroplasty with a cementless oblong acetabular component between September 2000 and June 2002. Six patients underwent revisional hip arthroplasty, and in one primary hip arthroplasty by oblong acetabular component was performed because of bone defect of acetabulum after gunshot fracture. The average follow up was thirteen months. Radiographic analysis in all patients demonstrated stable bone incorporated acetabular component with the restored hip. All the patients walked with full weight bearing and were without pain. On the basis of our experience we find this method statisfactory in certain types of bone defefects of acetabulum, and that it provides stable reconstruction of acetabulum with the correction of hip joint.

  13. Tear Osmolarity and Tear Film Parameters in Patients With Ocular Rosacea.

    Science.gov (United States)

    Karaman Erdur, Sevil; Eliacik, Mustafa; Kocabora, Mehmet Selim; Balevi, Ali; Demirci, Goktug; Ozsutcu, Mustafa; Gulkilik, Gokhan; Aras, Cengiz

    2016-11-01

    The aim of this study was to evaluate tear osmolarity and tear film parameters in patients with ocular rosacea. In a single center, 25 eyes of 25 patients with ocular rosacea (group 1), 25 eyes of 25 patients with rosacea without ocular involvement (group 2), and 20 eyes of 20 healthy individuals (group 3) were evaluated using the Ocular Surface Disease Index (OSDI) questionnaire, Schirmer I test, tear film break-up time (TBUT), scoring of ocular surface fluorescein staining using modified Oxford scale, and tear osmolarity. Tear osmolarity values, OSDI and Oxford scale scores were significantly higher in group 1 than in groups 2 and 3 (Ptear osmolarity between groups 2 and 3 (P=0.629, P=0.175, P=0.713, P=865, and P=0.388, respectively). This study showed that ocular rosacea is associated with tear hyperosmolarity and tear film dysfunction.

  14. Acetabular fractures following rugby tackles: a case series

    LENUS (Irish Health Repository)

    Good, Daniel W

    2011-10-05

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

  15. Posterior column acetabular fracture fixation using a W-shaped angular plate: A biomechanical analysis.

    Directory of Open Access Journals (Sweden)

    Ke Su

    Full Text Available The purpose of this study was to compare the stability and feasibility of four fixation constructs in a posterior column acetabular fracture: one reconstruction plate, one reconstruction plate and lag screw, two reconstruction plates, and a W-shaped acetabular angular plate.Twenty embalmed cadaveric pelvises with a posterior column acetabular fractures were allocated to one of four groups: 1 a reconstruction plate, 2 a reconstruction plate with a posterior column lag screw, 3 double reconstruction plates, and 4 a W-shaped acetabular angular plate. These constructs were mechanically loaded on a testing machine, and construct stiffness values were measured. Strain gauges were utilized to measure the mechanical behavior in the condition of compressive force.Final stiffness was not different between the two reconstruction plates (445.81±98.30 N/mm and the W-shaped acetabular angular plate (447.43±98.45 N/mm, p = 0.524, both of which were superior to a single reconstruction plate (248.90±61.95 N/mm and a combined plate and lag screw (326.41±94.34 N/mm. Following the fixation of the W-shaped acetabular angular plate, the strain distribution was similar to the intact condition around the acetabulum. The parameters of the W-shaped acetabular angular plate that were observed at the superior region of the acetabulum were less than those of a single reconstruction plate (p<0.05, a single reconstruction plate with lag screw (p<0.05, and two reconstruction plates (p<0.05.The novel W-shaped acetabular angular plate fixation technique was able to provide the biomechanically stiffest construct for stabilization of a posterior column acetabular fracture; it also resulted in a partial restoration of joint loading parameters toward the intact state.

  16. Deltoid muscle and tendon tears in patients with chronic rotator cuff tears

    Energy Technology Data Exchange (ETDEWEB)

    Ilaslan, Hakan; Recht, Michael P. [Cleveland Clinic, Musculoskeletal Radiology/A21, Division of Radiology, Cleveland, OH (United States); Iannotti, Joseph P. [Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, OH (United States)

    2007-06-15

    To describe the magnetic resonance imaging (MRI) appearances of tears of the deltoid muscle and tendon in patients with rotator cuff tears and without a prior history of shoulder surgery. Deltoid tears diagnosed on MR examinations were prospectively recorded between February 2003 through June 2004. The images of these patients were then retrospectively reviewed to determine the location of the deltoid tear, the presence of rotator cuff tears, tendon retraction, muscle atrophy, degree of humeral head subluxation, bony erosive changes involving the undersurface of the acromion, and the presence of edema or fluid-like signal intensity in the deltoid muscle and overlying subcutaneous tissues. There were 24 (0.3%) patients with deltoid tears; nine men and 15 women. The age range was 54 to 87 (average 73) years. The right side was involved in 20 cases, and the left in four cases. Fifteen patients had full thickness and nine had partial thickness tears of the deltoid. Shoulder pain was the most common presenting symptom. The physical examination revealed a defect in the region of the deltoid in two patients. Nineteen patients had tears in the muscle belly near the musculotendinous junction, and five had avulsion of the tendon from the acromial origin. Full thickness rotator cuff tears were present in all of the patients, and 22 patients had associated muscle atrophy. Subcutaneous edema and fluid-like signal was present in 15 patients. Tears of the deltoid muscle or tendon is an unusual finding, but they can be seen in patients with chronic massive rotator cuff tears. Partial thickness tears tend to involve the undersurface of the deltoid muscle and tendon. Associated findings such as intramuscular cyst or ganglion in the deltoid muscle belly and subcutaneous edema or fluid-like signal overlying the deltoid in a patient with a rotator cuff tear should raise the suspicion of a deltoid tear. (orig.)

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

    Directory of Open Access Journals (Sweden)

    Tetsuya Kimura

    2016-01-01

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

  18. Superior labral anterior-to-posterior lesions: comparison of external rotation and active supination CT arthrography with neutral CT arthrography.

    Science.gov (United States)

    Choi, Ja-Young; Kim, Sae Hoon; Yoo, Hye Jin; Shin, Seung Han; Oh, Joo Han; Baek, Goo Hyun; Hong, Sung Hwan

    2012-04-01

    To compare the diagnostic performance of computed tomographic (CT) arthrography performed with external rotation and active supination (ERAS) with that of CT angiography performed in the neutral position for superior labral anterior-to-posterior (SLAP) lesions. Institutional review board approval and informed consent were obtained. CT arthrography in neutral and ERAS positions was performed in 49 shoulders of 47 patients, with subsequent arthroscopic confirmation of the status of the superior labrum. Two musculoskeletal radiologists (1 and 8 years of experience) reviewed images and expressed the likelihood of SLAP lesions by using a continuous scale; they also measured gap widths and depths of labral detachment. Overall performances for the detection of SLAP lesions were determined with receiver-operating characteristic (ROC) analysis. Gap widths and depths measured with the two types of CT arthrography were also compared. For reader 1, area under the ROC curve increased insignificantly from 0.932 in the neutral position to 0.974 in the ERAS position (P = .210), whereas for reader 2, it increased significantly from 0.914 to 0.984 (P = .032). Mean gap width of SLAP lesion was significantly greater according to ERAS CT arthrography (3.98 mm ± 2.48 [standard deviation] vs 1.61 mm ± 1.11), whereas mean gap depth was not significantly different. Gap width and depth cutoff values for the detection of a SLAP lesion with ERAS CT arthrography were 1.7 mm and 1.6 mm, respectively. ERAS CT arthrography might improve the detection of SLAP lesions compared with neutral-position CT arthrography. © RSNA, 2012.

  19. Outcome after arthroscopic labral surgery in patients previously treated with periacetabular osteotomy: a follow-up study of 43 patients.

    Science.gov (United States)

    Hartig-Andreasen, Charlotte; Nielsen, Torsten G; Lund, Bent; Søballe, Kjeld; Lind, Martin

    2017-01-01

    To identify factors predicting failure after hip arthroscopy in patients with previous periacetabular osteotomy (PAO) defined as a conversion to total hip replacement (THR) and to evaluate the patient reported outcome scores. Of 55 hips treated with hip arthroscopy after PAO from Aug 2008 to 2012 at Aarhus University Hospital, 43 hips were included (median age: 36.1 yrs, range 16.3-56.9 yrs). Indications were unacceptable pain, a positive FABER and impingement test and signs of labral damage on MR-arthrography. Outcomes were evaluated with mHHS and HOS. Failure was defined as conversion to a THR. Nine hips were converted to a THR. Kaplan-Meier survival rate was 52.8% (95% CI, 10%-83.8%) at 6.5 years follow-up. Statistically significant predictors of failure: joint space width after PAO hips needed revision hip arthroscopy. Labral damage was present in 84% of the hips. In 42% of the hips cartilage lesions of Becks grade >3 were found. Mean mHHS and HOS were 65.7 and 68.8 respectively at follow-up. A NRS pain score of >3 in rest and during activity were present in respectively, 43% and 62% of the patients. Hip arthroscopy after PAO demonstrated limited clinical benefit with no decrease in pain levels and 21% of patients needing reoperation to THR. Radiographic signs of joint degeneration after PAO are predictors of faiElure. Further studies are needed to clarify what role hip arthroscopy should play in this patient group.

  20. Clinical results of acetabular fracture management with the Pararectus approach.

    Science.gov (United States)

    Keel, Marius Johann Baptist; Tomagra, Salvatore; Bonel, Harald Marcel; Siebenrock, Klaus Arno; Bastian, Johannes Dominik

    2014-12-01

    To present the accuracy of reduction, complications and results two years after open reduction and internal fixation of displaced acetabular fractures involving the anterior column (AC) through the Pararectus approach. Frequencies for conversion to total hip replacement in the early follow up, the clinical outcome in preserved hips, and the need for an extension of the approach (1st window of the ilioinguinal approach) are compared to the literature about the modified Stoppa approach. Forty-eight patients (mean age 62 years, range: 16–98; 41 male) with displaced acetabular fractures involving the AC (AC: n = 9; transverse fracture: n = 2; AC and hemitransverse: n = 24; both column: n = 13) were treated between 12/2009 and 12/2011 using the Pararectus approach. Surgical data and accuracy of reduction (using computed tomography) were assessed. Patients were routinely followed up at eight weeks, 6, 12 and 24 months postoperatively. Failure was defined as the need for total hip arthroplasty. Twenty-four months postoperatively the outcome was rated according to Matta. In four patients there were four intraoperative complications (minor vascular damage in two, small perforations of the peritoneum in two) which were managed intraoperatively. Fracture reduction showed statistically significant decreases (mean ± SD, pre- vs. postoperative, in mm) in “step-offs”: 2.6 ± 1.9 vs. 0.1 ± 0.3, p clinical outcome was graded as “excellent” in 13 or “good” in 20; radiographically, 27 were graded as “excellent”, four as “good” and two as “fair”. An extension of the approach was infrequently used (1st window ilioinguinal approach in 2%, mini-incision at the iliac crest in 21%). In the treatment of acetabular fractures involving the anterior column the Pararectus approach allowed for anatomic restoration with minimal access morbidity. Results obtained by means of the Pararectus approach after two years at least parallel those reported after utilisation of

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

    Directory of Open Access Journals (Sweden)

    Marincek Borut

    2010-08-01

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

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

    Science.gov (United States)

    Fornaro, Jürgen; Keel, Marius; Harders, Matthias; Marincek, Borut; Székely, Gábor; Frauenfelder, Thomas

    2010-08-04

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

  3. Radiographic anatomy of the canine coxofemoral joint using the dorsal acetabular rim (DAR) view.

    Science.gov (United States)

    Trumpatori, Brian J; Mathews, Kyle G; Roe, Simon R; Robertson, Ian D

    2003-01-01

    A radiographic study of the anatomy of the canine acetabulum was performed. The relationship between the area of dorsal acetabular rim that is subject to early damage in dogs with coxofemoral joint laxity, and the "DAR point" identified on dorsal acetabular rim (DAR) radiographic views was examined. Radiographs and digital photographs were made of the pelvis harvested from each of six skeletally mature dogs. Through analysis of these images, it was determined that in the standing animal, the DAR point is located 4-6 mm (or approximately 37 degrees) caudal to the dorsal acetabular rim area that is prone to early damage in dogs with coxofemoral joint laxity. This study suggests that the DAR radiographic view may under-represent changes to the dorsal acetabular rim in dogs with coxofemoral laxity.

  4. 21 CFR 888.3370 - Hip joint (hemi-hip) acetabular metal cemented prosthesis.

    Science.gov (United States)

    2010-04-01

    .... This generic type of device includes prostheses that have an acetabular component made of alloys, such as cobalt-chromium-molybdenum. This generic type of device is limited to those prostheses intended...

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

    Science.gov (United States)

    Wang, Zhang-Fu; Hong, Zheng-Hua; Wang, Mei-Zhen; Ruan, Jian-Wei; Wang, Wei; Pan, Wei-Bo

    2015-01-01

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

  6. [Demonstration of a new safe incision for acetabular fractures on cadaveric samples].

    Science.gov (United States)

    Ramos-Maza, Edgardo; García-Estrada, Fernando; Chávez-Covarrubias, Gabriel

    2012-01-01

    acetabular fractures are very complex due to their fracture pattern, localization and surrounding anatomical structures. The aim was to demonstrate a safe anatomical corridor that allows a safe osteosynthesis in cadaveric specimens. adult cadaveric specimens of any sex were used. A vertical 7 cm incision was made in the union of the second and medial third of a traced line from anterior-upper iliac spine to pubis tubercle. Dissection is done to reach the peritoneum and identification of iliopectineal line and all structures for development an acetabular osteosynthesis were evaluated. in 7 cadavers, 6 were male, the incision was performed bilaterally identifying all necessary structures to make acetabular osteosynthesis. In any case an important anatomical structure were founded thorough the incision. Suprapectineal and infrapectineal plates could be placed without structural damage. it is possible to perform acetabular osteosynthesis using this incision representing a safe anatomical corridor with lower iatrogenic damage.

  7. The role of trochanteric flip osteotomy in fixation of certain acetabular fractures

    Directory of Open Access Journals (Sweden)

    Sandeep Gupta

    2017-06-01

    Conclusion: Trochanteric flip osteotomy is a very effective technique to fix certain acetabular fractures especially those with dome involvement. It is more accurate and associated with no significant complications compared with conventional way.

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

    Directory of Open Access Journals (Sweden)

    Zhang-Fu Wang

    2015-01-01

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

  9. Paediatric acetabular fractures. Data from the German Pelvic Trauma Registry Initiative

    DEFF Research Database (Denmark)

    von Heyden, Johanna; Hauschild, Oliver; Strohm, Peter C

    2012-01-01

    The aim of this study was to present an analysis of acetabular fractures during childhood as compared to those in adults. Within a multicenter register study, data of 3 time periods (1991-93, 1998-2000, 2004-2008) were pooled and analyzed for incidence, epidemiology, classification, outcome and t......%. Fractures of the acetabulum in childhood remain a rare injury with distinct fracture characteristics, usually caused by high impact accidents.......The aim of this study was to present an analysis of acetabular fractures during childhood as compared to those in adults. Within a multicenter register study, data of 3 time periods (1991-93, 1998-2000, 2004-2008) were pooled and analyzed for incidence, epidemiology, classification, outcome...... and treatment of acetabular fractures in children (fractures were included in the study. Only 15 children sustained an acetabular fracture (9.8%). Simple fracture types according to Letournels' classification were more frequent...

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

    LENUS (Irish Health Repository)

    Brennan, S A

    2009-04-01

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

  11. Tear ferning in normal dogs and dogs with keratoconjunctivitis sicca ...

    African Journals Online (AJOL)

    This study evaluates tear ferning as an ancillary technique for the evaluation of the canine tear film in normal eyes and eyes affected by keratoconjunctivitis sicca (KCS). Thirty dogs with KCS and 50 control dogs with normal tear film were evaluated with a full ophthalmoscopic examination and a Schirmer tear test type 1 ...

  12. Tear Movement through a Contact Lens of Variable Thickness

    Science.gov (United States)

    Gerhart, Matthew; Anderson, Daniel

    2013-11-01

    This work is on a two-dimensional tear film with a movable porous contact lens. The inclusion of a contact lens into a tear film results in three layers: Pre-Lens Tear Film, Contact Lens, and the Post-Lens Tear Film layers. The interfaces between the contact lens and the tear films are modeled as planar interfaces. There is a free surface interface between the tear film and the outside air. The goal is analyze the effects of the spatial variability of thickness on the Post-Lens Tear Film thickness and on the fluid flow through the Contact Lens layer.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2013-03-15

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

  14. Comparison of cement pressurisation in flanged and unflanged acetabular cups

    Directory of Open Access Journals (Sweden)

    Bhattacharya Rajarshi

    2012-02-01

    Full Text Available Abstract Background This biomechanical study examined difference in cement pressures generated by flanged and unflanged acetabular cups in hip arthroplasty. Method Using a model acetabulum, cement was inserted and pressurised followed by cup insertion and pressurisation. Pressures were recorded using transducers in the acetabulum. We compared Charnley Ogee (flanged, Exeter contemporary (flanged and Exeter low profile (unflanged cups using Simplex and CMW1 cements in turn. Results Using Simplex, Charnley Ogee cup generated highest initial peak pressure and overall mean pressure. Exeter unflanged cup generated higher initial and mean pressures compared to Exeter flanged cup. With CMW, there was no significant difference between the pressures generated by the cups. Conclusions Our experiment suggests that flanged cups do not consistently generate significantly higher cement pressures compared to unflanged cups.

  15. Spontaneous healing of bucket handle tear of the medial meniscus associated with ACL tear

    OpenAIRE

    Rabelo,Neiffer Nunes; Rabelo,Nícollas Nunes; Cunha,Aluísio Augusto Gonçalves; Correia,Francisco

    2013-01-01

    We report a case of injury of the medial bucket handle meniscal tears (BH), which resolved spontaneously, in association with anterior cruciate ligament (ACL) injury. The patient twisted his left knee during a fight in martial arts, progressing to pain and joint locking and a sense of distortion. In NMR it could be seen bucket-handle tear of the medial meniscus with displacement of the fragment to the intercondylar region, rupture of the lateral meniscus and ACL tear. After conservative treat...

  16. Current Concepts in Acetabular Positioning in Total Hip Arthroplasty

    Science.gov (United States)

    Bhaskar, Deepu; Rajpura, Asim; Board, Tim

    2017-01-01

    Being one of the most successful surgeries in the history of medicine, the indications for total hip arthroplasty have widened and are increasingly being offered to younger and fitter patients. This has also led to high expectations for longevity and outcomes. Acetabular cup position has a significant impact on the results of hip arthroplasty as it affects dislocation, abductor muscle strength, gait, limb lengths, impingement, noise generation, range of motion (ROM), wear, loosening, and cup failure. The variables in cup position are depth, height, and angular position (anteversion and inclination). The implications of change in depth of center of rotation (COR) are medialized versus anatomical positioning. As opposed to traditional medialization with beneficial effects on joint reaction force, the advantages of an anatomical position are increasingly recognized. The maintained acetabular offset offers advantages in terms of ROM, impingement, cortical rim press fit, and maintaining medial bone stock. The height of COR influences muscle activity and limb lengths and available bone stock for cup support. On the other hand, ideal angular position remains a matter of much debate and reliably achieving a target angular position remains elusive. This is not helped by variations in the way we describe angular position, with operative, radiologic, or anatomic definitions being used variably to describe anteversion and inclination. Furthermore, pelvic tilt plays a major role in functional positions of the acetabulum. In addition, commonly used techniques of positioning often do not inform us of the real orientation of the pelvis on operating table, with possibility of significant adduction, flexion, and external rotation of the pelvis being possibilities. This review article brings together the evidence on cup positioning and aims to provide a systematic and pragmatic approach in achieving the best position in individual cases. PMID:28790467

  17. Acetabular cartilage defects cause altered hip and knee joint coordination variability during gait.

    Science.gov (United States)

    Samaan, Michael A; Teng, Hsiang-Ling; Kumar, Deepak; Lee, Sonia; Link, Thomas M; Majumdar, Sharmila; Souza, Richard B

    2015-12-01

    Patients with acetabular cartilage defects reported increased pain and disability compared to those without acetabular cartilage defects. The specific effects of acetabular cartilage defects on lower extremity coordination patterns are unclear. The purpose of this study was to determine hip and knee joint coordination variability during gait in those with and without acetabular cartilage defects. A combined approach, consisting of a semi-quantitative MRI-based quantification method and vector coding, was used to assess hip and knee joint coordination variability during gait in those with and without acetabular cartilage lesions. The coordination variability of the hip flexion-extension/knee rotation, hip abduction-adduction/knee rotation, and hip rotation/knee rotation joint couplings were reduced in the acetabular lesion group compared to the control group during loading response of the gait cycle. The lesion group demonstrated increased variability in the hip flexion-extension/knee rotation and hip abduction-adduction/knee rotation joint couplings, compared to the control group, during the terminal stance/pre-swing phase of gait. Reduced variability during loading response in the lesion group may suggest reduced movement strategies and a possible compensation mechanism for lower extremity instability during this phase of the gait cycle. During terminal stance/pre-swing, a larger variability in the lesion group may suggest increased movement strategies and represent a compensation or pain avoidance mechanism caused by the load applied to the hip joint. Copyright © 2015 Elsevier Ltd. All rights reserved.

  18. Isolated tear of the plantaris tendon: ultrasound and MRI appearance

    Energy Technology Data Exchange (ETDEWEB)

    Bianchi, Stefano [CIM, Cabinet Imagerie Medicale, Geneva (Switzerland); Sailly, Matthieu [CIM, Cabinet Imagerie Medicale, Geneva (Switzerland); Health Center, ASPIRE, Doha (Qatar); Molini, Lucio [Ospedale Galliera, Struttura complessa di Radiodiagnostica, Genova (Italy)

    2011-07-15

    We report a retrospective analysis of the ultrasound and magnetic resonance imaging appearance of five patients with isolated plantaris tendon tears. Both imaging techniques allowed detection of the tear, assessment of its severity and of its location. Compared with magnetic resonance imaging, ultrasound resulted in a less expensive and time-consuming evaluation. Isolated plantaris tendon tears can clinically mimic Achilles tendon tears or thrombophlebitis. Unlike these conditions, plantaris tear has a benign outcome and does not need surgical treatment or anticoagulation. (orig.)

  19. Influence of toroidal rotation on tearing modes

    Science.gov (United States)

    Cai, Huishan; Cao, Jintao; Li, Ding

    2017-10-01

    Tearing modes stability analysis including toroidal rotation is studied. It is found that rotation affects the stability of tearing modes mainly through the interaction with resistive inner region of tearing mode. The coupling of magnetic curvature with centrifugal force and Coriolis force provides a perturbed perpendicular current, and a return parallel current is induced to affect the stability of tearing modes. Toroidal rotation plays a stable role, which depends on the magnitude of Mach number and adiabatic index Γ, and is independent on the direction of toroidal rotation. For Γ >1, the scaling of growth rate is changed for typical Mach number in present tokamaks. For Γ = 1 , the scaling keeps unchanged, and the effect of toroidal rotation is much less significant, compared with that for Γ >1. National Magnetic Confinement Fusion Science Program and National Science Foundation of China under Grants No. 2014GB106004, No. 2013GB111000, No. 11375189, No. 11075161 and No. 11275260, and Youth Innovation Promotion Association CAS.

  20. Human tears reveal insights into corneal neovascularization.

    Science.gov (United States)

    Zakaria, Nadia; Van Grasdorff, Sigi; Wouters, Kristien; Rozema, Jos; Koppen, Carina; Lion, Eva; Cools, Nathalie; Berneman, Zwi; Tassignon, Marie-José

    2012-01-01

    Corneal neovascularization results from the encroachment of blood vessels from the surrounding conjunctiva onto the normally avascular cornea. The aim of this study is to identify factors in human tears that are involved in development and/or maintenance of corneal neovascularization in humans. This could allow development of diagnostic tools for monitoring corneal neovascularization and combination monoclonal antibody therapies for its treatment. In an observational case-control study we enrolled a total of 12 patients with corneal neovascularization and 10 healthy volunteers. Basal tears along with reflex tears from the inferior fornix, superior fornix and using a corneal bath were collected along with blood serum samples. From all patients, ocular surface photographs were taken. Concentrations of the pro-angiogenic cytokines interleukin (IL)-6, IL-8, Vascular Endothelial Growth Factor (VEGF), Monocyte Chemoattractant Protein 1 (MCP-1) and Fas Ligand (FasL) were determined in blood and tear samples using a flow cytometric multiplex assay. Our results show that the concentration of pro-angiogenic cytokines in human tears are significantly higher compared to their concentrations in serum, with highest levels found in basal tears. Interestingly, we could detect a significantly higher concentration of IL- 6, IL-8 and VEGF in localized corneal tears of patients with neovascularized corneas when compared to the control group. This is the first study of its kind demonstrating a significant difference of defined factors in tears from patients with neovascularized corneas as compared to healthy controls. These results provide the basis for future research using animal models to further substantiate the role of these cytokines in the establishment and maintenance of corneal neovascularization.

  1. Tear film MMP accumulation and corneal disease

    OpenAIRE

    Smith, V; Rishmawi, H; Hussein, H; Easty, D

    2001-01-01

    BACKGROUND/AIMS—Matrix metalloproteinases (MMPs) accumulate in the tears of patients with active peripheral ulcerative keratitis (PUK) but it is unknown whether these enzymes have a central role in disease progression. The aims of the present investigation were to determine the source of these enzymes and to ascertain whether their accumulation in tears is a phenomenon specific to PUK or a general feature of other anterior segment diseases.
METHODS—The experimental samples were obtained from ...

  2. Mallory-Weiss Tear during Esophagogastroduodenoscopy

    Directory of Open Access Journals (Sweden)

    Ji Wan Kim

    2015-02-01

    Full Text Available Mallory-Weiss tears (MWTs are mucosal lacerations caused by forceful retching and are typically located at the gastroesophageal junction. Reported cases of MWT with serious complications seen in esophagogastroduodenoscopy are limited. We report MWT in an 81-year-old woman who presented with gastric perforation by esophagogastroduodenoscopy. We discuss and indicate that hiatal hernia, atrophic gastritis and old age may be associated with the gastric perforation in comparison to typical tears occurring at the gastroesophageal junction.

  3. Effect of Ramadan fasting on tear proteins.

    Science.gov (United States)

    Sariri, Reyhaneh; Varasteh, Abdolali; Sajedi, Reza Hassan

    2010-01-01

    Muslims abstain from eating, drinking and smoking from dawn to sunset during the holy month of Ramadan. Prolonged fasting is thought to be among risk factors for many diseases, e.g., cardiovascular, gastrointestinal and various infectious diseases. It could also play a part in several eye diseases, including dry eye syndrome, glaucoma, and cataract. Toxic and oxidative effects due to increased concentrations of some biochemicals as a result of reduction in tear volume thought to play an important role in damaging ocular tissue. Human tear is an important biological fluid similar to blood in many aspects. Tear film is composed of three basic layers i.e. lipid, aqueous and mucin. The tear film covering the ocular surface presents a mechanical and antimicrobial barrier, and endures an optical refractive surface. The aim of this study was to analyze and compare tear protein of volunteers during fasting. Using two reliable analytical methods, i.e. electrophoresis and high performance liquid chromatography (HPLC), we compared tear protein content of sixty volunteers (35 males and 25 females, 23-27 years old) during fasting in holly month of Ramadan (FAST: n = 62) and one month before Ramadan (CTRL: n = 60). The results showed that some identified tear proteins decreased during fasting. On the other hand, the activity of some enzymes such as lysozyme, lactoferrin and alpha amylase also decreased in fasting samples. Electrophoresis results showed that tear protein patterns in FAST (P < 0.05) were different from those of CTRL. There were a few more protein peaks in the FAST group (P < 0.005) than in CTRL.

  4. Quantitative Computerized Assessment of the Degree of Acetabular Bone Deficiency: Total radial Acetabular Bone Loss (TrABL

    Directory of Open Access Journals (Sweden)

    Frederik Gelaude

    2011-01-01

    Full Text Available A novel quantitative, computerized, and, therefore, highly objective method is presented to assess the degree of total radical acetabular bone loss. The method, which is abbreviated to “TrABL”, makes use of advanced 3D CT-based image processing and effective 3D anatomical reconstruction methodology. The output data consist of a ratio and a graph, which can both be used for direct comparison between specimens. A first dataset of twelve highly deficient hemipelves, mainly Paprosky types IIIB, is used as illustration. Although generalization of the findings will require further investigation on a larger population, it can be assumed that the presented method has the potential to facilitate the preoperative use of existing classifications and related decision schemes for treatment selection in complex revision cases.

  5. Tear film measurement by optical reflectometry technique

    Science.gov (United States)

    Lu, Hui; Wang, Michael R.; Wang, Jianhua; Shen, Meixiao

    2014-01-01

    Abstract. Evaluation of tear film is performed by an optical reflectometer system with alignment guided by a galvanometer scanner. The reflectometer system utilizes optical fibers to deliver illumination light to the tear film and collect the film reflectance as a function of wavelength. Film thickness is determined by best fitting the reflectance-wavelength curve. The spectral reflectance acquisition time is 15 ms, fast enough for detecting film thickness changes. Fast beam alignment of 1 s is achieved by the galvanometer scanner. The reflectometer was first used to evaluate artificial tear film on a model eye with and without a contact lens. The film thickness and thinning rate have been successfully quantified with the minimum measured thickness of about 0.3 μm. Tear films in human eyes, with and without a contact lens, have also been evaluated. A high-contrast spectral reflectance signal from the precontact lens tear film is clearly observed, and the thinning dynamics have been easily recorded from 3.69 to 1.31 μm with lipid layer thickness variation in the range of 41 to 67 nm. The accuracy of the measurement is better than ±0.58% of the film thickness at an estimated tear film refractive index error of ±0.001. The fiber-based reflectometer system is compact and easy to handle. PMID:24500519

  6. Rotator cuff tear: A detailed update

    Directory of Open Access Journals (Sweden)

    Vivek Pandey

    2015-01-01

    Full Text Available Rotator cuff tear has been a known entity for orthopaedic surgeons for more than two hundred years. Although the exact pathogenesis is controversial, a combination of intrinsic factors proposed by Codman and extrinsic factors theorized by Neer is likely responsible for most rotator cuff tears. Magnetic resonance imaging remains the gold standard for the diagnosis of rotator cuff tears, but the emergence of ultrasound has revolutionized the diagnostic capability. Even though mini-open rotator cuff repair is still commonly performed, and results are comparable to arthroscopic repair, all-arthroscopic repair of rotator cuff tear is now fast becoming a standard care for rotator cuff repair. Appropriate knowledge of pathology and healing pattern of cuff, strong and biological repair techniques, better suture anchors, and gradual rehabilitation of postcuff repair have led to good to excellent outcome after repair. As the healing of degenerative cuff tear remains unpredictable, the role of biological agents such as platelet-rich plasma and stem cells for postcuff repair augmentation is still under evaluation. The role of scaffolds in massive cuff tear is also being probed.

  7. Diet, nutraceuticals and the tear film.

    Science.gov (United States)

    Jalbert, Isabelle

    2013-12-01

    Nutrition disorders and their correlates such as obesity are increasingly prevalent worldwide. A number of studies to date have suggested numerous potential associations between diet and tear film health; this paper will provide a summary of the available literature. The tear film is characterized through its protein and lipid content and through clinical measurements of characteristics such as osmolarity, volume and stability. Malnutrition, protein and vitamin-A deficiencies are extremely deleterious to tear film health and supplementation with oral vitamin A in this setting is of clear benefit. The relative impact of diet on tear film within what would be considered normal ranges of consumption is less clear. A number of population studies have suggested that hyperlipidemia and a diet low in omega-3 fatty acids are risks factor for dry eye disease. Numerous studies have investigated the effectiveness of oral supplementation with antioxidants, omega-3 (e.g. fish oil and linseed oil) and omega-6 (e.g. evening primrose oil) fatty acids in the last 10 years. Taken together, these suggest a small benefit of oral supplementation on tear film volume, stability and decreased ocular symptoms in patients previously diagnosed with diseases involving the ocular surface (e.g. Sjögren's syndrome, meibomian gland dysfunction, dry eye disease) and contact lens wearers suffering from dry eye. More research is required to determine the exact composition, dosage and indications for their use and to fully characterize how these nutraceuticals modulate the tear film. Copyright © 2013 Elsevier Ltd. All rights reserved.

  8. Impact of Smoking on the Ocular Surface, Tear Function, and Tear Osmolarity.

    Science.gov (United States)

    Aktaş, Serdar; Tetikoğlu, Mehmet; Koçak, Ahmet; Kocacan, Metin; Aktaş, Hatice; Sağdık, Hacı Murat; Özcura, Fatih

    2017-12-01

    This study evaluated the effects of cigarette smoking on the ocular surface, tear function, and tear osmolarity. A total of 50 smokers with at least 5 years of heavy smoking (defined as 1 pack/day) and 51 nonsmoking, healthy individuals were enrolled. Tear osmolarity was measured with an osmometer (TearLab™ Osmolarity System). Ocular surface examinations involved corneal fluorescein staining, measurement of the tear film breakup time (TBUT), the Schirmer 1 test, measurement of corneal sensitivity with a Cochet-Bonnet esthesiometer, and conjunctival impression cytology. Dry eye symptoms were scored using the Ocular Surface Disease Index (OSDI) questionnaire. The results were compared with those from an age and sex-matched control group. The Chi-squared and independent sample t-tests were used for statistical analyses. The smokers had significantly higher tear osmolarity values (305.38 ± 9.81 vs. 301.14 ± 7.04 mOsm/L; p = 0.014) and OSDI scores (34.13 ± 16.58 vs. 18.09 ± 9.61; p tear film, which can damage the ocular surface and tear function.

  9. Contact lens interactions with the tear film.

    Science.gov (United States)

    Mann, Aisling; Tighe, Brian

    2013-12-01

    Biochemical changes brought about by the influence of the contact lens on the tear film are conveniently split into two categories. Firstly, the lens can remove or reduce the levels of specific components in the tear film, and secondly, the lens can augment the tear film, by stimulating the influx of new components or increasing the level of existing components. The most obvious tear film components for study in this context are lipids, proteins, mucins and electrolytes. The interactions are affected by the properties of the lens, the characteristics of the individual wearer and the wear schedule. An additional complicating factor is the fact that the lens is many times thicker than the tear film and any immobilised tear components will be more extensively exposed to oxygen and UV radiation than is the case in the absence of a lens. It is arguably the lipoidal components that are most markedly affected by lens wear, since their immobilisation on the lens surface markedly increases their susceptibility to autoxidative degradation. The limited information that is available highlights the importance of subject specificity and suggests that lipid oxidation phenomena are potentially important in contributing to the 'end of day' discomfort of symptomatic contact lens patients. It is clear that tear lipids, although regarded as relatively inert for many years, are now seen as a reactive and potentially important family of compounds in the search for understanding of contact lens-induced discomfort. The influence of the lens on tear proteins shows the greatest range of complexity. Deposition and denaturation can stimulate immune response, lower molecular weight proteins can be extensively absorbed into the lens matrix and the lens can stimulate cascade or upregulation processes leading either to the generation of additional proteins and peptides or an increase in concentration of existing components. Added to this is the stimulating influence of the lens on vascular

  10. Can the alpha angle assessment of cam impingement predict acetabular cartilage delamination?

    Science.gov (United States)

    Beaulé, Paul E; Hynes, Kelly; Parker, Gillian; Kemp, Kyle A

    2012-12-01

    Substantial acetabular cartilage damage is commonly present in patients suffering from femoral acetabular impingement (FAI). A better understanding of which patient is at risk of developing substantial cartilage damage is critical for establishing appropriate treatment guidelines. We asked: (1) Does the cam deformity severity in FAI as assessed by alpha angle predict acetabular cartilage delamination? And (2) what are the clinical and radiographic findings in patients with acetabular cartilage delamination? One hundred sixty-seven patients (129 males, 38 females) with a mean age of 38 years (range, 17-59 years) underwent joint preservation surgery for cam-type FAI. All data were collected prospectively. We assessed center-edge angle and Tönnis grade on AP radiographs and alpha angle on specialized lateral radiographs. Acetabular cartilage damage was assessed intraoperatively using the classification of Beck et al., with Type 3 and greater qualifying as delamination. For all hips, mean alpha angle was 65.5° (range, 41°-90°), and mean center-edge angle was 33.3° (range, 21°-52.5°). Patients with an alpha angle of 65° or greater had an odds ratio (OR) of 4.00 (95% CI, 1.26-12.71) of having Type 3 or greater damage. Increased age (OR, 1.04; 95% CI, 1.01-1.07) and male sex (OR, 2.24; 95% CI, 1.09-4.62) were associated with Type 3 or greater damage, while this was the opposite for acetabular coverage as assessed by center-edge angle (OR, 0.94; 95% CI, 0.89-0.99). Patients with cam-type FAI and an alpha angle of 65° or more are at increased risk of substantial cartilage damage while increasing acetabular coverage appears to have a protective effect. Level III, prognostic study. See the Instructions for Authors for a complete description of levels of evidence.

  11. Acetabular component position of the noncemented total hip endoprosthesis after previous Chiari pelvic osteotomy.

    Science.gov (United States)

    Slavković, N; Vukašinović, Z; Sešlija, I; Bukumirić, Z; Baščarević, Z; Spasovski, D

    2013-01-01

    The aim of the study was to determine the validity of acetabular component position of the noncemented total hip endoprosthesis after Chiari pelvic osteotomy. The study involved 75 patients operated on at the Institute of Orthopedic Surgery "Banjica" in the period from 1990-2009. The first group consisted of 39 patients (46 hips) who underwent Chiari pelvic osteotomy and also later the implantation of a noncemented total hip endoprosthesis. A control group consisted of 36 patients (47 hips) who underwent total hip arthroplasty due to degenerative hip dysplasia. In the previously operated patients the centre of rotation of the hip was on the average placed more proximally, while in the control group of patients the position of the acetabular component was closer to the anatomical one. In the group of patients after Chiari osteotomy the mean acetabular cup abduction angle rated 41.8°±9.8°, while in the control group this value was on the average higher (45.4°±8.6°). There was a significant difference between the studied groups in relation to the distance between the acetabular component of endoprosthesis and the acetabular teardrop (t=-2.763; p=0.007). No statistically significant difference was determined in the mean value of the angle of acetabular abduction component of endoprosthesis between the studied groups of patients (t=1.878; p=0.064). Acetabular component position of the total hip endoprosthesis was not compromised by anatomic changes of the acetabulum caused by Chiari pelvic osteotomy.

  12. Posterior column acetabular fracture fixation using a W-shaped angular plate: A biomechanical analysis.

    Science.gov (United States)

    Su, Ke; Liu, Song; Wu, Tao; Yin, Yingchao; Zhang, Ruipeng; Li, Shilun; Zhang, Yingze

    2017-01-01

    The purpose of this study was to compare the stability and feasibility of four fixation constructs in a posterior column acetabular fracture: one reconstruction plate, one reconstruction plate and lag screw, two reconstruction plates, and a W-shaped acetabular angular plate. Twenty embalmed cadaveric pelvises with a posterior column acetabular fractures were allocated to one of four groups: 1) a reconstruction plate, 2) a reconstruction plate with a posterior column lag screw, 3) double reconstruction plates, and 4) a W-shaped acetabular angular plate. These constructs were mechanically loaded on a testing machine, and construct stiffness values were measured. Strain gauges were utilized to measure the mechanical behavior in the condition of compressive force. Final stiffness was not different between the two reconstruction plates (445.81±98.30 N/mm) and the W-shaped acetabular angular plate (447.43±98.45 N/mm, p = 0.524), both of which were superior to a single reconstruction plate (248.90±61.95 N/mm) and a combined plate and lag screw (326.41±94.34 N/mm). Following the fixation of the W-shaped acetabular angular plate, the strain distribution was similar to the intact condition around the acetabulum. The parameters of the W-shaped acetabular angular plate that were observed at the superior region of the acetabulum were less than those of a single reconstruction plate (pfracture; it also resulted in a partial restoration of joint loading parameters toward the intact state.

  13. [Surgical treatment of unstable pelvic fractures combined with acetabular fractures].

    Science.gov (United States)

    Wang, Tao; Wang, Jun; Li, Zong-yuan; Liu, Gang

    2015-05-01

    To discuss the treatment strategy of acetabular fractures and unstable pelvic fracture of the hip and to evaluate its outcome. Retrospective analysis of clinical data in 32 patients with unstable pelvic fracture and acetabular fractures from January 2007 to June 2013 were collected. There were 18 males and 14 females aged from 18 to 62 years old (means 38 years old). According to Tile classification of pelvic fracture, 11 cases were type B1, 8 were type B2.1, 7 were type B2.2, 3 were type C1.1, 2 were type C1.2, 1 was type C3. According to Judet-Letournel classification, anterior column fracture was in 1 case, transverse fracture in 8, transverse plus posterior wall fracture in 6, T-type fracture in 1, anterior column plus half transverse fractures in 5, double column fracture in 11. Other combined injuries were treated early, the surgical operation were performed after stable condition. The hip joint function and the fracture reduction were assessed during follow-up. The operative time was from 1.8 to 6.5 hours (averaged 3 hours). Two fat patients' incision occurred in fat liquefaction and healed after dressing, no incision infection happened. Only 1 case was lost to follow-up, 31 patients were followed up with a mean time of 23 months (6 to 42 months). The healing time of pelvic fracture was from 8 to 18 weeks (averaged in 10.6 weeks). The hip function was evaluated according to the Matta and Tornetta standard postoperatively, the result was excellent in 15 cases, good in 14 cases, fair and poor in 1 case respectively. The Majeed score of the hip function was 83.65? 7.67, the result was excellent in 15 cases, good in 12 cases and fair in 4 cases. The healing time of acetabular fractures was from 8 to 16 weeks (averaged in 10.2 weeks). The fracture reduction was assessed by Matta standard, the result was excellent in 15 cases, good in 12 cases and fair in 4 cases. The heterotopic ossification was evaluated by Brooker standard, 4 cases were grade I, 1 case was

  14. Danish translation and validation of the International Skin Tear Advisory Panel Skin Tear Classification System.

    Science.gov (United States)

    Skiveren, J; Bermark, S; LeBlanc, K; Baranoski, S

    2015-08-01

    The aim of this study was to translate, validate and establish reliability of the International Skin Tear Classification System in Danish. Phase 1 of the project involved the translation of the International Skin Tear Advisory Panel (ISTAP) Skin Tear Classification System into Danish, using the forward-back translation method described by the principles of good practice for the translation process for patient-reported outcomes. In Phase 2, the Danish group sought to replicate the ISTAP validation study and validate the classification system with registered nurses (RN) and social and health-care assistants (non-RN) from both primary health care and a Danish university hospital in Copenhagen. Thirty photographs, with equal representation of the three types of skin tears, were selected to test validity. The photographs chosen were those originally used for internal and external validation by the ISTAP group. The subjects were approached in their place of work and invited to participate in the study and to attend an educational session related to skin tears. The Danish translation of the ISTAP classification system was tested on 270 non-wound specialists. The ISTAP classification system was validated by 241 RNs, and 29 non-RN. The results indicated a moderate level of agreement on classification of skin tears by type (Fleiss' Kappa=0.460). A moderate level of agreement was demonstrated for both the RN group and the non-RN group (Fleiss' Kappa=0.464 and 0.443, respectively). The ISTAP Skin Tear Classification System was developed with the goal of establishing a global language for describing and documenting skin tears and to raise the health-care community's awareness of skin tears. The Danish translation of the ISTAP classification system supports the earlier ISTAP study and further validates the classification system. The Danish translation of the classification system is vital to the promotion of skin tears in both research and the clinical settings in Denmark.

  15. RETROSPECTIVE STUDY ON OUTCOME OF SURGICAL MANAGEMENT OF ACETABULAR FRACTURE

    Directory of Open Access Journals (Sweden)

    Saravana Kumar Kadirvelu

    2016-11-01

    Full Text Available BACKGROUND Fractures of the acetabulum occur primarily in young adults as a result of high-velocity trauma and in old age even with trivial trauma. Anatomic reduction and stable fixation of the fracture such that the femoral head is concentrically reduced under an adequate portion of the weight bearing dome of the acetabulum is the treatment goal in these difficult fractures. The aim of the study is: 1. To study the outcome after reconstruction of fracture of acetabulum. 2. To study the postoperative complications and failures. MATERIALS AND METHODS The present study was carried out from March 2015 to September 2016 at Orthopaedics Department, Aarupadai Veedu Medical College and Hospital. During this period, 25 patients of acetabular fracture (20 males and 5 females were managed in our hospital surgically. The indication for surgery in acetabulum fracture was decided according to displacement of fracture and it is decided by measuring the roof arc measurement developed by Matta. If the fracture has been displaced medially or anteriorly or posteriorly to 45° or 25° or 70°, then the fracture should be taken for surgery. All our patients were operated under general anaesthesia with plate and screws (reconstruction or dynamic compression. Some patients were treated with interfragmentary screws. RESULTS Our results were evaluated on the basis of both clinical and radiologic criteria as well as according to fracture type. 1,2,3 Radiologic evaluation showed 76% of excellent and good results and 24% of fair or poor results, while the functional outcome assessment according to d’Aubigne postal scoring and Harris hip score in acetabulum fracture, excellent functional outcome in 13 patients with posterior column acetabulum fracture and fair or poor result in 5 patients. In anterior column acetabulum fracture, 7 patients had excellent functional outcome (44%. Similar results have been reported by Letournel 2 and Matta. 4,3,5 If results were associated

  16. Rehabilitation after labral repair and femoroacetabular decompression: criteria-based progression through the return to sport phase.

    Science.gov (United States)

    Wahoff, Michael; Dischiavi, Steve; Hodge, Jenna; Pharez, Joseph D

    2014-11-01

    Rehabilitation following hip arthroscopy for femoroacetabular impingement (FAI) and labral-chondral dysfunction has evolved rapidly over the past 15 years. There have been multiple commentaries published on rehabilitation following hip arthroscopy without any published standardized objective criteria to address the advancement of the athlete through the phases of rehabilitation. The purpose of this clinical commentary is to describe a criteria driven algorithm for safe integration and return to sport rehabilitation following hip arthroscopy. The criteria based program allows for individuality of the athlete while providing guidance from early post-operative phases through late return to sport phases of rehabilitation. Emphasis is placed on the minimum criteria to advance including healing restraints, patient reported outcomes, range of motion, core and hip stability, postural control, symmetry with functional tasks and gait, strength, power, endurance, agility, and sport-specific tasks. Evidence to support the criteria will be offered as available. Despite limitations, this clinical commentary will offer a guideline for safe return to sport for the athlete while identifying areas for further investigation. 5.

  17. Rotator cuff tears: An evidence based approach

    Science.gov (United States)

    Sambandam, Senthil Nathan; Khanna, Vishesh; Gul, Arif; Mounasamy, Varatharaj

    2015-01-01

    Lesions of the rotator cuff (RC) are a common occurrence affecting millions of people across all parts of the globe. RC tears are also rampantly prevalent with an age-dependent increase in numbers. Other associated factors include a history of trauma, limb dominance, contralateral shoulder, smoking-status, hypercholesterolemia, posture and occupational dispositions. The challenge lies in early diagnosis since a high proportion of patients are asymptomatic. Pain and decreasing shoulder power and function should alert the heedful practitioner in recognizing promptly the onset or aggravation of existing RC tears. Partial-thickness tears (PTT) can be bursal-sided or articular-sided tears. Over the course of time, PTT enlarge and propagate into full-thickness tears (FTT) and develop distinct chronic pathological changes due to muscle retraction, fatty infiltration and muscle atrophy. These lead to a reduction in tendon elasticity and viability. Eventually, the glenohumeral joint experiences a series of degenerative alterations - cuff tear arthropathy. To avert this, a vigilant clinician must utilize and corroborate clinical skill and radiological findings to identify tear progression. Modern radio-diagnostic means of ultrasonography and magnetic resonance imaging provide excellent visualization of structural details and are crucial in determining further course of action for these patients. Physical therapy along with activity modifications, anti-inflammatory and analgesic medications form the pillars of nonoperative treatment. Elderly patients with minimal functional demands can be managed conservatively and reassessed at frequent intervals. Regular monitoring helps in isolating patients who require surgical interventions. Early surgery should be considered in younger, active and symptomatic, healthy patients. In addition to being cost-effective, this helps in providing a functional shoulder with a stable cuff. An easily reproducible technique of maximal strength and

  18. Allergy and allergic mediators in tears.

    Science.gov (United States)

    Leonardi, Andrea

    2013-12-01

    The identification of inflammatory mediators in the tear fluid have been extensively used in ocular allergy to find either a 'disease marker', to better understand the immune mechanisms involved in the ocular surface inflammation, or to identify potential targets for therapeutic interventions. While the clinical characteristics allow a relatively convincing diagnosis of ocular allergic diseases, in the initial, non active phases, or in the chronic stages, the diagnosis may not be clear. Although not highly specific, total tear IgE can be measured with local tests by inserting a paper strip in the lower meniscus. The measurement of tear specific inflammatory markers, such as histamine, tryptase, ECP, IL-4, IL-5 and eotaxin, may be useful for the diagnosis or monitoring ocular allergy. New technologies such as multiplex bead assays, membrane-bound antibody array and proteomic techniques can characterize the distribution of a wide range of bioactive trace proteins in tears. Dozens of mediators, cytokines, chemokines, growth factors, angiogenic modulators, enzymes and inhibitors were thus identified in small tear samples using these techniques, providing the possible identification of specific biomarker for either specific disease or disease activity. However, to date, there is no a single specific laboratory test suitable for the diagnosis and monitoring of allergic conjunctivitis. Copyright © 2013 Elsevier Ltd. All rights reserved.

  19. A case of recurrent bloody tears

    Directory of Open Access Journals (Sweden)

    Karslıoğlu Ş

    2011-07-01

    Full Text Available Şafak Karslioğlu1, Ilke Bahçeci Şimşek2, Müslime Akbaba11Ìstanbul Oculoplastic and Orbital Surgery and Ocular Oncology Center, 2Ophthalmology Department, Medicine Hospital, Ìstanbul, TurkeyAbstract: Well-known causes of blood-tinged epiphora are conjunctival lesions, tumors of the lacrimal apparatus, and systemic bleeding disorders. We describe an unusual patient who presented with recurrent episodes of bloody tearing which began following an erythema multiforme-like drug eruption. He experienced chronic conjunctivitis which resulted in a few minor symblephara. One year later, the patient developed attacks of bloody tearing. All clinical, radiologic, and laboratory investigations related to bloody epiphora were within normal limits except for a mild, nonspecific chronic inflammatory reaction in the perivascular tissues of the lacrimal gland and orbital soft tissues. Also, an increase in vascular permeability and contrast extravasation on carotid angiography was detected. High-dose vitamin C was administered. The patient continued to have unilateral bloody tears intermittently for two years, but the episodes became much less frequent and had resolved by three years. It is conceivable that increased vascular permeability following the systemic inflammatory process could have played a role in the etiology of recurrent bloody tears in this atypical patient.Keywords: bloody tears, erythema multiforme, drug eruption, vitamin C

  20. Meniscal root tears: significance, diagnosis, and treatment.

    Science.gov (United States)

    Bhatia, Sanjeev; LaPrade, Christopher M; Ellman, Michael B; LaPrade, Robert F

    2014-12-01

    Meniscal root tears, less common than meniscal body tears and frequently unrecognized, are a subset of meniscal injuries that often result in significant knee joint disorders. The meniscus root attachment aids meniscal function by securing the meniscus in place and allowing for optimal shock-absorbing function in the knee. With root tears, meniscal extrusion often occurs, and the transmission of circumferential hoop stresses is impaired. This alters knee biomechanics and kinematics and significantly increases tibiofemoral contact pressure. In recent years, meniscal root tears, which by definition include direct avulsions off the tibial plateau or radial tears adjacent to the root itself, have attracted attention because of concerns that significant meniscal extrusion dramatically inhibits normal meniscal function, leading to a condition biomechanically similar to a total meniscectomy. Recent literature has highlighted the importance of early diagnosis and treatment; fortunately, these processes have been vastly improved by advances in magnetic resonance imaging and arthroscopy. This article presents a review of the clinically relevant anatomic, biomechanical, and functional descriptions of the meniscus root attachments, as well as current strategies for accurate diagnosis and treatment of common injuries to these meniscus root attachments. © 2014 The Author(s).

  1. Role of lactoferrin in the tear film.

    Science.gov (United States)

    Flanagan, J L; Willcox, M D P

    2009-01-01

    The surface of the eye provides an inert barrier against infection. Through its unique combination of antimicrobial action and anti-inflammatory activities lactoferrin (Lf) in the tear film plays an important role in the maintenance of ocular health. In order to maintain clarity the eye must provide immunological defense without immunopathology. Along with physical barriers, soluble plasma factors and other proteins such as lysozyme, Lf produced by the acinar cells of the lacrimal gland serves a number of roles in defense for this purpose. Lf in tears provides antimicrobial efficacy by binding free iron thus reducing the availability of iron necessary for microbial growth and survival as well as pathogenesis. Lf has been shown to inhibit biofilm formation and thus may play a role in protecting contact lens surfaces from colonization. Virus particles' entry into epithelial cells is inhibited by Lf while an excess of Lf in tear film is thought to limit the opportunistic Lf-mediated bridging of adenovirus and host cell that occurs in other tissues. Lf dampens the classical complement activation pathway by binding to markers of inflammation and immune activation while pathogen-associated molecular patterns such as lipopolysaccharide (LPS) are targeted by Lf for removal through tears and hydrodynamic flushing. This review focuses on the role of Lf in human tear film and its contribution to ocular health during contact lens wear.

  2. Surgical Stabilization of Pelvic and Acetabular Fractures: A Review on the Determinants of Clinical Outcomes

    Directory of Open Access Journals (Sweden)

    SS Sathappan

    2010-03-01

    Full Text Available AIM: Pelvic and acetabular fractures are associated with high-energy trauma. The aim of this study was to identify factors that are associated with specific clinical outcomes following treatment for these fractures. METHODS: A consecutive series of 30 patients who had surgical intervention for either pelvic or acetabular fractures formed the sample for this study. Clinical variables reviewed were: age, associated injuries, number of surgical procedures, time to surgery and post-operative complications. Clinical outcomes were assessed using Matta’s grading of post- operative fracture reduction alignment, and functional outcomes were graded using D'Aubigne & Postel’s Hip scoring system. RESULTS: Study subjects included twelve pelvic fractures and eighteen acetabular fractures. Patients older than 50 years of age had poorer hip scores despite surgery. Earlier fracture fixation (within five days was associated with better hip scores. Patients with acetabular fractures generally had better functional outcomes than patients with pelvic fractures (mean hip score 15.0 vs. 13.5. Closer anatomical reduction of acetabular fractures was associated with better functional outcome. CONCLUSION: Improved clinical outcomes are associated with younger age, fewer concomitant injuries, shorter time interval to surgery and more closely approximated anatomical fracture reduction.

  3. Acetabular revision in THA using tantalum augments combined with impaction bone grafting.

    Science.gov (United States)

    Gehrke, Thorsten; Bangert, Yannic; Schwantes, Bernd; Gebauer, Matthias; Kendoff, Daniel

    2013-01-01

    Acetabular revision with associated bone loss in uncontained defects can be difficult. We report preliminary results utilising a novel technique, combining tantalum-augments with allograft bone and cemented cups. Forty-six patients undergoing cup revision with a tantalum augment and allografting were clinically (HHS) and radiographically reviewed at an average of 46 months postoperatively. There were 28 type-2B and 18 type-3A Paprosky defects. Postoperative images were assessed for osteointegration, bone-remodelling and recreation of the native hip centre. The average patient age at time of acetabular revision was 65 years, with 18 male and 28 female patients. The HHS improved on average from 44 to 82 points. Correction of the high hip centre was possible in all patients with average medialisation of 10 mm and lowering of the hip centre by 14 mm. Four patients (four hips) sustained a hip dislocation postoperatively and one required revision. Two acetabular revisions were necessary after implantation, because of early cup loosening and failure of the construct. In one of these, the tantalum augment was found to be well fixed. Of the remaining hips, at latest radiographic follow-up, 44 tantalum implants were radiographically stable and osteointegrated. Non-progressive radiolucent lines were present around the acetabular component in two other hips. The combination of tantalum-augmentation with impaction allografting is a promising technique to manage severe uncontained acetabular defects.

  4. Pelvic Incidence: A Predictive Factor for Three-Dimensional Acetabular Orientation—A Preliminary Study

    Directory of Open Access Journals (Sweden)

    Christophe Boulay

    2014-01-01

    Full Text Available Acetabular cup orientation (inclination and anteversion is a fundamental topic in orthopaedics and depends on pelvis tilt (positional parameter emphasising the notion of a safe range of pelvis tilt. The hypothesis was that pelvic incidence (morphologic parameter could yield a more accurate and reliable assessment than pelvis tilt. The aim was to find out a predictive equation of acetabular 3D orientation parameters which were determined by pelvic incidence to include in the model. The second aim was to consider the asymmetry between the right and left acetabulae. Twelve pelvic anatomic specimens were measured with an electromagnetic Fastrak system (Polhemus Society providing 3D position of anatomical landmarks to allow measurement of acetabular and pelvic parameters. Acetabulum and pelvis data were correlated by a Spearman matrix. A robust linear regression analysis provided prediction of acetabulum axes. The orientation of each acetabulum could be predicted by the incidence. The incidence is correlated with the morphology of acetabula. The asymmetry of the acetabular roof was correlated with pelvic incidence. This study allowed analysis of relationships of acetabular orientation and pelvic incidence. Pelvic incidence (morphologic parameter could determine the safe range of pelvis tilt (positional parameter for an individual and not a group.

  5. Pelvic Incidence: A Predictive Factor for Three-Dimensional Acetabular Orientation—A Preliminary Study

    Science.gov (United States)

    Bollini, Gérard; Legaye, Jean; Tardieu, Christine; Prat-Pradal, Dominique; Chabrol, Brigitte; Jouve, Jean-Luc; Duval-Beaupère, Ginette; Pélissier, Jacques

    2014-01-01

    Acetabular cup orientation (inclination and anteversion) is a fundamental topic in orthopaedics and depends on pelvis tilt (positional parameter) emphasising the notion of a safe range of pelvis tilt. The hypothesis was that pelvic incidence (morphologic parameter) could yield a more accurate and reliable assessment than pelvis tilt. The aim was to find out a predictive equation of acetabular 3D orientation parameters which were determined by pelvic incidence to include in the model. The second aim was to consider the asymmetry between the right and left acetabulae. Twelve pelvic anatomic specimens were measured with an electromagnetic Fastrak system (Polhemus Society) providing 3D position of anatomical landmarks to allow measurement of acetabular and pelvic parameters. Acetabulum and pelvis data were correlated by a Spearman matrix. A robust linear regression analysis provided prediction of acetabulum axes. The orientation of each acetabulum could be predicted by the incidence. The incidence is correlated with the morphology of acetabula. The asymmetry of the acetabular roof was correlated with pelvic incidence. This study allowed analysis of relationships of acetabular orientation and pelvic incidence. Pelvic incidence (morphologic parameter) could determine the safe range of pelvis tilt (positional parameter) for an individual and not a group. PMID:25006461

  6. Femoral anteversion in THA and its lack of correlation with native acetabular anteversion.

    Science.gov (United States)

    Bargar, William L; Jamali, Amir A; Nejad, Amir H

    2010-02-01

    Several studies support the concept that, for optimum range of motion in THA, the combined femoral and acetabular anteversion should be some constant or fall within some "safe zone." When using a cementless femoral component, the surgeon has little control of the anteversion of the component since it is dictated by native femoral anteversion. Given this constraint, we asked whether the surgeon should use the native anteversion of the acetabulum as a target for implant position in THA. Forty-six patients scheduled for primary THA underwent CT scanning and preoperative planning using a computer workstation. The native acetabular anteversion and the native femoral anteversion were measured. Prosthetic femoral anteversion was measured on the workstation by three-dimensional templating of a straight-stemmed tapered implant. The mean of the sum of the native acetabular anteversion and native femoral anteversion was 28.9 degrees; however, 17% varied by 10 degrees to 15 degrees and 11% by more than 15 degrees. The mean of native femoral anteversion and prosthetic femoral anteversion was 13.8 degrees (range, -6.1 degrees-32.7 degrees) and 22.5 degrees (range, 1 degrees-39 degrees), respectively. Based on our data, we believe the surgeon should not use the native acetabular anteversion as a target for positioning the acetabular component.

  7. Tear film break-up time in rabbits.

    Science.gov (United States)

    Wei, Xiaojia E; Markoulli, Maria; Zhao, Zhenjun; Willcox, Mark D P

    2013-01-01

    Rabbits have a longer inter-blink time (approximately 10 minutes) compared with humans (five to eight seconds), suggesting that rabbits have a much more stable tear film. Using fluorescein, the tear break-up time of rabbits has been reported to be similar to that of humans. This study set out to measure the tear break-up time in rabbits using non-invasive methods and to establish the pattern of tear break-up compared to humans. The tear break-up time was measured and the pattern of tear break-up was observed in six New Zealand White rabbits on two separate occasions using both the Keeler Tearscope-plus(TM) and a slitlamp biomicroscope. The mean rabbit tear break-up time was 29.8 ± 3.4 (SD) minutes. This contrasts with the reports of human tear break-up time of eight to 30 seconds. The tear breaking spread very slowly and was often restricted to the area of the initial break. Rabbit tears have a significantly higher tear break-up time than humans and this aligns with previously demonstrated differences in inter-blink time between rabbits and humans. Understanding the underlying mechanisms of tear stability may lead to novel ways of increasing human tear film stability. © 2012 The Authors. Clinical and Experimental Optometry © 2012 Optometrists Association Australia.

  8. HPLC analysis of closed, open, and reflex eye tear proteins

    Directory of Open Access Journals (Sweden)

    Sitaramamma T

    1998-01-01

    Full Text Available Changes in the closed, open and reflex eye tear proteins of normal subjects were compared and analysed. Tear proteins were resolved by high-performance liquid chromatography (HPLC utilising both gel filtration (P-300 SW and reverse-phase (C-18 columns and the HPLC fractions were further analysed by sodium dodecyl sulphate - polyacrylamide gel electrophoresis (SDS-PAGE under reducing and non-reducing conditions. The protein composition of the closed-eye tear was significantly different from that of the open and reflex-eye tear. Secretory IgA (sIgA was the predominant protein in closed eye tears constituting 49% of the total protein compared to 11% in reflex tears, whereas lysozyme was the predominant protein (53% in reflex tears. Levels of lactoferrin, lipocalin and lysozyme were relatively constant in both open and reflex tears. HPLC profiles of the closed-eye tears, upon continuous stimulation of lacrimal glands indicated that sIgA was significantly reduced whereas lactoferrin, lipocalin, and lysozyme were significantly increased. These results indicate that the tear composition upon waking attains that of the open eye within 4 to 5 minutes, and upon continuous stimulation this reflects the reflex-eye tear composition. It also indicates that mechanisms responsible for changes in concentration of constitutive and regulated tear protein with stimulus can be studied successfully using non-invasive methods to collect human tears.

  9. HPLC analysis of closed, open, and reflex eye tear proteins.

    Science.gov (United States)

    Sitaramamma, T; Shivaji, S; Rao, G N

    1998-12-01

    Changes in the closed, open and reflex eye tear proteins of normal subjects were compared and analysed. Tear proteins were resolved by high-performance liquid chromatography (HPLC) utilising both gel filtration (P-300 SW) and reverse-phase (C-18) columns and the HPLC fractions were further analysed by sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) under reducing and non-reducing conditions. The protein composition of the closed-eye tear was significantly different from that of the open and reflex-eye tear. Secretory IgA (sIgA) was the predominant protein in closed eye tears constituting 49% of the total protein compared to 11% in reflex tears, whereas lysozyme was the predominant protein (53%) in reflex tears. Levels of lactoferrin, lipocalin and lysozyme were relatively constant in both open and reflex tears. HPLC profiles of the closed-eye tears, upon continuous stimulation of lacrimal glands indicated that sIgA was significantly reduced whereas lactoferrin, lipocalin, and lysozyme were significantly increased. These results indicate that the tear composition upon waking attains that of the open eye within 4 to 5 minutes, and upon continuous stimulation this reflects the reflex-eye tear composition. It also indicates that mechanisms responsible for changes in concentration of constitutive and regulated tear protein with stimulus can be studied successfully using non-invasive methods to collect human tears.

  10. Classification of acetabular changes in osteoarthritis: a histological and radiological analysis of 122 consecutive drill biopsies routinely taken during THA

    NARCIS (Netherlands)

    Clauss, Martin; Ilchmann, Thomas; Zimmermann, Peter; Schafroth, Matthias U.; Lüem, Martin; Ochsner, Peter E.

    2008-01-01

    Aseptic acetabular loosening cannot be explained with a single theory and lots of studies deal with the influence of implant design and surgical technique on implant survival. Implant registers show the effect of demographic and patient-related parameters on acetabular loosening. There is little

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

    LENUS (Irish Health Repository)

    Magill, Paul

    2012-04-01

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

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

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Hip joint metal/metal semi-constrained, with an... Devices § 888.3330 Hip joint metal/metal semi-constrained, with an uncemented acetabular component, prosthesis. (a) Identification. A hip joint metal/metal semi-constrained, with an uncemented acetabular...

  13. 21 CFR 888.3320 - Hip joint metal/metal semi-constrained, with a cemented acetabular component, prosthesis.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Hip joint metal/metal semi-constrained, with a... Devices § 888.3320 Hip joint metal/metal semi-constrained, with a cemented acetabular component, prosthesis. (a) Identification. A hip joint metal/metal semi-constrained, with a cemented acetabular...

  14. Radiographic evaluation of BFX acetabular component position in dogs.

    Science.gov (United States)

    Renwick, Alasdair; Gemmill, Toby; Pink, Jonathan; Brodbelt, David; McKee, Malcolm

    2011-07-01

    To assess the reliability of radiographic measurement of angle of lateral opening (ALO) and angle of version of BFX acetabular cups. In vitro radiographic study. BFX cups (24, 28, and 32 mm). Total hip replacement constructs (cups, 17 mm femoral head and a #7 CFX stem) were mounted on an inclinometer. Ventrodorsal radiographs were obtained with ALO varying between 21° and 70° and inclination set at 0°, 10°, 20°, and 30°. Radiographs were randomized using a random sequence generator. Three observers blinded to the radiograph order assessed ALO using 3 methods: (1) an ellipse method based on trigonometry; (2) using a measurement from the center of the femoral head to the truncated surface of the cup; (3) by visual estimation using a reference chart. Version was measured by assessing the ventral edge of the truncated surface. ALO methods 2 and 3 were accurate and precise to within 10° and were significantly more accurate and precise than method 1 (P < .001). All methods were significantly less accurate with increasing inclination. Version measurement was accurate and precise to within 7° with 0-20° of inclination, but significantly less accurate with 30° of inclination. Methods 2 and 3, but not method 1, were sufficiently accurate and precise to be clinically useful. Version measurement was clinically useful when inclination was ≤ 20°. © Copyright 2011 by The American College of Veterinary Surgeons.

  15. [Tears' immunology in acute eye diseases].

    Science.gov (United States)

    Ignat, F; Godeanu, L; Davidescu, L; Voiculescu, M

    2001-01-01

    The aim of the study is to research the immunoglobulins' concentration into the tears liquid and into the blood serum at the patients with acute affections of the anterior ocular pole. The study was accomplished on two groups of patients: one group with herpetic Keratitis, the other with anterior uveitis, the second having a different etiology--that the viral one. Another group of patients with senile cataract was used like witness-group. The immunoglobulins concentration were detected into the serum and into the tears by the Mancini method of the radial immunodiffusion. The results indicate a general immunodefficiency signed by the decrease of IgG and IgM into the serum on the one hand, and the increase of local defense mechanisms reflected on the growing of IgA and IgG level into the tears, on the other hand.

  16. Slab tears and intermediate-depth seismicity

    Science.gov (United States)

    Meighan, Hallie E.; ten Brink, Uri S.; Pulliam, Jay

    2013-01-01

    Active tectonic regions where plate boundaries transition from subduction to strike slip can take several forms, such as triple junctions, acute, and obtuse corners. Well-documented slab tears that are associated with high rates of intermediate-depth seismicity are considered here: Gibraltar arc, the southern and northern ends of the Lesser Antilles arc, and the northern end of Tonga trench. Seismicity at each of these locations occurs, at times, in the form of swarms or clusters, and various authors have proposed that each marks an active locus of tear propagation. The swarms and clusters start at the top of the slab below the asthenospheric wedge and extend 30–60 km vertically downward within the slab. We propose that these swarms and clusters are generated by fluid-related embrittlement of mantle rocks. Focal mechanisms of these swarms generally fit the shear motion that is thought to be associated with the tearing process.

  17. Tear osmolarity and tear function assessment in patients with polycystic ovary syndrome

    Directory of Open Access Journals (Sweden)

    Derya Alp Guliyev

    Full Text Available ABSTRACT Purpose: Polycystic ovary syndrome (PCOS is an endocrine disease characterized by chronic anovulation and hyperandrogenism. Hormonal changes can affect tear function. This study evaluates tear function and impact of hyperandrogenism on it in PCOS patients. Methods: Fifty patients with PCOS and thirty control volunteers were examined for tear break-up time, Schirmer-I and tear osmolarity. Also, serum levels of total testosterone, FSH, LH and AMH were determined in venous blood samples in the early follicular phase. PCOS patients were divided into two groups by plasma total testosterone level: Group A with normal (≤0.513 ng/ml;n=27, Group B with higher hormone level (>0.513 ng/ml;n=23. Healthy control group indicated as Group C (n=30. Results: LH, total testosterone levels were higher in the PCOS group than in the control group (p=0.012; p=0.025. Mean values of tear break-up time and Schirmer-I were different between groups and especially Group A and C were near to each other differing from B (p>0.05. Tear osmolarity results were higher in Group B, compared to A and C (p=0.049; p=0.033. No significant difference detected in tear osmolarity value means of Group A and C (p=0.107. AMH levels were higher in Group B, compared to A and C (p=0.002; p=0.001. AMH levels in Group A were higher than that of C (p=0.002. Positive correlation between levels of total testosterone and AMH was detected in all PCOS patients (n=50;Pearson's r=0.579; p<0.001. Conclusion: Tear function can be affected in PCOS patients with hyperandrogenism. Tear osmolarity is the most sensitive and objective assessment method for ocular surface changes in PCOS.

  18. Superior labrum anterior-to-posterior tear.

    Science.gov (United States)

    Sum, Jonathan C; Omid, Reza

    2012-12-01

    The patient was a 25-year-old male college student with a chief complaint of right shoulder pain. The patient was initially diagnosed with bicipital tendinitis by his physician and had been treated for 4 weeks by a physical therapist. However, his symptoms did not improve and he was unable to return to his preinjury activity levels, so he sought the services of another physical therapist for a second opinion. Due to concern for a labrum tear, the physical therapist referred the patient to an orthopaedic surgeon. Magnetic resonance arthrography revealed findings consistent with a superior labrum anterior-to-posterior tear.

  19. Use of porous tantalum for acetabular reconstruction in revision hip arthroplasty.

    Science.gov (United States)

    Issack, Paul S

    2013-11-06

    ➤ Over the past decade, porous tantalum has emerged as a powerful tool for reconstruction of the failed acetabular component.➤ The increased porosity, high coefficient of friction, and favorable elastic modulus of porous tantalum compared with traditional titanium mesh or cobalt chromium acetabular components allow for greater bone ingrowth potential, implant stability, and host bone preservation, respectively, in porous tantalum shells.➤ Several studies have confirmed the excellent early and midterm results of porous tantalum reconstruction for revision hip arthroplasty.➤ Depending on the degree of bone loss, excellent results have been achieved with modular or revision porous tantalum shells, tantalum shells with tantalum augments, and cup-cage constructs.➤ These implants and techniques are greatly changing the approach to acetabular revision surgery and are providing constructs with greater stability and more physiologic biomechanical properties than those achieved through the use of traditional reconstructive methods.

  20. [Postoperative rehabilitation strategy for acetabular fracture: application of 3D printing technique].

    Science.gov (United States)

    Deng, Aiwen; Xiong, Ribo; He, Weiming; Wei, Dong; Zeng, Canjun

    2014-04-01

    To explore the value of 3D printing technique in the surgical management and strategy of rehabilitation therapy of acetabular fracture. For a patient with acetabular fracture, the pelvis model was printed preoperatively by 3D printing technique for surgical simulation to determine the optimal position of the screw, measure the screw length, and design the route of screw entry. Laparoscopic assisted internal fixation was performed, and a gradual and systematic rehabilitation plan was carried out after the surgery based on the results of simulation. The operation was completed successfully with a shortened postoperative recovery time. The application of 3D printing allows more accurate and safer surgical management of acetabular fracture to promote postoperative recovery of the patient and lower the medical costs.

  1. Acetabular QCT in Total Hip Arthroplasty - a reliability study using porcine hips

    DEFF Research Database (Denmark)

    Mussmann, Bo Redder; Overgaard, Soren; Torfing, Trine

    previously shown better delineation of the interface between bone and prosthesis and may be beneficial in quantitative analysis of bone loss close to the implant as compared to single energy computed tomography (SECT). The purpose of this porcine ex-vivo study was to test the intra-observer agreement...... and reliability of bone mineral density measurements (BMD) in close proximity of the acetabular cup using SECT and DECT images and 3D segmentation software. Materials and methods 22 acetabular cups (12 cemented, 10 un-cemented) were inserted in porcine hip specimens ex vivo. A femoral stem was attached to each...... specimen and imaging was performed with SECT and DECT. The specimens were repositioned and scans repeated to obtain double measurements. For each scan BMD was measured in a hemispherical volume around the acetabular cup using in-house segmentation software. Results In the uncemented concept mean BMD...

  2. Biomechanical Analysis of the Fixation System for T-Shaped Acetabular Fracture

    Directory of Open Access Journals (Sweden)

    Yanping Fan

    2015-01-01

    Full Text Available This study aims to evaluate the biomechanical mechanism of fixation systems in the most frequent T-shaped acetabular fracture using finite element method. The treatment of acetabular fractures was based on extensive clinical experience. Three commonly accepted rigid fixation methods (double column reconstruction plates (P × 2, anterior column plate combined with posterior column screws (P + PS, and anterior column plate combined with quadrilateral area screws (P + QS were chosen for evaluation. On the basis of the finite element model, the biomechanics of these fixation systems were assessed through effective stiffness levels, stress distributions, force transfers, and displacements along the fracture lines. All three fixation systems can be used to obtain effective functional outcomes. The third fixation system (P + QS was the optimal method for T-shaped acetabular fracture. This fixation system may reduce many of the risks and limitations associated with other fixation systems.

  3. Massive perineal wound slough after treatment of complex pelvic and acetabular fractures using a traction table.

    Science.gov (United States)

    Hammit, Matthew D; Cole, Peter A; Kregor, Philip J

    2002-09-01

    An operating table with the capacity for skeletal traction against a pudendal post is a helpful and commonly used piece of equipment for certain pelvic and acetabular fracture patterns. Perineal soft tissue trauma and urogenital injuries are associated with some pelvic and acetabular fractures. The perineal region is vulnerable to compromise after such injuries. There is little documentation available in the literature that addresses intraoperative complications of the perineum after the use of a traction table for pelvic fractures. We present here a case in which prolonged traction against a pudendal post during operative fixation of complex pelvic and acetabular fractures resulted in massive perineal wound slough. This case should heighten surgeons' awareness of the vulnerability of the perineum to injury with the use of a traction table and should prompt measures to prevent complications.

  4. Effects of acetabular rim trimming on hip joint contact pressures: how much is too much?

    Science.gov (United States)

    Bhatia, Sanjeev; Lee, Simon; Shewman, Elizabeth; Mather, Richard C; Salata, Michael J; Bush-Joseph, Charles A; Nho, Shane J

    2015-09-01

    In patients with femoroacetabular impingement (FAI), acetabular rim trimming removes the offending area of the acetabular deformity in patients with pincer-type and mixed-type FAI to improve hip joint kinematics. Although the rationale for arthroscopic acetabular rim trimming in patients with FAI is well established, the amount of rim resection has not been quantified, and the threshold at which excessive rim resection results in abnormal hip contact pressures has not been described. To investigate the changes in contact areas, contact pressures, and peak forces within the hip joint with sequential acetabular rim trimming. Controlled laboratory study. Six fresh-frozen, nondysplastic, human cadaveric hemipelvises were analyzed utilizing thin-film piezoresistive load sensors to measure the contact area, contact pressure, and peak force after anterosuperior acetabular rim trimming at depths of 0 mm (intact), 2 mm, 4 mm, 6 mm, and 8 mm. Each specimen was examined at 20° of extension and 60° of flexion. Analysis was performed on 2 regions of interest: the acetabular rim and the acetabular base (deep part of the acetabulum). After each experimental condition, the acetabulum was normalized with respect to the intact state to account for specimen variability. Statistical analysis was conducted through 1-way analysis of variance with post hoc Games-Howell tests. At the acetabular base, there were significant increases in the contact area after 4-mm resection (60°: 169.12% ± 30.64%; P = .0138), contact pressure after 6-mm resection (60°: 292.76% ± 79.07%; P = .009), and peak force after 6-mm resection (60°: 166.00% ± 34.40%; P = .027). At the acetabular rim, there were significant decreases in the contact area after 6-mm resection (60°: 66.32% ± 18.80%; P = .0354) (20°: 65.47% ± 15.87%; P = .0127), contact pressure after 6-mm resection (60°: 50.77% ± 11.49%; P < .001) (20°: 58.01% ± 23.10%; P = .0335), and peak force after 6-mm resection (60°: 60.67% ± 9

  5. Acetabular Fractures in the Elderly: Midterm Outcomes of Column Stabilisation and Primary Arthroplasty

    Directory of Open Access Journals (Sweden)

    A. Ortega-Briones

    2017-01-01

    Full Text Available Background. Interest in arthroplasty techniques for periarticular or intra-articular fractures in the elderly/osteoporotic patient continues to rise, including for geriatric acetabular fractures. In line with this, many acetabular fracture surgeons are now undertaking acute total hip arthroplasty in elderly/osteoporotic patients. Little is known however of the outcomes of this procedure, beyond the first year after surgery. Questions/Purposes. We determined the clinical outcomes of a series of elderly osteoporotic patients (mean age at surgery 77.4 years treated for acetabular fractures with column fixation and simultaneous total hip arthroplasty, at a mean of 49 months after surgery. Methods. 24 patients (25 hips were reviewed at a mean of 49 months after surgery. The surgical technique employed has previously been described. Radiographs were obtained, and clinical outcomes were assessed using Harris Hip Scores and the Merle d’Aubigné score. Results. 14 hips were available for assessment (9 deceased, 2 lost to follow-up. No patient suffered any complications beyond the perioperative period, no acetabular components were loose clinically or on latest radiographs, and the mean Harris Hip Score was 92. All but one patient scored good or excellent on the Merle d’Aubigné score. Conclusions. Column fixation and simultaneous total hip arthroplasty are a viable option for complex geriatric acetabular fractures, with encouraging midterm results. We conclude that THR is a viable long-term solution in this situation provided that the acetabular columns are stabilised prior to implantation, but more research is needed to aid in overall management decision making.

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

    Energy Technology Data Exchange (ETDEWEB)

    Williams, T.R. [Portsmouth Naval Medical Center, Radiology Department, Charette Health Care Center, Portsmouth, VA (United States); Puckett, M.L.; Shin, A.Y.; Gorman, J.D. [Naval Medical Center San Diego, Radiology Department, San Diego, CA (United States); Denison, G. [US Naval Hospital Guam (United States)

    2002-05-01

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

  7. Is rehabilitation effective in massive rotator cuff tears?

    Science.gov (United States)

    Collin, P G; Gain, S; Nguyen Huu, F; Lädermann, A

    2015-06-01

    Irreparable massive rotator cuff tears are challenging to treat. Our objective here was to evaluate the efficacy of a specifically designed rehabilitation programme. We hypothesised that outcomes of the rehabilitation programme would vary with the site of the tears. Patients with irreparable massive rotator cuff tears and shoulder pseudoparalysis were included prospectively. They followed a five-session specific rehabilitation programme. The outcomes were analysed according to the site of the tears. We included 45 patients with a mean age of 67 years. At last follow-up after rehabilitation, 24 patients had recovered more than 160° of anterior shoulder elevation. Treatment failure was common in patients with massive anterior rotator cuff tears or tears involving three or more tendons. Patients with massive posterior tears, in contrast, often experienced substantial improvements, even in the medium term. Outcomes of rehabilitation therapy in patients with irreparable massive rotator cuff tears and shoulder pseudoparalysis vary according to the site and number of the tears. Failure of rehabilitation therapy is common in patients with massive anterior tears or tears involving at least three tendons. In contrast, in patients with isolated massive posterior tears, substantial benefits from rehabilitation therapy can be expected. III. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  8. The contact lens environment: tear proteins in perspective.

    Science.gov (United States)

    Carney, L G; Hill, R M

    1985-03-01

    Tear protein deposition on contact lenses can lead to interruption or even cessation of lens wear. Yet, there are positive roles that tear proteins play in the maintenance of ocular integrity, with and without contact lenses present. One of these roles, that of tear buffering, is explored here.

  9. Displaced Anterior Column Acetabular Fracture: Closed Reduction and Percutaneous CT-Navigated Fixation

    Energy Technology Data Exchange (ETDEWEB)

    Huegli, R.W.; Staedele, H.; Messmer, P.; Regazzoni, P.; Steinbrich, W.; Gross, T. [Univ. Hospital of Basel (Switzerland). Dept. of Radiology

    2004-10-01

    The purpose of this study is to demonstrate the feasibility of computer-tomography-navigated closed reduction and percutaneous fixation (CRPF) in a patient with an externally rotated left acetabular fracture. After a follow-up of 18 months the patient was pain-free and had a normal range of motion in both hip joints. Radiologically, the fracture was fully consolidated, remodelled, and there were no signs of osteoarthritis. To our knowledge, CT-navigated CRPF of a rotated acetabular fracture has not been reported before. Further studies regarding the feasibility of the method are warranted(CRPF)

  10. Danish translation and validation of the International Skin Tear Advisory Panel Skin Tear Classification System

    DEFF Research Database (Denmark)

    Skiveren, J; Bermark, S; LeBlanc, K

    2015-01-01

    OBJECTIVE: The aim of this study was to translate, validate and establish reliability of the International Skin Tear Classification System in Danish. METHOD: Phase 1 of the project involved the translation of the International Skin Tear Advisory Panel (ISTAP) Skin Tear Classification System...... and external validation by the ISTAP group. The subjects were approached in their place of work and invited to participate in the study and to attend an educational session related to skin tears. RESULTS: The Danish translation of the ISTAP classification system was tested on 270 non-wound specialists...... into Danish, using the forward-back translation method described by the principles of good practice for the translation process for patient-reported outcomes. In Phase 2, the Danish group sought to replicate the ISTAP validation study and validate the classification system with registered nurses (RN...

  11. An Athlete's Nightmare: Tearing the ACL

    Science.gov (United States)

    ... on the balls of their feet. "If the calf muscles are not absorbing the force, and if ... A stretch and/or tear of a ligament. Strain An injury to either a muscle or a tendon. Photo courtesy of NIAMS Summer ...

  12. Massive rotator cuff tears: definition and treatment.

    Science.gov (United States)

    Lädermann, Alexandre; Denard, Patrick J; Collin, Philippe

    2015-12-01

    The aim of this review is to summarise tear pattern classification and management options for massive rotator cuff tears (MRCT), as well as to propose a treatment paradigm for patients with a MRCT. Data from 70 significant papers were reviewed in order to define the character of reparability and the possibility of alternative techniques in the management of MRCT. Massive rotator cuff tears (MRCT) include a wide panoply of lesions in terms of tear pattern, functional impairment, and reparability. Pre-operative evaluation is critical to successful treatment. With the advancement of medical technology, arthroscopy has become a frequently used method of treatment, even in cases of pseudoparalytic shoulders. Tendon transfer is limited to young patients with an irreparable MRCT and loss of active rotation. Arthroplasty can be considered for the treatment of a MRCT with associated arthritis. There is insufficient evidence to establish an evidence-based treatment algorithm for MRCTs. Treatment is based on patient factors and associated pathology, and includes personal experience and data from case series.

  13. Treatment for acute anterior cruciate ligament tear

    DEFF Research Database (Denmark)

    Frobell, Richard B; Roos, Harald P; Roos, Ewa M

    2013-01-01

    To compare, in young active adults with an acute anterior cruciate ligament (ACL) tear, the mid-term (five year) patient reported and radiographic outcomes between those treated with rehabilitation plus early ACL reconstruction and those treated with rehabilitation and optional delayed ACL...

  14. Ion Landau Damping on Drift Tearing Modes

    CERN Document Server

    Connor, J W; Zocco, A

    2012-01-01

    The equations governing the ion Landau damping (ILD) layers for a drift tearing mode are derived and solved to provide a matching to ideal MHD solutions at large $x$ and to the drift tearing solution emerging from the ion kinetic region, $k\\rho_{i}\\sim1$, at small $x,$ the distance from the rational surface. The ILD layers lie on either side of the mode rational surface at locations defined by $k_{y}xV_{Ti}/L_{s}=\\omega_{*e}(1+0.73\\eta_{e})$ and have been ignored in many previous analyses of linear drift tearing stability. The effect of the ILD layer on the drift tearing mode is to introduce an additional stabilizing contribution, requiring even larger values of the stability index, $\\Delta^{\\prime}$ for instability, than predicted by Connor Hastie and Zocco [PPCF,54, 035003, (2012)] and Cowley, Kulsrud and Hahm [Phys. Fluids,29, 3230, (1986)]. The magnitude and scaling of the new stabilizing effect in slab geometry is discussed.

  15. Acetabular anteversion is associated with gluteal tendinopathy at MRI.

    Science.gov (United States)

    Moulton, Kyle M; Aly, Abdel-Rahman; Rajasekaran, Sathish; Shepel, Michael; Obaid, Haron

    2015-01-01

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

  16. Acetabular anteversion is associated with gluteal tendinopathy at MRI

    Energy Technology Data Exchange (ETDEWEB)

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

    2015-01-15

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

  17. Biomechanical Study of Acetabular Tridimensional Memoryalloy Fixation System

    Science.gov (United States)

    Liu, Xin-Wei; Xu, Shuo-Gui; Zhang, Yun-Tong; Zhang, Chun-Cai

    2011-07-01

    We developed the acetabular tridimensional memoryalloy fixation system (ATMFS), which is made of NiTi shape memory alloy, according to the specific mechanical properties of biological memory material, NiTi shape memory alloy and measured distribution of contact area and pressure between the acetabulum and the femoral head of cadaveric pelvis. Seven formalin-preserved cadaveric pelves were used for this investigation. Pressure-sensitive film was used to measure contact area and pressure within the anterior, superior, and posterior regions of the acetabulum. The pelves were loaded under the following four conditions: (1) intact; (2) following a creation posterior wall fracture defect; (3) following reduction and standard internal fixation with reconstruction plate; and (4) following reduction and internal fixation with a new shape memory alloy device named ATMFS. A posterior wall fracture was created along an arc of 40° to 90° about the acetabulur rim. Creation of a posterior wall defect resulted in increased load in the superior acetabulum (1485 N) as compared to the intact condition (748 N, P = 0.009). Following reduction and internal fixation, the load distributed to the superior acetabulum (1545 N) was not statistically different from the defect condition. Following the fixation with ATMFS, the load seen at the superior region of the actabulum (964 N) was familiar with fixation with reconstruction plate and was not different from intact state ( P = 0.45). These data indicate that the use of ATMFS as a fracture internal fixation device resulted a partial restoration of joint loading parameters toward the intact state. ATMFS fixation may result in a clinical benefit.

  18. Correlations among upper and lower tear menisci, noninvasive tear break-up time, and the Schirmer test.

    Science.gov (United States)

    Wang, Jianhua; Palakuru, Jayachandra R; Aquavella, James V

    2008-05-01

    To determine the relationships among tear meniscus parameters, noninvasive tear break-up time (NITBUT), and the Schirmer test. Experimental study. Thirty-six subjects were tested on one randomly selected eye. Real-time corneal optical coherence tomography (OCT) was used to image the upper and lower tear menisci during normal and delayed blinking followed by measurement of NITBUT and the Schirmer test. Digital images of the eye were taken for measuring the lid lengths to estimate tear volume in the menisci. Compared with normal blinking, significant increases of tear menisci occurred during delayed blinking (post hoc, P < .01). NITBUT was weakly but significantly correlated with the height (r = 0.36; P = .03) and area (r = 0.37; P = .03) of the lower tear meniscus during normal blinks. NITBUT was also correlated with the lower tear meniscus volume (r = 0.45; P < .05) and total tear meniscus volume (r = 0.43; P < .05) during normal blinking. The Schirmer test was not significantly related to any parameters of the tear menisci, volumes, or NITBUT; however, it was negatively correlated with the age of the subjects (r = -0.47; P = .004). The age was negatively correlated with the upper tear meniscus (r ranged from 0.36 to 0.37 for the radius, height, and area, P < .05) measured during delayed blinking. NITBUT appears correlated with the lower tear meniscus during normal blinking, and the Schirmer test appears not correlated with the noninvasively measured tear meniscus.

  19. Effect degree of crosslinking on the tearing energy

    Science.gov (United States)

    Fedors, R. F.

    1974-01-01

    Much recent work has been carried out on the tear behavior of elastomers, both filled and unfilled. By use of a criterion for tearing involving the concept of the tearing energy, the effects of variables such as test temperature, test rate, specimen geometry, and chemical nature of the elastomer have been investigated. The one variable which has not yet been studied is the specific effect of changes in the degree of crosslinking on tear behavior. By use of data published in the literature on the smooth tear behavior of unfilled vulcanizates, it is shown that these data can all be superposed onto a common response curve when the proper normalizations are applied.

  20. Delayed Total Hip Arthroplasty for Failed Acetabular Fractures: The Influence of Initial Fracture Management on Outcome After Arthroplasty.

    Science.gov (United States)

    Gavaskar, Ashok S; Gopalan, Hitesh; Karthik, Bhupesh; Srinivasan, Parthasarathy; Tummala, Naveen C

    2017-03-01

    Total hip arthroplasty (THA) provides a successful salvage option for failed acetabular fractures. The complexity of arthroplasty for a failed acetabular fracture will depend on the fracture pattern and the initial management of the fracture. Our objective was to compare the midterm outcome of THA between patients who presented with failed acetabular fractures following initial surgical or nonsurgical treatment. Forty-seven patients underwent cementless THA ± acetabular reconstruction following failed treatment of acetabular fractures. Twenty-seven were initially treated by surgery (group A) and 20 had nonsurgical treatment (group B). Intraoperative measures, preoperative and follow-up clinical, radiological, and functional outcomes were compared between the 2 groups. The mean surgical time, blood loss, and need for blood transfusion were significantly less in group A (P fracture is greatly facilitated by initial surgical treatment. Although functional results and survivorship were similar in both groups, failed nonsurgical treatment in complex fractures is associated with migrated femoral head and extensive acetabular defects requiring complex acetabular reconstruction. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Posterior horn lateral meniscal tears simulating meniscofemoral ligament attachment in the setting of ACL tear: MRI findings

    Energy Technology Data Exchange (ETDEWEB)

    Park, Lawrence S.; Jacobson, Jon A.; Jamadar, David A.; Caoili, Elaine; Kalume-Brigido, Monica [University of Michigan, Department of Radiology, Ann Arbor, MI (United States); Wojtys, Edward [University of Michigan, Department of Orthopaedic Surgery, 24 Frank Lloyd Wright Drive, Box 391, Ann Arbor, MI (United States); University of Michigan Sports Medicine Program, Department of MedSport, 24 Frank Lloyd Wright Drive, Box 391, Ann Arbor, MI (United States)

    2007-05-15

    We have noted apparent far lateral meniscal attachment of the meniscofemoral ligament (MFL) with an anterior cruciate ligament (ACL) tear. This study evaluates MFL attachment and association with posterior horn lateral meniscus (PHLM) tear. Nine months of knee arthroscopy reports were reviewed to classify the PHLM and ACL as torn or normal. After excluding those with prior knee surgery, MR images were reviewed by two radiologists to determine the number of images lateral to PCL, which showed the ligaments of Humphrey and Wrisberg visible as structures separate from the PHLM. Any patient with abnormal PHLM surface signal not continuous with the MFL was excluded. MRI findings were compared with arthroscopy using Student's t test and Fisher's exact test. Of the 54 participants, 5 had PHLM tears and 49 were normal. Twenty-one had ACL tears; all those with an PHLM tear had an ACL tear. The ligament of Humphrey inserted on average 0.9 consecutive images lateral to the PCL without an PHLM tear and 4.7 with an PHLM tear; the ligament of Wrisberg inserted on average 3.0 consecutive images without an PHLM tear and 4.5 with an PHLM tear (slice thickness/gap = 3 mm/0.5 mm). There was a significant association between PHLM tear and number of images (p = 0.0028), and between ACL tear and this type of PHLM tear (p = 0.0064). Apparent far lateral meniscal extension of a meniscofemoral ligament (greater than or equal to four images lateral to the PCL) should be considered as a possible PHLM tear, especially in the setting of an ACL tear. (orig.)

  2. The Comparative Analysis of a Novel Acetabular Component against Hemispherical Component in Case of Extensive Acetabular Bone Defects — A Study of Finite Element Analysis

    Directory of Open Access Journals (Sweden)

    Wenhui Ma

    2013-02-01

    Full Text Available The purpose of this study was to evaluate the design of a cup using finite element method and to analyze possible effects of joint loading postoperatively, and its initial mechanical stability, so as to direct its further optimization. Finite-element (FE models of the cup with three wings and the hemispherical cup were created to calculate the stress patterns during a normal gait cycle. The stress in the acetabular components were analyzed and compared. The FE analysis demonstrated that all kinds of acetabular components had the same trend for stress and strain. The stress of the wings increased gradually from rim to root. Its peak stress was significantly lower than the yield force of the Co-Cr-Mo alloy at the joint between the wing and the shell. The graft portion near the acetabular component was subjected to higher stress conditions. The contact stresses were found to be decreased with a reduced abduction angle of wings. The cup with wings of abduction angle of 15° had lower stresses compared with other cups. The cup with wings is a reliable option for the reconstruction of the acetabulum with extensive bone socket defects. The reduced abduction angle of wings helps to decrease the stress of the cup with wings. The FE analysis is a useful tool with which to address these issues.

  3. Total hip replacement with dorsal acetabular rim augmentation using the SOP(TM) implant and polymethylmethacrylate cement in seven dogs with dorsal acetabular rim deficiency.

    Science.gov (United States)

    Fitzpatrick, Noel; Bielecki, Malgorzata; Yeadon, Russell; Hamilton, Michael

    2012-01-01

    To describe a surgical technique for reinforced augmentation of the dorsal acetabular rim (DAR) using a string-of-pearls (SOP™) locking plate and polymethylmethacrylate (PMMA) bone cement, and to report clinical outcome in 7 dogs. Case series. Dogs (n=7). Medical records (November 2009-April 2010) of 7 dogs with large DAR deficits, that had total hip replacement (THR) with reinforced augmentation of the DAR using a SOP™ plate and PMMA were evaluated retrospectively. Reinforced augmentation of the DAR involved anchorage of a precontoured 2.0 or 2.7 mm SOP™ plate dorsal to the acetabulum followed by application of PMMA cement to cover the reamed acetabulum and plate. Cemented acetabular components were used. Implant associated complications were recorded and ≥6-month follow-up obtained. In all dogs, lameness improved at medium-term reassessment (median, 8 months; range, 6-11 months). Complications included transient sciatic neurapraxia in 2 dogs, which resolved by 3 months. Reinforced augmentation of the DAR using a SOP™ plate and PMMA cement may facilitate placement of acetabular THR component implantation in dogs with severe DAR insufficiency. © Copyright 2011 by The American College of Veterinary Surgeons.

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

    Directory of Open Access Journals (Sweden)

    G. García del Pino

    2002-01-01

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

  5. Combined Subscapularis Tears in Massive Posterosuperior Rotator Cuff Tears: Do They Affect Postoperative Shoulder Function and Rotator Cuff Integrity?

    Science.gov (United States)

    Park, Jin-Young; Chung, Seok Won; Lee, Seoung-Joon; Cho, Hyoung-Weon; Lee, Jae Hyung; Lee, Jun-Hee; Oh, Kyung-Soo

    2016-01-01

    Previous studies on massive rotator cuff tears have not addressed the outcomes of tears extending to the subscapularis tendon. The retear rate in patients with a massive posterosuperior rotator cuff tear combined with a subscapularis tear is higher than that in patients with a massive posterosuperior rotator cuff tear with an intact subscapularis tendon. Cohort study; Level of evidence, 3. Data were collected and analyzed from 92 consecutive patients who underwent arthroscopic repair of a massive posterosuperior rotator cuff tear. Patients were divided into 3 groups according to the status of the subscapularis tendon: intact subscapularis tendon (I-massive tear; n = 42), tear involving half or less than half of the subscapularis tendon (S-massive tear; n = 22), and tear involving more than half of the subscapularis tendon (L-massive tear; n = 28). The integrity of the rotator cuff was determined by ultrasonography at 4.5 and 12 months or later after surgery. Clinical evaluations were performed using the visual analog scale (VAS) pain score, the American Shoulder and Elbow Surgeons (ASES) score, the Constant score, and active shoulder range of motion. Data were collected on the day before surgery and at final follow-up (at least 24 months postoperatively). A total of 25 retears (27%) were identified based on an ultrasonographic evaluation. Although statistical significance was not found, there was a trend toward a higher retear rate in patients with an L-massive tear (43%) compared with those with an S-massive tear (18%; P = .050) or I-massive tear (21%; P = .059) at final follow-up. The subclassification of retears according to the involved tendons revealed that subsequent retears of the subscapularis tendon were noted only in patients with an L-massive tear. In patients with an L-massive tear, postoperative data comparison between patients with intact subscapularis tendons and those with failed subscapularis tendons revealed that a significant difference was noted

  6. Antioxidant content and ultraviolet absorption characteristics of human tears.

    Science.gov (United States)

    Choy, Camus Kar Man; Cho, Pauline; Benzie, Iris F F

    2011-04-01

    Dry eye syndrome is a common age-related disorder, and decreased antioxidant/ultraviolet (UV) radiation protection in tears may be part of the cause. This study aimed to compare the tear antioxidant content and flow rate in young and older adults. The total antioxidant content and UV absorbing properties of various commercially available ophthalmic solutions used to alleviate dry eye symptoms were also examined. Minimally stimulated tears were collected from 120 healthy Chinese adults with no ocular pathology. Two age groups were studied: 19 to 29 years (n = 58) and 50 to 75 years (n = 62). Tear samples from each subject and 13 ophthalmic solutions were analyzed for total antioxidant content (as the Ferric Reducing/Antioxidant Power value). Tear flow rates were estimated from time taken to collect a fixed volume of tear fluid. UV absorbance spectra of pooled fresh reflex tear fluid and the ophthalmic solutions were determined. Results showed that the antioxidant content of minimally stimulated tears from older subjects (398 ± 160 μmol/l) was not significantly lower than that of younger subjects (348 ± 159 μmol/l; p = 0.0915). However, there was a significant difference in the tear flow rates between the two groups (p tears. The effect of low flow rate on the dynamic antioxidant supply to the corneal surface indicates that older subjects have poorer overall defense against photooxidative and other oxidative processes. This could predispose older persons to corneal stress and development of dry eye syndrome. The commercially available artificial tears tested lack both the antioxidant content and UV absorbing characteristics of natural tears. Artificial tears formulations that help restore natural antioxidant and UV absorbing properties to the tear film of the aging eye may help prevent or improve dry eye symptoms and promote ocular health.

  7. Shell design and reaming technique affect deformation in mobile-bearing total hip arthroplasty acetabular components.

    Science.gov (United States)

    Small, Scott R; Meding, John B; Oja, Jordan W; Lakstins, Katherine S; Gehron, Danielle J; Rogge, Renee D; Buckley, Christine A

    2017-08-01

    Press-fit acetabular components are susceptible to rim deformation. The inherent variability within acetabular reaming techniques may generate increased press-fit and, subsequently, additional component deformation. The purpose of this study was to analyze the insertion and deformation characteristics of acetabular components designed for dual-mobility systems based on component design, size, and reaming technique. Shell deformation was quantified in a validated worst-case scenario foam pinch model. Thin-walled, one-piece, and modular dual-mobility shells of varying size were implanted in under- and over-reamed cavities with insertion force measured and shell deformation assessed using digital image correlation. Increased shell size resulted in larger rim deformation in one-piece components, with a reduction in press-fit by 1 mm resulting in up to 48% reduction in insertion forces and between 23% and 51% reduction in shell deformation. Lower insertion forces and deformations were observed in modular components. Variability in acetabular reaming plays a significant role in the ease of implantation and component deformation in total hip arthroplasty. Modular components are less susceptible to deformation than thin-walled monoblock shells. Care should be taken to avoid excessive under-reaming, particularly in the scenario of large shell size and high-density patient bone stock.

  8. A Monoblock Porous Tantalum Acetabular Cup Has No Osteolysis on CT at 10 Years

    Science.gov (United States)

    Ghate, Raju; Salaz, Noel; Ghodasra, Jason; Stulberg, S. David

    2010-01-01

    Background Aseptic osteolysis has been the single most important factor limiting the longevity of a THA. A great deal of attention has been focused on the development of implants and materials that minimize the development of osteolysis. The monoblock porous tantalum acetabular cup was designed to minimize osteolysis, but whether it does so is unclear. Questions/purposes We evaluated the incidence of osteolytic lesions after THA using a monoblock porous tantalum acetabular component. Methods We retrospectively reviewed 51 patients who had a THA using a monoblock porous tantalum acetabular cup. At a minimum of 9.6 years postoperatively (average, 10.3 years; SD, 0.2 years; range, 9.6–10.8 years), a helical CT scan of the pelvis using a metal suppression protocol was obtained. This scan was evaluated for the presence of osteolysis. Results We found no evidence of osteolysis on CT scan at an average of 10.3 years. Conclusions Osteolysis appears not to be a major problem at 10 years with this monoblock porous tantalum acetabular component, but longer term followup will be required to determine whether these findings persist. Level of Evidence Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. PMID:20809172

  9. Is radiation superior to indomethacin to prevent heterotopic ossification in acetabular fractures?: a systematic review.

    NARCIS (Netherlands)

    Blokhuis, T.J.; Frolke, J.P.M.

    2009-01-01

    Heterotopic ossification is a well-known complication after fixation of an acetabular fracture. Indomethacin and radiation therapy are used as prophylaxis to prevent heterotopic ossification. It is unclear, however, whether either is superior, although this may relate to lack of power in individual

  10. Laparoscopic Acetabular Fracture Fixation after Three-dimensional Modelling and Printing.

    Science.gov (United States)

    Zeng, Can-Jun; Huang, Wen-Hua; Huang, Hua-Jun; Wu, Zhang-Lin

    2017-01-01

    Current surgical treatment of acetabular fractures is open reduction and internal fixation and requires a large incision resulting in considerable blood loss and a potentially long duration of recovery. We report a case of an acetabular fracture that received laparoscopic internal fixation after three-dimensional (3D) modelling and printing of the acetabulum. A 43 year old male fell from a height of 3 m resulting in a right acetabulum anterior column fracture. Thin section computed tomography scanning with 0.6 mm increments and subsequent 3D reconstruction was performed, and a 3D model of the acetabulum and fracture was printed. The steel reconstruction plate was prebent in vivo and placed into the optimized position based on the 3D modelling and the optimized insert orientation and measured screw length were determined. The fracture was reduced and the plate placed laparoscopically without complications, and the patient had excellent functional recovery. Acetabular fractures are complex injuries, and while minimally invasive surgical techniques are used in many fields, they are not common for the treatment of acetabular fractures. 3D modelling is commonly used in medicine, and although 3D printing is used in some fields, it has not found widespread use in orthopedics.

  11. Rare combination of ipsilateral acetabular fracture-dislocation and pertrochanteric fracture.

    Science.gov (United States)

    Kuhn, Kevin M; Boudreau, John A; Watson, J T

    2013-08-01

    Acetabular fracture-dislocations are severe injuries that require urgent closed reduction of the hip and often require surgery to restore hip stability. Other authors have described acetabular fracture-dislocations associated with femoral neck fractures, but to our knowledge, this case report is the first to describe an acetabular fracture-dislocation in association with an ipsilateral pertrochanteric fracture and subtrochanteric extension. The polytraumatized patient initially was not stable enough for prolonged surgery. Through a 3-cm anterolateral hip incision, a 5-mm Schanz screw was introduced percutaneously into the femoral head through the primary fracture site under fluoroscopic guidance. With inline traction on the leg, the Schanz screw was used to manipulate the femoral head back into the acetabular fossa. The Schanz screw was removed, the head remained reduced, and a skeletal traction pin was placed to maintain length and alignment of the pertrochanteric fracture until definitive stabilization was possible. We propose a staged treatment strategy consisting of early closed reduction of the hip, and after the patient has been stabilized, reduction and fixation of the fractures. This strategy may be useful in managing an unstable polytraumatized patient or a patient who requires prolonged transfer to receive definitive care.

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

    Science.gov (United States)

    Banks, Louisa N; McElwain, John P

    2010-04-01

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

  13. Direct measurement of acetabular radiographic version using an ordinary goniometer: a precision study.

    Science.gov (United States)

    Liaw, Chen-Kun; Wu, Tai-Yin; Yang, Rong-Sen; Hsu, Yuan-Nian; Wu, Tai-Jung; Hou, Sheng-Mou

    2011-01-01

    The acetabular version following total hip arthroplasty is an important prognostic factor. Computer navigation serves as a precise tool during hip arthroplasty, which requires precise measurement to verify the effect of the procedure. Wan and colleagues have reported an innovative method for measuring acetabular radiographic version with an ordinary goniometer. Our objective was to study the precision of this method. We derived the underlying mathematical principle of Wan's method and produced a correction formula and chart. Forty-eight computer-synthesized radiographs were used to study the method and its mathematical correction. Ten real radiographs were used to detect intra-observer difference. The paired t-test was used for statistical analysis. There was a significant difference between synthetic acetabular radiographic version and the measurement obtained with Wan's method (p < 0.05), but there was no difference after mathematical correction (p = 0.15). For smaller radiographic version (<20(o)), there was no statistical difference using Wan's method (p = 0.054). The method of Wan and colleagues can be used when acetabular radiographic version is less than 20°. For larger radiographic versions, however, mathematical correction is necessary to obtain precise results.

  14. Secure Screw Placement in Management of Acetabular Fractures Using the Suprapectineal Quadrilateral Buttress Plate

    OpenAIRE

    Egli, R.J.; Keel, M. J. B.; Cullmann, J. L.; Bastian, J. D.

    2017-01-01

    Acetabular fractures involving predominantly the anterior column associated with a disruption of the quadrilateral surface can be treated with instrumentation implementing the stabilization of the quadrilateral surface. The recently introduced suprapectineal quadrilateral buttress plate is specifically designed to prevent secondary medial subluxation of the femoral head, especially in elderly patients with reduced ability for partial weight bearing. Whereas there are guidelines available for ...

  15. Constrained captive acetabular cup for recurrent dislocation of hemiarthroplasty in elderly: A case series

    Directory of Open Access Journals (Sweden)

    Aysha Rajeev

    2016-01-01

    Conclusion: We describe a new method of treatment of this difficult condition with a cemented constrained acetabular captive cup and cement to cement revision using a CDH femoral stem. This method prevents further dislocations and will give good functional outcomes thus reducing the high morbidity and mortality.

  16. Favorable survival of acetabular reconstruction with bone impaction grafting in dysplastic hips.

    NARCIS (Netherlands)

    Somford, M.P.; Bolder, S.B.T.; Gardeniers, J.W.M.; Slooff, T.J.J.H.; Schreurs, B.W.

    2008-01-01

    Acetabular bone loss hampers implantation of a total hip arthroplasty in patients with developmental dysplasia of the hip. The bone impaction grafting technique in combination with a cemented total hip can restore the bone stock in these patients, but do these reconstructions yield satisfying

  17. Laparoscopic acetabular fracture fixation after three-dimensional modelling and printing

    Directory of Open Access Journals (Sweden)

    Can-Jun Zeng

    2017-01-01

    Full Text Available Current surgical treatment of acetabular fractures is open reduction and internal fixation and requires a large incision resulting in considerable blood loss and a potentially long duration of recovery. We report a case of an acetabular fracture that received laparoscopic internal fixation after three-dimensional (3D modelling and printing of the acetabulum. A 43 year old male fell from a height of 3 m resulting in a right acetabulum anterior column fracture. Thin section computed tomography scanning with 0.6 mm increments and subsequent 3D reconstruction was performed, and a 3D model of the acetabulum and fracture was printed. The steel reconstruction plate was prebent in vivo and placed into the optimized position based on the 3D modelling and the optimized insert orientation and measured screw length were determined. The fracture was reduced and the plate placed laparoscopically without complications, and the patient had excellent functional recovery. Acetabular fractures are complex injuries, and while minimally invasive surgical techniques are used in many fields, they are not common for the treatment of acetabular fractures. 3D modelling is commonly used in medicine, and although 3D printing is used in some fields, it has not found widespread use in orthopedics.

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

    LENUS (Irish Health Repository)

    Banks, Louisa N

    2012-02-01

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

  19. Three-dimensional kinetic simulation before and after rotational acetabular osteotomy.

    Science.gov (United States)

    Iwai, Shintaro; Kabata, Tamon; Maeda, Toru; Kajino, Yoshitomo; Watanabe, Shin; Kuroda, Kazunari; Fujita, Kenji; Hasegawa, Kazuhiro; Tsuchiya, Hiroyuki

    2014-05-01

    Some reports indicate that one of major causes of clinical failure after periacetabular osteotomy is development of secondary femoroacetabular impingement (FAI). To assess the impact of range of motion (ROM) on the increase in FAI following rotational acetabular osteotomy (RAO), we performed FAI simulations before and after RAO. We evaluated 12 hips that had undergone RAO (study group), and 12 normal hips (control group). The study group was evaluated before and after surgery. Morphological parameters were evaluated to assess acetabular coverage. The acetabular anteversion angle, anterior CE angle, alpha angle, and combined anteversion angle were also measured. Impingement simulations were performed using 3D-CT. The ROM which causes bone-to-bone impingement was evaluated in flexion (flex), abduction, external rotation at 0° flexion, and internal rotation at 90° flexion. The lesions caused by impingement were evaluated. Radiographic measurements indicated improved postoperative acetabular coverage in the study group. The crossover sign was recognized pre- and postoperatively in every case in the study group and in no cases in the control group. In the simulation study, flexion, abduction, and internal rotation at 90° flexion decreased postoperatively. Impingement occurred within 45° internal rotation at 90° flexion in two preoperative and nine postoperative cases. The impingement lesions were anterosuperior of the acetabulum in all cases. There were correlations between anterior CE angle, CE angle, acetabular anteversion angle, and hip flexion angle. There were also correlations between the anterior CE angle, combined anteversion angle, and angle of internal rotation at 90° flexion. In the postoperative simulation, there was a tendency to reduce the ROM in flexion, abduction, and internal rotation at 90° flexion due to impingement. Since there were more cases which caused impingement within 45° internal rotation at 90° flexion after RAO, we consider there

  20. Responsiveness of the SF-36 and WOMAC following periacetabular osteotomy for acetabular dysplasia.

    Science.gov (United States)

    Davidson, Darin; Yen, Yi-Meng; Jette, Alan M; Olarsch, Sippy; Kim, Young-Jo

    2011-12-07

    Periacetabular osteotomy is a relatively common reconstructive procedure for the adolescent or young adult with acetabular dysplasia. Although several measures have been used to characterize the outcome, the responsiveness of these measures in this population has not been determined. The purpose of this study was to estimate the responsiveness of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Short Form-36 (SF-36) in patients with acetabular dysplasia treated with periacetabular osteotomy. Eighty-three patients with acetabular dysplasia treated with periacetabular osteotomy between 2000 and 2005 completed the WOMAC and SF-36 both preoperatively and postoperatively. The scores on each domain of these outcome measures were calculated and analyzed to determine the parameters of responsiveness, including the minimal detectable change at the 90% confidence level. The mean duration of follow-up was 1.9 years. Comparison of the effect size, standardized response mean, and minimal detectable change for the SF-36 and WOMAC demonstrated that the WOMAC was more sensitive to change than the SF-36 was, particularly in the physical function domain (minimal detectable change, 9.1) and the pain domain (minimal detectable change, 5.5). Only one of the eight domains of the SF-36, bodily pain, demonstrated a change in outcome that exceeded the minimal detectable change, which was 2.38. Both the WOMAC and the SF-36 demonstrated adequate responsiveness to change over time in patients with acetabular dysplasia treated with periacetabular osteotomy, although the WOMAC was more sensitive to change. These results indicate that the WOMAC is sufficiently responsive to be used as a joint-specific measure for assessing changes following periacetabular osteotomy for the treatment of acetabular dysplasia.

  1. Prediction of acetabular development after closed reduction by overhead traction in developmental dysplasia of the hip.

    Science.gov (United States)

    Kitoh, Hiroshi; Kitakoji, Takahiko; Katoh, Mitsuyasu; Ishiguro, Naoki

    2006-10-01

    The prediction of acetabular development after reduction of developmental dysplasia of the hip (DDH) is important to ensure optimal timing of acetabuloplasty and to avoid unnecessary surgery. The objective of this study was to find early and reliable predictors of future acetabular dysplasia in the hips reduced by overhead traction (OHT). We retrospectively reviewed 45 hips in 40 patients treated by OHT for DDH without additional procedures. The average age at the time of closed reduction was 9.3 months, and the average age at the latest examination was 17.3 years. Residual hip dysplasia at skeletal maturity was defined according to Severin's classification. The following variables were evaluated as possible predictors of the final outcome: age at reduction, severity of the dislocation, serial measurements of acetabular index (AI), center-edge angle of Wiberg (CE), and the center-head discrepancy distance (CHDD). Sixty-two percent of the hips had satisfactory results in Severin I/II and 38% had unsatisfactory results in Severin III. Bilateral DDH showed significantly poorer outcome than unilateral DDH. The average AI of the unsatisfactory group was significantly greater than that of the satisfactory group at 4 years or more after reduction. Similarly, the average CE of the satisfactory group was greater than that of the unsatisfactory group at 5 years or more after reduction. In unilateral cases, the AI and the CE of the uninvolved hip at 1 year after reduction also correlated with the final outcome of the involved hip. The AI of 4 years and the CE of 5 years after reduction were the earliest predictors of the final outcome. Careful consideration for the need of acetabuloplasty would be given at 4 or 5 years after reduction by OHT. Bilateral DDH and poor acetabular coverage of the uninvolved hip in unilateral DDH were the prognostic factors of unfavorable acetabular development of the dislocated hip.

  2. Long-Term Survival of the Native Hip After a Minimally Displaced, Nonoperatively Treated Acetabular Fracture.

    Science.gov (United States)

    Clarke-Jenssen, John; Wikerøy, Annette K B; Røise, Olav; Øvre, Stein Arne; Madsen, Jan Erik

    2016-08-17

    Few studies have evaluated the long-term results for nonoperatively treated acetabular fractures. The purpose of this study was to describe the long-term survival of the native acetabulum as well as the clinical and radiographic outcome for patients with nonoperatively treated acetabular fractures. All patients with acetabular fractures are prospectively registered in our acetabular fracture database and followed up at regular intervals for up to 20 years. We identified 236 patients (237 fractures) who had been treated nonoperatively between 1994 and 2004; 51 patients with incomplete data were excluded. For the survival analysis, 186 fractures with an average follow-up of 9 years (range, 1 to 20 years) were included. For the long-term clinical outcome, 104 patients with an average follow-up of 12.1 years (range, 9 to 20 years) were included. The 10-year survival of the native hips was 94% (111 hips were at risk). Eighty-nine percent of the patients had a good or excellent Harris hip score, and 88% had a good or excellent Merle d'Aubigné and Postel score. The most important negative predictor for clinical outcome and survival of the hip was a fracture step-off of ≥2 mm measured in the obturator oblique radiograph. Nonoperative treatment of minimally displaced acetabular fractures yields good to excellent long-term results. For patients with a questionable indication for fracture surgery, oblique radiographs (Judet views) are a helpful tool in the decision-making process, as a fracture step-off of ≥2 mm is a strong predictor for a poor clinical and radiographic result at 10 years. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated.

  3. Meniscal tears associated with anterior cruciate ligament injury.

    Science.gov (United States)

    Hagino, Tetsuo; Ochiai, Satoshi; Senga, Shinya; Yamashita, Takashi; Wako, Masanori; Ando, Takashi; Haro, Hirotaka

    2015-12-01

    To investigate the frequency of meniscal tear and the location of tear associated with anterior cruciate ligament (ACL) injury. We studied 549 patients (552 knees) who were diagnosed with ACL injury by arthroscopy at our center between January 2006 and March 2014 (8 years and 3 months). The subjects comprised 289 males and 263 females ranging in age from 13 to 66 (mean 26.1) years. The cause of injury was sports-related in 89.1 %, and the mean interval from injury to initial arthroscopy was 23 months. The patients were divided into two groups: arthroscopy performed within 8 weeks after injury (acute group; 256 knees) and more than 8 weeks after injury (chronic group; 296 knees). Frequency of meniscal tear and location of tear were compared between two groups. The incidence of meniscal tear diagnosed by arthroscopic examination was 79.2 % (437 of 552 knees) in all subjects; 72.7 % (186 of 256 knees) in acute group and 84.8 % (251 of 296 knees) in chronic group, and was significantly higher in chronic group. Regarding the locations of meniscal tears, in acute group (186 knees), medial meniscal tear only was found in 20 knees (10.8 %), lateral meniscal tear only in 129 knees (69.4 %), and bilateral (including medial and lateral) meniscal tears in 37 knees (19.9 %). In chronic group (251 knees), medial meniscal tear only was found in 62 knees (24.7 %), lateral meniscal tear only in 85 knees (33.9 %), and bilateral meniscal tears in 104 knees (41.4 %). Lateral meniscal tear was commonly associated with acute ACL injury, while medial meniscal tear with chronic ACL injury. Bucket handle tear was observed in 25 knees (medial: 17 knees, lateral: 8 knees) in acute group, and 81 knees (medial: 69 knees, lateral: 12 knees) in chronic group, and was more common in the chronic group. The incidence of meniscal tear associated with ACL injury is higher in chronic cases; the number of medial meniscal tears is particularly high, many of which require meniscectomy. Early ACL

  4. Role of metalloproteinases in rotator cuff tear.

    Science.gov (United States)

    Garofalo, Raffaele; Cesari, Eugenio; Vinci, Enzo; Castagna, Alessandro

    2011-09-01

    The role of matrix metalloproteinases (MMPs) and their inhibitors (TIMPS) in the pathophysiology of rotator cuff tears has not been established yet. Recent advances empathize about the role of MMPs and TIMPS in extracellular matrix (ECM) remodeling and degradation in rotator cuff tears pathogenesis and healing after surgical repair. An increase in MMPs synthesis and the resulting MMPs mediated alterations in the ECM of tendons have been implicated in the etiopathogenesis of tendinopathy, and there is an increase in the expression of MMPs and a decrease in TIMP messenger ribonucleic acid expression in tenocytes from degenerative or ruptured tendons. Importantly, MMPs are amenable to inhibition by cheap, safe, and widely available drugs such as the tetracycline antibiotics and bisphosphonates. A better understanding of relationship and activity of these molecules could provide better strategies to optimize outcomes of rotator cuff therapy.

  5. Plate Tearing Under Mixed Mode Loading

    DEFF Research Database (Denmark)

    Andersen, Rasmus Grau; Nielsen, Kim Lau; Felter, Christian Lotz

    2016-01-01

    Cohesive-zone finite element modeling is often the technique of choice when dealing with extensive crack growth in large-scale ductile sheet metal structures. Shell elements with in-plane dimensions much larger than the plate thickness are typically employed to discretize the structure, and thus...... that takes place in front of an advancing crack can significantly enhance the crack growth resistanceas the energy going into thinning the sheet typically dominates the total fracture energy.This has been investigated in great details for the case of pure Mode I tearing and both the energy dissipation, peak...... stress, and shape of the cohesive traction-separation law have been laid out. In a similar fashion, the present study resolves the sequence of failure details related to steady-state sheet tearing under mixed mode loading by employing the micro-mechanics based Gurson model. But, the fracture process...

  6. Tearing mode stability calculations with pressure flattening

    CERN Document Server

    Ham, C J; Cowley, S C; Hastie, R J; Hender, T C; Liu, Y Q

    2013-01-01

    Calculations of tearing mode stability in tokamaks split conveniently into an external region, where marginally stable ideal MHD is applicable, and a resonant layer around the rational surface where sophisticated kinetic physics is needed. These two regions are coupled by the stability parameter. Pressure and current perturbations localized around the rational surface alter the stability of tearing modes. Equations governing the changes in the external solution and - are derived for arbitrary perturbations in axisymmetric toroidal geometry. The relationship of - with and without pressure flattening is obtained analytically for four pressure flattening functions. Resistive MHD codes do not contain the appropriate layer physics and therefore cannot predict stability directly. They can, however, be used to calculate -. Existing methods (Ham et al. 2012 Plasma Phys. Control. Fusion 54 025009) for extracting - from resistive codes are unsatisfactory when there is a finite pressure gradient at the rational surface ...

  7. Characterization of ocular gland morphology and tear composition of pinnipeds.

    Science.gov (United States)

    Kelleher Davis, Robin; Doane, Marshall G; Knop, Erich; Knop, Nadja; Dubielzig, Richard R; Colitz, Carmen M H; Argüeso, Pablo; Sullivan, David A

    2013-07-01

    The importance of tear film integrity to ocular health in terrestrial mammals is well established, however, in marine mammals, the role of the tear film in protection of the ocular surface is not known. In an effort to better understand the function of tears in maintaining health of the marine mammal eye surface, we examined ocular glands of the California sea lion and began to characterize the biochemical nature of the tear film of pinnipeds. Glands dissected from California sea lion eyelids and adnexa were examined for gross morphology, sectioned for microscopic analysis, and stained with hematoxylin and eosin. The tear film was examined using interferometry. Tears were collected from humans and pinnipeds for the analysis of protein and carbohydrate content. The sea lion has sebaceous glands in the lid, but these glands are different in size and orientation compared with typical meibomian glands of terrestrial mammals. Two other accessory ocular glands located dorsotemporally and medially appeared to be identical in morphology, with tubulo-acinar morphology. An outer lipid layer on the ocular surface of the sea lion was not detected using interferometry, consistent with the absence of typical meibomian glands. Similar to human tears, the tears of pinnipeds contain several proteins but the ratio of carbohydrate to protein was greater than that in human tears. Our findings indicate that the ocular gland architecture and biochemical nature of the tear film of pinnipeds have evolved to adapt to the challenges of an aquatic environment. © 2012 American College of Veterinary Ophthalmologists.

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

    Science.gov (United States)

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

    2014-07-01

    During the one-stage exchange procedure for periprosthetic joint infection (PJI) after total hip arthroplasty (THA), acetabular defects challenge reconstructive options. Porous tantalum augments are an established tool for addressing acetabular destruction in aseptic cases, but their utility in septic exchange is unknown. This retrospective case-control study presents the initial results of tantalum augmentation during one-stage exchange for PJI. Primary endpoints were rates of re-infection and short-term complications associated with this technique. Study patients had no higher risk of re-infection with equivalent durability at early follow-up with a re-infection rate in both groups of 4%. In conclusion, tantalum augments are a viable option for addressing acetabular defects in one-stage exchange for septic THA. Further study is necessary to assess long-term durability when compared to traditional techniques for acetabular reconstruction. Copyright © 2014 Elsevier Inc. All rights reserved.

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

    DEFF Research Database (Denmark)

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

    2010-01-01

    The appearance of acetabular version differs between the supine and weight bearing positions in developmental dysplasia of the hip. Weight bearing radiographic evaluation has been recommended to ensure the best coherence between symptoms, functional appearance, and hip deformities. Previous...

  10. Quality of life following total hip arthroplasty in patients with acetabular fractures, previously managed by open reduction and internal fixation

    Directory of Open Access Journals (Sweden)

    Prasoon Kumar

    2016-08-01

    Conclusion: From this study it is inferred that the functional outcome of THR and quality of life in patients who had acetabular fractures and were initially managed by open reduction and internal fixation is good.

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

    DEFF Research Database (Denmark)

    Eckardt, Henrik; Lind, Dennis; Toendevold, Erik

    2015-01-01

    was evaluated on reconstructed coronal and sagittal images of the acetabulum. Results - The fracture severity and patient characteristics were similar in the 2 groups. In the 3D group, 46 of 72 patients (0.6) had a perfect result after open reduction and internal fixation, and in the control group, 17 of 42 (0......Background and purpose - During acetabular fracture surgery, the acetabular roof is difficult to visualize with 2-dimensional fluoroscopic views. We assessed whether intraoperative 3-dimensional (3D) imaging can aid the surgeon to achieve better articular reduction and improve implant fixation....... Patients and methods - We operated on 72 acetabular fractures using intraoperative 3D imaging and compared the operative results, duration of surgery, and complications with those for 42 consecutive acetabular fracture operations conducted using conventional fluoroscopic imaging. Postoperative reduction...

  12. [Aseptic, simultaneous and bilateral mobilisation due to an acetabular shell fracture in a 43 year-old patient].

    Science.gov (United States)

    Ceretti, M; Fanelli, M; Pappalardo, S

    2014-01-01

    The acetabular shell mobilization is the main long-term complication in total hip replacement. Metal-back fracture has also to be considered among the possible causes of shell mobilization. A case is presented of bilateral acetabular shell mobilization due to the trabecular covering de-soldering from the metal-back in a 43 year-old patient, 13-14 years after the first surgery. Copyright © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

  13. Cytokine changes in tears and relationship to contact lens discomfort

    OpenAIRE

    Willcox, Mark D.P.; Zhao, Zhenjun; Naduvilath, Thomas; Lazon de la Jara, Percy

    2015-01-01

    Purpose To determine the reproducibility of a multiplex bead assay for measuring cytokines in tears and correlations between ocular discomfort with or without contact lens wear and the concentration of cytokines in tears. Methods Ninety participants (divided into two groups) were enrolled in this prospective study. They were asked to rate their ocular comfort and collect their tears in the morning and just before sleep for 10 days with or without contact lenses. The participants collected the...

  14. HPLC analysis of closed, open, and reflex eye tear proteins

    OpenAIRE

    Sitaramamma T; Shivaji S; Rao Gullapalli

    1998-01-01

    Changes in the closed, open and reflex eye tear proteins of normal subjects were compared and analysed. Tear proteins were resolved by high-performance liquid chromatography (HPLC) utilising both gel filtration (P-300 SW) and reverse-phase (C-18) columns and the HPLC fractions were further analysed by sodium dodecyl sulphate - polyacrylamide gel electrophoresis (SDS-PAGE) under reducing and non-reducing conditions. The protein composition of the closed-eye tear was significantly different fro...

  15. A technique to remove a stable all-polyethylene cemented acetabular liner in revision hip arthroplasty: A case report.

    Science.gov (United States)

    Judas, Fernando M; Lucas, Francisco M; Fonseca, Ruben L

    2015-01-01

    The removal of a well-fixed acetabular component in a total hip arthroplasty can cause bone fractures, excessive bleeding, as well as extended bone loss. The reimplantation of a new acetabular component may be compromised. We report a technique using 2 cork-screws for removal a stable cemented acetabular component for the treatment of a recurrent dislocation of a cemented total hip arthroplasty, due to acetabular malposition. A diversity of approaches and tools has been used for extraction of the acetabular prosthesis. Using 2 cork-screws it is possible to create fissures and fractures into the cement mantle, and greater manual control is obtained facilitating the manipulation of the acetabular component in different directions. The cup-cemented bond can be disrupted, the host bone is preserved and the risks of complications are minimized. This technique is simple, available in any environment, reproducible, non-costly, non-timing consuming and safe. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  16. Quantitative measures of damage to subchondral bone are associated with functional outcome following treatment of displaced acetabular fractures.

    Science.gov (United States)

    Lubovsky, Omri; Kreder, Michael; Wright, David A; Kiss, Alex; Gallant, Aimee; Kreder, Hans J; Whyne, Cari M

    2013-12-01

    Current analysis of displaced acetabular fractures is limited in its ability to predict functional outcome. This study aimed to (1) quantify initial acetabular damage following acetabular fracture through measurement of subchondral bone density and fracture lines, and (2) evaluate associations between acetabular damage and functional outcomes following fracture. Subchondral bone intensity maps were created for 24 patients with unilateral acetabular fractures. Measures of crack length and density differences between corresponding regions in the fractured acetabuli, normalized by the unfractured side, were generated from preoperative CT images. Damage measures were compared to quality of life survey data collected for each patient at least 2 years post-injury (Musculoskeletal Functional Assessment [MFA] and Short Form-36 [SF-36], with specific focus on parameters that best describe patients' physical health). CT image quantification of initial damage to acetabular subchondral bone was associated with functional outcome post-injury. In general, damage as quantified through differences in density in the superior dome region (zones 8 and 12) and the central anterior region of the acetabulum (zone 3) were found to be the strongest significant predictors of functional outcome (adjusted R(2) = 0.3-0.45, p fractures toward improving clinical prognoses. © 2013 Orthopaedic Research Society.

  17. Treatment of periprosthetic acetabular fractures after previous hemi- or total hip arthroplasty: Introduction of a new implant.

    Science.gov (United States)

    Resch, H; Krappinger, D; Moroder, P; Blauth, M; Becker, J

    2016-04-01

    Treatment of displaced periprosthetic acetabular fractures in elderly patients. The goal is to stabilize an acetabular fracture independent of the fracture pattern, by inserting the custom-made roof-reinforcement plate and starting early postoperative full weight-bearing mobilization. Acetabular fracture with or without previous hemi- or total hip arthroplasty. Non-displaced acetabular fractures. Watson-Jones approach to provide accessibility to the anterior and supraacetabular part of the iliac bone. Angle-stable positioning of the roof-reinforcement plate without any fracture reduction. Cementing a polyethylene cup into the metal plate and restoring prosthetic femoral components. Full weight-bearing mobilization within the first 10 days after surgery. In cases of two column fractures, partial weight-bearing is recommended. Of 7 patients with periprosthetic acetabular fracture, 5 were available for follow-up at 3, 6, 6, 15, and 24 months postoperatively. No complications were recognized and all fractures showed bony consolidation. Early postoperative mobilization was started within the first 10 days. All patients except one reached their preinjury mobility level. This individual and novel implant is custom made for displaced acetabular and periprosthetic fractures in patients with osteopenic bone. It provides a hopeful benefit due to early full weight-bearing mobilization within the first 10 days after surgery. In case of largely destroyed supraacetabular bone or two-column fractures according to Letournel additional synthesis via an anterior approach might be necessary. In these cases partial weight bearing is recommended.

  18. [Effects of Surgically Treated Pelvic Ring and Acetabular Fractures on Postural Control].

    Science.gov (United States)

    Lang, P; Schnegelberger, A; Riesner, H-J; Stuby, F; Friemert, B; Palm, H-G

    2016-04-01

    The aim of surgical treatment of pelvic ring and acetabular fractures is to allow rapid mobilisation of patients in order to restore stance and gait stability (postural control), as this significantly correlates with a positive outcome. The regulation of postural stability is mainly controlled by transmission of proprioceptive stimuli. In addition, the pelvis serves as a connection between the legs and the spine and thus is also of great importance for mechanical stabilisation. It remains unclear whether surgical treatment of pelvic ring and acetabular fractures affects the regulation of postural control. Therefore, the aim of this study was to examine the impact of surgically treated pelvic ring and acetabular fractures on postural stability by means of computerised dynamic posturography (CDP) after a mean of 35 months and to compare the results with a healthy control group. A retrospective case control study of 38 patients with surgically treated pelvic ring and acetabular fractures and 38 healthy volunteers was carried out using CDP. The average time of follow-up was 35 (12-78) months. The most important outcome parameter in this investigation was the overall stability index (OSI). Hip joint mobility, the health-related quality of life (SF-12) and pain were supplementary outcome parameters. It was found that surgically treated pelvic ring and acetabular fractures had no influence on postural stability. The OSI was 2.1 ° in the patient group and 1.9 ° in the control group. There was no significant difference between the groups in hip joint mobility. A total of 52 % of patients showed no or only mild pain. Mean health-related quality of life was the same as in the total population. Surgically treated pelvic ring and acetabular fractures do not lead to deterioration in postural control in the mid term. This is of high prognostic importance for rapid mobilisation of the patients. Therefore no increase in the risk of falling is expected after successfully

  19. Early reduction of acetabular fractures decreases the risk of post-traumatic hip osteoarthritis?

    Science.gov (United States)

    Cahueque, Mario; Martínez, Marcos; Cobar, Andrés; Bregni, María

    2017-01-01

    Acetabular fractures are complex high-energy injuries. Increasing in recent years with the increased use of high-speed motor vehicles. One of the most important complications of acetabular fracture is the post-traumatic hip osteoarthritis; this complication has been associated to poor fracture reduction, type of fracture and delay in the reduction and fixation of acetabular fracture (Timing surgery). The aims of this study were to determine the incidence of post-traumatic hip osteoarthritis after acetabulum fracture and demonstrate whether the delay surgery is associated to early post-traumatic hip osteoarthritis. Using the database of patients with acetabular fractures treated with open reduction and internal fixation (ORIF) over 3 years (2011-2014) with minimum of 2 years follow-up. Data was acquired and saved in a digital format. Demographic information was obtained from each patient with minimum of 2 years follow-up. Acetabular fracture was distributed according to the classification of Judet. The quality of reduction was classified in anatomic (0-1 mm) and non-anatomic (>1 mm) and the timing surgery, early (7 days). Clinical and radiographic follow-up was generally performed at six weeks, three months, one and two years after fracture fixation. Multivariate logistic regression analyses were performed to assess the strength of the covariates in relation to the development of post-traumatic hip osteoarthritis. 59 (48%) patients of 122, developed post-traumatic hip osteoarthritis before 2 years. Posterior wall fracture with or without transverse fracture was associated with higher post-traumatic hip osteoarthritis compared with other types of fractures (p osteoarthritis compared with those who had nonanatomic reduction (p osteoarthritis (p = 7092). According to our results, the anatomical reduction of the articular surface in acetabular fractures is the most important factor in hip osteoarthritis prevention. This factor is strongly associated with early

  20. Analysis of acetabular orientation and femoral anteversion using images of three-dimensional reconstructed bone models.

    Science.gov (United States)

    Park, Jaeyeong; Kim, Jun-Young; Kim, Hyun Deok; Kim, Young Cheol; Seo, Anna; Je, Minkyu; Mun, Jong Uk; Kim, Bia; Park, Il Hyung; Kim, Shin-Yoon

    2017-05-01

    Radiographic measurements using two-dimensional (2D) plain radiographs or planes from computed tomography (CT) scans have several drawbacks, while measurements using images of three-dimensional (3D) reconstructed bone models can provide more consistent anthropometric information. We compared the consistency of results using measurements based on images of 3D reconstructed bone models (3D measurements) with those using planes from CT scans (measurements using 2D slice images). Ninety-six of 561 patients who had undergone deep vein thrombosis-CT between January 2013 and November 2014 were randomly selected. We evaluated measurements using 2D slice images and 3D measurements. The images used for 3D reconstruction of bone models were obtained and measured using [Formula: see text] and [Formula: see text] (Materialize, Leuven, Belgium). The mean acetabular inclination, acetabular anteversion and femoral anteversion values on 2D slice images were 42.01[Formula: see text], 18.64[Formula: see text] and 14.44[Formula: see text], respectively, while those using images of 3D reconstructed bone models were 52.80[Formula: see text], 14.98[Formula: see text] and 17.26[Formula: see text]. Intra-rater reliabilities for acetabular inclination, acetabular anteversion, and femoral anteversion on 2D slice images were 0.55, 0.81, and 0.85, respectively, while those for 3D measurements were 0.98, 0.99, and 0.98. Inter-rater reliabilities for acetabular inclination, acetabular anteversion and femoral anteversion on 2D slice images were 0.48, 0.86, and 0.84, respectively, while those for 3D measurements were 0.97, 0.99, and 0.97. The differences between the two measurements are explained by the use of different tools. However, more consistent measurements were possible using the images of 3D reconstructed bone models. Therefore, 3D measurement can be a good alternative to measurement using 2D slice images.

  1. Hall effect on tearing mode instabilities in tokamak

    Science.gov (United States)

    Zhang, W.; Ma, Z. W.; Wang, S.

    2017-10-01

    The tearing mode instability is one of the most important dynamic processes in space and laboratory plasmas. Hall effects, resulting from the decoupling of electron and ion motions, can cause fast development and rotation of the perturbation structure of the tearing mode. A high-accuracy nonlinear magnetohydrodynamics code is developed to study Hall effects on the evolution of tearing modes in the Tokamak geometry. It is found that the linear growth rate increases with the increase in the ion skin depth and the self-consistently generated rotation can greatly alter the dynamic behavior of the double tearing mode.

  2. Oral alcohol administration disturbs tear film and ocular surface.

    Science.gov (United States)

    Kim, Joo Hyun; Kim, Jung Ha; Nam, Woo Ho; Yi, Kayoung; Choi, Dong Gyu; Hyon, Joon Young; Wee, Won Ryang; Shin, Young Joo

    2012-05-01

    To investigate whether ethanol administration disturbs the tear film and ocular surface. Case-control study. Twenty healthy male subjects were recruited. Ethanol was administered to 10 subjects and another 10 subjects served as controls. Twenty healthy male subjects with no ocular disease were recruited. Ethanol (0.75 g/kg) was administered orally at 8 pm for 2 hours to 10 subjects. The tear film and ocular surface were evaluated at 6 pm before drinking, at midnight, and immediately (6 am) and 2 hours (8 am) after waking the next morning. Tear osmolarity, ethanol concentration in tears and serum, Schirmer's test results, tear film break-up time (TBUT), corneal punctuate erosion, and corneal sensitivity were measured. Ethanol was detected in tears and serum at midnight, but it was not detected the next morning. The mean tear osmolarity level increased in the alcohol group at midnight compared with that in the control group (Ptears. Ethanol in tears induced tear hyperosmolarity and shortened TBUT and triggered the development of ocular surface diseases. Similar changes could exacerbate signs and symptoms in patients with ocular surface disease. Copyright © 2012 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

  3. Integrated multimodal metrology for objective and noninvasive tear evaluation.

    Science.gov (United States)

    Kottaiyan, Ranjini; Yoon, Geunyoung; Wang, Qi; Yadav, Rahul; Zavislan, James M; Aquavella, James V

    2012-01-01

    The clinical tests used to assess tear film and diagnose dry eye are invasive and produce results that are different from natural tear characteristics. There is a need to objectively and noninvasively assess tear parameters under controlled environmental circumstances to refine dry eye diagnosis and therapy. We have developed multimodal tear imaging systems integrated in a chamber in which individual environmental factors can be precisely varied to investigate their impacts on tear parameters. With the custom-built high-resolution wavefront sensor combined with placido disc, it is possible to objectively detect two-dimensional tear breakups in real time and evaluate its impact on visual quality. Micrometer ultra-high resolution optical coherence tomography (OCT) enables us to quantify thickness and volume of the tear over the cornea and tear menisci. The ocular surface imaging ellipsometer uses polarized illumination from which both the lipid refractive index and thickness can be measured at a very high resolution. Using an enhanced thermal camera, we measure the ocular surface temperature noninvasively, which makes it possible to study spatial and temporal changes in tear evaporation. The multimodal deployment of these four components in the controlled chamber will assist in better differentiating the various clinical dry eye entities and will lead to the development of specific dry eye treatments. Copyright © 2012 Elsevier Inc. All rights reserved.

  4. Immunoglobulin Concentration in Tears of Contact Lens Wearers

    OpenAIRE

    Maurya, Rajendra P.; Bhushan, Prashant; Singh, Virendra P.; Singh, Mahendra K.; Kumar, Prakash; Bhatia, Ravindra P.S.; Singh, Usha

    2014-01-01

    Purpose: To evaluate changes in the concentration of tear immunoglobulins in contact lens wearers. Methods: A total of 45 cases including 23 contact lens wearers (43 eyes) and 22 age and sex matched healthy controls having no ocular pathology were studied for immunoglobulins (IgA, IgG, IgM) in their tears by single radial immunodiffusion method. Results: Most of the cases used soft (56.6%) and semi-soft gas permeable (30.4%) contact lenses. Tear IgM was detected in only 17.4% and tear I...

  5. Changes of tear film after trabeculectomy in glaucoma

    Directory of Open Access Journals (Sweden)

    Xue-Jun Li

    2015-07-01

    Full Text Available AIM: To learn the changes of the tear film before and after the trabeculectomy of glaucoma and explore the incidence of dry eye and the prevention and control measures.METHODS: The 36 patients(60 eyesof glaucoma were examined in detail before 3d of trabeculectomy and after the surgery at 3, 7, 14 and 30d. The examinations include lower eyelid central river of tears, break-up time(BUT, Schirmer Ⅰ test(SⅠtand staining scores of corneal fluorescein under slit lamp microscope.RESULTS:The tear meniscus height of central lower eyelid was increased and the tear film BUT was shortened at the same time, the scores of SⅠt was reduced and corneal fluorescein staining score was increased at postoperative 3 and 7d compared with that of preoperation. The tear meniscus height of central lower eyelid, tear film BUT and SIt and score of corneal fluorescein staining began to recover in most of the affected eyes after surgery 14d. At 30d after surgery, 22% of patients tear film failed to recover to the preoperative level; dry eye occured in 18% preoperative eyes with normal tear film.CONCLUSION:Trabeculectomy of glaucoma may affect the stability of the tear film and some patients showeing obvious dry eye and should be intervened and treatmented timely.

  6. Relationship between Corneal Sensation, Blinking, and Tear Film Quality

    National Research Council Canada - National Science Library

    Nosch, Daniela Sonja; Pult, Heiko; Albon, Julie; Purslow, Christine; Murphy, Paul John

    2016-01-01

    PURPOSETo examine the possible role of corneal sensitivity and tear film quality in triggering a blink by investigating the relationship between blink rate, central corneal sensitivity threshold (CST...

  7. Tear lipocalins bind a broad array of lipid ligands.

    Science.gov (United States)

    Glasgow, B J; Abduragimov, A R; Farahbakhsh, Z T; Faull, K F; Hubbell, W L

    1995-05-01

    To identify the native ligands of tear lipocalins, tear proteins were separated by size exclusion chromatography and the lipid content in the major protein fractions identified. Lipids extracted from native tears and purified tear lipocalins comigrated with fatty acids, fatty alcohols, phospholipids, glycolipids, and cholesterol on thin layer chromatograms. Abundant stearic and palmitic acids as well as cholesterol, and lesser amounts of lauric acid were specifically identified in extracts of purified lipocalins by gas chromatography-mass spectroscopy. A preliminary study of the ligand-protein interaction was carried out using nitroxide spin-labeled lipids.

  8. Polymorphonuclear leukocyte cells and elastase in tears.

    Science.gov (United States)

    Sakata, M; Sack, R A; Sathe, S; Holden, B; Beaton, A R

    1997-08-01

    To characterize the effects that mode of sampling and overnight eye closure have on the nature of caseinolytic activity recovered in tear fluid. Reflex, open and closed (R, O and C) eye tear fluids were collected by microcapillary tubes or from the inferior formix by Schirmer strip. Microcapillary collected samples were centrifuged and recovered cells cytochemically characterized and probed by immunofluorescence microscopy, or alternatively extracted in acidic PBS. Tear supernatants, pellets and Schirmer strip extracts were subjected to casein zymography or SDS-PAGE and immunoprobed for plasmin/plasminogen. To identify caseinolytic activity, samples were immunoprecipitated with antibodies to plasmin/plasminogen or to elastase, and the immunoprecipitated materials were subjected to zymographic analysis. Immunoblot assays revealed R and O samples contained low levels of plasminogen (approximately 1.1 micrograms/ml) and only trace levels of plasmin (leukocyte (PMN) cell elastase based on size and antigenicity. This is derived from PMNs recovered from the C pellet. Elastase could also be recovered from Schirmer strips from 90% of donors, provided that the strips were extracted in sample loading buffer. The activity was restricted to the portion of the strip that had been in contact with the ocular tissue. The main source of caseinolytic activity in C fluid is elastase. This arises from PMNs that undergo recruitment, activation and degranulation in the C environment. In contrast, the elastase recovered in Schirmer strip extracts is derived from intact PMNs that adhere to the strip during sample collection. This would suggest that PMN cells undergo a low level of recruitment into the open eye environment.

  9. Double acetabular wall--a misleading point for hip arthroplasty: an anatomical, radiological, clinical study.

    Science.gov (United States)

    Madadi, Firooz; Yazdanshenas, Hamed; Madadi, Firoozeh; Bazargan-Hejazi, Shahrzad

    2013-06-01

    Despite the great attention focused on cup positioning in primary total hip arthroplasty (PTHA), it is surprising to find so few studies that have dealt with cup placement. A common thwarting problem for correct cup placement during PTHA is the existence of osteophytes, which obscure the anatomical landmarks. In this study we aimed to evaluate the morphology of acetabular osteophyte formation in patients with osteoarthritis. We evaluated 276 patients with hip complaints, using plain X-rays and CT scans. Of these patients, 57 underwent surgery. We developed a staging system for central osteophytes in hip osteoarthritis based on the radiographic and anatomical findings of our patients. We recommend routine use of CT scans for patients scheduled for PTHA in order to assess the stage of osteophyte before surgery and, thus, reduce the risk of failure resulting from the interrupted acetabular landmarks.

  10. Intra- and inter-observer agreement and reliability of bone mineral density measurements around acetabular cup

    DEFF Research Database (Denmark)

    Mussmann, Bo Redder; Overgaard, Soren; Torfing, Trine

    2017-01-01

    with single-energy CT (SECT) and DECT in cemented and cementless cups.Material and Methods: Twenty-four acetabular cups inserted in porcine hip specimens were scanned with SECT and DECT. Bone density was measured in a three-dimensional volume adjacent to the cup. Double measurements were performed.......Results: BMD derived from SECT was approximately four times higher than that of DECT. In both scan modes, intraclass correlation coefficient (ICC) was >0.90 with no differences between repeated measurements, except for uncemented cups where a statistically significant difference of 11 mg/cm3 was found...... with DECT. DECT showed narrower limits of agreement than SECT. Inter-observer analysis showed small differences.Conclusion: BMD can be estimated with high intra- and inter-observer reliability with SECT and DECT around acetabular cups using custom software. The intra- and inter-observer agreement of DECT...

  11. Use of iPhone technology in improving acetabular component position in total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Xiau Wei Tay, MBBS

    2017-09-01

    Full Text Available Improper acetabular cup positioning is associated with high risk of complications after total hip arthroplasty. The aim of our study is to objectively compare 3 methods, namely (1 free hand, (2 alignment jig (Sputnik, and (3 iPhone application to identify an easy, reproducible, and accurate method in improving acetabular cup placement. We designed a simple setup and carried out a simple experiment (see Method section. Using statistical analysis, the difference in inclination angles using iPhone application compared with the freehand method was found to be statistically significant (F[2,51] = 4.17, P = .02 in the “untrained group”. There is no statistical significance detected for the other groups. This suggests a potential role for iPhone applications in junior surgeons in overcoming the steep learning curve.

  12. [Conservative treatment of acetabular fractures: epidemiology and medium-term clinical and radiological results].

    Science.gov (United States)

    Magala, M; Popelka, V; Božík, M; Heger, T; Zamborský, V; Šimko, P

    2015-01-01

    The vast majority of studies on fractures of the acetabulum are concerned with surgical treatment. All displaced fractures are presented as surgically treated. The purpose of this study was to evaluate the results of surgical and conservative treatment of patients with acetabular fractures in relation to the degree of fracture displacement. We analysed 140 fractures of the acetabulum treated in our institution by different methods between 2009 and 2013. In addition to the use of Letournel´s classification, we allocated each fracture to one of six groups: 1. Sixty displaced fractures treated surgically, 2. Twenty three fractures with a displacement of more than 6 mm, 3. Eighteen slightly displaced fractures (2-3 mm in the acetabular roof or 4-5 mm in other parts of the acetabulum), 4. Twenty non-displaced fractures, 5. Six pelvic fractures involving the acetabulum and 6. Thirteen fractures of old people, mostly displaced but not examined by CT. Groups 2 to 6 were treated conservatively. In all patients, demographic and epidemiologic factors were analysed in relation to the patient's group assignment. In 107 patients, hip function was assessed using the Matta clinical grading system at a minimum follow-up of 12 months (average 3.16 years). Radiological status, time of admission, start of weight-bearing after the accident, working ability, mortality and complications were also evaluated. Non-displaced fractures were often associated with serious injury or polytrauma in 20 patients; not all of them had excellent functional outcome. (mean score, 17.25). Excluding two patients who developed avascular necrosis, fourteen slightly displaced fractures had a fixal score of 16.92. Sixteen patients with displaced fractures were managed conservatively due to their poor medical condition and other circumstances. Their functional outcome (mean score, 15.25) was significantly worse than that of the patients with non-displaced fractures (p=0.02) and worse than the outcome in

  13. A case of recurrent bloody tears

    OpenAIRE

    Karslıoğlu, Şafak; Şimşek, İlke Bahçeci; Akbaba, Müslime

    2011-01-01

    Şafak Karslioğlu1, Ilke Bahçeci Şimşek2, Müslime Akbaba11Ìstanbul Oculoplastic and Orbital Surgery and Ocular Oncology Center, 2Ophthalmology Department, Medicine Hospital, Ìstanbul, TurkeyAbstract: Well-known causes of blood-tinged epiphora are conjunctival lesions, tumors of the lacrimal apparatus, and systemic bleeding disorders. We describe an unusual patient who presented with recurrent episodes of bloody tearing which began following an eryt...

  14. Apomictic maternal diploids in tetraploid Job's tears.

    Science.gov (United States)

    Venkateswarlu, J; Rao, P N

    1975-06-01

    Two cases of reversion to diploidy were observed in autotetraploid Job's tears (Coix lacryma-jobi L. 4n = 40) out of a total of 1,112 plants examined over a period of 7 years. One of these was a trisomie (2n = 21) and the other a disomic (2n = 20), derived from apomictic development ofn+1 andn maternal gametes of the tetraploid, respectively. In some respects both these derivatives differed from the original diploid that gave rise to the tetraploid through colchicine treatment. The potentialities of such reversions in the evolution of new diploid races are discussed.

  15. Long-Term MRI Findings in Operated Rotator Cuff Tear

    Energy Technology Data Exchange (ETDEWEB)

    Kyroelae, K.; Niemitukia, L.; Jaroma, H.; Vaeaetaeinen, U. [Kuopio Univ. Hospital (Finland). Dept. of Orthopaedics and Traumatology

    2004-08-01

    Purpose: To describe magnetic resonance imaging (MRI) findings at long-term follow-up after rotator cuff (RC) tear using standard MRI sequences without fat saturation. Material and Methods: Twenty-eight patients aged 55.8{+-}7.6 underwent MRI examination 4.6{+-}2.1 years after surgery for RC tear. Standard sequences in oblique coronal, oblique sagittal, and axial planes were obtained. The RC, including re-tears and tendon degeneration, was independently evaluated by two observers. Thickness of the supraspinatus tendon and narrowing of the subacromial space were measured. The clinical outcome was evaluated with the Constant score and compared with the MRI findings. Results: The RC tear was traumatic in 18 (64%) patients and degenerative in 10 (36%). At follow-up, 11 (39%) had normal RC tendons with good clinical outcome. Four (14%) patients had painful tendinosis without RC tear. A full-thickness RC tear was found in 7 (25%) patients and a partial tear in 6 (21%). In one patient with a full-thickness tear, and in two with partial tear, tendinosis was found in another of the RC tendons. The subacromial space was narrowed in 13 (46%) of the patients. A narrowing of the subacromial space correlated with re-tear (P<0.05). Conclusions: The RC may be evaluated with standard MRI sequences without fat saturation at long-term follow-up. A normal appearance of the RC is correlated with good clinical outcome, while re-tear and tendinosis are associated with pain.

  16. Role of MRI in predicting meniscal tear reparability

    Energy Technology Data Exchange (ETDEWEB)

    Felisaz, Paolo Florent [Universita degli Studi di Pavia, Pavia (Italy); Fondazione IRCCS Policlinico San Matteo, Istituto di Radiologia, Pavia (Italy); Alessandrino, Francesco; Perelli, Simone [Universita degli Studi di Pavia, Pavia (Italy); Zanon, Giacomo; Benazzo, Francesco [Fondazione IRCCS Policlinico San Matteo, Clinica Ortopedica e Traumatologica, Pavia (Italy); Calliada, Fabrizio; Sammarchi, Luigi [Fondazione IRCCS Policlinico San Matteo Radiologia, Diagnostica per Immagini-Istituto di Radiologia, Pavia (Italy)

    2017-10-15

    To elucidate the role of MRI in predicting meniscal tear reparability according to tear type and location in relation to vascular zones. In this retrospective study, two readers evaluated 79 pre-surgical MRIs of meniscal tears arthroscopically treated with meniscectomy or meniscal repair. Tears were classified according to type into vertical, horizontal, radial, complex, flaps and bucket handle and were considered reparable if the distance measured from the tear to the menisco-capsular junction was less than or equal to 5 mm. Predictions were compared with the surgical procedure performed in arthroscopy. We assessed the diagnostic performance of MRI, agreement between MRI and arthroscopy, and interrater agreement. Then, we conducted an ROC analysis on the distances measured by the first reader and built a multivariate logistic regression model. MRI had a sensitivity, specificity, PPV, NPV and accuracy, respectively, of 85%, 79%, 86%, 76% and 83% in predicting meniscal tear reparability. Correct predictions for the specific tear pattern were 76% for vertical, 84% for horizontal, 88% for radial, 86% for complex, 84% for flaps and 86% for bucket handle. Agreement between the two readers' predictions and arthroscopy was good (k = 0.65 and 0.61, respectively). Inter-rater agreement was almost excellent (k = 0.79). The ROC analysis revealed sensitivity and specificity of 73% and 83% with a cutoff value of <4 mm (p < 0.001). Anterior cruciate ligament injury and medial meniscal tear increased the likelihood of meniscal tear reparability. MRI can be a reliable and accurate tool to predict the reparability of meniscal tears, with higher prediction rates for bucket-handle tears. (orig.)

  17. Revision of migrated pelvic acetabular components in THA with or without vascular involvement

    Directory of Open Access Journals (Sweden)

    Ștefan Cristea

    2016-05-01

    Full Text Available Purpose. The literature describes a high rate of mortality in cases of intrapelvic acetabular component migration, which is a rare but serious complication. Our aim is to establish and propose a treatment protocol according to our results and experience. Material and Methods. We performed eight (8 total hip revisions with acetabular cup migration between 2006 and 2012. A vascular graft was needed in four (4 of these cases. Two (2 cases were revisions after a spacer for infected arthroplasties. The protocol included the following: X-Ray examination (frontal and lateral views, CT angiography, a biological evaluation, a suitable pre-operative plan, at least six (6 units of blood stock, an experienced anesthesiologist, an experienced surgical team that included a vascular surgeon and a versatile arsenal of revision prostheses, bone grafts and vascular grafts. The anterolateral approach was generally used for hip revisions and the retroperitoneal approach in the dorsal decubitus position was used when vascular risk was involved. Results: The acetabular defect was reconstructed using bone grafts and tantalum revision cups in 4 cases, Burch-Schneider cages in 2 cases, a Kerboull ring in 1 case and a cementless oblong cup (Cotyle Espace in 1 case. In 4 cases, an iliac vessel graft procedure was conducted by the vascular surgeon. All patients survived the revision procedures and returned regularly for subsequent check-ups, during which they did not show any septic complications. Conclusions: Intrapelvic acetabular cup migration is a rare but serious complication that can occur after total hip arthroplasty in either septic or aseptic cases. An experienced, multidisciplinary team of surgeons should be involved in planning and conducting such complicated revisions.

  18. Creating Three-dimensional Printed Models of Acetabular Fractures for Use as Educational Tools.

    Science.gov (United States)

    Manganaro, Matthew S; Morag, Yoav; Weadock, William J; Yablon, Corrie M; Gaetke-Udager, Kara; Stein, Erica B

    2017-01-01

    Acetabular fractures are frequently encountered in some clinical practices, and the precise classification of these fractures greatly influences treatments and outcomes. The authors identified the need for an educational aid when teaching acetabular fracture classifications, given the complex spatial anatomy and the nonintuitive classification system that is commonly used. Three-dimensional ( 3D three-dimensional ) printing is an evolving technique that has applications as an educational aid, providing the student with a tangible object to interact with and learn from. In this article, the authors review their experience creating 3D three-dimensional printed models of the hip for educational purposes. Their goal was to create 3D three-dimensional printed models for use as educational aids when teaching acetabular fracture classifications. Complex cases involving a combination of fracture types, subtle nondisplaced fractures, and/or fractures with associated osteopenia or artifacts were excluded. The selected computed tomographic (CT) scans were loaded into a medical 3D three-dimensional volume-rendering program, and a 3D three-dimensional volumetric model was created. Standard Tessellation Language ( STL Standard Tessellation Language ) files were then exported to STL Standard Tessellation Language model-editing software and edited to retain only the involved hemipelvis. In some cases, the proximal femur and ipsilateral hemisacrum may be included to emphasize hip alignment or disruption of the force transfer. Displaced fracture fragments can be printed as separate segments or a single unit after the addition of struts. Printing was performed by using an additive manufacturing principle, with approximately 36-48 hours needed for printing, postprocessing, and drying. The cost to print a 1:1 scale model was approximately $100-$200, depending on the amount of plastic material used. These models can then be painted according to the two-column theory regarding acetabular

  19. Retrograde Transpubic Approach for Percutaneous Radiofrequency Ablation and Cementoplasty of Acetabular Metastasis

    Directory of Open Access Journals (Sweden)

    Salem Bauones

    2015-01-01

    Full Text Available We report a case of painful and disabling anterior acetabular bone metastasis treated with bipolar radiofrequency ablation and cementoplasty. Due to the high risk of complications related to the proximity of the femoral neurovascular structures with a direct approach, we successfully performed a retrograde transpubic approach under combined CT and fluoroscopic guidance. In the present report, we describe this approach detailing its indications, advantages, and the technical tips to achieve a safe and satisfactory procedure.

  20. Nonoperative Treatment of Posterior Wall Acetabular Fractures After Dynamic Stress Examination Under Anesthesia: Revisited.

    Science.gov (United States)

    McNamara, Andrew R; Boudreau, John A; Moed, Berton R

    2015-08-01

    Performing an examination under general anesthesia (EUA) using dynamic stress fluoroscopy of patients with posterior wall acetabular fractures has been used as a tool to determine hip stability and the need for surgical intervention. The purpose of this study was to further evaluate the effectiveness of this technique, from a source other than its primary advocates, in patients with posterior wall acetabular fractures less than or equal to 50% who were stable on EUA and treated nonoperatively. Retrospective case series. University Level 1 Trauma Center. Seventeen patients with a posterior wall acetabular fracture stable on EUA treated nonoperatively. The patients were treated nonoperatively as guided by an EUA negative for instability. Patient follow-up averaged 30 months (range, 6-64 months). Outcome evaluation included the modified Merle d'Aubigné clinical score and the Short Musculoskeletal Function Assessment Questionnaire. Radiographic evaluation for subluxation or arthritis consisted of the 3 standard pelvic radiographs. Radiographic evaluation showed all hips to be congruent with a normal joint space. Sixteen of the 17 patients had radiographic outcomes rated as "excellent"; 1 patient was rated "good." The modified Merle d'Aubigné score (obtained in 12 patients) averaged very good, with only 1 having less than a good (graded as fair) clinical outcome. The Short Musculoskeletal Function Assessment Questionnaire scores (from 11 patients) were not significantly different from normal and were within the normal reported values for all indices and categories. There was no correlation between fracture fragment size and outcome. This study further supports the contention that a stable hip joint, as determined by EUA, after posterior wall acetabular fracture treated nonoperatively is predictive of continued joint congruity, an excellent radiographic outcome, and good-to-excellent early clinical and functional outcomes. Therapeutic Level IV. See Instructions for

  1. Hip Arthroscopy Failure in the Setting of Acetabular Dysplasia: A Concerning Trend?

    OpenAIRE

    Clohisy, John C.; An, Tonya; Haynes, Jacob; Nepple, Jeffrey J.; Schoenecker, Perry; Baca, Geneva

    2017-01-01

    Objectives: Despite the success of hip arthroscopy, evidence suggests that arthroscopy alone is inadequate for treatment of conditions such as acetabular dysplasia (AD) due to its failure to correct structural deformity. Our objective was to define the incidence of failed hip arthroscopy in patients with symptomatic AD requiring periacetabular osteotomy (PAO). We secondarily analyzed the patient and structural characteristics of the failed arthroscopy cases. Methods: Utilizing a prospective, ...

  2. USING TRABECULAR METAL AUGMENTS FOR TOTAL HIP REPLACEMENT IN PATIENTS AFTER ACETABULAR FRACTURES

    Directory of Open Access Journals (Sweden)

    R. M. Tikhilov

    2011-01-01

    Full Text Available The authors presented the experience of treatment of two patients with hip arthritis after acetabular fracture. Both patients were treated with total hip replacement. During the operation, to manage posterior-superior bone defects of the acetabulum, augments of trabecular metal were used. Pain and limitation of motions in hip were indications for operative treatment. After a year of follow up there was no pain in hip; also recovery of motion and improved quality of life were observed.

  3. The impact of race on the development of severe heterotopic ossification following acetabular fracture surgery.

    Science.gov (United States)

    Slone, Harris S; Walton, Zeke J; Daly, Charles A; Chapin, Russell W; Barfield, William R; Leddy, Lee R; Hartsock, Langdon A

    2015-01-01

    To determine the association between race on severe heterotopic ossification (HO) following acetabular fracture surgery. Retrospective case control study. Level I university trauma centre. Two hundred and fifty-three patients who were surgically treated for acetabular fractures were retrospectively evaluated. Postoperative radiographs were evaluated for HO by a blinded musculoskeletal radiologist, and classified based on a modified Brooker classification. Of the 253 patients that met inclusion and exclusion criteria, 175 (69%) were male and 78 (31%) were female. One hundred and fifty-four (61%) patients were Caucasian, and 99 (39%) were African American (AA). Fifty-five (21%) patients developed severe HO. Of those who developed severe HO, 25 were Caucasian (45%), 30 were African American (55%). Forty-one patients (75%) with severe HO were male, and 14 (25%) were female. No statistical differences (p>0.05) were found between groups in terms of age, days to surgery, GCS at presentation, surgical approach, perioperative HO prophylaxis, or AO/OTA fracture classification. The patient population was then stratified by race, gender, and race/gender. AA were more likely than Caucasians to develop severe HO (odds ratio [OR], 2.24; confidence interval [CI], 1.22-4.11). When gender was considered independent of race, no statistical differences (p>0.05) were observed (OR, 1.40; CI, 0.71-2.75). AA males were much more likely to develop severe HO when compared to Caucasian females (OR, 4.4; CI, 1.38-14.06). Race is associated with different rates of severe HO formation following acetabular fracture surgery. AA patients are significantly more likely to develop severe HO following acetabular fracture surgery when compared to Caucasian patients. Copyright © 2015 Elsevier Ltd. All rights reserved.

  4. Magnetic resonance imaging of para-acetabular insufficiency fractures in patients with malignancy

    Energy Technology Data Exchange (ETDEWEB)

    Theodorou, S.J. [Department of Radiology, School of Medicine, University of California, San Diego Medical Center, San Diego, CA (United States)]|[Department of Radiology, Veterans Administration Medical Center, San Diego, CA (United States)]|[Department of Clinical Radiology, University of Manchester, Manchester (United Kingdom); Theodorou, D.J. [Department of Radiology, School of Medicine, University of California, San Diego Medical Center, San Diego, CA (United States)]|[Department of Radiology, Veterans Administration Medical Center, San Diego, CA (United States)]. E-mail: daphne_theodorou@hotmail.com; Schweitzer, M.E. [Department of Radiology, New York University Hospital for Joint Diseases, NY (United States); Kakitsubata, Y. [Department of Radiology, School of Medicine, University of California, San Diego Medical Center, San Diego, CA (United States)]|[Department of Radiology, Veterans Administration Medical Center, San Diego, CA (United States); Resnick, D. [Department of Radiology, School of Medicine, University of California, San Diego Medical Center, San Diego, CA (United States)]|[Department of Radiology, Veterans Administration Medical Center, San Diego, CA (United States)

    2006-02-15

    AIM: To describe the characteristic magnetic resonance imaging (MRI) findings of para-acetabular insufficiency fractures in patients with malignancy, and compare the MRI appearance of these fractures with that of metastatic bone disease. MATERIALS AND METHODS: MRI examinations were reviewed in 16 patients with a known malignant tumour and severe hip pain that raised the possibility of local recurrence or metastatic disease. Six patients had received pelvic irradiation, and three patients were receiving steroid medication. RESULTS: The total number of fractures detected was 21: a solitary fracture was present in 11 patients and five patients had bilateral para-acetabular fractures. Two patients had associated sacral insufficiency fractures, and one of them had stress fractures involving both acetabular columns. Conventional radiography allowed the diagnosis of 14 (67%) fractures; six (28%) radiographic examinations were negative; and one (5%) examination was equivocal for fracture. Available scintigraphic and computed tomography (CT) studies revealed typical findings of fracture. Using MRI, insufficiency fractures appeared as linear regions of low signal intensity on T1- and T2-weighted images. Marked marrow oedema was evident in all cases. Fractures characteristically were parallel to the superior acetabulum in a curvilinear fashion in 18 (86%) instances, and were oblique in three (14%) instances. The fractures demonstrated considerable enhancement after intravenous gadolinium administration. No associated soft tissue masses were documented. CONCLUSION: Para-acetabular insufficiency fractures are a cause of hip pain, which may mimic skeletal metastasis in the patient with malignancy and pelvic irradiation. Recognition of the characteristic MRI findings of these fractures can preclude misdiagnosis and unnecessary bone biopsy.

  5. Acetabular reconstruction in developmental hip dysplasia using reinforcement ring with a hook.

    Science.gov (United States)

    Pitto, Rocco P; Schikora, Nils

    2004-08-01

    We followed prospectively 27 patients with severe acetabular bone-stock deficiencies due to developmental dysplasia of the hip. Mean preoperative patient age was 56 (34-78) years, mean Harris hip score was 31 (16-66) points and pre-operative mean acetabular angle of Sharp was 47 degrees (34 degrees - 61 degrees). Operative acetabular reconstruction was performed in 28 hips using reinforcement ring with a hook placed in the true acetabulum and autologous bone grafting. A 2-year clinical and radiological follow-up was available in 27 hips. Mean Harris hip score improved to 91 (70-100) points. There were no clinical or radiological signs of aseptic loosening in 25 hips, and the bone graft was radiologically incorporated in all hips. In 24 hips, a radiostereometric analysis showed low rates of non-progressive translation and rotation in 21 reinforcement rings. Three rings showed progressive translation and/or rotation at the 2-year follow-up and were rated probably loose.

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

    Directory of Open Access Journals (Sweden)

    Yasuhiro Homma

    2014-01-01

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

  7. Spinal Realignment for Adult Deformity: Three-column Osteotomies Alter Total Hip Acetabular Component Positioning.

    Science.gov (United States)

    Barry, Jeffrey J; Yucekul, Altug; Theologis, Alexander A; Hansen, Erik N; Ames, Christopher; Deviren, Vedat

    2017-02-01

    A goal of adult spinal deformity surgery is correction of sagittal imbalance by increasing lumbar lordosis (LL), allowing a previously retroverted pelvis to normalize as evidenced by decreases in pelvic tilt (PT). Realignment of pelvic orientation may alter the position of preexisting total hip arthroplasties (THAs). Twenty-seven patients with unilateral THA who underwent thoracolumbar fusions for adult spinal deformity from the pelvis to L1 or above were retrospectively reviewed (levels fused, 10.3 [range, 6 to 17]; age, 70 ± 9 years). Comparisons of preoperative and postoperative spinal deformity parameters, acetabular tilt (AT), and acetabular cup abduction angle (CAA) were performed, with subgroup analysis for those who had undergone three-column osteotomy and those who had not. Preoperative deformity was severe, with findings of a sagittal vertical axis >9 cm, PT >25°, and pelvic incidence-LL >20°. Postoperatively, AT decreased significantly (-7° ± 10°; P Spinal deformity correction, with techniques such as three-column osteotomy, result in significant THA acetabular component repositioning in the sagittal plane. Resultant decreased AT (ie, retroversion) theoretically may affect tribology, wear, and joint stability and warrants further investigation.

  8. Does Pelvic Embolization Increase Infection Rates in Patients Who Undergo Open Treatment of Acetabular Fractures?

    Science.gov (United States)

    Firoozabadi, Reza; Little, Milton; Alton, Timothy; Scoloro, John; Agel, Julie; Kogut, Mathew

    2017-04-01

    Evaluate the impact of pelvic embolization on postoperative infection rate after acetabular fracture fixation. Retrospective study of 3 separate cohorts. Level I Trauma Center. Identified patients who underwent angiography of the pelvis as well as required an open reduction internal fixation (ORIF) of an acetabular fracture. This group was compared to a control group of patients with an acetabular fracture, which did not undergo angiography, and underwent ORIF. ORIF of an aectabular fracture with angiography ± embolization. Deep infection rate. Seventy-two patients remained for final analysis; 25 patients underwent embolization, 16 patients underwent angiography without embolization, and 31 patients did not undergo angiography. Two out of 25 (8%) patients developed infections in the embolization group, one deep infection and one superficial infection. Five out of 16 (31%) patients developed deep infections in the nonembolization group. Control group of patients who did not undergo angiography had a deep infection rate of 9.6%. Despite previous reports of high infection rates after pelvic embolization, the deep infection rate was only 4% after embolization in our cohort. This suggests that concerns for higher rates of infection are not substantiated, and pelvic embolization should be performed when indicated. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

  9. Surgical dislocation of the hip for reduction of acetabular fracture and evaluation of chondral damage.

    Science.gov (United States)

    Maini, Lalit; Batra, Sahil; Arora, Sumit; Singh, Shailendra; Kumar, Santosh; Gautam, V K

    2014-04-01

    To assess the outcome of open reduction and internal fixation combined with surgical dislocation of the hip for displaced acetabular fractures. 20 men and 2 women aged 20 to 55 (mean, 28) years underwent open reduction and internal fixation combined with surgical dislocation of the hip for displaced acetabular fracture. The most common fracture pattern was bicolumnar (n=12), followed by transverse (n=6) and T-type (n=4). Femoral head chondral lesions were classified as grade 0 (no defect) to grade 4 (osteochondral defect). Fracture fragments were fixed with titanium plates and screws, and the femoral head was redislocated to inspect for intraarticular screws. The association between functional status and acetabular fracture pattern and femoral head chondral lesions was explored. Nine patients had chondral lesions in the femoral head (mostly in the anterosuperior zone), but none in the acetabulum. All femoral heads were viable. Reduction was anatomic in 6 patients and satisfactory in 16. Functional outcome was very good in 6 patients, good in 13, medium in 2, and fair in one. No patient developed avascular necrosis of the femoral head. Four patients had iatrogenic sciatic nerve palsy. One patient developed early degenerative hip arthritis and underwent total hip arthroplasty 14 months later. Surgical dislocation of the hip facilitated anatomic reduction and inspection of any chondral lesions. It did not result in avascular necrosis of the femoral head.

  10. [Auxiliary cerclage-wiring in internal fixation of displaced acetabular fractures].

    Science.gov (United States)

    Erichsen, C J; von Rüden, C; Hierholzer, C; Bühren, V; Woltmann, A

    2015-01-01

    Displaced fractures of the acetabulum involving the quadrilateral plate continue to be a surgical challenge. In this study, we describe our operation technique of auxiliary acetabular cerclage-wiring combined with plate osteosynthesis and present our results as well as short-term outcome. All patients aged 18 years and older treated with auxiliary cerclage-wiring between 2007 and 2012 were included in this study. Fractures were classified according to Letournel. Cerclage wiring was used when reposition and retention of the fracture was insufficient with plates and screws alone. Short-term outcome was evaluated by the German Short Musculoskeletal Functional Assessment (SMFA-D) questionnaire. Data from 23 patients were collected. The follow-up period was 7 months (range 2-23 months). Of the 23 patients, 22 showed excellent fracture reduction and retention. One patient had to undergo revision surgery due to loss of reposition. Patients showed good functional outcome. Auxiliary acetabular cerclage-wiring is a safe and effective method for fracture reduction and retention especially in displaced acetabular fractures involving the quadrilateral plate.

  11. Paediatric acetabular fractures. Data from the German Pelvic Trauma Registry Initiative.

    Science.gov (United States)

    von Heyden, Johanna; Hauschild, Oliver; Strohm, Peter C; Stuby, Fabian; Südkamp, Norbert P; Schmal, Hagen

    2012-10-01

    The aim of this study was to present an analysis of acetabular fractures during childhood as compared to those in adults. Within a multicenter register study, data of 3 time periods (1991-93, 1998-2000, 2004-2008) were pooled and analyzed for incidence, epidemiology, classification, outcome and treatment of acetabular fractures in children (< 15 years). One hundred fifty three children (2.1%) among 7360 patients with pelvic fractures were included in the study. Only 15 children sustained an acetabular fracture (9.8%). Simple fracture types according to Letournels' classification were more frequent in paediatric patients (p < 0.01), receiving less often operative treatment. Multiple injuries were present in 36% of children, the average Injury Severity Score (ISS) of all children was 17 points. Clinical results were good with an average Merle d'Aubigné score of 16.4 points and a Karnofsky performance of 90%. Fractures of the acetabulum in childhood remain a rare injury with distinct fracture characteristics, usually caused by high impact accidents.

  12. Effect of ingested raw ginger (zingerber officinale ) on tear production

    African Journals Online (AJOL)

    4.36years to chew and swallow as a bolus. Its effect on tear production was then monitored using Schirmer's test. The initial rate of tear production was measured before administration of ginger for each subject. Subsequent measurements were ...

  13. Measurement of Tear Production in English Angora and Dutch Rabbits.

    Science.gov (United States)

    Rajaei, Seyed Mehdi; Rafiee, Siamak Mashhady; Ghaffari, Masoud Selk; Masouleh, Mohammad N; Jamshidian, Mahmoud

    2016-03-01

    The purpose of this study was to establish normal values for tear production tests in different breeds of domestic rabbits. Healthy adult rabbits (n = 60; 120 eyes) of 2 different breeds (English angora and Dutch; n = 15 of each sex and breed) were used in this study. Tear production was measured by using the 1-min Schirmer tear test (STT), phenol red thread test (PRTT), and endodontic absorbent paper point tear test (EAPTT). In addition, horizontal palpebral fissure length was evaluated as a measure of ocular adnexal dimensions. Tear production (mean ± 1 SD) in English angora rabbits was 5.4 ± 1.6 mm/min according to the STT, 25.0 ± 2.7 mm in 15 s for the PRTT, and 18.8 ± 2.1 mm/min by the EAPTT; in Dutch rabbits, these values were 4.6 ± 1.2 mm/min, 23.6 ± 2.3 mm in 15 s, and 16.9 ± 1.7 mm/min, respectively. Only the EAPTT revealed a significant difference in tear production between English Angora and Dutch rabbits. These results provide reference values for tear production in English Angora and Dutch rabbits according to 3 different quantitative tear film assessment methods.

  14. State Secret: North Carolina and the Cherokee Trail of Tears

    Science.gov (United States)

    Bryant, James

    2008-01-01

    This paper is an analytic essay that examines the treatment of the Cherokee Trail of Tears in a North Carolina fourth grade textbook. I begin by offering a satiric look at an imaginary textbook's treatment of the Holocaust that is based closely on the actual narrative of the Trail of Tears written in the fourth grade text. Following this, close…

  15. Rotator cuff tears in the throwing athlete.

    Science.gov (United States)

    Shaffer, Benjamin; Huttman, Daniel

    2014-06-01

    Tears of the rotator cuff, both partial, and less commonly, full thickness, are relatively common in the throwing athlete. The rotator cuff is subjected to enormous stresses during repetitive overhead activity. The supraphysiological strains, especially when combined with pathology elsewhere in the kinetic chain, can lead to compromise of the cuff fabric, most commonly on the undersurface where tensile overload occurs. Exacerbation by a tight posterior capsular, anterior instability, and internal impingement render the cuff progressively compromised, with intrinsic shear stresses and undersurface fiber failure. Advances in imaging technology, including contrast magnetic resonance imaging, dynamic ultrasound, and arthroscopic visualization have enhanced our understanding of cuff pathology in this athletic population. Unfortunately, this has not yet translated into how to best approach these athletes to return them to their previous level of activity. Nonoperative management remains the mainstay for most throwers, with arthroscopic debridement an effective surgical option for those with refractory symptoms. Despite technological advances in cuff repair in the general population, comparable outcomes have not been achieved in high-level throwers. Widespread appreciation that securing the cuff operatively will likely end an athletes' throwing career has led to adopting a surgical approach that emphasizes debridement over repair for nearly all partial and full-thickness tears. Whether advances in surgical technique will ultimately permit definitive and lasting repairs that allow overhead throwers to return to their previous level of sports remains unknown at this time.

  16. Tönnis stage 0 and 1 acetabular rim cartilage injuries: Incidence, grade, location and associated pre-surgical factors.

    Science.gov (United States)

    Más Martínez, J; Sanz-Reig, J; Verdú Román, C M; Bustamante Suárez de Puga, D; Morales Santías, M; Martínez Giménez, E

    Articular cartilage lesions have a direct effect on the success of surgical treatment. The aim of this study was to determine the prevalence rate, location, grade, and factors associated with acetabular rim articular cartilage lesions in patients undergoing hip arthroscopy. A prospective study was conducted by analysing the intraoperative data of 152 hips in 122 patients treated with hip arthroscopy for femoroacetabular impingement from January 2011 to May 2016. The prevalence rate, location, and grade were calculated, as well as the pre-operative factors associated with acetabular rim articular cartilage lesions. The mean age of the patients was 38.6 years. The Tönnis grade was 0 in 103 hips, and 1 in 52 hips. Acetabular rim articular cartilage lesions were present in 109 (70.3%) hips. The location of the lesions was superior-anterior. Independent risk factors for the presence of acetabular rim articular cartilage lesions were an alpha-angle equal or greater than 55°, duration of symptoms equal or greater than 20 months, and Tegner activity scale level equal or greater than 6. Although patients were classified as Tönnis grade 0 and 1, and 3tesla MRI reported acetabular lesions in 1.3% of cases, there was a high frequency of acetabular rim cartilage lesions. Knowledge of the independent risk factors associated with acetabular rim articular cartilage lesions may assist the orthopaedic surgeon with the decision to perform hip arthroscopy. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  17. Risk factors for the need of hip arthroscopy following periacetabular osteotomy

    DEFF Research Database (Denmark)

    Hartig-Andreasen, Charlotte; Troelsen, Anders; Thillemann, Theis M

    2015-01-01

    was to identify risk factors predicting the need for a hip arthroscopy (HA) after periacetabular osteotomy (PAO). Ninety-nine patients (104 hips) scheduled for PAO were evaluated preoperatively and at 2-year follow-up. MRA was performed in all patients prior to PAO. At follow-up, patients were divided into a non-arthroscopy...... and arthroscopy group. The two groups were compared clinical and radiological, and risk factors for HA after PAO were calculated. Patient reported outcome measures (WOMAC, Oxford Hip and SF36) were filled out before PAO and at follow-up. Ninety-five hips (91.3%) were evaluated. Twenty-six hips (27%) required...... an arthroscopy within 2 years of the PAO. Risk factors were preoperative borderline dysplasia, acetabular retroversion and complete labral detachment. Labral tearing, degeneration or hypertrophy did not negatively affect the outcome of PAO. Patients not requiring an arthroscopy had a statistically significant...

  18. Visual Quality Metrics Resulting from Dynamic Corneal Tear Film Topography

    Science.gov (United States)

    Solem, Cameron Cole

    The visual quality effects from the dynamic behavior of the tear film have been determined through measurements acquired with a high resolution Twyman-Green interferometer. The base shape of the eye has been removed to isolate the aberrations induced by the tear film. The measured tear film was then combined with a typical human eye model to simulate visual performance. Fourier theory has been implemented to calculate the incoherent point spread function, the modulation transfer function, and the subjective quality factor for this system. Analysis software has been developed for ease of automation for large data sets, and outputs movies have been made that display these visual quality metrics alongside the tear film. Post processing software was written to identify and eliminate bad frames. As a whole, this software creates the potential for increased intuition about the connection between blinks, tear film dynamics and visual quality.

  19. Tear levels of macrophage migration inhibitory factor in vernal keratoconjunctivitis

    Directory of Open Access Journals (Sweden)

    Onur Çatak

    2013-06-01

    Full Text Available Objective: The pathogenesis of vernal keratoconjunctivitis(VKC is not fully understood and cannot be explainedonly with type I hypersensitivity reaction. The aim of thisstudy was to determine the Macrophage migration inhibitoryfactor (MIF levels in tear fluids of patients with VKC.Methods: Tear fluid samples were collected with microcapillarytubes for hematocrit at the lateral canthus ofpatients in the supine position without any anesthesia.Tear levels of MIF were measured by ELISA kit. Tear fluidsamples were collected from 10 healthy subjects and 20patients with VKC.Results: Tear levels of MIF in patients with VKC weresignificantly higher than those in controls (p<0,001.Conclusion: These results suggested that MIF may havesignificant effect on the pathogenetic process of VKC. JClin Exp Invest 2013; 4 (2: 195-198Key words: Macrophage migration inhibitory factor, vernalkeratoconjunctivitis, ELISA

  20. Separation of human tear proteins by high performance liquid chromatography.

    Science.gov (United States)

    Boonstra, A; Kijlstra, A

    1984-12-01

    The optimal conditions for separating human tear proteins by high performance liquid chromatography (HPLC) using a Waters I-125 gel filtration column were investigated. Several elution buffers were tested including phosphate buffer alone and phosphate buffer to which varying amounts of NaCl or 0.1% Tween was added. The combination of phosphate buffer (pH 5.28), 0.5 M NaCl and 0.1% Tween gave the best resolution and a recovery of 90% of the proteins applied. Tear lactoferrin was shown to adhere to the column packing when the molarity of the elution buffer was not high enough. Using optimal conditions, the tear proteins IgA, lactoferrin and lysozyme were identified in distinct peaks after a preparative HPLC run. When used in combination with Schirmer strips as a tear sampling method, HPLC was shown to be a rapid, simple and reproducible way of investigating the composition of tear proteins.

  1. Outcome of unstable isolated fractures of the posterior acetabular wall associated with hip dislocation.

    Science.gov (United States)

    de Palma, L; Santucci, A; Verdenelli, A; Bugatti, M G; Meco, L; Marinelli, M

    2014-04-01

    Traumatic hip dislocation with fracture of the posterior acetabular wall is associated with high rates of residual invalidity. The records of patients who underwent surgical treatment of traumatic dislocation of the hip associated with an isolated fracture of the posterior acetabular wall from 1999 to 2009 were reviewed. There were 30 men and 12 women, who at the time of the trauma had a mean age of 42 years (range 21-65). Mean follow-up duration was 5 years (range 2-10). Pre-operative fracture evaluation was based on the classification of Judet et al. which divided this fractures into three types: type 1 is characterized by a single fracture line separating a single bone fragment from the remaining part of the posterior wall; type 2 fracture involves several fragments of the posterior wall and in type 3, a type 1 or type 2 fracture is associated with a sunk cancellous area in the acetabular wall medial to the fracture line but not affected by it, due to the shear impact of the femoral head at the time of dislocation. Clinical evaluation of the outcome was according to the criteria of Merle D'Aubigné and Postel as modified by Matta. Outcomes were divided into excellent/good and fair/poor. Since treatment was standard, data were further analyzed to assess the relative importance of age, sex, follow-up duration, sciatic nerve lesion on admission and mechanism of injury, using the Chi-square test. Full clinical recovery without sequelae or radiographic abnormalities was achieved by 10 patients, 8 with type 1 fracture and 2 with type 2 fracture. A good outcome was seen in 13 patients, 3 with type 1 fracture, 9 with type 2 fracture and 1 with type 3 fracture. Eight patients, 3 with type 2 fracture and 5 with type 3 fracture, had a fair outcome. Only follow-up ≥6 years influenced outcome significantly (p > 0.005). Our conclusions in light of our experience are that in type 1 lesions, anatomical reduction and stabilization achieve excellent outcomes, both clinical

  2. Acetabular cartilage delamination in femoroacetabular impingement. Risk factors and magnetic resonance imaging diagnosis.

    Science.gov (United States)

    Anderson, Lucas A; Peters, Christopher L; Park, Brandon B; Stoddard, Gregory J; Erickson, Jill A; Crim, Julia R

    2009-02-01

    Delamination of acetabular articular cartilage is a common abnormality in hips with femoroacetabular impingement. The purpose of the present study was to identify clinical and radiographic factors predisposing to delamination and to assess the diagnostic accuracy of magnetic resonance arthrography for the detection of these lesions. Following a retrospective review of records, we determined that acetabular cartilage delamination had been present in twenty-eight of sixty-four hips that had undergone a surgical dislocation procedure for the treatment of femoroacetabular impingement. Multivariable logistic regression was performed to assess the correlation of radiographic findings (i.e., magnetic resonance imaging and computerized tomography findings) with the status of delamination. The preoperative interpretations of the magnetic resonance arthrograms for twenty-seven hips that underwent surgical dislocation were reviewed to assess the accuracy of detecting delamination. At the time of surgery, nine of these twenty-seven hips were found to have delamination. Magnetic resonance arthrography interpretations that did not correlate with operative findings were subjected to conspicuity assessment and error analysis. The rate of delamination of the acetabular cartilage as noted at the time of surgical dislocation was 44% (twenty-eight of sixty-four). Delamination was strongly associated with male sex and femoral sided signs of impingement; however, it was not associated with acetabular overcoverage (center-edge angle, >40 degrees) (odds ratio = 0.16; p delamination lesions were found in the same hip, they were directly adjacent to one another. Preoperative magnetic resonance arthrography had a low sensitivity for delamination (22%) but had a high specificity (100%). Two-thirds of the delamination lesions were visible on retrospective review of these images when the reader was unblinded to the surgical findings. Delamination could most often be identified on the sagittal T

  3. WHOQOL-BREF Hindi questionnaire: Quality of life assessment in acetabular fracture patients.

    Science.gov (United States)

    Meena, Umesh K; Sen, Ramesh K; Behera, Prateek; Tripathy, Sujit K; Aggrawal, Sameer; Rajoli, Sreekanth R

    2015-01-01

    The incidence of acetabular fractures in India has increased over the past years but so has the operating skills of pelvi-acetabular trauma surgeons. The outcomes of surgical management need to be assessed so as to be able to devise proper treatment plan and execute the same during and after surgery, which in turn requires assessment of quality of life indices as well as functional scores. While there are studies assessing Harris Hip scores (HHS) and world health organization quality of life BREF (WHOQOL BREF) in the western population there is no study which assesses the same in Indian population. We designed this study to evaluate and define reference values for use of WHOQOL BREF Hindi scores in QOL Assessment in patients with acetabular fractures and to assess the relationship between it and HHS. 118 patients with acetabular fractures who were treated surgically were included in this retrospective study. Assessment of reduction quality (Matta's radiological criteria), clinical outcome (HHS) and functional outcome (WHOQOL-BREF score) were done. The affect of age, gender, fracture displacement, hip dislocation, delay in surgery and associated injury on the clinical and functional outcome was evaluated. The mean HHS was 90.65 (42-100) which showed an overall good to excellent outcome in 78.8% cases. WHOQOL-BREF Hindi score of domain-one was 63.06 ± 20.31 (13-94), of domain-two was 58.22 ± 19.57 (13-100), of domain-three was 70.49 ± 17.92 (13-100) and of domain-four was 64.48 ± 18.46 (13-100), which showed significant functional deficit in domain-one (P = 0.0001) and domain-two (P = 0.0001) but not in domain-three (P = 0.458) and domain-four (P = 0.722) when compared to score of general healthy population. The domain scores of general population norms were achieved in 59.3%, 61.9%, 69.5% and 66.1% cases in domain one, two, three and four respectively. Based on these results one can conclude that WHOQOL-Hindi questionnaire is good enough for assessment of QOL in

  4. Effect of acetabular modularity on polyethylene wear and osteolysis in total hip arthroplasty.

    Science.gov (United States)

    Young, Anthony M; Sychterz, Christi J; Hopper, Robert H; Engh, Charles A

    2002-01-01

    Debris from polyethylene wear causes osteolysis. In this study, we examined the effect of acetabular liner modularity on polyethylene wear and osteolysis. We compared forty-one hips (thirty-nine patients) treated with a nonmodular, porous-coated acetabular component with a matched group of forty-one hips (forty patients) treated with a modular acetabular component. The groups were matched by patient gender and age, type of polyethylene material, method of polyethylene sterilization, femoral head size and manufacturer, and stem manufacturer. The mean follow-up period was 5.3 years (range, 3.8 to 6.8 years) for the nonmodular group and 5.5 years (range, 3.8 to 8.0 years) for the modular group. Using serial radiographs and a computer-assisted method, we measured two-dimensional head penetration into the polyethylene liner. Temporal head-penetration data and linear regression analysis were used to calculate the true wear rates. The nonmodular acetabular components demonstrated a lower, but not a significantly lower, mean true wear rate than did the modular components (0.11 compared with 0.16 mm/yr, p = 0.22), and they were associated with a significantly lower rate of osteolysis (2% compared with 22%, p = 0.01). In addition, the true wear rates of the nonmodular components were less variable than those of the modular components. The 95% confidence interval for the wear rates of the nonmodular components (0.08 to 0.13 mm/yr) was nearly half that of the modular group (0.11 to 0.20 mm/yr). The lower and more consistent true wear rates of the nonmodular components could be attributed to the fact that these cups were designed to have greater liner-shell conformity, greater liner thickness, and less liner-shell micromotion than modular components. These design factors could have favorably altered the stress distribution throughout the liner and could have thereby decreased wear. Although nonmodular components may present a partial solution to the problems of wear and

  5. [Pararectus approach for treatment of acetabular both-column fracture combined with translocation of quadrilateral surface].

    Science.gov (United States)

    Xia, Guang; Yang, Xiaodong; Xiong, Ran; Zhang, Xiao; Shao, Yanqing; Du, Guizhong; Li, Tao; Mai, Qiguang; Wang, Hua; Fan, Shicai

    2015-09-01

    To study the clinical effect and surgical operating points of pararectus approach for the internal fixation of acetabular both-column fractures with concurrent displaced quadrilateral plate fractures. From January 2012 to December 2013, in the Third Affiliated Hospital of Southern Medical University, 15 patients with acetabular both-column fractures and displaced quadrilateral plate fractures were surgically managed through the pararectus approach. There were 11 male and 4 female patients, with an average age of 40 years (from 19 to 61 years). According to Judet-Letournel classification, there were 9 anterior column plus posterior hemitransverse fractures, 6 both-column fractures, 8 cases involving the pelvic fracture. All these fractures were treated through the pararectus approach, in the horizontal position with general anesthesia. The pre-bended plate was placed in interior pelvic ring to fix the anterior wall, anterior column and quadrilateral plate in direct sight. Then, the posterior column was exposed and fixed with antegrade lag screw. Patients were followed up in 4 weeks, 12 weeks, 6 months, 1 year after the operation, and the anteroposterior radiograph of pelvis and the X-ray examination of the fractured hip was performed. All the 15 cases underwent the operation successfully. Postoperative X-ray and CT exams showed excellent and good reduction of anterior column, posterior column and quadrilateral plate, with none surgical complication occurred. According to the Matta radiological evaluation postoperatively, reduction of acetabular fracture was rated as excellent in 9 cases, good in 3 cases and poor in 3 cases. The rate of excellent and good was 12/15. After 8 to 18 months' follow-up (median follow-up time was 14 months), all the patients gained bone union. According to the modified Merle D'Aubigne and Postel scoring system, 9 cases were excellent, 4 were good, and 2 were fair. The rate of excellent and good was 13/15. Surgical management of acetabular

  6. The mechanics of focal chondral defects in the hip.

    Science.gov (United States)

    Klennert, Brenden J; Ellis, Benjamin J; Maak, Travis G; Kapron, Ashley L; Weiss, Jeffrey A

    2017-02-08

    There is a mean incidence of osteoarthritis (OA) of the hip in 8% of the overall population. In the presence of focal chondral defects, defined as localized damage to the articular cartilage, there is an increased risk of symptomatic progression toward OA. This relationship between chondral defects and subsequent development of OA has led to substantial efforts to develop effective procedures for surgical cartilage repair. This study examined the effects of chondral defects and labral delamination on cartilage mechanics in the dysplastic hip during the gait cycle using subject-specific finite element analysis. Models were generated from volumetric CT data and analyzed with simulated chondral defects at the chondrolabral junction on the posterior acetabulum during five distinct points in the gait cycle. Focal chondral defects increased maximum shear stress on the osteochondral surface of the acetabular cartilage, when compared to the intact case. This effect was amplified with labral delamination. Additionally, chondral defects increased the first principal Lagrange strain on the articular surface of the acetabular cartilage and labrum. Labral delamination relieved some of this tensile strain. As defect size was increased, contact stress increased in the medial zone of the acetabulum, while it decreased anteriorly. The results suggest that in the presence of chondral defects and labral delamination the cartilage experiences elevated tensile strains and shear and contact stress, which could lead to further damage of the cartilage, and subsequent arthritic progression. The framework presented here will serve as the procedure for future finite element studies on cartilage mechanics in hips with varying disease states with simulated chondral defects and labral tears. Copyright © 2016. Published by Elsevier Ltd.

  7. Effects of topical cyclosporine a plus artificial tears versus artificial tears treatment on conjunctival goblet cell density in dysfunctional tear syndrome.

    Science.gov (United States)

    Demiryay, Elvan; Yaylali, Volkan; Cetin, Ebru Nevin; Yildirim, Cem

    2011-09-01

    The aim was to compare the effects of topical cyclosporine A and artificial tears combination with artificial tears alone in patients with dysfunctional tear syndrome (DTS). Forty-two eyes of 42 patients with DTS were enrolled in the study. The inclusion criteria for the study were Schirmer I (without anesthesia) scores below 10 mm/5 min and tear film break-up time (BUT) below 10 sec. The patients were randomly divided into two groups. The study group (22 patients) underwent 0.05% cyclosporine A treatment twice a day and preservative-free artificial tears for four times a day for 4 months. The control group (20 patients) was administered only preservative-free artificial tears four times a day for 4 months. The BUT, Schirmer test scores, corneal fluorescein staining, conjunctival lissamine green staining, and goblet cell density derived by impression cytology were recorded before and after treatment in each group. In the study group, all parameters improved statistically significantly after treatment at the 4-month follow-up compared with the pretreatment values (Ptears treatment significantly increases goblet cell density, decreases the signs of DTS, and improves ocular surface health.

  8. Posterior horn medial meniscal root tear: the prequel

    Energy Technology Data Exchange (ETDEWEB)

    Umans, H. [Albert Einstein College of Medicine, Bronx, NY (United States); Lenox Hill Radiology and Imaging Associates, New York, NY (United States); Morrison, W. [Thomas Jefferson University Hospital, Philadelphia, PA (United States); DiFelice, G.S. [Hospital for Special Surgery, New York, NY (United States); Vaidya, N. [Crystal Run Healthcare, Middletown, NY (United States); Winalski, C.S. [Cleveland Clinic, Imaging Institute, Department of Biomedical Engineering, Lerner Research Institute, Cleveland, OH (United States)

    2014-06-15

    To determine whether subarticular marrow changes deep to the posterior horn medial meniscal root anchor might predict subsequent medial meniscal root tear. Fifteen patients with MR-diagnosed posterior horn medial meniscal root (PHMMR) tear and a knee MRI antecedent to the tear were identified at three imaging centers over a 7-year period. The pre- and post-tear MR images were evaluated for marrow signal changes deep to the root anchor, meniscal root signal intensity, medial compartment articular cartilage thinning, and meniscal body extrusion. Images of 29 age- and gender-matched individuals with two MRIs of the same knee were reviewed as a control group. MRI in 11 of 15 (73 %) cases with subsequent PHMMR tear demonstrated linear subcortical marrow edema deep to the meniscal root anchor on the antecedent MRI compared to only 1 of 29 (3 %) non-tear controls (p < 0.0001). The abnormal signal resolved on post-tear MRI in all but two patients. Cyst-like changes deep to the PHMMR were present on initial MRI in three of 15 (23 %) cases and three of 29 (10 %) controls, persisting in all but one case on follow-up imaging. The PHMMR was gray on the initial MRI in seven of 15 (47 %) of cases that developed tears compared to four of 29 (14 %) controls (p < 0.0001). There was medial meniscal extrusion (MME) prior to tear in two of 15 (13 %) patients and in ten of 15 (67 %) patients after PHMMR failure. In the control group, MME was present in one (3 %) and three (10 %) of 29 subjects on the initial and follow-up MRIs, respectively. Articular cartilage loss was noted in two of 15 (15 %) cases before tear and nine of 15 (69 %) on follow-up imaging, as compared to one (3 %) and four (14 %) of 29 subjects in the control group. Subcortical marrow edema deep to the PHMMR may result from abnormal stresses and thus be a harbinger of meniscal root failure. This hypothesis is supported by resolution of these marrow signal changes after root tear. Following tear, extrusion of the

  9. Idiopathic horseshoe-like macular tear: a case report

    Directory of Open Access Journals (Sweden)

    Kubota M

    2016-07-01

    Full Text Available Masaomi Kubota,1 Tomohiro Shibata,1 Hisato Gunji,1 Hiroshi Tsuneoka2 1Department of Ophthalmology, The Jikei University School of Medicine Kashiwa Hospital, Chiba, 2Department of Ophthalmology, The Jikei University School of Medicine, Tokyo, Japan Background: Although a few cases with idiopathic horseshoe-like macular tear have been reported, the mechanism remains unknown and a standard treatment has yet to be determined. Objective: To report the outcome for a patient with idiopathic horseshoe-like macular tear who underwent vitreous surgery. Case report: A 65-year-old man with no previous injury or ophthalmic disease presented with abnormal vision in his left eye. Best-corrected visual acuity was 0.8 in the right and 0.3 in the left, and the relative afferent pupillary defect was negative. Ophthalmoscopy revealed a horseshoe-like tear on the temporal side of the macula in the left eye. The tear size was 0.75 disc diameters (DD. Optical coherence tomography showed that the focal retinal detachment reached the fovea. A few days after the first visit, there was no longer adhesion of the flap of the tear to the retina and the tear size had increased to 1.5 DD. The patient underwent vitreous surgery similar to large macular hole surgery, with the tear closure repaired using the inverted internal limiting membrane flap technique with 20% SF6 gas tamponade. Although the tear decreased to 0.5 DD after the surgery, complete closure of the tear was not achieved. Conclusion: While cases with horseshoe-like macular tear following trauma and branch retinal vein occlusion have been reported, to the best of our knowledge, this is the first reported idiopathic case. In the present case, there was expansion of the tear until the patient actually underwent surgery. If vertical vitreous traction indeed plays a role in horseshoe-like macular tears, this will need to be taken into consideration at the time of the vitreous surgery in these types of cases. Keywords

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

    NARCIS (Netherlands)

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

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

  11. Tear film physiology and contact lens wear. II. Contact lens-tear film interaction.

    Science.gov (United States)

    Holly, F J

    1981-04-01

    The successful fitting of contact lenses requires the practitioner to take into account many properties of the specific lens type used but the practitioner must also understand patient factors including tear properties, use of appropriate solutions, procedures for lens cleaning, and efficiency of blinking. Selection of appropriate patients, selection of lens type, proper fitting, good maintenance, and training and monitoring of patients increase the probability of achieving success.

  12. Accuracy of non-arthrographic 3T MR imaging in evaluation of intra-articular pathology of the hip in femoroacetabular impingement

    Energy Technology Data Exchange (ETDEWEB)

    Linda, Dorota D. [University of Toronto, Department of Medical Imaging, Joint Department of Medical Imaging, Division of Musculoskeletal Imaging, Toronto (Canada); Mount Sinai Hospital, Toronto, ON (Canada); Naraghi, Ali; White, Lawrence M. [University of Toronto, Department of Medical Imaging, Joint Department of Medical Imaging, Division of Musculoskeletal Imaging, Toronto (Canada); Murnaghan, Lucas; Whelan, Daniel [University of Toronto, Department of Surgery, Division of Orthopedics, Toronto (Canada)

    2017-03-15

    To investigate the accuracy of non-arthrographic 3-T MRI compared to hip arthroscopy in the assessment of labral and cartilaginous pathology in patients with suspected FAI. Following IRB approval and waived consent, 42 consecutive cases of suspected FAI with non-arthrographic 3-T MRI and arthroscopy of the hip were reviewed. High-resolution TSE MR imaging was evaluated in consensus by two musculoskeletal radiologists, blinded to arthroscopic findings, for the presence of labral tears and articular cartilage lesions. Acetabular cartilage was categorized as normal, degeneration/fissuring, delamination, or denudation. MRI findings were compared to arthroscopy. Sensitivity, specificity, accuracy, and predictive values for MRI were calculated using arthroscopy as the standard of reference. Forty-two hips in 38 patients with a mean age of 29 (range 13-45 years) were assessed. Mean interval between MRI and arthroscopy was 154 days (range 27-472 days). MRI depicted 41 cases with labral tears (sensitivity 100%, specificity 50%, accuracy 98%, PPV 98%, NPV 100%), 11 cases with femoral cartilage abnormalities (sensitivity 85%, specificity 100%, accuracy 95%, PPV 100%, NPV 94%), and 36 cases with acetabular cartilage lesions (sensitivity 94% specificity 67%, accuracy 90%, PPV 94%, NPV 67%). Of the 36 cases with acetabular cartilage lesions on MRI, 7 were characterized as degeneration/fissuring, 26 as delamination, and 3 as denudation, with discordant results between MRI and arthroscopy for grading of articular cartilage in ten cases. Non-arthrographic 3-T MR imaging is a highly accurate technique for evaluation of the labrum and cartilage in patients with clinically suspected FAI. (orig.)

  13. Tear Mediators in Corneal Ectatic Disorders.

    Directory of Open Access Journals (Sweden)

    Dorottya Pásztor

    Full Text Available To compare the concentrations of 11 tear mediators in order to reveal the biochemical difference between pellucid marginal degeneration (PMD and keratoconus (KC.We have designed a cross-sectional study in which patients with corneal ectasia based on slit-lamp biomicroscopy and Pentacam HR (keratometry values (K1, K2, Kmax, astigmatism, minimal radius of curvature (Rmin, corneal thickness (Apex and Min, indices (surface variation, vertical asymmetry, keratoconus, central keratoconus, height asymmetry and decentration were enrolled. Eyes of keratoconic patients were similar to the PMD patients in age and severity (K2, Kmax and Rmin. Non-stimulated tear samples were collected from nine eyes of seven PMD patients, 55 eyes of 55 KC patients and 24 eyes of 24 healthy controls. The mediators' (interleukin -6, -10, chemokine ligand 5, -8, -10, matrix metalloproteinase (MMP -9, -13, tissue inhibitor of metalloproteinases (TIMP-1, tissue plasminogen activator, plasminogen activator inhibitor, nerve growth factor concentrations were measured using Cytometric Bead Array.MMP-9 was the only mediator which presented relevant variances between the two patient groups (p = 0.005. The ratios of MMP-9 and TIMP-1 were 2.45, 0.40 and 0.23 in PMD, KC and the controls, respectively.As far as we are aware, this is the first study that aims to reveal the biochemical differences between PMD and KC. Further studies of biomarkers to investigate the precise role of these mediators need to be defined, and it is important to confirm the observed changes in a larger study to gain further insights into the molecular alterations in PMD.

  14. Correlation between Rotator Cuff Tears and Systemic Atherosclerotic Disease

    Directory of Open Access Journals (Sweden)

    Andrea Donovan

    2011-01-01

    Full Text Available The purpose of this study was to investigate the association of aortic arch calcification, a surrogate marker of atherosclerosis, with rotator cuff tendinosis and tears given the hypothesis that decreased tendon vascularity is a contributing factor in the etiology of tendon degeneration. A retrospective review was performed to identify patients ages 50 to 90 years who had a shoulder MRI and a chest radiograph performed within 6 months of each other. Chest radiographs and shoulder MRIs from 120 patients were reviewed by two sets of observers blinded to the others' conclusions. Rotator cuff disease was classified as tendinosis, partial thickness tear, and full thickness tear. The presence or absence of aortic arch calcification was graded and compared with the MRI appearance of the rotator cuff. The tendon tear grading was positively correlated with patient age. However, the tendon tear grading on MRI was not significantly correlated with the aorta calcification scores on chest radiographs. Furthermore, there was no significant correlation between aorta calcification severity and tendon tear grading. In conclusion, rotator cuff tears did not significantly correlate with aortic calcification severity. This suggests that tendon ischemia may not be associated with the degree of macrovascular disease.

  15. Cytokine changes in tears and relationship to contact lens discomfort.

    Science.gov (United States)

    Willcox, Mark D P; Zhao, Zhenjun; Naduvilath, Thomas; Lazon de la Jara, Percy

    2015-01-01

    To determine the reproducibility of a multiplex bead assay for measuring cytokines in tears and correlations between ocular discomfort with or without contact lens wear and the concentration of cytokines in tears. Ninety participants (divided into two groups) were enrolled in this prospective study. They were asked to rate their ocular comfort and collect their tears in the morning and just before sleep for 10 days with or without contact lenses. The participants collected their tears using a glass microcapillary tube for both stages. Galyfilcon A lenses were worn on a daily disposable basis during the contact lens stage, and comfort scores and tears were collected before lens insertion and prior to lens removal at the end of the day. Tears were analyzed for cytokine concentrations using a 27-plex multibead assay. Correlations were sought between cytokine concentrations and comfort. There was a significant (pocular comfort over the day with or without lens wear. The magnitude of ocular discomfort was significantly greater (p-0.5 Log pg/ml, p-0.2 Log pg/ml, ptears was correlated to ocular comfort, but this was not changed by contact lens wear. Ocular comfort during the day is magnified by contact lens wear. However, the increase in the change in comfort during lens wear was not associated with changes in 15 cytokines in the tear film.

  16. The potential of optical coherence tomography in meniscal tear characterization

    Science.gov (United States)

    Ling, Hang-yin; Guo, Shuguang; Thieman, Kelley M.; Wise, Brent T.; Pozzi, Antonio; Xie, Huikai; Horodyski, MaryBeth

    2009-02-01

    Meniscal tear is one of the most common knee injuries leading to pain and discomfort. Partial and total meniscectomies have been widely used to treat the avascular meniscal injuries in which tears do not heal spontaneously. However, the meniscectomies would cause an alteration of the tibiofemoral contact mechanics resulting in progressive osteoarthritis (OA). To mitigate the progression of OA, maximal preservation of meniscal tissue is recommended. The clinical challenge is deciding which meniscal tears are amenable to repair and which part of damaged tissues should be removed. Current diagnosis techniques such as arthroscopy and magnetic resonance imaging can provide macrostructural information of menisci, but the microstructural changes that occur prior to the observable meniscal tears cannot be identified by these techniques. Serving as a nondestructive optical biopsy, optical coherence tomography (OCT), a newly developed imaging modality, can provide high resolution, cross-sectional images of tissues and has been shown its capabilty in arthroscopic evaulation of articular cartilage. Our research was to demonstrate the potential of using OCT for nondestructive characterization of the histopathology of different types of meniscal tears from clinical cases in dogs, providing a fundamental understanding of the failure mechanism of meniscal tears. First, cross-sectional images of torn canine menisci obtained from the OCT and scanning electronic microscopy (SEM) were be compared. By studying the organization of collegan fibrils in torn menisci from the SEM images, the feasibility of using OCT to characterize the organization of collegan fibrils was elucidated. Moreover, the crack size of meniscal tears was quantatitively measured from the OCT images. Changes in the crack size of the tear may be useful for understanding the failure mechanism of meniscal tears.

  17. Tear osmolarity and ocular surface parameters in patients with psoriasis

    Directory of Open Access Journals (Sweden)

    Goktug Demirci

    Full Text Available ABSTRACT Purpose: The aim of this study was to evaluate tear osmolarity, tear film function, and ocular surface changes in patients with psoriasis. Methods: At a single center, 30 eyes of 30 patients with psoriasis (group 1 and 30 eyes of 30 healthy individuals (group 2 were evaluated using the Ocular Surface Disease Index (OSDI questionnaire, Schirmer I test, tear film break-up time (TBUT test, scoring of ocular surface fluorescein staining using a modified Oxford scale, and tear osmolarity measurement. Results: Tear osmolarity values, OSDI, and Oxford scale scores were significantly higher in group 1 (309.8 ± 9.4 mOsm, 38.9 ± 1.1, and 0.7 ± 1.1, respectively than in group 2 (292.7 ± 7.7 mOsm, 4.2 ± 0.3, and 0.1 ± 0.3, respectively; p<0.01 for all. TBUT was significantly lower in group 1 (8.7 ± 3.6 s than in group 2 (18.1 ± 2.8 s; p<0.001. No significant differences were detected in Schirmer I test values between the groups (16.2 ± 2.5 mm in group 1 and 16.6 ± 2.3 mm in group 2; p=0.629. Conclusions: The results of this study showed that psoriasis may influence tear osmolarity and tear film function. Patients with psoriasis showed tear hyperosmolarity and tear film dysfunction.

  18. Investigation of Tear Biomarkers as an Indicator of Human Health

    Science.gov (United States)

    Morton, Stephen; Tucker, Bethany; Crucian, Brian; Steinberg, Susan; Hagan, Suzanne

    2017-01-01

    Scientific literature suggests that tear biomarkers can be used as a guide towards clinical diagnosis of human health (Hagan et al., 2016). This study will investigate whether tear biomarkers represents a research and clinical opportunity to assess human health prior to, during, and after exposure to the spaceflight environment. The focus of this study is to compare biomarkers previously identified as potentially relevant to both ocular and brain health against unique physiological outcomes of exposure to the space flight environment. Study subjects suffering from terrestrial conditions thought to be similar to Spaceflight Associated Neuro-ocular Syndrome (SANS: formerly VIIP), e.g. patients with idiopathic intracranial hypertension (IIH) and optic neuritis may be relevant to conditions associated with spaceflight. This study will review methodologies, tear biomarkers related to state of ocular and brain health, the strengths and weakness of using tear fluid biomarkers versus other body fluid samples, and will survey current tear fluid biomarker knowledge in research and clinical practice. A strength of using tear biomarkers is that sampling is non-invasive and used as a guide in understanding pathologies, including ocular and systemic inflammatory conditions (Cocho et al., 2016)., Salvisberg et al., 2014). Moreover, tear biomarkers may reflect diseases affecting the central nervous system (CNS) (Salvisberg et al., 2014). For example, in multiple sclerosis (MS), the concordance rate between tear biomarkers versus cerebrospinal fluid (CSF) is approximately 83%, indicating that, in the majority of cases, tears are at least as effective as CSF in potentially identifying novel MS biomarkers (Devos et al., 2001).

  19. Immunoglobulin concentration in tears of contact lens wearers.

    Science.gov (United States)

    Maurya, Rajendra P; Bhushan, Prashant; Singh, Virendra P; Singh, Mahendra K; Kumar, Prakash; Bhatia, Ravindra P S; Singh, Usha

    2014-01-01

    To evaluate changes in the concentration of tear immunoglobulins in contact lens wearers. A total of 45 cases including 23 contact lens wearers (43 eyes) and 22 age and sex matched healthy controls having no ocular pathology were studied for immunoglobulins (IgA, IgG, IgM) in their tears by single radial immunodiffusion method. Most of the cases used soft (56.6%) and semi-soft gas permeable (30.4%) contact lenses. Tear IgM was detected in only 17.4% and tear IgG in 43.6% of contact lens wearers, while in controls IgG was detected in 9.1% but none of the controls had IgM. There was a significant rise in total tear IgA (13.17 ± 4.44 mg/dl) in contact lens wearer as compared to controls (8.93 ± 3.79 mg/dl). Rise of tear IgA was more in symptomatic patients (15.38 ± 5.28 mg/dl) and in those wearing hard (19.73 ± 5.43 mg/dl) and semi-soft contact lenses (13.31 ± 5.43 mg/dl). A significant increase in tear IgA was noticed in subjects wearing lenses for >3 years (15.69 ± 5.39 mg/dl). About 43.4% of lens wearers were symptomatic and 80% of their lenses showed deposits and/or haziness. All cases with IgM in tear were symptomatic. The relation of immunoglobulin concentration with increasing duration of wear and material of contact lens shows that tear immunoglobulin rise accrues due to mechanical stimulation, hence contact lenses should not be used for a long period and lenses of hard nature should be discouraged. The maintenance, cleaning and deproteinization of the lenses are of high importance to avoid immunostimulation.

  20. Evaluation of Tear Function Tests and Lower Tear Meniscus Height in Keratoconus Patients

    Directory of Open Access Journals (Sweden)

    Özge Saraç

    2012-07-01

    Full Text Available Pur po se: To assess the tear function tests and the lower tear meniscus height (LTMH in keratoconus patients and to evaluate the relationship of these parameters with the progression of keratoconus. Ma te ri al and Met hod: Thirty-eight eyes (group 1 of 21 keratoconus patients and 36 eyes (group 2 of 18 healthy subjects were included in this prospective study. Both groups underwent corneal topographic and keratometric measurements, tear break-up time (T-BUT and Schirmer tests as well as measurement of the LTMH with anterior segment optic coherence tomography (OCT after the ophthalmologic examination. The values obtained from both groups were compared and evaluated for statistical significance and reliability. Re sults: There was no statistically significant difference between the two groups in terms of age and gender (p>0.05. The mean Schirmer test values were 14.87±8.9 mm and 16.77±8.1 mm in group 1 and group 2, respectively (p=0.367. There was not any correlation between the keratometric power and the Schirmer test in group 1 and group 2 (group 1: r=0.114, p=0.548, group 2: r=0.151, p=0.972. The mean TBUT value was 12.83±7.3 sec in group 1, and 18.25±8.5 sec in group 2 (p=0.018. There was a negative correlation between keratometric power and TBUT in group 1, while there was no correlation in group 2 (group 1: r=0.717, p=0.001, group 2: r=0.235, p=0.212. The mean LTMH was 265.30±112 µm in group 1 and 313.29±167 µm in group 2 (p=0.151. There was no correlation between keratometric power and LTMH in both groups (group 1: r=0.001, p=0.997, group 2: r=0.318, p=0.130. Dis cus si on: In this study, it was shown that keratoconus patients have normal tear volume but reduced tear film stability compared to healthy individuals and this reduction is relate to the progression of keratoconus. (Turk J Ophthalmol 2012; 42: 249-52

  1. Uncemented porous tantalum acetabular components: early follow-up and failures in 613 primary total hip arthroplasties.

    Science.gov (United States)

    Noiseux, Nicolas O; Long, William J; Mabry, Tad M; Hanssen, Arlen D; Lewallen, David G

    2014-03-01

    Uncemented tantalum acetabular components were introduced in 1997. The purpose was to determine the 2- to 10-year results with this implant material in primary total hip arthroplasty. Our registry identified all primary total hip cases with porous tantalum cups implanted from 1997 to 2004. Clinical outcomes and radiographs were studied. 613 cases were identified. Seventeen percent of patients were lost to follow-up. Twenty-five reoperations were performed (4.4%). Acetabular cup removal occurred in 6 cases (1.2%). No cups were revised for aseptic loosening. Incomplete radiolucent lines were found on 9.3% of initial postoperative radiographs. At 2 years, 67% had resolved. Zero new radiolucent lines were detected. Two- to 10-year results of porous tantalum acetabular components for primary total hip arthroplasty demonstrate high rates of initial stability and apparent ingrowth. © 2014.

  2. A cadaveric study of posterior dislocation after total hip replacement-effects of head diameter and acetabular anteversion.

    Science.gov (United States)

    Ng, Fu Yuen; Zhang, Jiang Tao; Chiu, Kwong Yuen; Yan, Chun Hoi

    2011-03-01

    The size of the femoral head and acetabular anteversion are crucial for stability in total hip replacements. This study examined the effects of head diameter and acetabular anteversion on the posterior instability after total hip replacement in an in vivo setting. The acetabular shell was inserted at 0-20° of anteversion at five degree intervals. By using different head sizes (28 mm, 32 mm, 36 mm), the degrees of dislocation were recorded by computer navigation. The 36-mm group consistently showed better stability compared with the 32- and 28-mm groups, regardless of the degree of cup anteversion. Within each group of head size, the hip was significantly more stable when the cup anteversion increased from 0° to 10°. The difference became insignificant when it increased from 15° to 20°.

  3. Automatic assessment of tear film break-up dynamics.

    Science.gov (United States)

    Ramos, L; Barreira, N; Pena-Verdeal, H; Giráldez, M J

    2014-01-01

    Dry eye syndrome is a common disorder of the tear film which affects a remarkable percentage of the population. The Break-Up Time (BUT) is a clinical test used for the diagnosis of this disease, which computes the time the first tear film break-up appears. This work describes a fully automatic methodology to compute the BUT measurement and evaluate the break-up dynamics until the final blink. This analysis provides useful additional information for the assessment of tear film stability.

  4. Inside-Out Repair for Radial Meniscus Tears.

    Science.gov (United States)

    Pareek, Ayoosh; O'Malley, Michael P; Levy, Bruce A; Stuart, Michael J; Krych, Aaron J

    2016-08-01

    Understanding of meniscal function through basic science, natural history, and biomechanics has highlighted the importance of preserving the meniscus to maintain normal knee biomechanics. Tears that may alter these biomechanics can contribute to the progressive nature of degenerative joint disease in the knee. Radial tears result in the disruption of the circumferential fibers causing inability of the native meniscus to resist normal hoop stresses, thereby leading to increased focal areas of pressure that cause complications such as early onset arthrosis. In this technical note, we describe our preferred operative technique to repair radial meniscal tears using an arthroscopic inside-out approach with satisfactory clinical outcomes and healing response.

  5. The Role of Thermal Conduction in Tearing Mode Theory

    CERN Document Server

    Connor, J W; Hastie, R J; Liu, Y Q

    2014-01-01

    The role of anisotropic thermal diffusivity on tearing mode stability is analysed in general toroidal geometry. A dispersion relation linking the growth rate to the tearing mode stability parameter, Delta, is derived. By using a resistive MHD code, modified to include such thermal transport, to calculate tearing mode growth rates, the dispersion relation is employed to determine Delta in situations with finite plasma pressure that are stabilised by favourable average curvature in a simple resistive MHD model. We also demonstrate that the same code can also be used to calculate the basis-functions [C J Ham, et al, Plasma Phys. Control. Fusion 54 (2012) 105014] needed to construct Delta.

  6. Development of Job’s-tears ice cream recipe

    Directory of Open Access Journals (Sweden)

    Wiwat Wangcharoen

    2009-10-01

    Full Text Available Job’s tears ice cream recipe was developed by varying proportions of Job’s tears, sucrose, salt and coconut milk. Product positioning mapping was used to identify the sensory attributes that were drivers of preference, which appeared to be sweetness, smoothness, richness, and coconut milk and Job's-tears flavours of the product. Cluster analysis was used to differentiate consumers by their preference direction. Nutritional composition, antioxidant capacity and total phenolic content of the final product were also determined.

  7. Comparison of Schirmer's test and tear film breakup time test to detect tear film abnormalities in patients with pterygium.

    Science.gov (United States)

    Rahman, Atiya; Yahya, Kamran; Fasih, Uzma; Waqar-ul-Huda; Shaikh, Arshad

    2012-11-01

    To compare tear film breakup time test with Schirmer's test in patients with pterygium. The case-control study, involving 86 patients with unilateral primary pterygium aged between 30 and 70 years, was conducted at the Department of Ophthalmology, Karachi Medical and Dental College, Abbasi Shaheed Hospital, from May 2009 to December 2010. The eye with pterygium was taken as the case, and was compared with the other eye without pterygium which was taken as the control in these patients. All patients underwent routine ophthalmic examination. Tear film tests such as Schirmer's test and tear film breakup time test were performed on all these eyes. Results of tear function test between the eyes with pterygium (cases) and the eye without pterygium (control) were compared. SPSS 17 was used for statistical analysis. Chi square test was used for comparing the results of the cases and the controls. Of the 86 patients, 63 (73.3%) were men, while 23 (26.7%) were women. The median age was 41 years. There were 62 (72.1%) patients with pterygium in the right eye, while 24 (27.9%) had it in the left. Among the involved eyes, decreased tear breakup time (10 seconds. On the other hand, 8 (9.3 %) eyes with pterygium had Schirmer's test positive and 78 (90.7 %) eyes had it negative. Tear film breakup time test has better diagnostic value compared to Schirmer's test in detecting tear film abnormality in patients with pterygium.

  8. Serial measurement of tear meniscus by FD-OCT after instillation of artificial tears in patients with dry eyes.

    Science.gov (United States)

    Bujak, Matthew C; Yiu, Samuel; Zhang, Xinbo; Li, Yan; Huang, David

    2011-01-01

    To use Fourier-domain optical coherence tomography (FD-OCT) to study the effect of artificial tears on the tear meniscus in patients with dry eyes. The lower tear meniscus of 16 consecutive patients with dry eyes was imaged by an FD-OCT system (RTVue; Optovue, Inc., Fremont, CA). Baseline and five serial pairs of measurements were taken after the instillation of artificial tears (Optive; Allergan, Irvine, CA) at 1, 2, 5, 10, and 15 minutes. The lower meniscus height, depth, and area were measured with a computer caliper. Baseline meniscus measurements were 235.5 ± 150.0 μm, 138.1 ± 78.7 μm, and 0.020 ± 0.022 mm(2) for height, depth, and area, respectively. After instillation of artificial tears, all lower tear meniscus parameters remained significantly elevated for 5 minutes and returned to baseline by 10 minutes. FD-OCT is able to quantify a dramatic initial increase in tear meniscus, followed by a decay back to baseline values after approximately 5 minutes. FD-OCT may be useful in objectively quantifying the dynamic efficacy of dry eye treatments. Copyright 2011, SLACK Incorporated.

  9. Cemented reconstruction of acetabular ceiling using the vertebroplasty set in treatment of metastatic lesions.

    Science.gov (United States)

    Guzik, Grzegorz

    2014-01-01

    The number of patients suffering from malignant tumors with bony metastases has been increasing. Surgery makes it possible to preserve physical function and decrease pain. Safe and efficient techniques for filling cancer-related bone defects within the pelvis are still being searched for. A total of 13 patients with cancer metastases to the acetabular ceiling area in the hip were operated on using vertebroplasty sets in the Oncological Orthopedics Department in Brzozów in the years 2010-2013. A percutaneous approach was employed in 4 patients, while in 9 the surgery was combined with acetabulofemoral joint resection and arthroplasty. Patient qualification for the treatment took into account the size and shape of the bone defect as determined per computed tomography. Pain intensity (VAS scale) and gait efficiency were evaluated before and after the treatment. All patients reported a distinct decrease in pain intensity. All of them started to ambulate and loading the joint did not aggravate the symptoms. No thrombo-embolic or infectious complications were observed. The mobility of the operated joints was good. The filling of lytic bone defects in the acetabular ceiling area determines walking efficiency and reduced pain intensity. Surgical procedures take a long time, are complicated and associated with a high risk of complications. Percutaneous administration of bone cement may be an alternative solution in patients with an intact cortical bone layer. The literature data indicate good outcomes of this approach, with a minimal number of complications. Acetabuloplasty with bone cement is a safe and effective treatment method in the case of cancer metastases to the acetabular ceiling area.

  10. The acetabular wall index for assessing anteroposterior femoral head coverage in symptomatic patients.

    Science.gov (United States)

    Siebenrock, Klaus A; Kistler, Lea; Schwab, Joseph M; Büchler, Lorenz; Tannast, Moritz

    2012-12-01

    Understanding acetabular pathomorphology is necessary to correctly treat patients with hip complaints. Existing radiographic parameters classify acetabular coverage as deficient, normal, or excessive but fail to quantify contributions of anterior and posterior wall coverage. A simple, reproducible, and valid measurement of anterior and posterior wall coverage in patients with hip pain would be a clinically useful tool. We (1) introduce the anterior wall index (AWI) and posterior wall index (PWI), (2) report the intra- and interobserver reliability of these measurements, and (3) validate these measurements against an established computer model. We retrospectively reviewed 87 hips (63 patients) with symptomatic hip disease. A validated computer model was used to determine total anterior and posterior acetabular coverage (TAC and TPC) on an AP pelvis radiograph. Two independent observers measured the AWI and PWI on each film, and the intraclass correlation coefficient (ICC) was calculated. Pearson correlation was used to determine the strength of linear dependence between our measurements and the computer model. Intra- and interobserver ICCs were 0.94 and 0.99 for the AWI and 0.81 and 0.97 for the PWI. For validation against the computer model, Pearson r values were 0.837 (AWI versus TAC) and 0.895 (PWI versus TPC). Mean AWI and PWI were 0.28 and 0.81 for dysplastic hips, 0.41 and 0.91 for normal hips, 0.61 and 1.15 for hips with a deep acetabulum. Our data suggest these measures will be helpful in evaluating anterior and posterior coverage before and after surgery but need to be evaluated in asymptomatic individuals without hip abnormalities to establish normal ranges. Level III, diagnostic study. See Instructions for Authors for a complete description of levels of evidence.

  11. Interobserver agreement for Letournel acetabular fracture classification with multidetector CT: are standard Judet radiographs necessary?

    Science.gov (United States)

    Ohashi, Kenjirou; El-Khoury, Georges Y; Abu-Zahra, Khalil W; Berbaum, Kevin S

    2006-11-01

    To retrospectively evaluate interobserver agreement for Letournel acetabular fracture classification with radiography alone and multidetector computed tomography (CT) alone and to retrospectively assess whether standard Judet views lead to a change in the classification. Institutional review board approval was obtained; informed consent was not required for this HIPAA-compliant study, which included 101 imaging studies performed in 99 patients (78 male, 21 female; mean age, 43 years; age range, 15-86 years) with acetabular fractures. Two musculoskeletal radiologists independently classified the fractures with radiography alone and multidetector CT alone. Multiplanar reformatted and three-dimensional (3D) CT images were reviewed at a computer workstation. Readers were shown radiographs at the end of multidetector CT image reading to see if this would change the multidetector CT-based classification. kappa Values were calculated to assess interobserver agreement. For surgically treated patients, the McNemar test was used to compare the accuracy of readers' classifications. The reference standard was a combination of preoperative radiographic and multidetector CT image findings and intraoperative findings. Interobserver agreement was moderate (kappa = 0.42) with radiography and substantial (kappa = 0.70) with multidetector CT. Multidetector CT classification was changed in two cases (one case for each reader) after standard Judet views were added. In 73 surgically treated patients, agreement with the surgeons' classification was higher with multidetector CT than with radiography (P < .01 for one reader, P = .06 for the other reader). There is substantial interobserver agreement for Letournel acetabular fracture classification with multiplanar reformatted and 3D multidetector CT images. Standard Judet pelvic radiographs add little information for changing the multidetector CT classification.

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

    Directory of Open Access Journals (Sweden)

    Reza Firoozabadi

    2015-09-01

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

  13. Single column locking plate fixation is inadequate in two column acetabular fractures. A biomechanical analysis

    Directory of Open Access Journals (Sweden)

    Bellino Michael J

    2010-05-01

    Full Text Available Abstract Background The objective of this study was to determine whether one can achieve stable fixation of a two column (transverse acetabular fracture by only fixing a single column with a locking plate and unicortical locking screws. We hypothesized that a locking plate applied to the anterior column of a transverse acetabular fracture would create a construct that is more rigid than a non-locking plate, and that this construct would be biomechanically comparable to two column fixation. Methods Using urethane foam models of the pelvis, we simulated transverse acetabular fractures and stabilized them with 1 an anterior column plate with bicortical screws, 2 an anterior locking plate with unicortical screws, 3 an anterior plate and posterior column lag screw, and 4 a posterior plate with an anterior column lag screw. These constructs were mechanically loaded on a servohydraulic material testing machine. Construct stiffness and fracture displacement were measured. Result and Discussion We found that two column fixation is 54% stiffer than a single column fixation with a conventional plate with bicortical screws. There was no significant difference between fixation with an anterior column locking plate with unicortical screws and an anterior plate with posterior column lag screw. We detected a non-significant trend towards more stiffness for the anterior locking plate compared to the anterior non-locking plate. Conclusion In conclusion, a locking plate construct of the anterior column provides less stability than a traditional both column construct with posterior plate and anterior column lag screw. However, the locking construct offers greater strength than a non-locking, bicortical construct, which in addition often requires extensive contouring and its application is oftentimes accompanied by the risk of neurovascular damage.

  14. Acetabular Global Insufficiency in Patients with Down Syndrome and Hip-Related Symptoms: A Matched-Cohort Study.

    Science.gov (United States)

    Bulat, Evgeny; Maranho, Daniel A; Kalish, Leslie A; Millis, Michael B; Kim, Young-Jo; Novais, Eduardo N

    2017-10-18

    The etiology of hip instability in Down syndrome is not completely understood. We investigated the morphology of the acetabulum and femur in patients with Down syndrome and compared measurements of the hips with those of matched controls. Computed tomography (CT) images of the pelvis of 42 patients with Down syndrome and hip symptoms were compared with those of 42 age and sex-matched subjects without Down syndrome or history of hip disease who had undergone CT for abdominal pain. Each of the cohorts had 23 male and 19 female subjects. The mean age (and standard deviation) in each cohort was 11.3 ± 5.3 years. The lateral center-edge angle (LCEA), acetabular inclination angle (IA), acetabular depth-width ratio (ADR), acetabular version, and anterior and posterior acetabular sector angles (AASA and PASA) were compared. The neck-shaft angle and femoral version were measured in the patients with Down syndrome only. The hips of the patients with Down syndrome were further categorized as stable (n = 21) or unstable (n = 63) for secondary analysis. The hips in the Down syndrome group had a smaller LCEA (mean, 10.8° ± 12.6° compared with 25.6° ± 4.6°; p Down syndrome cohort, the unstable hips showed greater femoral anteversion (mean, 32.7° ± 14.6° compared with 23.6° ± 10.6°; p = 0.002) and worse global acetabular insufficiency compared with the stable hips. No differences between the unstable and stable hips were found with respect to acetabular version (mean AVC, 7.8° ± 5.5° compared with 7.6° ± 3.8°; p = 0.93) and the neck-shaft angle (mean, 133.7° ± 6.7° compared with 133.2° ± 6.4°; p = 0.81). Patients with Down syndrome and hip-related symptoms had more retroverted and shallower acetabula with globally reduced coverage of the femoral head compared with age and sex-matched subjects. Hip instability among those with Down syndrome was associated with worse global acetabular insufficiency and increased femoral anteversion, but not with more severe

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

    DEFF Research Database (Denmark)

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

    2007-01-01

    BACKGROUND: In RSA, tantalum markers attached to metal-backed acetabular cups are often difficult to detect on stereo radiographs due to the high density of the metal shell. This results in occlusion of the prosthesis markers and may lead to inconclusive migration results. Within the last few years...... underwent migration analyses with 3 different RSA systems: conventional RSA using tantalum markers, an RSA system using a hemispherical cup algorithm, and a novel model-based RSA system. RESULTS: We found narrow confidence intervals, indicating high precision of the conventional marker system and model...

  16. Are quadrilateral surface buttress plates comparable to traditional forms of transverse acetabular fracture fixation?

    Science.gov (United States)

    Kistler, Brian J; Smithson, Ian R; Cooper, Seth A; Cox, Jacob L; Nayak, Aniruddh N; Santoni, Brandon G; Sagi, H Claude

    2014-11-01

    Several construct options exist for transverse acetabular fracture fixation. Accepted techniques use a combination of column plates and lag screws. Quadrilateral surface buttress plates have been introduced as potential fixation options, but as a result of their novelty, biomechanical data regarding their stabilizing effects are nonexistent. Therefore, we aimed to determine if this fixation method confers similar stability to traditional forms of fixation. We biomechanically compared two acetabular fixation plates with quadrilateral surface buttressing with traditional forms of fixation using lag screws and column plates. Thirty-five synthetic hemipelves with a transverse transtectal acetabular fracture were allocated to one of five groups: anterior column plate+posterior column lag screw, posterior column plate+anterior column lag screw, anterior and posterior column lag screws only, infrapectineal plate+anterior column plate, and suprapectineal plate alone. Specimens were loaded for 1500 cycles up to 2.5x body weight and stiffness was calculated. Thereafter, constructs were destructively loaded and failure loads were recorded. After 1500 cycles, final stiffness was not different with the numbers available between the infrapectineal (568±43 N/mm) and suprapectineal groups (602±87 N/mm, p=0.988). Both quadrilateral plates were significantly stiffer than the posterior column buttress plate with supplemental lag screw fixation group (311±99 N/mm, p0.223). The infrapectineal group failed at the highest loads (5.4±0.6 kN) and this was significant relative to the suprapectineal (4.4±0.3 kN; p=0.023), lag screw (2.9±0.8 kN; p<0.001), and anterior buttress plate with posterior column lag screw (4.0±0.6 kN; p=0.001) groups. Quadrilateral surface buttress plates spanning the posterior and anterior columns are biomechanically comparable and, in some cases, superior to traditional forms of fixation in this synthetic hemipelvis model. Quadrilateral surface buttress

  17. [CT-based classification aid for acetabular fractures: evaluation and clinical testing].

    Science.gov (United States)

    Schäffler, A; Fensky, F; Knöschke, D; Haas, N P; Becken, A G; Stöckle, U; König, B

    2013-11-01

    The basis for the classification of acetabular fractures depends on accurate radiological diagnostics. The use of conventional X-rays alone implicates a low intrapersonal reproducibility and interpersonal reliability. By applying computed tomography (CT) at an early stage in the emergency room, the typical diagonal X-rays of ala and obturator, on which the classification is based, are no longer recommended. The aim of this study was to develop a new reliable classification system based on standardized CT slices according to the system of Judet and Letournel without using diagonal X-rays. In this study 12 select cases with acetabular fractures were peer reviewed. In each case eight characteristic CT slices (five axial, two coronal and one sagittal) were selected as well as the conventional anteroposterior X-ray of the pelvis. All cases were peer reviewed by 14 members of the "AG Becken" (working group pelvis). The classification of the acetabular fractures was based on Judet and Letournel and the results were compared with the reference classification. The results were scaled according to differences to the original classification and the relevance to the approach as well as the medical qualification of the member. A total of 167 out of 168 possible classifications were conducted, 90 cases (54 %) were in accordance with the reference classification. In 69 cases (41 %) the outcome was different, which would have had no influence on the choice of the surgical approach. A wrong classification was present eight times (5 %). According to the medical qualification status the senior physicians were right in 54%, the residents in 53 %. Within the group of senior physicians 7.5 % of the classifications were completely wrong and 93 % of the participating members would have preferred to have more CT slices. The CT-based classification developed represents an adaption to the current standard of diagnostics of acetabular fractures and represents a step towards

  18. From Complication to Diagnosis: Prostate Cancer in an Acetabular Fracture Patient Presenting with Hip Pain

    Directory of Open Access Journals (Sweden)

    Rana Terlemez

    2017-04-01

    Full Text Available According to the Turkish Public Health Institution data, prostate cancer is the 2nd most common cancer in men. Advanced stage patients may apply with pain in the lower back, hips, or upper thighs. In this case report, a 66 year-old man who has hip pain referred to our rheumatology department with sacroiliitis is presented. Further investigations revealed that hip pain was the result of acetabular fracture due to osteoblastic bone metastases. Significant pain palliation was achieved in the patient who is diagnosed with primer prostate carcinoma after radiation therapy.

  19. Contact lens and tear film dynamics during blinking

    Science.gov (United States)

    Reid, Timothy; Anderson, Daniel

    2016-11-01

    We develop a mathematical model that couples the dynamics of the tear film and contact lens during blinking. We derive an ordinary differential equation for the motion of the contact lens (parallel to the cornea) driven and retarded by viscous forces in the thin fluid films separating the contact lens from the eyelids and the corneal surface. Using the contact lens motion and tear film dynamics models we calculate a numerical solution of tear film thickness, showing that the lens and lid motion influence the tear film dynamics. The numerical solution uses a mapped Chebyshev spectral method for the spatial derivatives to reduce the model to a system of differential algebraic equations. National Science Foundation Grants (DMS-1407087) and (DMS-1107848).

  20. Surgery for ACL Tear Often Successful Over Long Term

    Science.gov (United States)

    ... fullstory_167352.html Surgery for ACL Tear Often Successful Over Long Term Even 10 years after procedure, ... were scheduled for presentation Friday at the annual meeting of the AOSSM in Toronto. Findings presented at ...

  1. The influence of nonpolar lipids on tear film dynamics

    Science.gov (United States)

    Breward, Chris

    2013-11-01

    We will examine the effects of the presence of nonpolar lipids on the evolution of a tear film during a blink. We will track the thickness of the aqueous tear layer, the thickness of the nonpolar lipid layer, and the concentration of the polar lipids that reside between the two. Our model can be reduced in various limits to previous models for tear dynamics studied. We present numerical solutions for the evolution of the tear film and show how the key parameters play a role in determining how the nonpolar lipid spreads. This work was partially supported by Award No. KUK-C1-013-04 made by King Abdullah University of Science and Technology (KAUST).

  2. Tearing mode dynamics and sawtooth oscillation in Hall-MHD

    Science.gov (United States)

    Ma, Zhiwei; Zhang, Wei; Wang, Sheng

    2017-10-01

    Tearing mode instability is one of the most important dynamic processes in space and laboratory plasmas. Hall effects, resulted from the decoupling of electron and ion motions, could cause the fast development and perturbation structure rotation of the tearing mode and become non-negligible. We independently developed high accuracy nonlinear MHD code (CLT) to study Hall effects on the dynamic evolution of tearing modes with Tokamak geometries. It is found that the rotation frequency of the mode in the electron diamagnetic direction is in a good agreement with analytical prediction. The linear growth rate increases with increase of the ion inertial length, which is contradictory to analytical solution in the slab geometry. We further find that the self-consistently generated rotation largely alters the dynamic behavior of the double tearing mode and the sawtooth oscillation. National Magnetic Confinement Fusion Science Program of China under Grant No. 2013GB104004 and 2013GB111004.

  3. Anatomical Knee Variants in Discoid Lateral Meniscal Tears

    Directory of Open Access Journals (Sweden)

    Xu-Xu Chen

    2017-01-01

    Conclusions: The condylar cutoff sign observed on the tunnel view of the radiograph is helpful in predicting meniscal tear in adult patients with discoid lateral meniscus. As for these patients, further MRI test is recommended.

  4. The Effect of Polar Lipids on Tear Film Dynamics

    KAUST Repository

    Aydemir, E.

    2010-06-17

    In this paper, we present a mathematical model describing the effect of polar lipids, excreted by glands in the eyelid and present on the surface of the tear film, on the evolution of a pre-corneal tear film. We aim to explain the interesting experimentally observed phenomenon that the tear film continues to move upward even after the upper eyelid has become stationary. The polar lipid is an insoluble surface species that locally alters the surface tension of the tear film. In the lubrication limit, the model reduces to two coupled non-linear partial differential equations for the film thickness and the concentration of lipid. We solve the system numerically and observe that increasing the concentration of the lipid increases the flow of liquid up the eye. We further exploit the size of the parameters in the problem to explain the initial evolution of the system. © 2010 Society for Mathematical Biology.

  5. Tear levels of IL-16 in vernal keratoconjunctivitis

    Directory of Open Access Journals (Sweden)

    Onur Çatak

    2013-09-01

    Full Text Available Objective: Vernal keratoconjunctivitis is more common inchildren and young adults having an atopic background.The aim of the present study was to determine the interleukin-16 (IL-16 levels in tear fluids of patients withvernal keratoconjunctivitis (VKC.Methods: Tear fluid samples were collected from 20patients with VKC and 10 healthy subjects. Tear fluidsamples were collected with microcapillary tubes for hematocritat the lateral canthus of patients in the supineposition without any anesthesia. Tear levels of IL-16 weremeasured by ELISA kit.Results: The mean levels of IL-16 among the patients(514±135 pg/ml was significantly higher than amongcontrols (358±139 pg/ml (p=0.04.Conclusions: These results considered that IL-16 havesignificant effect on the pathogenetic process of vernalkeratoconjunctivitis.Key words: Interleukin-16, vernal keratoconjunctivitis,enzyme-linked immunosorbent assay

  6. Progression from calcifying tendinitis to rotator cuff tear

    Energy Technology Data Exchange (ETDEWEB)

    Gotoh, Masafumi; Higuchi, Fujio; Suzuki, Ritsu; Yamanaka, Kensuke [Department of Orthopaedic Surgery, Medical Center of Kurume University, 155-1 Kokubu-machi, Kurume City, Fukuoka 839-0862 (Japan)

    2003-02-01

    This report documents the clinical, radiographic and histologic findings in a 46-year-old man with calcifying tendinitis in his left shoulder which progressed to rotator cuff tear. The patient had a 1-year history of repeated calcifying tendinitis before being referred to our hospital. On the initial visit, radiographs and magnetic resonance imaging (MRI) revealed calcium deposition localized in the supraspinatus tendon without apparent tear. Three months after the first visit, MRI revealed a partial-thickness rotator cuff tear at the site of calcium deposition. Surgical and histologic findings demonstrated that calcium deposition was the cause of cuff rupture. To our knowledge, based on a review of the English literature, this is the first case report in which the progression from calcifying tendinitis to rotator cuff tear has been serially observed. (orig.)

  7. Tear fluid electrolytes and albumin in persons under environmental stress

    Energy Technology Data Exchange (ETDEWEB)

    Thygesen, J.E.; Bach, B.; Molhave, L.; Pedersen, O.F.; Prause, J.U.; Skov, P.

    1987-06-01

    Sixty-two subjects selected among 287 persons with indoor air complaints were exposed to a standard mixture of 22 different organic gases and vapors normally found in Danish houses. Persons were randomly assigned to one of four exposure groups, and each subject stayed during the test day from 10:00 AM to 4:00 PM under standardized conditions in a climate chamber. During exposure the blink frequency was recorded, and after exposure the tear fluid contents of serum albumin, potassium, and sodium were measured. It was found that the persons had an increased concentration of serum albumin in the tear fluid, and that exposure to high concentrations of organic gases and vapors induced a tear reflex-mediated dilution of the tears.

  8. Comparison of Medial and Lateral Meniscus Root Tears.

    Directory of Open Access Journals (Sweden)

    Ji Hyun Koo

    Full Text Available The meniscus root plays an essential role in maintaining the circumferential hoop tension and preventing meniscal displacement. Studies on meniscus root tears have investigated the relationship of osteoarthritis and an anterior cruciate ligament tear. However, few studies have directly compared the medial and lateral root tears. To assess the prevalence of meniscal extrusion and its relationship with clinical features in medial and lateral meniscus root tears, we performed a retrospective review of the magnetic resonance imaging (MRI results of 42 knee patients who had meniscus posterior horn root tears and who had undergone arthroscopic operations. The presence of meniscal extrusion was evaluated and the exact extent was measured from the tibial margin. The results were correlated with arthroscopic findings. Clinical features including patients' ages, joint abnormalities, and previous trauma histories were evaluated. Twenty-two patients had medial meniscus root tears (MMRTs and twenty patients had lateral meniscus root tears (LMRTs. Meniscal extrusion was present in 18 MMRT patients and one LMRT patient. The mean extent of extrusion was 4.2mm (range, 0.6 to 7.8 in the MMRT group and 0.9mm (range, -1.9 to 3.4 in the LMRT group. Five patients with MMRT had a history of trauma, while 19 patients with LMRT had a history of trauma. Three patients with MMRT had anterior cruciate ligament (ACL tears, while 19 patients with LMRT had ACL tears. The mean age of the patients was 52 years (range: 29-71 years and 30 years (range: 14-62 years in the MMRT and LMRT group, respectively. There was a significant correlation between a MMRT and meniscal extrusion (p<0.0001, and between an ACL tear and LMRT (p<0.0001. A history of trauma was significantly common in LMRT (p<0.0001. LMRT patients were significantly younger than MMRT patients (p<0.0001. Kellgren-Lawrence (K-L grade differed significantly between MMRT and LMRT group (p<0.0001. Meniscal extrusion is

  9. Tear osmolarity and dry eye symptoms in diabetics

    Science.gov (United States)

    Fuerst, Nicole; Langelier, Nicole; Massaro-Giordano, Mina; Pistilli, Maxwell; Stasi, Kalliopi; Burns, Carrie; Cardillo, Serena; Bunya, Vatinee Y

    2014-01-01

    Purpose To assess the relationship between tear osmolarity and dry eye symptoms in patients with diabetes. Patients and methods Fifty patients with diabetes were enrolled. Demographic information and past medical history were recorded. Symptoms were assessed using the ocular surface disease index (OSDI). Tear osmolarity of each eye was measured with the TearLab® Osmolarity System. Results The majority of the subjects were female (76%), African American (56%), and/or had a diagnosis of type 2 diabetes (82%). The mean ± standard deviation (SD) for age was 54.6±13.4, and maximum tear osmolarity was 304.6±12.7 mOsm/L. Men had higher osmolarity than women (mean ± standard error (SE) 311.8±4.0 mOsm/L versus 302.3±1.9 mOsm/L, P=0.02). Age, race, use of artificial tears, years of diabetes, and hemoglobin A1c did not have a statistically significant association with tear osmolarity. Longer duration of diabetes was associated with lower (less severe) OSDI scores (r=−0.35, P=0.01). Higher tear osmolarity was associated with lower (less severe) OSDI scores (r=−0.29, P=0.04). Conclusion Approximately half of the diabetic subjects in our study had elevated tear osmolarity, and half of our population also reported symptoms consistent with dry eye disease. However, the two were slightly inversely related in that those with higher osmolarity reported fewer symptoms. Subjects with a longer duration of diabetes also reported fewer dry eye symptoms. Therefore, health care providers should be aware that patients who are most likely to have ocular surface disease, including those with long-standing diabetes, may not experience symptoms and seek care in a timely manner. PMID:24648714

  10. The eyelids and tear film in contact lens discomfort.

    Science.gov (United States)

    Siddireddy, Jaya Sowjanya; Vijay, Ajay Kumar; Tan, Jacqueline; Willcox, Mark

    2017-10-17

    To investigate characteristics of the eyelid margins, meibomian glands and the tear film of contact lens wearers, and to determine whether these characteristics were related to symptoms of contact lens discomfort. A cross sectional study was performed on thirty existing daily wear soft contact lens wearers (6 male; 24 female) with median age of 23 years (range 18-41). Eyelid signs and tear film characteristics were evaluated during a single visit and subjects completed the contact lens and dry eye questionnaire (CLDEQ-8) to evaluate ocular discomfort. Based on the CLDEQ-8 responses, subjects were classified as symptomatic (n=17) or asymptomatic (n=13). Grades of foam at meibomian gland orifices (3±1), expressibility (2±1) and quality of secretions (2±1), tear evaporation rate with (112±54g/m(2)/h) or without (88±45g/m(2)/h) contact lens wear, fluorescein tear breakup time (8±2 seconds) and tear lipid layer thickness (45±17nm) were significantly associated with symptoms of discomfort in symptomatic lens wearers only (r(2)>0.45; p value<0.05). Upper lid-wiper epitheliopathy, meibomian gland acini reflectivity and tear meniscus height showed significant correlations with comfort scores in both symptomatic and asymptomatic contact lens wearers (p<0.05). A greater number of Demodex mites was also observed in the upper eyelid of symptomatic lens wearers (2±1) compared to asymptomatic lens wearers (0±0; p value=0.042). Morphological irregularities of the meibomian glands and alterations to tear film secretions that affect tear evaporative dynamics were associated with symptoms of discomfort amongst the symptomatic lens wearers. Copyright © 2017 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

  11. The severe acute respiratory syndrome coronavirus in tears.

    Science.gov (United States)

    Loon, S-C; Teoh, S C B; Oon, L L E; Se-Thoe, S-Y; Ling, A-E; Leo, Y-S; Leong, H-N

    2004-07-01

    Severe acute respiratory syndrome (SARS) is a new infectious disease that caused a global outbreak in 2003. Research has shown that it is caused by a novel coronavirus. A series of cases is reported where polymerase chain reaction (PCR) testing on tears had demonstrated the presence of the virus. Detection of ocular infection from tears using the PCR technique has been widely used by ophthalmologists to diagnose infections for other viruses. This is a case series report from cases classified as probable or suspect SARS cases. Tear samples were collected from 36 consecutive patients who were suspected of having SARS in Singapore over a period of 12 days (7-18 April 2003), and analysed by PCR using protocols developed by the WHO network of laboratories. Three patients with probable SARS (one female and two male patients) had positive results from their tear samples. Tear samples were used to confirm SARS in the female patient, who was positive only from her tears. The positive specimens were found in cases sampled early in their course of infection. This is the first case series reported with the detection of the SARS coronavirus from tears, and has important implications for the practice of ophthalmology and medicine. The ability to detect and isolate the virus in the early phase of the disease may be an important diagnostic tool for future patients and tear sampling is both simple and easily repeatable. Many healthcare workers are in close proximity to the eyes of patients and this may be a source of spread among healthcare workers and inoculating patients. Ophthalmic practices may need to change as more stringent barrier methods, appropriate quarantine, and isolation measures are vital when managing patients with SARS.

  12. Predictive MRI correlates of lesser metatarsophalangeal joint plantar plate tear

    Energy Technology Data Exchange (ETDEWEB)

    Umans, Rachel L. [Cornell University Medical College, New York, NY (United States); Umans, Benjamin D. [Harvard University, Cambridge, MA (United States); Umans, Hilary [Albert Einstein College of Medicine, Bronx, NY (United States); Lenox Hill Radiology and Imaging Associates, New York, NY (United States); Elsinger, Elisabeth [Albert Einstein College of Medicine, Bronx, NY (United States); Montefiore Medical Center, Bronx, NY (United States)

    2016-07-15

    To identify correlated signs on non-enhanced MRI that might improve diagnostic detection of plantar plate (PP) tear. We performed an IRB-approved, HIPAA-compliant retrospective analysis of 100 non-contrast MRI (50 PP tear, 50 controls). All were anonymized, randomized, and reviewed; 20 were duplicated to assess consistency. One musculoskeletal radiologist evaluated qualitative variables. A trained non-physician performed measurements. Consistency and concordance were assessed. Pearson's Chi-square test was used to test the correlation between qualitative findings and PP tear status. Correlation between measurements and PP status was assessed using t tests and Wilcoxon's rank-sum test (p values < 0.05 considered significant). Classification and regression trees were utilized to identify attributes that, taken together, would consistently distinguish PP tear from controls. Quantitative measurements were highly reproducible (concordance 0.88-0.99). Elevated 2nd MT protrusion, lesser MT supination and rotational divergence of >45 between the 1st-2nd MT axis correlated with PP tear. Pericapsular soft tissue thickening correlated most strongly with PP tear, correctly classifying 95 % of cases and controls. Excluding pericapsular soft tissue thickening, sequential assessment of 2nd toe enthesitis, 2nd flexor tendon subluxation, and splaying of the second and third toes accurately classified PP status in 92 %. Pericapsular soft tissue thickening most strongly correlated with PP tear. For cases in which it might be difficult to distinguish pericapsular fibrosis from neuroma, sequential assessment of 2nd toe enthesitis, flexor tendon subluxation and splaying of the 2nd and 3rd toe is most helpful for optimizing accurate diagnosis of PP tear. (orig.)

  13. Human Tear Lipocalin Exhibits Antimicrobial Activity by Scavenging Microbial Siderophores

    OpenAIRE

    Fluckinger, Maria; Haas, Hubertus; Merschak, Petra; Glasgow, Ben J.; Redl, Bernhard

    2004-01-01

    Human tear lipocalin (TL; also known as Lcn1) is a secretory protein present in large amounts in fluids that cover epithelial surfaces such as tears and respiratory secretions. It is supposed to act as a physiological scavenger of hydrophobic, potentially harmful molecules, but there is evidence that it also inhibits bacterial growth. In the present study, we reconsidered the possibility that TL might interfere with microbial growth by scavenging of siderophores, as described for human neutro...

  14. ANAL INCONTINENCE AFTER UNRECOGNISED ANAL SPHINCTER TEAR AT VAGINAL DELIVERY

    Directory of Open Access Journals (Sweden)

    Mija Blaganje

    2018-02-01

    Full Text Available Background: Anal sphincter tears during vaginal delivery may result in serious sequel. Anal sphincter tears occur in approximately 2–19 % of all vaginal deliveries and are the most common precursor for faecal incontinence,1 however »occult« anal sphincter injury has been defined in 33 % of primiparous women following vaginal delivery.2 Methods: 31-year old primiparous woman received transfusion due to atony after delivery. Episiotomy, second degree perineal tear and vaginal tear were surgically corrected immediately after delivery. In the following days inability to control passing of liquid stools and flatulence together with stress urinary incontinence appeared. The complaint persisted. Ultrasound and EMG examination confirmed rupture of the external anal sphincter, which had been missed at delivery. Over a year after delivery the patient had a posterior colporraphy with surgical correction of external anal sphincter, which did not result in any clinical improve- ment. On follow-up ultrasound examination a hypoechoegenic area between the external sphincter and vaginal wall was detected. The patient was referred to The University Hos- pital in Graz, where the tear will be treated with autologous myoblast transplantation in a clinical trial. Conclusions: Treatment of a missed anal sphincter tear is complicated, expensive and unpleasant for the patient. Early detection with immediate appropriate surgical correction after delivery is most efficient, but it takes experience.

  15. Comparison of non-invasive tear film stability measurement techniques.

    Science.gov (United States)

    Wang, Michael Tm; Murphy, Paul J; Blades, Kenneth J; Craig, Jennifer P

    2018-01-01

    Measurement of tear film stability is commonly used to give an indication of tear film quality but a number of non-invasive techniques exists within the clinical setting. This study sought to compare three non-invasive tear film stability measurement techniques: instrument-mounted wide-field white light clinical interferometry, instrument-mounted keratoscopy and hand-held keratoscopy. Twenty-two subjects were recruited in a prospective, randomised, masked, cross-over study. Tear film break-up or thinning time was measured non-invasively by independent experienced examiners, with each of the three devices, in a randomised order, within an hour. Significant correlation was observed between instrument-mounted interferometric and keratoscopic measurements (p 0.05). Tear film stability values obtained from the hand-held device were significantly shorter and demonstrated narrower spread than the other two instruments (all p 0.05). Good clinical agreement exists between the instrument-mounted interferometric and keratoscopic measurements but not between the hand-held device and either of the instrument-mounted techniques. The results highlight the importance of specifying the instrument employed to record non-invasive tear film stability. © 2017 Optometry Australia.

  16. Fewer rotator cuff tears fifteen years after arthroscopic subacromial decompression.

    Science.gov (United States)

    Björnsson, Hanna; Norlin, Rolf; Knutsson, Anders; Adolfsson, Lars

    2010-01-01

    A successful clinical result is reported in 75% to 85% of impingement patients after arthroscopic subacromial decompression. The result is maintained over time, but few studies have investigated the integrity of the rotator cuff in these patients. Using ultrasonography, we examined the integrity of the rotator cuff in 70 patients 15 years after arthroscopic subacromial decompression. All patients had an intact rotator cuff at the index procedure. Tendons were still intact in 57 patients (82%), 10 (14%) had partial-thickness tears, and 3 (4%) had full-thickness tears. The total number of 18% tears (partial and full thickness) in this study, including patients clinically diagnosed with subacromial impingement at a mean age of 60 years, is unexpectedly low compared with 40% degenerative tears reported in asymptomatic adults of the same age. Arthroscopic subacromial decompression seems to reduce the prevalence of rotator cuff tears in impingement patients. This appears attributable to elimination of extrinsic factors such as mechanical wear and bursitis. The potential effect of surgery on intrinsic cuff degeneration is unknown, but intrinsic factors may explain tears still developing despite decompression. Level III, therapeutic study.

  17. Artificially modified collagen fibril orientation affects leather tear strength.

    Science.gov (United States)

    Kelly, Susyn J; Wells, Hannah C; Sizeland, Katie H; Kirby, Nigel; Edmonds, Richard L; Ryan, Tim; Hawley, Adrian; Mudie, Stephen; Haverkamp, Richard G

    2017-12-30

    Ovine leather has around half the tear strength of bovine leather and is therefore not suitable for high value applications such as shoes. Tear strength has been correlated with the natural collagen fibril alignment (orientation index, OI). It is hypothesized that it could be possible to artificially increase the OI of the collagen fibrils and that an artificial increase in OI could increase tear strength. Ovine skins, after the pickling and bating, were strained bi-axially during chrome tanning. The strain ranged from 2% to 15% of the initial sample length, either uniformly in both directions by 10% or with 3% in one direction and 15% in the other. Once tanned the leather tear strengths were measured and the collagen fibril orientation measured using synchrotron based small angle X-ray scattering. The OI increased as a result of strain during tanning, from 0.48 to 0.79 (P = 0.001), measured edge-on and the thickness normalized tear strength increased from 27 N/mm to 43 N/mm (P leather was strained 10% in two orthogonal directions. This is evidence to support a causal relationship between high OI (measured edge-on), highly influenced by thickness, and tear strength. It also provides a method to produce stronger leather. This article is protected by copyright. All rights reserved.

  18. Towards Multiscale Interactions Between Tearing Modes and Microturbulence

    Science.gov (United States)

    Williams, Z. R.; Pueschel, M. J.; Terry, P. W.

    2017-10-01

    Work on the Madison Symmetric Torus Reversed-Field Pinch (RFP) has shown that large-scale tearing modes present in standard operation are highly detrimental to confinement. These tearing modes, even when reduced in improved confinement regimes of operation, significantly affect zonal flow activity and play a large role in setting microturbulent-induced transport levels. Previous gyrokinetic work has shown that a small but finite tearing fluctuation amplitude is necessary to produce transport values in agreement with experimental observation. This has previously been implemented via an ad-hoc, constant-in-time A∥ perturbation. This work details self-consistent modeling of tearing fluctuations in the RFP using the Gene code via the inclusion of a current gradient drive incorporated into the background distribution function. Tearing mode growth rates calculated from gyrokinetic simulations are benchmarked with results from fluid theory. Additionally, first results from multiscale Gene simulations describing tearing mode interactions with RFP microturbulence are presented. This work is supported by the U.S. Department of Energy, Grant No. DE-FG02-85ER-53121.

  19. Meniscal Tear Film Fluid Dynamics Near Marx’s Line

    KAUST Repository

    Zubkov, V. S.

    2013-07-03

    Extensive studies have explored the dynamics of the ocular surface fluid, though theoretical investigations are typically limited to the use of the lubrication approximation, which is not guaranteed to be uniformly valid a-priori throughout the tear meniscus. However, resolving tear film behaviour within the meniscus and especially its apices is required to characterise the flow dynamics where the tear film is especially thin, and thus most susceptible to evaporatively induced hyperosmolarity and subsequent epithelial damage. Hence, we have explored the accuracy of the standard lubrication approximation for the tear film by explicit comparisons with the 2D Navier-Stokes model, considering both stationary and moving eyelids. Our results demonstrate that the lubrication model is qualitatively accurate except in the vicinity of the eyelids. In particular, and in contrast to lubrication theory, the solution of the full Navier-Stokes equations predict a distinct absence of fluid flow, and thus convective mixing in the region adjacent to the tear film contact line. These observations not only support emergent hypotheses concerning the formation of Marx\\'s line, a region of epithelial cell staining adjacent to the contact line on the eyelid, but also enhance our understanding of the pathophysiological consequences of the flow profile near the tear film contact line. © 2013 Society for Mathematical Biology.

  20. Risk factors for the need of hip arthroscopy following periacetabular osteotomy

    Science.gov (United States)

    Hartig-Andreasen, Charlotte; Troelsen, Anders; Thillemann, Theis M.; Gelineck, John; Søballe, Kjeld

    2015-01-01

    Despite the frequency of labral tears in symptomatic developmental dysplasia of the hip, no consensus exists regarding the treatment of coexisting dysplasia of the hip and tearing of the acetabular labrum. The purpose of this prospective, MR arthrography (MRA) based 2-year follow-up study was to identify risk factors predicting the need for a hip arthroscopy (HA) after periacetabular osteotomy (PAO). Ninety-nine patients (104 hips) scheduled for PAO were evaluated preoperatively and at 2-year follow-up. MRA was performed in all patients prior to PAO. At follow-up, patients were divided into a non-arthroscopy and arthroscopy group. The two groups were compared clinical and radiological, and risk factors for HA after PAO were calculated. Patient reported outcome measures (WOMAC, Oxford Hip and SF36) were filled out before PAO and at follow-up. Ninety-five hips (91.3%) were evaluated. Twenty-six hips (27%) required an arthroscopy within 2 years of the PAO. Risk factors were preoperative borderline dysplasia, acetabular retroversion and complete labral detachment. Labral tearing, degeneration or hypertrophy did not negatively affect the outcome of PAO. Patients not requiring an arthroscopy had a statistically significant better outcome measured by patients reported outcome measures. After PAO, 27% of the hips needed intra-articular assessment. Conventional radiographs and MRA analysis can be used to identify predictors for patients requiring HA after PAO. At 2-year follow-up, the clinical outcome improved in all patients. However, those patients who had no need of a HA after their PAO had superior results. PMID:27011862

  1. Biomechanical analysis of the acetabular buttress-plate: are complex acetabular fractures in the quadrilateral area stable after treatment with anterior construct plate-1/3 tube buttress plate fixation?

    Directory of Open Access Journals (Sweden)

    Yong-De Wu

    Full Text Available OBJECTIVE: The acetabular buttress-plate has been widely used in treating difficult cases with satisfying clinical results. However, the biomechanical properties of a postoperative acetabular fracture fixed by the buttress-plate are not clear. The purpose of this study was to evaluate the biomechanical properties of stability after the anterior tube buttress-plate fixation of complex acetabular fractures in the quadrilateral area. METHODS: A construct was proposed based on anterior construct plate - 1/3 tube buttress plate fixation for acetabular both-column fractures. Two groups of six formalin-preserved cadaveric pelvises were analyzed: (1 group A, the normal pelvis and (2 group B, anterior construct plate-1/3 tube buttress plate with quadrilateral area fixation. The displacements were measured, and cyclical loads were applied in both standing and sitting simulations. RESULTS: As the load was added, the displacements were A

  2. Conservative management of an elite ice hockey goaltender with femoroacetabular impingement (FAI): a case report.

    Science.gov (United States)

    MacIntyre, Kyle; Gomes, Brendan; MacKenzie, Steven; D'Angelo, Kevin

    2015-12-01

    To detail the presentation of an elite male ice hockey goaltender with cam-type femoroacetabular impingement (FAI) and acetabular labral tears. This case will outline the prevalence, clinical presentation, imaging criteria, pathomechanics, and management of FAI, with specific emphasis on the ice hockey goaltender. A 22-year old retired ice hockey goaltender presented to a chiropractor after being diagnosed by an orthopaedic surgeon with MRI confirmed left longitudinal and chondral flap acetabular labral tears and cam-type femoroacetabular impingement (FAI). As the patient was not a candidate for surgical intervention, a multimodal conservative treatment approach including manual therapy, electroacupuncture and rehabilitation exercises were implemented. FAI is prevalent in ice hockey players, particularly with goaltenders. Both skating and position-dependent hip joint mechanics involved in ice hockey may exacerbate or contribute to acquired and congenital forms of symptomatic FAI. As such, practitioners managing this population must address sport-specific demands in manual therapy, rehabilitation and physical training, to improve functional outcomes and prevent future injury.

  3. Deformation of the Zurich cementless acetabular cup caused by implantation in a canine cadaver model.

    Science.gov (United States)

    Panjeton, Geoffrey D; Kim, Stanley E; Chang, Kelvin; Palm, Lindsey S; Ifju, Peter G

    2017-04-01

    To evaluate the change in geometry of the Zurich total hip arthroplasty (THA) acetabular component after implantation. Hemipelves from adult mix-breed dogs weighing between 20 and 25 kg. Digital image correlation imaging was performed prior to, immediately after, and 24 hours after impaction of Zurich THA acetabular component, and after removal of the cup from the specimen. Patterns of deformation were qualitatively described, and maximal deformations were compared between time points. All cups deformed after implantation into the hemipelves by "pinching" in a cranial-caudal direction and dorsoventral expansion, resulting in an ellipsoid configuration to the peripheral rim. The mean ± SD maximum deformation at the rim immediately post-impaction was 0.202 ± 0.052 mm, or approximately 0.4 mm of diametrical deformation. Deformation did not change after the 24-hour saline bath. Impaction and subsequent extraction had a marginal effect on the original cup geometry, as maximum deformation at the rim after cup extraction was 0.074 ± 0.032 mm, relative to prior to impaction. The original Zurich cup geometry is distorted as a consequence of the press-fit mechanism. Further studies are required to determine whether deformation induced by impaction has any association with polyethylene wear rates or other prosthesis-related complications. © 2017 The American College of Veterinary Surgeons.

  4. A short buttress plate fixation of posterior column through single ilioinguinal approach for complex acetabular fractures.

    Science.gov (United States)

    Zhuang, Yan; Zhang, Kun; Wang, Hu; Wei, Xing; Liu, Ping; Wang, Peng-Fei; Cong, Yu-Xuan; Lei, Jin-Lai; Kandemir, Utku

    2017-01-01

    The goal of this study was to evaluate the safety and efficacy of a new technique for posterior column fixation through the standard ilioinguinal approach. We conducted a retrospective review involving 33 consecutive patients with complex acetabular fractures treated using a short buttress plate fixation of posterior column through single ilioinguinal approach. Radiographic evaluation was performed using criteria described by Matta. Functional outcome was assessed using modified Postel Merle D'Aubigné score. Between 2008 and 2013, 33 adult patients with mean age of 46 years and mean follow up of 37.5 months were enrolled. Anatomic reduction was obtained in 61 % of cases, imperfect reduction in 24 % of cases and poor reduction in 15 % of cases. The average modified Merle d'Aubigné score was 15: categorized as excellent in seven, good in 18, fair in three, and poor in four. One patient died at 15 days because of pulmonary embolism. Four patients sustained temporary lateral femoral cutaneous palsy. At final follow up, two patients had severe post-traumatic arthritis; one of them underwent a total hip arthroplasty at 93 months. None of the patients had loss of reduction. A short buttress plate fixation of posterior column through single ilioinguinal approach for complex acetabular fractures is a safe and effective method.

  5. Bone apposition of the acetabular rim in deep hips: a distinct finding of global pincer impingement.

    Science.gov (United States)

    Corten, Kristoff; Ganz, Reinhold; Chosa, Etsuo; Leunig, Michael

    2011-05-01

    Hips with coxa profunda can develop a pincer-type impingement with linear impact between the proximal part of the femur and the acetabulum, leading to bone apposition on the acetabular rim. Twenty hips with radiographic features of rim ossification were isolated from a pilot cohort of 220 patients for histologic assessment of the acetabular rim and the labrum. In the second part of the study, the prevalence of radiographic signs of bone apposition in a cohort of 148 hips treated for femoroacetabular impingement was assessed. Histologic analysis confirmed that the labrum may become displaced and replaced by the appositional bone formation. The double-line sign and the recess sign are suggestive of an ongoing process of this bone formation, and the described phenotypes of bone apposition indicate the site of the impingement problem. Morphological anomalies of the proximal part of the femur, such as a low neck-shaft angle or a short femoral neck, may further contribute to the mechanism of pincer impingement. In later stages, this bone formation cannot be distinguished from the native bone and the labrum may appear to be nearly absent on imaging studies. While the bone apposition on the rim is first reactive to chronic impingement, the impingement then increases and may lead to further bone apposition.

  6. Secure Screw Placement in Management of Acetabular Fractures Using the Suprapectineal Quadrilateral Buttress Plate

    Directory of Open Access Journals (Sweden)

    R. J. Egli

    2017-01-01

    Full Text Available Acetabular fractures involving predominantly the anterior column associated with a disruption of the quadrilateral surface can be treated with instrumentation implementing the stabilization of the quadrilateral surface. The recently introduced suprapectineal quadrilateral buttress plate is specifically designed to prevent secondary medial subluxation of the femoral head, especially in elderly patients with reduced ability for partial weight bearing. Whereas there are guidelines available for safe screw fixation for the anterior and posterior columns, there might be a concern for intra-articular placement of screws placed through the infrapectineal part of the quadrilateral buttress plate. Within this report we analyzed retrospectively screw placement in 30 plates in postoperative CT scans using algorithms for metal artifact reduction. None of the screws of the buttress plate penetrated the hip joint. We describe the placement, length, and spatial orientation of the screws used for fracture fixation and suggest that the use of intraoperative image intensifiers with a combined inlet-obturator view of 30–45° best projects the screws and the hip joint. Preoperative knowledge of approximate screw placement and information for accurate intraoperative imaging may contribute to safe acetabular fracture fixation and may reduce operating time and limit radiation exposure to the patient and the personnel. This trial is registered with KEK-BE: 266/2014.

  7. Secure Screw Placement in Management of Acetabular Fractures Using the Suprapectineal Quadrilateral Buttress Plate.

    Science.gov (United States)

    Egli, R J; Keel, M J B; Cullmann, J L; Bastian, J D

    2017-01-01

    Acetabular fractures involving predominantly the anterior column associated with a disruption of the quadrilateral surface can be treated with instrumentation implementing the stabilization of the quadrilateral surface. The recently introduced suprapectineal quadrilateral buttress plate is specifically designed to prevent secondary medial subluxation of the femoral head, especially in elderly patients with reduced ability for partial weight bearing. Whereas there are guidelines available for safe screw fixation for the anterior and posterior columns, there might be a concern for intra-articular placement of screws placed through the infrapectineal part of the quadrilateral buttress plate. Within this report we analyzed retrospectively screw placement in 30 plates in postoperative CT scans using algorithms for metal artifact reduction. None of the screws of the buttress plate penetrated the hip joint. We describe the placement, length, and spatial orientation of the screws used for fracture fixation and suggest that the use of intraoperative image intensifiers with a combined inlet-obturator view of 30-45° best projects the screws and the hip joint. Preoperative knowledge of approximate screw placement and information for accurate intraoperative imaging may contribute to safe acetabular fracture fixation and may reduce operating time and limit radiation exposure to the patient and the personnel. This trial is registered with KEK-BE: 266/2014.

  8. 3D Printing Aids Acetabular Reconstruction in Complex Revision Hip Arthroplasty

    Directory of Open Access Journals (Sweden)

    Andrew J. Hughes

    2017-01-01

    Full Text Available Revision hip arthroplasty requires comprehensive appreciation of abnormal bony anatomy. Advances in radiology and manufacturing technology have made three-dimensional (3D representation of osseous anatomy obtainable, which provide visual and tactile feedback. Such life-size 3D models were manufactured from computed tomography scans of three hip joints in two patients. The first patient had undergone multiple previous hip arthroplasties for bilateral hip infections, resulting in right-sided pelvic discontinuity and a severe left-sided posterosuperior acetabular deficiency. The second patient had a first-stage revision for infection and recurrent dislocations. Specific metal reduction protocols were used to reduce artefact. The images were imported into Materialise MIMICS 14.12®. The models were manufactured using selective laser sintering. Accurate templating was performed preoperatively. Acetabular cup, augment, buttress, and cage sizes were trialled using the models, before being adjusted, and resterilised, enhancing the preoperative decision-making process. Screw trajectory simulation was carried out, reducing the risk of neurovascular injury. With 3D printing technology, complex pelvic deformities were better evaluated and treated with improved precision. Life-size models allowed accurate surgical simulation, thus improving anatomical appreciation and preoperative planning. The accuracy and cost-effectiveness of the technique should prove invaluable as a tool to aid clinical practice.

  9. Fretting and Corrosion at the Backside of Modular Cobalt Chromium Acetabular Inserts: A Retrieval Analysis.

    Science.gov (United States)

    Tarity, T David; Koch, Chelsea N; Burket, Jayme C; Wright, Timothy M; Westrich, Geoffrey H

    2017-03-01

    Adverse local tissue reaction formation has been suggested to occur with the Modular Dual Mobility (MDM) acetabular design. Few reports in the literature have evaluated fretting and corrosion damage between the acetabular shell and modular metal inserts in this modular system. We evaluated a series of 18 retrieved cobalt chromium MDM inserts for evidence of fretting and corrosion. We assessed the backsides of 18 MDM components for evidence of fretting and corrosion in polar and taper regions based on previously established methods. We collected and assessed 30 similarly designed modular inserts retrieved from metal-on-metal (MoM) total hip arthroplasties as a control. No specific pattern of fretting or corrosion was identified on the MDM inserts. Both fretting and corrosion were significantly greater in the MoM cohort than the MDM cohort, driven by higher fretting and corrosion scores in the engaged taper region of the MoM inserts. MoM components demonstrated more fretting and corrosion than MDM designs, specifically at the taper region, likely driven by differences in the taper engagement mechanism and geometry among the insert designs. The lack of significant fretting and corrosion observed in the MDM inserts are inconsistent with recent claims that this interface may produce clinically significant metallosis and adverse local tissue reactions. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Finite element analysis of acetabular fractures--development and validation with a synthetic pelvis.

    Science.gov (United States)

    Shim, Vickie; Böhme, Jörg; Vaitl, Peter; Klima, Stefan; Josten, Christoph; Anderson, Iain

    2010-05-28

    Acetabular fracture presents a challenging situation to trauma surgeons today due to its complexity. Finite element (FE) models can be of great help as they can improve the surgical planning and post surgery patient management for those with acetabular fractures. We have developed a non-linear finite element model of the pelvis and validated its fracture prediction capability with synthetic polyurethane pelves. A mechanical experiment was performed with the synthetic bones and fracture loads and patterns were observed for two different loading cases. Fracture loads predicted by our FE model were within one standard deviation of the experimental fracture loads for both loading cases. The incipient fracture pattern predicted by the model also resembled the actual pattern from the experiment. Although it is not a complete validation with human cadaver bones, the good agreement between model predictions and experimental results indicate the validity of our approach in using non-linear FE formulation along with contact conditions in predicting bone fractures. Copyright 2010 Elsevier Ltd. All rights reserved.

  11. Posterior acetabular column and quadrilateral plate fractures: fixation with tension band principles.

    Science.gov (United States)

    Aly, Tarek A; Hamed, Hany

    2013-07-01

    Acetabular fractures can be classified into 5 simple and 5 associated fracture patterns. A significant amount of variation and complexity exists in these fractures patterns. Fractures of the posterior wall are the most common acetabular fractures. Comminution of the quadrilateral plate adds to fracture instability, and more rigid and stable internal fixation is mandatory. The goal of this study was to assess the results of reconstruction of comminuted posterior wall fractures of the acetabulum associated with quadrilateral plate fractures using the tension band technique. Twelve patients (9 men and 3 women) were included in the study. Mean patient age was 38.6 years (range, 24-47 years). Minimum follow-up was more than 2 years postoperatively. Reconstruction of the fracture included anatomic reduction of the fracture and fixation with a buttress plate for the posterior column and a prebent one-third tubular plate for the quadrilateral plate fracture. Clinical results were excellent in 58% of patients and good in 17% of patients. Radiologic results were excellent in 50% of patients and good in 17% of patients. Radiologically, based on the fracture gap postoperatively, 8 (66%) patients showed anatomic reduction, 2 (17%) showed good reduction, and 2 (17%) showed poor reduction. The study confirms that this method of reconstruction facilitates accurate and firm reduction of displaced posterior wall fractures of the acetabulum. Copyright 2013, SLACK Incorporated.

  12. Percutaneous Fixation of Anterior Column Acetabular Fracture in a Renal Transplant Recipient

    Directory of Open Access Journals (Sweden)

    Halil Ceylan

    2013-01-01

    Full Text Available Renal transplantation, performed per million population, ranges from 30 to 60 in developed countries. The transplanted kidney is generally placed in iliac fossa; therefore the treatment procedure of the pelvic trauma in these patients should be selected carefully. The gold standard technique for the treatment of displaced acetabulum fractures is open reduction and internal fixation. Our patient had received a living-related-donor renal transplant due to chronic renal failure. In the second year of transplantation, she had been injured in a motor-vehicle accident, and radiographs showed a right acetabular anterior column fracture and left pubic rami fractures. The patient was treated with percutaneous fixation techniques and at one year of postoperative period there was no evidence of degenerative signs and the clinical outcome was good. Beside having the advantage of avoiding dissection through the iliac fossa by the standard ilioinguinal approach, percutaneous techniques, with shorter surgical time, decreasing soft tissue disruption, and the potential for early discharge from hospital might be ideal for a renal transplant recipient carrying a higher risk of infection. Percutaneous fixation of selected acetabular fractures in a renal transplant recipient would presumably have the potential to decrease the morbidity associated with traditional open surgical procedures.

  13. Reproducibility of Acetabular Landmarks and a Standardized Coordinate System Obtained from 3D Hip Ultrasound.

    Science.gov (United States)

    Mabee, Myles; Dulai, Sukhdeep; Thompson, Richard B; Jaremko, Jacob L

    2015-10-01

    Two-dimensional (2D) ultrasound detection of developmental dysplasia of the hip (DDH) is limited by variation in acetabular appearance and alpha angle measurements, which change with position of the ultrasound probe. Three-dimensional (3D) ultrasound captures the entire acetabular shape, and a reproducible "standard central plane" may be generated, from two landmarks located on opposite ends of the acetabulum, for measurement of alpha angle and other indices. Two users identified landmarks on 51 3D ultrasounds, with ranging severity of disease, and inter- and intra-observer reproducibility of landmark and "standard plane" locations was compared; landmarks were chosen within 2 mm, and the "standard plane" rotation was reproducible within 10° between observers. We observed no difference in variability between alpha angles measured on the "standard plane" in comparison with 2D ultrasound. Applications of the standardized 3D ultrasound central plane will be to fuse serial ultrasounds for follow-up and development of new indices of 3D deformity. © The Author(s) 2014.

  14. Effectiveness of Combined Tear Film Therapy in Patients with Evaporative Dry Eye with Short Tear Film Breakup Time.

    Science.gov (United States)

    Kim, Yung Hui; Kang, Yeon Soo; Lee, Hyo Seok; Choi, Won; You, In Cheon; Yoon, Kyung Chul

    2017-10-01

    The aim of this study was to evaluate the effectiveness of combined tear film therapy targeted to aqueous, mucin, and lipid layers in patients with refractory evaporative dry eye (EDE) with short tear film breakup time (TBUT). The patients who had EDE with short TBUT and severe symptoms refractory to artificial tears were treated with hyaluronic acid (HA) 0.15% and diquafosol tetrasodium (DQS) 3% (Group 1), HA and carbomer-based lipid-containing eyedrops (Liposic EDO Gel, LPO) (Group 2), or HA, DQS, and LPO (Group 3). Ocular Surface Disease Index (OSDI) score, visual analog scale (VAS) symptom score, TBUT, Schirmer score, and corneal and conjunctival staining scores were evaluated, and noninvasive tear film breakup time (NIBUT) and tear meniscus height were measured using Keratograph ® 5 M before and 1 and 3 months after treatment. OSDI scores, VAS scores, TBUT, and NIBUT were improved at 1 and 3 months after treatment in all groups (all P film layers was most effective in improving ocular symptoms and tear film quality.

  15. Comparative study of lubricating properties of tear substitutes Systane® Ultra and Visine® Clear Tears

    Directory of Open Access Journals (Sweden)

    Yu. A. Pavlova

    2014-07-01

    Full Text Available Purpose: To compare tear substitutive properties of Systane® Ultra and Visine® Clear Tears in dry eye therapy.Methods: 20 patients with dry eye due to chronic blepharoconjunctivitis and 20 patients with neurotrophic dry eye following corneal refractive surgery were examined. Treatment schedule was the following: in the first 7 days, Systane® Ultra was instilled in the right eye and Visine® Clear Tears was instilled in the left eye, while from day 8 to day 30, only one medicine selected by the patient was applied. Their efficacy was measured by tear film stability and patients’ subjective sensations.Results: Norn test results improved to day 7 in patients with dry eye following corneal refractive surgery and to day 30 in patients with dry eye due to blepharoconjunctivitis regardless of eye drops used. As to patients’ comfort, Systane® Ultra is preferable to Visine® Clear Tears.Conclusion: Systane® Ultra is therapeutically similar to but preferable to Visine® Clear Tears due to good tolerability.

  16. Cost-effectiveness analysis of the diagnosis of meniscus tears.

    Science.gov (United States)

    Mather, Richard C; Garrett, William E; Cole, Brian J; Hussey, Kristen; Bolognesi, Michael P; Lassiter, Tally; Orlando, Lori A

    2015-01-01

    Diagnostic imaging represents the fastest growing segment of costs in the US health system. This study investigated the cost-effectiveness of alternative diagnostic approaches to meniscus tears of the knee, a highly prevalent disease that traditionally relies on MRI as part of the diagnostic strategy. To identify the most efficient strategy for the diagnosis of meniscus tears. Economic and decision analysis; Level of evidence, 1. A simple-decision model run as a cost-utility analysis was constructed to assess the value added by MRI in various combinations with patient history and physical examination (H&P). The model examined traumatic and degenerative tears in 2 distinct settings: primary care and orthopaedic sports medicine clinic. Strategies were compared using the incremental cost-effectiveness ratio (ICER). In both practice settings, H&P alone was widely preferred for degenerative meniscus tears. Performing MRI to confirm a positive H&P was preferred for traumatic tears in both practice settings, with a willingness to pay of less than US$50,000 per quality-adjusted life-year. Performing an MRI for all patients was not preferred in any reasonable clinical scenario. The prevalence of a meniscus tear in a clinician's patient population was influential. For traumatic tears, MRI to confirm a positive H&P was preferred when prevalence was less than 46.7%, with H&P preferred above that. For degenerative tears, H&P was preferred until the prevalence reaches 74.2%, and then MRI to confirm a negative was the preferred strategy. In both settings, MRI to confirm positive physical examination led to more than a 10-fold lower rate of unnecessary surgeries than did any other strategy, while MRI to confirm negative physical examination led to a 2.08 and 2.26 higher rate than H&P alone in primary care and orthopaedic clinics, respectively. For all practitioners, H&P is the preferred strategy for the suspected degenerative meniscus tear. An MRI to confirm a positive H&P is

  17. Precision of radiostereometric analysis (RSA) of acetabular cup stability and polyethylene wear improved by adding tantalum beads to the liner

    DEFF Research Database (Denmark)

    Nebergall, Audrey K; Rader, Kevin; Palm, Henrik

    2015-01-01

    Background and purpose - In traditional radiostereometric analysis (RSA), 1 segment defines both the acetabular shell and the polyethylene liner. However, inserting beads into the polyethylene liner permits employment of the shell and liner as 2 separate segments, enabling distinct analysis of th...

  18. Uncemented metal-on-metal acetabular component: follow-up of 112 hips for a minimum of 5 years.

    Science.gov (United States)

    Vassan, Uma T; Sharma, Sanjeev; Chowdary, Koganti P; Bhamra, Manjit S

    2007-08-01

    Aseptic loosening is the major cause of implant failure. In cemented hip arthroplasty, failure of the acetabular side is mainly due to lysis caused by wear particles. By using an implant with low wear characteristics and by enhancing acetabular fixation using an uncemented implant, we aimed to reduce acetabular lysis and thereby loosening. This was a retrospective cohort study of 119 hips (101 patients) that had the Uncemented Fitmore cup (Sulzer Orthopedics). In 66 patients, the femoral component was CF-30 (Sulzer) used with cement. In the remaining 35 patients, thrust plate prosthesis (TPP) (Sulzer) was used. Of the 101 patients, 94 (112 hips) were available for study. Mean follow-up of the 94 patients was 7 (5-13) years. The mean preoperative Harris hip score was 38 and the mean postoperative Harris hip score was 89 at the last follow-up. Taking aseptic loosening as the endpoint, the survival rate of the Fitmore cup was 100% at 11 years. The uncemented Fitmore acetabular cup with second generation metal-on-metal articulation showed good results with regard to aseptic loosening in the medium term.

  19. T2* relaxation time of acetabular and femoral cartilage with and without intraarticular gadopentetate dimeglumine in patients with femoroacetabular impingement.

    Science.gov (United States)

    Nissi, Mikko J; Mortazavi, Shabnam; Hughes, John; Morgan, Patrick; Ellermann, Jutta

    2015-06-01

    The purpose of this study was to assess whether the presence of intraarticular gadopentetate dimeglumine during clinical MR arthrography significantly alters the T2* relaxation time of hip articular cartilage in patients with femoroacetabular impingement. T2* mapping of 10 patient volunteers (seven female patients, three male patients; age range, 14-49 years; mean, 33.0 ± 12.2 [SD] years) with symptomatic femoroacetabular impingement was performed before and after intraarticular administration of gadopentetate dimeglumine. Overall 323 ROIs were defined in each acetabular and femoral cartilage before and after gadolinium injection. Agreement of the T2* relaxation times before and after gadolinium injection was assessed with the Krippendorff alpha coefficient and linear regression through the origin. T2* relaxation times before and after gadolinium injection in both acetabular and femoral cartilage were found to agree strongly. Specifically, estimated Krippendorff alpha values were greater than 0.8 for both acetabular and femoral cartilage, linear regressions through the origin yielded estimated slopes very close to 1, and R(2) values were greater than 0.98. The results indicate that intraarticular injection of gadopentetate dimeglumine according to the protocol described in this study has little effect on the T2* of femoral and acetabular cartilage. The results suggest that T2* mapping can be safely performed as an addition to a standard clinical hip imaging protocol that includes gadopentetate dimeglumine administration.

  20. Three-dimensional printing model improves morphological understanding in acetabular fracture learning: A multicenter, randomized, controlled study.

    Directory of Open Access Journals (Sweden)

    Zhenfei Huang

    Full Text Available Conventional education results in unsatisfactory morphological understanding of acetabular fractures due to lack of three-dimensional (3D details and tactile feedback of real fractures. Virtual reality (VR and 3D printing (3DP techniques are widely applied in teaching. The purpose of this study was to identify the effect of physical model (PM, VR and 3DP models in education of morphological understanding of acetabular fractures. 141 students were invited to participate in this study. Participants were equally and randomly assigned to the PM, VR and 3DP learning groups. Three-level objective tests were conducted to evaluate learning, including identifying anatomical landmarks, describing fracture lines, identifying classification, and inferring fracture mechanism. Four subjective questions were asked to evaluate the usability and value of instructional materials. Generally, the 3DP group showed a clear advantage over the PM and VR groups in objective tests, while there was no significant difference between the PM and VR groups. 3DP was considered to be the most valuable learning tool for understanding acetabular fractures. The findings demonstrate that 3DP modelling of real fractures is an effective learning instrument that can be used to understand the morphology of acetabular fractures and promote subjective interest.

  1. External iliac artery thrombosis associated with the ilio-inguinal approach in the management of acetabular fractures: a case report

    Directory of Open Access Journals (Sweden)

    Klos Kajetan

    2008-01-01

    Full Text Available Abstract Introduction The ilio-inguinal approach has come to be used routinely in the management of acetabular fractures involving the anterior wall. Thrombotic complications following surgery via this route are a serious, but rare, complication. Case presentation We report the case of a 66-year-old male patient who slipped on an icy pavement and fell on his left hip. He sustained a comminuted acetabular fracture (a transtectal T-fracture with an incomplete posterior stem through the ischial tuberosity, and was operated on five days later, via an ilio-inguinal approach. In the recovery room, his left lower limb was found to be cool and pale. Immediate re-exploration showed a left external iliac artery thrombosis, and thrombectomy was performed. In the surgical management of acetabular fractures, thrombosis of a major pelvic artery is a rare but potentially devastating complication. We discuss the possible aetiology (initial vessel trauma versus iatrogenic, intraoperative arterial injury and pathomechanism, and wish to draw attention to this complication and to recommend ways in which it can be prevented. Conclusion We recommend circulation monitoring in patients with acetabular fractures, especially where nerve blocks and/or deep sedation/analgesia have been used. High-risk patients should be identified and subjected to intensive preoperative screening, including ultrasonography and if necessary angiography.

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

    Directory of Open Access Journals (Sweden)

    Cem Copuroglu

    2011-01-01

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

  3. The design, production and clinical application of 3D patient-specific implants with drilling guides for acetabular surgery

    NARCIS (Netherlands)

    Merema, B. J.; Kraeima, J.; ten Duis, K.; Wendt, K. W.; Warta, R.; Vos, E.; Schepers, R. H.; Witjes, M. J. H.; IJpma, F. F. A.

    2017-01-01

    An innovative procedure for the development of 3D patient-specific implants with drilling guides for acetabular fracture surgery is presented. By using CT data and 3D surgical planning software, a virtual model of the fractured pelvis was created. During this process the fracture was virtually

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

    Science.gov (United States)

    Eckardt, Henrik; Lind, Dennis; Toendevold, Erik

    2015-01-01

    Background and purpose — During acetabular fracture surgery, the acetabular roof is difficult to visualize with 2-dimensional fluoroscopic views. We assessed whether intraoperative 3-dimensional (3D) imaging can aid the surgeon to achieve better articular reduction and improve implant fixation. Patients and methods — We operated on 72 acetabular fractures using intraoperative 3D imaging and compared the operative results, duration of surgery, and complications with those for 42 consecutive acetabular fracture operations conducted using conventional fluoroscopic imaging. Postoperative reduction was evaluated on reconstructed coronal and sagittal images of the acetabulum. Results — The fracture severity and patient characteristics were similar in the 2 groups. In the 3D group, 46 of 72 patients (0.6) had a perfect result after open reduction and internal fixation, and in the control group, 17 of 42 (0.4) had a perfect result. The mean difference in postoperative articular incongruity was 0.5 mm (95% CI: 0.4–0.7). In 29 of 72 operations, the intraoperative 3D scans led to intraoperative correction of the reduction and an improved result. The duration of surgery and infection rate were similar in the 2 groups. Interpretation — Intraoperative 3D imaging, which is not time-consuming, allowed the surgeon to correct malreductions and screw placement in 29 of 72 operations, leading to better articular reduction and more precise screw placement than in operations where conventional fluoroscopic imaging was used to control the reduction. PMID:26012545

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

    Science.gov (United States)

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

    2013-12-26

    Heterotopic ossification is a common postoperative complication of acetabular fracture. However, functionally significant heterotopic ossification with associated late bone defects in the posterior wall of the acetabulum is rare and challenging to treat. When heterotopic ossification is a late complication of failed acetabular fracture operation, it is disabling and may only be treated by THA. THA is highly susceptible to premature failure in young and active patients and may require numerous revisions. This article describes a 40-year-old man with massive heterotopic ossification associated with late bone defects in the posterior wall of the acetabulum after a failed acetabular fracture operation. The primary fracture type was a 62-A2.3 fracture according to the AO/OTA Classification.Surgical excision and anatomical reconstruction of the acetabular wall using heterotopic ossific bone were performed 10 months after the fracture repair. Postoperatively, indomethacin was administered for prophylaxis against recurrence of heterotopic ossification, and hip range of motion was progressively increased. At 5 years and 6 months follow-up, the patient's pain was relieved and hip function had recovered. Though radiography and CT showed minimal subchondral cysts and mild joint-space narrowing, there was no evidence of graft resorption, progressive posttraumatic osteoarthritis or necrosis of the femoral head. To the authors' knowledge, this is the first case of such a challenging condition. Although it is an extremely rare case, it provides an attractive option for avoiding THA, as the long-term follow-up shows a satisfactory outcome.

  6. Pipkin type III femoral head fracture-dislocation combined with complicated acetabular fracture: A rare case report and literature review.

    Science.gov (United States)

    Zhao, Bei; Li, Hao; Yan, Jun; Han, Li-Ren; Yang, Xiao-Fei

    2017-12-01

    Pipkin III fracture, which is characterized by high risk of avascular necrosis of the femoral head, is extremely rare. It is more difficult to treat and has a worse prognosis when accompanied with severe acetabular fractures. Few studies show that both Pipkin type III femoral head fracture-dislocation and complicated acetabular fracture presented in one patient. A 34-year-old male suffered a terrible traffic accident with a serious damage to the left side when he was sitting in the car's cockpit. Pelvic radiograph and 3-dimensional reconstruction of computed tomography revealed characteristics of fractures before the emergency operation. Pipkin III fractures combined with complicated acetabular fracture. Firstly, we used combined anterior and posterior approach for treatment to fix the femoral head fractures. Then, we completed anatomical reduction of fractures with countersunk head screw, hollow screw, and reconstruction plate. At the 12-months follow-up, the patient could walk freely and perform activities of daily living without necrosis of femoral head and heterotopic ossification. Although there are serious complications in Pipkin III fractures combined with complicated acetabular fracture, early surgical treatment with appropriate approach and fixation could get satisfactory results. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

  7. Glycan involvement in the adhesion of Pseudomonas aeruginosa to tears.

    Science.gov (United States)

    Kautto, Liisa; Nguyen-Khuong, Terry; Everest-Dass, Arun; Leong, Andrea; Zhao, Zhenjun; Willcox, Mark D P; Packer, Nicolle H; Peterson, Robyn

    2016-04-01

    The human eye is constantly bathed by tears, which protect the ocular surface via a variety of mechanisms. The O-linked glycans of tear mucins have long been considered to play a role in binding to pathogens and facilitating their removal in the tear flow. Other conjugated glycans in tears could similarly contribute to pathogen binding and removal but have received less attention. In the work presented here we assessed the contribution of glycan moieties, in particular the protein attached N-glycans, presented by the broad complement of tear proteins to the adhesion of the opportunistic pathogen Pseudomonas aeruginosa, a leading cause of microbial keratitis and ulceration of the cornea. Our adhesion assay involved immobilising the macromolecular components of tears into the wells of a polyvinyl difluoride (PVDF) microtitre filter plate and probing the binding of fluorescently labelled bacteria. Three P. aeruginosa strains were studied: a cytotoxic strain (6206) and an invasive strain (6294) from eye infections, and an invasive strain (320) from a urinary tract infection (UTI). The ocular isolates adhered two to three times more to human tears than to human saliva or porcine gastric mucin, suggesting ocular niche-specific adaptation. Support for the role of the N-glycans carried by human tear proteins in the binding and removal of P. aeruginosa from the eye was shown by: 1) pre-incubation of the bacteria with free component sugars, galactose, mannose, fucose and sialyl lactose (or combination thereof) inhibiting adhesion of all the P. aeruginosa strains to the immobilised tear proteins, with the greatest inhibition of binding of the ocular cytotoxic 6206 and least for the invasive 6294 strain; 2) pre-incubation of the bacteria with N-glycans released from the commercially available human milk lactoferrin, an abundant protein that carries N-linked glycans in tears, inhibiting the adhesion to tears of the ocular bacteria by up to 70%, which was significantly more

  8. Can experts in acetabular fracture care determine hip stability after posterior wall fractures using plain radiographs and computed tomography?

    Science.gov (United States)

    Davis, Adrian T; Moed, Berton R

    2013-10-01

    Hip stability status after a posterior wall acetabular fracture involving 20%-50% of the posterior wall is difficult to determine. However, noted experts have professed that hip stability can be accurately determined by careful review of high-quality anteroposterior and oblique plain radiographs and a computed tomography scan. The objective of this investigation was to evaluate the interobserver and intraobserver reliabilities and accuracies in determining hip stability status by fellowship-trained orthopedic traumatologists expert in acetabular fracture care using these studies. Reliability and validation study. Level 1 trauma center. Fifteen patients with isolated unilateral posterior wall (OTA 62-A1) acetabular fractures involving 20%-50% of the posterior acetabular wall and known clinical outcome had undergone dynamic stress fluoroscopy under anesthesia to determine hip stability. High-quality anteroposterior and oblique plain radiographs and axial computed tomography images of 15 fractures involving 20%-50% of the posterior acetabular wall were reviewed in random order by 4 fellowship-trained orthopedic traumatologists specializing in acetabular fracture care in 2 separate sessions. The second session occurred after a minimum 1-month washout period. Determination of hip stability status was made for each fracture at the 2 time points based on the images along with any history of dislocation of the hip at the time of injury. These determinations were compared with the findings of examination under anesthesia, which served as the gold standard. Measurement of agreement using the Kappa statistic. Although intraobserver reliability was good (0.65), interobserver reliability was poor (0.12). In addition, percent correct was only 53% (32/60) for the initial reading and only 52% (31/60) for the second. For the initial reading, sensitivity and specificity were 100% (28/28) and 13% (4/32), respectively. For the second reading, the sensitivity and specificity were 57

  9. Anterior Combined Endopelvic (ACE) approach for the treatment of acetabular and pelvic ring fractures: A new proposal.

    Science.gov (United States)

    Rocca, G; Spina, M; Mazzi, M

    2014-12-01

    We present our experience of using the Anterior Combined Endopelvic (ACE) approach, which consists of a combination of a newly modified Stoppa approach with the lateral approach to the iliac crest. This approach is discussed in terms of fracture reduction and fixation, technical aspects, and the incidence of complications, and as an alternative to the ilioinguinal approach for the treatment of acetabular fractures. A consecutive group of 34 adult patients with acetabular fractures treated surgically with the ACE approach was compared with a group of 42 adult patients treated with the ilioinguinal approach between 2010 and 2013. Both approaches were performed by a single surgeon to fix the acetabular fractures with main anterior displacement and the anterior and lateral parts of the pelvis. All the patients were analysed with typical X-ray projections for acetabular fractures and CT-scan. Charts and radiographs were reviewed for fracture pattern. Operative time, blood loss, quality of reduction, functional outcomes and perioperative complications were compared between the two groups of patients. The mean follow-up of patients was 26 months (range 6-49 months), with a median of 24.5 months. The types of acetabular fraction in the study were as follows: 32 anterior and posterior columns, 18 anterior columns, 10 anterior columns with posterior hemitransverse, 10 transverse associated with posterior walls, two transverse; two T-Type transverse and two anterior walls. Average blood loss was 1090 mL in the ACE group and 1200 mL in the ilioinguinal group. Anatomic or satisfactory reduction was achieved in 94% of the acetabular fractures. Two patients (one in each group) had mild symptoms of the lateral femoral cutaneous nerve and improved within 4-6 months; one patient in the ilioinguinal group developed ossification Brooks grade III. The ACE approach for the treatment of acetabular fractures is highly recommended when the fracture involves the quadrilateral surface and

  10. Lacritin Level in Tear Film of Rheumatoid Arthritis Patients

    Directory of Open Access Journals (Sweden)

    Rana Sorkhabi

    2013-12-01

    Full Text Available Purpose: The main ocular manifestation of rheumatoid arthritis is dry eye. Lacritin is a secreted glycoprotein of tear and when applied topically in rabbits, it increased the volume of basal tear secretion. So the aim of this study was to compare Lacritin level in rheumatoid arthritis (RA and control group. Methods: This cross-sectional study was done on 40 patients with RA and 48 healthy subjects as a control group. In all participants, tear break-up time (TBUT and Schirmer test with anesthesia were accomplished. Tear samples were collected directly from the inferior lateral tear meniscus and were immediately stored at -80° C until use. Lacritin level of tears were assessed by enzyme- linked immunosorbent assay. Results: The mean age of participants was 44.7±16.3 and 43.3±18 years, respectively (p=0.70. Lacritin level in RA group (19.6±23.1 ng/ml was significantly lower (31.9±23.3 ng/ml than control (p=0.008. Pearson correlation between Lacritin level and TBUT, Schirmer value, ESR, and high-sensitivity C-creative protein (hs-CRP in RA patients were not significant with p=0.27, 0.67, 0.09 and 0.07 accordingly. Conclusion: In early stages of RA in spite of normal tear production, Lacritin level decreased, however there is not any correlation between Lacritin level and TBUT, Schirmer value, ESR, and hs-CRP in these patients.

  11. Nonlinear Stability and Evolution of Drift-Tearing Modes

    Science.gov (United States)

    Scott, Bruce Douglas

    The question of the nonlinear stability and subsequent evolution of drift-tearing modes in tokamak-like environments is considered. The tearing mode and the drift physics are introduced, and a brief review of previous work given. A set of reduced equations for the drift-tearing mode is derived from two-fluid magnetohydrodynamics. The equations are specialised for small, nonlinear magnetic islands in slab geometry. These are used to scrutinise the results of linear stability theory in light of nonlinear physics arising from the effect of the mode on the equilibrium density and temperature profiles. It is shown that linearly growing drift-tearing modes are rendered stable at a very small island width by quasilinear thermal effects. However, both linearly and quasilinearly stabilised modes grow to large amplitude if the initial island width is larger than the linear tearing layer, demonstrating the importance of nonlinear considerations in predictions of stability. Having concluded that drift-tearing modes will in fact be seen in present and near-future thermal regimes, their evolution is addressed. Observations of rotating m = 2 magnetic fluctuations in tokamak discharges are often attributed to diamagnetically propagating drift-tearing modes. It is shown, however, that this propagation ceases at small island width as the local density profile is flattened by sound waves. The critical width for density flattening is small compared to island widths typically inferred from the observed fluctuations. The rotation of these fluctuations must therefore result from radial electric fields, implying that observed rotation rates can be used as a local diagnostic for these fields.

  12. Subnormal Cytokine Profile in the Tear Fluid of Keratoconus Patients

    Science.gov (United States)

    Jun, Albert S.; Cope, Leslie; Speck, Caroline; Feng, Xiaojun; Lee, Seakwoo; Meng, Huan; Hamad, Abdel; Chakravarti, Shukti

    2011-01-01

    Keratoconus, historically viewed as a non-inflammatory disease, is an ectatic corneal disorder associated with progressive thinning of the corneal stroma. Recently, a few inflammatory mediators have been reported to be elevated in the tear fluid of keratoconus patients. Consequently, we investigated a wide range of inflammation regulating cytokines in the tears and sera of keratoconus and control subjects. Interleukin (IL)-1β, IL-4, IL-6, IL-10, IL-12, IL-13, IL-17, interferon (IFN)-γ, chemokine C-C motif ligand 5 (CCL5) and tumor necrosis factor (TNF)-α were tested in tear samples and sera of keratoconus and control individuals by multiplex immuno-bead assays. Selected cytokines were further tested by standard ELISA on pooled tear samples. All cytokines in the sera were generally low, with no significant changes between keratoconus and control subjects. However, in tear fluids, clear differences were detected between the two groups. These differences include increased IL-6, and decreased IL-12, TNF-α, IFN-γ, IL-4, IL-13 and CCL5 in keratoconus compared to control tear fluids. The decreases in IL-12, TNF-α and CCL5 were statistically significant, while the IL-13 decrease was statistically significant in the severe keratoconus group only. IL-17 could not be detected by multiplex immuno-bead assay, but showed an increase in keratoconus by conventional ELISA on a limited number of pooled tear samples. Our findings confirm increased IL-6, but dispute earlier reports of increased TNF-α, and suggest a cytokine imbalance in keratoconus disrupting corneal homeostasis. Moreover, an increase in IL-17 suggests tissue degenerative processes at work, contributing to the thinning and weakening of the corneal connective tissue in keratoconus. PMID:21298010

  13. Tears at the myotendinous junction of the infraspinatus: ultrasound findings.

    Science.gov (United States)

    Guerini, H; Pluot, E; Pessis, E; Thevenin, F; Campagna, R; Feydy, A; Gaudin, P; Drapé, J L

    2015-04-01

    Tears involving the myotendinous junction (MTJ) of the infraspinatus (IS) have been recently described on MRI. These occur centrally in the muscle belly, and are not associated with full thickness tears of the distal infraspinatus tendon. They also induce a rapidly progressive fatty infiltration of the muscles and amyotrophy. The purpose of this study is to assess the accuracy of ultrasonography in diagnosing MTJ tears of the infraspinatus and to describe the usual ultrasonographic appearance compared with MRI. Retrospective study of 2403 US examinations of the shoulder (over 5 years). Fifteen patients with a reported suspicion of infraspinatus MTJ tears were included. MRI examination was available in all cases, CT arthrography in 13 cases, and one patient underwent surgical confirmation. All patients were sent for an ultrasound for suspect lesion of the tendons of the rotator cuff, with posterior pain in the infraspinatus fossa. All cases seen on ultrasonography were confirmed on MRI. CT arthrography confirmed the absence of tear of the IS tendon in all cases and did not reveal the MTJ tears. Two signs appeared to us as being of special interest: the "tadpole sign" on longitudinal views, and the "black eye sign" on sagittal views. The proximal retraction of the tendon at the MTJ is the anatomical explanation of both signs. Tears at the myotendinous junction of the infraspinatus are rare but can be diagnosed on US examination, provided that the sonographer pays attention to the infraspinatus fossa especially in cases of normality of the distal tendinous cuff. Copyright © 2015 Éditions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.

  14. Is intraarticular pathology common in patients with hip dysplasia undergoing periacetabular osteotomy?

    Science.gov (United States)

    Domb, Benjamin G; Lareau, Justin M; Baydoun, Hasan; Botser, Itamar; Millis, Michael B; Yen, Yi-Meng

    2014-02-01

    Periacetabular osteotomy (PAO) enables correction of bony acetabular deficiency in the setting of hip dysplasia. Patients with insufficient acetabular coverage often have intraarticular pathology, but the degree of this pathology has been incompletely characterized. We have used arthroscopy as an adjunct to PAO to further delineate intraarticular pathology in patients with hip dysplasia with mechanical symptoms. We documented the arthroscopic incidence of (1) femoral and acetabular chondral pathology, (2) femoral neck cam lesions, and (3) internal snapping or ligamentum teres pathology among patients having arthroscopy before PAO. We reviewed all 16 patients (17 hips; mean age at surgery, 21 years; range, 12-33 years) with hip dysplasia who underwent PAOs and concomitant hip arthroscopy at our institutions from October 2010 to March 2012. During this period, 80 patients underwent PAOs, making the arthroscopic cohort 21% of the total cohort. Indications for concomitant hip arthroscopy were mechanical symptoms consistent with labral pathology identified on MRI. We documented pathology involving the labrum, chondral surface, ligamentum teres, cam deformity, and psoas tendon. Arthroscopy revealed significant intraarticular pathology in all patients. Fourteen hips had anterosuperior labral tears, and three hips had preoperative findings of internal snapping hip. Eleven hips had femoral cam-type lesions in addition to dysplasia, and 16 hips had articular chondral injury. Two hips had full-thickness ligamentum tears, and 13 hips had partial-thickness tears. Intraarticular pathology at the time of PAO is common. Future studies are needed to rigorously address the use of arthroscopic intervention during PAO and the impact on clinical outcome compared to PAO alone.

  15. Blinking and tear break-up during four visual tasks.

    Science.gov (United States)

    Himebaugh, Nikole L; Begley, Carolyn G; Bradley, Arthur; Wilkinson, Jenni A

    2009-02-01

    This study investigates the relationship between blinking, tear film break-up, and ocular symptoms for normal and dry eye subjects performing four different visual tasks. Sixteen control and sixteen dry eye subjects performed four visual tasks (looking straight ahead, watching a movie, identifying rapidly changing letters, and playing a computer game) while blink patterns and fluorescein images of the tear film were videotaped. Pre and posttesting symptom questionnaires, querying the intensity of nine symptoms of ocular irritation, were completed by all subjects. Blink rate and blink amplitude were computed from digitized videos. The percentage of tear film break-up before the blink was calculated. Dry eye subjects had a significantly higher blink rate (p = 0.017, t-test). Both groups blinked significantly less during the game and letter tasks (p break-up in normal subjects was typically inferior; whereas dry eye subjects showed more tear break-up centrally and superiorly. Real-time video recording of tear break-up and blink behavior pointed to complex interaction between the two. Dry eye subjects shifted more toward intense ocular symptoms at posttesting (p break-up during normal visual tasks may explain the increased level of ocular discomfort symptoms reported at the end of the day, particularly in dry eye patients.

  16. Abdominal breathing increases tear secretion in healthy women.

    Science.gov (United States)

    Sano, Kokoro; Kawashima, Motoko; Ikeura, Kazuhiro; Arita, Reiko; Tsubota, Kazuo

    2015-01-01

    To determine the relationship between abdominal breathing and tear meniscus volume in healthy women, we investigated the change in tear meniscus volume in two groups: normal breathing and abdominal breathing. We used a crossover experimental model and examined 20 healthy women aged 20-54 years (mean ± SD, 32.7 ± 11.1 years). The participants were randomly assigned to one of two groups. During the first visit, the normal breathing group was subjected to normal breathing for 3 min, whereas the abdominal breathing group was subjected to abdominal breathing (4-second inhalation and 6-second exhalation) for 3 min. During the second visit, the protocols were swapped between the two groups. We estimated the R wave to R wave (R-R) interval, tear meniscus volume, salivary amylase activity, pulse, and blood pressure before and immediately after, 15 min after, and 30 min after completion of the breathing activity. After abdominal breathing, compared to that before breathing, the tear meniscus volume increased significantly 15 min after breathing (Pabdominal breathing (PAbdominal breathing for 3 minutes increases the tear meniscus volume in healthy women. Consequently, abdominal breathing may be considered in the treatment of dry eye disease. Copyright © 2015 Elsevier Inc. All rights reserved.

  17. Preference direction study of Job’s-tears ice cream

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    Wiwat Wangcharoen

    2007-09-01

    Full Text Available Job's-tears (Coix lachryma-jobi L. is a kind of cereal commonly used in Asia as food and medicine, but it is still not widely consumed in Thailand. Four prototype products of Job’s-tears ice cream were developed by varying 2 levels of glucose syrup (16 and 32% of Job's-tears used and coconut milk (50 and 100 % of Job's-tears used. Their sensory attribute profiles were evaluated by 3 groups of 10 selected panelists using Ratio profile test (RPT, and their acceptances, hedonic scores, were evaluated by 100 consumers. Results showed that there were significant effects of coconut milk quantity on several attributes, such as appearance (whiteness, texture (hardness, smoothness, and flavour (coconut milk aroma, sweetness, saltiness, but the effect of glucose syrup quantity was significant on hardness only. Acceptance data were analyzed by cluster analysis to find out the difference of preference directions and 3 clusters (n1 = 39, n2 = 25, n3 = 36 were found. The first cluster preferred Job's tears ice cream containing high glucose syrup and low coconut milk, whilst the second preferred high level of only one of these two ingredients, and the third preferred high level of both ingredients. External preference maps were created from RPT and acceptance data to express the preference direction of each cluster.

  18. Tear film evaporation--effect of age and gender.

    Science.gov (United States)

    Guillon, Michel; Maïssa, Cécile

    2010-08-01

    Dry eye is more prevalent in older patients and among them more marked in women than men. The increase in dry eye with aging is traditionally thought to be associated with a decrease in tear production enhanced by hormonal changes. Clinical evidence of an abnormal lipid production system in older patients, in particular women is established. It is therefore postulated that the greater prevalence of dry eye problems in an older population has an evaporative component. Tear film evaporation was measured with the Oregon Health Sciences University Evaporimeter at 30% and 40% humidity. 160 subjects less than 45 years old and 57 subjects aged 45 years or more formed the study population. The results revealed a significant effect of age (p women; and (iii) the synergic effect of age and gender was very marked: the rate of evaporation of older women was 34-80% higher than that of older men and 36-69% than younger women. Aging of the tear film includes a significant evaporative component characterised by higher tear film evaporation for the over 45 compared to younger people. Further, in the over 45 years of age, a significantly greater tear film evaporation was recorded in women than men. The findings have significant implications for the management of presbyopic dry eye sufferers. 2010 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

  19. Dog Tear Film Proteome In-Depth Analysis.

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    Mateusz Winiarczyk

    Full Text Available In this study, mass spectrometry was used to explore the canine tear proteome. Tear samples were obtained from six healthy dogs, and one-dimensional sodium dodecyl sulphate polyacrylamide gel electrophoresis (1D SDS-PAGE was used as a first step to separate intact proteins into 17 bands. Each fraction was then trypsin digested and analysed by matrix-assisted laser desorption/ionization time-of-flight tandem mass spectrometry (MALDI-TOF-MS/MS to characterize the protein components in each fraction. In total, 125 tear proteins were identified, with MCA (Major Canine Allergen, Serum albumin, UPF0557 protein C10orf119 homolog, Collagen alpha-2(I chain, Tyrosine -protein kinase Fer, Keratine type II cytoskeletal, Beta-crystallin B2, Interleukin-6 and Desmin occurring as the most confident ones with the highest scores. The results showed that the proteomic strategy used in this study was successful in the analysis of the dog tear proteome. To the best of our knowledge, this study is the first to report the comprehensive proteome profile of tears from healthy dogs by 1D SDS PAGE and MALDI-TOF. Data are available via ProteomeXchange with identifier PXD003124.

  20. The epidemiology and injury patterns of acetabular fractures: are the USA and China comparable?

    Science.gov (United States)

    Mauffrey, Cyril; Hao, Jiandong; Cuellar, Derly O; Herbert, Benoit; Chen, Xiao; Liu, Bo; Zhang, Yingze; Smith, Wade

    2014-11-01

    Acetabular fractures are rare injuries in heterogeneous patient groups, making it difficult to develop adequately powered prospective single-center clinical trials in the USA or Europe. Chinese trauma centers treat a high volume of these injuries, and if the patient population and injury patterns are comparable to those in the USA, this might support development of multicenter studies in Level I trauma centers in the two countries. We determined whether the following parameters were similar between operative acetabular fractures treated at Chinese and US trauma centers: (1) epidemiology of injured patients, (2) mechanism of injuries and fracture types, and (3) hospital stay parameters, including symptomatic postoperative deep vein thrombosis (DVT) rate. We extracted data from trauma databases for patients admitted with acetabular fractures managed surgically from 2005 to 2012 for one Chinese center and from 2008 to 2012 for one US center. Sex, age, mechanism of injury, fracture classification, Injury Severity Score (ISS), time from injury to surgery, length of hospital stay, and symptomatic DVT rate were analyzed. We included 661 Chinese patients (539 men, 122 women) and 212 US patients (163 men, 49 women). Mean age at time of injury was different between China and the USA, at 40 years with a unimodal distribution and 44 years with a bimodal distribution (pISSs were comparable. Although the distribution of mechanisms of injury was different (p=0.004), high-energy injuries (motor vehicle accidents, falls>10 feet) still accounted for most fractures in both centers. Fracture classifications (per Letournel) were comparable, with posterior wall fractures most common. Mean time from injury to surgery and mean hospital stay were longer in China than in the USA (9 versus 3 days [p<0.001] and 26 versus 11 days [p<0.001], respectively). Symptomatic DVT rates were comparable. Although we identified differences between the two centers, we also noted important similarities

  1. Early Intraprosthetic Dislocation of a Dual Mobility Acetabular Construct after Total Hip Arthroplasty.

    Science.gov (United States)

    Tyagi, Vineet; Akinbo, Oluwaseun

    2017-01-01

    The concept of a dual mobility (DM) cup has been in existence for more than 40 years and was initially popularized in Europe. Only recently has it started to garner attention in the United States. Its design, consisting of a small femoral head articulating within a larger polyethylene (PE) insert, which articulates with an outer shell, has found increasing use in patients that are at risk for post-operative dislocations. This case report describes a case of recurrent total hip arthroplasty (THA) dislocation managed with the implantation of a DM cup with an acute intraprosthetic dislocation of the DM construct. A 52-year-old woman underwent an uneventful left THA through a posterior approach. Within 6 weeks of her surgery, she had four dislocations, managed with closed reductions. She then underwent an open revision of her acetabular component with conversion to a DM construct. 5 weeks after her revision, she had another dislocation treated with closed reduction in the operating room, with the resultant eccentric location of the femoral head in the acetabular component. Computed tomography (CT) confirmed intraprosthetic dislocation with the PE liner lodged in the gluteal tissue. She was taken to the operating room with a plan to revise her acetabular component to another DM construct, but with an increase in the anteversion despite initial anteversion being "appropriate" on CT imaging. Intraoperatively, the PE liner was embedded in gluteal tissue as depicted on the CT. The abductors were intact. There was no impingement in extension and maximal external rotation when trialed with a conventional head/liner construct. A new DM construct was then implanted. Intraprosthetic dislocation is a rare occurrence and unique complication to DM constructs. It is not common in the short-term setting postoperatively to our knowledge, and this case report represents an early report of intraprosthetic dislocation in the literature. Care should be taken during reduction of dislocated

  2. Usefulness of Arthroscopic Treatment of Painful Hip after Acetabular Fracture or Hip Dislocation.

    Science.gov (United States)

    Hwang, Jung-Taek; Lee, Woo-Yong; Kang, Chan; Hwang, Deuk-Soo; Kim, Dong-Yeol; Zheng, Long

    2015-12-01

    Painful hip following hip dislocation or acetabular fracture can be an important signal for early degeneration and progression to osteoarthritis due to intraarticular pathology. However, there is limited literature discussing the use of arthroscopy for the treatment of painful hip. The purpose of this retrospective study was to analyze the effectiveness and benefit of arthroscopic treatment for patients with a painful hip after major trauma. From July 2003 to February 2013, we reviewed 13 patients who underwent arthroscopic treatment after acetabular fracture or hip dislocation and were followed up for a minimum of 2 postoperative years. The degree of osteoarthritis based on the Tonnis classification pre- and postoperatively at final follow-up was determined. Clinical outcomes were evaluated using visual analogue scale for pain (VAS) and modified Harris hip score (MHHS), and range of motion (ROM) of the hip pre- and postoperatively at final follow-up. There were nine male and four female patients with a mean age at surgery of 28 years (range, 20 to 50 years). The mean follow-up period of the patients was 59.8 months (range, 24 to 115 months), and the mean interval between initial trauma and arthroscopic treatment was 40.8 months (range, 1 to 144 months). At the final follow-up, VAS and MHHS improved significantly from 6.3 and 53.4 to 3.0 and 88.3, respectively (p = 0.002 and p hip flexion, abduction, adduction, external rotation, and internal rotation as minor improvements from 113.1°, 38.5°, 28.5°, 36.5°, and 22.7° to 118.5°, 39.0°, 29.2°, 38.9°, and 26.5° were observed, respectively (p = 0.070, p = 0.414, p = 0.317, p = 0.084, and p = 0.136, respectively). None of the patients exhibited progression of osteoarthritis of the hip at the final follow-up. Arthroscopic treatment after acetabular fracture or hip dislocation is effective and delays the progression of traumatic osteoarthritis.

  3. Early Functional Outcomes of Periacetabular Osteotomy After Failed Hip Arthroscopic Surgery for Symptomatic Acetabular Dysplasia.

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    Ricciardi, Benjamin F; Fields, Kara G; Wentzel, Catherine; Kelly, Bryan T; Sink, Ernest L

    2017-09-01

    Persistent acetabular dysplasia is a common reason for the failure of hip arthroscopic surgery; however, the effect of prior hip arthroscopic surgery on functional outcomes after subsequent periacetabular osteotomy (PAO) is unknown. Hypothesis/Purpose: The purpose of this study was to (1) compare demographic and radiological findings in patients who had and had not undergone previous hip arthroscopic surgery before PAO for symptomatic acetabular dysplasia and (2) compare the short-term, hip-specific patient-reported outcomes in these same patient populations. It was hypothesized that prior hip arthroscopic surgery is associated with worse early functional outcomes in PAO. Cohort study; Level of evidence, 3. A retrospective cohort study design was utilized. Patients undergoing PAO were enrolled from a single-center, prospective hip preservation registry from March 2011 to April 2015. Patients with a minimum of 1-year clinical follow-up with preoperative and postoperative outcome scores undergoing PAO were eligible for inclusion (n = 93 patients; mean clinical follow-up, 24 months [range, 11-58 months]). The study group consisted of patients undergoing PAO for symptomatic hip dysplasia after prior hip arthroscopic surgery (PREVSCOPE group; 22 patients, 25 hips). Patients undergoing PAO without prior hip arthroscopic surgery (PAOALONE group; 71 patients, 85 hips) were included as a comparison group. Demographic and radiological variables were recorded. Postoperative functional outcome scores (modified Harris Hip Score [mHHS], Hip Outcome Score [HOS], and International Hip Outcome Tool [iHOT-33]) were recorded at 6 months and annually postoperatively. There were no demographic differences between the 2 groups at baseline. Acetabular version, femoral version, Tönnis grade, preoperative lateral center edge angle, and intraoperative procedures were not different between the 2 groups. At 1-year follow-up from the last hip surgical procedure, the mean (±SD) mHHS (73 ± 14

  4. Ilioinguinal approach versus Stoppa approach for open reduction and internal fixation in the treatment of displaced acetabular fractures: A systematic review and meta-analysis

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    Xiao-Jian Wang

    2017-08-01

    Conclusion: Though both techniques can obtain satisfactory clinical functions in the treatment of displaced acetabular fractures, Stoppa approach is superior to the ilioinguinal approach in terms of operation time and intraoperative blood loss.

  5. Positioning of the acetabular component in cemented prostheses - radiographic calculation Posicionamento do componente acetabular em próteses cimentadas – cálculo radiográfico

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    Pedro José Labronici

    2013-01-01

    Full Text Available OBJECTIVE: to assess the reliability of the inclination angle and anteversion of acetabular cup component in patients with idiopatic osteoarthritis of the hip, aseptic necrosis and hip neck fracture using trigonometric formula and plain radiographs. METHODS: 66 patients underwent cemented total arthroplasty of 72 hips. The inclination of acetabular component was measured using plain radiograph. The acetabular component anteversion was measured using trigonometric formula. RESULTS: it was observed that, in the osteoarthritic hips, hip neck fracture and aseptic necrosis, the degree of agreement was highly significant (p 0.80. CONCLUSION: using plain radiographs and trigonometric formula, the method resulted to be highly accurate and reliable. Besides being easy to be calculated. No significant variation was found in the anteversion and inclination angles when compared with osteoarthritis of the hip, aseptic necrosis and hip neck fracture. OBJETIVO: Medir a confiabilidade do ângulo de inclinação e a anteversão do componente acetabular em pacientes com osteoartrose idiopática do quadril, necrose asséptica e na fratura do colo do fêmur por meio de uma fórmula trigonométrica e radiografias convencionais. MÉTODOS: Foram tratados 66 pacientes com artroplastia total cimentada em 72 quadris. A inclinação do componente acetabular foi medida por radiografias panorâmicas de bacia em incidência anteroposterior. A anteversão do componente acetabular foi medida com o uso de fórmula trigonométrica. RESULTADOS: Observou-se que, tanto nos quadris com artrose, na fratura do colo do fêmur e na necrose asséptica, o grau de concordância foi altamente significativo (p 0,80. CONCLUSÃO: Usando radiografias convencionais e uma fórmula trigonométrica, o método mostrou ser altamente preciso, fácil de ser calculado e com grande confiabilidade. Não foi encontrada variação significativa no ângulo de anteversão e no ângulo de inclinação quando

  6. Artificial tears alone versus 0.45% ketorolac tromethamine with artificial tears for the treatment of acute viral conjunctivitis

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    Adriana Falcão Veloso Lyra

    2014-04-01

    Full Text Available Purpose: To evaluate the effects of preservativefree 0.45% ketorolac tromethamine and artificial tears (carboxymethylcellulose compared with those of preservativefree artificial tears alone on the symptoms and signs of acute viral conjunctivitis. Methods: This was a randomized, doublemasked clinical trial that included 50 patients who were diagnosed with acute viral conjunctivitis and distributed into two groups (Group 0: artificial tears and Group 1: 0.45% ketorolac tromethamine + carboxymethylcellulose. The patients were instructed to use the medication 4 times daily. Signs (conjunctival hyperemia, chemosis, follicles, and secretion and symptoms (general ocular discomfort, itching, foreign body sensation, tearing, redness, and swelling of the eyelids were scored at baseline and on the third and seventh days of treatment using a standardized questionnaire and slitlamp anterior segment examination. Results: Both groups showed an improvement in the signs and symptoms of conjunctivitis in their follow-up visits. There was no significant difference in symptom and sign scores between Group 0 and Group 1 in the study visits (p>0.05. The frequency of side effects during treatment was similar between groups (p>0.05. Conclusions: Our findings indicate that 0.45% ketorolac tromethamine was not superior to the use of artificial tears in relieving the signs and symptoms of viral conjunctivitis.

  7. Tear film dynamics: modeling the glycocalyx as a porous medium

    Science.gov (United States)

    Siddique, Javed; Mastroberardinob, , Antonio; Braun, Richard; Anderson, Daniel

    2015-11-01

    The human tear film is a complex fluid structure composed of multiple layers: an aqueous layer that comprises most of the film and an outermost thinner lipid layer coat a forest of large transmembrane mucins at the epithelial surface. The glycocalyx helps provide stability to the ocular surface by assisting the tear film to wet it. It is also permeable to water, but less so to ions. We formulate a thin film model based on lubrication theory in order to understand the dynamics between the aqueous layer and the glycocalyx, which we treat as a rigid porous medium. We present numerical solutions for the evolution of the tear film and discuss the roles played by the key parameters of the system. This work was supported by the Simons Foundation Grant No. 281839.

  8. Tear Break-up Time in High Altitude Areas.

    Science.gov (United States)

    Jha, K N

    2009-01-01

    In high altitude areas, patients report with irritation, redness and foreign body sensation in their eyes suggesting tear film abnormality due to low humidity and windy environmental conditions. Tear Break- up Time (TBUT) was studied in 100 subjects consisting of local population and those originally from plains residing in high altitude areas in Ladakh. There were 24% individuals with TBUT of 10 seconds. In symptomatic patients with TBUT of <5 seconds, eight cases had irritation of eyes, six foreign body sensation and two cases had pain, watering, irritation and redness of eyes. Pterygium was seen in 12 individuals and inter palpebral congestion in 4 cases. A total of 24% cases showed abnormal (<5 seconds) TBUT. Abnormality of tear film in the presence of low humidity and windy condition with high ultraviolet radiation may lead to ocular discomfort and pterygium in these areas.

  9. Skin tear prevalence and associated factors: a systematic review

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    Kelly Cristina Strazzieri-Pulido

    2015-08-01

    Full Text Available OBJECTIVETo identify and analyse skin tear prevalence and factors associated with its occurrence.METHODSystematic review of literature of studies published until June 2014 including studies published in full in English, Spanish or Portuguese. The studies were analysed according to the Strengthening the Reporting of Observational Studies in Epidemiology and the Guidelines for Critically Appraising Studies of Prevalence or Incidence of a Health Problem.RESULTSThe analysis of eight studies showed skin tear prevalence of 3.3% to 22% in the hospital setting and 5.5% to 19.5% in homecare. Advanced age, dependence on basic activities of daily life, frail elderly, level of mobility, agitated behavior, non-responsiveness, greater risk for concurrent development of pressure ulcers, cognitive impairment, spasticity and photoaging were cited as risk factors.CONCLUSIONSkin tear prevalence ranged from 3.3% to 22% and is mainly associated with advanced age and dependence on basic activities of daily life.

  10. [Skin tear prevalence and associated factors: a systematic review].

    Science.gov (United States)

    Strazzieri-Pulido, Kelly Cristina; Peres, Giovana Ribau Picolo; Campanili, Ticiane Carolina Gonçalves Faustino; Santos, Vera Lúcia Conceição de Gouveia

    2015-08-01

    To identify and analyse skin tear prevalence and factors associated with its occurrence. Systematic review of literature of studies published until June 2014 including studies published in full in English, Spanish or Portuguese. The studies were analysed according to the Strengthening the Reporting of Observational Studies in Epidemiology and the Guidelines for Critically Appraising Studies of Prevalence or Incidence of a Health Problem. The analysis of eight studies showed skin tear prevalence of 3.3% to 22% in the hospital setting and 5.5% to 19.5% in homecare. Advanced age, dependence on basic activities of daily life, frail elderly, level of mobility, agitated behavior, non-responsiveness, greater risk for concurrent development of pressure ulcers, cognitive impairment, spasticity and photoaging were cited as risk factors. Skin tear prevalence ranged from 3.3% to 22% and is mainly associated with advanced age and dependence on basic activities of daily life.

  11. Tear fluid-eye drops compatibility assessment using surface tension.

    Science.gov (United States)

    Hotujac Grgurević, Martina; Juretić, Marina; Hafner, Anita; Lovrić, Jasmina; Pepić, Ivan

    2017-02-01

    To evaluate the compatibility of commercially available eye drop surface tension with the tear film physiological range and to characterize commonly used ophthalmic excipients in terms of their surface activity under eye-biorelevant conditions. There are a number of quality requirements for the eye drops (e.g. tonicity, pH, viscosity, refractive index) that needs to comply with the physiological parameters of the eye surface. However, the adjustment of surface tension properties of the eye drops to the normal range of surface tension at the air/tear fluid interface (40-46 mN/m) has received rather less attention thus far. Yet, the surface tension at the air/tear fluid interface is of vital importance for the normal function of the eye surface. The surface tension compatibility of the isotonic aqueous solutions of commonly used ophthalmic excipients as well as 18 approved eye drops with the tear fluid have been evaluated using surface tension method. Each ophthalmic ingredient including the preservatives, solubilizing agents and thickening agents can influence the surface tension of the final formulation. In case of complex ophthalmic formulations one should also consider the possible interactions among excipients and consequent impact on overall surface activity. Out of 18 evaluated eye drops, three samples were within, 12 samples were below and three samples were above the physiological range of the tear fluid surface tension. Our results provide a rationale for clinical studies aiming to assess the correlation between the eye drops surface tension and the tear film (in)stability.

  12. Cytokine and chemokine levels in tears from healthy subjects.

    Science.gov (United States)

    Carreño, Ester; Enríquez-de-Salamanca, Amalia; Tesón, Marisa; García-Vázquez, Carmen; Stern, Michael E; Whitcup, Scott M; Calonge, Margarita

    2010-11-01

    There is growing evidence for the existence of an 'immune tone' in normal tears. The aim of this study was to determine the levels of a large panel of cytokines and chemokines in tears obtained from healthy subjects. These levels can then serve as baseline values for comparison with patients suffering from ocular surface diseases. Nine healthy subjects participated in this study, and normal ocular surface health was documented by the results of a dry eye questionnaire, Schirmer strip wetting, and vital staining of the cornea. Four microliters of tears were collected from each eye and analysed separately with multiplex bead-based assays for the concentration of 30 cytokines and chemokines. Twenty-five cytokines/chemokines were detected. CCL11/Eotaxin1, GM-CSF, G-CSF, IFN-γ, IL-2, IL-3, IL-4, IL-5, IL-10, IL-13, IL-12p70, IL-15, CX3CL1/Fractalkine, TNF-α, epidermal growth factor, and CCL4/MIP-1β were present at 5-100 pg/ml. IL-1β, IL-6, IL-7A, CXCL8/IL-8, and CCL2/MCP-1 were present at 100-400 pg/ml. IL-1Ra, CXCL10/IP-10 and vascular endothelial growth factor were present at more than 1000 pg/ml. Multiplex bead-based assays are convenient for cytokine/chemokine detection in tears. Fracktalkine has been detected in human healthy tears for the first time. The knowledge of cytokine/chemokine concentrations in tears from normal subjects is an important reference for further comparison with patients suffering from ocular surface diseases. Variability in their levels can reflect a phenomenon of potential importance for the understanding of the ocular surface cytokine pattern. © 2010 The Authors. Journal compilation © 2010 Acta Ophthalmol.

  13. Assessment of Tear Film Using Videokeratoscopy Based on Fractal Dimension.

    Science.gov (United States)

    Llorens-Quintana, Clara; Iskander, D Robert

    2018-01-01

    The proposed automated approach for estimating the quality of the tear film closes the gap between the manual and automated assessment, translating the high-speed videokeratoscopy technology from scientific laboratories to a clinical practice. To develop and test a new method for characterizing Tear Film Surface Quality with high-speed videokeratoscopy utilizing a fractal dimension approach. The regularity of the reflected pattern in high-speed videokeratoscopy (E300; Medmont) depends on tear film stability. Thus, determining tear film stability can be addressed by estimating the fractal dimension of the reflected pattern. The method is tested on 39 normal subjects. The results of the fractal dimension approach are compared with those obtained using previously proposed automated method, based on a gray-level co-occurrence matrix approach, and with subjective results obtained by two operators that were assessing the video recordings in ideal conditions. Fractal dimension method was less affected by eye movements and changes in the videokeratoscopic image background than gray-level co-occurrence matrix method. Median difference of the noninvasive break-up time between manual and automated methods was 0.03 s (IQR = 4.47 s) and 0.0 s (IQR = 2.22 s) for gray-level co-occurrence matrix and fractal dimension approaches, respectively. Correlation coefficient with manual noninvasive break-up time was r = 0.86 (P dimension approach. Significant statistical difference was found between noninvasive break-up measurements of manual and gray-level co-occurrence matrix method (P = 0.008). The proposed method has the potential to characterize tear film dynamics in more detail compared to previous methods based on high-speed videokeratoscopy. It showed good correlation with manual assessment of tear film.

  14. Rotator cuff tears noncontrast MRI compared to MR arthrography

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Ji Hyun; Yoon, Young Cheol [Sungkyunkwan University, School of Medicine, Department of Radiology, Samsung Medical Center, Gangnam-gu, Seoul (Korea, Republic of); Jung, Jee Young [Chungang University School of Medicine, Dep