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Sample records for bilateral tibial metaphysis

  1. Bilateral tibial hemimelia I.

    Science.gov (United States)

    Suganthy, J; Rassau, Marina; Koshi, Rachel; Battacharjee, Suranjan

    2007-05-01

    Congenital absence of tibia is a rare anomaly. We report a case of bilateral tibial hemimelia born to phenotypically normal parents. The two amputated legs with tibial dysplasia obtained from a 3-year-old boy were studied by radiography and anatomical dissection. The radiological evaluation revealed a normal hip joint. The lower end of femur was normal without any bifurcation, shortening or bowing. Fibula was present on both legs and there was no sign of bowing or doubling. Both right and left tibiae were absent. In addition, on the right side, five tarsal bones, two metatarsals and the corresponding digital rays were absent. On the left side, three tarsal bones were absent. Dissection of the amputated segments showed the presence of extensor digitorum longus, peroneus tertius, peroneus longus and brevis, gastrocnemius, and soleus. Following bilateral knee disarticulation the patient was fitted with prosthesis and is doing well.

  2. Osteogenic capacity of nanocrystalline bone cement in a weight-bearing defect at the ovine tibial metaphysis

    Directory of Open Access Journals (Sweden)

    Mittlmeier T

    2012-06-01

    Full Text Available Christoph Harms,1 Kai Helms,1 Tibor Taschner,1 Ioannis Stratos,1 Anita Ignatius,5 Thomas Gerber,2 Solvig Lenz,3 Stefan Rammelt,6 Brigitte Vollmar,4 Thomas Mittlmeier11Department of Trauma and Reconstructive Surgery, 2Department for Materials Research and Nanostructures, Institute for Physics, 3Department of Oral and Maxillofacial Plastic Surgery, 4Institute for Experimental Surgery, University of Rostock, Rostock, 5Institute of Orthopaedic Research and Biomechanics, University of Ulm, Ulm, 6Clinic of Trauma and Reconstructive Surgery, University Hospital "Carl Gustav Carus", Dresden, GermanyAbstract: The synthetic material Nanobone® (hydroxyapatite nanocrystallines embedded in a porous silica gel matrix was examined in vivo using a standardized bone defect model in the ovine tibial metaphysis. A standardized 6 × 12 × 24-mm bone defect was created below the articular surface of the medial tibia condyles on both hind legs of 18 adult sheep. The defect on the right side was filled with Nanobone®, while the defect on the contralateral side was left empty. The tibial heads of six sheep were analyzed after 6, 12, and 26 weeks each. The histological and radiological analysis of the defect on the control side did not reveal any bone formation after the total of 26 weeks. In contrast, the microcomputed tomography analysis of the defect filled with Nanobone® showed a 55%, 72%, and 74% volume fraction of structures with bone density after 6, 12, and 26 weeks, respectively. Quantitative histomorphological analysis after 6, and 12 weeks revealed an osteoneogenesis of 22%, and 36%, respectively. Hematoxylin and eosin sections demonstrated multinucleated giant cells on the surface of the biomaterial and resorption lacunae, indicating osteoclastic resorptive activity. Nanobone® appears to be a highly potent bone substitute material with osteoconductive properties in a loaded large animal defect model, supporting the potential use of Nanobone® also in

  3. Aneurisma verdadeiro bilateral de artéria tibial posterior True bilateral aneurysm of the posterior tibial artery

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    Silvio Romero de Barros Marques

    2006-03-01

    Full Text Available Neste artigo, faz-se o relato de um caso de aneurisma verdadeiro bilateral da artéria tibial posterior em paciente de 57 anos. Os aneurismas surgiram em épocas diferentes. Os aspectos clínicos, diagnósticos e terapêuticos deste caso são discutidos. Este relato é importante, pois os autores não têm conhecimento de caso semelhante na literatura consultada.This article reports a case of true bilateral aneurysm of the tibial posterior artery in a 57 year-old patient. The aneurysms occurred at different times. The clinical, diagnostic and therapeutic aspects of this case are discussed. This report is important because the authors did not find a similar description in the literature.

  4. Effect of a carbonated HAP/β-glucan composite bone substitute on healing of drilled bone voids in the proximal tibial metaphysis of rabbits

    Energy Technology Data Exchange (ETDEWEB)

    Borkowski, Leszek, E-mail: leszek.borkowski@umlub.pl [Department of Biochemistry and Biotechnology, Medical University of Lublin, Chodźki 1, 20-093 Lublin (Poland); Pawłowska, Marta; Radzki, Radosław P.; Bieńko, Marek [Department of Animal Physiology, University of Life Sciences in Lublin, Akademicka 12, 20-033 Lublin (Poland); Polkowska, Izabela [Department and Clinic of Animal Surgery, University of Life Sciences in Lublin, Głęboka 30, 20-612 Lublin (Poland); Belcarz, Anna [Department of Biochemistry and Biotechnology, Medical University of Lublin, Chodźki 1, 20-093 Lublin (Poland); Karpiński, Mirosław [Department of Companion and Wildlife Animals, University of Life Sciences in Lublin, Akademicka 13, 20-950 Lublin (Poland); Słowik, Tymoteusz [Independent Radiology Unit at Lublin Small Animals Medical Centre, Stefczyka 11, 20-151 Lublin (Poland); Matuszewski, Łukasz [Children' s Orthopaedic Clinic and Rehabilitation Department, Medical University of Lublin, Chodzki 2, 20-093 Lublin (Poland); Ślósarczyk, Anna [Faculty of Materials Science and Ceramics, AGH-University of Science and Technology, Mickiewicza 30, 30-059 Krakow (Poland); Ginalska, Grażyna [Department of Biochemistry and Biotechnology, Medical University of Lublin, Chodźki 1, 20-093 Lublin (Poland)

    2015-08-01

    A novel elastic hydroxyapatite-based composite of high surgical handiness has been developed. Its potential application in orthopedics as a filler of bone defects has been studied. The biomaterial was composed of carbonated hydroxyapatite (CHAP) granules and polysaccharide polymer (β-1,3-glucan). Cylinders of 4 mm in diameter and 6 mm in length were implanted into bone cavities created in the proximal metaphysis of tibiae of 24 New Zealand white rabbits. 18 sham-operated animals were used as controls. After 1, 3 or 6 months, the rabbits were euthanized, the bones were harvested and subjected to analysis. Radiological images and histological sections revealed integration of implants with bone tissue with no signs of graft rejection. Peripheral quantitative computed tomography (pQCT) indicated the stimulating effect of the biomaterial on bone formation and mineralization. Densitometry (DXA) analysis suggested that biomineralization of bones was preceded by bioresorption and gradual disappearance of porous ceramic granules. The findings suggest that the CHAP–glucan composite material enables regeneration of bone tissue and could serve as a bone defect filler. - Highlights: • Highly porous carbonate HAP granules and β-1,3-glucan were used to fill bone voids. • Critical size defects of rabbit tibiae were filled with the composite scaffolds. • Biocompatibility, mineralization and osseointegration of implants were examined. • Histological analysis indicated a high biocompatibility of composite grafts. • We report penetration of bony tissue into implants and advanced osseointegration.

  5. Reconstruction of bilateral tibial aplasia and split hand-foot syndrome in a father and daughter

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    Ali Al Kaissi

    2014-01-01

    Full Text Available Background: Tibial aplasia is of heterogeneous aetiology, the majority of reports are sporadic. We describe the reconstruction procedures in two subjects - a daughter and father manifested autosomal dominant (AD inheritance of the bilateral tibial aplasia and split hand-foot syndrome. Materials and Methods: Reconstruction of these patients required multiple surgical procedures and orthoprosthesis was mandatory. The main goal of treatment was to achieve walking. Stabilization of the ankle joint by fibular-talar-chondrodesis on both sides, followed by bilateral Brown-procedure at the knee joint level has been applied accordingly. Results: The outcome was with improved function of the deformed limbs and walking was achieved with simultaneous designation of orthotic fitting. Conclusion: This is the first study encompassing the diagnosis and management of a father and daughter with bilateral tibial aplasia associated with variable split hand/foot deformity without foot ablation. Our patients showed the typical AD pattern of inheritance of split-hand/foot and tibial aplasia.

  6. [Bilateral stress fracture of the mid-tibial shaft in a professional dancer].

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    Tomčovčík, L; Tomčovčíková, A

    2011-01-01

    Stress fractures of the anterior cortex of the mid-tibial shaft in dancers are rare, with a 1.4 % incidence in injured eli- te dancers. Treatment can be difficult and long-lasting and can seriously influence the dancer's career. The authors pre- sent the case of a 26-year-old professional dancer of a folk dance ensemble who suffered rare simultaneous bilateral mid-tibial shaft stress fractures. A conservative method of treatment with avoiding exercise and dancing activities resulted in the resolution of symptoms and healing of the fractures after 6 months. The patient finished his dancing career because of the necessity of a prolonged therapy interfering with his dancing activities. Current options of the treatment are also presented.

  7. Bilateral tibial hemimelia type 1 (1a and 1b with T9 and T10 hemivertebrae: a novel association

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    Victor Michael Salinas-Torres

    Full Text Available CONTEXT Congenital absence of the tibia is a rare anomaly with an incidence of one per 1,000,000 live births. It is mostly sporadic and can be identified as an isolated disorder or as part of malformation syndromes. CASE REPORT A male child, born to unaffected and non-consanguineous parents, presented with shortening of the legs and adduction of both feet. Physical examination at six months of age showed head circumference of 44.5 cm (75th percentile, length 60 cm (< 3rd percentile, weight 7,700 g (50th percentile, shortening of the left thigh and both legs with varus foot. There were no craniofacial dysmorphisms or chest, abdominal, genital or upper-extremity anomalies. Psychomotor development was normal. His workup, including renal and cranial ultrasonography, brainstem auditory evoked potential, and ophthalmological and cardiological examinations, was normal. X-rays showed bilateral absence of the tibia with intact fibulae, distally hypoplastic left femur, and normal right femur. In addition, spinal radiographs showed hemivertebrae at T9 and T10. CONCLUSION This novel association expands the spectrum of tibial hemimelia. Moreover, this observation highlights the usefulness of this inexpensive diagnostic method (X-rays for characterizing the great clinical and radiological variability of tibial hemimelia.

  8. Sequential Proximal Tibial Stress Fractures associated with Prolonged usage of Methotrexate and Corticosteroids: A Case Report

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    Tan TJL

    2015-11-01

    Full Text Available Stress fractures of the proximal tibia metaphysis are rare in the elderly. We present a case of a 65-year old male who developed sequential proximal tibia stress fractures associated with prolonged usage of methotrexate and prednisolone within a span of 18 months. Magnetic Resonance Imaging revealed an incomplete stress fracture involving the medial proximal tibial region. The patient was treated with stemmed total knee arthroplasty (TKA bilaterally. Stress fractures should be considered in patients with atypical knee pain who have a history of methotrexate and prednisolone usage. TKA is an effective treatment in stress fractures of the proximal tibia.

  9. Acute simultaneous bilateral avulsion fractures of the tibial tubercles in a 15-year-old male hurler: case report and literature review.

    LENUS (Irish Health Repository)

    Hanley, C

    2012-02-01

    BACKGROUND: Avulsion fractures of the tibial tubercle are an unusual injury pattern generally occurring in the adolescent male during sporting activities. Bilateral simultaneous fractures are extremely rare. They are often associated with other underlying orthopaedic pathology. AIMS: We present a case of bilateral tibial tubercle avulsions occurring in a 15 year-old male hurler. We describe the management and necessary investigations required for this type of trauma and present a literature review on this rarely encountered injury. CONCLUSION: Although this type of atypical fracture pattern is associated with high energy trauma and other underlying pathology, we have shown that once treated, the patient can expect to make a prompt return to sporting activities with no significant long-term functional deficit.

  10. Tibial hypoplasia with a bifid tibia: an unclassified tibial hemimelia.

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    Shah, Krupa; Shah, Hitesh

    2016-08-16

    Tibial hemimelia is a rare congenital limb deficiency which is characterised by a hypoplastic/aplastic tibia. It actually represents a spectrum of anomalies, ranging from mild hypoplasia of the tibia to total absence of the tibia. Several classifications based on radiological description exist in the literature. The tibial hemimelia is usually described with preaxial mirror polydactyly, split hand/foot syndrome-ectrodactyly, polydactyly-triphalangeal thumb syndrome (Werner syndrome) and micromelia-trigonal brachycephaly syndrome. We describe a child with unclassified tibial hemimelia. The child had right incomplete tibial hemimelia with bifid tibia, left complete tibial hemimelia, bilateral split hands and left split foot. This is the first report of the bifid tibia in the literature.

  11. Physeal growth arrest after tibial lengthening in achondroplasia

    OpenAIRE

    Song, Sang-Heon; Agashe, Mandar Vikas; Huh, Young-Jae; Hwang, Soon-Young; Song, Hae-Ryong

    2012-01-01

    Background and purpose Bilateral tibial lengthening has become one of the standard treatments for upper segment-lower segment disproportion and to improve quality of life in achondroplasia. We determined the effect of tibial lengthening on the tibial physis and compared tibial growth that occurred at the physis with that in non-operated patients with acondroplasia. Methods We performed a retrospective analysis of serial radiographs until skeletal maturity in 23 achondroplasia patients who und...

  12. Posterior Tibial Tendon Dysfunction

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    .org Posterior Tibial Tendon Dysfunction Page ( 1 ) Posterior tibial tendon dysfunction is one of the most common problems of the foot and ankle. It occurs when the posterior tibial tendon becomes inflamed or torn. As a result, the ...

  13. Tibial bowing in children - what is normal? A radiographic study

    Energy Technology Data Exchange (ETDEWEB)

    Zbinden, Isabella [University of Basel, Department of Radiology, Basel (Switzerland); Rutz, Erich [University Children' s Hospital, Department of Orthopedic Surgery, Basel (Switzerland); Jacobson, Jon A. [University of Michigan, Department of Radiology, Ann Arbor, MI (United States); Magerkurth, Olaf [University Children' s Hospital, Department of Radiology, Basel (Switzerland); Kantonsspital Baden, Department of Radiology, Baden (Switzerland)

    2015-12-15

    To define osseous landmarks on tibia radiographs in order to establish age-related normal values characterizing physiological tibial bowing in children. Five hundred and twenty-six patients aged 0-17 years with normal radiographs of the lower legs were identified and retrospectively reviewed by two blinded radiologists. In anteroposterior (ap)/lateral (lat)-views, 3 lines defined tibial length and angulation. Line-A connecting proximal to distal corner of tibial metaphysic, lines B and C corresponding to corners of tibial metaphysis. Angle A/B defines proximal, A/C distal tibial-angulation. Tibial curvature is defined by distance of line-D parallel to A and tangential to tibial cortex. Normal values were calculated with linear-regression. Intra-/Interreader agreement were tested with a Bland-Altman-plot. Intrareader-agreement: Reader 1 showed a bias of -0.1, standard-deviation of bias was 1.9 and 95 %-limits-of-agreement -3.9- 3.7. Reader 2: -0.01, 2.4 and -4.7- 4.7. Interreader: 0.2, 1.6 and -2.9- 3.3. Angle-A/B ap was 80-100 , increasing with age (86.5-88); angle-AC ap was 82-107 (96.8-90.5), angle-AB lat was 81-107 (93.0-98.0); angle-AC lat was 76-102 (89.5-86.5); depth of curve ap was 0-11 % (8-3.5) and lat 2-13 %, (8.5-3.5). Age dependent tibial bowing can be assessed with this new measurement system and age-related normal-values characterizing physiological tibial bowing in children is established. (orig.)

  14. Stereological measures of trabecular bone structure: comparison of 3D micro computed tomography with 2D histological sections in human proximal tibial bone biopsies

    DEFF Research Database (Denmark)

    Thomsen, Jesper Skovhus; Laib, A.; Koller, B.;

    2005-01-01

    tibial metaphysis. The biopsies were embedded in methylmetacrylate before microCT scanning in a Scanco microCT 40 scanner at a resolution of 20 x 20 x 20 microm3, and the 3D data sets were analysed with a computer program. After microCT scanning, 16 sections were cut from the central 2 mm of each biopsy...

  15. Nonossifying fibroma developed in metaphysis and epiphysis--a case report.

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    Noh, Jung Ho; Ryu, Kyung Nam; Bae, Ji Yoon; Roh, Young Hak; Choi, In Seok

    2013-04-01

    Nonossifying fibroma is developed in childhood and adolescence and is usually asymptomatic. It is typically arises in the metaphysis of long bone and migrates toward the diaphysis with growth. We present a very rare case of nonossifying fibroma involving metaphysis and epiphysis of the distal femur in a 20-year-old man. Nonossifying fibroma is a benign fibroblastic lesion, which is also termed benign cortical defect and fibroxanthoma. A nonossifying fibroma rarely causes problems and does not interfere with healing or growth. The lesions are usually asymptomatic. With growth and remodeling of the bone, the lesion typically disappears and is replaced with normal bone. However, the lesion may weaken the involved bone, causing fracture. The lesion typically arises in the metaphysis of long bones and may migrate toward the diaphysis with growth. There have never been reports of nonossifying fibroma involving epiphysis that we know of. We report a very rare case of nonossifying fibroma involving metaphysis and epiphysis in a young adult. Written, informed consent was obtained from the patient to publish this case report, including the images.

  16. [Tibial periostitis ("medial tibial stress syndrome")].

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    Fournier, Pierre-Etienne

    2003-06-01

    Medial tibial stress syndrome is characterised by complaints along the posteromedial tibia. Runners and athletes involved in jumping activities may develop this syndrome. Increased stress to stabilize the foot especially when excessive pronation is present explain the occurrence this lesion.

  17. The accuracy of intramedullary tibial guide of sagittal alignment of PCL-substituting total knee arthroplasty.

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    Han, Hyuk-Soo; Kang, Seung-Baik; Jo, Chris H; Kim, Sun-Hong; Lee, Jung-Ha

    2010-10-01

    Experimental and clinical studies on the accuracy of the intramedullary alignment method have produced different results, and few have addressed accuracy in the sagittal plane. Reported deviations are not only attributable to the alignment method but also to radiological errors. The purpose of this study was to evaluate the accuracy of the intramedullary alignment method in the sagittal plane using computed tomography (CT) and 3-dimensional imaging software. Thirty-one TKAs were performed using an intramedullary alignment method involving the insertion of a long 8-mm diameter rod into the medullary canal to the distal metaphysis of the tibia. All alignment instruments were set to achieve an ideal varus/valgus angle of 0° in the coronal plane and a tibial slope of 0° in the sagittal plane. The accuracy of the intramedullary alignment system was assessed by measuring the coronal tibial component angle and sagittal tibial slope angles, i.e., angles between the tibial anatomical axis and the tangent to the medial and lateral tibial plateau or the cut-surface. The mean coronal tibial component angle was 88.5° ± 1.2° and the mean tibial component slope in the sagittal plane was 1.6° ± 1.2° without anterior slope. Our intramedullary tibial alignment method, which involves passing an 8-mm diameter long rod through the tibial shaft isthmus, showed good accuracy (less than 3 degrees of variation and no anterior slope) in the sagittal plane in neutral or varus knees.

  18. MRI signal-based quantification of subchondral bone at the tibial plateau: a population study

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    MacKay, James W. [Norfolk and Norwich University Hospital, Department of Radiology, Norwich (United Kingdom); Norfolk and Norwich University Hospital, Radiology Academy, Cotman Centre, Norwich (United Kingdom); Godley, Keith C.; Toms, Andoni P. [Norfolk and Norwich University Hospital, Department of Radiology, Norwich (United Kingdom)

    2014-11-15

    To determine whether differences in subchondral sclerosis at the tibial plateau could be detected with magnetic resonance (MR) imaging in two different age groups. This was a retrospective hypothesis-testing study. Thirty-two knees in group A (25-30 year olds) and 32 knees in group B (45-50 years old) were included. Participants had no MR features of osteoarthritis (OA). On coronal images, tibial articular cartilage thickness was measured, and regions of interest were created in the medial and lateral tibial plateau subchondral bone and in the tibial metaphysis. The measure of heterogeneity at the tibial plateaux was the ratio of the standard deviation of the signal in the medial/lateral compartment to the standard deviation of the signal in the metaphysis (ratio of standard deviations - RSS{sub medial}/RSS{sub lateral}). Differences between groups were assessed using unpaired Student's t-tests. Mean RSS{sub medial} was 2.61 (standard deviation, SD = 0.77) in group A and 2.97 (SD = 0.59) in group B. Mean RSS{sub lateral} in group A was 1.86 (SD = 0.63) and 1.89 (SD = 0.43) in group B. Mean total cartilage thickness (in mm) in group A was 3.38 (SD = 0.90) for the medial and 3.90 (SD = 1.09) for the lateral compartment and 3.44 (SD = 0.74) for the medial and 3.96 (SD = 0.96) for the lateral compartment in group B. The only parameter to show a statistically significant difference between groups was RSS{sub medial} (p = 0.04). A difference in medial subchondral bone sclerosis between two age groups was demonstrated in the absence of MR features of OA. This may represent the earliest OA change detectable on MR imaging. (orig.)

  19. Physeal growth arrest after tibial lengthening in achondroplasia

    Science.gov (United States)

    2012-01-01

    Background and purpose Bilateral tibial lengthening has become one of the standard treatments for upper segment-lower segment disproportion and to improve quality of life in achondroplasia. We determined the effect of tibial lengthening on the tibial physis and compared tibial growth that occurred at the physis with that in non-operated patients with acondroplasia. Methods We performed a retrospective analysis of serial radiographs until skeletal maturity in 23 achondroplasia patients who underwent bilateral tibial lengthening before skeletal maturity (lengthening group L) and 12 achondroplasia patients of similar height and age who did not undergo tibial lengthening (control group C). The mean amount of lengthening of tibia in group L was 9.2 cm (lengthening percentage: 60%) and the mean age at the time of lengthening was 8.2 years. The mean duration of follow-up was 9.8 years. Results Skeletal maturity (fusion of physis) occurred at 15.2 years in group L and at 16.0 years in group C. The actual length of tibia (without distraction) at skeletal maturity was 238 mm in group L and 277 mm in group C (p = 0.03). The mean growth rates showed a decrease in group L relative to group C from about 2 years after surgery. Physeal closure was most pronounced on the anterolateral proximal tibial physis, with relative preservation of the distal physis. Interpretation Our findings indicate that physeal growth rate can be disturbed after tibial lengthening in achondroplasia, and a close watch should be kept for such an occurrence—especially when lengthening of more than 50% is attempted. PMID:22489887

  20. Concave distal end of ulna metaphysis alone is not a sign of rickets

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    Oestreich, Alan E. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, 5031, Cincinnati, OH (United States)

    2015-07-15

    Statements have been made in the literature and in legal testimony that misrepresent the radiographic finding of concave distal end of the ulnar metaphysis. To demonstrate that a concave distal end of the ossified ulna in infancy can be normal. Eighty distal wrists of randomly selected infants in the first year of life with radiographic evidence that ruled out rickets were reviewed. In 16 of the cases (20%), mild or moderate concavity of the distal end of the ulna was seen. An intact metaphyseal collar of distal radius or ulna confirmed the absence of radiographic rickets. The finding of 20% of concave distal ulnas in the first year of life confirms the widely acknowledged statements that concave distal end of the ulna alone is not indicative of rickets. Statements to the contrary are not justified. (orig.)

  1. Atypical presentation of popliteal artery entrapment syndrome: involvement of the anterior tibial artery.

    Science.gov (United States)

    Bou, Steven; Day, Carly

    2014-11-01

    Popliteal artery entrapment syndrome (PAES) is a rare condition that should be suspected in a young patient with exertional lower extremity pain. We report the case of an 18-year-old female volleyball player with bilateral exertional lower extremity pain who had been previously diagnosed with tendinitis and periostitis. Diagnostic studies showed entrapment of the left popliteal artery and the left anterior tibial artery. To our knowledge, there has only been 1 previous report of anterior tibial artery involvement in PAES.

  2. Tibial shaft fracture

    DEFF Research Database (Denmark)

    Larsen, Peter

    IV also showed a significant worse outcome in 3 of the 5 KOOS subscales compared to a reference population at 12-months follow-up. Moreover, this study showed that increasing difference in muscle strength for knee extension between legs was associated with a decreasing QOL. The results of this thesis...... suggested that regaining pre injured QOL and muscle strength following a tibial shaft fracture takes considerable time....

  3. Fraturas do planalto tibial Tibial plateau fractures

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    Maurício Kfuri Júnior

    2009-01-01

    Full Text Available As fraturas do planalto tibial são lesões articulares cujos princípios de tratamento envolvem a redução anatômica da superfície articular e a restauração funcional do eixo mecânico do membro inferior. Contribuem para a tomada de decisões no tratamento dessas fraturas o perfil do paciente, as condições do envelope de tecidos moles, a existência de outros traumatismos associados e a infraestrutura disponível para abordagens cirúrgicas. Para as fraturas de alta energia, o tratamento estagiado, seguindo o princípio do controle de danos, tem como prioridade a manutenção do alinhamento do membro enquanto se aguarda a resolução das más condições de tecidos moles. Já nos traumas de baixa energia, desde que os tecidos moles não sejam um fator adverso, o tratamento deve ser realizado em tempo único, com osteossíntese definitiva. Fixação estável e movimento precoce são variáveis diretamente relacionadas com os melhores prognósticos. Desenvolvimentos recentes, como os implantes com estabilidade angular, substitutos ósseos e imagens tridimensionais para controle intraoperatório, deverão contribuir para cirurgias menos invasivas e melhores resultados.Tibial plateau fractures are joint lesions that require anatomical reduction of joint surface and functional restoration of mechanical axis of a lower limb. Patient profile, soft tissue conditions, presence of associated injuries and the available infrastructure for the treatment all contribute to the decision making about the best treatment for these fractures. High-energy fractures are usually approached in a staged manner respecting the principle of damage control, and are primarily targeted to maintain limb alignment while the resolution unfavorable soft tissue conditions is pending. Low-energy trauma can be managed on a single-stage basis, provided soft tissues are not an adverse factor, with open reduction and internal f-ixation. Stable fixation and early painless joint

  4. [Treatment of tibial pseudoarthrosis. Complications after intramedullary, allogeneic fibular grafting].

    Science.gov (United States)

    Helfen, T; Prall, W C; Mutschler, W; Thaller, P H

    2015-04-01

    A 24-year-old woman underwent cosmetic bilateral tibial lengthening with severe complications. In all, 15 operations, including allogeneic fibular grafting of both tibia, were required to treat unstable bilateral non-union, malalignment, and osteomyelitis of the right tibia.The present article describes the surgical strategy of revision to achieve good recovery with full consolidation and proper alignment of the lower leg. Furthermore, the indications for allogeneic bone grafting, which was described by Erich Lexer 100 years ago, are discussed. For surgical revision, a T-external fixator was used on the right leg, while a customized tibial nail was used on the left leg. Using these techniques, full consolidation and proper alignment was achieved. Allogeneic bone grafts in upper extremity defects cannot be recommended.

  5. Collagen turnover after tibial fractures

    DEFF Research Database (Denmark)

    Joerring, S; Krogsgaard, M; Wilbek, H;

    1994-01-01

    collagen. A group comparison showed characteristic sequential changes in the turnover of types I and III collagen in fractures of the tibial diaphysis and tibial condyles. The turnover of type III collagen reached a maximum after 2 weeks in both groups. The synthesis of type I collagen reached a maximum......Collagen turnover after tibial fractures was examined in 16 patients with fracture of the tibial diaphysis and in 8 patients with fracture in the tibial condyle area by measuring sequential changes in serological markers of turnover of types I and III collagen for up to 26 weeks after fracture....... The markers were the carboxy-terminal extension peptide of type I procollagen (PICP), the amino-terminal extension peptide of type III procollagen (PIIINP), and the pyridinoline cross-linked carboxy-terminal telopeptide of type I collagen (ICTP). The latter is a new serum marker of degradation of type I...

  6. Giant Cell Tumor of Bone: Documented Progression over 4 Years from Its Origin at the Metaphysis to the Articular Surface

    Directory of Open Access Journals (Sweden)

    Colin Burke

    2016-01-01

    Full Text Available The exact location of origin for giant cell tumors of bone (GCTB remains controversial, as lesions are not routinely imaged early but rather late when the tumor is large and clinically symptomatic. At the time of diagnosis, GCTB are classically described as lucent, eccentric lesions with nonsclerotic margins, located within the epiphysis to a greater extent than the metaphysis. Here we present a case of a biopsy proven GCTB initially incidentally seen on MRI as a small strictly metaphyseal lesion, which over the course of several years expanded across a closed physis to involve the epiphysis and abut the articular surface/subchondral bone plate.

  7. Medial tibial stress syndrome.

    Science.gov (United States)

    Reshef, Noam; Guelich, David R

    2012-04-01

    MTSS is a benign, though painful, condition, and a common problem in the running athlete. It is prevalent among military personnel, runners, and dancers, showing an incidence of 4% to 35%. Common names for this problem include shin splints, soleus syndrome, tibial stress syndrome, and periostitis. The exact cause of this condition is unknown. Previous theories included an inflammatory response of the periosteum or periosteal traction reaction. More recent evidence suggests a painful stress reaction of bone. The most proven risk factors are hyperpronation of the foot, female sex, and history of previous MTSS. Patient evaluation is based on meticulous history taking and physical examination. Even though the diagnosis remains clinical, imaging studies, such as plain radiographs and bone scans are usually sufficient, although MRI is useful in borderline cases to rule out more significant pathology. Conservative treatment is almost always successful and includes several options; though none has proven more superior to rest. Prevention programs do not seem to influence the rate of MTSS, though shock-absorbing insoles have reduced MTSS rates in military personnel, and ESWT has shortened the duration of symptoms. Surgery is rarely indicated but has shown some promising results in patients who have not responded to all conservative options.

  8. Implanting hydroxyapatite-coated porous titanium with bone morphogenetic protein-2 and hyaluronic acid into distal femoral metaphysis of rabbits

    Institute of Scientific and Technical Information of China (English)

    PENG Lei; BIAN Wei-guo; LIANG Fang-hui; XU Hua-zi

    2008-01-01

    Objective: To assess the osseointegration capability of hydroxyapatite-coated porous titanium with bone morphogenetic protein-2 (BMP-2) and hyaluronic acid to repair defects in the distal femur metaphysis in rabbits. Methods: Porous titanium implants were made by sintering titanium powder at high temperature, which were coated with hydroxyapatite by alkali and heat treatment and with BMP-2 combined with bone regeneration materials. And hyaluronic acid was further used as delivery system to prolong the effect of BMP-2. The implants were inserted into the metaphysis of the distal femur of rabbits. The animals were killed at 6, 12 and 24 weeks to accomplish histological and biomechanical analyses. Results: According to the result of histological analysis, the osseointegration in BMP-2 group was better than that of the HA-coated porous titanium group. In push-out test, all the samples had bigger shear stress as time passed by. There was statistical difference between the two groups in 6 and 12 weeks but not in 24 weeks. Conclusion: Hydroxyapatite-coated porous titanium with BMP-2 and hyaluronic acid has a good effect in repairing defects of distal fumur in rabbits, which is a fine biotechnology for future clinical application.

  9. Distal tibial fracture: An ideal indication for external fixation using locking plate

    Institute of Scientific and Technical Information of China (English)

    Jing-wei Zhang; Nabil A.Ebraheim; Ming Li; Xian-Feng He; Joshua Schwind; Li-Mei Zhu; Yi-Hui Yu

    2016-01-01

    Objective:To evaluate the feasibility and efficiency of one-stage external fixation by using locking plate in distal tibial fractures.Methods:In this non-control prospective study,28 patients with distal tibial fractures were included and underwent one-stage external fixation by using locking plate.There were 21 males and 7 females,with a mean age of 43 years (19-63).According to AO/OTA fracture classification,there were 9 cases of Type A1,9 of Type A2,10 of Type A3 fractures.There were 21 close and 7 open fractures.The locking plate was placed on the anteromedial aspect of the tibia with 4-5 bicortical screws inserted in both distal metaphysis and diaphysis.The radiographic and clinic results were evaluated.Results:All patients were followed up for the average of 16 months (ranging from 12 to 21 months).The average surgery duration was 38 (25-60) minutes.The mean time to fracture healing were 14.6 ± 2.67,17.5 ± 3.66,and 18.4 ± 3.37 (p < 0.05) weeks in type A1,A2,and A3 fractures respectively.By the end of the follow-ups,the mean AOFAS score were 96.11 ± 2.32,92.67 ± 1.80 and 92.00 ± 2.06 (p > 0.05) in type A1,A2,and A3 fractures respectively.None of nonunion,deep infection,or breakage of screw or plate were observed.Conclusions:Distal tibial fracture was the ideal indication for external fixation using locking plate.The external plating is characterized by ease of performance,less invasive,fewer soft tissue impingement,improved cosmesis,and convenient for removal.

  10. Measurement of tibial slope angle after medial opening wedge high tibial osteotomy: case series

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    Ricardo Hideki Yanasse

    Full Text Available CONTEXT AND OBJECTIVE: In the past, changes in tibial slope were not considered when planning or evaluating osteotomies, and success in high tibial osteotomy was related to the alignment and amount of femorotibial angular correction. The aim here was to measure changes in tibial slope after medial opening wedge tibial osteotomy and investigate the effect of tibial slope angle on the clinical results. DESIGN AND SETTING: Retrospective review study on a series of cases, at the Department of Orthopedics and Traumatology, Faculdade de Medicina de Marília (Famema, Marília, Brazil. METHODS: Twenty-eight patients were studied, and a total of thirty-one knees. Lateral roentgenograms of the tibia were used pre and postoperatively to measure the tibial slope based on the proximal tibial anatomical axis. The clinical results were measured using the Lysholm knee score. RESULTS: There was an average increase in tibial slope angle after surgery of 2.38° (95% confidence interval: ± 0.73°. There was no correlation (r = -0.28 between the postoperative Lysholm knee score and the difference in tibial slope angle from before to after surgery (P = 0.13. CONCLUSION: Medial opening wedge tibial osteotomy led to a small increase in tibial slope. No significant correlation was found between increased tibial slope and short-term clinical results after high tibial osteotomy. Other clinical studies are needed in order to establish whether extension or flexion osteotomy could benefit patients with medial compartment gonarthrosis.

  11. Proximal Tibial Epiphysis Injury (Flexion Type, Salter–Harris Type 1)

    Science.gov (United States)

    Israni, Pratik; Panat, Mangesh

    2016-01-01

    Introduction: Fractures of the proximal tibial epiphysis rare. It has been estimated that fractures of the upper tibial epiphysis account for 0.5-3.1% of all epiphyseal injuries. Who had no neurovascular deficit, with fixed extension deformity at the left knee was treated early with closed reduction techniques. Case Report: We present a case of a 16-year-old boy who while playing cricket on the road was hit by a car. The patient presented in emergency room with extremely swollen knee and soft tissue swelling (hemarthrosis), he was unable to lift his leg actively due to severe pain because of hamstrings spasm, and he had no wound over his left knee and had no other associated injuries. Plain radiographs were taken which revealed, separated proximal tibial epiphysis (salter harris Type 1 injury) The epiphysis was anteriorly displaced fracture line extending beyond growth plate through metaphysis and tibial tuberosity also displaced anteriorly, the proximal fibular epiphysis fragment was displaced anteriorly with no injury to femoral epiphysis and no patellar fracture, radiograph also revealed no intra-articular fracture as joint appears congruent. Under spinal anesthesia, under all aseptic precautions traction was applied for few minutes, the fracture was reduced closed as the hamstring spasm gave way, reduction was confirmed under image intensifier in both AP and lateral planes, and joint congruity was examined. Proximal fibular epiphysis also snapped back in place. Post-operative patient was immobilized with nil weight bearing for 4 weeks, check X-rays taken, he was mobilized in wheelchair. After 4 weeks slab was removed, K-wires were removed, and partial weight bearing was started with rehabilitation for full range of motion of the left knee. At 6 weeks, both the knee joints appeared symmetrical with no abnormalities or limb length discrepancy or instability with knee from 0° to 140°, with full weight bearing. Conclusion: Although less commonly seen, Salter

  12. Triple plating of tibia in a complex bicondylar tibial plateau fracture

    Institute of Scientific and Technical Information of China (English)

    Atin Jaiswal; Naiman Deepak Kachchhap; Yashwant S Tanwar; Birendra Kumar; Sachin K Yadav

    2014-01-01

    High-energy tibial plateau fracture poses a significant challenge and difficulty for orthopaedic surgeons.Fracture of tibial plateau involves major weight bearing joint and may alter knee kinematics.Anatomic reconstruction of the proximal tibial articular surfaces,restoration of the limb axis (limb alignment) and stable fixation permitting early joint motion are the goals of the treatment.In cases of complex bicondylar tibial plateau fractures,isolated lateral plating is frequently associated with varus malalignment and better results have been obtained with bilateral plating through dual incisions.However sometimes a complex type of bicondylar tibial plateau fractures is encountered in which medial plateau has a biplaner fracture in posterior coronal plane as well as sagittal plane.In such fractures it is imperative to fix the medial plateau with buttressing in both planes.One such fracture pattern of the proximal tibia managed by triple plating through dual posteromedial and anterolateral incisions is discussed in this case report with emphasis on mechanisms of this type of injury,surgical approach and management.

  13. Electron microscopic studies on the uptake of exogenous marker particles by different cell types in the guinea pig metaphysis.

    Science.gov (United States)

    Thyberg, J

    1975-01-01

    Guinea pig metaphyseal bone was exposed to horse spleen ferritin in vitro and to colloidal thorium dioxide in vivo. The cellular uptake and intracellular accumulation of these marker particles were studied ultrastructurally. In vitro, the ferritin molecules were found to spread evely throughout the tissue. After 1-2 hours ferritin was mainly found in plasma membrane invaginations and in endocytic vesicles of varying size. At 4-6 hours a successive accumulation of the marker in secondary lysosomes could be observed. In addition to ferritin, the lysosomes and the large endocytic vesicles often contained other inclusions. In vivo, the pattern of intracellular accumulation of the marker particles was identical to that in vitro. Moreover, the presence within the cells of similar amounts of thorium dioxide after 1 and 4 days suggested that these indigestible molecules are stored intracellularly for a considerable time. In accordance therewith there were no definite signs of extrusion of labeled bodies or secretion of the exogenous marker by exocytosis. Ferritin and thorium dioxide were taken up by all cell types in the metaphysis. Both in vitro and in vivo perivascular cells type B ingested large amounts of marker particles, whereas chondroclasts, endothelial cells. perivascular cells type A and osteoblasts showed a more restricted endocytizing ability. On the basis of these observations, the functional significance of different cell types in the resorption of the epiphyseal cartilage and the formation of bone is discussed.

  14. Tibial hyperostosis: A diagnostic approach

    Energy Technology Data Exchange (ETDEWEB)

    Touraine, Sébastien, E-mail: sebastien.touraine@lrb.aphp.fr [Radiologie ostéo-articulaire, Hôpital Lariboisière, 2 rue Ambroise Paré, 75475 Paris Cedex 10 (France); Parlier-Cuau, Caroline, E-mail: caroline.parlier@lrb.aphp.fr [Radiologie ostéo-articulaire, Hôpital Lariboisière, 2 rue Ambroise Paré, 75475 Paris Cedex 10 (France); Bousson, Valérie, E-mail: valerie.bousson@lrb.aphp.fr [Radiologie ostéo-articulaire, Hôpital Lariboisière, 2 rue Ambroise Paré, 75475 Paris Cedex 10 (France); Sverzut, Jean-Michel, E-mail: jmsverzut21@hotmail.com [Radiologie ostéo-articulaire, Hôpital Lariboisière, 2 rue Ambroise Paré, 75475 Paris Cedex 10 (France); Centre d’imagerie du centre cardiologique du Nord, 32-36 rue des Moulins Gémeaux, 93200 Saint-Denis (France); Genah, Idan, E-mail: idan.genah@lrb.aphp.fr [Radiologie ostéo-articulaire, Hôpital Lariboisière, 2 rue Ambroise Paré, 75475 Paris Cedex 10 (France); and others

    2013-12-01

    Tibial hyperostosis may be encountered in musculoskeletal imaging, incidentally or during the investigation of a leg pain. Hyperostosis involves the exuberant production of osseous tissue and results in cortical, periosteal and/or endosteal thickening of the bone. As a long bone with thick cortices, the tibia has a significant probability of being affected by ubiquitous bone diseases. As a tubular long bone, the tibia is likely to be involved in extensive infectious conditions such as osteomyelitis. As a bone of the lower limb, the tibia undergoes high stresses and may be affected by decrease in bone strength or repetitive submaximal stress. The tibia is also particularly involved in some bone sclerosing dysplasias and Paget's disease. In this work, we aim at highlighting the main conditions leading to tibial hyperostosis and try to provide key elements to narrow down the several diagnostic possibilities. Osteoid osteomas, fatigue or insufficiency fractures, infectious conditions, vascular lesions, sclerosing bone dysplasias and Paget's disease represent the main challenging diagnoses to discuss.

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

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    Milenković Saša

    2013-01-01

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

  16. Chronic shin splints. Classification and management of medial tibial stress syndrome.

    Science.gov (United States)

    Detmer, D E

    1986-01-01

    A clinical classification and treatment programme has been developed for chronic medial tibial stress syndrome. Medial tibial stress syndrome has been reported to be either tibial stress fracture or microfracture, tibial periostitis, or distal deep posterior chronic compartment syndrome. Three chronic types exist and may coexist: Type I (tibial microfracture, bone stress reaction or cortical fracture); type II (periostalgia from chronic avulsion of the periosteum at the periosteal-fascial junction); and type III (chronic compartment syndrome syndrome). Type I disease is treated nonoperatively. Operations for resistant types II and III medial tibial stress syndrome were performed in 41 patients. Bilaterality was common (type II, 50% type III, 88%). Seven had coexistent type II/III; one had type I/II. Preoperative symptoms averaged 24 months in type II, 6 months in type III, and 33 months in types II/III. Mean age was 22 years (15 to 51). Resting compartment pressures were normal in type II (mean 12 mm Hg) and elevated in type III and type II/III (mean 23 mm Hg). Type II and type II/III patients received fasciotomy plus periosteal cauterisation. Type III patients had fasciotomy only. All procedures were performed on an outpatient basis using local anaesthesia. Follow up was complete and averaged 6 months (2 to 14 months). Improved performance was as follows: type II, 93%, type III, 100%; type II/III, 86%. Complete cures were as follows: type II, 78%; type III, 75%; and type II/III, 57%. This experience suggests that with precise diagnosis and treatment involving minimal risk and cost the athlete has a reasonable chance of return to full activity.

  17. Bilateral lower limb amputations as a result of landmine injuries.

    Science.gov (United States)

    Atesalp, A S; Erler, K; Gür, E; Köseğlu, E; Kirdemir, V; Demiralp, B

    1999-04-01

    Landmine explosions cause most of the war injuries in the battlefield. Amputations resulting from severe injuries reveal serious problems despite the improvements in surgery. Bilateral lower limb amputations have more impact than unilateral on social life. Some 29 cases with lower limb amputations due to landmine injuries were treated in the Department of Orthopaedics and Traumatology, Gülhane Military Medical Academy between January 1992 and December 1996. Amputation levels were as follows: 1 case had hip disarticulation and a trans-femoral amputation, 6 had bilateral trans-femoral amputations, 6 had trans-femoral and trans-tibial amputations, 12 had bilateral trans-tibial amputations, 1 had trans-femoral and Chopart amputations and the remaining 3 cases had trans-tibial and Chopart amputations. The initial treatment was done for all cases in the first 6-8 hours after injury at the field hospitals. Aggressive debridement, excision and primary closure were performed. None of the stumps required reamputations and/or revision. No case had gas gangrene or tetanus. Postoperative, pre-prosthetic training programme which ranged between 30-120 days with an average 48 days; and prosthesis fitting and adequate post-prosthetic training programme which ranged 32-126 (average 94) days was applied. All the cases were followed-up with a mean of 38.5 months (14-72 months). Nine (9) cases (31%) returned to their previous occupation, while 20 (69%) cases had to change their jobs.

  18. Bilateral high division of sciatic nerve

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    K. Shwetha

    2014-08-01

    Full Text Available Sciatic nerve is the thickest nerve in the body formed by the sacral plexus from L4 to S3 in the lesser pelvis. It emerges through the greater sciatic foramen below the piriformis and enter the gluteal region. Then the nerve passes on the back of the thigh and at the level of superior angle of popliteal fossa it terminates by dividing into tibial and common peroneal nerve. The knowledge of anatomical variations in the division of nerve is important for various surgical and anaesthetic procedures. During routine dissection in the department of anatomy, Mysore Medical College and Research Institute, Mysore, a rare bilateral high division of sciatic nerve was observed in a female cadaver aged about 40 years. In the present case there was bilateral high division of sciatic nerve. The nerve was seen dividing into two branches before it emerges through the greater sciatic foramen. The tibial nerve was entering the gluteal region below the piriformis muscle and common peroneal nerve was entering by piercing the piriformis. The knowledge of this variation is important as the nerve may get compressed with surrounding anatomical structures resulting in non discogenic sciatica. The awareness of variations is important for surgeons during various procedures like fracture, posterior dislocation of hip joint and hip joint replacement. The anatomical variations are important during deep intramuscular injections in gluteal region and also for anaesthetists during sciatic nerve block. [Int J Res Med Sci 2014; 2(4.000: 1785-1787

  19. Tibial cortical lesions: A multimodality pictorial review

    Energy Technology Data Exchange (ETDEWEB)

    Tyler, P.A., E-mail: philippa.tyler@rnoh.nhs.uk [Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore HA7 4LP (United Kingdom); Mohaghegh, P., E-mail: pegah1000@gmail.com [Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore HA7 4LP (United Kingdom); Foley, J., E-mail: jfoley1@nhs.net [Department of Radiology, Glasgow Royal Infirmary, 16 Alexandra Parade, Glasgow G31 2ES (United Kingdom); Isaac, A., E-mail: amandaisaac@doctors.org.uk [Department of Radiology, King' s College Hospital, Denmark Hill, London SE5 9RS (United Kingdom); Zavareh, A., E-mail: ali.zavareh@gmail.com [Department of Radiology, North Bristol NHS Trust, Frenchay, Bristol BS16 1LE (United Kingdom); Thorning, C., E-mail: cthorning@doctors.org.uk [Department of Radiology, East Surrey Hospital, Canada Avenue, Redhill, Surrey RH1 5RH (United Kingdom); Kirwadi, A., E-mail: anandkirwadi@gmail.com [Department of Radiology, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL (United Kingdom); Pressney, I., E-mail: ipressney@hotmail.com [Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore HA7 4LP (United Kingdom); Amary, F., E-mail: fernanda.amary@rnoh.nhs.uk [Department of Histopathology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore HA7 4LP (United Kingdom); Rajeswaran, G., E-mail: grajeswaran@gmail.com [Department of Radiology, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH (United Kingdom)

    2015-01-15

    Highlights: • Multimodality imaging plays an important role in the investigation and diagnosis of shin pain. • We review the multimodality imaging findings of common cortically based tibial lesions. • We also describe the rarer pathologies of tibial cortical lesions. - Abstract: Shin pain is a common complaint, particularly in young and active patients, with a wide range of potential diagnoses and resulting implications. We review the natural history and multimodality imaging findings of the more common causes of cortically-based tibial lesions, as well as the rarer pathologies less frequently encountered in a general radiology department.

  20. Measurement of tibial torsion by computer tomography

    Energy Technology Data Exchange (ETDEWEB)

    Jend, H.H.; Heller, M.; Dallek, M.; Schoettle, H. (Hamburg Univ. (Germany, F.R.))

    1981-01-01

    A CT procedure for objective measurements of tibial torsion independent of axial rotation in the nearby joints is described. Transverse sections in defined planes of the tibia permit easy calculation of normal and abnormal congenital or posttraumatic angles of torsion. In 69 limbs normal tibial torsion was 40/sup 0/+-9/sup 0/. In a series of 42 limbs with complicated healing of a fracture of both bones of the leg it is shown that tibial maltorsion is a deformity which in most cases leads to arthrosis of the ankle joint.

  1. TIBIAL BONE DENSITY IN ATHLETES WITH MEDIAL TIBIAL STRESS SYNDROME: A CONTROLLED STUDY

    Directory of Open Access Journals (Sweden)

    Cengizhan Özgürbüz

    2011-12-01

    Full Text Available Medial tibial stress syndrome (MTSS is a common overuse injury of the lower extremity predominantly observed in weight bearing activities. Knowledge about the pathological lesions and their pathophysiology is still limited. Only a single study was found to have investigated tibial bone density in the pain region, revealing lower density in athletes with long standing (range, 5-120 month MTSS. In a follow-up study, bone density was determined to return to normal levels after recovery. The purpose of the present study was to investigate tibial bone density in athletes with shorter MTSS history (range, 3-10 weeks. A total of 11 athletes (7 males, 4 females diagnosed with medial tibial stress syndrome were included in the study. The control group consisted of 11 regularly exercising individuals (7 males, 4 females. Tibial, femoral and vertebral bone densities were measured by dual energy x-ray absorptiometry. Total calcium intake was calculated by evaluating detailed nutrition history. No statistically significant differences were found in the tibial, femoral and vertebral bone densities between the groups. No statistically significant difference was found among groups, considering for calcium intake. Tibial bone densities were not lower in athletes with MTSS of 5.0 weeks mean duration (range, 3-10 weeks compared to the healthy control group. Longitudinal studies with regular tibial bone density measurements in heavily trained athletes are necessary to investigate tibial density alterations in MTSS developing athletes during the course of the symptoms

  2. Bilateral ankle edema with bilateral iritis.

    Science.gov (United States)

    Kumar, Sunil

    2007-07-01

    I report two patient presented to me with bilateral symmetrical ankle edema and bilateral acute iritis. A 42-year-old female of Indian origin and 30-year-old female from Somalia both presented with bilateral acute iritis. In the first patient, bilateral ankle edema preceded the onset of bilateral acute iritis. Bilateral ankle edema developed during the course of disease after onset of ocular symptoms in the second patient. Both patients did not suffer any significant ocular problem in the past, and on systemic examination, all clinical parameters were within normal limit. Lacrimal gland and conjunctival nodule biopsy established the final diagnosis of sarcoidosis in both cases, although the chest x-rays were normal.

  3. Bilateral Duane syndrome and bilateral aniridia.

    Science.gov (United States)

    Khan, Arif O; Aldahmesh, Mohammad

    2006-06-01

    Duane retraction syndrome has been reported in association with structural abnormalities of the eye, including epibulbar dermoid, keratoconus, iris dysplasia, heterochromia iridis, persistent fetal vasculature, cataract, choroidal coloboma, microphthalmia, and optic nerve dysplasia. A novel association, that of bilateral Duane syndrome with bilateral aniridia, is the subject of this report.

  4. Short-term survival analysis of the all-polyethylene tibial component in total knee arthroplasty

    Institute of Scientific and Technical Information of China (English)

    SHEN Bin; YANG Jing; PEI Fu-xing

    2005-01-01

    Objective: To report the clinical and radiological results of 24 total knee arthroplasty in which all-polyethylene tibial components were used. Methods: Between December 2000 and December 2002, 24 cemented total knee arthroplasty in 21 patients were performed using all-polyethylene tibial components. The mean age of the 21 patients (9 men and 12 women) at operation was 55 years, ranging 48-61 years. The mean preoperative hospital for special surgery (HSS)score was 40.2 (range, 36-43). The diagnoses were degenerative osteoarthritis in 15 patients, rheumatoid arthritis in 5 and traumatic arthritis in 1. All the operations were performed by the same surgeon group and there were unilateral operations in 18 patients and bilateral operations in 3.Results: Eighteen patients were followed up with a follow-up rate of 85.7%. The mean follow-up is 2.5 years (range, 1-3 years) and mean postoperative HSS scores was 87.5 (range, 83-89). Among them, 18 were excellent, 3 good, 3 poor and none was fair (the results of three lost patients were classified as poor). Of those reviewed, the prosthesis was all in situ and no revision occurred. Radiological assessment of these patients revealed 4 (16.67%) tibial components with radiolucent lines (mean width≤2 mm) distributed mainly in zone 1 and zone 4. None of these knees was symptomatic.Conclusions: The result of total knee arthroplasty using all-polyethylene tibial components is encouraging. The operative techniques are similar to those in arthroplasty using metal-backed tibial component.

  5. Tibial bone density in athletes with medial tibial stress syndrome: a controlled study.

    Science.gov (United States)

    Ozgürbüz, Cengizhan; Yüksel, Oğuz; Ergün, Metin; Işlegen, Cetin; Taskiran, Emin; Denerel, Nevzad; Karamizrak, Oğuz

    2011-01-01

    Medial tibial stress syndrome (MTSS) is a common overuse injury of the lower extremity predominantly observed in weight bearing activities. Knowledge about the pathological lesions and their pathophysiology is still limited. Only a single study was found to have investigated tibial bone density in the pain region, revealing lower density in athletes with long standing (range, 5-120 month) MTSS. In a follow-up study, bone density was determined to return to normal levels after recovery. The purpose of the present study was to investigate tibial bone density in athletes with shorter MTSS history (range, 3-10 weeks). A total of 11 athletes (7 males, 4 females) diagnosed with medial tibial stress syndrome were included in the study. The control group consisted of 11 regularly exercising individuals (7 males, 4 females). Tibial, femoral and vertebral bone densities were measured by dual energy x-ray absorptiometry. Total calcium intake was calculated by evaluating detailed nutrition history. No statistically significant differences were found in the tibial, femoral and vertebral bone densities between the groups. No statistically significant difference was found among groups, considering for calcium intake. Tibial bone densities were not lower in athletes with MTSS of 5.0 weeks mean duration (range, 3-10 weeks) compared to the healthy control group. Longitudinal studies with regular tibial bone density measurements in heavily trained athletes are necessary to investigate tibial density alterations in MTSS developing athletes during the course of the symptoms. Key pointsTibial, femoral and vertebral bone densities were measured by dual energy x-ray absorptiometry.No differences were found between the MTSS group (MTSS history 3-10 weeks) and the healthy athletes group.

  6. Bilateral orbital cavernous haemangiomas.

    OpenAIRE

    Fries, P D; Char, D. H.

    1988-01-01

    Simultaneous bilateral orbital lesions are rare. The differential diagnosis includes orbital pseudotumour, metastasis, leukaemia, lymphoma, Wegener's granulomatosis, and neurofibromatosis. We report what we believe to be the first case of bilateral orbital cavernous haemangiomas.

  7. Bilateral otogenic cerebellar abscesses.

    Directory of Open Access Journals (Sweden)

    Nadkarni T

    1993-01-01

    Full Text Available An unusual presentation of bilateral otogenic cerebellar abscesses observed in two of our patients is reported. Both gave a history of otorrhoea, fever, headache, vomiting and had bilateral cerebellar signs and conductive hearing loss. The abscesses were detected on computerised tomography. X-rays revealed bilateral mastoiditis. The therapy followed was excision of abscesses, mastoidectomy and antibiotic therapy.

  8. Hydroxyapatite-enhanced tibial prosthetic fixation.

    Science.gov (United States)

    Toksvig-Larsen, S; Jorn, L P; Ryd, L; Lindstrand, A

    2000-01-01

    Sixty-two knees (60 patients) were randomized to four noncemented groups. In Groups 1, 3, and 4, the bone cuts were made with a cooled saw blade. In Group 1, 15 patients were operated on with the porous coated Osteonic 7000 tibial component. In Group 2, 15 patients were operated on with the same tibial component as in Group 1 but with the use of a standard saw blade. In Group 3, 16 patients were operated on with the hydroxyapatite-coated Osteonic tibial component, and in Group 4, 16 patients were operated on with the hydroxyapatite Duracon tibial component. All patients were followed up clinically and with roentgenstereometric analysis. There were no differences among the groups regarding clinical outcome. One knee was revised (Group 2) after 1 year because of loosening of the tibial component. The maximum migration at 1 year was 1.7 mm in Group 1, 1.9 mm in Group 2, 1.3 mm in Group 3, and 1 mm in Group 4. At the 2-year followup, the migrations were 1.8 mm, 1.5 mm, 1.4 mm, and 1 mm in Groups 1, 2, 3, and 4, respectively. The inducible displacement that occurred at 1 year was 0.6 mm in Group 1, 0.5 mm in Group 2, 0.4 mm in Group 3, and 0.4 mm in Group 4. The hydroxyapatite coating had a strong positive effect on the tibial component fixation. No prosthesis in the hydroxyapatite groups showed continuous migration.

  9. The importance of tibial alignment: finite element analysis of tibial malalignment.

    Science.gov (United States)

    Perillo-Marcone, A; Barrett, D S; Taylor, M

    2000-12-01

    The influence of the tibial plateau orientation on cancellous bone stress was examined by finite element analysis for a cemented device. The objectives of the study were i) to examine the effect of the plateau-ankle angle on the cancellous bone stress, ii) to analyze the significance of the anteroposterior angles of the tibial component on these stresses, and iii) to compare the finite element predictions with clinical data. In general, positioning the tibial plateau in valgus resulted in lower cancellous bone stresses. These results support previous clinical studies, which suggest that overall alignment in valgus results in lower migration rates and lower incidence of loosening.

  10. Bilateral variant of sciatic nerve exhibiting intra-pelvic division

    Directory of Open Access Journals (Sweden)

    Rejeena P Raj, Kunjumon PC, More Anju B

    2014-04-01

    Full Text Available Context (background: In case of high division of the sciatic nerve in the pelvis its, common peroneal component may pierce the Piriformis muscle. This anatomical variant can explain many clinical findings. Aims: Its objective is to report a case of high division of the sciatic nerve in order to contribute towards better anatomical understanding of the gluteal region. Methods and Material: Routine undergraduate dissection of a male cadaver revealed bilateral variation in sciatic nerve. Results: Sciatic nerve is dividing into tibial and common peroneal components in the pelvis. Common peroneal component is piercing through the piriformis muscle. Tibial component is emerging between piriformis and superior gemelli muscle. Conclusions: Sciatic nerve variation can lead to a Piriformis muscle syndrome, inadvertent injury during operations in the gluteal region, failure of sciatic nerve block and/or sciatic neuropathy. The differences in routes of these two nerve components can explain them.

  11. Effects of composition of biocomposite materials implanted into hole defects of the metaphysis on the reparative regeneration and mineralization of bone tissue.

    Science.gov (United States)

    Luneva, S N; Talashova, I A; Osipova, E V; Nakoskin, A N; Emanov, A A

    2013-12-01

    We carried out a comparative analysis of morphological pattern and element composition of regenerated bone tissue forming in the metaphysis defects after substitution of these defects with calcium phosphate substance containing low-molecular non-collagen bone proteins with various affinities to ion exchangers. We have found that regenerated tissue in the defects grew from the edges to the center and its element composition depended on the maturity of newly formed bone tissue. Implantation material containing non-collagen bone proteins with various affinities to ion exchangers induced no significant changes in the content of analyzed elements of bone tissue around the defect. The content of analyzed elements in the areas distant from the defect area did not change during the experiment.

  12. Irreducible tibial pilon fracture caused by incarceration of the fibula in the tibial medullary canal.

    Science.gov (United States)

    Ellanti, Prasad; Hammad, Yassir; Kosutic, Damir; Grieve, Philip P

    2012-01-01

    Fractures can be irreducible for several reasons, including soft tissue or bone fragment interposition. We report an unusual fracture configuration of a comminuted tibial pilon fracture in which the distal fibular shaft fragment was occupying the medullary canal of the proximal tibial shaft fragment and inhibiting reduction and fixation. To the best of our knowledge, this has not been previously reported in a published study.

  13. Tibial somatosensory evoked potential can prognosticate for ambulatory function in subacute hemiplegic stroke.

    Science.gov (United States)

    Hwang, Pyoungsik; Sohn, Min Kyun; Kim, Cuk-Seong; Jee, Sungju

    2016-04-01

    Early prediction of expected recovery in stroke can help in planning appropriate medical and rehabilitation interventions. Recovery of ambulation is one of the essential endpoints in stroke rehabilitation. However, the correlation of somatosensory evoked potentials (SSEP) with clinical parameters and their predictive significance are not clearly defined. We aimed to examine the association between tibial nerve SSEP and ambulatory outcomes in subacute hemiplegic stroke patients. We reviewed medical records for hemiplegic patients with first-ever stroke who received inpatient rehabilitation from January 2009 to May 2013. We excluded patients with diabetes mellitus, quadriplegia, bilateral lesions, brainstem lesions, those aged over 80 years, and those with severe musculoskeletal problems. Tibial nerve SSEP were performed when they were transferred to the rehabilitation department. SSEP findings were divided into three groups; normal, abnormal and absent response. Berg balance scale and functional ambulation category (FAC) at discharge were compared with initial tibial SSEP findings using one-way analysis of variance. Thirty-one hemiplegic patients were included. Berg balance scale and FAC were significantly different according to the SSEP (Phemiplegic patients.

  14. TIBIAL LANDMARKS IN ACL ANATOMIC REPAIR

    Directory of Open Access Journals (Sweden)

    M. V. Demesсhenko

    2016-01-01

    Full Text Available Purpose: to identify anatomical landmarks on tibial articular surface to serve as reference in preparing tibial canal with respect to the center of ACL footprint during single bundle arthroscopic repair.Materials and methods. Twelve frozen knee joint specimens and 68 unpaired macerated human tibia were studied using anatomical, morphometric, statistical methods as well as graphic simulation.Results. Center of the tibial ACL footprint was located 13,1±1,7 mm anteriorly from posterior border of intercondylar eminence, at 1/3 of the distance along the line connecting apexes of internal and external tubercles and 6,1±0,5 mm anteriorly along the perpendicular raised to this point.Conclusion. Internal and external tubercles, as well as posterior border of intercondylar eminence can be considered as anatomical references to determine the center of the tibial ACL footprint and to prepare bone canals for anatomic ligament repair.

  15. Bilateral Diabetic Knee Neuroarthropathy in a Forty-Year-Old Patient

    Directory of Open Access Journals (Sweden)

    Patrick Goetti

    2016-01-01

    Full Text Available Diabetic osteoarthropathy is a rare cause of neuropathic joint disease of the knee; bilateral involvement is even more exceptional. Diagnosis is often made late due to its unspecific symptoms and appropriate surgical management still needs to be defined, due to lack of evidence because of the disease’s low incidence. We report the case of a forty-year-old woman with history of diabetes type I who developed bilateral destructive Charcot knee arthropathy. Bilateral total knee arthroplasty was performed in order to achieve maximal functional outcome. Follow-up was marked by bilateral tibial periprosthetic fractures treated by osteosynthesis with a satisfactory outcome. The diagnosis of Charcot arthropathy should always be in mind when dealing with atraumatic joint destruction in diabetic patients. Arthroplasty should be considered as an alternative to arthrodesis in bilateral involvement in young patients.

  16. Bilateral Diabetic Knee Neuroarthropathy in a Forty-Year-Old Patient

    Science.gov (United States)

    Gallusser, Nicolas; Borens, Olivier

    2016-01-01

    Diabetic osteoarthropathy is a rare cause of neuropathic joint disease of the knee; bilateral involvement is even more exceptional. Diagnosis is often made late due to its unspecific symptoms and appropriate surgical management still needs to be defined, due to lack of evidence because of the disease's low incidence. We report the case of a forty-year-old woman with history of diabetes type I who developed bilateral destructive Charcot knee arthropathy. Bilateral total knee arthroplasty was performed in order to achieve maximal functional outcome. Follow-up was marked by bilateral tibial periprosthetic fractures treated by osteosynthesis with a satisfactory outcome. The diagnosis of Charcot arthropathy should always be in mind when dealing with atraumatic joint destruction in diabetic patients. Arthroplasty should be considered as an alternative to arthrodesis in bilateral involvement in young patients. PMID:27668112

  17. Bilateral ekstrauterin graviditet

    DEFF Research Database (Denmark)

    Kirkegaard, Ida; Kruse, Christina

    2009-01-01

    Bilateral tubal pregnancies are extremely rare and they are usually found after assisted reproductive techniques have been applied. A rare case of bilateral tubal pregnancy after natural conception, occurring in a woman without any predisposing factors for ectopic pregnancy, is presented....... The condition was diagnosed during laparoscopic surgery, and she was optimally treated with conservative tubal surgery. A short review of the literature is provided and discussed along with the clinical features, diagnostic difficulties and treatment options of bilateral tubal pregnancy. Udgivelsesdato: 2009...

  18. Brachyphalangy, polydactyly and tibial aplasia/hypoplasia syndrome (OMIM 609945): case report and review of the literature.

    Science.gov (United States)

    Shafeghati, Yousef; Kahrizi, Kimia; Najmabadi, Hossein; Kuss, Andreas Walter; Ropers, Hans-Hilger; Tzschach, Andreas

    2010-12-01

    Brachyphalangy, polydactyly and tibial aplasia/hypoplasia syndrome (OMIM 609945) is a rare congenital disorder. Only seven patients have been reported to date, and the etiology of this syndrome is unknown. Autosomal dominant inheritance with variable expression has been suggested based on the presence of minor features in some parents and the fact that neither parental consanguinity nor pairs of affected siblings were observed. We report on the first patient with this syndrome who was born to consanguineous parents. Neither the mother nor the father, who were first cousins, had clinical features suggestive of a manifestation of brachyphalangy, polydactyly and tibial aplasia/hypoplasia syndrome. The patient had no siblings, and the family history was unremarkable. Clinical problems included brachydactyly of hands and feet, splaying of fingers and toes, preaxial polydactyly of feet, bilateral tibial aplasia, shortened radius and ulna, and characteristic facial dysmorphic signs. The detailed description of this patient adds to our knowledge of the clinical manifestations of brachyphalangy, polydactyly and tibial aplasia/hypoplasia syndrome and will eventually also contribute to the elucidation of the underlying gene defects.

  19. Proximal tibial osteophytes and their relationship with the height of the tibial spines of the intercondylar eminence: paleopathological study

    Energy Technology Data Exchange (ETDEWEB)

    Hayeri, Mohammad Reza [Children' s National Medical Center, Department of Radiology, Washington, DC (United States); Shiehmorteza, Masoud; Trudell, Debra J.; Resnick, Donald [University of California San Diego, Department of Radiology, San Diego, CA (United States); Hefflin, Tori [Museum of Man San Diego, San Diego, CA (United States)

    2010-09-15

    Tibial spiking (i.e., spurring of tibial spines), eburnation, and osteophytes are considered features of osteoarthritis. This investigation employed direct inspection of the medial and lateral tibial plateaus in paleopathological specimens to analyze the frequency and morphological features of osteoarthritis and to define any relationship between the size of osteophytes and that of the intercondylar tibial spines. A total of 35 tibial bone specimens were evaluated for the degree of osteoarthritis and presence of eburnation. Each plateau was also divided into four quadrants and the presence and size of bone outgrowths were recorded in each quadrant. The ''medial/lateral tibial intercondylar spine index'' for each specimen was calculated as follows: (medial/lateral intercondylar tibial spine height)/(anteroposterior width of the superior tibial surface). The relationships between medial and lateral tibial height indexes with the degree of osteoarthritis were then tested. Osteophytes were observed more frequently in the anterior quadrants of both tibial plateaus than in the posterior quadrants (29 vs 16 for the medial tibial plateau [p = 0.01] and 28 vs 20 for the lateral tibial plateau [p = 0.04]). Eburnation was seen more frequently in the posterior regions of both tibial plateaus than in the anterior regions (17 vs 5, p < 0.01). In specimens with no signs of osteoarthritis the lateral intercondylar tibial index was significantly lower than that in specimens with some degree of osteoarthritis (p = 0.02). The medial intercondylar tibial index of the specimens with no signs of osteoarthritis was not significantly different from that of the specimens with some degree of osteoarthritis (p = 0.45). There was a positive correlation between the lateral spine height index and the overall grading of osteoarthritis, (r = 0.6, p < 0.01). In the anteromedial and posteromedial quadrants of the lateral tibial plateau, the association between the lateral

  20. [Hemorrhagic bilateral renal angiomyolipoma].

    Science.gov (United States)

    Benjelloun, Mohamed; Rabii, Redouane; Mezzour, Mohamed Hicham; Joual, Abdenbi; Bennani, Saâd; el Mrini, Mohamed

    2003-09-01

    Renal angiomyolipoma is a rare benign tumour, often associated with congenital diseases especially de Bourneville's tuberous sclerosis. Bilateral angiomyolipoma is exceptional. The authors report a case of bilateral renal angiomyolipoma in a 33-year-old patient presenting with haemorrhagic shock. In the light of this case and a review of the literature, the authors discuss the diagnostic and therapeutic aspects of this disease.

  1. Bilateral microform cleft lip

    OpenAIRE

    Pace, David; Attard Montalto, Simon; Grech, Victor E.

    2006-01-01

    Microform cleft lip (MCL), also called congenital healed cleft lip or cleft lip "frustré", is a rare congenital anomaly. MCL has been described as having the characteristic appearance of a typical cleft lip which has been corrected in utero. We present a girl with bilateral microform cleft lip associated with a preauricular sinus and bilateral camptodactyly.

  2. Bilateral assymetric epidural hematoma

    Directory of Open Access Journals (Sweden)

    Edmundo Luis Rodrigues Pereira

    2015-01-01

    Full Text Available Background: Acute bilateral extradural hematoma is a rare presentation of head trauma injury. In sporadic cases, they represent 0.5-10% of all extradural hematomas. However, higher mortality rates have been reported in previous series. Case Description: The authors described the case of a 28-year-old male presenting head injury, comatose, Glasgow Coma Scale of 6, anisocoric pupils without puppilary light reflex. Computed tomography showed asymmetric bilateral epidural hematomas, effacement of the lateral ventricles and sulci, midline shift and a bilateral skull fracture reaching the vertex. Surgical evacuation was performed with simultaneous hematoma drainage. Patient was discharged on the 29 th postoperative day with no neurological deficit. Conclusion: The correct approach on bilateral epidural hematomas depends on the volume, moment of diagnosis, and neurological deficit level. Simultaneous drainage of bilateral hematomas has been demonstrated to be an effective technique for it, which soon decreases the intracranial pressure and promotes an efficient resolution to the neurological damage.

  3. Tibial crest fracture correction after tibial tuberosity advancement (TTA using a modified TTA technique

    Directory of Open Access Journals (Sweden)

    Tiago Carmagnani Prada

    2015-06-01

    Full Text Available Corrective osteotomies are challenging techniques that require specialized training and acquisition of specific materials. Nevertheless, they have been increasingly studied and used in clinical routine in the world. Several variations on the model and the application technique have been developed and refined in search of the improvement of surgical techniques and development of implants more affordable to purchase. The tibial tuberosity advancement (TTA consists on stabilization of tibial plateau perpendicular to the patellar tendon through the tibial tuberosity advancement. Our goal is to report a surgical complication of fracture of the tibial crest after TTA procedure. A dog with a confirmed diagnosis of rupture of the cranial cruciate ligament (CCLR was operated using conventional technique of TTA. After 3 days of surgery, the same animal had a fracture of the proximal tibial crest. The animal was sent back to surgery and was used a variation of TTA technique, with autologous iliac wing and three cortical screws. This variation of the technique was able to replace the original technique successfully.

  4. [Magnetic resonance imaging of tibial periostitis].

    Science.gov (United States)

    Meyer, X; Boscagli, G; Tavernier, T; Aczel, F; Weber, F; Legros, R; Charlopain, P; Martin, J P

    1998-01-01

    Tibial periostitis frequently occurs in athletes. We present our experience with MRI in a series of 7 patients (11 legs) with this condition. The clinical presentation and scintigraphic scanning suggested the diagnosis. MRI exploration of 11 legs demonstrated a high band-like juxta-osseous signal enhancement of SE and IR T2 weighted sequences in 6 cases, a signal enhancement after i.v. contrast administration in 4. Tibial periostitis is a clinical diagnosis and MRI and scintigraphic findings can be used to assure the differential diagnosis in difficult cases with stress fracture. MRI can visualize juxta-osseous edematous and inflammatory reactions and an increased signal would appear to be characteristic when the band-like image is fixed to the periosteum.

  5. Finite element analysis of tibial fractures

    DEFF Research Database (Denmark)

    Wong, Christian Nai En; Mikkelsen, Mikkel Peter W; Hansen, Leif Berner;

    2010-01-01

    of bony healing. The biomechanical results are the basis for fracture healing, biomechanical fall analysis and stability analysis of osteosynthesis. MATERIAL AND METHODS: A finite element model of the bony part of the lower leg was generated on the basis of computed tomography data from the Visible Human......INTRODUCTION: Fractures of the tibial shaft are relatively common injuries. There are indications that tibial shaft fractures share characteristics in terms of site, type and local fracture mechanisms. In this study, we aimed to set up a mathematical, computer-based model using finite element...... analysis of the bones of the lower leg to examine if such a model is adequate for prediction of fracture locations and patterns. In future studies, we aim to use these biomechanical results to examine fracture prevention, among others, and to simulate different types of osteosynthesis and the process...

  6. Finite element analysis of tibial fractures

    DEFF Research Database (Denmark)

    Wong, Christian Nai En; Mikkelsen, Mikkel Peter W; Hansen, Leif Berner;

    2010-01-01

    of bony healing. The biomechanical results are the basis for fracture healing, biomechanical fall analysis and stability analysis of osteosynthesis. MATERIAL AND METHODS: A finite element model of the bony part of the lower leg was generated on the basis of computed tomography data from the Visible Human...... Project. The data consisted of 21,219 3D elements with a cortical shell and a trabecular core. Three types of load of torsion, a direct lateral load and axial compression were applied. RESULTS: The finite element linear static analysis resulted in relevant fracture localizations and indicated relevant......INTRODUCTION: Fractures of the tibial shaft are relatively common injuries. There are indications that tibial shaft fractures share characteristics in terms of site, type and local fracture mechanisms. In this study, we aimed to set up a mathematical, computer-based model using finite element...

  7. Anterior Tibial Artery Pseudoaneurysm: Case Report

    Directory of Open Access Journals (Sweden)

    Funda Tor

    2012-06-01

    Full Text Available The aneurysmsatic changes of the infrapopliteal arteries are rarely seen. They are pseudoaneurysms rather than true aneursyms. The most important cause of them is trauma. There is not a standart treatment for infrapopliteal aneursyms. In this study, we have evaluated a case operated for anterior tibial artery pseudoaneurysm developed after penetrant trauma and diagnosed two weeks later. [Cukurova Med J 2012; 37(3.000: 172-175

  8. Wedged tibial components for total knee arthroplasty.

    Science.gov (United States)

    Jeffery, R S; Orton, M A; Denham, R A

    1994-08-01

    Severe coronal deformity of the knee is frequently associated with erosion of one tibial condyle. This can cause problems with fixation and alignment during total knee arthroplasty. If the tibia is cut to the level of the more worn side, valuable bone is sacrificed; if the less worn side is chosen, the deficiency must be filled with bone--graft, cement, or a prosthesis. Tibial components with an integral polyethylene wedge on the undersurface were introduced in 1980 for use in patients with a bony deficit on one tibial condyle. The authors believe that the Denham prosthesis (Biomet, Wales, U.K.) was the first knee arthroplasty to offer such spacers. Twenty-six patients with preoperative varus deformity in whom a wedged component was used were compared with 29 historic control subjects. None of the wedged components loosened after a median follow-up period of 8 years compared with loosening in five of the control subjects (P = .01). In three of the control subjects a fractured triangle of cement was present on the radiographs. Use of the wedges was not accompanied by an improvement in postoperative alignment. The authors conclude that the wedges resulted in improved fixation that was independent of postoperative alignment.

  9. Tibial Tubercle Osteotomy: Indication and Techniques.

    Science.gov (United States)

    Grawe, Brian; Stein, Beth Shubin

    2015-08-01

    Osteotomy of the tibial tubercle is a versatile procedure that can be utilized for several common pathologies about the patellofemoral joint. Most commonly, tuberosity transfer is employed for the treatment of patellar instability or symptomatic overload of the patella. The osteotomy can be combined with soft tissue realignment procedures or cartilage reconstructive techniques. A precise understanding of the surgical anatomy and the biomechanics of the patellofemoral articulation is essential for producing a successful outcome during surgery. Tailoring the direction of transfer to the pathoanatomy of each patient is critical for producing a durable and lasting result following a tibial tubercle osteotomy. When evaluating a patient for a possible transfer, a thorough history and physical evaluation must be undertaken, along with imaging to the patellofemoral joint. Several useful advanced imaging techniques can also be used to guide the surgeon toward the most appropriated osteotomy for the patient. The purpose of this article is to review the indications for performing a tibial tubercle osteotomy, and highlighting the various techniques for transfer.

  10. Pregnancy following bilateral salpingectomy

    DEFF Research Database (Denmark)

    Oturai, Annette Bang

    2008-01-01

    This report presents a rare case of spontaneous pregnancy following bilateral salpingectomy. A woman with a history of bilateral salpingectomy was admitted to hospital because of abdominal pain and positive urine HCG. Surprisingly, ultrasound confirmed a live intrauterine fetus. The pregnancy...... was unwanted, and the woman decided to terminate the pregnancy. She was offered diagnostic examination to localise a potential fistula, but she declined. In a MEDLINE search of English literature this is only the second case of spontaneous pregnancy following bilateral salpingectomy Udgivelsesdato: 2008/4/21...

  11. Bilateral Control - Operational enhancements

    OpenAIRE

    Altınışık, Ahmet; Altinisik, Ahmet

    2006-01-01

    A succinct definition of the word bilateral is having two sides [1]. In robotics the term bilateral control is used to define the specific interaction of two systems by means of position and/or force. Bilateral systems are composed of two sides named master and slave side. The aim of such an arrangement is such that position command dictated by master side is followed by a slave side, and at the same time the force sensation of the remote environment experienced by slave is transferred to the...

  12. Surgical Treatment of a Rare Isolated Bilateral Agenesis of Anterior and Posterior Cruciate Ligaments

    OpenAIRE

    2014-01-01

    The isolated bilateral agenesis of both cruciate ligaments is a rare congenital disorder. A 17-year-old male came to our attention due to an alteration in gait pattern, pain, and tendency to walk on the forefoot with his knee flexed. The patient did not recall previous injuries. Upon physical examination anterior and posterior chronic instability were observed. Radiographic examination of both knees showed hypoplasia of the tibial eminence, a hypoplastic lateral femoral condyle, and a narrow ...

  13. Staged bilateral carotid endarterectomy

    DEFF Research Database (Denmark)

    Schroeder, T; Sillesen, H; Engell, Hans Christian

    1986-01-01

    In a series of 56 staged bilateral carotid endarterectomies, new neurologic symptoms developed in 5% and 20% following the first and second procedure, respectively. All complications were transient or minor. The incidence of postendarterectomy hypertension was significantly higher following...

  14. Echinoderms have bilateral tendencies.

    Science.gov (United States)

    Ji, Chengcheng; Wu, Liang; Zhao, Wenchan; Wang, Sishuo; Lv, Jianhao

    2012-01-01

    Echinoderms take many forms of symmetry. Pentameral symmetry is the major form and the other forms are derived from it. However, the ancestors of echinoderms, which originated from Cambrian period, were believed to be bilaterians. Echinoderm larvae are bilateral during their early development. During embryonic development of starfish and sea urchins, the position and the developmental sequence of each arm are fixed, implying an auxological anterior/posterior axis. Starfish also possess the Hox gene cluster, which controls symmetrical development. Overall, echinoderms are thought to have a bilateral developmental mechanism and process. In this article, we focused on adult starfish behaviors to corroborate its bilateral tendency. We weighed their central disk and each arm to measure the position of the center of gravity. We then studied their turning-over behavior, crawling behavior and fleeing behavior statistically to obtain the center of frequency of each behavior. By joining the center of gravity and each center of frequency, we obtained three behavioral symmetric planes. These behavioral bilateral tendencies might be related to the A/P axis during the embryonic development of the starfish. It is very likely that the adult starfish is, to some extent, bilaterian because it displays some bilateral propensity and has a definite behavioral symmetric plane. The remainder of bilateral symmetry may have benefited echinoderms during their evolution from the Cambrian period to the present.

  15. Micro CT observation on femoral metaphysis after spinal cord injury and immobilization in rats%脊髓损伤早期及制动大鼠股骨干骺端的显微CT观察

    Institute of Scientific and Technical Information of China (English)

    余文超; 刘岩; 袁文; 郭永飞; 曹振羽; 邹翰林

    2011-01-01

    背景:脊髓损伤后可引起损伤平面以下骨量大量丢失,导致骨质疏松.目的:观察比较脊髓损伤及失用性制动模型大鼠股骨远端骨密度及骨微观结构的改变.方法:将SD大鼠随机分为3组:对照组,切除T10椎板,不损伤硬膜及脊髓;脊髓损伤组,切除T10椎板后行Allen's法造成脊髓损伤;制动组,以大鼠双侧腿-尾缝合造成双下肢制动.10 d后取一侧尺、桡骨及股骨行骨密度检测,另一侧股骨行显微CT扫描.结果与结论:脊髓损伤组与制动组大鼠股骨远端骨密度、骨矿物质含量、骨体积分数表、骨小梁厚度、骨皮质面积及厚度、骨小梁数量均低于对照组(P < 0.05 ),骨小梁结构模型指数、骨表面积体积比、骨小梁分离度均高于对照组;脊髓损伤组上述指标较制动组变化程度更显著(P < 0.05).3组尺、桡骨密度差异无显著性意义.说明脊髓损伤及制动均可导致骨量丢失,在脊髓损伤早期损伤平面以下部位骨微观结构呈现骨质疏松明显改变,且程度比失用性因素严重.%BACKGROUND: Osteoporosis results from spine cord injury (SCI), due to a great deal of bone loss.OBJECTIVE: To make an observation and comparison on bone density and bone microstructure at the distal femora changes after both SCI in early stage and osteoporosis due to immobilization.METHODS: The SD rats were randomly divided into three groups. In the control group, T1o vertebrae plate resection was performed to rats without injuring dura mate of spinal cord and spinal cord. T io vertebrae plate resection was also performed to rats in the SCI group with spinal cord injury by Allen's method. Rats in the immobilization group were immobilized by limb-tail fixation at bilateral hindlimbs. The femoral metaphysis, ulna and radius were chosen for detection of bone density individuals and Micro CT scanning was performed to the other femoral metaphysis.RESULTS AND CONCLUSION: Compared with the control group

  16. Medial tibial stress syndrome: a critical review.

    Science.gov (United States)

    Moen, Maarten H; Tol, Johannes L; Weir, Adam; Steunebrink, Miriam; De Winter, Theodorus C

    2009-01-01

    Medial tibial stress syndrome (MTSS) is one of the most common leg injuries in athletes and soldiers. The incidence of MTSS is reported as being between 4% and 35% in military personnel and athletes. The name given to this condition refers to pain on the posteromedial tibial border during exercise, with pain on palpation of the tibia over a length of at least 5 cm. Histological studies fail to provide evidence that MTSS is caused by periostitis as a result of traction. It is caused by bony resorption that outpaces bone formation of the tibial cortex. Evidence for this overloaded adaptation of the cortex is found in several studies describing MTSS findings on bone scan, magnetic resonance imaging (MRI), high-resolution computed tomography (CT) scan and dual energy x-ray absorptiometry. The diagnosis is made based on physical examination, although only one study has been conducted on this subject. Additional imaging such as bone, CT and MRI scans has been well studied but is of limited value. The prevalence of abnormal findings in asymptomatic subjects means that results should be interpreted with caution. Excessive pronation of the foot while standing and female sex were found to be intrinsic risk factors in multiple prospective studies. Other intrinsic risk factors found in single prospective studies are higher body mass index, greater internal and external ranges of hip motion, and calf girth. Previous history of MTSS was shown to be an extrinsic risk factor. The treatment of MTSS has been examined in three randomized controlled studies. In these studies rest is equal to any intervention. The use of neoprene or semi-rigid orthotics may help prevent MTSS, as evidenced by two large prospective studies.

  17. Posterior cruciate ligament's tibial insertions: topographic anatomy and morphometric study

    Directory of Open Access Journals (Sweden)

    Julio Cesar Gali

    2013-06-01

    Full Text Available OBJECTIVE: To provide anatomical and morphometric basis of the posterior cruciate ligament's tibial insertions in order to assist the creation of anatomical tibial tunnels, in the ligament surgical reconstruction. MATERIAL AND METHODS: The topographic anatomy and morphometry of the posterior cruciate ligament's anterolateral and posteromedial bundles' tibial insertions were analyzed in 24 anatomical knee pieces. The pieces were photographed by a digital camera and the images obtained were studied by the software ImageJ, where the bundles' insertion areas were measured in square millimeters, and the length of structures and the distances between significant points were measured in millimeters. RESULTS: In 54.2% of the knees the insertion' shape was concave; in most pieces (41.6% the form of insertion was oval. The average posterior cruciate ligament's tibial insertion total area was 88.33 ± 21.66 mm2; the average anterolateral bundle's tibial insertion area was 46.79 ± 14.10 mm2 and it was 41.54 ± 9.75 mm2 for the posteromedial bundle. CONCLUSIONS: The anterolateral bundle has a tibial insertion area larger than the posteromedial bundle; the insertion areas of those bundles in our study, were smaller than the ones found in the literature. The variations in the posterior cruciate ligament's tibial insertion area suggest that there should be an indication for anatomical reconstructions of this ligament using single or double tibial tunnels according to individual characteristics.

  18. The soleal line: a cause of tibial pseudoperiostitis.

    Science.gov (United States)

    Levine, A H; Pais, M J; Berinson, H; Amenta, P S

    1976-04-01

    An unusually prominent soleal line (a normal anatomic variant) may mimic periosteal reaction along the posterior margin of the proximal tibial shaft. This area of pseudoperiostitis is differentiated from hyperostoses arising from the anterior tibial tubercle and the interosseous membrane. It is always associated with normal, undisturbed architecture of the underlying bone.

  19. Escleritis posterior bilateral Bilateral posterior scleritis

    Directory of Open Access Journals (Sweden)

    A. Zurutuza

    2011-08-01

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

  20. Bilaterally Incarcerated Morgagni Hernia

    Directory of Open Access Journals (Sweden)

    Zuhal Demirhan Yananli

    2013-06-01

    Full Text Available Morgagni hernia is a rare congenital diaphragmatic hernia. It is seen rarely bilaterally. Patients are usually asymptomatic. Therefore, diagnosis may be delayed until adulthood. Significant morbidity can occur in case complications arise and diagnosis is delayed. The patient, a 74 year-old female, presented in this article, was admitted to the emergency department with abdominal pain, vomiting, and shortness of breath. The plain abdominal radiograph of the patient revealed bowel obstruction and suspicious appearence in favor of the diaphragmatic hernia on both sides of the sternum. Computed tomography revealed bilaterally incarcerated Morgagni hernia with strangulated omentum in the right side of the sternum and a part of colon in the left side of sternum. Incarcerated organs were withdrawn to peritoneal cavity and defects of hernia were sutured primarily on laparatomy. Because bilateral incarcerated Morgagni hernia can be seen rarely, this case was reported.

  1. Bilateral inferior turbinate osteoma

    Science.gov (United States)

    Sahemey, R.; Warfield, A.T.; Ahmed, S.

    2016-01-01

    Osteomas are the most common benign osteoclastic tumours of the paranasal sinuses. However, nasal cavity and turbinate osteomas are extremely rare. Only nine middle turbinate, three inferior turbinate and one inferior turbinate osteoma cases have been reported to date. The present case report describes the management and follow-up of symptomatic bilateral inferior turbinate osteoma. A 60-year-old female presented with symptoms of bilateral nasal obstruction and right-sided epiphora. Radiological investigation found hypertrophic bony changes involving both inferior turbinates. The patient was managed successfully by endoscopic inferior turbinectomies in order to achieve a patent airway, with no further recurrence of tumour after 3 months postoperatively. To the best of our knowledge, this is the first reported case of bilateral inferior turbinate osteoma. We describe a safe and minimally invasive method of tumour resection, which has a better cosmetic outcome compared with other approaches. PMID:27534890

  2. High tibial closing wedge osteotomy for medial compartment osteoarthrosis of knee

    Directory of Open Access Journals (Sweden)

    Tuli S

    2008-01-01

    Full Text Available Background: Most patients of symptomatic osteoarthrosis of knee are associated with varus malalignment that is causative or contributory to painful arthrosis. It is rational to correct the malalignment to transfer the functional load to the unaffected or less affected compartment of the knee to relieve symptoms. We report the outcome of a simple technique of high tibial osteotomy in the medial compartment of osteoarthrosis of the knee. Materials and Methods: Between 1996 and 2004 we performed closing wedge osteotomy in 78 knees in 65 patients. The patients selected for osteotomy were symptomatic essentially due to medial compartment osteoarthrosis associated with moderate genu varum. Of the 19 patients who had bilateral symptomatic disease 11 opted for high tibial osteotomy of their second knee 1-3 years after the first operation. Preoperative grading of osteoarthrosis and postoperative function was assessed using Japanese Orthopaedic Association (JOA rating scale. Results: At a minimum follow-up of 2 years (range 2-9 years 6-10° of valgus correction at the site of osteotomy was maintained, there was significant relief of pain while walking, negotiating stairs, squatting and sitting cross-legged. Walking distance in all patients improved by two to four times their preoperative distance of 200-400 m. No patient lost any preoperative knee function. The mean JOA scoring improved from preoperative 54 (40-65 to 77 (55-85 at final follow-up. Conclusion: Closing wedge high tibial osteotomy performed by our technique can be undertaken in any setup with moderate facilities. Operation related complications are minimal and avoidable. Kirschner wire fixation is least likely to interfere with replacement surgery if it becomes necessary.

  3. Tibial lengthening over humeral and tibial intramedullary nails in patients with sequelae of poliomyelitis: a comparative study.

    Science.gov (United States)

    Chen, Daoyun; Chen, Jianmin; Jiang, Yao; Liu, Fanggang

    2011-06-01

    Leg discrepancy is common after poliomyelitis. Tibial lengthening is an effective way to solve this problem. It is believed lengthening over a tibial intramedullary nail can provide a more comfortable lengthening process than by the conventional technique. However, patients with sequelae of poliomyelitis typically have narrow intramedullary canals allowing limited space for inserting a tibial intramedullary nail and Kirschner wires. To overcome this problem, we tried using humeral nails instead of tibial nails in the lengthening procedure. In this study, we used humeral nails in 20 tibial lengthening procedures and compared the results with another group of patients who were treated with tibial lengthening over tibial intramedullary nails. The mean consolidation index, percentage of increase and external fixation index did not show significant differences between the two groups. However, less blood loss and shorter operating time were noted in the humeral nail group. More patients encountered difficulty with the inserted intramedullary nail in the tibial nail group procedure. The complications did not show a statistically significant difference between the two techniques on follow-up. In conclusion, we found the humeral nail lengthening technique was more suitable in leg discrepancy patients with sequelae of poliomyelitis.

  4. Bilateral Simultaneous Avulsion Fractures of the Proximal Tibia in a 14-Year-Old Athlete with Vitamin-D Deficiency

    Directory of Open Access Journals (Sweden)

    Ziad Harb

    2015-01-01

    Full Text Available Fractures involving the proximal tibial epiphysis are rare and form 0.5% of all epiphyseal injuries. The specific anatomical and developmental features of the proximal tibial epiphysis make it vulnerable to unique patterns of fractures. Vitamin-D plays a vital role in bone homeostasis and its deficiency has an impact on fracture risk and healing. We present the first ever reported case of simultaneous bilateral proximal tibial physeal fractures in an athlete with vitamin-D deficiency. Treatment consisted of plaster immobilisation, and the patient made a full recovery and returned to preinjury level of activities. We report this case for its uniqueness and as an educational review of the importance of the developmental anatomy of the proximal tibia. We review the literature and discuss how the stages of the growing physis determine the type of fracture sustained.

  5. Bilateral Primary Intraocular Lymphoma

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    Mehrdad Karimi

    2011-01-01

    Full Text Available Purpose: To report a case of bilateral primary intraocular lymphoma. Case report: A 33-year-old man presented with bilateral blurred vision since two years ago. Examination revealed large keratic precipitates, anterior chamber reaction, posterior subcapsular cataracts, and vitreous infiltration. After a short trial of topical and periocular steroids, diagnostic 25-gauge pars plana vitrectomy was performed and cytologic evaluation of the aspirate confirmed a diagnosis of intraocular lymphoma. The patient was subsequently managed with intravitreal methotrexate in both eyes and responded favorably. Central nervous system workup for lymphoma was negative. Conclusion: Primary intraocular lymphoma should be considered in young adults suffering from chronic recalcitrant panuveitis.

  6. Ultrasound measurement of the size of the anterior tibial muscle group: the effect of exercise and leg dominance

    LENUS (Irish Health Repository)

    McCreesh, Karen

    2011-09-13

    Abstract Background Knowledge of normal muscle characteristics is crucial in planning rehabilitation programmes for injured athletes. There is a high incidence of ankle and anterior tibial symptoms in football players, however little is known about the effect of limb dominance on the anterior tibial muscle group (ATMG). The purpose of this study was to assess the effect of limb dominance and sports-specific activity on ATMG thickness in Gaelic footballers and non-football playing controls using ultrasound measurements, and to compare results from transverse and longitudinal scans. Methods Bilateral ultrasound scans were taken to assess the ATMG size in 10 Gaelic footballers and 10 sedentary controls (age range 18-25 yrs), using a previously published protocol. Both transverse and longitudinal images were taken. Muscle thickness measurements were carried out blind to group and side of dominance, using the Image-J programme. Results Muscle thickness on the dominant leg was significantly greater than the non-dominant leg in the footballers with a mean difference of 7.3%, while there was no significant dominance effect in the controls (p < 0.05). There was no significant difference between the measurements from transverse or longitudinal scans. Conclusions A significant dominance effect exists in ATMG size in this group of Gaelic footballers, likely attributable to the kicking action involved in the sport. This should be taken into account when rehabilitating footballers with anterior tibial pathology. Ultrasound is a reliable tool to measure ATMG thickness, and measurement may be taken in transverse or longitudinal section.

  7. Bilateral Naevus Of OTA

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    Ahmad Qazi Masood

    2001-01-01

    Full Text Available Naevus of Ota is a type of dermal melanocytic naevus characterized by extensive blue patch of dermal melanocytic pigmentation of the sclera and the skin adjacent to the eye. The condition is usually unilateral. Here we report a patient with bilateral naevus of Ota in view of the rarity of this condition.

  8. Elastic Knee Sleeves Limit Anterior Tibial Translation in Healthy Females

    Directory of Open Access Journals (Sweden)

    Robert Csapo, Simona Hosp, Ramona Folie, Robert Eberle, Michael Hasler, Werner Nachbauer

    2016-03-01

    Full Text Available Knee sleeves or braces represent auxiliary tools that have repeatedly been used by athletes, in an attempt to increase knee stability and, thus, reduce the risk of (recurrent ligamentous injuries. Since ACL injuries typically occur in situations involving either torsion or hyperextension of the knee, it has been speculated that braces might protect the ACL by countering excessive anterior translation of the tibia with respect to the femur (Beynnon et al., 1997. However, the preponderance of in vivo studies to test this hypothesis was performed in cohorts of patients suffering from existent ligamentous (Branch et al., 1988; Colville et al., 1986 or other knee injury (Beynnon et al., 1997; Fleming et al., 2000. This complicates the extrapolation of results to healthy subjects. Further, the braces used in these studies were mostly rigid constructs that consisted of either uni- or bilateral hinged bars (Rishiraj et al., 2009. Such braces might hinder performance (Veldhuizen et al., 1991 and would be rejected by the vast majority of healthy athletes. For these reasons, we would like to use this letter to the editor to report the results of our experiments investigating whether a relatively light elastic knee sleeve would limit the degree of anterior tibial translation in computerized arthrometry tests as performed in a sample of non-injured subjects. We recruited ten female college students (age: 23.4 ± 3.2 yrs, height: 1.68 ± 0.05 m, mass: 59.9 ± 5.5 kg who were free of acute or previous injury or any form of orthopaedic disease of the knee joints. The anterior displacement of the tibia was measured using the GNRB® computerized arthrometer (GeNouRob, Laval, France. With subjects lying in the supine position, the lower leg was firmly fixed with plastic caps mounted over the ankle joint and patella. An electrical pressure pad then exerted increasing pressure of up to 250 N on the calf, while a motion sensor, which was positioned on the ventral

  9. Bilateral matrix-exponential distributions

    DEFF Research Database (Denmark)

    Bladt, Mogens; Esparza, Luz Judith R; Nielsen, Bo Friis

    2012-01-01

    In this article we define the classes of bilateral and multivariate bilateral matrix-exponential distributions. These distributions have support on the entire real space and have rational moment-generating functions. These distributions extend the class of bilateral phasetype distributions of [1]...

  10. Surgical Treatment of a Rare Isolated Bilateral Agenesis of Anterior and Posterior Cruciate Ligaments

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    G. Cerulli

    2014-01-01

    Full Text Available The isolated bilateral agenesis of both cruciate ligaments is a rare congenital disorder. A 17-year-old male came to our attention due to an alteration in gait pattern, pain, and tendency to walk on the forefoot with his knee flexed. The patient did not recall previous injuries. Upon physical examination anterior and posterior chronic instability were observed. Radiographic examination of both knees showed hypoplasia of the tibial eminence, a hypoplastic lateral femoral condyle, and a narrow intercondylar notch. MRI brought to light a bilateral agenesis of both posterior cruciate ligaments. Arthroscopic evaluation confirmed bilateral isolated agenesis of both cruciate ligaments. We recommended a rehabilitation program to prepare the patient for the arthroscopic construction of both cruciate ligaments.

  11. Surgical treatment of a rare isolated bilateral agenesis of anterior and posterior cruciate ligaments.

    Science.gov (United States)

    Cerulli, G; Amanti, A; Placella, G

    2014-01-01

    The isolated bilateral agenesis of both cruciate ligaments is a rare congenital disorder. A 17-year-old male came to our attention due to an alteration in gait pattern, pain, and tendency to walk on the forefoot with his knee flexed. The patient did not recall previous injuries. Upon physical examination anterior and posterior chronic instability were observed. Radiographic examination of both knees showed hypoplasia of the tibial eminence, a hypoplastic lateral femoral condyle, and a narrow intercondylar notch. MRI brought to light a bilateral agenesis of both posterior cruciate ligaments. Arthroscopic evaluation confirmed bilateral isolated agenesis of both cruciate ligaments. We recommended a rehabilitation program to prepare the patient for the arthroscopic construction of both cruciate ligaments.

  12. Bilateral chronic subdural hematoma

    DEFF Research Database (Denmark)

    Andersen-Ranberg, Nina Christine; Poulsen, Frantz Rom; Bergholt, Bo

    2017-01-01

    OBJECTIVE Bilateral chronic subdural hematoma (bCSDH) is a common neurosurgical condition frequently associated with the need for retreatment. The reason for the high rate of retreatment has not been thoroughly investigated. Thus, the authors focused on determining which independent predictors...... are associated with the retreatment of bCSDH with a focus on surgical laterality. METHODS In a national database of CSDHs (Danish Chronic Subdural Hematoma Study) the authors retrospectively identified all bCSDHs treated in the 4 Danish neurosurgical departments over the 3-year period from 2010 to 2012....... Univariate and multivariate analyses were performed to determine the relationship between retreatment of bCSDH and clinical, radiological, and surgical variables. RESULTS Two hundred ninety-one patients with bCSDH were identified, and 264 of them underwent unilateral (136 patients) or bilateral (128 patients...

  13. [Spontaneous bilateral Petit hernia].

    Science.gov (United States)

    Fontoura, Rodrigo Dias; Araújo, Emerson Silveira de; Oliveira, Gustavo Alves de; Sarmenghi Filho, Deolindo; Kalil, Mitre

    2011-01-01

    Petit's lumbar hernia is an uncommon defect of the posterior abdominal wall that represents less than 1% of all abdominal wall hernias. It is more often unilateral and founded in young females, rarely containing a real herniated sac. There are two different approaches to repair: laparoscopy and open surgery. The goal of this article is to report one case of spontaneous bilateral lumbar Petit's hernia treated with open surgery.

  14. Bilateral lunate intraosseous ganglia

    Energy Technology Data Exchange (ETDEWEB)

    Pablos, J.M. [Department of Radiology, Hospital San Juan de Dios, Seville (Spain); Valdes, J.C. [Department of Radiology, Cemedi, Seville (Spain); Gavilan, F. [Department of Pathology, Hospital Universitario Virgen del Rocio, Seville (Spain)

    1998-12-01

    An intraosseous ganglion is a relatively uncommon, benign, cyst-like lesion that occurs in young and middle-aged adults. Most commonly seen adjacent to the hip, ankle, knee, or wrist, they are histologically identical to their soft tissue counterparts. A review of the literature revealed only two previously reported examples of bilateral symmetrical ganglia of the lunate bones. (orig.) With 3 figs., 10 refs.

  15. Ischemic Bilateral Opercular Syndrome

    OpenAIRE

    Aysel Milanlioglu; Mehmet Nuri Aydın; Alper Gökgül; Mehmet Hamamcı; Mehmet Atilla Erkuzu; Temel Tombul

    2013-01-01

    Opercular syndrome, also known as Foix-Chavany-Marie syndrome, is a paralysis of the facial, pharyngeal, masticatory, tongue, laryngeal, and brachial muscles. It is a rare cortical form of pseudobulbar palsies caused by vascular insults to bilateral operculum. Its clinical presentations include anarthria, weakness of voluntary muscles involving face, tongue, pharynx, larynx, and masticatory muscles. However, autonomic reflexes and emotional activities of these structures are preserved. In the...

  16. Bilateral akillesseneruptur hos nyretransplanterede

    DEFF Research Database (Denmark)

    Skovgaard, D; Feldt-Rasmussen, B F; Nimb, L

    1996-01-01

    Increased incidence of tendinitis and tendon ruptures is reported in recipients of a kidney transplant. Two cases of bilateral achilles tendon rupture after minimal trauma are described. Tendon ruptures are more frequent in individuals with kidney disease in dialysis or after transplantation...... compared with patients receiving other organ transplantations. It is therefore more likely that tendon ruptures are related to metabolic changes associated with kidney disease rather than with transplantation or with glucocorticoid treatment per se. Clinical symptoms of achilles tendinitis should...

  17. Bilateral Malignant Brenner Tumour

    Directory of Open Access Journals (Sweden)

    Nasser D Choudhary, S.Manzoor Kadri, Ruby Reshi, S. Besina, Mansoor A. Laharwal, Reyaz tasleem, Qurrat A. Chowdhary

    2002-10-01

    Full Text Available Bilateral malignant Brenner tumour ofovary is extremely rate. A case ofmalignant Brenner tumourinvolving both the ovaries with mctastasis to mesentery in a 48 year femalc is presented. Grosslyo'arian masses were firm with soft areas, encapsulated and having bosselated external surfaces.Cut sections showed yellowish white surface with peripheral cysts (in both tumours. Microscopyrevealed transitional cell carcinoma with squamoid differentiation at places. Metastatic deposits werefound in the mesentery. Endometrium showed cystic glandular hyperplasia.

  18. Re-evaluation of low intensity pulsed ultrasound in treatment of tibial fractures (TRUST): randomized clinical trial

    Science.gov (United States)

    Bhandari, Mohit; Einhorn, Thomas A; Schemitsch, Emil; Heckman, James D; Tornetta, Paul; Leung, Kwok-Sui; Heels-Ansdell, Diane; Makosso-Kallyth, Sun; Della Rocca, Gregory J; Jones, Clifford B; Guyatt, Gordon H

    2016-01-01

    Objective To determine whether low intensity pulsed ultrasound (LIPUS), compared with sham treatment, accelerates functional recovery and radiographic healing in patients with operatively managed tibial fractures. Design A concealed, randomized, blinded, sham controlled clinical trial with a parallel group design of 501 patients, enrolled between October 2008 and September 2012, and followed for one year. Setting 43 North American academic trauma centers. Participants Skeletally mature men or women with an open or closed tibial fracture amenable to intramedullary nail fixation. Exclusions comprised pilon fractures, tibial shaft fractures that extended into the joint and required reduction, pathological fractures, bilateral tibial fractures, segmental fractures, spiral fractures >7.5 cm in length, concomitant injuries that were likely to impair function for at least as long as the patient’s tibial fracture, and tibial fractures that showed 1 cm gap after surgical fixation. 3105 consecutive patients who underwent intramedullary nailing for tibial fracture were assessed, 599 were eligible and 501 provided informed consent and were enrolled. Interventions Patients were allocated centrally to self administer daily LIPUS (n=250) or use a sham device (n=251) until their tibial fracture showed radiographic healing or until one year after intramedullary fixation. Main outcome measures Primary registry specified outcome was time to radiographic healing within one year of fixation; secondary outcome was rate of non-union. Additional protocol specified outcomes included short form-36 (SF-36) physical component summary (PCS) scores, return to work, return to household activities, return to ≥80% of function before injury, return to leisure activities, time to full weight bearing, scores on the health utilities index (mark 3), and adverse events related to the device. Results SF-36 PCS data were acquired from 481/501 (96%) patients, for whom we had 2303/2886 (80

  19. PHILOS humerus plate for a distal tibial fracture.

    Science.gov (United States)

    Twaij, Haider; Damany, Dev

    2013-01-04

    This report discusses the use of an alternative implant in the emergency fixation of a distal tibial fracture. We planned to fix the shear-type medial malleolar fracture in a closed, tri-malleolar fracture with a locking distal tibial plate. Intra-operatively, it was noted that the required plate was unavailable. A PHILOS humeral plate seemed to fit the contours of the distal tibia. The broad end of the PHILOS, when placed distally, gave options to place locking screws in the medial malleolar fragment. The fracture was stable after fixation. The patient made a full post-operative recovery and follow-up at 4 months was satisfactory. Despite adequate planning, there will be instances where one has to improvise. An understanding of the principles of fracture management can aid in finding solutions. PHILOS humeral plate may be used to stabilize a distal tibial fracture if an appropriate distal tibial locking plate is not available.

  20. Safe surgical technique: intramedullary nail fixation of tibial shaft fractures.

    Science.gov (United States)

    Zelle, Boris A; Boni, Guilherme

    2015-01-01

    Statically locked, reamed intramedullary nailing remains the standard treatment for displaced tibial shaft fractures. Establishing an appropriate starting point is a crucial part of the surgical procedure. Recently, suprapatellar nailing in the semi-extended position has been suggested as a safe and effective surgical technique. Numerous reduction techiques are available to achieve an anatomic fracture alignment and the treating surgeon should be familiar with these maneuvers. Open reduction techniques should be considered if anatomic fracture alignment cannot be achieved by closed means. Favorable union rates above 90 % can be achieved by both reamed and unreamed intramedullary nailing. Despite favorable union rates, patients continue to have functional long-term impairments. In particular, anterior knee pain remains a common complaint following intramedullary tibial nailing. Malrotation remains a commonly reported complication after tibial nailing. The effect of postoperative tibial malalignment on the clinical and radiographic outcome requires further investigation.

  1. Tibial tubercle osteotomy for patello-femoral joint disorders.

    Science.gov (United States)

    Hall, Matthew J; Mandalia, Vipul I

    2016-03-01

    Tibial tubercle osteotomy has a long history in the management of patella instability and patello-femoral arthritis. This review aims to provide a comprehensive review of the literature describing the biomechanics of the patello-femoral joint and the rationale behind the use of the tibial tubercle osteotomy in modern day practice. Several different tibial tubercle osteotomies are available and we aim to detail the concepts behind their use and the subsequent clinical results. With continued developments of chondrocyte implantation techniques, the potential to fill defects on the chondral surface of either the patella or trochlea in conjunction with a tibial tubercle osteotomy may well become more commonplace in a group that is commonly young and difficult to manage. Level of evidence III.

  2. Total knee arthroplasty and fractures of the tibial plateau

    Science.gov (United States)

    Softness, Kenneth A; Murray, Ryan S; Evans, Brian G

    2017-01-01

    Tibial plateau fractures are common injuries that occur in a bimodal age distribution. While there are various treatment options for displaced tibial plateau fractures, the standard of care is open reduction and internal fixation (ORIF). In physiologically young patients with higher demand and better bone quality, ORIF is the preferred method of treating these fractures. However, future total knee arthroplasty (TKA) is a consideration in these patients as post-traumatic osteoarthritis is a common long-term complication of tibial plateau fractures. In older, lower demand patients, ORIF is potentially less favorable for a variety of reasons, namely fixation failure and the need for delayed weight bearing. In some of these patients, TKA can be considered as primary mode of treatment. This paper will review the literature surrounding TKA as both primary treatment and as a salvage measure in patients with fractures of the tibial plateau. The outcomes, complications, techniques and surgical challenges are also discussed.

  3. The medial tibial stress syndrome. A cause of shin splints.

    Science.gov (United States)

    Mubarak, S J; Gould, R N; Lee, Y F; Schmidt, D A; Hargens, A R

    1982-01-01

    The medial tibial stress syndrome is a symptom complex seen in athletes who complain of exercise-induced pain along the distal posterior-medial aspect of the tibia. Intramuscular pressures within the posterior compartments of the leg were measured in 12 patients with this disorder. These pressures were not elevated and therefore this syndrome is a not a compartment syndrome. Available information suggests that the medial tibial stress syndrome most likely represents a periostitis at this location of the leg.

  4. Absence of Clinical and Hemodynamic Consequences due to Posterior Tibial Artery Congenital Aplasia

    Directory of Open Access Journals (Sweden)

    Georgios Karaolanis

    2015-01-01

    Full Text Available The exact knowledge of popliteal artery and its branches’ anatomic variations is important for the clinical practice of angiology, vascular surgery, and interventional procedures. Congenital absence of the artery leads, in some cases, to early malformations of the extremity in the childhood; however, it may also remain asymptomatic. We present an unusual case of a 76-year-old male patient complaining of paraesthesia in both limbs and bilateral aplasia of posterior tibial artery (PTA. Physical examination, ankle-brachial indexes, before and after exercise, arterial duplex scan, and magnetic resonance arteriography were performed. Arterial pulses for PTA at the level of the ankle were normal; arterial duplex study showed biphasic arterial flow at the level of the ankle. Color duplex ultrasound as well as magnetic resonance arteriography revealed the absence of the PTA in both limbs. The vascularization of the fibula was bilaterally normal. The patient underwent also neurological examination and electromyography, which were normal. The evaluation of the possible clinical signs and symptoms and the hemodynamic consequences of this condition are further discussed.

  5. Bilateral optic neuropathy with bilateral putaminal lesions: a case report.

    Science.gov (United States)

    Togawa, Jumpei; Ohi, Takekazu

    2015-01-01

    Bilateral optic neuropathy with bilateral putaminal lesions may be caused by methanol or cyanide poisoning or mitochondrial disorders including Leber hereditary optic neuropathy and Leigh syndrome. We report the case of a 34-year-old Japanese man who developed bilateral visual loss 5 days after the development of gastrointestinal symptoms. Magnetic resonance imaging of the brain on admission revealed high-intensity signal areas in the bilateral putamina on diffusion-weighted and T2-weighted images as well as a high-intensity signal area in the left middle cerebellar peduncle that had been identified 3 years previously. We diagnosed bilateral optic neuropathy with bilateral putaminal lesions caused by preceding infection-triggered demyelination. We administered methylprednisolone, but his vision did not recover.

  6. Ischemic Bilateral Opercular Syndrome

    Directory of Open Access Journals (Sweden)

    Aysel Milanlioglu

    2013-01-01

    Full Text Available Opercular syndrome, also known as Foix-Chavany-Marie syndrome, is a paralysis of the facial, pharyngeal, masticatory, tongue, laryngeal, and brachial muscles. It is a rare cortical form of pseudobulbar palsies caused by vascular insults to bilateral operculum. Its clinical presentations include anarthria, weakness of voluntary muscles involving face, tongue, pharynx, larynx, and masticatory muscles. However, autonomic reflexes and emotional activities of these structures are preserved. In the present case, an 81-year-old male presented with acute onset of anarthria with difficulties in chewing, speaking, and swallowing that was diagnosed with opercular syndrome.

  7. Ischemic bilateral opercular syndrome.

    Science.gov (United States)

    Milanlioglu, Aysel; Aydın, Mehmet Nuri; Gökgül, Alper; Hamamcı, Mehmet; Erkuzu, Mehmet Atilla; Tombul, Temel

    2013-01-01

    Opercular syndrome, also known as Foix-Chavany-Marie syndrome, is a paralysis of the facial, pharyngeal, masticatory, tongue, laryngeal, and brachial muscles. It is a rare cortical form of pseudobulbar palsies caused by vascular insults to bilateral operculum. Its clinical presentations include anarthria, weakness of voluntary muscles involving face, tongue, pharynx, larynx, and masticatory muscles. However, autonomic reflexes and emotional activities of these structures are preserved. In the present case, an 81-year-old male presented with acute onset of anarthria with difficulties in chewing, speaking, and swallowing that was diagnosed with opercular syndrome.

  8. The Validity of Osteoarthritis Model Induced by Bilateral Ovariectomy in Guinea Pig

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    To evaluate the validity of osteoarthritis model induced by bilateral ovariectomy in guinea pig, 32-month-old female guinea pigs were randomly divided into two groups: a sham operation group (control group) and an ovariectomized group (OVX group). The animals were killed 6 or 12 weeks after the operation and the degeneration of the knees were assessed microscopically and histologically by scanning electron microscope (SEM), transmission electron microscope (TEM) and light microscope. The serum levels of estrogen and gestone were detected by immune contest assay.The scoring of articular cartilage histopathology of tibial plateau was performed by histopathological examination. The blood serum levels of estrogen and gestone were decreased significantly in the OVX group as compared with the control group 6 or 12 weeks after the operation. Joint cartilage degeneration as detected by SEM and TEM could be found at the 6th week, but severe degenerative lesions were observed at the 12th week in the OVX group as compared with the control group (P<0.01).The histopathological score of articular cartilage in tibial plateau in OVX group was higher than that of control group, which was coincident with the changes of estrogen and the ultrastructure (P<0.01).The findings suggested that bilateral ovariectomy in guinea pig can induce the severe osteoarthritis that is similar to the aging-induced OA in human. Therefore, the model of the osteoarthritis by bilateral ovariectomy in guinea pig in this study is valid.

  9. Bilateral accessory thoracodorsal artery.

    Science.gov (United States)

    Natsis, Konstantinos; Totlis, Trifon; Tsikaras, Prokopios; Skandalakis, Panagiotis

    2006-09-01

    The subscapular artery arises from the third part of the axillary artery and gives off the circumflex scapular and the thoracodorsal arteries. Although anatomical variations of the axillary artery are very common, the existence of a unilateral accessory thoracodorsal artery has been described in the literature only once. There are no reports of bilateral accessory thoracodorsal artery, in the literature. In the present study, a bilateral accessory thoracodorsal artery, originating on either side of the third part of the axillary artery, is described in a 68-year-old female cadaver. All the other branches of the axillary artery had a typical origin, course, distribution and termination. This extremely rare anatomical variation apart from the anatomical importance also has clinical significance for surgeons in this area. Especially, during the dissection or mobilization of the latissimus dorsi that is partly used for coverage problems in many regions of the body and also in dynamic cardiomyoplasty, any iatrogenic injury of this accessory artery may result in ischemia and functional loss of the graft.

  10. Reconstrucción tibial: transferencia sóleo-peroné ipsilateral. Tibialización peroneal Tibial reconstruction: ipsilateral soleus-fibula transfer. Fibular tibialization

    Directory of Open Access Journals (Sweden)

    E. Revelo Jiron

    2009-12-01

    Full Text Available Las transferencias óseas peroneales en forma libre o ipsilateral han sido propuestas para la reconstrucción de grandes defectos tibiales. Están también descritas varias modificaciones al respecto, siendo una de ellas la constitución de un colgajo compuesto soleo-peroné realizado como transferencia libre. En este estudio presentamos nuestra experiencia con esta variante, pero en forma ipsilateral. logrando la reconstrucción del defecto tibial por medio de la tibialización peroneal. Escogimos realizar un colgajo compuesto soleo-peroné ipsilateral a flujo anterógrado o retrogrado para la reconstrucción de una serie personal de 14 pacientes consecutivos, 13 hombre y 1 mujer, con edad media de 30 años, y con amplios defectos tibiales y de tejidos blandos causados por accidentes de transito en 12 casos, 1 por proyectil balístico y 1 por artefacto explosivo artesanal. El promedio de tamaño del defecto tibial fue de 9.4 cm. Elegimos la forma ipsilateral por no disponer de infraestructura adecuada para realizar una transferencia libre. La serie de estudio se realizó durante el periodo comprendido entre Abril de 1995 y Abril del 2005. Todos los colgajos sobrevivieron. Dos pacientes desarrollaron pseudoartrosis. El apoyo completo y la marcha en 12 pacientes, se logró en un periodo promedio de 9 meses. El seguimiento postoperatorio ha sido de 3 a 6 años. Doce pacientes se han incorporado a la vida activa. Discutimos algunos aspectos prácticos de la técnica como resultado de la experiencia quirúrgica obtenida de esta serie personal. Consideramos que el método es fiable, fácil de realizar y proporciona excelentes resultados.Fibular flaps such as in there free form or as ipsilateral transfers have been proposed for reconstruction of large tibial defects. Several modifications have been described for the use of this flap. In this study we will present our experience using the ipsilateral transfer of an osteomuscular soleous fibular flap

  11. Alternative method for direct measurement of tibial slope

    Directory of Open Access Journals (Sweden)

    Stijak Lazar

    2014-01-01

    Full Text Available Background/Aim. The tibial slope is one of the most frequently cited anatomical causes of anterior cruciate ligament trauma. The aim of this study was to determine the possibility of direct measuring of the tibial slope of the knee without prior soft tissue dissection in cadavers. Methods. Measurement was performed on the two groups of samples: osteological and cadaveric. The osteological group consisted of 102 matured tibiae and measurement was performed: indirectly by sagittal photographing of the tibia, and directly by a set of parallel bars. The cadaveric group consisted of 50 cadaveric knees and measurement was performed directly by a set of parallel bars. The difference and correlation between indirect and the direct measurements were observed, which included also measuring of the difference and correlation of the tibial slope on the medial and lateral condyles. Results. A statistically significant difference between the direct and indirect method of measuring (p 0.05. However, the slope on the medial condyle, as well as indirect measurement showed a statistically significant difference (p < 0.01. Conclusion. By the use of a set of parallel bars it is possible to measure the tibial slope directly without removal of the soft tissue. The results of indirect, photographic measurement did not statistically differ from the results of direct measurement of the tibial slope.

  12. Spontaneous collapse of the tibial plateau: radiological staging

    Energy Technology Data Exchange (ETDEWEB)

    Carpintero, P.; Leon, F.; Zafra, M. [University Hospital ' ' Reina Sofia' ' , Orthopaedic Department, Cordoba (Spain); Montero, R.; Carreto, A. [University Hospital ' ' Reina Sofia' ' , Radiology Department, Cordoba (Spain)

    2005-07-01

    This paper proposes a radiological staging system for necrosis of the tibial plateau, similar to those already developed for the hip and the medial femoral condyle. We retrospectively studied the clinical case histories and radiographic findings of 14 patients (15 affected knees) with histologically proven osteonecrosis of the tibial plateau. Stage I was marked by normal radiograph, but increased uptake in bone scan and subchondral areas of abnormal marrow signal intensity in magnetic resonance imaging (MRI), as reported in other osteonecrosis sites. Stage II was characterised by cystic and sclerotic changes, and stage III fracture of the medial rim of the medial tibial plateau and tibial plateau collapse were present. Stage IV was marked by joint narrowing. These changes appeared earlier and were more pronounced when there was genu varum/valgum or involvement of the lateral tibial plateau. The radiological evolution of the disease appears to follow a four-stage course over a period of roughly one year from the onset of symptoms. (orig.)

  13. Bilateral Antepartum Mastitis

    Directory of Open Access Journals (Sweden)

    Peyman Alibeigi

    2010-12-01

    Full Text Available Antepartum mastitis is a rare condition, whereas postpartum orlactation mastitis is a common problem. This report introducesa case of complicated bilateral antepartum mastitis, which wastreated successfully by drain insertion and antibiotic therapy.The patient was a 23-year-old woman in the 23rd week of herfirst pregnancy. Her chief complaint was progressive swelling,redness and radicular pain in both breasts, which had beenstarted gradually from the 18th week of pregnancy. The patientwas admitted to hospital, and received oral and intravenous antibioticsempirically, which was not effective. The patient wastreated by drainage and oral antibiotic therapy. Based on theapproaches employed and the outcomes achieved it is suggestedthat early surgical insertion in the presence of fluid collection inantepartum mastitis will shorten hospitalization and course ofintravenous antibiotic therapy.Iran J Med Sci 2010; 35(4: 327-330.

  14. [Bilateral cochlear implantation].

    Science.gov (United States)

    Kronenberg, Jona; Migirov, Lela; Taitelbaum-Swead, Rikey; Hildesheimer, Minka

    2010-06-01

    Cochlear implant surgery became the standard of care in hearing rehabilitation of patients with severe to profound sensorineural hearing loss. This procedure may alter the lives of children and adults enabling them to integrate with the hearing population. In the past, implantation was performed only in one ear, despite the fact that binaural hearing is superior to unilateral, especially in noisy conditions. Cochlear implantation may be performed sequentially or simultaneously. The "sensitive period" of time between hearing loss and implantation and between the two implantations, when performed sequentially, significantly influences the results. Shorter time spans between implantations improve the hearing results after implantation. Hearing success after implantation is highly dependent on the rehabilitation process which includes mapping, implant adjustments and hearing training. Bilateral cochlear implantation in children is recommended as the proposed procedure in spite of the additional financial burden.

  15. 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.

  16. Bilateral acute corneal calcification.

    Science.gov (United States)

    Freddo, T F; Leibowitz, H M

    1985-04-01

    A 38-year-old man with brittle, juvenile onset diabetes mellitus and bilateral severe dry eyes with recurrent corneal ulcers developed atypical band-shaped calcifications of both corneas during a 24-hour period. Serum calcium, phosphate, and carbon dioxide levels all were within normal limits. The patient was mildly uremic but was not in renal failure. When EDTA chelation failed to clear the deposits, partial keratectomies were performed in both eyes and the specimens were examined by light and electron microscopy, including energy dispersive x-ray analysis. Microscopic studies revealed an atypical calcific keratopathy which involved neither Bowman's layer nor the most superficial stromal lamellae. The deposits were confined to deeper lamellae in the anterior stroma and by electron microscopy were composed of extracellular crystalline aggregates. Energy dispersive x-ray analysis of these aggregates confirmed the presence of calcium and phosphate. Corneal dessication appeared to be a major contributing factor in the rapid formation of these deposits.

  17. Bilateral eventration of sciatic nerve

    Directory of Open Access Journals (Sweden)

    T Sharma

    2010-12-01

    Full Text Available During routine dissection of a 60 years male cadaver, it was observed that the two divisions of sciatic nerve were separate in the gluteal region on both the sides with the tibial nerve passing below the piriformis and the common peroneal nerve piercing the piriformis muscle. The abnormal passage of the sciatic nerve (SN, the common peroneal nerve (CPN, and the tibial nerve (TN, either through the piriformis or below the superior gemellus may facilitate compression of these nerves. Knowledge of such patterns is also important for surgeons dealing with piriformis syndrome which affects 5-6% of patients referred for the treatment of back and leg pain. A high division may also account for frequent failures reported with the popliteal block. Keywords: eventration, piriformis muscle, piriformis syndrome, sciatic nerve

  18. [Anatomical quantification of the tibial part of the plantar aponeurosis].

    Science.gov (United States)

    Hiramoto, Y

    1983-03-01

    The metrical analysis of the anatomical characteristics is important because of its objectiveness. As it is concerned with the organs belonging to the locomotor system, the metrical method of the bones has already been systematized by Martin (1928), whereas the same kind of method for use on other organs remains undeveloped. The author aims to establish the metrical method of the plantar aponeurosis. The method for measuring the tibial part of the aponeurosis developed in this paper is sufficiently applicable for obtaining its principal anatomical characteristics. The results show that the tibial portion of the plantar aponeurosis becomes statistically significantly wider and thinner in its anterior part, and that the thickness of the tibial portion of the aponeurosis in the anterior part is larger on the right side than on the left side.

  19. Silicosis with bilateral spontaneous pneumothorax

    Directory of Open Access Journals (Sweden)

    Fotedar Sanjay

    2010-01-01

    Full Text Available Presentation with simultaneous bilateral pneumothorax is uncommon and usually in the context of secondary spontaneous pneumothorax.The association of pneumothorax and silicosis is infrequent and most cases are unilateral. Bilateral pneumothorax in silicosis is very rare with just a few reports in medical literature.

  20. Pediatric isolated bilateral iliac aneurysm.

    Science.gov (United States)

    Chithra, R; Sundar, R Ajai; Velladuraichi, B; Sritharan, N; Amalorpavanathan, J; Vidyasagaran, T

    2013-07-01

    Aneurysms are rare in children. Isolated iliac artery aneurysms are very rare, especially bilateral aneurysms. Pediatric aneurysms are usually secondary to connective tissue disorders, arteritis, or mycotic causes. We present a case of a 3-year-old child with bilateral idiopathic common iliac aneurysms that were successfully repaired with autogenous vein grafts.

  1. TIBIAL PLATEAU FRACTURES – SURGICAL MANAGEMENT BY MIPPO

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    Bharath Raju

    2014-06-01

    Full Text Available BACKGROUND AND OBJECTIVES: Tibial plateau fractures are one of the most common intra-articular fractures. They are the outcome of indirect coronal or direct compressive forces. The incidence of tibial plateau fractures is 1.3% of all fractures. These fractures have varied degree of fracture configuration involving medial, lateral or both tibial plateaus with varied degree of intra-articular depressions and displacements. Due to speedy vehicles and mechanization there has been increase in the number of tibial plateau fractures. Knee joints being one of the major weight bearing joints of human body, these fractures are of big importance. METHODS: We studied 30 cases of tibial plateau fractures treated by MIPPO at kempegowda institute of medical sciences from June 2012 to April 2014 with minimum follow up of up to 6months. RESULTS: All the selected patients were evaluated both clinically as well as radiologically. The lab investigations were done and then they were taken up for the surgery. The fractures were classified as per schatzker’s classification and treated accordingly. In the post-op period early range of movements were started and the patients were non weight bearing till 6 weeks. Till 12 weeks partial weight bearing was allowed and full weight bearing was allowed after radiological union of the fracture. CONCLUSION: Tibial plateau fractures when treated with MIPPO give articular anatomical reduction, rigid fixation and early mobolisation of the knee joint. This prevents development of osteoarthritis and includes all the advantages of minimally invasive procedure and so better patient compliance.

  2. 21 CFR 888.3590 - Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Knee joint tibial (hemi-knee) metallic resurfacing... Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis. (a) Identification. A knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis is a device intended to be...

  3. Tibial and fibular angles in homozygous sickle cell disease

    Energy Technology Data Exchange (ETDEWEB)

    Akamaguna, A.I.; Odita, J.C.; Ugbodaga, C.I.; Okafor, L.A.

    1986-05-01

    Measurements of the tibial and fibular angles made on ankle radiographs of 34 patients with sickle cell disease were compared with those of 36 normal Nigerians. Widening of the fibular angle, which is an indication of tibiotalar slant, was demonstrated in about 79% of sickle cell disease patients. By using fibular angle measurements as an objective method of assessing subtle tibiotalar slant, it is concluded that the incidence of this deformity is much higher among sickle cell disease patients than previously reported. The mean values of tibial and fibular angles in normal Nigerians are higher than has been reported amongst Caucasians.

  4. High tibial osteotomy in Sweden, 1998-2007

    DEFF Research Database (Denmark)

    W-Dahl, Annette; Robertsson, Otto; Lohmander, Stefan

    2012-01-01

    Most studies on high tibial osteotomies (HTOs) have been hospital-based and have included a limited number of patients. We evaluated the use and outcome-expressed as rate of revision to knee arthroplasty-of HTO performed in Sweden with 9 million inhabitants, 1998-2007.......Most studies on high tibial osteotomies (HTOs) have been hospital-based and have included a limited number of patients. We evaluated the use and outcome-expressed as rate of revision to knee arthroplasty-of HTO performed in Sweden with 9 million inhabitants, 1998-2007....

  5. Rotational alignment of the tibial component in total knee arthroplasty is better at the medial third of tibial tuberosity than at the medial border

    Directory of Open Access Journals (Sweden)

    Günther Klaus-Peter

    2010-03-01

    Full Text Available Abstract Background Correct rotational alignment of the femoral and tibial component is an important factor for successful TKA. The transepicondylar axis is widely accepted as a reference for the femoral component. There is not a standard reference for the tibial component. CT scans were used in this study to measure which of 2 tibial landmarks most reliably reproduces a correct femoro-tibial rotational alignment in TKA. Methods 80 patients received a cemented, unconstrained, cruciate-retaining TKA with a rotating platform. CT scans were performed 5-7 days postoperatively but before discharge. The rotational mismatch between the femoral and tibial components was measured. Furthermore, the rotational variance between the transepicondylar line, as a reference for the orientation of the femoral component and different tibial landmarks, was measured. Results There was notable rotational mismatch between the femoral and tibial components. The median mismatch was 0° (range: 16.2 degrees relative external to 14.4 degrees relative internal rotation of the femoral component. Using the transepicondylar line as a reference for femoral rotational alignment and the medial third of the tuberosity as a reference for tibial rotational alignment, 67.5% of all TKA had a femoro-tibial variance within ± 5 degrees, 85% within ± 10 degrees and 97.5% within ± 20 degrees. Using the medial border of the tibial tubercle as a reference this variance was greater, only 3.8% had a femoro-tibial variance within ± 5 degrees, 15% within ± 10 degrees and 68.8% within ± 20 degrees. Conclusion Using fixed bone landmarks for rotational alignment leads to a notable variance between femoral and tibial components. Referencing the tibial rotation on a line from the medial third of the tibial tubercle to the center of the tibial tray resulted in a better femoro-tibial rotational alignment than using the medial border of tibial tubercle as a landmark. Surgeons using fixed bearings

  6. Traumatic bilateral hip dislocation with bilateral sciatic nerve palsy

    Institute of Scientific and Technical Information of China (English)

    Ajay Pal Singh; Amarjit Singh Sidhu; Arun Pal Singh

    2010-01-01

    Bilateral hip dislocation rarely occurs.In this paper, a case of bilateral hip dislocation associated with bilateral sciatic nerve palsy resulted from a road traffic acci-dent is reported.Both hips were emergently reduced under general anaesthesia.Acetabular reconstruction was done bilaterally due to the unstable hips.The patient subsequently developed heterotopic ossification and avascular necrosis on the left hip and underwent total hip arthroplasty.The sciatic nerve on the right side achieved complete recovery but that on the left side only partly recovered and was aug-mented by tendon transfer.Such injuries are serious and one should be aware of the complications because they can resurface and so patients should be followed up for a long time.To the best of our knowledge, this kind of injury has not been reported in the English .language literature.

  7. Through-knee amputation for a patient with proximal femur focal deficiency and tibial hemimelia: surgical anatomy and clinical implications.

    Science.gov (United States)

    Lloyd, Selvyn; Rashid, Abdul Halim Abd; Das, Srijit; Ibrahim, Sharaf

    2014-03-01

    Tibial hemimelia is a rare anomaly of unknown etiology. This condition can occur sporadically or may have a familial inheritance. It is characterized by deficiency of the tibia with a relatively intact fibula. The anomaly may be unilateral or bilateral. We report a case of a 2-year-old girl who presented with right lower limb deformity since birth. She was diagnosed with proximal femur focal deficiency with absence of the ipsilateral tibia. She presented with a shorter right lower limb and a deformed foot. She was treated with a through-knee amputation. Anatomical dissection of the amputated limb was carried out to verify the anomalies. The dissection showed that the distal phalanx of the great toe was trifid. The anatomical and clinical significance of this interesting case is discussed.

  8. Preliminary evaluation of the tibial tuberosity-trochlear groove measurement

    DEFF Research Database (Denmark)

    Miles, James Edward; Kirpensteijn, Jolle; Svalastoga, Eiliv Lars

    guide surgical treatment. The TTTG measures tibial tuberosity position relative to the axis of the femoral trochlea. A preliminary investigation of TTTG measurement was performed using the red fox (Vulpes vulpes) cadavers as a morphologically similar and homogenous substitute for dog cadavers. CT...

  9. Total knee arthroplasty after high tibial osteotomy. A systematic review

    NARCIS (Netherlands)

    T.M. van Raaij (Tom); M. Reijman (Max); A. Furlan (Alessandro); J.A.N. Verhaar (Jan)

    2009-01-01

    textabstractBackground: Previous osteotomy may compromise subsequent knee replacement, but no guidelines considering knee arthroplasty after prior osteotomy have been developed. We describe a systematic review of non-randomized studies to analyze the effect of high tibial osteotomy on total knee art

  10. Osteoarthritis Imaging by Quantification of Tibial Trabecular Bone

    DEFF Research Database (Denmark)

    Marques, Joselene

    The pathogenesis of osteoarthritis (OA) includes complex events in the whole joint. In this project, we combined machine-learning techniques in a texture analysis framework and evaluated it in a longitudinal study, where magnetic resonance images of knees were used to quantify the tibial trabecul...

  11. Contact Stress Generation on the UHMWPE Tibial Insert

    Directory of Open Access Journals (Sweden)

    S. Petrović Savić

    2014-12-01

    Full Text Available Total knee replacement (TKR is considered, during last years, as a very successful surgical technique for removing knee joint deformities and eliminating pain caused by cartilage damage. In literature, as primary causes for knee joint endoprothesis damage are cited complex movements which cause occurrences of complex stress conditions, sagital radius conformity, sliding, types of materials etc. Aim of this study is analysis of contact stresses that occur on tibial implant for 15°, 45° and 60° knee flexion and 50 kg, 75 kg, 100 kg and 125 kg weight. Knee joint prosthesis model and finite elements method (FEM analysis are done in software Catia V5. For this analysis we used ultra-high molecular weight polyethylene (UHMWPE for tibial implant material and AISI 316, AISI 317, AISI 321, 17-4PH, CoCrMo, Ti6Al4V and SAE A-286 for femoral component materials. Results show that area of maximal contact stress is identified in medial and lateral part of tibial implant. Von Mises stress values vary regarding of flexion degree and weight, but values are approximate for types of chosen materials. Contact stress location corresponds to damage that occur on tibial implant during exploitation.

  12. Asymmetry in gait pattern following tibial shaft fractures

    DEFF Research Database (Denmark)

    Larsen, Peter; Læssøe, Uffe; Rasmussen, Sten

    2017-01-01

    INTRODUCTION: Despite the high number of studies evaluating the outcomes following tibial shaft fractures, the literature lacks studies including objective assessment of patients' recovery regarding gait pattern. The purpose of the present study was to evaluate whether gait patterns at 6 and 12 m...

  13. Aetiology, imaging and treatment of medial tibial stress syndrome

    NARCIS (Netherlands)

    Moen, M.H.

    2012-01-01

    The work contained is this thesis discusses aetiology, imaging and treatment of a common leg injury: medial tibial stress syndrome (MTSS). Although a common injury, the number of scientific articles on this topic is relatively low as is explained in chapter 1. This chapter also highlights that the m

  14. Tibial inlay for posterior cruciate ligament reconstruction: a systematic review.

    Science.gov (United States)

    Papalia, Rocco; Osti, Leonardo; Del Buono, Angelo; Denaro, Vincenzo; Maffulli, Nicola

    2010-08-01

    Although no consensus has been reached regarding the management of PCL deficiency, in vitro and in vivo studies have investigated whether the tibial inlay technique restores the anatomical site of insertion of the PCL, prevents elongation, stretching, graft failure, and improves long-term PCL stability. A systematic search using PubMed, Ovid, the Cochrane Reviews, and Google Scholar databases using 'posterior cruciate ligament tear', 'Tibial inlay technique' and 'posterior cruciate ligament reconstruction' as keywords identified 71 publications, of which 10 were relevant to the topic, and included a total of 255 patients. The tibial inlay technique restores the anatomic insertion site of the PCL, eliminates the killer turn effect, and places the graft at lower potential risk for abrasion and subsequent rupture. It has the disadvantages of increased operating time and risk to the posterior neurovascular structures. There was no evidence of an association between outcome results and Coleman methodology score, but the Coleman methodology scores correlated positively with the level-of-evidence rating. The methodological quality of the studies included has not improved over the years. Given the few reported published findings, we cannot ascertain whether this procedure may provide a consistent alternative to commonly used PCL surgical strategies. The lack of published randomized clinical trials and few reported findings did not allow to ascertain whether the tibial inlay for posterior cruciate ligament reconstruction may provide a consistent alternative to commonly used PCL surgical strategies and to demonstrate procedure efficacy.

  15. Olanzapine-induced tender pitting pre-tibial edema

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    Kaliaperumal Mathan

    2015-01-01

    Full Text Available Antipsychotic-induced edema is uncommonly encountered in clinical practice. We report a case of tender pitting pre-tibial edema with olanzapine in a woman with no medical comorbidities. The peculiar distribution of edema resulted in diagnostic confusion necessitating specific investigations. Eventually, the edema resolved following complete stoppage of the drug, but caused distress to the patient and the caregiver.

  16. Anterior cruciate ligament reconstruction failure after tibial shaft malunion.

    Science.gov (United States)

    LaFrance, Russell M; Gorczyca, John T; Maloney, Michael D

    2012-02-17

    Anterior cruciate ligament (ACL) reconstruction is common, with >100,000 procedures performed each year in the United States. Several factors are associated with failure, including poor surgical technique, graft incorporation failure, overly aggressive rehabilitation, and trauma. Tibial shaft fracture is also common and frequently requires operative intervention. Failure to reestablish the anatomic alignment of the tibia may cause abnormal forces across adjacent joints, which can cause degenerative joint disease or attritional failure of the surrounding soft tissues. This article describes a case of ACL reconstruction failure after a tibial fracture that resulted in malunion. Excessive force across the graft from lower-extremity malalignment and improper tunnel placement likely contributed to the attritional failure of the graft. This patient required a staged procedure for corrective tibial osteotomy followed by revision ACL reconstruction. This article describes ACL reconstruction failure, tibial shaft malunions, their respective treatments, the technical details of each procedure, and the technical aspects that must be considered when these procedures are done in a staged manner by 2 surgeons.

  17. Age variations in the properties of human tibial trabecular bone

    DEFF Research Database (Denmark)

    Ding, Ming; Dalstra, M; Danielsen, CC;

    1997-01-01

    We tested in compression specimens of human proximal tibial trabecular bone from 31 normal donors aged from 16 to 83 years and determined the mechanical properties, density and mineral and collagen content. Young's modulus and ultimate stress were highest between 40 and 50 years, whereas ultimate...

  18. MR imaging findings of medial tibial crest friction

    Energy Technology Data Exchange (ETDEWEB)

    Klontzas, Michail E., E-mail: miklontzas@gmail.com; Akoumianakis, Ioannis D., E-mail: ioannis.akoumianakis@gmail.com; Vagios, Ilias, E-mail: iliasvagios@gmail.com; Karantanas, Apostolos H., E-mail: akarantanas@gmail.com

    2013-11-01

    Objective: Medial tibial condyle bone marrow edema (BME), associated with soft tissue edema (STe) surrounding the medial collateral ligament, was incidentally observed in MRI examinations of young and athletic individuals. The aim of the present study was to 1. Prospectively investigate the association between these findings and coexistence of localized pain, and 2. Explore the possible contribution of the tibial morphology to its pathogenesis. Methods: The medial tibial condyle crest was evaluated in 632 knee MRI examinations. The angle and depth were measured by two separate evaluators. The presence of STe and BME was recorded. A third evaluator blindly assessed the presence of pain at this site. Results: BME associated with STe was found in 24 patients (with no history of previous trauma, osteoarthritis, tumor or pes anserine bursitis). The mean crest angle was 151.3° (95%CI 147.4–155.3°) compared to 159.4° (95%CI 158.8–160°) in controls (Mann–Whitney test, P < 0.0001). MRI findings were highly predictive of localized pain (sensitivity 92% specificity 99%, Fisher's exact test, P < 0.0001). Conclusion: Friction at the medial tibial condyle crest is a painful syndrome. MRI is a highly specific and sensitive imaging modality for its diagnosis.

  19. Multichannel recording of tibial-nerve somatosensory evoked potentials

    NARCIS (Netherlands)

    de Wassenberg, W. J. G. van; Kruizinga, W. J.; van der Hoeven, J. H.; Leenders, K. L.; Maurits, N. M.

    2008-01-01

    Study aims. -The topography of the peaks of tibial.-nerve somatosensory evoked potential (SEP) varies among healthy subjects, most likely because of differences in position and orientation of their cortical generator(s). Therefore, amplitude estimation with a standard one- or two-channel derivation

  20. The Effect of Malrotation of Tibial Component of Total Knee Arthroplasty on Tibial Insert during High Flexion Using a Finite Element Analysis

    Directory of Open Access Journals (Sweden)

    Kei Osano

    2014-01-01

    Full Text Available One of the most common errors of total knee arthroplasty procedure is a malrotation of tibial component. The stress on tibial insert is closely related to polyethylene failure. The objective of this study is to analyze the effect of malrotation of tibial component for the stress on tibial insert during high flexion using a finite element analysis. We used Stryker NRG PS for analysis. Three different initial conditions of tibial component including normal, 15° internal malrotation, and 15° external malrotation were analyzed. The tibial insert made from ultra-high-molecular-weight polyethylene was assumed to be elastic-plastic while femoral and tibial metal components were assumed to be rigid. Four nonlinear springs attached to tibial component represented soft tissues around the knee. Vertical load was applied to femoral component which rotated from 0° to 135° while horizontal load along the anterior posterior axis was applied to tibial component during flexion. Maximum equivalent stresses on the surface were analyzed. Internal malrotation caused the highest stress which arose up to 160% of normal position. External malrotation also caused higher stress. Implanting prosthesis in correct position is important for reducing the risk of abnormal wear and failure.

  1. External fixation in the treatment of open tibial shaft fractures

    Directory of Open Access Journals (Sweden)

    Golubović Zoran

    2008-01-01

    Full Text Available Background/Aim. Besides the conquasant fractures, open tibia shaft fractures belong to the group of the most severe fractures of tibia. Open tibia shaft fracture is one of the most common open fractures of long bones. They most frequently occur as a result of traffic accidents caused by the influence of a strong direct force. Methods. Within the period from January, 2000 to December 31, 2005. at the Clinic for Orthopaedics and Traumatology, Clinical Center Nis, 107 patients with open tibial fractures were treated. We analyzed 96 patients with open tibial fracture. In the series analyzed, the male sex was prevalent - there were 74 men (77.08%. The mean age was 47.3 years. The youngest patient was 17 years old, while the oldest patient was 79. According to the classification of the Gustilo et al. in the analysed group there were 30 (31.25% open tibial fractures of the I degree, 31 (32.29% of the II degree, 25 (26.05% of the III A degree, 8 (8.33% of the III B degree and 2 (2.08% of the III C degree. In 95 of the patients the treatment of open tibia shaft fractures consisted of the surgical treatment of wound and the external fixation of the fractured bone using "Mitkovic" type external fixator with a convergent method of pin applications. One primary amputations had been done in patients with grade IIIC open tibial fracture with large soft tissue defect. Results. Of the 96 open tibial fractures available for follow-up, 73 (76.04% healed without severe complications (osteitis, pseudoarthrosis, valgus malunion and amputation. Ther were nine (9.38% soft tissue pin track infections and six (6.25% superficial wound infections. The mean time of union was 21 (14-36 week. Among severe local complications associated with open tibial fractures, in eight patients (8.33% was registered osteitis, and in nine patients (9.38% fracture nonunion and the development of pseudoarthrosis. Three of the patients (3.13% had more than 10 degree valgus malunion. In one

  2. Posterior tibial tendon dysfunction and flatfoot: analysis with simulated walking.

    Science.gov (United States)

    Watanabe, Kota; Kitaoka, Harold B; Fujii, Tadashi; Crevoisier, Xavier; Berglund, Lawrence J; Zhao, Kristin D; Kaufman, Kenton R; An, Kai-Nan

    2013-02-01

    Many biomechanical studies investigated pathology of flatfoot and effects of operations on flatfoot. The majority of cadaveric studies are limited to the quasistatic response to static joint loads. This study examined the unconstrained joint motion of the foot and ankle during stance phase utilizing a dynamic foot-ankle simulator in simulated stage 2 posterior tibial tendon dysfunction (PTTD). Muscle forces were applied on the extrinsic tendons of the foot using six servo-pneumatic cylinders to simulate their action. Vertical and fore-aft shear forces were applied and tibial advancement was performed with the servomotors. Three-dimensional movements of multiple bones of the foot were monitored with a magnetic tracking system. Twenty-two fresh-frozen lower extremities were studied in the intact condition, then following sectioning peritalar constraints to create a flatfoot and unloading the posterior tibial muscle force. Kinematics in the intact condition were consistent with gait analysis data for normals. There were altered kinematics in the flatfoot condition, particularly in coronal and transverse planes. Calcaneal eversion relative to the tibia averaged 11.1±2.8° compared to 5.8±2.3° in the normal condition. Calcaneal-tibial external rotation was significantly increased in flatfeet from mean of 2.3±1.7° to 8.1±4.0°. There were also significant changes in metatarsal-tibial eversion and external rotation in the flatfoot condition. The simulated PTTD with flatfoot was consistent with previous data obtained in patients with PTTD. The use of a flatfoot model will enable more detailed study on the flatfoot condition and/or effect of surgical treatment.

  3. Analysis of Knee Joint Line Obliquity after High Tibial Osteotomy.

    Science.gov (United States)

    Oh, Kwang-Jun; Ko, Young Bong; Bae, Ji Hoon; Yoon, Suk Tae; Kim, Jae Gyoon

    2016-11-01

    The aim of this study was to evaluate which lower extremity alignment (knee and ankle joint) parameters affect knee joint line obliquity (KJLO) in the coronal plane after open wedge high tibial osteotomy (OWHTO). Overall, 69 knees of patients that underwent OWHTO were evaluated using radiographs obtained preoperatively and from 6 weeks to 3 months postoperatively. We measured multiple parameters of knee and ankle joint alignment (hip-knee-ankle angle [HKA], joint line height [JLH], posterior tibial slope [PS], femoral condyle-tibial plateau angle [FCTP], medial proximal tibial angle [MPTA], mechanical lateral distal femoral angle [mLDFA], KJLO, talar tilt angle [TTA], ankle joint obliquity [AJO], and the lateral distal tibial ground surface angle [LDTGA]; preoperative [-pre], postoperative [-post], and the difference between -pre and -post values [-Δ]). We categorized patients into two groups according to the KJLO-post value (the normal group [within ± 4 degrees, 56 knees] and the abnormal group [greater than ± 4 degrees, 13 knees]), and compared their -pre parameters. Multiple logistic regression analysis was used to examine the contribution of the -pre parameters to abnormal KJLO-post. The mean HKA-Δ (-9.4 ± 4.7 degrees) was larger than the mean KJLO-Δ (-2.1 ± 3.2 degrees). The knee joint alignment parameters (the HKA-pre, FCTP-pre) differed significantly between the two groups (p knee joint alignment and knee joint convergence angle evaluated by HKA-pre and FCTP-pre angle, respectively, were significant predictors of abnormal KJLO after OWHTO. However, -pre ankle joint parameters were not significantly associated with abnormal KJLO after OWHTO.

  4. Localização do ponto de entrada tibial Localization of the tibial entry point

    Directory of Open Access Journals (Sweden)

    Pedro José Labronici

    2010-01-01

    Full Text Available OBJETIVO: Verificar, através de um questionário, o ponto de entrada da haste intramedular na região proximal da tíbia. Métodos: 230 participantes que tratam fraturas da tíbia foram entrevistados. O questionário foi formulado com três segmentos que poderiam ser respondidos com um formato "sim" ou "não" e um quarto, com duas figuras que representavam uma radiografia em anteroposterior (AP e lateral que poderiam ser respondidas com um formato "A", "B" ou "C". RESULTADOS: A razão mais frequente foi a "facilidade de acesso" (67,8%, seguida do "melhor acesso para inserção da haste" (60,9% e em terceiro "prevenir a dor no joelho" (27,4%. Existiu relação significativa entre as razões de escolha do acesso como "prevenir dor no joelho" e "evitar tendinites" com os pontos A e C da figura esquemática de radiografia em AP, principalmente o ponto C (crista tibial medial. Observou-se que não existiu diferença significativa nos tipos de acesso em relação ao ligamento patelar, nas figuras esquemáticas de radiografia em AP e perfil entre as faixas etárias. CONCLUSÃO: Observou-se que quanto maior a faixa etária maior a proporção de escolher a pergunta "evitar deformidade em valgo". As razões de aspecto médico (prático foram relacionadas com o tipo de acesso no ligamento transpatelar, enquanto que as razões de aspecto paciente (funcional foram relacionadas com o acesso parapatelar medial. O acesso transpatelar foi escolhido pela maioria dos participantes (66,5%.OBJETIVE: To assess, through a questionnaire, the intramedullary nail entry point in the proximal aspect of the tibia. Me-thods: 230 attendees who treat tibial fractures were interviewed. The questionnaire was created with three sections that could be answered with "Yes" or "No" answers and a fourth section that had two figures representing anteroposterior (AP and lateral view x-rays that could be answered with a format "A, "B" or "C". RESULTS: The most frequent reason was "ease

  5. Bilateral, independent juvenile nasopharyngeal angiofibroma

    DEFF Research Database (Denmark)

    Mørkenborg, Marie-Louise; Frendø, M; Stavngaard, T;

    2015-01-01

    BACKGROUND: Juvenile nasopharyngeal angiofibroma is a benign, vascular tumour that primarily occurs in adolescent males. Despite its benign nature, aggressive growth patterns can cause potential life-threatening complications. Juvenile nasopharyngeal angiofibroma is normally unilateral, originating...... from the sphenopalatine artery, but bilateral symptoms can occur if a large tumour extends to the contralateral side of the nasopharynx. This paper presents the first reported case of true bilateral extensive juvenile nasopharyngeal angiofibroma involving clinically challenging pre-surgical planning...... embolisation. Radical removal performed as one-step, computer-assisted functional endoscopic sinus surgery was performed. The follow-up period was uncomplicated. CONCLUSION: This case illustrates the importance of suspecting bilateral juvenile nasopharyngeal angiofibroma in patients presenting with bilateral...

  6. Bilateral Olecranon Tophaceous Gout Bursitis

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    Güzelali Özdemir

    2017-01-01

    Full Text Available In this case, we present a patient with the diagnosis of bilateral olecranon tophaceous gout. After the surgical treatment, there was no limitation of range of motion or wound problem at 6th month control.

  7. Bilateral custom-fit total knee arthroplasty in a patient with poliomyelitis.

    Science.gov (United States)

    Tardy, Nicolas; Chambat, Pierre; Murphy, Colin G; Fayard, Jean-Marie

    2014-09-01

    In limbs affected by poliomyelitis, total knee arthroplasty results in satisfactory pain relief. However, the risk of failure is high, especially if the preoperative quadriceps power is low. Therefore, treating osteoarthritis in the current patient represented a challenging procedure. A 66-year-old man presented with tricompartmental osteoarthritis of both knees, with valgus deformity of 14° on the left knee and 11° on the right knee. He walked with a bilateral knee recurvatum of 30° and a grade 1 quadriceps power. The authors treated both knees with cemented custom-fit hinged total knee arthroplasty with 30° of recurvatum in the tibial keel. Clinical scores showed good results 1 year postoperatively, especially on the subjective data of quality of life and function. At follow-up, radiographs showed good total knee arthroplasty positioning on the right side and a small mechanical loosening at the end of the tibial keel on the left side. Only 5 studies (Patterson and Insall; Moran; Giori and Lewallen; Jordan et al; and Tigani et al) have reported total knee arthroplasty results in patients with poliomyelitis. This study reports an original case of bilateral custom-fit hinged total knee arthroplasty in a patient with poliomyelitis. To the authors' knowledge, this is the first report of this type of procedure in the literature. The key point is the degree of recurvatum that is needed to allow walking, avoiding excessive constraints on the implants that can lead to early mechanical failure.

  8. BILATERAL PRESENTATION OF TENSOR FASCIA SURALIS MUSCLE IN A MALE CADAVER: A CASE REPORT

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    Kusum Rajendra Gandhi

    2015-12-01

    Full Text Available Tensor fascia suralis muscle is an anomalous muscle located in popliteal fossa. The muscle may arise from any of the hamstring muscles and is inserted into the crural fascia or tendoclacaneus. We found tensor fascia suralis muscle in a male cadaver taking origin from medial side of tendon of biceps femoris muscle. The tendinous origin was then transformed into a well defined fusiform belly in the roof of popliteal fossa. After traversing downwards and medially the muscle again became tendinous to get inserted into deep fascia of leg. Bilateral presentation of the anomalous muscle is not yet documented in literature. The anatomical relation of the muscle explains its great clinical importance. The tendinous origin was anteriorly related to sciatic nerve and the muscle belly to the tibial nerve. Sural nerve and short saphenous vein were in lateral relation to the muscle. Contraction of muscle in the roof of popliteal fossa may lead to sciatic, tibial or sural nerve neuropathy. The muscle can confuse the physician of a soft tissue mass or an aberrant vessel. Hence, the bilateral presence of tensor fascia suralis muscle is documented for further references. Clinical Significance: The precise knowledge of anatomy of popliteal region is mandatory for the surgeons to perform safe and uncomplicated surgery in and around popliteal fossa and also for radiologist for correct radiographic interpretations.

  9. Bilateral Morgagni Hernia in Adult

    Directory of Open Access Journals (Sweden)

    Ali Celik

    2014-03-01

    Full Text Available       Morgagni hernia is a congenital anterior diaphragma hernias. Although it generally seen in childhood and on the right side, rarely seen bilaterally and adult. Computarize tomography is helpful in diagnosis for this lesions asymptomatic in adult. In this article, bilaterally morgagni hernia diagnosed a sixty-five year old male patient looked for due to dyspne was presented.

  10. Bilateral sarkoidose i glandula parotis

    DEFF Research Database (Denmark)

    Hahn, Pernille; Krogdahl, Annelise; Godballe, Christian

    2012-01-01

    We describe an unusual case of sarcoidosis in which the patient presented with a bilateral swelling of the parotid salivary glands and no other manifestation of the disease. Sarcoidosis is a multisystem granulomatous disorder of unknown cause in which there may be multiple exocrine involvement......, including the salivary glands. This case emphasises the importance of including sarcoidosis in the differential diagnosis of bilateral parotid swelling....

  11. Multiple bilateral lower limb fractures in a 2-year-old child: previously unreported injury with a unique mechanism

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    Anuj Jain

    2014-10-01

    Full Text Available 【Abstract】Fall from height is a common cause of unintentional injuries in children and accounts for 6% of all trauma-related childhood deaths, usually from head injury. We report a case of a 2-year-old child with multiple fractures of the bilateral lower limbs due to this reason. A child fell from a height of around 15 feet after toppling from a alcony. He developed multiple fractures involving the right femoral shaft, right distal femoral epiphysis (Salter Harris type 2, right distal metaphysis of the tibia and fi bula, and undisplaced Salter Harris type 2 epiphyseal injury of the left distal tibia. There were no head, abdominal or spinal injuries. The patient was taken into emergency operation theatre after initial management which consisted of intravenous fl uids, blood transfusion, and splintage of both lower limbs. Fracture of the femoral shaft was treated by closed reduction and fixation using two titanium elastic nails. Distal femoral physeal injury required open eduction and fixation with K wires. Distal tibia fractures were closely reduced and managed nonoperatively in both the lower limbs. All the fractures united in four weeks. At the last follow-up, the child had no disability and was able to perform daily ctivities comfortably. We also proposed the unique mechanism of injury in this report. Key words: Multiple bilateral lower limb fractures; Fall; Child

  12. Tibial torsion in non-arthritic Indian adults: A computer tomography study of 100 limbs

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    Mullaji Arun

    2008-01-01

    Full Text Available Background: Knowledge of normal tibial torsion is mandatory during total knee replacement (TKR, deformity correction and fracture management of tibia. Different values of tibial torsion have been found in different races due to biological and mechanical factors. Value of normal tibial torsion in Indian limbs is not known, hence this study to determine the norm of tibial torsional value in normal Indian population. Materials and Methods: Computer tomography (CT scans were performed in 100 non-arthritic limbs of 50 Indian adults (42 males, eight females; age 26-40 years. Value of tibial torsion was measured using dorsal tangent to tibial condyles proximally and bimalleolar axis distally. Results: Normal tibial torsion was found to be 21.6 ± 7.6 (range 4.8 to 39.5 with none of the values in internal rotation. Right tibia was externally rotated by 2 degrees as compared to the left side ( P 0.029. No significant difference was found in male and female subjects. Value of tibial torsion was less than in Caucasian limbs, but was comparable to Japanese limbs when studies using similar measurement technique were compared. Conclusions: Indian limbs have less tibial torsion than Caucasian limbs but the value of tibial torsion is comparable to Japanese limbs.

  13. Bilateral zeta functions and their applications

    OpenAIRE

    Shibukawa, Genki

    2011-01-01

    We introduce a new type of multiple zeta functions, which we call bilateral zeta functions, analogous to the Barnes zeta functions. The bilateral zeta function is a periodic function and shares certain basic properties of Barnes zeta function. Especially, we prove that the bilateral zeta function has a nice Fourier series expansion and the Barnes zeta function can be expressed as a finite sum of bilateral zeta functions. By these properties of the bilateral zeta functions, We obtain simple pr...

  14. Paralisia facial bilateral Bilateral facial paralysis: a case report

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    J. Fortes-Rego

    1976-03-01

    Full Text Available É apresentado um caso de diplegia facial surgida após meningite meningocócica e infecção por herpes simples. Depois de discutir as diversas condições que o fenômeno pode apresentar-se, o autor inclina-se por uma etiologia herpética.A case of bilateral facial paralysis following meningococcal meningitis and herpes simplex infection is reported. The author discusses the differential diagnosis of bilateral facial nerve paralysis which includes several diseases and syndromes and concludes by herpetic aetiology.

  15. Bilateral spontaneous hemotympanum: Case report

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    Economou Nicolas C

    2006-10-01

    Full Text Available Abstract Background The most common causes of hemotympanum are therapeutic nasal packing, epistaxis, blood disorders and blunt trauma to the head. Hemotympanum is characterized as idiopathic, when it is detected in the presence of chronic otitis media. A rare case of spontaneous bilateral hemotympanum in a patient treated with anticoagulants is presented herein. Case presentation A 72-year-old male presented with acute deterioration of hearing. In the patient's medical history aortic valve replacement 1 year before presentation was reported. Since then he had been administered regularly coumarinic anticoagulants, with INR levels maintained between 3.4 and 4.0. Otoscopy revealed the presence of bilateral hemotympanum. The audiogram showed symmetrical moderately severe mixed hearing loss bilaterally, with the conductive component predominating. Tympanograms were flat bilaterally with absent acoustic reflexes. A computerized tomography scan showed the presence of fluid in the mastoid and middle ear bilaterally. Treatment was conservative and consisted of a 10-day course of antibiotics, anticongestants and temporary interruption of the anticoagulant therapy. After 3 weeks, normal tympanic membranes were found and hearing had returned to previous levels. Conclusion Anticoagulant intake should be included in the differential diagnosis of hemotympanum, because its detection and appropriate treatment may lead to resolution of the disorder.

  16. MR evaluation of femoral neck version and tibial torsion

    Energy Technology Data Exchange (ETDEWEB)

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

    2012-01-15

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

  17. Open tibial shaft fractures: II. Definitive management and limb salvage.

    Science.gov (United States)

    Melvin, J Stuart; Dombroski, Derek G; Torbert, Jesse T; Kovach, Stephen J; Esterhai, John L; Mehta, Samir

    2010-02-01

    Definitive treatment of open fractures of the tibial diaphysis is challenging. The high-energy nature of these fractures, as well as the contamination of the fracture site and devitalization of the soft-tissue envelope, greatly increases the risk of infection, nonunion, and wound complications. The goals of definitive treatment include wound coverage or closure; prevention of infection; restoration of length, alignment, rotation, and stability; fracture healing; and return of function. Advances in orthobiologics, modern plastic surgical techniques, and fracture stabilization methods, most notably locked intramedullary nailing, have led to improved prognosis for functional recovery and limb salvage. Despite improved union and limb salvage rates, the prognosis for severe type III open fracture of the tibial shaft remains guarded, and outcomes are often determined by patient psychosocial variables.

  18. Posterior Tibial Tendon Dysfunction: An Overlooked Cause of Foot Deformity

    Science.gov (United States)

    Bubra, Preet Singh; Keighley, Geffrey; Rateesh, Shruti; Carmody, David

    2015-01-01

    Posterior tibial tendon dysfunction is the most common cause of adult acquired flatfoot. Degenerative changes in this tendon, lead to pain and weakness and if not identified and treated will progress to deformity of the foot and degenerative changes in the surrounding joints. Patients will complain of medial foot pain, weakness, and a slowly progressive foot deformity. A “too many toes” sign may be present and patients will be unable to perform a single heal raise test. Investigations such X-ray, ultrasound and magnetic resonance imaging will help stage the disease and decide on management. The optimal manage may change based on the progression of deformity and stage of disease. Early identification and prompt initiation of treatment can halt progression of the disease. The purpose of this article is to examine the causes, signs, symptoms, examinations, investigations and treatment options for posterior tibial tendon dysfunction. PMID:25810985

  19. Aetiology, imaging and treatment of medial tibial stress syndrome

    OpenAIRE

    Moen, M.H.

    2012-01-01

    The work contained is this thesis discusses aetiology, imaging and treatment of a common leg injury: medial tibial stress syndrome (MTSS). Although a common injury, the number of scientific articles on this topic is relatively low as is explained in chapter 1. This chapter also highlights that the most probable cause of MTSS is bone overload and not traction induced periostitis. In chapter 2 a review of the literature on MTSS is provided until 2009. Chapters 3 and 4 discuss different common a...

  20. Human tibial torsion - Morphometric assessment and clinical relevance

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    Swati Gandhi

    2014-02-01

    Full Text Available Background: Tibial torsion is an important anatomical parameter in clinical practice and displays variability among individuals. These variations are extremely significant in view of alignment guides such as those related to rotational landmarks of tibia in total knee arthroplasty. Further, precise knowledge and information pertaining to angle of tibial torsion also helps in correction of traumatic malunion or congenital maltorsion of tibia. Methods: The present study was carried out to determine the angle of tibial torsion in 100 adult dry tibia bones in the Department of Anatomy, Government Medical College, Amritsar. The study group comprised 50 males and 50 females with equal number of right- and left-sided bones. The measurements were meticulously recorded and the data were subjected to statistical analysis. The results were analyzed and discussed in the light of existing literature. Results: On the right side, it was found to be 29.84° ± 4.86°° (range = 22.00° -38.00° in males and 28.92° ± 5.10°° (range = 15.00°-38.00° in females. On the left side, it was found to be 28.00° ± 4.94°° (range = 20.00°-40.00°° in males and 28.12° ± 4.28°° (range = 20.00°-37.00°° in females. Conclusion: The present study is an endeavor to provide baseline data with reference to the angle of tibial torsion in the Indian population. The results of the study assume special importance in view of the technical advancements in reconstructive surgical procedures in orthopedic practice.

  1. Posterior Tibial Tendon Dysfunction and Flatfoot: Analysis with Simulated Walking

    OpenAIRE

    Watanabe, Kota; Kitaoka, Harold B; Fujii, Tadashi; Crevoisier, Xavier M.; Berglund, Lawrence J.; Zhao, Kristin D.; Kaufman, Kenton R.; An, Kai-Nan

    2012-01-01

    Many biomechanical studies investigated pathology of flatfoot and effects of operations on flatfoot. The majority of cadaveric studies are limited to the quasistatic response to static joint loads. This study examined the unconstrained joint motion of the foot and ankle during stance phase utilizing a dynamic foot-ankle simulator in simulated stage 2 posterior tibial tendon dysfunction (PTTD). Muscle forces were applied on the extrinsic tendons of the foot using six servo-pneumatic cylinders ...

  2. Osteotomia tibial alta em pacientes com artrose do joelho High tibial osteotomy in patients with knee arthrosis

    Directory of Open Access Journals (Sweden)

    Roger Avakian

    2008-01-01

    Full Text Available OBJETIVO: Avaliar o tratamento da gonartrose medial com osteotomia tibial tipo cunha de fechamento lateral associado à liberação da articulação tibiofibular proximal. MÉTODOS: Realizamos esta técnica associado com liberação da articulação tibiofibular proximal no tratamento da gonartrose medial em 36 pacientes (41 joelhos de janeiro de 1995 a abril de 2003, com idade de 53,4 anos (média, seguidos por 51,6 meses (média. RESULTADOS: Na avaliação notamos que as osteotomias tibiais com cunha de fechamento lateral permitem correção satisfatória da deformidade fêmorotibial, com angulação femorotibial final em torno de 7º de valgo; o eixo mecânico foi desviado da região tibial medial (posição 1,2% para o centro do joelho (posição 50,5%; a inclinação tibial na incidência perfil pré-operatória de 9,8º foi corrigida para 6,5º (média; a mobilidade articular apresentou perda de 2,3º na extensão (média. CONCLUSÃO: A técnica permite correção satisfatória da deformidade em varo fêmorotibial, porém não é isenta de complicações (14,6%. O grau de satisfação (Lysholm dos pacientes teve incremento de 27,3 para 89. Assim, constitui uma parte essencial no arsenal de tratamento da gonartrose.PURPOSE: To assess medial gonarthrosis treatment with wedge-like side-closed tibial osteotomy combined with proximal tibial-fibular joint release. METHODS: we employed this technique combined with proximal tibial-fibular joint release in the treatment of medial gonarthrosis in 36 patients (41 knees, from January 1995 to April 2003, with mean age of 53.4 years, followed-up for 51.6 months (in average. RESULTS: In the assessment, we noticed that wedge-like side-closed tibial osteotomies allow for a satisfactory repair of the femorotibial deformity, with end femorotibial angle of about 7° valgus; the mechanical axis was dislocated from the medial region of the tibia (position: 1.2% to knee center (position: 50.5%; the 9.8° tibial

  3. Role of the fibula in the stability of diaphyseal tibial fractures fixed by intramedullary nailing

    OpenAIRE

    John G. Galbraith; Daly, Charles J.; Harty, James A; Dailey, Hannah L.

    2016-01-01

    Background: For tibial fractures, the decision to fix a concomitant fibular fracture is undertaken on a case-by-case basis. To aid in this clinical decision-making process, we investigated whether loss of integrity of the fibula significantly destabilises midshaft tibial fractures, whether fixation of the fibula restores stability to the tibia, and whether removal of the fibula and interosseous membrane for expediency in biomechanical testing significantly influences tibial interfragmentary m...

  4. Pseudoarthrosis of medial tibial plateau fracture——role of alignment procedure

    Institute of Scientific and Technical Information of China (English)

    Ashish Devgan; Pradeep Kamboj; Vinay Gupta; Narender K Magu; Rajesh Rohilla

    2013-01-01

    Nonunion in tibial plateau fractures is very rare.Limited literature is available on Pubmed search on intraarticular tibial nonunion.Most of the cases reported have been following failed surgical treatment and none was neglected fractures.Three patients of isolated and neglected medial tibial plateau nonunion with almost similar demographic profile are reported in this paper.All the three patients were managed by minimally invasive compression fixation using lag screws supplemented with limb realignme nt procedure of high tibial osteotomy.We discussed theinjury mechanism,management and rehabilitation in such cases and reviewed the available literature regarding such a presentation.

  5. Local and Widespread Hyperalgesia After Isolated Tibial Shaft Fractures Treated with Intramedullary Nailing

    DEFF Research Database (Denmark)

    Larsen, Peter; Elsøe, Rasmus; Graven-Nielsen, Thomas

    2016-01-01

    OBJECTIVES: Knee pain is accepted as a common complication to intramedullary nailing of tibial fractures. However, no studies have systematically studied the pain sequel following tibial fractures. The objective of this study was to assess pain and hyperalgesia from 6 weeks to 12 months postopera......OBJECTIVES: Knee pain is accepted as a common complication to intramedullary nailing of tibial fractures. However, no studies have systematically studied the pain sequel following tibial fractures. The objective of this study was to assess pain and hyperalgesia from 6 weeks to 12 months...

  6. Stress analysis of the tibial plateau according to the difference of blade path entry in opening wedge high tibial osteotomy

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jun Woo; Xin, YuanZhu; Yang, Seok Jo [Chungnam National University, Daejeon (Korea, Republic of); Ji, Jong Hun; Panchal, Karnav; Kwon, Oh Soo [The Catholic University of Korea, Daejeon (Korea, Republic of)

    2015-03-15

    High tibial osteotomy (HTO) has been used to successfully treat patients with genu varus deformities that can improve mechanical function and condition in the knee joint. Clinical studies have reported that bow legs often occur with a concentrated load on the varus of the tibia. This study aimed to analyze and verify the clinical test data result by utilizing the three-dimensional (3D) static finite element method (FEM). The 3D model of lower extremities, which include the femur, tibia, meniscus, and knee articular cartilage, was created using the images from a computer tomography scan and magnetic resonance imaging. In this report, we compared changes in stress distribution and force reaction on the tibial plateau because of critical problems caused by unexpected changes in the tibial posterior-slope angle because of HTO. The results showed that the 5 .deg. wedge-angle virtual opening wedge HTO without and with the posterior-slope angle shows has a load concentration of approximately 60% and 45% in the medial region, respectively.

  7. Bilateral familial nevus of Ota.

    Science.gov (United States)

    Goyal, Sunali; Uwaydat, Sami H; Phillips, Paul H; Schaefer, G Bradley

    2014-12-01

    Nevus of Ota is a benign congenital melanocytic lesion found most commonly in people of Asian ancestry. It is associated with an increased risk of glaucoma and uveal melanomas. Most cases are sporadic and unilateral. We present the first reported case of a brother and sister with familial, bilateral nevus of Ota.

  8. Spontaneous bilateral quadriceps tendon rupture.

    Science.gov (United States)

    Vigneswaran, N; Lee, K; Yegappan, M

    2007-11-01

    Spontaneous bilateral quadriceps tendon ruptures are uncommon. We present a 30-year-old man with end-stage renal failure, who sustained this injury, and subsequently had surgical repair of both tendons on separate occasions. He has since regained full range of movement of both knees.

  9. Bilateral breast in brothers - abreast

    Directory of Open Access Journals (Sweden)

    Altamash Mohammed Yusuf Shaikh

    2013-01-01

    Full Text Available Gynecomastia is a common occurrence in pubertal age group, and is physiological in up to 65 percent of cases. When occurs in the family it should be investigated in order not to miss on a treatable etiology. Two brothers within the same family, presenting with bilateral gynecomastia of different causes and requiring different treatment are presented.

  10. Bilateral acetabular fracture without trauma

    OpenAIRE

    De Rosa, M. A.; G. Maccauro; D’Arienzo, M.

    1999-01-01

     In the absence of trauma fracture of the acetabulum is an extremely rare injury. We describe a 70 year old man who spontaneously developed fractures in both acetabulae due to bony insufficiency. It was successfully treated by bilateral total hip replacement.

  11. Medial tibial pain: a dynamic contrast-enhanced MRI study.

    Science.gov (United States)

    Mattila, K T; Komu, M E; Dahlström, S; Koskinen, S K; Heikkilä, J

    1999-09-01

    The purpose of this study was to compare the sensitivity of different magnetic resonance imaging (MRI) sequences to depict periosteal edema in patients with medial tibial pain. Additionally, we evaluated the ability of dynamic contrast-enhanced imaging (DCES) to depict possible temporal alterations in muscular perfusion within compartments of the leg. Fifteen patients with medial tibial pain were examined with MRI. T1-, T2-weighted, proton density axial images and dynamic and static phase post-contrast images were compared in ability to depict periosteal edema. STIR was used in seven cases to depict bone marrow edema. Images were analyzed to detect signs of compartment edema. Region-of-interest measurements in compartments were performed during DCES and compared with controls. In detecting periosteal edema, post-contrast T1-weighted images were better than spin echo T2-weighted and proton density images or STIR images, but STIR depicted the bone marrow edema best. DCES best demonstrated the gradually enhancing periostitis. Four subjects with severe periosteal edema had visually detectable pathologic enhancement during DCES in the deep posterior compartment of the leg. Percentage enhancement in the deep posterior compartment of the leg was greater in patients than in controls. The fast enhancement phase in the deep posterior compartment began slightly slower in patients than in controls, but it continued longer. We believe that periosteal edema in bone stress reaction can cause impairment of venous flow in the deep posterior compartment. MRI can depict both these conditions. In patients with medial tibial pain, MR imaging protocol should include axial STIR images (to depict bone pathology) with T1-weighted axial pre and post-contrast images, and dynamic contrast enhanced imaging to show periosteal edema and abnormal contrast enhancement within a compartment.

  12. Bilateral pallidotomy for generalized dystonia Palidotomia bilateral para distonias generalizadas

    Directory of Open Access Journals (Sweden)

    Hélio A. G. Teive

    2001-06-01

    Full Text Available OBJECTIVE: To evaluate the efficacy and safety of bilateral pallidotomies in five patients with generalized dystonia. BACKGROUND: Generalized dystonias are frequently a therapeutic challenge, with poor responses to pharmacological treatment. GPi (globus pallidus internus pallidotomies for Parkinson's disease ameliorate all kinds of dyskinesias/dystonia, and recent studies reported a marked improvement of refractory dystonias with this procedure. METHODS: Five patients with generalized dystonias refractory to medical treatment were selected; one posttraumatic and four idiopathic. The decision to perform bilateral procedures was based on the predominant axial involvement in these patients. Dystonia severity was assessed with the Burke-Fahn-Marsden Dystonia Scale (BFM. Simultaneous procedures were performed in all but one patient, who had a staged procedure. They were reevaluated with the same scale (BFM by an unblinded rater at 1, 2, 3, 30, 60, 90, 120 and 180 days post-operatively. RESULTS: The four patients with idiopathic dystonia showed a progressive improvement up to three months; the patient with posttraumatic dystonia relapsed at three months. One patient had a marked improvement, being able to discontinue all the medications. A mean decrease in the BFM scores of 52,58% was noted. One patient had a trans-operative motor seizure followed by a transient hemiparesis secondary to rack hemorrhage; other was lethargic up to three days after the procedure. CONCLUSIONS: Our results show that bilateral GPi pallidotomies may be a safe and effective approach to medically refractory generalized dystonias; it can also be speculated that the posttraumatic subgroup may not benefit with this procedure.As distonias generalizadas são freqüentemente um desafio terapêutico, com pobres respostas aos tratamentos farmacológicos. As cirurgias estereotáxicas, como a palidotomia, têm sido utilizadas com êxito no tratamento da doença de Parkinson e estudos

  13. Immediate Sequential Bilateral Cataract Surgery

    DEFF Research Database (Denmark)

    Kessel, Line; Andresen, Jens; Erngaard, Ditte

    2015-01-01

    The aim of the present systematic review was to examine the benefits and harms associated with immediate sequential bilateral cataract surgery (ISBCS) with specific emphasis on the rate of complications, postoperative anisometropia, and subjective visual function in order to formulate evidence......-based national Danish guidelines for cataract surgery. A systematic literature review in PubMed, Embase, and Cochrane central databases identified three randomized controlled trials that compared outcome in patients randomized to ISBCS or bilateral cataract surgery on two different dates. Meta-analyses were...... performed using the Cochrane Review Manager software. The quality of the evidence was assessed using the GRADE method (Grading of Recommendation, Assessment, Development, and Evaluation). We did not find any difference in the risk of complications or visual outcome in patients randomized to ISBCS or surgery...

  14. Bilateral Lhermitte-Duclos disease

    Directory of Open Access Journals (Sweden)

    Bozbuga Mustafa

    2010-01-01

    Full Text Available Lhermitte-Duclos disease (LDD is a pathologic entity with progrediating, diffuse hypertrophy chiefly of the stratum granulosum of the cerebellum. Typically LDD is a unilateral lesion of the cerebellum or in vermis. Here we report a case of LDD with bilateral lesions of cerebellar hemispheres managed surgically. A 28-year-old woman presented with one-year history of progressive headache, nausea, vomiting, and blurred vision. Neurologic examination revealed a bilateral mild papilledema, mild dysmetria, and dysdiadochokinesia. The cerebellar lesions caused moderate mass effect in posterior fossa with hydrocephalus, and Chiari type I malformation. We performed the suboccipital-retrosigmoid approach, and removed completely the left intracerebellar mass. Symptoms related to elevated intracranial pressure disappeared in a short period postoperatively.

  15. Double segmental tibial fractures——an unusual fracture pattern

    Institute of Scientific and Technical Information of China (English)

    Kamal Bali; Vishal Kumar; Sandeep Patel; Sameer Aggarwal

    2011-01-01

    A case of a 50-year-old pedestrian who was hit by a bike and suffered fractures of both bones of his right leg was presented. Complete clinical and radiographic assessment showed double segmental fractures of the tibia and multisegmental fractures of the fibula. Review of the literature revealed that this fracture pattern was unique and only a single case was reported so far. Moreover, we discussed the possible mechanisms which can lead to such an injury. We also discussed the management of segmental tibial fracture and the difficulties encountered with them. This case was managed by modern osteosynthesis tech nique with a pleasing outcome.

  16. Expected long-term outcome after a tibial shaft fracture

    DEFF Research Database (Denmark)

    Faergemann, C; Frandsen, P A; Röck, N D

    1999-01-01

    these expectations with the outcome measured in patients. METHODS: There were five groups of nonpatients: (1) 42 orthopedic surgeons, (2) 36 physiotherapists, (3) 42 students, (4) 49 white collar workers, and (5) 38 blue collar workers. Outcome was measured by Sickness Impact Profile (SIP). The SIP scores were...... compared with SIP scores obtained from 33 patients with a unilateral tibial fracture. RESULTS: Marked variation was observed between the groups. CONCLUSION: Physiotherapists expected the lowest degree of disability and orthopedic surgeons the highest. In the three groups of students, white collar workers...

  17. Chronic venous disease as a clinical manifestation of tibial osteochondroma

    Directory of Open Access Journals (Sweden)

    Marcelo Fernandes Lima

    2013-06-01

    Full Text Available Osteochondromas are the most common type of benign tumor of the skeleton. They most frequently affect the distal extremity of the femur, with the tibia being the second most commonly affected long bone. Vascular complications of these lesions are rare, but pseudoaneurysm formation is the most frequently reported of them. In this case report, we describe a case of compression of the popliteal neurovascular bundle by a tibial osteochondroma in a diabetic patient who had been admitted to hospital to treat an infected lesion on his left foot and complained of edema and paresthesia of the left lower limb.

  18. An outcome of surgical management of the tibial plateau fractures

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    Biju Ravindran

    2014-01-01

    Full Text Available Background: Advance in mechanization and acceleration of travel has been accompanied by an increase in number and severity of fractures and those of the tibial plateau are not an exception. As it is one of the major weight bearing joints of the body, fractures around it will be of at most importance. Aims: (1 To restore articular congruity and limb alignment by open reduction and rigid internal fixation. (2 To enable early knee motion and improve quadriceps and hamstring power. (3 To study the role of surgical treatment and functional outcome in tibial plateau fractures and its complications. Settings and Design: A prospective study was carried out, 32 cases of the tibial plateau fractures, which were admitted from August 2010 to April 2012 at Department of Orthopedics of our Hospital. Materials and Methods: 32 patients underwent surgical treatment for tibial plateau fractures. Fractures were classified according to the Schatzker′s system. The indications for surgery were defined as the presence of displacement, depression and instability being more than 4 mm, 10 mm and 10 degrees. The mean follow-up was 12 months. The selected patients were evaluated and were taken up for surgery. The indicated fractures were treated with closed reduction and internal fixation with percutaneous cannulated cancellous screws, external fixator, open reduction and internal fixation with buttress plate with or without bone grafting. The range of motion was started soon after surgery. The patients were advised nonweight bearing up to 6-8 weeks. Total weight bearing deferred until 12 weeks or complete union of fracture. Statistical Analysis: All parameters before and after the treatment were expressed in mean ± standard deviation and analyzed by the Student′s t-test using SPSS version 16. Results: The knee range of motion was excellent to very good and weight bearing after complete union was satisfactory. Malunion in two cases, knee stiffness in three

  19. Posterior cruciate ligament reconstruction by means of tibial tunnel: anatomical study on cadavers for tunnel positioning

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    Antônio Altenor Bessa de Queiroz

    2014-08-01

    Full Text Available Objective:To determine the reference points for the exit of the tibial guidewire in relation to the posterior cortical bone of the tibia.Methods:Sixteen knees from fresh cadavers were used for this study. Using a viewing device and a guide marked out in millimeters, three guidewires were passed through the tibia at 0, 10 and 15 mm distally in relation to the posterior crest of the tibia. Dissections were performed and the region of the center of the tibial insertion of the posterior cruciate ligament (PCL was determined in each knee. The distances between the center of the tibial insertion of the PCL and the posterior tibial border (CB and between the center of the tibial insertion of the PCL and wires 1, 2 and 3 (CW1, CW2 and CW3 were measured.Results:In the dissected knees, we found the center of the tibial insertion of the PCL at 1.09 ± 0.06 cm from the posterior tibial border. The distances between the wires 1, 2 and 3 and the center of the tibial insertion of the PCL were respectively 1.01 ± 0.08, 0.09 ± 0.05 and 0.5 ± 0.05 cm.Conclusion:The guidewire exit point 10 mm distal in relation to the posterior crest of the tibia was the best position for attempting to reproduce the anatomical center of the PCL.

  20. Immediate weight-bearing after osteosynthesis of proximal tibial fractures may be allowed

    DEFF Research Database (Denmark)

    Haak, Karl Tobias; Palm, Henrik; Holck, Kim;

    2012-01-01

    Immediate weight-bearing following osteosynthesis of proximal tibial fractures is traditionally not allowed due to fear of articular fracture collapse. Anatomically shaped locking plates with sub-articular screws could improve stability and allow greater loading forces. The purpose of this study...... was to investigate if immediate weight-bearing can be allowed following locking plate osteosynthesis of proximal tibial fractures....

  1. Arthroscopically assisted osteosynthesis of tibial plateau fractures in patients older than 55 years

    NARCIS (Netherlands)

    Roerdink, WH; Oskam, J; Vierhout, PAM

    2001-01-01

    Purpose: To evaluate the end results of arthroscopically assisted osteosynthesis of tibial plateau fractures in patients older than 55 years of age. Type of Study: Case series. Methods: Over a 5-year period, 201 consecutive patients presented with tibial plateau fracture; 131 of these patients were

  2. Are both the knees of the same size? Analysis of component asymmetry in 289 bilateral knee arthroplasties

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    Venkata Gurava Reddy

    2011-01-01

    Full Text Available Background: Variations in the anatomy of knee are well described, however the true incidence of component asymmetry in bilateral total knee arthroplsties is rarely reported. Incidence of component asymmetry in bilateral total knee arthroplasties (TKA was retrospectively analysed in 289 cruciate retaining total knee arthroplasties. Materials and Methods: Medical records of these 289 patients were evaluated for the incidence of asymmetry of either femoral or tibial components. Clinical outcomes were compared between the cases of asymetrical components to that of symmetrical components. Results: Incidence of femoral component asymmetry was found to be 9.2% and tibial component asymmetry to be 8.7%. Of 289 cases, TKA 178 were done in a single day (group A, while 111 were done at 2- to 3-day intervals (group B. Asymmetric and symmetric knees were equally distributed among both groups, male and female patients in both groups, and the incidence of component asymmetry was similar between all four different implants - Optetrak-CR (Exactech, Gainesville, FL, USA, Nexgen-CR (Zimmer, Warsaw, IN, USA, PFC-Sigma CR (DePuy, Warsaw, IN, USA, Genesis II CR (Smith and Nephew, Memphis, TN, USA we used. The pre- and postoperative range of motion and pre- and postoperative knee society scores were compared between the symmetric and asymmetric cases in both the groups and the difference was found to be insignificant. Conclusion: We conclude that incidence of component asymmetry in bilateral total knee arthroplasty is around 9 % and independent sizing of both knees during bilateral arthoplasty is recommended rather than simply relying on the contralateral knee measurements.

  3. Compensation following bilateral vestibular damage

    Directory of Open Access Journals (Sweden)

    Bill J Yates

    2011-12-01

    Full Text Available Bilateral loss of vestibular inputs affects far fewer patients than unilateral inner ear damage, and thus has been understudied. In both animal subjects and human patients, bilateral vestibular hypofunction (BVH produces a variety of clinical problems, including impaired balance control, inability to maintain stable blood pressure during postural changes, difficulty in visual targeting of images, and disturbances in spatial memory and navigational performance. Experiments in animals have shown that nonlabyrinthine inputs to the vestibular nuclei are rapidly amplified following the onset of BVH, which may explain the recovery of postural stability and orthostatic tolerance that occurs within 10 days. However, the loss of the vestibulo-ocular reflex and degraded spatial cognition appear to be permanent in animals with BVH. Current concepts of the compensatory mechanisms in humans with BVH are largely inferential, as there is a lack of data from patients early in the disease process. Translation of animal studies of compensation for BVH into therapeutic strategies and subsequent application in the clinic is the most likely route to improve treatment. In addition to physical therapy, two types of prosthetic devices have been proposed to treat individuals with bilateral loss of vestibular inputs: those that provide tactile stimulation to indicate body position in space, and those that deliver electrical stimuli to branches of the vestibular nerve in accordance with head movements. The relative efficacy of these two treatment paradigms, and whether they can be combined to facilitate recovery, is yet to be ascertained.

  4. Pseudoarthrosis of medial tibial plateau fracture-role of alignment procedure

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    Devgan Ashish

    2013-04-01

    Full Text Available 【Abstract】 Nonunion in tibial plateau fractures is very rare. Limited literature is available on Pubmed search on intraarticular tibial nonunion. Most of the cases reported have been following failed surgical treatment and none was neglected fractures. Three patients of isolated and neglected medial tibial plateau nonunion with almost similar demo-graphic profile are reported in this paper. All the three pa-tients were managed by minimally invasive compression fixation using lag screws supplemented with limb realign-ment procedure of high tibial osteotomy. We discussed the injury mechanism, management and rehabilitation in such cases and reviewed the available literature regarding such a presentation. Key words: Fracture healing; Tibial fractures; Frac-ture fixation; Osteotomy

  5. A Patient with Unilateral Tibial Aplasia and Accessory Scrotum: A Pure Coincidence or Nonfortuitous Association?

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    Zoran Gucev

    2010-01-01

    Full Text Available Tibial aplasia is an uncommon lower limb malformation that can occur isolated or be part of a more complex malformation pattern. We describe a 9-year-old boy born after uneventful pregnancy and delivery. Family history was negative for maternal diabetes and other malformations. The patient presented with left tibial aplasia and homolateral prexial foot polydactyly. He also displayed enamel dysplasia and bifid scotum with cryptorchidism. Literature review failed to identify a significant syndromic association between lower limb defects of the tibial type and the genital anomalies reported here. The combination of tibial aplasia with midline genital malformations further supports the hypothesis that the tibial ray development mirrors the morphogenetic process of the radial structures. Accordingly, the malformation pattern observed in the present patient may be pathogenetically explained by an insult occurring during late blastogenesis.

  6. Clinical features of a rare anatomical variation of the posterior tibial and fibular arteries

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    Pedro Oliveira Portilho

    Full Text Available Abstract The posterior tibial artery normally arises from tibial-fibular trunk at the popliteal fossa, together with the fibular artery. The classic course of the posterior tibial artery is to run between the triceps surae muscle and muscles of the posterior compartment of the leg before continuing its course posteriorly to the medial malleolus, while the fibular artery runs through the lateral margin of the leg. Studies of both arteries are relevant to the fields of angiology, vascular surgery and plastic surgery. To the best of our knowledge, we report the first case of an anastomosis between the posterior tibial artery and the fibular artery in their distal course. The two arteries joined in an unusual “X” format, before division of the posterior tibial artery into plantar branches. We also provide a literature review of unusual variations and assess the clinical and embryological aspects of both arteries in order to contribute to further investigations regarding these vessels.

  7. Tibial tunnel and pretibial cysts following ACL graft reconstruction: MR imaging diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Ghazikhanian, Varand [Brigham and Women' s Hospital, Musculoskeletal Imaging and Intervention, Department of Radiology, Boston, MA (United States); Beltran, Javier [Maimonides Medical Center, Brooklyn, NY (United States); Nikac, Violeta [Maimonides Medical Center, Department of Radiology, Brooklyn, NY (United States); Bencardino, Jenny T. [NYU Hospital for Joint Diseases, New York, NY (United States); Feldman, Marina

    2012-11-15

    Tunnel cyst formation is a rare complication after anterior cruciate ligament reconstruction, usually occurring 1-5 years post-operatively, which may occasionally be symptomatic. There are multiple proposed theories regarding the etiology of tunnel cysts. Theories include necrosis, foreign-body reaction, lack of complete graft osteo-integration, and intravasation of articular fluid. It is important to know if the tunnel cysts are communicating or not communicating with the joint, as surgical management may be different. Imaging characteristics on magnetic resonance images (MRI) include tibial tunnel widening, multilocular or unilocular cyst formation in the graft or tibial tunnel, with possible extension into the pretibial space, intercondylar notch, and/or popliteal fossa. The MR imaging differential diagnosis of tibial tunnel cysts includes infection, foreign-body granuloma, or tibial screw extrusion. Importantly, to the best of our knowledge, graft failure or instability has not been reported in association with tibial tunnel cysts. (orig.)

  8. A multiaxial force-sensing implantable tibial prosthesis.

    Science.gov (United States)

    Kirking, Bryan; Krevolin, Janet; Townsend, Christopher; Colwell, Clifford W; D'Lima, Darryl D

    2006-01-01

    Accurate in vivo measurement of tibiofemoral forces is important in total knee arthroplasty. These forces determine polyethylene stresses and cold-flow, stress distribution in the implant, and stress transfer to the underlying implant bone interface. Theoretic estimates of tibiofemoral forces have varied widely depending on the mathematical models used. The six degrees of freedom of motion, complex articular surface topography, changing joint-contact position, intra- and extra-articular ligaments, number of muscles crossing the knee joint, and the presence of the patellofemoral joint contribute to the difficulty in developing reliable models of the knee. A prototype instrumented total knee replacement tibial prosthesis was designed, manufactured, and tested. This prosthesis accurately measured all six components of tibial forces (R2>0.997). The prosthesis was also instrumented with an internal microtransmitter for wireless data transmission. Remote powering of the sealed implanted electronics was achieved using magnetic coil induction. This device can be used to validate existing models of the knee that estimate these forces or to develop more accurate models. In conjunction with kinematic data, accurate tibiofemoral force data may be used to design more effective knee-testing rigs and wear simulators. Additional uses are intraoperative measurement of forces to determine soft-tissue balancing and to evaluate the effects of rehabilitation, external bracing, and athletic activities, and activities of daily living.

  9. Effect of interstitial low level laser therapy on tibial defect

    Science.gov (United States)

    Lee, Sangyeob; Ha, Myungjin; Hwang, Donghyun; Yu, Sungkon; Jang, Seulki; Park, Jihoon; Radfar, Edalat; Kim, Hansung; Jung, Byungjo

    2016-03-01

    Tibial defect is very common musculoskeletal disorder which makes patient painful and uncomfortable. Many studies about bone regeneration tried to figure out fast bone healing on early phase. It is already known that low level laser therapy (LLLT) is very convenient and good for beginning of bone disorder. However, light scattering and absorption obstruct musculoskeletal therapy which need optimal photon energy delivery. This study has used an interstitial laser probe (ILP) to overcome the limitations of light penetration depth and scattering. Animals (mouse, C57BL/6) were divided into three groups: laser treated test group 1 (660 nm; power 10 mW; total energy 5 J) and test group 2 (660 nm; power 20 mW; total energy 10 J); and untreated control group. All animals were taken surgical operation to make tibial defect on right crest of tibia. The test groups were treated every 48 hours with ILP. Bone volume and X-ray attenuation coefficient were measured on 0, 14th and 28th day with u-CT after treatment and were used to evaluate effect of LLLT. Results show that bone volume of test groups has been improved more than control group. X-ray attenuation coefficients of each groups have slightly different. The results suggest that LLLT combined with ILP may affect on early phase of bone regeneration and may be used in various musculoskeletal disease in deep tissue layer.

  10. Bone transport for limb reconstruction following severe tibial fractures

    Directory of Open Access Journals (Sweden)

    Julian Fürmetz

    2016-03-01

    Full Text Available A common treatment of tibial defects especially after infections is bone transport via external fixation. We compare complications and outcomes of 25 patients treated with a typical Ilizarov frame or a hybrid system for bone reconstruction of the tibia. Average follow up was 5.1 years. Particular interest was paid to the following criteria: injury type, comorbidities, development of osteitis and outcome of the different therapies. The reason for segmental resection was a second or third grade open tibia fractures in 24 cases and in one case an infection after plate osteosynthesis. Average age of the patients was 41 years (range 19 to 65 years and average defect size 6.6 cm (range 3.0 to 13.4 cm. After a mean time of 113 days 23 tibial defects were reconstructed, so we calculated an average healing index of 44.2 days/cm. Two patients with major comorbidities needed a below knee amputation. The presence of osteitis led to a more complicated course of therapy. In the follow up patients with an Ilizarov frame had better results than patients with hybrid systems. Bone transport using external fixation is suitable for larger defect reconstruction. With significant comorbidities, however, a primary amputation or other methods must be considered.

  11. Posterior coronal plating for tibial fractures: technique and advantages

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    Montu Jain

    2014-04-01

    Full Text Available Objective:Tibial shaft fractures are straightforward to treat but when associated with soft tissue injury particularly at the nail entry/plate insertion site or there is significant comminution proximally or a large butterfly fragment/a second split component in the posterior coronal plane, it is a challenge to the treating surgeon. The aim of the present report is to describe the technique of posterior coronal plating in such a scenario and its advantages. Methods:Between July 2008 and June 2011, 12 patients were pro spectively treated by this approach using 4.5 mm broad dynamic compression plates. Results:The time of bony consolidation and full weight bearing averaged 21.7 weeks (range, 16-26 weeks. Patients were followed up for at least 24 months (range, 24-48 months. At 1 year postoper atively, no loss in reduction or alignment was observed. Mean Hospital for Lower Extremity Measurement Functional Score was 72.8 (range, 64-78. All patients were satisfied with their treatment outcomes. Conclusion:Direct posterior approach and fixation using prone position helps to visualise the fracture fragments and provide rigid fixation. The approach is simple and extensile easily, apart from advantages of less soft tissue and hardware problems compared to standard medial or lateral plating. Key words: Tibial fractures; Bone plates; Orthopedic procedures

  12. Anterior and posterior tibial anesthetic block in diabetic foot surgery.

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    José Julio Ojeda González

    2004-12-01

    Full Text Available Fundament: Diabetes Mellitus is a disease of high and increasing prevalence and its complications follow a parallel course. Its morbidity is derived from its own complications which are produced at a long or short term and peripheral vascular disease hihglights among them.Objective: to check the usefulness of the anterior and posterior blockade of the tibia for the surgery of the diabetic foot. Method: Prospective study carried out from January to December 2003 at the University Hospital ¨Dr. Gustavo Aldereguía Lima¨ to patients who are carriers of a diabetic foot and who were initially assisted at the service of Angiology and later at the service of Anesthesiology when the surgical procedures were decided. All the patients were applied an anterior and posterior blockade of the tibial nerve . The variables measured were: age, weight, height, surgical time, type of surgery, cardiac frequency medium arterial pressure, and classification of patients according to the American Association of Anesthesiology All the patients were applied a scale for assessing pain in three different moments.Result: There was a predominance of females . The blockade of the posterior tibial nerve with lidocaine 1 % in different points permitted the performance of the surgical techniques proposed. The anesthetic procedure was favorable, and economic since the patients did not requiere of the use of analgesic in the post operatory stage.

  13. Multiple bilateral lower limb fractures in a 2-year-old child: previously unreported injury with a unique mechanism

    Institute of Scientific and Technical Information of China (English)

    Basant Repswal; Anuj Jain; Sunil Gupta; Aditya Aggarwal; Tushar Kohli; Devendra Pathrot

    2014-01-01

    Fall from height is a common cause of unintentional injuries in children and accounts for 6% of all trauma-related childhood deaths,usually from head injury.We report a case of a 2-year-old child with multiple fractures of the bilateral lower limbs due to this reason.A child fell from a height of around 15 feet after toppling from a balcony.He developed multiple fractures involving the right femoral shaft,right distal femoral epiphysis (Salter Harris type 2),right distal metaphysis of the tibia and fibula,and undisplaced Salter Harris type 2 epiphyseal injury of the left distal tibia.There were no head,abdominal or spinal injuries.The patient was taken into emergency operation theatre after initial management which consisted of intravenous fluids,blood transfusion,and splintage of both lower limbs.Fracture of the femoral shaft was treated by closed reduction and fixation using two titanium elastic nails.Distal femoral physeal injury required open reduction and fixation with K wires.Distal tibia fractures were closely reduced and managed nonoperatively in both the lower limbs.All the fractures united in four weeks.At the last follow-up,the child had no disability and was able to perform daily activities comfortably.We also proposed the unique mechanism of injury in this report.

  14. Bilateral cleft lip nasal deformity

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    Singh Arun

    2009-01-01

    Full Text Available Bilateral cleft lip nose deformity is a multi-factorial and complex deformity which tends to aggravate with growth of the child, if not attended surgically. The goals of primary bilateral cleft lip nose surgery are, closure of the nasal floor and sill, lengthening of the columella, repositioning of the alar base, achieving nasal tip projection, repositioning of the lower lateral cartilages, and reorienting the nares from horizontal to oblique position. The multiplicity of procedures in the literature for correction of this deformity alludes to the fact that no single procedure is entirely effective. The timing for surgical intervention and its extent varies considerably. Early surgery on cartilage may adversely affect growth and development; at the same time, allowing the cartilage to grow in an abnormal position and contributing to aggravation of deformity. Some surgeons advocate correction of deformity at an early age. However, others like the cartilages to grow and mature before going in for surgery. With peer pressure also becoming an important consideration during the teens, the current trend is towards early intervention. There is no unanimity in the extent of nasal dissection to be done at the time of primary lip repair. While many perform limited nasal dissection for the fear of growth retardation, others opt for full cartilage correction at the time of primary surgery itself. The value of naso-alveolar moulding (NAM too is not universally accepted and has now more opponents than proponents. Also most centres in the developing world have neither the personnel nor the facilities for the same. The secondary cleft nasal deformity is variable and is affected by the extent of the original abnormality, any prior surgeries performed and alteration due to nasal growth. This article reviews the currently popular methods for correction of nasal deformity associated with bilateral cleft lip, it′s management both at the time of cleft lip repair

  15. Amelogenesis imperfecta with bilateral nephrocalcinosis.

    Science.gov (United States)

    Poornima, P; Katkade, Shashikant; Mohamed, Roshan Noor; Mallikarjuna, Rachappa

    2013-05-24

    A 12-year-old patient presented with a severe delay of eruption in permanent maxillary and mandibular incisors. On examination, there was over-retained primary teeth and delayed eruption of permanent teeth. Retained primary teeth showed light yellow discolouration whereas permanent teeth were distinct yellow with thin or little enamel. Subsequent imaging revealed all the premolars except maxillary left first premolar showed signs of intra-alveolar coronal resorption, nephrocalcinosis with bilateral multiple calculi and small papillary tip calcifications, marked increase in alkaline phosphatase. Subsequent dental treatment for restoring the functional and aesthetic requirement followed by appropriate treatment for renal problem was undertaken.

  16. Impact of Fixed-Bearing and Mobile-Bearing Tibial Insert in Unicondylar Knee Arthroplasty

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    Mehmet Faruk Çatma

    2016-06-01

    Full Text Available INTRODUCTION: The aim of the study is to investigate the impact of fixed or mobile-bearing tibial inserts on patellofemoral arthrosis and evaluate which one to be preferred for patients with patellofemoral arthrosis. METHODS: Operated in our clinic between January 2009 and February 2013, 33 with patellofemoral arthritis together with anteromedial compartment arthritis were included in the study. Patellofemoral joints of patients were evaluated according to the scoring system defined by Fulkerson-Shea. RESULTS: Unicondylar knee arthroplasty with fixed-bearing tibial insertsand 22 (66,6% (male: 3, female: 19 and unicondylar knee arthroplasty with mobile-bearing tibial inserts 11 (33,9 % (male: 2, female: 9 were implanted.Average knee flexion was found to be 116,5 (100-135 degrees in 22 patients with mobile-bearing tibial inserts, and 114,5 (95-135 in 11 patients with fixed-bearing tibial inserts. DISCUSSION AND CONCLUSION: Patellofemoral arthrosis is an important factor for unicondylar knee arthroplasty prognosis and one of the determinants of patient satisfaction. Significantly less patellofemoral complaints were seen with UKA with fixed-bearing tibial insert compared to mobile-bearing tibial insert.

  17. Radiographic study on the tibial insertion of the posterior cruciate ligament

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    Julio Cesar Gali

    2015-06-01

    Full Text Available OBJECTIVE: To establish the radiographic distances from posterior cruciate ligament (PCL tibial insertions centers to the lateral and medial tibial cortex in the anteroposterior view, and from these centers to the PCL facet most proximal point on the lateral view, in order to guide anatomical tunnels drilling in PCL reconstruction and for tunnel positioning postoperative analysis.STUDY DESIGN: Controlled laboratory study.METHODS: Twenty cadaver knees were evaluated. The PCL's bundles tibial insertions were identified and marked out using metal tags, and the knees were radiographed. On these radiographs, the bundles insertion sites center location relative to the tibial mediolateral measure, and the distances from the most proximal PCL facet point to the bundle's insertion were determined. All measures were calculated using the ImageJ software.RESULTS: On the anteroposterior radiographs, the mean distance from the anterolateral (AL bundle insertion center to the medial tibial edge was 40.68 ± 4.10 mm; the mean distance from the posteromedial (PM bundle insertion center to the medial tibial edge was 38.74 ± 4.40 mm. On the lateral radiographs, the mean distances from the PCL facet most proximal point to AL and PM bundles insertion centers were 5.49 ± 1.29 mm and 10.53 ± 2.17 mm respectively.CONCLUSIONS: It was possible to establish a radiographic pattern for PCL tibial bundles insertions, which may be useful for intraoperative tunnels locations control and for postoperative tunnels positions analysis.

  18. Ultrasound Guidance in Performing a Tendoscopic Surgery to Treat Posterior Tibial Tendinitis: A Useful Tool?

    Directory of Open Access Journals (Sweden)

    Akinobu Nishimura

    2016-01-01

    Full Text Available A 25-year-old man with a pronation-external rotation type of fracture was surgically treated using a fibular plate. Five years later, he underwent resection of bone hyperplasia because of the ankle pain and limitation of range of motion. Thereafter, the left ankle became intermittently painful, which persisted for about one year. He presented at the age of 43 with persistent ankle pain. Physical and image analysis findings indicated a diagnosis of posttraumatic posterior tibial tendinitis, which we surgically treated using tendoscopy. Endoscopic findings showed tenosynovitis and fibrillation on the tendon surface. We cleaned and removed the synovium surrounding the tendon and deepened the posterior tibial tendon groove to allow sufficient space for the posterior tibial tendon. Full weight-bearing ambulation was permitted one day after surgery and he returned to his occupation in the construction industry six weeks after surgery. The medial aspect of the ankle was free of pain and symptoms at a review two years after surgery. Although tendoscopic surgery for stage 1 posterior tibial tendon dysfunction has been reported, tendoscopic surgery to treat posttraumatic posterior tibial tendinitis has not. Our experience with this patient showed that tendoscopic surgery is useful not only for stage 1 posterior tibial dysfunction, but also for posttraumatic posterior tibial tendinitis.

  19. Modified retro-tubercle opening-wedge versus conventional high tibial osteotomy.

    Science.gov (United States)

    Keyhani, Sohrab; Abbasian, Mohammad Reza; Kazemi, Seyed Morteza; Esmailiejah, Ali Akbar; Seyed Hosseinzadeh, Hamid Reza; Shahi, Alisina; Shahi, Ali Sina; Firouzi, Farzad

    2011-01-01

    Despite the fact that common surgical techniques for the treatment of genu varum usually correct the malalignment in the affected knee, these methods have significant complications and cause problems in the long term. Retro-tubercle opening-wedge high tibial osteotomy is among the newer techniques for the treatment of genu varum. The goal of this study was to compare the results of retro-tubercle opening-wedge high tibial osteotomy with those of medial opening-wedge osteotomy. In a randomized, controlled trial, 72 patients with varus knees who were scheduled for surgery were assigned into either the retro-tubercle opening-wedge high tibial osteotomy (n=34) or medial opening-wedge osteotomy groups (n=38). Groups were matched for age and sex. The position of the patella was compared with respect to the tuberosity and the upper tibial slope pre- and postoperatively. Patients were followed for an average of 13 months (range, 10-21 months). In the retro-tubercle opening-wedge high tibial osteotomy group, the length of the patellar tendon did not significantly differ pre- and postoperatively (P≥.5); however, in the medial opening-wedge osteotomy group, a statistically significant shortening was noted in patellar tendon postoperatively (P≤.05). Similarly, the tibial plateau inclination showed a statistically significant difference postoperatively in the medial opening-wedge osteotomy group, while the difference in the retro-tubercle opening-wedge high tibial osteotomy group did not reach statistical significance.

  20. Preoperative determination of tibial nail length: An anthropometric study

    Institute of Scientific and Technical Information of China (English)

    Renjit Thomas Issac; Hitesh Gopalan; Mathew Abraham; Cherian John; Sujith Mathew Issac; Diju Jacob

    2016-01-01

    Objective:To assess the correlation between five anthropometric parameters and the distance from tibial tuberosity to medial malleolus in 100 volunteers.Methods:Six anthropometric parameters were measured in 50 male and 50 female medical students using a metallic scale:medial knee joint line to ankle joint line (K-A),medial knee joint line to medial malleolus (K-MM),tibial tuberosity to ankle joint (TT-A),tibial tuberosity to medial malleolus (TT-MM),olecranon to 5th metacarpal head (O-MH) and body height (BH).Nail size predicted based upon TT-MM measurement was chosen as ideal nail size.A constant was derived for each of the six anthropometric parameters which was either added or subtracted to each measurement to derive nail size.A regression equation was applied to BH measurements.Nail sizes calculated were compared with that obtained from TT-MM measurement and accuracy was evaluated.Accuracy of O-MH and BH regression equations recommended by other authors were calculated in our data.Results:Adding 11 mm to TT-A distance had highest accuracy (81%) and correlation (0.966) in predicting nails correctly.Subtracting 33 mm from K-MM measurement and 25 mm from K-A distance derived accurate sizes in 69% and 76% respectively.Adding 6 mm to O-MH distance had a poor accuracy of 51%.Nail size prediction based upon body height regression equation derived correct nail sizes in only 34% of the cases.Regression equation analysis by other authors based on O-MH and BH distances yielded correct sizes in 11% and 5% of the cases respectively.Conclusion:TT-A,K-A and K-MM measurements can be used simultaneously to increase accuracy of nail size prediction.This method would be helpful in determining nail size preoperatively especially when one anatomic landmark is difficult to palpate.

  1. Bilateral zosteriform extragenital lichen sclerosus.

    Science.gov (United States)

    Kumar, Piyush; Jha, Abhijeet Kumar; Mallik, Sambeet Kumar; Raihan, Mohammed

    2014-01-01

    A 35-year-old man presented with asymptomatic eruption on both forearms and lower aspects of the legs for 6 months. The lesions first appeared on his inner aspects of the wrist, the dorsal surface of the hands, and legs and progressed to involve proximal aspects of the extremities. There was no significant past history. On examination, multiple pearly white papules and depigmented atrophic plaques were found bilaterally on the flexors of the arms and the extensors of the legs. The lesions were arranged in a linear manner, following the lines of Blaschko (Figures 1 and 2). The surface of the atrophic plaques was notable for prominent telangiectasia, giving an erythematous appearance. The genitalia, oral cavity, palms, and soles were spared. Systemic examination was noncontributory. Lichen striatus and extragenital lichen sclerosus (ELS) were considered the differential diagnosis. Clinically, the age of the patient, the absence of scaling, and the presence of atrophic plaques and telangiectasia were in favor of ELS. A punch biopsy from an atrophic plaque was performed, and it revealed hyperkeratosis, atrophic epidermis, basal layer vacuolar degeneration, mild lymphocytic infiltration in the dermis, edema, and homogenization of collagen of the upper portion of the dermis (Figures 3 and Figure 4). Histopathologic findings were consistent with lichen sclerosus. A diagnosis of bilateral zosteriform ELS was made.

  2. Direct contribution of axial impact compressive load to anterior tibial load during simulated ski landing impact.

    Science.gov (United States)

    Yeow, C H; Lee, P V S; Goh, J C H

    2010-01-19

    Anterior tibial loading is a major factor involved in the anterior cruciate ligament (ACL) injury mechanism during ski impact landing. We sought to investigate the direct contribution of axial impact compressive load to anterior tibial load during simulated ski landing impact of intact knee joints without quadriceps activation. Twelve porcine knee specimens were procured. Four specimens were used as non-impact control while the remaining eight were mounted onto a material-testing system at 70 degrees flexion and subjected to simulated landing impact, which was successively repeated with incremental actuator displacement. Four specimens from the impacted group underwent pre-impact MRI for tibial plateau angle measurements while the other four were subjected to histology and microCT for cartilage morphology and volume assessment. The tibial plateau angles ranged from 29.4 to 38.8 degrees . There was a moderate linear relationship (Y=0.16X; R(2)=0.64; p<0.001) between peak axial impact compressive load (Y) and peak anterior tibial load (X). The anterior and posterior regions in the impacted group sustained surface cartilage fraying, superficial clefts and tidemark disruption, compared to the control group. MicroCT scans displayed visible cartilage deformation for both anterior and posterior regions in the impacted group. Due to the tibial plateau angle, increased axial impact compressive load can directly elevate anterior tibial load and hence contribute to ACL failure during simulated landing impact. Axial impact compressive load resulted in shear cartilage damage along anterior-posterior tibial plateau regions, due to its contribution to anterior tibial loading. This mechanism plays an important role in elevating ACL stress and cartilage deformation during impact landing.

  3. Synovial C-Shaped Tibial Footprint of the Anterior Cruciate Ligament

    Science.gov (United States)

    Janovsky, César; Kaleka, Camila Cohen; Alves, Maria Teresa Seixas; Ferretti, Mario; Cohen, Moises

    2016-01-01

    Background: Although numerous anatomic studies about the anterior cruciate ligament (ACL) structure and attachments have been performed, these studies have not reached consensus on the ACL footprint. Purpose: To investigate the existing controversy regarding the morphology of the tibial ACL insertion (footprint) and confirm histologically that the tibial ACL footprint is not completely filled with ligament tissue. Study Design: Descriptive laboratory study. Methods: The tibial ACL footprint was dissected from 20 different fresh-frozen cadaveric knees (all males; mean age, 68.8 ± 5.4 years [range, 55-80 years]; mean weight, 78 ± 6.6 kg [range, 45-93 kg]). Two knees, 1 with severe osteoarthritis and 1 with previous knee surgery, were excluded. The tibial ACL insertion was observed, and this area was longitudinally divided into 4 parallel slices (0%-25%, 25-50%, 50%-75%, and 75%-100%), embedded in paraffin wax, and stained with hematoxylin-eosin, alcian blue, and picrosirius-polarization. The specimens were measured using a microscope to determine the distances from the anterior to the posterior border of the ACL ligament tibial insertion and the distance from the posterior border to the end of the ligament fibers of the ACL ligament tibial insertions. Results: The 18 evaluated knee specimens confirmed the finding of a C-shaped tibial insertion of the ACL. The measurements showed that the ligament (vertical parallel collagen fibers) occupied only 30.8% of the complete insertion. The remaining area was filled with synovial tissue, demonstrating histologically the “C” shape. Conclusion: This study confirms macroscopically the C-shaped tibial insertion of the ACL and shows histologically that synovial tissue is an indirect insertion filling the major part of the footprint. Clinical Relevance: This anatomic study suggests a different shape of the ACL tibial footprint, which may be useful for new perspectives regarding ACL reconstruction surgery research. PMID

  4. Danish Exports and Danish Bilateral Aid

    DEFF Research Database (Denmark)

    Hansen, Henrik; Rand, John

    Danish bilateral development assistance is aimed at reducing poverty in the partner countries. Even so, bilateral assistance may have secondary, or knock-on, effects, which are beneficial for Denmark. An important secondary effect is the prospect of increased export from Denmark to the partner...... countries. This Evaluation Study presents an econometric analysis of Danish exports to 144 countries over the period from 1981 to 2010. The analysis is based on the gravity model of bilateral trade; a structural model developed over decades and now the central model in analyses of bilateral trade flows...... and trade policies. The main result of the study is that Danish bilateral aid has a positive and statistically significant impact on Danish exports to the recipient countries. Bilateral development assistance may affect exports through several channels. Three of the main channels are direct aid tying...

  5. Osteotomía tibial valguizante: análisis de supervivencia

    OpenAIRE

    Modrego Aranda, Francisco Javier

    2005-01-01

    Presentamos un estudio retrospectivo de 38 osteotomías tibiales valguizantes, en 32 pacientes con "genu-varo" artrósico. La supervivencia a los 180 meses fue del 58%. Cuando el paciente presentaba un peso mayor 1,32 veces al peso ideal la supervivencia disminuía al 53%. Y cuando la corrección angular en ángulo femoro-tibial era menor de 6º la supervivencia disminuía al 33% We evaluated the results in thirty-two patients (thirty-eight knees) who had had a high tibial osteotomy for var...

  6. Medial tibial pain. A prospective study of its cause among military recruits.

    Science.gov (United States)

    Milgrom, C; Giladi, M; Stein, M; Kashtan, H; Margulies, J; Chisin, R; Steinberg, R; Swissa, A; Aharonson, Z

    1986-12-01

    In a prospective study of 295 infantry recruits during 14 weeks of basic training, 41% had medial tibial pain. Routine scintigraphic evaluation in cases of medial tibial bone pain showed that 63% had abnormalities. A stress fracture was found in 46%. Only two patients had periostitis. None had ischemic medial compartment syndrome. Physical examination could not differentiate between cases with medial tibial bone pain secondary to stress fractures and those with scintigraphically normal tibias. When both pain and swelling were localized in the middle one-third of the tibia, the lesion most likely proved to be a stress fracture.

  7. Arthroscopic and computer-assisted high tibial osteotomy using standard total knee arthroplasty navigation software.

    Science.gov (United States)

    Thompson, Stephen R; Zabtia, Nazar; Weening, Bradley; Zalzal, Paul

    2013-05-01

    Opening-wedge high tibial osteotomy is an increasingly performed procedure for treatment of varus gonarthrosis and correction of malalignment during meniscal transplantation or cartilage restoration. Precise preoperative planning and meticulous surgical technique are required to achieve an appropriate mechanical axis correction. We describe our technique of arthroscopic and computer-assisted high tibial osteotomy using commonly available total knee arthroplasty navigation software as an intraoperative goniometer. We believe that our technique, by providing intraoperative real-time guidance of the degree of correction that is accurate and reliable, represents a useful tool for the surgeon who uncommonly performs high tibial osteotomy.

  8. New Curious Bilateral q-Series Identities

    Directory of Open Access Journals (Sweden)

    Frédéric Jouhet

    2012-10-01

    Full Text Available By applying a classical method, already employed by Cauchy, to a terminating curious summation by one of the authors, a new curious bilateral q-series identity is derived. We also apply the same method to a quadratic summation by Gessel and Stanton, and to a cubic summation by Gasper, respectively, to derive a bilateral quadratic and a bilateral cubic summation formula.

  9. Expected long-term outcome after a tibial shaft fracture

    DEFF Research Database (Denmark)

    Faergemann, C; Frandsen, P A; Röck, N D

    1999-01-01

    these expectations with the outcome measured in patients. METHODS: There were five groups of nonpatients: (1) 42 orthopedic surgeons, (2) 36 physiotherapists, (3) 42 students, (4) 49 white collar workers, and (5) 38 blue collar workers. Outcome was measured by Sickness Impact Profile (SIP). The SIP scores were...... compared with SIP scores obtained from 33 patients with a unilateral tibial fracture. RESULTS: Marked variation was observed between the groups. CONCLUSION: Physiotherapists expected the lowest degree of disability and orthopedic surgeons the highest. In the three groups of students, white collar workers...... and blue collar workers only minor variations were observed and their SIP scores showed better correlation with the SIP scores obtained from the patients than those of orthopedic surgeons and physiotherapists....

  10. Elephantiasis nostras verrucosa complicated with chronic tibial osteomyelitis.

    Science.gov (United States)

    Turhan, Egemen; Ege, Ahmet; Keser, Selcuk; Bayar, Ahmet

    2008-10-01

    Elephantiasis nostras verrucosa represents an infrequent clinical entity with cutaneous changes characterized by dermal fibrosis, hyperkeratotic verrucous and papillamotous lesions resulting from chronic non-filarial lymphedema secondary to infections, surgeries, tumor obstruction, radiation, congestive heart failure, and obesity. Although recurrent streptococcal lymphangitis is believed to play a critical role in the origin of elephantiasis nostras verrucosa, the exact pathogenesis of the disorder is not yet clear. Therapeutic efforts should aim to reduce lymph stasis, which will also lead to improvement of the cutaneous changes but unfortunately there is no specific treatment for advanced cases. In this report, we present a patient who was treated by below knee amputation as a result of elephantiasis nostras verrucosa complicated with chronic tibial osteomyelitis.

  11. Risk Factors of Medial Tibial Stress Syndrome(MTSS)

    Institute of Scientific and Technical Information of China (English)

    Sae Yong Lee

    2009-01-01

    @@ Background According to Mubarak[1,2],who first coined the term medial tibial stress syndrome (MTSS)in 1982,the definition of MTSS is " a symptom complex in athletes who experience exercise-induced pain along thedistalposteromedialaspectofthetibia."Previous studies have shown that MTSS accounts for 6 to 15 percent of running related injuries [3-9] and has an incidence among certain populations (ie,military recruits) of up to 35 percent [10].The etiology of MTSS is not well known,but it is commonly believed that the cause is inflammation and possibly an avulsion of the origins of the posterior tibialis and/or the soleus from the periosteum of the posteromedial tibia [10].Traction at the periosteal interface is thought to lead to inflammation and pain at the periosteal-fascial junction.The location of the pain is usually localized over the posterior medial edge of the distal third of the tibia.

  12. Double segmental tibial fractures - an unusual fracture pattern

    Directory of Open Access Journals (Sweden)

    Bali Kamal

    2012-02-01

    Full Text Available 【Abstract】A case of a 50-year-old pedestrian who was hit by a bike and suffered fractures of both bones of his right leg was presented. Complete clinical and radiographic assessment showed double segmental fractures of the tibia and multisegmental fractures of the fibula. Review of the literature revealed that this fracture pattern was unique and only a single case was reported so far. Moreover, we discussed the possible mechanisms which can lead to such an injury. We also discussed the management of segmental tibial fracture and the difficulties encountered with them. This case was managed by modern osteosynthesis tech- nique with a pleasing outcome. Key words: Fracture, bone; Tibia; Fibula; Nails

  13. [Our experience with bilateral cochlear implantation].

    Science.gov (United States)

    Carmel, Eldar; Taitelbaum-Swead, Ricky; Migirov, Lela; Hildesheimer, Minka; Kronenberg, Jona

    2008-03-01

    Cochlear implantation is a standard method of hearing rehabilitation among patients with severe to profound bilateral sensorineural hearing loss. In recent years there have been an increasing number of studies showing superior hearing with bilateral cochlear implantation in comparison with a unilateral procedure. In this study we present our experience with 15 patients, children and adults, who had bilateral cochlear implant surgery. Speech perception test results demonstrated a hearing benefit in bilateral cochlear implantation in comparison with a unilateral device, mainly by improvement in the identification of speech in noise tests.

  14. A Rare Entity: Bilateral First Rib Fractures Accompanying Bilateral Scapular Fractures

    Directory of Open Access Journals (Sweden)

    Gultekin Gulbahar

    2015-01-01

    Full Text Available First rib fractures are scarce due to their well-protected anatomic locations. Bilateral first rib fractures accompanying bilateral scapular fractures are very rare, although they may be together with scapular and clavicular fractures. According to our knowledge, no case of bilateral first rib fractures accompanying bilateral scapular fractures has been reported, so we herein discussed the diagnosis, treatment, and complications of bone fractures due to thoracic trauma in bias of this rare entity.

  15. Bilateral metachronous breast cancer with bilateral recurrences: A case report and literature review

    Energy Technology Data Exchange (ETDEWEB)

    Park, So Hyun; Sohn, Yu Mee [Dept. of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul (Korea, Republic of); Kim, Eun Kyung [Dept. of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2014-05-15

    The incidence of bilateral breast cancer has been reported to range from 0.4% to 14%, and it increases gradually as a result of improved early detection capabilities and longer survival times. We report a rare case where the bilateral breast cancers occurred as a metachronous bilateral breast cancer with bilateral recurrences, detected by mammography, and the rapid growth of tumor that manifested as microcalcification and skin thickening within 3 months.

  16. Bilateral microvascular second toe transfer for bilateral post-traumatic thumb amputation

    OpenAIRE

    Rajendra Nehete; Anita Nehete; Sandeep Singla; Harshad Adhav

    2012-01-01

    In bilateral thumb amputations, the functional impairment is serious and every attempt should be made to reconstruct the thumb. We report a case of bilateral post traumatic thumb amputation, reconstructed with bilateral second toe transfer. Only two such cases have been reported in literature so far. Though there are various modalities for the reconstruction of thumb, microvascular toe transfer has its own merits. The convalescent period is minimal with excellent function. It is bilaterally s...

  17. Retrospective evaluation of the Duracon periapatite-coated tibial tray: midterm results and factors affecting success.

    Science.gov (United States)

    Larson, Brad J

    2013-02-01

    This study reports the retrospective radiographic outcome of a series of 63 consecutive total knee arthroplasties using an uncemented hydroxyapatite-coated Duracon cruciate-retaining tibial baseplate (Stryker Howmedica Osteonics Corp, Mahwah, NJ). Sixty-three knees were assessed at a mean follow-up of 65 months. The knees were primarily diagnosed with osteoarthritis with a mean age of 61 years. Radiographic analysis showed 6 knees with tibial baseplate radiolucencies, with all of these resolving or improving over the course of the study. All tibial baseplates were implanted with the concomitant use of autologous bone slurry. There were no reoperations for aseptic loosening, fracture, or patellofemoral problems. This intermediate study demonstrates excellent radiographic outcomes for uncemented hydroxyapatite-coated Duracon cruciate-retaining tibial baseplates and evaluates other factors felt to be important in the success of a cementless implant.

  18. Mid-Anterior Tibial Stress Fracture in a Female Elite Athlete : A Case Report.

    Science.gov (United States)

    Netzer, Patricia A M

    2007-02-01

    We report the case of an unusual tibial stress fracture and its successful surgical treatment in a female elite sprinter 2 years after complete consolidation of the same tibia following resection of an osteoid osteoma.

  19. Advantages of intramedullar fixation in treatment of congenital tibial pseudoarthrosis--a case report.

    Science.gov (United States)

    Kirin, Ivan; Jurisić, Davor; Mokrović, Hrvoje; Salem, Osman; Zamolo, Gordana; Kovacević, Miljenko

    2011-09-01

    This report describes a case of a 29-year old patient with congenital pseudoarthrosis of the distal tibia previously treated unsuccessfully by a conventional surgical method. Tibial congenital pseudoarthrosis is a rare disease characterized by segmental osseous weakness resulting in deformation of the bone and spontaneous fractures which progresses to a tibial nonunion. In our case we used intramedullary stabilization with bone grafting and six month after operation congenital pseudarthrosis of the tibia healed.

  20. Aetiology and mechanisms of injury in medial tibial stress syndrome: Current and future developments

    OpenAIRE

    Franklyn, Melanie; Oakes, Barry

    2015-01-01

    Medial tibial stress syndrome (MTSS) is a debilitating overuse injury of the tibia sustained by individuals who perform recurrent impact exercise such as athletes and military recruits. Characterised by diffuse tibial anteromedial or posteromedial surface subcutaneous periostitis, in most cases it is also an injury involving underlying cortical bone microtrauma, although it is not clear if the soft tissue or cortical bone reaction occurs first. Nuclear bone scans and magnetic resonance imagin...

  1. The effect of tibial lengthening on gastrosoleus muscle function: an electrophysiological study

    OpenAIRE

    Sarisozen, Bartu; Sadik Bilgen, Muhammet; Dinc, Mustafa; Murat Aksakal, Ahmet; Coskun, Ergür

    2004-01-01

    Objectives: We evaluated the changes in electrophysiological characteristics of the contraction forces of the gastrosoleus complex due to stretching in experimental tibial lengthening. Methods: Distraction histiogenesis was performed in 22 guinea pigs weighing 600 to 800 g. Following the application of a semicircular external fixator and right tibial osteotomy, distraction was applied at a rate of 0.25 mm two times a day for 15 days without a latency period. The animals were randomized to ...

  2. Concurrent bilateral ectopic pregnancy: a rarity

    Directory of Open Access Journals (Sweden)

    Prabhleen Kaur

    2015-08-01

    Full Text Available Bilateral ectopic pregnancy is a rare twin gestation with only a few cases reported in the literature. We report a 30 year old woman without any high risk factor for ectopic pregnancy, who had concurrent bilateral ectopic pregnancy. A 30 year old female presented to the Gynecology emergency department complaining of vaginal bleeding and abdominal pain. The presumptive diagnosis of ruptured left sided ectopic pregnancy was made on basis of clinical findings and ultrasound finings. An emergency laparotomy was done revealed a hemoperitoneum of 1.5 liters, a ruptured left tubal pregnancy with active bleeding and right tubal un-ruptured ectopic was found. A bilateral salpingectomy was performed. Histopathology confirmed presence of chorionic villi in both tubes. In theory, laparoscopic salpingostomy is the best surgical approach in bilateral tubal pregnancy. However, bilateral salpingectomy may be necessary when both tubes are extensively damaged or are actively bleeding. Successful pregnancies have been reported after conservative surgical treatment of bilateral ectopic, but the risk of recurrence is high. Our decision for an emergency laparotomy followed by bilateral salpingectomy was based on the fact that the patient presented with acute abdomen and was haemodynamically unstable and there was extensive bilateral tubal damage. As the incidence of ectopic pregnancies is increasing concurrently with the incidences of pelvic inflammatory disease and use of assisted fertility techniques; it may be that these and ldquo;rare ectopics and rdquo; will become less uncommon. [Int J Reprod Contracept Obstet Gynecol 2015; 4(4.000: 1197-1199

  3. Acral osteolysis in bilateral compartment syndrome

    Directory of Open Access Journals (Sweden)

    Iram Saeed

    2008-08-01

    Full Text Available Carpal tunnel syndrome is a common neurological condition with rare yet potentially serious cutaneous and skeletal complications. We present a case of mutilating/ulcerating bilateral carpal tunnel syndrome in a 63 year old female. Radiographs showed symmetrical acral osteolysis in the index and middle fingers distal phalanges bilaterally. Carpal tunnel decompressions provided symptomatic relief.

  4. Bilateral locked facets in the thoracic spine

    NARCIS (Netherlands)

    M.H.A. Willems; Braakman, R. (Reinder); B. van Linge (Bert)

    1984-01-01

    textabstractTwo cases of traumatic bilateral locked facets in the thoracic spine are reported. Both patients had only minor neurological signs. They both made a full neurological recovery after surgical reduction of the locked facets. Bilateral locked facets are very uncommon in the thoracic spine.

  5. Simultaneous and spontaneous bilateral quadriceps tendons rupture.

    Science.gov (United States)

    Celik, Evrim Coşkun; Ozbaydar, Mehmet; Ofluoglu, Demet; Demircay, Emre

    2012-07-01

    Simultaneous and spontaneous bilateral quadriceps tendon rupture is an uncommon injury that is usually seen in association with multiple medical conditions and some medications. We report a case of simultaneous and spontaneous bilateral quadriceps tendon rupture that may be related to the long-term use of a statin.

  6. Spontaneous bilateral adrenal hemorrhage following cholecystectomy.

    Science.gov (United States)

    Dahan, Meryl; Lim, Chetana; Salloum, Chady; Azoulay, Daniel

    2016-06-01

    Postoperative bilateral adrenal hemorrhage is a rare but potentially life-threatening complication. This diagnosis is often missed because the symptoms and laboratory results are usually nonspecific. We report a case of bilateral adrenal hemorrhage associated with acute primary adrenal insufficiency following laparoscopic cholecystectomy. The knowledge of this uncommon complication following any abdominal surgery allows timey diagnosis and rapid treatment.

  7. Bilateral zeta functions and their applications

    CERN Document Server

    Shibukawa, Genki

    2011-01-01

    We introduce a new type of multiple zeta functions, which we call bilateral zeta functions, analogous to the Barnes zeta functions. The bilateral zeta function is a periodic function and shares certain basic properties of Barnes zeta function. Especially, we prove that the bilateral zeta function has a nice Fourier series expansion and the Barnes zeta function can be expressed as a finite sum of bilateral zeta functions. By these properties of the bilateral zeta functions, We obtain simple proofs of some formulas, for example the reflection formula for the multiple gamma function, the inversion formula of the Dedekind eta function, Ramanujan's formula, Fourier expansion of the Barnes zeta function and multiple Iseki's formula.

  8. Manufacturing lot affects polyethylene tibial insert volume, thickness, and surface geometry.

    Science.gov (United States)

    Teeter, Matthew G; Milner, Jaques S; MacDonald, Steven J; Naudie, Douglas D R

    2013-08-01

    To perform wear measurements on retrieved joint replacement implants, a reference geometry of the implant's original state is required. Since implants are rarely individually scanned before implantation, a different, new implant of the same kind and size is frequently used. However, due to manufacturing variability, errors may be introduced into these measurements, as the dimensions between the retrieved and reference components may not be exactly the same. The hypothesis of this study was that new polyethylene tibial inserts from different manufacturing lots would demonstrate greater variability than those from the same lot. In total, 12 new tibial inserts of the same model and size were obtained, 5 from the same lot and the remainder from different lots. The geometry of each tibial insert was obtained using microcomputed tomography. Measurements of tibial insert volume, thickness, and three-dimensional surface deviations were obtained and compared between tibial inserts from the same and different manufacturing lots. Greater variability was found for the tibial inserts from different manufacturing lots for all types of measurements, including a fourfold difference in volume variability (p manufacturing lots for use as the reference geometry.

  9. Tibial tubercle osteotomy in patello-femoral instability and in patellar height abnormality.

    Science.gov (United States)

    Caton, Jacques H; Dejour, David

    2010-02-01

    The aim of this study was to present the different surgical procedures of tibial tubercle osteotomies for patellar instability or patellar mispositioning such as patella alta or patella infera. This study analysed the Caton-Deschamps index used for assessment of vertical patella height in order to make a precise plan for tibial tuberosity osteotomies. This study included 61 knees (50 patients) treated for patellar instability with patella alta and 24 patients treated for patella infera of mechanical origin. The results of medial transfer of the tibial tuberosity, with or without distal transfer in cases of patellar instability with patella alta, gives excellent results for stability in 76.8% of the cases. The results of the proximal transfer of the tibial tuberosity in cases of patella infera were excellent or good in 80% of the cases in our series of 24 patients. A precise preoperative plan is needed with determination of the vertical patellar height using the Caton-Deschamps index and the situation of the tibial tuberosity and the Tibial Tubercle to Trochlear Groove distance (TT-TG) of the knee on CT scan in order to obtain satisfactory results.

  10. An Innovative Intra-articular Osteotomy in the Treatment of Posterolateral Tibial Plateau Fracture Malunion.

    Science.gov (United States)

    Wang, Yukai; Luo, Congfeng; Hu, Chengfang; Sun, Hui; Zhan, Yu

    2016-07-13

    Posterolateral tibial plateau fractures are not uncommon and the diagnosis can be easily missed. The treatment is technically demanding, which can easily lead to malunion of the posterolateral tibial plateau fracture. Here, we describe an innovative intra-articular osteotomy for the treatment of posterolateral tibial plateau fracture malunion. From 2010 through 2012, 13 patients with a posterolateral tibial plateau fracture malunion were treated in our trauma center. The patients were referred because of instability or knee pain. The instability was confirmed by physical examinations preoperatively. The depression malunion and lower limb alignment were evaluated on X-rays and computed tomography scans. All posterolateral tibial plateau fracture malunions were treated with an innovative intra-articular osteotomy via an extended anterolateral approach. The mean follow-up was 19.6 months (range, 14-28 months). The posterolateral osteotomy healed at an average of 15.1 weeks. The depression malunion was corrected in all patients, which was from 15.4 mm preoperatively to 3.3 mm at 12 months postoperatively. The average Lysholm, Knee Society Score, and visual analog scale scores were 91.7, 92.5, and 0.5, respectively. No loss of reduction, nonunion, or wound infection was observed. An innovative intra-articular osteotomy via an extended anterolateral approach is an effective treatment for posterolateral tibial plateau fracture malunion. The treatment achieved satisfactory functional results and knee stability restoration.

  11. Biomechanical analysis on transverse tibial fixation in anterior cruciate ligament reconstructions

    Directory of Open Access Journals (Sweden)

    Edmar Stieven Filho

    2015-04-01

    Full Text Available OBJECTIVE: To verify whether the combination of tibial cross pin fixation and femoral screw fixation presents biomechanical advantages when compared to femoral cross pin fixation and tibial screw fixation for the reconstruction of the anterior cruciate ligament (ACL.METHODS: Thirty-eight porcine knees and bovine extensor digitorum tendons were used as the graft materials. The tests were performed in three groups: (1 standard, used fourteen knees, and the grafts were fixated with the combination of femoral cross pin and a tibial screw; (2 inverted, used fourteen knees with an inverted combination of tibial cross pin and a femoral screw; (3 control, ten control tests performed with intact ACL. After the grafts fixation, all the knees were subjected to tensile testing to determine yield strength and ultimate strength.RESULTS: There was no statistically significant difference in survival techniques in regard to strength, yield load and tension. There was a higher survival compared in the standard curves of yield stress (p < 0.05.CONCLUSION: There is no biomechanical advantage, observed in animal models testing, in the combination of tibial cross pin fixation and femoral screw when compared to femoral cross pin fixation and tibial screw.

  12. Determination of the optimal locations of surface-mounted markers on the tibial segment.

    Science.gov (United States)

    Peters, Alana; Sangeux, Morgan; Morris, Meg E; Baker, Richard

    2009-01-01

    This study aims to determine optimal locations on the lower limbs for skin-mounted markers representing the tibial segment in three-dimensional (3D) gait analysis. It was predicted that markers located on the anterior tibial crest and malleoli would be least susceptible to soft tissue movement. Ten retro-reflective markers were attached to each tibial segment for 20 participants. Participants performed 10 walking trials and two different range-of-movement tasks (knee flexion/extension and ankle plantarflexion/dorsiflexion). The results showed a subset of four markers with inter-marker pair distances on the tibia have less than 1.6 mm variation (standard deviation (S.D.)) during walking. Minimal variation was also found in isolated ROM tasks, where marker pairs showed variability of less than 2.2 mm. Other marker locations, the femoral epicondyles and the tibial tuberosity varied up to 4 mm during walking and up to 11 mm during the isolated ROM tasks. The four marker locations that are optimal for defining the tibia are the proximal anterior tibial crest, the distal anterior tibial crest, the lateral malleolus and the medial malleolus.

  13. Outcome of limb reconstruction system in open tibial diaphyseal fractures

    Directory of Open Access Journals (Sweden)

    Anand Ajmera

    2015-01-01

    Full Text Available Background: Management of open tibial diaphyseal fractures with bone loss is a matter of debate. The treatment options range from external fixators, nailing, ring fixators or grafting with or without plastic reconstruction. All the procedures have their own set of complications, like acute docking problems, shortening, difficulty in soft tissue management, chronic infection, increased morbidity, multiple surgeries, longer hospital stay, mal union, nonunion and higher patient dissatisfaction. We evaluated the outcome of the limb reconstruction system (LRS in the treatment of open fractures of tibial diaphysis with bone loss as a definative mode of treatment to achieve union, as well as limb lengthening, simultaneously. Materials and Methods: Thirty open fractures of tibial diaphysis with bone loss of at least 4 cm or more with a mean age 32.5 years were treated by using the LRS after debridement. Distraction osteogenesis at rate of 1 mm/day was done away from the fracture site to maintain the limb length. On the approximation of fracture ends, the dynamized LRS was left for further 15-20 weeks and patient was mobilized with weight bearing to achieve union. Functional assessment was done by Association for the Study and Application of the Methods of Illizarov (ASAMI criteria. Results: Mean followup period was 15 months. The mean bone loss was 5.5 cm (range 4-9 cm. The mean duration of bone transport was 13 weeks (range 8-30 weeks with a mean time for LRS in place was 44 weeks (range 24-51 weeks. The mean implant index was 56.4 days/cm. Mean union time was 52 weeks (range 31-60 weeks with mean union index of 74.5 days/cm. Bony results as per the ASAMI scoring were excellent in 76% (19/25, good in 12% (3/25 and fair in 4% (1/25 with union in all except 2 patients, which showed poor results (8% with only 2 patients having leg length discrepancy more than 2.5 cm. Functional results were excellent in 84% (21/25, good in 8% (2/25, fair in 8% (2/25. Pin

  14. [The geometry of the keel determines the behaviour of the tibial tray against torsional forces in total knee replacement].

    Science.gov (United States)

    García David, S; Cortijo Martínez, J A; Navarro Bermúdez, I; Maculé, F; Hinarejos, P; Puig-Verdié, L; Monllau, J C; Hernández Hermoso, J A

    2014-01-01

    The keel design of the tibial tray is essential for the transmission of the majority of the forces to the peripheral bone structures, which have better mechanical proprieties, thus reducing the risk of loosening. The aim of the present study was to compare the behaviour of different tibial tray designs submitted to torsional forces. Four different tibial components were modelled. The 3-D reconstruction was made using the Mimics software. The solid elements were generated by SolidWorks. The finite elements study was done by Unigraphics. A torsional force of 6 Nm. applied to the lateral aspects of each tibial tray was simulated. The GENUTECH® tibial tray, with peripheral trabecular bone support, showed a lower displacement and less transmitted tensions under torsional forces. The results suggest that a tibial tray with more peripheral support behaves mechanically better than the other studied designs.

  15. Sound localization ability of young children with bilateral cochlear implants.

    NARCIS (Netherlands)

    Beijen, J.W.; Snik, A.F.M.; Mylanus, E.A.M.

    2007-01-01

    OBJECTIVE: To evaluate the benefit of bilateral cochlear implantation in young children. STUDY DESIGN: Clinical trial comparing a group of bilaterally implanted children with a group of unilaterally implanted children. SETTING: Tertiary referral center. PATIENTS: Five bilaterally implanted children

  16. Heterochronic bilateral ectopic pregnancy after ovulation induction.

    Science.gov (United States)

    Zhu, Bo; Xu, Gu-feng; Liu, Yi-feng; Qu, Fan; Yao, Wei-miao; Zhu, Yi-min; Gao, Hui-juan; Zhang, Dan

    2014-08-01

    Ectopic pregnancy is identified with the widely-applied assisted reproductive technology (ART). Bilateral ectopic pregnancy is a rare form of ectopic pregnancy which is difficult to be diagnosed at the pre-operation stage. In this paper, we presented an unusual case of heterochronic bilateral ectopic pregnancy after stimulated intrauterine insemination (IUI), where there has been a delay of 22 d between the diagnoses of the two ectopic pregnancies. Literature was reviewed on the occurrence of bilateral ectopic pregnancy during the past four years in the MEDLINE database. We found 16 cases of bilateral ectopic pregnancy reported since 2008, and analyzed the characteristics of those cases of bilateral ectopic pregnancy. We emphasize that ovulation induction and other ARTs may increase the risk of bilateral ectopic pregnancy. Because of the difficulty in identification of bilateral ectopic pregnancy by ultrasonography, the clinician should be aware that the treatment of one ectopic pregnancy does not preclude the occurrence of a second ectopic pregnancy in the same patient and should pay attention to the intra-operation inspection of both side fallopian tubes in any ectopic pregnancy case.

  17. Bilateral optic neuropathy in acute cryptococcal meningitis

    Institute of Scientific and Technical Information of China (English)

    Qi Zhe Ngoo; Li Min Evelyn Tai; Wan Hazabbah Wan Hitam; John Tharakan

    2016-01-01

    We reported a case of cryptococcal meningitis presenting with bilateral optic neuropathy in an immunocompetent patient. A 64-year-old Malay gentleman with no medical comorbidities presented with acute bilateral blurring of vision for a week, which was associated with generalised throbbing headache and low grade fever. He also had som-nolence and altered consciousness. Visual acuity in both eyes was no perception of light with poor pupillary reflexes. Extraocular muscle movements were normal. Anterior segments were unremarkable bilaterally. Fundoscopy revealed bilateral optic disc swelling. CT scan of the brain showed multifocal infarct, but no meningeal enhancement or mass. Cerebrospinal fluid opening pressure was normal, while its culture grew Cryptococcus neoformans. A diagnosis of cryptococcal meningitis with bilateral optic neuropathy was made. Patient was treated with a six-week course of intravenous flu-conazole and started concomitantly on a fortnight's course of intravenous amphotericin B. After that, his general condition improved, but there was still no improvement in his visual acuity. On reviewing at two months post-initiation of treatment, fundi showed bilateral optic atrophy. Bilateral optic neuropathy secondary to cryptococcal meningitis was rare. The prognosis was guarded due to the sequelae of optic atrophy. Anti-fungal medication alone may not be sufficient to manage this condition. However, evidence for other treatment modalities is still lacking and further clinical studies are required.

  18. Bilateral Petit’s Triangle Hernia

    Directory of Open Access Journals (Sweden)

    Sanjay Kumar Bhasin, Arshad Bashir Khan, Sanjay Sharma

    2006-07-01

    Full Text Available Lumbar traingle hernia that occurs through lumbar triangles is very rare type of hernia. Only about 300 cases havebeen reported till date. Bilateral Petit’s triangle hernia find further rarity and the case under reference is probably thefirst ever reported case of Primary bilateral Petit’s triangle hernia. The present case is of a 46 years old married,multigravida female who presented with 1 year duration of LBA and subsequently notice of swelling both sides oflow back. FNAC revealed lipoma and on exploration it turned out to be rarest extra peritoneal bilateral Petit’s trianglehernia, fat as contents.

  19. Clinical and functional outcomes of tibial intercalary allograft reconstructions

    Directory of Open Access Journals (Sweden)

    Lucas López Millán

    2012-12-01

    Full Text Available Background The purpose of this study was to evaluate the survival, the complications and the functional outcome of intercalary tibial allografts reconstructions following tumor resections. Methods Intercalary tibia segmental allografts were implanted in 26 consecutive patients after segmental resections. Average follow-up was 6 years. Allograft survival was determined with the Kaplan-Meier method. Function was evaluated with the Musculoskeletal Tumor Society scoring system (MSTS. Results The rate of survival was 84% (CI 95%: 90%- 70% at 5 years and 79% at 10 years (CI 95%: 95%-63%. Allografts were removed in 5 patients (3 due to infections and 2 due to local recurrences. Two patients showed diaphyseal nonunion and 3 had an incomplete fracture, but it was not necessary to remove the allografts. Average MSTS functional score was 29 points (range 27 to 30. Conclusions Despite the incidence of complications, this analysis showed an acceptable survival with excellent functional scores. The use of intercalary allograft clearly has a place in the reconstruction of a segmental defect created by the resection of a tumor in the diaphyseal and/or metaphyseal portion of the tibia.

  20. Extensive Bilateral Naevus Comedonicus Exacerbating During Pregnancy

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    Rao M.V

    1999-01-01

    Full Text Available Naevus comedonicus is a rare developmental anomaly of the pilosebaceous apparatus. It occurred bilaterally in a 23 year old pregnant woman. She noted exacerbations during two pregnancies, hitherto unreported in the literature.

  1. FLOWING BILATERAL FILTER: DEFINITION AND IMPLEMENTATIONS

    Directory of Open Access Journals (Sweden)

    Maxime Moreaud

    2015-06-01

    Full Text Available The bilateral filter plays a key role in image processing applications due to its intuitive parameterization and its high quality filter result, smoothing homogeneous regions while preserving the edges of the objects. Considering the image as a topological relief, seeing pixel intensities as peaks and valleys, we introduce a way to control the tonal weighting coefficients, the flowing bilateral filter, reducing "halo" artifacts typically produced by the regular bilateral filter around a large peak surrounded by two valleys of lower values. In this paper we propose to investigate exact and approximated versions of CPU and parallel GPU (Graphical Processing Unit based implementations of the regular and flowing bilateral filter using the NVidia CUDA API. Fast implementations of these filters are important for the processing of large 3D volumes up to several GB acquired by x-ray or electron tomography.

  2. Bilateral areolar and periareolar pityriasis versicolor.

    Science.gov (United States)

    Sárdy, Miklós; Korting, Hans Christian; Ruzicka, Thomas; Wolff, Hans

    2010-08-01

    An adolescent boy presented with isolated, symmetrical, bilateral areolar and periareolar pityriasis versicolor. This extremely rare condition should be considered in the differential diagnosis of light brown patches on the areolae.

  3. Genetics of Infantile Bilateral Striatal Necrosis

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2006-09-01

    Full Text Available The gene mutation causing autosomal recessive infantile bilateral striatal necrosis (IBSN was identified in eight consanguineous Israeli Bedouin families, in a study at Schneider Children’s Medical Center, Petah Tikva, Israel, and other centers.

  4. Bilateral giant juvenile fibroadenoma of breasts

    Directory of Open Access Journals (Sweden)

    Mukhopadhyay Madhumita

    2009-01-01

    Full Text Available An 11-year-old girl with rapidly enlarging bilateral breast lumps is reported. It was diagnosed as a case of juvenile fibroadenoma following fine needle aspiration cytology and confirmed on histopathological examination of the excised specimens.

  5. BILATERAL TESSIER CLEFT 3: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Utpal

    2014-06-01

    Full Text Available Tessier cleft 3 is a very rare congenital anomaly, (2 especially the bilateral form. Very few cases have been reported worldwide. (1,2 I report a case of bilateral Tessier cleft 3 presenting at the age of three months with clefts extending from philtral regions, undermining the nasal alar bases to the medial canthal areas bilaterally. There were bilateral complete alveolar clefts with mild protrusion of the pre-maxilla, but the rest of the maxilla including the palate was not involved. Surgical correction was started at the age of three months and completed at the age of one and half years in three stages. There was no intra-operative or postoperative complications and the final result was satisfactory.

  6. THE EUROPEAN UNION’S BILATERAL APPROACH

    Directory of Open Access Journals (Sweden)

    Ludmila BORTA

    2014-12-01

    Full Text Available The EU is a world economic power and a major trading partner for most countries. All the time, this region has been interested and has acted towards a free and fair trade. The decrease and even the elimination of tariff and non-tariff barriers in the world trade are among the main objectives of the EU strategy for international trade. At the moment, the elusive outcome of the WTO Doha Round has led to the proliferation of bilateral trade agreements worldwide. Although the EU remains committed to further development of the multilateral trading system, however, the EU still has appealed also to the development of bilateral trade relations. The aim of this paper is to illustrate the current bilateral dimension of the common commercial policy of the EU. In conclusion, to describe this bilateral approach of the EU we are using one word, namely “diversity”.

  7. Sequential presentation of bilateral Brown syndrome.

    Science.gov (United States)

    Sekeroğlu, Hande Taylan; Türkçüoğlu, Peykan; Sanaç, Ali Şefik; Sener, Emin Cumhur

    2012-04-01

    Brown syndrome, characterized by a limitation of elevation in adduction and positive forced duction testing, is usually unilateral but occurs bilaterally in 10% of all cases. It may present as a congenital condition in one eye and develop in the other eye with no apparent cause. We present a case of bilateral Brown syndrome in which the right eye became involved within 1 year of surgery on the left eye for congenital Brown syndrome.

  8. Clinical subgroups in bilateral Meniere disease

    OpenAIRE

    2016-01-01

    Meniere disease (MD) is a heterogeneous clinical condition characterized by sensorineural hearing loss, episodic vestibular symptoms and tinnitus associated with several comorbidities such as migraine or autoimmune disorders (AD). The frequency of bilateral involvement may range from 5-50% and it depends on the duration of the disease. We have performed a two-step cluster analysis in 398 patients with bilateral MD to identify the best predictors to define clinical subgroups with a potential d...

  9. Bilateral anophthalmia with septo-optic dysplasia

    Directory of Open Access Journals (Sweden)

    Manisha Jana

    2010-01-01

    Full Text Available Bilateral anophthalmia is a rare entity and association with septo-optic dysplasia is an even rare condition. The condition is characterized by absent eyeballs in the presence of eyelids, conjunctiva or lacrimal apparatus. Though anophthalmia can be diagnosed clinically, imaging plays a crucial role in delineating the associated anomalies. In addition, often clinical anophthalmia may prove to be severe microphthalmia on imaging. We describe the imaging findings in an infant with bilateral anophthalmia and septo-optic dysplasia.

  10. Bilateral Keratectasia 34 Years after Corneal Transplant

    Directory of Open Access Journals (Sweden)

    Xavier Valldeperas

    2010-07-01

    Full Text Available We report the clinical findings of a patient with severe bilateral keratectasia 34 years after a penetrating keratoplasty (PK in both eyes. An otherwise healthy 67-year-old man complained of deterioration of the eyesight in both eyes over the last 6 months. The patient was diagnosed with bilateral keratoconus at the age of 32 years, and he underwent a bilateral PK. At presentation, visual acuity was 20/200 in the right eye and light perception in the left eye. A Pentacam pachymetric map revealed a central pachymetry of 720 µm in the right eye and of 710 µm in the left eye, as well as an average paracentral pachymetry of 436 and 270 µm in the 9-mm zone in the right and the left eye, respectively. Corneal topography revealed bilateral irregular and asymmetric bowing with generalized steepening and high corneal power. We describe a case of bilateral keratectasia 34 years after PK in a patient who was originally diagnosed with bilateral keratoconus.

  11. MODERN VIEWS ON BILATERAL BREAST CANCER

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    Ye. A. Fesik

    2014-01-01

    Full Text Available Presented modern literature data on the features of the pathogenesis, course, clinical and morphological expression and tumor characteristics, parameters and nodal metastasis of hematogenous bilateral breast cancer. Highlight the results of domestic and foreign studies in recent years to determine the prognostic factors and recurrence of synchronous and metachronous bilateral breast cancer. It was revealed that the frequency of bilateral breast tumor lesions varies widely, ranging from 0.1 to 20%, with metachronous tumors recorded significantly higher (69.6% than the synchronous (22.7%. The probability of occurrence of metachronous breast cancer is higher in women with a family history, as well as if they have a gene mutation BRCA-1. Found that the most common histological type of breast tumor with bilateral lesions is invasive ductal. However, the incidence of invasive lobular cancer and non-invasive lobular cancer is slightly higher among synchronous bilateral cancer compared with unilateral disease. Studies have shown that in a double-sided synchronous breast cancer tumor, as a rule, has a lower degree of differentiation, and the higher the expression level of estrogen receptors and progesterone receptors. Relevance of the issue because the identification of patterns in the study of lymphatic and hematogenous features bilateral metastasis of mammary tumors provides a basis for speculation about the differences in the progression of neoplastic disease in these groups and is a cause for further detailed research in this area to identify and evaluate the prognosis and also the choice of tactics of such patients.

  12. Backside wear of Miller-Galante I and Insall-Burstein II tibial inserts.

    Science.gov (United States)

    Taki, Naoya; Goldberg, Victor M; Kraay, Matthew J; Rimnac, Clare M

    2004-11-01

    The objective of this study was to determine if there was a difference in the amount, type, and location of backside wear in the Miller-Galante I and Insall-Burstein II PE tibial inserts. A secondary objective was to determine if backside wear damage in these two designs was a function of clinical factors (patient height, weight, gender, age, and length of time of implantation), shelf life of the PE tibial insert, and tibial component thickness. Backside wear damage was assessed on 24 Miller-Galante I and 11 Insall-Burstein II tibial inserts (implantation time, 0.5-12.4 years). For both groups combined, implantation time was positively correlated to wear damage and to PE peg height into screw holes. The Miller-Galante I group had significantly larger PE pegs than the Insall-Burstein II group. The Miller-Galante I group had significantly more burnishing and larger PE pegs posteriorly than anteriorly. There was no correlation between insert shelf life before initial surgery and backside wear. The thinner the component, the larger the total damage scores in the Miller-Galante I group. This study supports the hypothesis that backside wear of PE tibial inserts may be influenced by design and component thickness and by clinical factors.

  13. Modified stabilization method for the tibial tuberosity advancement technique: a biomechanical study

    Directory of Open Access Journals (Sweden)

    Bruno Testoni Lins

    Full Text Available The present study aimed to determine biomechanical alterations resultant from a modification in the fixation method of the tibial tuberosity advancement technique (TTA, originally described for stabilization of the cranial cruciate-deficient stifle. Ten adult mongrel dogs weighing 25-30kg were used. After euthanasia, performed for reasons unrelated to this study, the hind limbs were distributed into two groups: G1 operated (n=10 and G2 control (n=10, represented by the contralateral limb. The operated hind limbs were orthopedically, goniometrically and radiographically evaluated, sequentially at four moments: moment 1, in intact joints; moment 2, after cranial cruciate desmotomy; moment 3, after surgical stabilization of the stifle joint using modified TTA; and moment 4, after caudal cruciate ligament desmotomy. The tibial tuberosity was stabilized by one shaft screw craniocaudally and a titanium cage inserted at the osteotomy site. The position of the patellar tendon at 90° in relation to the tibial plateau allowed cranial tibial thrust force neutralization, despite cranial drawer motion maintenance in all dogs. The biomechanical tests confirm the viability of the tibial tuberosity fixation method and support future clinical trials to validate the technique.

  14. Increasing lateral tibial slope: is there an association with articular cartilage changes in the knee?

    Energy Technology Data Exchange (ETDEWEB)

    Khan, Nasir; Shepel, Michael; Leswick, David A.; Obaid, Haron [University of Saskatchewan, Department of Medical Imaging, Royal University Hospital, and College of Medicine, Saskatoon, Saskatchewan (Canada)

    2014-04-15

    The geometry of the lateral tibial slope (LTS) plays an important role in the overall biomechanics of the knee. Through this study, we aim to assess the impact of LTS on cartilage degeneration in the knee. A retrospective analysis of 93 knee MRI scans (1.5 T or 3 T) for patients aged 20-45 years with no history of trauma or knee surgery, and absence of internal derangement. The LTS was calculated using the circle method. Chondropathy was graded from 0 (normal) to 3 (severe). Linear regression analysis was used for statistical analysis (p < 0.05). In our cohort of patients, a statistically significant association was seen between increasing LTS and worsening cartilage degenerative changes in the medial patellar articular surface and the lateral tibial articular surface (p < 0.05). There was no statistically significant association between increasing LTS and worsening chondropathy of the lateral patellar, medial trochlea, lateral trochlea, medial femoral, lateral femoral, and medial tibial articular surfaces. Our results show a statistically significant association between increasing LTS and worsening cartilage degenerative changes in the medial patella and the lateral tibial plateau. We speculate that increased LTS may result in increased femoral glide over the lateral tibial plateau with subsequent increased external rotation of the femur predisposing to patellofemoral articular changes. Future arthroscopic studies are needed to further confirm our findings. (orig.)

  15. Effect of tibial tuberosity advancement on femorotibial contact mechanics and stifle kinematics.

    Science.gov (United States)

    Kim, Stanley E; Pozzi, Antonio; Banks, Scott A; Conrad, Bryan P; Lewis, Daniel D

    2009-01-01

    Objective- To evaluate the effects of tibial tuberosity advancement (TTA) on femorotibial contact mechanics and 3-dimensional kinematics in cranial cruciate ligament (CrCL)-deficient stifles of dogs. Study Design- In vitro biomechanical study. Animals- Unpaired pelvic limbs from 8 dogs, weighing 28-35 kg. Methods- Digital pressure sensors placed subjacent to the menisci were used to measure femorotibial contact force, contact area, peak and mean contact pressure, and peak pressure location with the limb under an axial load of 30% body weight and a stifle angle of 135 degrees . Three-dimensional static poses of the stifle were obtained using a Microscribe digitizing arm. Each specimen was tested under normal, CrCL-deficient, and TTA-treated conditions. Repeated measures analysis of variance with a Tukey post hoc test (Pcontact mechanic parameters were evident after CrCL transection, which corresponded to marked cranial tibial subluxation and internal tibial rotation in the CrCL-deficient stifle. No significant differences in any contact mechanic and kinematic parameters were detected between normal and TTA-treated stifles. Conclusion- TTA eliminates craniocaudal stifle instability during simulated weight-bearing and concurrently restores femorotibial contact mechanics to normal. Clinical Relevance- TTA may mitigate the progression of stifle osteoarthritis in dogs afflicted with CrCL insufficiency by eliminating cranial tibial thrust while preserving the normal orientation of the proximal tibial articulating surface.

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

    Institute of Scientific and Technical Information of China (English)

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

    2011-01-01

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

  17. Encoding of force increases and decreases by tibial campaniform sensilla in the stick insect, Carausius morosus.

    Science.gov (United States)

    Zill, Sasha N; Büschges, Ansgar; Schmitz, Josef

    2011-08-01

    Detection of force increases and decreases is important in motor control. Experiments were performed to characterize the structure and responses of tibial campaniform sensilla, receptors that encode forces through cuticular strains, in the middle leg of the stick insect (Carausius morosus). The sensilla consist of distinct subgroups. Group 6A sensilla are located 0.3 mm distal to the femoro-tibial joint and have oval shaped cuticular caps. Group 6B receptors are 1 mm distal to the joint and have round caps. All sensilla show directional, phasico-tonic responses to forces applied to the tibia in the plane of joint movement. Group 6B sensilla respond to force increases in the direction of joint extension while Group 6A receptors discharge when those forces decrease. Forces applied in the direction of joint flexion produce the reverse pattern of sensory discharge. All receptors accurately encode the rate of change of force increments and decrements. Contractions of tibial muscles also produce selective, directional sensory discharges. The subgroups differ in their reflex effects: Group 6B receptors excite and Group 6A sensilla inhibit tibial extensor and trochanteral depressor motoneurons. The tibial campaniform sensilla can, therefore, encode force increases or decreases and aid in adapting motor outputs to changes in load.

  18. Bilateral microvascular second toe transfer for bilateral post-traumatic thumb amputation.

    Science.gov (United States)

    Nehete, Rajendra; Nehete, Anita; Singla, Sandeep; Adhav, Harshad

    2012-01-01

    In bilateral thumb amputations, the functional impairment is serious and every attempt should be made to reconstruct the thumb. We report a case of bilateral post traumatic thumb amputation, reconstructed with bilateral second toe transfer. Only two such cases have been reported in literature so far. Though there are various modalities for the reconstruction of thumb, microvascular toe transfer has its own merits. The convalescent period is minimal with excellent function. It is bilaterally symmetric and aesthetically superior to the osteoplastic reconstruction. The technical details are discussed, and the long term functional and aesthetic results are presented.

  19. Bilateral microvascular second toe transfer for bilateral post-traumatic thumb amputation

    Directory of Open Access Journals (Sweden)

    Rajendra Nehete

    2012-01-01

    Full Text Available In bilateral thumb amputations, the functional impairment is serious and every attempt should be made to reconstruct the thumb. We report a case of bilateral post traumatic thumb amputation, reconstructed with bilateral second toe transfer. Only two such cases have been reported in literature so far. Though there are various modalities for the reconstruction of thumb, microvascular toe transfer has its own merits. The convalescent period is minimal with excellent function. It is bilaterally symmetric and aesthetically superior to the osteoplastic reconstruction. The technical details are discussed, and the long term functional and aesthetic results are presented.

  20. Vascularized fibular graft in infected tibial bone loss

    Directory of Open Access Journals (Sweden)

    C Cheriyan Kovoor

    2011-01-01

    Full Text Available Background : The treatment options of bone loss with infections include bone transport with external fixators, vascularized bone grafts, non-vascularized autogenous grafts and vascularized allografts. The research hypothesis was that the graft length and intact ipsilateral fibula influenced hypertrophy and stress fracture. We retrospectively studied the graft hypertrophy in 15 patients, in whom vascularized fibular graft was done for post-traumatic tibial defects with infection. Materials and Methods : 15 male patients with mean age 33.7 years (range 18 - 56 years of post traumatic tibial bone loss were analysed. The mean bony defect was 14.5 cm (range 6.5 - 20 cm. The mean length of the graft was 16.7 cm (range 11.5 - 21 cm. The osteoseptocutaneous flap (bone flap with attached overlying skin flap from the contralateral side was used in all patients except one. The graft was fixed to the recipient bone at both ends by one or two AO cortical screws, supplemented by a monolateral external fixator. A standard postoperative protocol was followed in all patients. The hypertrophy percentage of the vascularized fibular graft was calculated by a modification of the formula described by El-Gammal. The followup period averaged 46.5 months (range 24 - 164 months. The Pearson correlation coefficient (r was worked out, to find the relationship between graft length and hypertrophy. The t-test was performed to find out if there was any significant difference in the graft length of those who had a stress fracture and those who did not and to find out whether there was any significant difference in hypertrophy with and without ipsilateral fibula union. The Chi square test was performed to identify whether there was any association between the stress fracture and the fibula union. Given the small sample size we have not used any statistical analysis to determine the relation between the percentage of the graft hypertrophy and stress fracture. Results : Graft

  1. The Effect of Different Sagittal Angles of the Tibial Guide on Aperture Widening of the Tibial Tunnel during Modified Transtibial Anterior Cruciate Ligament Reconstruction: A Randomized In Vivo Study

    Science.gov (United States)

    Kim, Young Chan; Tawonsawatruk, Tulyapruek; Woon, Hyeong Hwa; Yum, Ji Woong; Shin, Myung Jin; Bravo, Rodolfo S.; Nha, Kyung Wook

    2017-01-01

    Purpose The effect of sagittal plane angle of the tibial tunnel on the severity of tibial intra-articular aperture expansion caused by iatrogenic re-reaming in anterior cruciate ligament (ACL) reconstruction using a modified transtibial technique is unknown. The purpose of this study was to compare the severity of intra-articular aperture widening at different angles (40°, 45°, and 50°) of the tibial guide (TG). Materials and Methods Ninety-seven patients who underwent modified transtibial ACL reconstruction were randomly allocated to TG 40°, 45°, and 50° groups. Intra-articular tibial aperture width (TW) and tibial tunnel length (TTL) were measured intraoperatively using an arthroscopic ruler and a depth gauge. Results The TG 50° group had significantly greater tibial aperture widening than the TG 40° group. There was a significant difference among TG 40°, 45°, and 50° groups and the percentage of knees with TTL <35 mm was 8%, 9% and 3%, respectively. There were 2 females with TTL <35 mm in TG 40° and 45° groups each. The average mediolateral length of the tibial plateau was 75 mm. Conclusions This study shows that the TG angle of 40° would reduce the severity of intra-articular aperture widening of the tibial tunnel compared to 45° or 50° in modified transtibial ACL reconstruction. PMID:28231645

  2. Pulsed electromagnetic stimulation in nonunion of tibial diaphyseal fractures

    Directory of Open Access Journals (Sweden)

    Gupta Anil

    2009-01-01

    Full Text Available Background: Nonunion of long bones is a difficult clinical problem and challenges the clinical acumen of surgeons. Multiple surgical or nonsurgical modalities have been used to treat nonunions. Noninvasive pulsed electromagnetic stimulation is an entity known to affect the piezoelectric phenomenon of bone forming cells. We conducted a study on 45 long-bone fractures of tibia treated by pulsed electromagnetic stimulation, which are analyzed and reported. Materials and Methods: A total of 45 tibial fractures with established atrophic nonunion were enrolled between 1981 and 1988. All the patients had abnormal mobility and no or minimal gap at fracture site with no evidence of callus formation across the fracture site. The patients′ age ranged between 24 and 68 years; 40 were men and 5 were women. All patients having evidence of infection, implant in situ , and gap nonunions were excluded from study. Pulsed electromagnetic stimulation was given using above-knee plaster of Paris cast (0.008 Weber/m 2 magnetic field was created for 12 h/day. The average duration for pulsed electromagnetic stimulation (PEMS therapy was 8.35 weeks, with the range being 6-12 weeks. The cases were evaluated at 6 weeks and subsequently every 6-weekly interval for clinical and radiological union. The withdrawal of therapy was decided as per clinicoradiological evidence of union. Results: All but three patients showed evidence of union. About 35% (n = 16 cases showed union in 10 weeks, and 85% (n = 38 cases showed union in 4 months. The average duration of therapy using PEMS was 8.35±0.48 weeks, and the average duration of immobilization was 3.02 ± 0.22 months. Three cases that did not show evidence of union were poorly compliant for the apparatus of PEMS. Conclusion: PEMS is a useful noninvasive modality of treatment for difficult nonunion of long bones.

  3. Bilateral agenesis of the anterior cruciate ligament: MRI evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Bedoya, Maria A.; Jaramillo, Diego [The Children' s Hospital of Philadelphia, Radiology Department, Philadelphia, PA (United States); McGraw, Michael H. [Hospitalof theUniversityof Pennsylvania, Divisionof Orthopaedics, Philadelphia, PA (United States); Wells, Lawrence [The Children' s Hospital of Philadelphia, Division of Orthopaedics, Philadelphia, PA (United States)

    2014-09-15

    Bilateral agenesis of the anterior cruciate ligament (ACL) is extremely rare. We describe a 13-year-old girl who presented with bilateral knee pain without history of trauma; she has two family members with knee instability. Magnetic resonance imaging showed bilateral absence of the ACL, and medial posterior horn meniscal tears. Bilateral arthroscopic partial meniscectomy and anterior cruciate ligament reconstruction was performed. (orig.)

  4. Tibial lengthening over nails in children using modified Ender nails: preliminary results of a new treatment.

    Science.gov (United States)

    Saraph, Vinay; Roposch, Andreas; Zwick, Ernst-Bernhard; Linhart, Wolfgang E

    2004-11-01

    Tibial lengthening over nails, using modified Ender nails, was performed in nine children whose mean age at surgery was 12.8 years. The prerequisite for using this technique was the absence of axial malalignment and an indication for tibial lengthening only. Lengthening was not performed in one case due to the development of a compartment syndrome after the tibial osteotomy. Breakage of one interlocking screw without loss of alignment or length was observed in one case. Superficial pin tract infections were observed in two cases. An average of 4.1 cm (range 3-4.5 cm) lengthening of the tibia was achieved in eight of the nine cases. The modified Ender nails used permitted locking at both ends after achieving the desired distraction and permitted early removal of the external fixator. The advantage of this technique is that it permits early removal of the fixator and thus decreases the incidence of fixator related problems and facilitates early rehabilitation.

  5. Intramedullary versus extramedullary alignment of the tibial component in the Triathlon knee

    LENUS (Irish Health Repository)

    Cashman, James P

    2011-08-20

    Abstract Background Long term survivorship in total knee arthroplasty is significantly dependant on prosthesis alignment. Our aim was determine which alignment guide was more accurate in positioning of the tibial component in total knee arthroplasty. We also aimed to assess whether there was any difference in short term patient outcome. Method A comparison of intramedullary versus extramedullary alignment jig was performed. Radiological alignment of tibial components and patient outcomes of 103 Triathlon total knee arthroplasties were analysed. Results Use of the intramedullary was found to be significantly more accurate in determining coronal alignment (p = 0.02) while use of the extramedullary jig was found to give more accurate results in sagittal alignment (p = 0.04). There was no significant difference in WOMAC or SF-36 at six months. Conclusion Use of an intramedullary jig is preferable for positioning of the tibial component using this knee system.

  6. Tibial nerve intraneural ganglion cyst in a 10-year-old boy

    Energy Technology Data Exchange (ETDEWEB)

    Squires, Judy H. [University of Cincinnati College of Medicine, Department of Radiology, Cincinnati, OH (United States); Emery, Kathleen H.; Johnson, Neil [Cincinnati Children' s Hospital Medical Center, Division of Radiology, Cincinnati, OH (United States); Sorger, Joel [Cincinnati Children' s Hospital Medical Center, Division of Orthopedics, Cincinnati, OH (United States)

    2014-04-15

    Intraneural ganglion cysts are uncommon cystic lesions of peripheral nerves that are typically encountered in adults. In the lower extremity, the peroneal nerve is most frequently affected with involvement of the tibial nerve much less common. This article describes a tibial intraneural ganglion cyst in a 10-year-old boy. Although extremely rare, intraneural ganglion cysts of the tibial nerve should be considered when a nonenhancing cystic structure with intra-articular extension is identified along the course of the nerve. This report also details the unsuccessful attempt at percutaneous treatment with US-guided cyst aspiration and steroid injection, an option recently reported as a viable alternative to open surgical resection. (orig.)

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

    Science.gov (United States)

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

    2015-04-01

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

  8. Tosic external fixator in the management of proximal tibial fractures in adults.

    Science.gov (United States)

    Tosic, A; Ebraheim, N A; Abou Chakra, I; Emara, K

    2001-06-01

    This retrospective clinical study assessed proximal tibial fractures managed with the Tosic external fixator. Nineteen patients with 21 proximal tibial fractures treated with the Tosic external fixator between July 1997 and October 1998 comprised the study population. Eleven fractures were graded as 41A2, 3 fractures as 41 A3, 4 fractures as 41C1, and 3 fractures as 41 C2. Fourteen fractures were closed, and 7 fractures were open. Average time to healing was 1 7 weeks. No revision of fixation was needed. There were five cases of pin tract infection. Average range of knee motion was 2 degrees-135 degrees. These results indicate the Tosic external fixator is an efficient and simple way to treat proximal tibial metaphyseal fractures.

  9. Intramedullary versus extramedullary alignment of the tibial component in the Triathlon knee

    Directory of Open Access Journals (Sweden)

    Synnott Keith

    2011-08-01

    Full Text Available Abstract Background Long term survivorship in total knee arthroplasty is significantly dependant on prosthesis alignment. Our aim was determine which alignment guide was more accurate in positioning of the tibial component in total knee arthroplasty. We also aimed to assess whether there was any difference in short term patient outcome. Method A comparison of intramedullary versus extramedullary alignment jig was performed. Radiological alignment of tibial components and patient outcomes of 103 Triathlon total knee arthroplasties were analysed. Results Use of the intramedullary was found to be significantly more accurate in determining coronal alignment (p = 0.02 while use of the extramedullary jig was found to give more accurate results in sagittal alignment (p = 0.04. There was no significant difference in WOMAC or SF-36 at six months. Conclusion Use of an intramedullary jig is preferable for positioning of the tibial component using this knee system.

  10. Orthopaedic surgeon's nightmare: iatrogenic fractures of talus and medial malleolus following tibial nailing

    Institute of Scientific and Technical Information of China (English)

    Sanjay Meena; Vivek Trikha; Pramod Saini; Rakesh Kumar; Buddhadev Chowdhary

    2013-01-01

    Intramedullary interlocking nailing is the gold standard for treatment of tibial shaft fractures.The growing use of intramedullary nailing has resulted in an increased number of tibial nailing in daily clinical practice.Despite adequate surgeon experience,tibial nailing is not without complications if proper techniques are not followed.A case of iatrogenic talar neck and medial malleolus fractures during intramedullary nailing of tibia in a 24-year-old male is reported.It is believed to be caused by forceful hammering of insertion zig with foot dorsiflexed.To the best of our knowledge,no such case has been reported in the literature.It is possible to reduce the risk of this complication by adoption of preventive measures.

  11. Age variations in the properties of human tibial trabecular bone and cartilage

    DEFF Research Database (Denmark)

    Ding, Ming

    2000-01-01

    such as osteoarthrosis and osteoporosis, and for the design, fixation and durability of total joint prosthesis. The specific aims of the present studies were: 1) to investigate normal age-related variations in the mechanical, physical/compositional, and structural properties of human tibial trabecular bone; and 2......) to investigate the age-related and osteoarthrosis-related changes in the mechanical properties of the human tibial cartilage-bone complex; and 3) to evaluate mutual associations among various properties. Normal specimens from human autopsy proximal tibiae were used for investigation of age variations...

  12. The clinico-anatomic explanation for tibial intraneural ganglion cysts arising from the superior tibiofibular joint

    Energy Technology Data Exchange (ETDEWEB)

    Spinner, Robert J. [Mayo Clinic, Department of Neurologic Surgery, Rochester, Minnesota (United States); Mayo Clinic, Department of Orthopedic Surgery, Rochester, Minnesota (United States); Mayo Clinic, Department of Anatomy, Rochester, Minnesota (United States); Mokhtarzadeh, Ali; Schiefer, Terry K. [Mayo Clinic College of Medicine, Rochester, Minnesota (United States); Krishnan, Kartik G. [Carl Gustav Carus University Hospital, Department of Neurological Surgery, Dresden (Germany); Kliot, Michel [University of Washington, Department of Neurosurgery, Seattle, Washington (United States); Amrami, Kimberly K. [Mayo Clinic, Department of Radiology, Rochester, Minnesota (United States)

    2007-04-15

    To demonstrate that tibial intraneural ganglia in the popliteal fossa are derived from the posterior portion of the superior tibiofibular joint, in a mechanism similar to that of peroneal intraneural ganglia, which have recently been shown to arise from the anterior portion of the same joint. Retrospective clinical study and prospective anatomic study. The clinical records and MRI findings of three patients with tibial intraneural ganglion cysts were analyzed and compared with those of one patient with a tibial extraneural ganglion cyst and one volunteer. Seven cadaveric limbs were dissected to define the articular anatomy of the posterior aspect of the superior tibiofibular joint. The condition of the three patients with intraneural ganglia recurred because their joint connections were not identified initially. In two patients there was no cyst recurrence when the joint connection was treated at revision surgery; the third patient did not wish to undergo additional surgery. The one patient with an extraneural ganglion had the joint connection identified at initial assessment and had successful surgery addressing the cyst and the joint connection. Retrospective evaluation of the tibial intraneural ganglion cysts revealed stereotypic features, which allowed their accurate diagnosis and distinction from extraneural cases. The intraneural cysts had tubular (rather than globular) appearances. They derived from the postero-inferior portion of the superior tibiofibular joint and followed the expected course of the articular branch on the posterior surface of the popliteus muscle. The cysts then extended intra-epineurially into the parent tibial nerves, where they contained displaced nerve fascicles. The extraneural cyst extrinsically compressed the tibial nerve but did not directly involve it. All cadaveric specimens demonstrated a small single articular branch, which derived from the tibial nerve to the popliteus. The branch coursed obliquely across the posterior

  13. Anterior avulsion fracture of the tibial tuberosity in adolescents - Two case reports

    Directory of Open Access Journals (Sweden)

    Aleilimar Teixeira da Silva Júnior

    Full Text Available ABSTRACT The objective here was to report two rare cases of anterior avulsion fracture of the tibial tuberosity in adolescents. Case 1 was a 15-year-old male who became injured through landing on his left knee and presented limited extension. Case 2 was a 16-year-old basketball player who presented sudden pain in the right knee and functional incapacity, after a jump. Imaging examinations (radiographs and computed tomography showed anterior avulsion fractures of the tibial tuberosity. Surgical fixation was performed using screws and anchors, while avoiding growth plate injury. The cases evolved without lower-limb deformities.

  14. Complicaciones en las fracturas complejas de la meseta tibial y factores asociados

    OpenAIRE

    Alberto Cuéllar-Avaroma; Ana Cristina King-Martínez; Armando Hernández-Salgado; Rubén Torres-González

    2006-01-01

    Objetivo: identificar factores asociados a complicaciones con el manejo quirúrgico de las fracturas complejas de la meseta tibial. Material y métodos: estudio de casos y controles. Muestra integrada con expedientes de 56 pacientes diagnosticados con fractura compleja de la meseta tibial (tipos IV, V y VI de Schatzker), tiempo de seguimiento promedio de 12.9 ± 3.2 meses (8 a 18), y con uno o más de los siguientes factores de riesgo: edad mayor de 50 años, comorbilidad, tiempo de isquemia mayor...

  15. Early tibial tray failure of a Duracon knee with retrieval analysis.

    Science.gov (United States)

    Ho, Ta-Feng; Tsai, Ruey-Yug; Lee, Pei-Yuan; Ku, Ming-Chou

    2004-09-01

    We report a case of early tibial tray fracture of a Duracon knee prosthesis. Aside from the clinical, radiographic, and gross analysis of the failed prosthesis, we also performed analysis on the retrieved polyethylene component and the fractured tibial baseplate. In the analyses, we noted significant femoral component malalignment, uneven tray cementation, and inherent metallurgical weakness. It appears that the high compressive load on the medial tray resulted in bending fatigue failure. To avoid this complication, it is important to restore the normal alignment of the knee joint and use a polyethylene insert of higher conformity, at least 6 mm thick.

  16. Clinical subgroups in bilateral Meniere disease

    Directory of Open Access Journals (Sweden)

    Lidia Frejo

    2016-10-01

    Full Text Available Meniere disease (MD is a heterogeneous clinical condition characterized by sensorineural hearing loss, episodic vestibular symptoms and tinnitus associated with several comorbidities such as migraine or autoimmune disorders (AD. The frequency of bilateral involvement may range from 5-50% and it depends on the duration of the disease. We have performed a two-step cluster analysis in 398 patients with bilateral MD to identify the best predictors to define clinical subgroups with a potential different etiology to improve the phenotyping of bilateral MD and to develop new treatments. We have defined five clinical variants in bilateral MD. Group 1 is the most frequently found, includes 46% of patients, and is defined by metachronic hearing loss without migraine and without AD. Group 2 is found in 17% of patients, and it is defined by synchronic hearing loss without migraine or AD. Group 3, with 13% of patients, is characterized by familial MD, while group 4, that includes 12% of patients, is associated by the presence of migraine in all cases. Group 5 is found in 11% of patients and is defined by AD. This approach can be helpful in selecting patients for genetic and clinical research. However, further studies will be required to improve the phenotyping in these clinical variants for a better understanding of the diverse etiological factors contributing to bilateral MD.

  17. Symptomatic versus asymptomatic knees after bilateral total knee arthroplasty: what is the difference in SPECT/CT?

    Energy Technology Data Exchange (ETDEWEB)

    Awengen, R.; Hirschmann, M.T. [Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Department of Orthopaedic Surgery and Traumatology, Bruderholz (Switzerland); Rasch, H. [Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Institute of Radiology and Nuclear Medicine, Bruderholz (Switzerland); Amsler, F. [Amsler Consulting, Basel (Switzerland)

    2016-04-15

    The primary purpose of this retrospective study was to evaluate the differences of bone tracer uptake (BTU) in symptomatic and asymptomatic knees after bilateral total knee arthroplasty (TKA) and identify typical BTU patterns with regards to TKA component position and alignment. A consecutive number of 37 patients after bilateral TKA were retrospectively included. The knees were grouped into symptomatic (group A) and asymptomatic (group B) knees. All patients underwent 99m-Tc-HDP-SPECT/CT. Coronal, rotational, and sagittal TKA component position was analysed in 3D reconstructed CT. BTU was anatomically localised and quantified using a validated standardized localization scheme. Maximum BTU values for each area were recorded and normalized values calculated. Signed log-rank test, chi-square test, paired t-tests, and Pearson correlations were used (p <0.05). Symptomatic TKAs were significantly more flexed and had a tendency to be more internally rotated when compared to asymptomatic ones (p < 0.05). In all regions, the mean BTU in asymptomatic knees was lower than in symptomatic knees. In both groups the highest mean BTU was found around the tibial stem (symptomatic 7.30; asymptomatic 6.30, p = 0.061) and at the tip of the tibial stem (symptomatic 5.49; asymptomatic 4.74, p = 0.062). Superior patellar regions showed higher BTU than inferior regions. The highest patellar BTU was found in the superior medial patella (symptomatic 4.99; asymptomatic 3.98, p = 0.048). The lowest BTU was found in the posterior femoral regions (flatsp, flatip, fmedsp, fmedip) (Table 3). Tibial and patellar areas showed twice as high mean BTUs than femoral areas (Fig. 3). A significant correlation of TKA component position and BTU was demonstrated. Distribution and intensity of BTU in SPECT/CT depends on TKA component position and alignment. In addition, typical BTU patterns in symptomatic and asymptomatic knees were identified. A profound knowledge of BTU pattern, TKA component position

  18. Intraoperative study on anthropometry and gender differences of the proximal tibial plateau at the arthroplasty resection surface

    Institute of Scientific and Technical Information of China (English)

    Yang Bo; Yu Jiakuo; Gong Xi; Chen Lianxu; Wang Yongjian; Wang Jian; Wang Haijun

    2014-01-01

    Background The tibial plateau is asymmetric with a larger medial plateau.We observed from clinical practice that the shape of the tibial plateau does not always present a larger medial plateau.Tibial plateau also showed other shapes.The purpose of this study was to analyze the anthropometric data of the proximal tibia in a large group of Chinese patients undergoing total knee arthroplasty and to investigate the morphology of the resected proximal tibial surface and its gender differences.Methods A total of 822 knees (164 males,658 females) from the Chinese population were measured intraoperatively for medial anteroposterior (MAP) and lateral anteroposterior (LAP) dimensions of the resected proximal tibial surface.The difference of MAP and LAP (DML) was also calculated as MAP minus LAP.We then classified the data into three groups based on the DML (<-2,-2 to 2,and >2 mm) to analyze the morphology of the proximal tibia and its distribution between male and female.Results The shape of proximal tibial plateau was of three types:larger medial plateau type,symmetric type,and larger lateral plateau type.There were significant differences between males and females in relation to the shape distribution of the proximal tibial plateau (P <0.05).Most of the proximal tibial plateau was asymmetric,with 517 of 822 (62.9%) tibia having a DML >2 mm and 120 of 822 (14.6%) tibia having a DML<-2 mm.Only 185 of 822 (22.5%) tibia had a DML between-2 and 2 mm.Conclusion The results of this study can be used as a guideline to design tibial components with different DMLs to better match the different anthropometry of the resected tibial surface.

  19. Risk factors associated with infection in tibial open fractures.

    Science.gov (United States)

    Almeida Matos, Marcos; Castro-Filho, Romulo Neves; Pinto da Silva, Bruno Vieira

    2013-01-01

    Introducción: El objetivo del tratamiento de las fracturas abiertas es prevenir las infecciones, estabilizar el hueso e restaurar la función. En relación a los objetivos mencionados, la prevención de infecciones tiene mayor destaque y es el punto mas importante a ser alcanzado. Objetivo: El objetivo de este trabajo es identificar los factores de riesgo asociados con la infección en un grupo de pacientes con fracturas abierta de la tibia. Paciente y métodos. Fue realizado un análisis retrospectivo con pacientes que tuvieron fractura abierta tibial que estaban en tratamiento en el Hospital Roberto Santos-Geral-HGRS, Salvador, Bahía, Brasil, de marzo a octubre de 2009. Fueron excluidos de este estudio todos los niños menores de 8 años con fracturas múltiples o que tenían alguna enfermedad sistémica o en los huesos. De acuerdo con los datos clínicos y demográficos, los pacientes fueron divididos en dos grupos: el grupo 1 estaba constituido por los que no tenían infección en las fracturas y el grupo 2 por los que tenían infección. En los dos grupos se investigo factores que podrían estar asociados a la infección. Resultados. De 50 pacientes estudiados la tasa de infección global fue de 14 (28%, IC95% = 15,5-40,5). El hecho de desenvolver infección fue asociado con el lugar del trauma (OR 3,78; IC 95% = 1,4-5,5, p = 0,02), y la demora en recibir tratamiento adecuado en tiempo superior a 24 horas (OR 3,4; IC95% 1.4-20.8 = p = 0,03). Las fracturas clasificadas como Gustilo I, II, IIIA tuvieron una menor chance de infección cuando comparadas como Gustilo IIIB y IIIC (OR 4.32; CI95%=1.3-19.1; p=0.01). Fracturas clasificadas como Tscherne III y IV tuvieron una mayor frecuencia de infección, lo que resulto ser el factor más importante e significativo (OR 8.07; CI95%=2.4-47.1; p ptiempo mayor de que 12 horas) y en pacientes que vivían en las zonas rurales del estado de Bahía.

  20. [Bilateral pheochromocytoma: laparoscopic surgery in 2 cases].

    Science.gov (United States)

    Lam, J; Castillo, O; Bravo, J; Henríquez, R; Tagle, F

    2001-01-01

    Laparoscopic adrenalectomy, if done by skilled surgeons, is now the first choice for treating most adrenal tumors, including bilateral pheochromocytoma. We report two women, aged 35 and 34 years old, with bilateral adrenal pheochromocytoma successfully excised by laparoscopic surgery. Both had severe hypertension, high urinary catecholamine values (epinephrine + norepinephrine: 528 and 1083 ug/24 h) and bilateral adrenal tumors at CT scan. After 4 weeks of doxazosin treatment, a laparoscopic transperitoneal adrenalectomy was done (Gugner's technique), with surgical times of 7 and 5 hours respectively. Both patients received hydrocortisone and only the second one required one unit of packed cells. Postoperative evolution was uneventful and both patients were discharged at the fifth postoperative day. At two months of follow up, both patients are asymptomatic and normotensive.

  1. Prognosis of synchronous bilateral breast cancer

    DEFF Research Database (Denmark)

    Holm, Marianne; Tjønneland, Anne; Balslev, Eva

    2014-01-01

    Currently, no consistent evidence-based guidelines for the management of synchronous bilateral breast cancer (SBBC) exist and it is uncertain how presenting with SBBC affects patients' prognosis. We conducted a review of studies analyzing the association between SBBC and prognosis. The studies...... that reported adjusted effect measures were included in meta-analyses of effect of bilaterality on breast cancer mortality. From 57 initially identified records 17 studies from 11 different countries including 8,050 SBBC patients were included. The quality of the studies varied but was generally low with small...... sample sizes, and lack of consistent, detailed histo-pathological information. When doing meta-analysis on the subgroup of studies that provided adjusted effect estimates on breast cancer mortality (nine studies including 3,631 SBBC cases), we found that bilaterality in itself had a negative impact...

  2. Langerhans Cell Histiocytosis in Bilateral Mastoid Cavity

    Directory of Open Access Journals (Sweden)

    Kazım Bozdemir

    2013-01-01

    Full Text Available A 39-year-old male was admitted to our clinic with symptoms of headache, dizziness, nausea, otalgia, otorrhea, tinnitus, and hearing loss in both ears for 3 weeks. Physical examination revealed edema in the tympanic membrane and external ear canal, and pain by palpation in the mastoid area bilaterally. There was no nystagmus, and the rest of the physical examination was otherwise normal. Temporal bone high resolution computed tomography (CT showed a lesion causing erosion in the mastoid cortex, tegmen tympani, ossicles, and in the bone covering the sigmoid sinus bilaterally. There was also erosion in the superior semicircular canal and petrous bone on the left side. Cortical mastoidectomy was performed under general anesthesia. Histopathologic examination of the tissue revealed Langerhans cell histiocytosis (LCH. In this paper a case with LCH, presenting with bilateral mastoid involvement which has been rarely reported in the literature, is discussed with the existing literature.

  3. Fratura avulsão do planalto tibial medial (Segond reverso Avulsion fracture of the medial tibial plateau (reverse Segond injury

    Directory of Open Access Journals (Sweden)

    Fabio Janson Angelini

    2007-01-01

    Full Text Available Descreve-se neste artigo um padrão de lesão descrito na literatura apenas duas vezes, num total de quatro casos, denominado Segond reverso por apresentar achados clínicos e radiológicos exatamente opostos aos da clássica lesão de Segond. Semelhantemente aos casos previamente descritos, apresentou fratura avulsão do planalto tibial medial, na inserção do ligamento colateral medial profundo, associada a lesão do ligamento cruzado posterior. Assim como em um dos casos prévios, foi constatada lesão do ligamento cruzado anterior. Entretanto, diferiu dos anteriormente relatados por não apresentar lesão do menisco medial.This article reports an injury pattern described only twice in literature, totaling four cases, and referred to as reverse Segond injury for its clinical and radiological findings are precisely opposite to those observed in the classical Segond injury. Similarly to the previously described cases, our case reported avulsion fracture of the medial tibial plateau at the insertion of the deep tibial collateral ligament, associated to posterior cruciate ligament injury. Similarly to one of the previous cases, anterior cruciate ligament injury was found in our case, although it differs from the previous ones because it does not show medial meniscal injury.

  4. Bilateral Meckel's cave amyloidoma: a case report.

    Science.gov (United States)

    Gültaşli, N; van den Hauwe, L; Bruneau, M; D'Haene, N; Delpierre, I; Balériaux, D

    2012-05-01

    Primary solitary amyloidoma of Meckel's cave is rare, and a bilateral location is even more rare. To the best of our knowledge, only 12 cases in the literature have described such a primary lesion, including one case of bilateral involvement of Meckel's cave. We report here on the case of a 57-year-old woman presenting with pseudotumor masses involving both Meckel's caves and responsible for trigeminal neuropathy. The final diagnosis of amyloidoma was made on the basis of histological examination of surgical biopsy specimens.

  5. [Bilateral choroidal osteoma--a case report].

    Science.gov (United States)

    Jędrychowska-Jamborska, Justyna; Kulig-Stochmal, Agnieszka; Markiewicz, Anna; Jakubowska, Barbara; Romanowska-Dixon, Bożena

    2014-01-01

    Choroidal osteoma is a an extremely rare (especially located bilaterally), benign, intraocular tumor, the type of choristoma. It occurs between 2-3 decades of life, women are particularly vulnerable. The main complication in 1/3 cases is a subretinal neovascularization which may cause bleeding. The gradually progressive decalcification develops within the tumour over time, which causes atrophy of the retinal pigment epithelium and Bruch's membrane deformity. The article presents a case of a 26-year-old woman with bilateral choroidal osteoma complicated by subretinal hemorrhage; the diagnosis was based on clinical examination (biomicroscopy and indirect ophthalmoscopy) as well as specialised tests including: ultrasonography, optical coherence tomography, and fluorescein angiography.

  6. Bilateral Renal Mass-Renal Disorder: Tuberculosis

    Directory of Open Access Journals (Sweden)

    Ozlem Tiryaki

    2013-01-01

    Full Text Available A 30-year-old woman has presented complaining of weakness and fatigue to her primary care physician. The renal sonography is a routine step in the evaluation of new onset renal failure. When the renal masses have been discovered by sonography in this setting, the functional imaging may be critical. We reported a case about bilateral renal masses in a young female patient with tuberculosis and renal insufficiency. Magnetic resonance (MR has revealed the bilateral renal masses in patient, and this patient has been referred to our hospital for further management. The patient’s past medical and surgical history was unremarkable.

  7. Sudden bilateral hearing loss after organophosphate inhalation

    OpenAIRE

    Dundar, Mehmet Akif; Derin, Serhan; Aricigil, Mitat; Eryilmaz, Mehmet Akif

    2016-01-01

    Sudden bilateral hearing loss are seen rarely and the toxic substance exposure constitutes a small part of etiology. A Fifty-eight-year-old woman admitted to our clinic with sudden bilateral hearing loss shortly after chlorpyrifos-ethyl exposure. Otolaryngologic examination findings were normal. The patient had 40 dB sensorineural hearing loss (SNHL) on the right ear and 48 dB SNHL on the left ear. Additional diagnostic tests were normal. The conventional treatment for sudden hearing loss was...

  8. Bilateral accessory cleidohyoid in a human cadaver

    Directory of Open Access Journals (Sweden)

    Stark ME

    2009-10-01

    Full Text Available During routine anatomical dissection of the infrahyoid region, a muscle was found bilaterally originating from the sternal end of clavicle and inserting into the hyoid bone. The muscle coursed parallel and lateral to the sternohyoid muscle. The muscle was found in the presence of an intact omohyoid, thus being classified as an accessory cleidohyoid (cleidohyoideus accessorius muscle. While other authors have reported the presence of a unilateral cleidohyoideus accessorius muscle, to our knowledge this is the first case of a bilateral cleidohyoideus accessorius muscle in the medical literature. Anatomical variations of the infrahyoid muscles may have functional, diagnostic, surgical and pathological implications.

  9. Isolated Bilateral Congenital Iris Sphincter Agenesis

    Directory of Open Access Journals (Sweden)

    Aparna Rao

    2011-01-01

    Full Text Available Purpose. We herein report a patient with bilateral congenital total iris sphincter agenesis with no other abnormality detected on systemic examination. Methods. A 24-year-old laborer presented to us for a routine checkup with complaint of photophobia and inability to work under sunlight. Examination revealed bilateral absence of sphincter and 6.5 mm pupil in both eyes in the undilated state. Results. Accommodation was poor in both eyes. Systemic examination was within normal limits. He was prescribed bifocal photochromic glasses for constant wear. Conclusions. Congenital sphincter agenesis can occur in an isolated form without systemic abnormalities which can be managed conservatively.

  10. Analysis of the characteristics of patients with open tibial fractures of Gustilo and Anderson type III

    Directory of Open Access Journals (Sweden)

    Frederico Carlos Jaña Neto

    2016-04-01

    Full Text Available OBJECTIVE: To analyze the characteristics of patients with Gustilo-Anderson Type III open tibial fractures treated at a tertiary care hospital in São Paulo between January 2013 and August 2014. METHODS: This was a cross-sectional retrospective study. The following data were gathered from the electronic medical records: age; gender; diagnosis; trauma mechanism; comorbidities; associated fractures; Gustilo and Anderson, Tscherne and AO classifications; treatment (initial and definitive; presence of compartment syndrome; primary and secondary amputations; MESS (Mangled Extremity Severity Score index; mortality rate; and infection rate. RESULTS: 116 patients were included: 81% with fracture type IIIA, 12% IIIB and 7% IIIC; 85% males; mean age 32.3 years; and 57% victims of motorcycle accidents. Tibial shaft fractures were significantly more prevalent (67%. Eight patients were subjected to amputation: one primary case and seven secondary cases. Types IIIC (75% and IIIB (25% predominated among the patients subjected to secondary amputation. The MESS index was greater than 7 in 88% of the amputees and in 5% of the limb salvage group. CONCLUSION: The profile of patients with open tibial fracture of Gustilo and Anderson Type III mainly involved young male individuals who were victims of motorcycle accidents. The tibial shaft was the segment most affected. Only 7% of the patients underwent amputation. Given the current controversy in the literature about amputation or salvage of severely injured lower limbs, it becomes necessary to carry out prospective studies to support clinical decisions.

  11. Analysis of the characteristics of patients with open tibial fractures of Gustilo and Anderson type III☆

    Science.gov (United States)

    Jaña Neto, Frederico Carlos; de Paula Canal, Marina; Alves, Bernardo Aurélio Fonseca; Ferreira, Pablício Martins; Ayres, Jefferson Castro; Alves, Robson

    2016-01-01

    Objective To analyze the characteristics of patients with Gustilo–Anderson Type III open tibial fractures treated at a tertiary care hospital in São Paulo between January 2013 and August 2014. Methods This was a cross-sectional retrospective study. The following data were gathered from the electronic medical records: age; gender; diagnosis; trauma mechanism; comorbidities; associated fractures; Gustilo and Anderson, Tscherne and AO classifications; treatment (initial and definitive); presence of compartment syndrome; primary and secondary amputations; MESS (Mangled Extremity Severity Score) index; mortality rate; and infection rate. Results 116 patients were included: 81% with fracture type IIIA, 12% IIIB and 7% IIIC; 85% males; mean age 32.3 years; and 57% victims of motorcycle accidents. Tibial shaft fractures were significantly more prevalent (67%). Eight patients were subjected to amputation: one primary case and seven secondary cases. Types IIIC (75%) and IIIB (25%) predominated among the patients subjected to secondary amputation. The MESS index was greater than 7 in 88% of the amputees and in 5% of the limb salvage group. Conclusion The profile of patients with open tibial fracture of Gustilo and Anderson Type III mainly involved young male individuals who were victims of motorcycle accidents. The tibial shaft was the segment most affected. Only 7% of the patients underwent amputation. Given the current controversy in the literature about amputation or salvage of severely injured lower limbs, it becomes necessary to carry out prospective studies to support clinical decisions. PMID:27069881

  12. Measurement repeatability of tibial tuberosity-trochlear groove offset distance in red fox (Vulpes vulpes) cadavers

    NARCIS (Netherlands)

    Miles, J.E.; Jensen, B.R.; Kirpensteijn, J.; Svalastoga, E.L.; Eriksen, T.

    2013-01-01

    Abstract OBJECTIVE: To describe CT image reconstruction criteria for measurement of the tibial tuberosity-trochlear groove (TT-TG) offset distance, evaluate intra- and inter-reconstruction repeatability, and identify key sources of error in the measurement technique, as determined in vulpine hind li

  13. Hindfoot Valgus following Interlocking Nail Treatment for Tibial Diaphysis Fractures: Can the Fibula Be Neglected?

    Directory of Open Access Journals (Sweden)

    Metin Uzun

    2014-01-01

    Full Text Available Purpose. We evaluated whether intramedullary nail fixation for tibial diaphysis fractures with concomitant fibula fractures (except at the distal one-third level managed conservatively with an associated fibula fracture resulted in ankle deformity and assessed the impact of the ankle deformity on lower extremity function. Methods. Sixty middle one-third tibial shaft fractures with associated fibular fractures, except the distal one-third level, were included in this study. All tibial shaft fractures were anatomically reduced and fixed with interlocking intramedullary nails. Fibular fractures were managed conservatively. Hindfoot alignment was assessed clinically. Tibia and fibular lengths were compared to contralateral measurements using radiographs. Functional results were evaluated using the Knee Injury and Osteoarthritis Outcome Score (KOOS and the Foot and Ankle Disability Index Score (FADI. Results. Anatomic union, defined as equal length in operative and contralateral tibias, was achieved in 60 fractures (100%. Fibular shortening was identified in 42 fractures (68%. Mean fibular shortening was 1.2 cm (range, 0.5–2 cm. Clinical exams showed increased hindfoot valgus in 42 fractures (68%. The mean KOOS was 88.4, and the mean FADI score was 90. Conclusion. Fibular fractures in the middle or proximal one-third may need to be stabilized at the time of tibial intramedullary nail fixation to prevent development of hindfoot valgus due to fibular shortening.

  14. Distal tibial fractures are a poorly recognised complication with fibula free flaps

    OpenAIRE

    Durst, A.; Clibbon, J; Davis, B

    2015-01-01

    The fibula free flap is ideal for complex jaw reconstructions, with low reported donor and flap morbidity. We discuss a distal tibial stress fracture two months following a vascularised fibula free flap procedure. Despite being an unrecognised complication, a literature review produced 13 previous cases; only two were reported in the reconstructive surgery literature, with the most recent claiming to be the first.

  15. Pre-tibial synovial cyst after reconstruction of the anterior cruciate ligament: case report,

    Directory of Open Access Journals (Sweden)

    Luís Eduardo Pedigoni Bulisani

    2014-12-01

    Full Text Available Arthroscopic reconstruction of the anterior cruciate ligament has been modernized through new surgical techniques and new materials. When tibial fixation is performed using an absorbable screw, complications may occur, such as formation of a pre-tibial cyst. The case described here is about a patient who presented an anteromedial synovial cyst in his right knee, three years after having undergone ACL reconstruction. The patient did not present any pain nor any complaints other than a mass that progressively increased in size, worsened after physical activities. Imaging examinations were requested: simple radiography of the knee and magnetic resonance. Anteromedial imaging of the knee showed a mass with well-delimited borders and internal fluid content, suggestive of a synovial cyst, with communication with the joint cavity through the tibial tunnel, without presenting enlargement or absorption of the bone tunnel. The cyst was surgically resected and the tibial tunnel occlusion was performed using a bone plug. The diagnosis of a synovial cyst was subsequently confirmed through the results from the anatomopathological examination. The patient presented good clinical evolution, with disappearance of the symptoms and a return to physical activities.

  16. A non-invasive device to objectively measure tibial rotation: verification of the device.

    Science.gov (United States)

    Lorbach, Olaf; Wilmes, P; Maas, S; Zerbe, T; Busch, L; Kohn, D; Seil, R

    2009-07-01

    The purpose of this study was the correlation of the results of a new measurement device for tibial rotation (Rotameter) in comparison with the measurements of a knee navigation system as standard method. In a biomechanical laboratory study, all soft tissues were removed from 20 human cadaveric knees leaving only the intact capsule and the bone. Specific tracers were bicortically fixed in the bone in order to measure tibial rotation using a knee navigation system. The knees were fixed to a custom-made inside-boot to rule out undesirable rotation of the reconstruction inside the Rotameter measurement device. Internal and external rotation values were measured at an applied torque of 5, 10 and 15 Nm. The different methods to evaluate tibial rotation were compared using the Pearson correlation coefficient. The correlations were deemed to be reliable if a value of >or=0.80 was achieved. At 5 Nm of applied torque, high correlations for the internal rotation, external rotation and the entire rotational range were found in the Pearson correlation coefficient between the Rotameter testing device in comparison with the knee navigation system as invasive reference method. These results were also confirmed at an applied torque of 10 and 15 Nm. In conclusion, the Rotameter testing device showed high correlations compared with the knee navigation system as an invasive standard method. It might be used as a non-invasive and easy alternative to investigate tibial rotation.

  17. An unusual form of congenital anterolateral tibial angulation - the delta tibia

    Energy Technology Data Exchange (ETDEWEB)

    Currarino, Guido [Department of Radiology, Texas Scottish Rite Hospital for Children, Dallas, TX (United States); Department of Radiology, University of Texas, Southwestern Medical Center, Dallas, TX (United States); Herring, John A.; Johnston II, Charles E.; Birch, John G. [Department of Orthopaedic Surgery, Texas Scottish Rite Hospital for Children, Dallas, TX (United States)

    2003-05-01

    We report three infants with a poorly known form of congenital anterolateral angulation of the tibia with distinctive features seen on lateral roentgenograms. In these films the affected tibia appears to be divided into two segments, one proximal and the other distal, which taper as they approach each other at the site of the angulation, and end separately at the apex of the curve with an intervening radiolucent gap in the anterior tibial cortex. The two tibial segments are originally bridged and held firmly in that position by a well-defined triangular osseous structure located in the concavity of the tibial bow. It appears from the three cases reported in this paper and a few comparable cases in the literature that this form of tibial bowing is not prone to fracture followed by pseudoarthrosis and that it tends to improve (and resolve) spontaneously, with a resorption of the intramedullary bony structures at the apex of the curve resulting in the formation of a normal medullary cavity. A limb length discrepancy of varying degree is the main residual change of the anomaly. (orig.)

  18. Serum chemistry and histopathology of broiler femoral head necrosis and tibial dyschondroplasia

    Science.gov (United States)

    Femoral head necrosis (FHN) and tibial dyschondroplasia (TD) are two major leg problems in young meat type poultry which cause lameness, bone deformity and infections. Whereas FHN results from disarticulation of the femoral growth plate from the articular cartilage, TD lesions are characterized by i...

  19. Literature review of the possible advantages of silicon liner socket use in trans-tibial prostheses

    NARCIS (Netherlands)

    Baars, ECT; Geertzen, JHB

    2005-01-01

    The silicon liner socket has been used in the trans-tibial prosthesis since the 1980s. Silicon liner sockets are sleeves of silicon material that are rolled onto the stump and fix the prosthesis to it. The producers of the liners propagate many advantages in their use i.e. better suspension of the p

  20. Preoperative estimation of tibial nail length--because size does matter.

    LENUS (Irish Health Repository)

    Galbraith, J G

    2012-11-01

    Selecting the correct tibial nail length is essential for satisfactory outcomes. Nails that are inserted and are found to be of inappropriate length should be removed. Accurate preoperative nail estimation has the potential to reduce intra-operative errors, operative time and radiation exposure.

  1. Prediction of progression of radiographic knee osteoarthritis using tibial trabecular bone texture

    DEFF Research Database (Denmark)

    Woloszynski, T; Podsiadlo, P; Stachowiak, G W

    2012-01-01

    OBJECTIVE.: To develop a system for prediction of progression of radiographic knee osteoarthritis (OA) using tibial trabecular bone (TB) texture. METHODS.: We studied 203 knees with (n=68) or without (n=135) radiographic tibiofemoral OA in 105 subjects (90 men, 15 women, mean age 54 years) who had...

  2. Early treatment of trans-tibial amputees: retrospective analysis of early fitting and elastic bandaging

    NARCIS (Netherlands)

    Velzen, van A.D.; Nederhand, M.J.; Emmelot, C.H.; IJzerman, M.J.

    2005-01-01

    This study investigates the effects of early fitting in trans-tibial amputees. The assumption is that compared to elastic bandaging, the use of a rigid dressing in early fitting will result in quicker wound healing and earlier ambulation. A retrospective file search was carried out in three differen

  3. Combined Total Ankle Arthroplasty With Posterior Tibial Tendon Transfer for End-Stage Cavovarus Deformity.

    Science.gov (United States)

    Schuberth, John M; Bowlby, Melinda A; Christensen, Jeffrey C

    2016-01-01

    Posterior tibial tendon transfer has been described to reduce and balance the cavovarus deformity in those patients who receive a total ankle replacement for end-stage arthritis. In this article, we discuss the indications and provide a detailed description of the technique for this powerful procedure. Case examples that demonstrate the utility of the procedure are provided.

  4. TIBIAL PLATEAU PROXIMAL AND DISTAL BONE BEHAVE SIMILARLY: BOTH ARE ASSOCIATED WITH FEATURES OF KNEE OSTEOARTHRITIS

    Science.gov (United States)

    There is a growing imperative to understand how changes in peri-articular bone relate to pathological progression of knee osteoarthritis (KOA). Peri-articular bone density can be measured using dual x-ray absorptiometry (DXA). The medial:lateral tibial BMD ratio (M:L BMD) is associated with MRI and...

  5. Baseline Vitamin D Status is Predictive of Longitudinal Change in Tibial BMD in Knee Osteoarthritis (OA)

    Science.gov (United States)

    With its lack of effective treatment and high prevalence, the public health impact of OA is substantial. Peri-articular bone in OA can be evaluated with the medial:lateral tibial BMD ratio (M:L BMD) obtained from dual x-ray absorptiometry (DXA). Higher M:L BMD is associated with medial OA features...

  6. Neuroanatomy of the complex tibial organ of Stenopelmatus (Orthoptera: Ensifera: Stenopelmatidae).

    Science.gov (United States)

    Strauss, Johannes; Lakes-Harlan, Reinhard

    2008-11-01

    Stenopelmatidae (or "Jerusalem crickets") belong to the atympanate Ensifera, lacking hearing organs in the foreleg tibiae. Their phylogenetic position is controversial, either as a taxon in Tettigonioidea or within the clade of Gryllacridoidea. Similarly, the origin of tibial auditory systems in Ensifera is controversial. Therefore, we investigated the neuronal structures of the proximal tibiae of Stenopelmatus spec. with the hypothesis that internal sensory structures are similar to those in tympanate Ensifera. In Stenopelmatus the complex tibial organ consists of three neuronal parts: the subgenual organ, the intermediate organ, and a third part with linearly arranged neurons. This tripartite organization is also found in tympanate Ensifera, verifying our hypothesis. The third part of the sense organ found in Stenopelmatus can be regarded by the criterion of position as homologous to auditory receptors of hearing Tettigonioidea. This crista acustica homolog is found serially in all thoracic leg pairs and contains 20 +/- 2 chordotonal neurons in the foreleg. The tibial organ was shown to be responsive to vibration, with a broad threshold of about 0.06 ms(-2) in a frequency range from 100-600 Hz. The central projection of tibial sensory neurons terminates into two equally sized lobes in the primary sensory neuropil, the medial ventral association center. The data are discussed comparatively to those of other Ensifera and mapped phylogenetically onto recently proposed phylogenies for Ensifera. The crista acustica homolog could represent a neuronal rudiment of a secondarily reduced ear, but neuronal features are also consistent with an evolutionary preadaptation.

  7. Relationship between serum adhesion molecules, trace elements and delayed union of tibial and fibula fractures

    Institute of Scientific and Technical Information of China (English)

    Xian-Yu Yan; Zhi-Bang Zhao; Wen-Liang Fan; Qing-Bo Zhu; Ya-Chang Xing

    2017-01-01

    Objective:To investigate the relationship between serum adhesion molecules, trace elements and delayed union of tibial and fibula fractures.Methods:A total of 46 patients with delayed union of tibial and fibula fractures in our hospital from May 2014 to June 2016 were selected as the observation group, 46 patients with normal healing of tibial and fibula fractures were selected as the control group, then the serum adhesion molecules and trace elements levels of two groups at forth, eighth and sixteenth week after the surgery were compared.Results:The serum dhesion molecules levels of observation group at forth, eighth and sixteenth week after the surgery were all higher than those of control group, the serum trace elements levels were all lower than those of control group, and the serum adhesion molecules levels of two groups at eighth week after the surgery were all higher than those at other time, the trace elements levels were all lower than those at other time (allP<0.05).Conclusions:The serum adhesion molecules and trace elements of patients with delayed union of tibial and fibula fractures show obviously abnormal state, so those indexes of those patients should be paid to more monitoring and improvement.

  8. Intermittent foot claudication caused by a dynamic compression of the posterior tibial artery.

    Science.gov (United States)

    Kaczynski, Jakub; Topliss, Claire; Fligelstone, Louis

    2016-07-14

    A young adult presented with an atypical intermittent foot claudication caused by a dynamic compression of the posterior tibial artery by a ganglion. This case highlights the diagnostic challenges when dealing with an entrapment syndrome. Subsequent open surgical treatment was successful, and the patient has made a good recovery.

  9. The Changed Route of Anterior Tibial Artery due to Healed Fracture

    Directory of Open Access Journals (Sweden)

    Kemal Gökkuş

    2016-01-01

    Full Text Available We would like to highlight unusual sequelae of healed distal third diaphyseal tibia fracture that was treated conservatively 36 years ago, in which we incidentally detected peripheral CT angiography. The anterior tibial artery was enveloped three-quarterly by the healing callus of the bone (distal tibia.

  10. Neuroanatomy of the complex tibial organ in the splay-footed cricket Comicus calcaris Irish 1986 (Orthoptera: Ensifera: Schizodactylidae).

    Science.gov (United States)

    Strauss, Johannes; Lakes-Harlan, Reinhard

    2010-11-15

    The subgenual chordotonal organ complex in insects is modified in ensiferan taxa like Gryllidae and Tettigoniidae into hearing organs with specific sets of auditory receptors. Here, this sensory organ complex is documented in the nonhearing splay-footed cricket Comicus calcaris. The tibial chordotonal organ consists of three parts: the subgenual organ, the intermediate organ, and the crista acustica homolog. The latter is an array of linearly organized neurons homologous to auditory receptors in the tibial hearing organs of Tettigoniidae. The tibial organ is structurally similar in all three leg pairs, with similar neuron numbers in the fore- and midleg, but lower numbers in the hindleg. The foreleg crista acustica homolog consists of 34±4 neurons, the highest number in an atympanate Ensiferan. Additionally, an accessory chordotonal organ with 15±5 neurons innervated by nerve 5B1 is present in the foreleg. The central projection of the tibial organreveals ipsilateral sensory terminals in the primary sensory neuropil, the medial ventral association center with terminations close to the midline. As determined from extracellular recordings, the entire tibial organ is vibrosensitive. The organization of the tibial organ is compared to other ensiferan auditory and nonauditory tibial organs. Spatial orientation of neurons in the crista acustica homolog is not reminiscent of auditory structures, and the neuroanatomy is discussed with respect to stridulation behavior and the evolutionary origin of hearing in Ensifera.

  11. Bilateral Facial Nerve Palsy: A Diagnostic Dilemma

    Directory of Open Access Journals (Sweden)

    Sohil Pothiawala

    2012-01-01

    Conclusion. We reinforce the importance of considering the range of differential diagnosis in all cases presenting with bilateral FNP. These patients warrant admission and prompt laboratory and radiological investigation for evaluation of the underlying cause and specific further management as relevant.

  12. [Congenital lumbar hernia and bilateral renal agenesis].

    Science.gov (United States)

    Barrero Candau, R; Garrido Morales, M

    2007-04-01

    We report a new case of congenital lumbar hernia. This is first case reported of congenital lumbar hernia and bilateral renal agenesis. We review literature and describe associated malformations reported that would be role out in every case of congenital lumbar hernia.

  13. Bilateral chylothorax, chylopericardium and chylous ascitis

    Directory of Open Access Journals (Sweden)

    Anil Kashyap

    2011-01-01

    Full Text Available Non-Hodgkin′s lymphoma (NHL can commonly present as chylothorax and rarely as chylopericardium. Here we are presenting a case of a 21-years-old female with bilateral chylothorax, chylopericardium and chylous ascites all together finally diagnosed to have NHL as the etiology. To the best of our knowledge, it has been reported very infrequently.

  14. Bilateral duplication of the internal auditory canal

    Energy Technology Data Exchange (ETDEWEB)

    Weon, Young Cheol; Kim, Jae Hyoung; Choi, Sung Kyu [Seoul National University College of Medicine, Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si (Korea); Koo, Ja-Won [Seoul National University College of Medicine, Department of Otolaryngology, Seoul National University Bundang Hospital, Seongnam-si (Korea)

    2007-10-15

    Duplication of the internal auditory canal is an extremely rare temporal bone anomaly that is believed to result from aplasia or hypoplasia of the vestibulocochlear nerve. We report bilateral duplication of the internal auditory canal in a 28-month-old boy with developmental delay and sensorineural hearing loss. (orig.)

  15. Bilateral eyelid edema : Cutis laxa or blepharochalasis?

    NARCIS (Netherlands)

    Braakenburg, A; Nicolai, JPA

    2000-01-01

    A 59-year-old woman with massive bilateral edema of the upper and lower eyelids is presented. The edema occurred suddenly and without provocation. No cause could be identified despite a multitude of examinations. Initially the patient was diagnosed as having blepharochalasis, but later skin biopsy s

  16. Bilateral Diabetic Papillopathy and Metabolic Control

    DEFF Research Database (Denmark)

    Ostri, Christoffer; Lund-Andersen, Henrik; Sander, Birgit;

    2010-01-01

    -six patients with type 1 diabetes. METHODS: Review of clinical, photographic, and clinical chemistry records from a large diabetology and ophthalmology unit between 2001 and 2008. MAIN OUTCOME MEASURES: Simultaneous, bilateral diabetic papillopathy. RESULTS: The mean follow-up was 4.9 years. During 10 020...

  17. Bilateral carpal tunnel syndrome in Graves' disease.

    Science.gov (United States)

    Manganelli, P; Pavesi, G; Salaffi, F

    1987-01-01

    Carpal tunnel syndrome (CTS) may be associated with endocrinopathies, such as hypothyroidism and acromegaly. A direct relationship between CTS and hyperthyroidism has recently been suggested. We now report a case in which bilateral CTS developed after treatment of Graves' disease, thus, questioning the possibility of a relationship between these two disease processes.

  18. Bilateral synchronous rupture of the quadriceps tendon.

    LENUS (Irish Health Repository)

    Ellanti, P

    2012-09-01

    Bilateral simultaneous rupture of the quadriceps tendon is a rare entity. They are often associated with degenerative changes of the tendons and predisposing conditions such as diabetes or excessive steroid use. They most commonly tend to occur in patients of 40 years of age or older.

  19. ANAESTHETIC MANAGEMENT OF BILATERAL PHEOCHROMOCYTOM A

    OpenAIRE

    Joginder Pal; Veena; Ranjana; Gurmeet Kaur; Anju

    2012-01-01

    A 27 year old female patient with bilateral pheochrom ocytoma presented with hypertension. Confirmation of diagnosis was done by CT scan and raised 24 hour urinary vanillylmandelic acid levels. Preoperative BP was co ntrolled with prazosin, labetolol, indapamide and clonidine. The anaesthetic technique used was general anaesthesia with epidural analgesia.

  20. ANAESTHETIC MANAGEMENT OF BILATERAL PHEOCHROMOCYTOM A

    Directory of Open Access Journals (Sweden)

    Joginder Pal

    2012-11-01

    Full Text Available A 27 year old female patient with bilateral pheochrom ocytoma presented with hypertension. Confirmation of diagnosis was done by CT scan and raised 24 hour urinary vanillylmandelic acid levels. Preoperative BP was co ntrolled with prazosin, labetolol, indapamide and clonidine. The anaesthetic technique used was general anaesthesia with epidural analgesia.

  1. Fetal goiter and bilateral ovarian cysts

    DEFF Research Database (Denmark)

    Lassen, Pernille; Sundberg, Karin; Juul, Anders

    2008-01-01

    A unique case of fetal goiter accompanied by bilateral ovarian cysts in a mother treated with methimazole for Graves'disease is reported. The abnormal findings were detected by ultrasound at 31 weeks of gestation. Umbilical fetal blood sampling revealed elevated serum TSH, normal concentrations o...

  2. "Ostrich sign" indicates bilateral vertebral artery dissection.

    Science.gov (United States)

    Rose, David Z; Husain, M Rizwan

    2012-11-01

    Vertebral artery dissections (VADs) comprise about 2% of ischemic strokes and can be associated with trauma, chiropractic manipulation, motor vehicle collisions, whiplash, amusement park rides, golfing, and other motion-induced injuries to the neck. We present a case of bilateral extracranial VAD as a complication of conducting an orchestra. To our knowledge, this has not been documented in the literature. Conceivably, vigorous neck twisting in an inexperienced, amateur conductor may place excessive rotational forces upon mobile portions of the verterbral arteries, tear the intima, deposit subintimal blood that extends longitudinally, and cause neck pain and/or posterior fossa ischemic symptoms. Magnetic resonance angiography examinations of axially oriented slices of bilateral VADs resemble the face of an ostrich. This observation is similar to the "puppy sign," in which bilateral internal carotid artery dissections resemble the face of a dog. Craniocervical dissections of either the carotid or vertebral arteries have the potential to form an aneurysm, cause artery-to-artery embolism, or completely occlude the parent artery, resulting in an ischemic stroke. Because bilateral VADs in axial magnetic resonance angiographic sections stand out like the eyes of an ostrich, and because the fast identification of VADs is so critical, we eponymize this image the "ostrich sign."

  3. Fast and Provably Accurate Bilateral Filtering.

    Science.gov (United States)

    Chaudhury, Kunal N; Dabhade, Swapnil D

    2016-06-01

    The bilateral filter is a non-linear filter that uses a range filter along with a spatial filter to perform edge-preserving smoothing of images. A direct computation of the bilateral filter requires O(S) operations per pixel, where S is the size of the support of the spatial filter. In this paper, we present a fast and provably accurate algorithm for approximating the bilateral filter when the range kernel is Gaussian. In particular, for box and Gaussian spatial filters, the proposed algorithm can cut down the complexity to O(1) per pixel for any arbitrary S . The algorithm has a simple implementation involving N+1 spatial filterings, where N is the approximation order. We give a detailed analysis of the filtering accuracy that can be achieved by the proposed approximation in relation to the target bilateral filter. This allows us to estimate the order N required to obtain a given accuracy. We also present comprehensive numerical results to demonstrate that the proposed algorithm is competitive with the state-of-the-art methods in terms of speed and accuracy.

  4. Severe Hyperkalemia and Bilateral Adrenal Metastasis

    Directory of Open Access Journals (Sweden)

    Michael Nagler

    2009-01-01

    Full Text Available Adrenal metastases are a common finding in metastatic lung and breast cancer. Often there are no clinical symptoms suggesting them. In this paper, we present a case of a 66-year-old man with metastatic lung cancer suffering from severe hyperkaliemia due to hypoaldosteronism as a result of bilateral adrenal metastasis.

  5. Giant early components of somatosensory evoked potentials to tibial nerve stimulation in cortical myoclonus.

    Science.gov (United States)

    Anzellotti, Francesca; Onofrj, Marco; Bonanni, Laura; Saracino, Antonio; Franciotti, Raffaella

    2016-01-01

    Enlarged cortical components of somatosensory evoked potentials (giant SEPs) recorded by electroencephalography (EEG) and abnormal somatosensory evoked magnetic fields (SEFs) recorded by magnetoencephalography (MEG) are observed in the majority of patients with cortical myoclonus (CM). Studies on simultaneous recordings of SEPs and SEFs showed that generator mechanism of giant SEPs involves both primary sensory and motor cortices. However the generator sources of giant SEPs have not been fully understood as only one report describes clearly giant SEPs following lower limb stimulation. In our study we performed a combined EEG-MEG recording on responses elicited by electric median and tibial nerve stimulation in a patient who developed consequently to methyl bromide intoxication CM with giant SEPs to median and tibial nerve stimuli. SEPs wave shapes were identified on the basis of polarity-latency components (e.g. P15-N20-P25) as defined by earlier studies and guidelines. At EEG recording, the SEP giant component did not appear in the latency range of the first cortical component for median nerve SEP (N20), but appeared instead in the range of the P37 tibial nerve SEP, which is currently identified as the first cortical component elicited by tibial nerve stimuli. Our MEG and EEG SEPs recordings also showed that components in the latency range of P37 were preceded by other cortical components. These findings suggest that lower limb P37 does not correspond to upper limb N20. MEG results confirmed that giant SEFs are the second component from both tibial (N43m-P43m) and median (N27m-P27m) nerve stimulation. MEG dipolar sources of these giant components were located in the primary sensory and motor area.

  6. Changes in the Serum Level of Vitamin D During Healing of Tibial and Femoral Shaft Fractures

    Directory of Open Access Journals (Sweden)

    Ettehad

    2014-01-01

    Full Text Available Background: Several systemic factors and hormones are thought to regulate the fracture healing process. Vitamin D has emerged as a compound or hormone that actively participates in the regulation of calcium homeostasis and bone metabolism. Objectives: The aim of this study is to determine the serum changes in the level of vitamin D during the acute healing period of tibial and femoral shaft fractures. Patients and Methods: This cross-sectional study included of 73 patients with tibial and femoral shaft fractures referred to the Poursina Hospital between February 2011 and February 2012. Changes in the serum levels of vitamin D were assessed three times in a period of three weeks (at the first visit, end of first week, and end of the third week. Variables such as age, gender, fractured bone, concomitant fracture of tibia and fibula, type of fracture, time of measurement and serum levels of 25-hydroxyvitamin D were assessed. All statistical analyses were performed using the SPSS software. Results: Forty tibial fractures and 33 femoral fractures were recorded. Mean vitamin D levels at the time of admission, after one week and at the end of the third week for the 73 participants included in the study were 39.23, 31.49, and 28.57 ng/mL, respectively. The overall reduction of vitamin D level was significantly more evident in the first week versus the following (P < 0.0001. Conclusions: Serum levels of vitamin D in patients with tibial or femoral fractures were reduced during the curative period of the fracture. This can be related the role of vitamin D in the formation and mineralization of the callus. Patients with tibial or femoral shaft fractures may benefit from the administration of vitamin D supplements during the fracture healing process.

  7. Management of open fractures of the tibial shaft in multiple trauma

    Directory of Open Access Journals (Sweden)

    Stanislaw Boltuc

    2008-01-01

    Full Text Available Background: The work presents the assessment of the results of treatment of open tibial shaft fractures in polytrauma patients. Materials and Methods: The study group comprised 28 patients who underwent surgical treatment of open fractures of the tibial shaft with locked intramedullary nailing. The mean age of the patients was 43 years (range from 19 to 64 years. The criterion for including the patients in the study was concomitant multiple trauma. For the assessment of open tibial fractures, Gustilo classification was used. The most common concomitant multiple trauma included craniocerebral injuries, which were diagnosed in 12 patients. In 14 patients, the surgery was performed within 24 h after the injury. In 14 patients, the surgery was delayed and was performed 8-10 days after the trauma. Results: The assessment of the results at 12 months after the surgery included the following features: time span between the trauma and the surgery and complications in the form of osteomyelitis and delayed union. The efficacy of gait, muscular atrophy, edema of the operated limb and possible disturbances of its axis were also taken under consideration. In patients operated emergently within 24 h after the injury, infected nonunion was observed in three (10.8% males. These patients had grade III open fractures of the tibial shaft according to Gustilo classification. No infectious complications were observed in patients who underwent a delayed operation. Conclusion: Evaluation of patients with open fractures of the tibial shaft in multiple trauma showed that delayed intramedullary nailing performed 8-10 days after the trauma, resulted in good outcome and avoided development of delayed union and infected nonunion. This approach gives time for stabilization of general condition of the patient and identification of pathogens from wound culture.

  8. Management of closed tibial plateau fractures with percutaneous cancellous screw fixation

    Directory of Open Access Journals (Sweden)

    Tushar Agarwal

    2013-01-01

    Full Text Available Background: Tibial plateau fractures, intra-articular in nature and caused by high-velocity trauma, constitute approximately 1% of all fractures. Primary goal in the management of proximal tibial articular fracture aims for a stable, congruous, pain-free, mobile joint. Objective: To study the technique, results, and complications of percutaneous cancellous screw fixation for tibial plateau fractures. Materials and Methods: Twenty-three men and seven women aged 18-65 years (mean = 36.8 years underwent closed reduction and percutaneous screw fixation for closed tibial plateau fractures with <5 mm depression. According to the Schatzker classification, patients were grouped as type I (n = 18, type II (n = 4, type III (n = 0, type IV (n = 8, type V (n = 2, and type VI (n = 1. Closed reduction was achieved by manual ligamentotaxis technique under image intensifier control and fixed percutaneously with two cancellous screws (6.5 mm with or without washers in a parallel fashion. Results: Functional outcome was evaluated using the Mason Hohl evaluation system. A total score of 19-24 was considered as excellent, 13-18 as good, 7-12 as fair, and <6 as poor. Outcomes were excellent in 10 patients, good in 15, fair in 4, and poor in 1 patient. Patients were allowed partial weight bearing with walker after 1 month and full weight bearing after radiological union in approximately 3-4 months. The mean period of hospital stay was 5 (range 2-15 days. All the fractures united radiologically after a mean of 3 (range 2.5- 5 months. Patients were evaluated at a mean of 3 years after injury. No patient had any complication like infection, wound dehiscence, or hardware problem. Conclusion: Percutaneous cancellous screw fixation for closed tibial plateau fractures is minimally invasive. It reduces hospital stay and cost, enables early mobilization with minimal instrumentation, and achieves satisfactory outcomes.

  9. Ultrasound elasticity imaging of human posterior tibial tendon

    Science.gov (United States)

    Gao, Liang

    Posterior tibial tendon dysfunction (PTTD) is a common degenerative condition leading to a severe impairment of gait. There is currently no effective method to determine whether a patient with advanced PTTD would benefit from several months of bracing and physical therapy or ultimately require surgery. Tendon degeneration is closely associated with irreversible degradation of its collagen structure, leading to changes to its mechanical properties. If these properties could be monitored in vivo, it could be used to quantify the severity of tendonosis and help determine the appropriate treatment. Ultrasound elasticity imaging (UEI) is a real-time, noninvasive technique to objectively measure mechanical properties in soft tissue. It consists of acquiring a sequence of ultrasound frames and applying speckle tracking to estimate displacement and strain at each pixel. The goals of my dissertation were to 1) use acoustic simulations to investigate the performance of UEI during tendon deformation with different geometries; 2) develop and validate UEI as a potentially noninvasive technique for quantifying tendon mechanical properties in human cadaver experiments; 3) design a platform for UEI to measure mechanical properties of the PTT in vivo and determine whether there are detectable and quantifiable differences between healthy and diseased tendons. First, ultrasound simulations of tendon deformation were performed using an acoustic modeling program. The effects of different tendon geometries (cylinder and curved cylinder) on the performance of UEI were investigated. Modeling results indicated that UEI accurately estimated the strain in the cylinder geometry, but underestimated in the curved cylinder. The simulation also predicted that the out-of-the-plane motion of the PTT would cause a non-uniform strain pattern within incompressible homogeneous isotropic material. However, to average within a small region of interest determined by principal component analysis (PCA

  10. Hereditary Neuropathy with Liability to Pressure Palsy: A Recurrent and Bilateral Foot Drop Case Report

    Directory of Open Access Journals (Sweden)

    Filipa Flor-de-Lima

    2013-01-01

    Full Text Available Hereditary neuropathy with liability to pressure palsy is characterized by acute, painless, recurrent mononeuropathies secondary to minor trauma or compression. A 16-year-old boy had the first episode of right foot drop after minor motorcycle accident. Electromyography revealed conduction block and slowing velocity conduction of the right deep peroneal nerve at the fibular head. After motor rehabilitation, he fully recovered. Six months later he had the second episode of foot drop in the opposite site after prolonged squatting position. Electromyography revealed sensorimotor polyneuropathy of left peroneal, sural, posterior tibial, and deep peroneal nerves and also of ulnar, radial, and median nerves of both upper limbs. Histological examination revealed sensory nerve demyelination and focal thickenings of myelin fibers. The diagnosis of hereditary neuropathy with liability to pressure palsy was confirmed by PMP22 deletion of chromosome 17p11.2. He started motor rehabilitation and avoidance of stressing factors with progressive recovery. After one-year followup, he was completely asymptomatic. Recurrent bilateral foot drop history, “sausage-like” swellings of myelin in histological examination, and the results of electromyography led the authors to consider the diagnosis despite negative family history. The authors highlight this rare disease in pediatric population and the importance of high index of clinical suspicion for its diagnosis.

  11. Quadriceps Tendon Rupture and Contralateral Patella Tendon Avulsion Post Primary Bilateral Total Knee Arthroplasty: A Case Report

    Directory of Open Access Journals (Sweden)

    Gaurav Sharma

    2016-07-01

    Full Text Available Background: Extensor mechanism failure secondary to knee replacement could be due to tibial tubercle avulsion, Patellar tendon rupture, patellar fracture or quadriceps tendon rupture. An incidence of Patella tendon rupture of 0.17% and Quadriceps tendon rupture of around 0.1% has been reported after Total knee arthroplasty. These are considered a devastating complication that substantially affects the clinical results and are challenging situations to treat with surgery being the mainstay of the treatment. Case Description: We report here an interesting case of a patellar tendon rupture of one knee and Quadriceps tendon rupture of the contralateral knee following simultaneous bilateral knee replacement in a case of inflammatory arthritis patient. End to end repair for Quadriceps tear and augmentation with Autologous Hamstring tendon graft was done for Patella tendon rupture. OUTCOME: Patient was followed up for a period of 1 year and there was no Extension lag with a flexion of 100 degrees in both the knees. DISCUSSION: The key learning points and important aspects of diagnosing these injuries early and the management techniques are described in this unique case of bilateral extensor mechanism disruption following knee replacements.

  12. Fratura periprotética da tíbia combinada com fratura de fadiga da haste tibial de artroplastia total do joelho Tibial periprosthetic fracture combined with tibial stem stress fracture from total knee arthroplasty

    Directory of Open Access Journals (Sweden)

    Fernando Fonseca

    2011-01-01

    Full Text Available As complicações das artroplastias totais do joelho relacionadas com o próprio material são muito raras, exceto o desgaste do polietileno. Neste artigo os autores reportam o caso de uma paciente do sexo feminino de 58 anos referenciada ao pronto-socorro do nosso hospital por uma fratura periprotética tibial (tipo I da classificação da Mayo Clinic. Uma observação mais cuidadosa mostrou a presença concomitante da referida fratura da tíbia associada à fratura de fadiga da haste tibial. A prótese com a haste foi remetida a um laboratório de biomecânica independente onde foi avaliada e efetuada uma reconstrução com uso de sistema de elementos finitos em CAD de modo a verificar a existência de algum defeito de fabricação e as eventuais causas para o sucedido. Depois de avaliadas diversas hipóteses, concluiu-se que a fratura do material foi provocada por uma sobrecarga na zona de transição prato/haste secundária à falência óssea prévia (fratura. Da avaliação do caso ressalta-se novamente a necessidade de efetuar uma avaliação adequada da mineralização óssea e, em caso de dúvida, utilizar uma haste longa.Total knee arthroplasty complications related to the prosthetic material are very rare, except for polyethylene wear. We report the case of a 58-year-old woman who came to the emergency service of our hospital with a periprosthetic tibial fracture (Mayo Clinic type I. Careful examination showed that this fracture was concomitantly associated with a tibial stem fatigue fracture. The prosthesis and the stem were sent to an independent biomechanics laboratory for evaluation. A finite-element CAD system was used to make a reconstruction, so as to ascertain whether there had been any manufacturing defect and what the causes of the event might have been. After evaluation of several hypotheses, it was concluded that the fracture in the prosthetic material had been caused by overloading at the plate/stem transition zone

  13. MRI diagnosis of trapped periosteum following incomplete closed reduction of distal tibial Salter-Harris II fracture

    Energy Technology Data Exchange (ETDEWEB)

    Raman, Subha [University of Massachusetts Memorial Medical Center, University of Massachusetts Medical School, Department of Radiology, Worcester, MA (United States); Wallace, E.C. [University of Massachusetts Memorial Medical Center, University of Massachusetts Medical School, Department of Radiology, Worcester, MA (United States); UMass Memorial Medical Center, Division of Pediatric Radiology, Worcester, MA (United States)

    2011-12-15

    Irreducible fracture of the distal tibial physis due to interposed soft tissue including periosteum is well documented in the orthopedic literature but is uncommon. This condition has been associated with subsequent growth disturbance and requires open reduction. There are very few prior reports of MRI depiction of soft tissue interposition and none of periosteal interposition in the distal tibial physis. This is a relatively common location of physeal injury and related growth disturbance. We present a case of periosteum trapped in the distal tibial physis, diagnosed on MRI, in a Salter-Harris II fracture and its management implications. (orig.)

  14. Bilateral Facial Paralysis Caused by Bilateral Temporal Bone Fracture: A Case Report and a Literature Review

    Directory of Open Access Journals (Sweden)

    Sultan Şevik Eliçora

    2015-01-01

    Full Text Available Bilateral facial paralysis caused by bilateral temporal bone fracture is a rare clinical entity, with seven cases reported in the literature to date. In this paper, we describe a 40-year-old male patient with bilateral facial paralysis and hearing loss that developed after an occupational accident. On physical examination, House-Brackmann (HB facial paralysis of grade 6 was observed on the right side and HB grade 5 paralysis on the left. Upon temporal bone computed tomography (CT examination, a fracture line exhibiting transverse progression was observed in both petrous temporal bones. Our patient underwent transmastoid facial decompression surgery of the right ear. The patient refused a left-side operation. Such patients require extensive monitoring in intensive care units because the presence of multiple injuries means that facial functions are often very difficult to evaluate. Therefore, delays may ensue in both diagnosis and treatment of bilateral facial paralysis.

  15. Amnesia Associated with Bilateral Hippocampal and Bilateral Basal Ganglia Lesions in Anoxia with Stimulant Use

    Science.gov (United States)

    Haut, Marc W.; Hogg, Jeffery P.; Marshalek, Patrick J.; Suter, Blair C.; Miller, Liv E.

    2017-01-01

    We report a case of a 55-year-old man with ischemic lesions of the bilateral hippocampus and bilateral basal ganglia following a myocardial infarction during an episode of multiple drug use with subsequent anoxia requiring resuscitation. He presented for a neuropsychological evaluation with an anterograde amnesia for both explicit and procedural memory. There are two main points to this case, the unique aspects of the bilateral multifocal lesions and the functional, cognitive impact of these lesions. We hypothesize that his rare focal bilateral lesions of both the hippocampus and basal ganglia are a result of anoxia acting in synergy with his stimulant drug use (cocaine and/or 3,4-methylenedioxy-methamphetamine). Second, his unique lesions produced an explicit and implicit/procedural anterograde amnesia. PMID:28228745

  16. A FUNCTIONAL AND ROENTGENOGRAPHIC PRELIMINARY COMPARATIVE STUDY USING METAL-BACKED AND ALL-POLYETHYLENE TIBIAL COMPONENTS IN TOTAL KNEE ARTHROPLASTY

    Science.gov (United States)

    de Andrade, Marco Antônio Percope; dos Santos, Juliano Rodrigues; Gonzaga, Luiz Gustavo Alves; Silva, Guilherme Moreira Abreu e

    2015-01-01

    Objective: To describe and clinically and radiographically compare patients who underwent total knee arthroplasty (TKA) with all-polyethylene (ALP) and metal-backed (MTB) tibial implants. Methods: Patients who underwent TKA between January 1988 and December 2004 were grouped according to the type of implant received: all-polyethylene or metal-backed. Sixty patients came for evaluations, totaling 82 operated knees. Among these, 22 patients had undergone TKA only with ALP (12 unilateral and 10 bilateral cases), 33 patients only with MTB (26 unilateral and 7 bilateral cases) and five patients underwent TKA with ALP in one knee and MTB in the other. The knees were divided thus: group 1, 37 knees with ALP; and group 2, 45 knees with MTB. Results: There were no differences in clinical or functional evaluations between the groups. The mean radiolucency in the femur was 0.838 mm for the patients in group 1 and 0.356 mm for the patients in group 2 (p = 0.049). For the tibia, in the AP view, there was a mean value of 2.703 mm for group 1 and 0.733 mm for group 2 (p = 0.000). In the lateral view, the mean values for osteolysis was 0.405 mm for group 1 and 0.200 mm for group 2 (p = 0.074). Conclusions: There were no differences between the groups in the functional and clinical evaluations. However, greater radiolucency was observed in the arthroplasties with ALP, both in the femur in the lateral view and in the tibia in the AP view. Level of evidence IV – case series study. PMID:27022556

  17. Economic Diplomacy in Africa: The Impact of Regional Integration versus Bilateral Diplomacy on Bilateral Trade

    OpenAIRE

    Afesorgbor, Sylvanus Kwaku

    2016-01-01

    The paper examines the impact of two main instruments of economic diplomacy — regional integration and commercial diplomacy on export flows among African states. We test whether there is any evidence of a trade-off or complementary interaction between these two instruments in trade facilitation. We compare the effects of these two instruments of economic diplomacy on bilateral trade by employing a gravity model for 45 African states over the period 1980-2005. The results show that bilateral d...

  18. One-stage clipping of bilateral middle cerebral artery aneurysms via the bilateral pterional keyhole approach.

    Science.gov (United States)

    Maruyama, Keisuke; Kurita, Hiroki; Yamaguchi, Ryuichi; Noguchi, Akio; Shiokawa, Yoshiaki

    2013-01-01

    Five patients aged 55 to 73 years (mean 63 years) underwent one-stage clipping for unruptured aneurysms in the bilateral middle cerebral arteries (mean size 4.5 mm, range 2 to 7 mm) via the bilateral pterional keyhole approach in our institute. Important points are as follows: the head is affixed with no rotation; one side manipulation is started 5 minutes after the other side to avoid conflict of surgical instruments; a 5-cm curvilinear skin incision is made inside the hairline and pterional keyhole craniotomy is made bilaterally using 2 burr holes; the whole operating table is rotated 15 degrees to one side to facilitate the microsurgical trans-sylvian approach and aneurysm clipping; the operating table is rotated to the other side for the contralateral procedure; and particular care is taken to avoid bilateral brain injury. This approach provided minimum but sufficient working space required for trans-sylvian dissection. Aneurysm neck clipping was safely performed in a mean operation time of 5 hours 17 minutes. No complications occurred and satisfactory cosmetic results were obtained in all patients. Postoperative neuroimaging studies exhibited bilateral complete clipping with minimal intracranial air content and minimum consequences of brain retraction. One-stage clipping via the pterional keyhole approach is a safe and effective therapeutic option for small bilateral aneurysms.

  19. Bilateral cerebellar activation in unilaterally challenged essential tremor

    Directory of Open Access Journals (Sweden)

    Marja Broersma

    2016-01-01

    Conclusions: Our results expand on previous findings of bilateral cerebellar involvement in ET. We have identified specific areas in the bilateral somatomotor regions of the cerebellum: lobules V, VI and VIII.

  20. Bilateral internal auditory canal gangliogliomas mimicking neurofibromatosis Type II

    Directory of Open Access Journals (Sweden)

    Kristopher G Hooten

    2016-01-01

    Conclusion: This is the first reported case of bilateral IAC/CPA gangliogliomas. When evaluating bilateral IAC/CPA lesions with unusual imaging characteristics, ganglioglioma should be included in the differential diagnosis.

  1. Avaliação do ângulo de inclinação tibial e altura patelar após osteotomia tibial de abertura medial Assessment of tibial slope angle and patellar height after medial-opening tibial osteotomy

    Directory of Open Access Journals (Sweden)

    Alan de Paula Mozella

    2012-01-01

    Full Text Available OBJETIVO: Mensurar a variação do ângulo de inclinação tibial posterior e da altura patelar em pacientes submetidos à osteotomia valgizante tibial proximal com técnica de cunha de abertura medial. MÉTODOS: Foram analisadas radiografias panorâmicas de membros inferiores em anteroposterior e perfil do joelho pré e pós-operatórias de 46 pacientes com artrose unicompartimental do joelho, em que se realizou osteotomia tibial. RESULTADOS: Em 23 casos, utilizou-se fixador externo para confecção de cunha de abertura medial gradual e nos outros 23, foi utilizada placa bloqueada com batente como método de fixação. Foram excluídos deste estudo aqueles pacientes com doença tricompartimental do joelho e aqueles submetidos à osteotomias para tratamento de sequelas de fraturas. Após a cirurgia, a inclinação tibial proximal aumentou, em média, 1,7 graus (p OBJECTIVE: To measure the variation in posterior tibial slope angle and patellar height in patients who underwent proximal tibial valgus-producing osteotomy using the medial-opening wedge technique. METHODS: Anteroposterior panoramic radiographs of the lower limbs and lateral radiographs of the knee obtained before and after tibial valgus-producing osteotomy on 46 patients with unicompartmental arthrosis of the knee were analyzed. RESULTS: In 23 patients, an external fixator was used to gradually apply a medial-opening wedge; and in the other 23, a blocked plate with a stop bar was applied as a fixation method. Patients with tricompartmental knee disease and those who underwent osteotomy to treat fracture sequelae were excluded from this study. After surgery, the mean increase in the tibial slope was 1.7 degrees (p < 0.01 in the group in which the blocked plate with a stop bar was used; and 2.7 degrees (p < 0.05 in the group in which the external fixator was used. There was no statistical difference between the groups regarding the increase in the posterior tibial slope. CONCLUSION: The

  2. Tratamiento conservador en pacientes con retinoblastoma bilateral

    Directory of Open Access Journals (Sweden)

    Juan C. Suárez

    2008-11-01

    Full Text Available OBJETIVO: comparar el tratamiento convencional del retinoblastoma bilateral, usado hasta hace algunos años, consistente en radioterapia o enucleación bilateral, con el tratamiento conservador actual que incluye termoterapia transpupilar (TTT o TTT/quimioterapia al menos en un ojo, en niños con diagnóstico de retinoblastoma bilateral. DISEÑO: estudio retrospectivo descriptivo. MUESTRA: 20 pacientes con diagnóstico de retinoblastoma bilateral que consultaron al Hospital Universitario San Vicente de Paúl, de Medellín, Colombia, entre 1997 y 2007. MÉTODO: se hizo enucleación del ojo con el tumor de mayor tamaño. En el otro ojo se hizo tratamiento con TTT, con el láser diodo (810 nm, spot amplio, solo o combinado con otras terapias. RESULTADOS: se dividió a los pacientes en dos grupos: 16 pacientes (32 ojos en el grupo 1 tratados conservadoramente y 4 pacientes (8 ojos en el grupo 2 con tratamiento convencional. El rango de edad fue de 1-72 meses en el grupo 1 y de 1-12 meses en el grupo 2. El tiempo de seguimiento fue de 7-67 meses para el grupo 1 y de 13-73 meses para el grupo 2. En el grupo 1 se hizo enucleación de 16 ojos (50%, radioterapia externa de uno (3,1%, quimioterapia más termoterapia de 5 (15,6% y quimioterapia más termoterapia más crioterapia de 10 (31,3%. En todos los pacientes se logró preservar al menos un ojo. En el grupo 2, se enuclearon 7 ojos (87,5% y se hizo radioterapia externa más enucleación en un paciente (12.5%. Además, todos los pacientes recibieron quimioterapia. CONCLUSIÓN: la terapia conservadora actual consistente en tratamiento local (termoterapia, crioterapia o braquiterapia y quimiorreducción permite preservar al menos un ojo y en algunos casos de los dos, muchas veces con buena agudeza visual, en niños con retinoblastoma bilateral; se evitan así la enucleación bilateral y la radioterapia externa usada en el tratamiento convencional con todos sus efectos secundarios. La enucleación contin

  3. Recurrence of bilateral herpes simplex virus keratitis following bimatoprost use

    Directory of Open Access Journals (Sweden)

    Kothari Mihir

    2006-01-01

    Full Text Available A 76-year-old man presented with features of bilateral herpes simplex virus (HSV keratitis. It was found to be recurrence of bilateral HSV keratitis following the use of Bimatoprost eye drops for uncontrolled intraocular pressure in a case of bilateral primary open-angle glaucoma.

  4. Bilateral Severe Ectropion and Mature Cataract in Lamellar Ichthyosis

    Directory of Open Access Journals (Sweden)

    Intiyaz A. Lone, Reyaz A. Untoo, Sheikh S. Ahmad

    2004-07-01

    Full Text Available Lamellar ichthyosis is a rare, autosomal recessive, genetically heterogeneous skin disorder causedby mutations in the transglutaminase-1 gene. Eye abnormalities include bilateral ectropion of lowerlids, chronic blepharitis and rarely cataract. A case of lamellar ichthyosis with bilateral lower lidectropion and bilateral mature cataract is hereby presented for its rarity.

  5. Bilateral Diabetic Papillopathy and Metabolic Control

    DEFF Research Database (Denmark)

    Ostri, Christoffer; Lund-Andersen, Henrik; Sander, Birgit;

    2010-01-01

    OBJECTIVE: The pathogenesis of diabetic papillopathy largely is unknown, but case reports suggest that it may follow rapidly improved metabolic control. The present study was designed to investigate this hypothesis. DESIGN: Retrospective case-control study. PARTICIPANTS: Two thousand sixty......-six patients with type 1 diabetes. METHODS: Review of clinical, photographic, and clinical chemistry records from a large diabetology and ophthalmology unit between 2001 and 2008. MAIN OUTCOME MEASURES: Simultaneous, bilateral diabetic papillopathy. RESULTS: The mean follow-up was 4.9 years. During 10 020...... patient-years of observation, bilateral diabetic papillopathy developed in 5 patients. During the year preceding this incident, all 5 patients had experienced a decrease in glycosylated hemoglobin A(1c) (HbA(1C)) at a maximum rate of -2.5 (mean) percentage points per quarter year, which was significantly...

  6. [Bilateral dependency and the minimal group paradigm].

    Science.gov (United States)

    Jin, N; Yamagishi, T; Kiyonari, T

    1996-06-01

    Two experiments examined the effect of illusion of control on in-group favoritism found in the minimal group situation (Tajfel, Billig, Bundy, & Flament, 1971). In bilateral dependency condition, each member made allocation decisions for in-group as well as out-group participants. It was exactly the same situation used in the original studies under the minimal group paradigm, and the subjects knew that their reward allocation too depended on others' decisions. In contrast, in unilateral dependency condition, the subjects made allocation decisions knowing that theirs were not dependent on others' decisions. In Experiment 1, an in-group bias in reward distribution was found in the bilateral dependency condition, but not in the unilateral condition. In Experiment 2, it was found that only those who felt illusion of control exhibited such an in-group bias. Results of the experiments therefore confirmed that illusion of control explained in-group favoritism, as Karp, Jin, Yamagishi, and Shinotsuka (1993) originally hypothesized.

  7. [Bilateral eye injuries by external transversal force].

    Science.gov (United States)

    Geidel, K; Schob, S; Unterlauft, J D; Wiedemann, P; Meier, P

    2016-12-14

    A 49-year-old female victim of violent crime with an acute bilateral loss of vision was referred to our hospital. The ophthalmological evaluation showed complete subconjunctival hemorrhage of both eyes, bilateral hemophthalmos and hypotonia of the left eye. These raised the suspicion of an occult scleral rupture. We immediately performed exploratory surgery and found a perforating scleral lesion of the left eye and a penetrating scleral lesion of the right eye. Furthermore, a small, cruciform wound was detected on the left temple. In cooperation with the department of radiology, the extraordinary injury pattern was reconstructed: a horizontal stab wound with perforation of the left eye and penetration of the right eye caused by a screwdriver. Visual rehabilitation necessitated further surgical interventions. Besides the intraoperative approach, immediate primary wound management within 100 h of trauma plays a pivotal role for long-term outcome.

  8. Sudden bilateral hearing loss after organophosphate inhalation.

    Science.gov (United States)

    Dundar, Mehmet Akif; Derin, Serhan; Aricigil, Mitat; Eryilmaz, Mehmet Akif

    2016-12-01

    Sudden bilateral hearing loss are seen rarely and the toxic substance exposure constitutes a small part of etiology. A Fifty-eight-year-old woman admitted to our clinic with sudden bilateral hearing loss shortly after chlorpyrifos-ethyl exposure. Otolaryngologic examination findings were normal. The patient had 40 dB sensorineural hearing loss (SNHL) on the right ear and 48 dB SNHL on the left ear. Additional diagnostic tests were normal. The conventional treatment for sudden hearing loss was performed. On the second week following organophosphate (OP) exposure the patient's hearing loss almost completely resolved. OP's are heavily used in agriculture and should be taken into consideration as an etiologic factor in sudden hearing loss.

  9. Bilateral akillesseneruptur efter behandling med ciprofloxacin

    DEFF Research Database (Denmark)

    Attarzadeh, Amir Pasha; Ryge, Camilla

    2013-01-01

    We report a case of spontaneous non-traumatic bilateral rupture of the Achilles tendons following ciprofloxacin treatment. A 54-year-old man presented with spontaneous Achilles tendon rupture on the left side, tendinitis and partial tear on the right side following few days of treatment with cipr......We report a case of spontaneous non-traumatic bilateral rupture of the Achilles tendons following ciprofloxacin treatment. A 54-year-old man presented with spontaneous Achilles tendon rupture on the left side, tendinitis and partial tear on the right side following few days of treatment...... with ciprofloxacin 500 mg twice daily and long-term treatment with prednisolon 10 mg once daily. This rare side effect caused by concurrent treatment with steroids and ciprofloxacin should be kept in mind. Any signs of tendinitis following this treatment should arouse the physicians' suspicion towards ciprofloxacin....

  10. [Bilateral acetabulum fracture after suffering sport trauma].

    Science.gov (United States)

    Trost, P; Kollersbeck, C; Pelitz, M; Walcher, T; Genelin, F

    2013-07-01

    This case study describes a 37-year-old male who suffered a bilateral transverse acetabulum fracture with a fracture of the posterior wall and a double-sided dorsal hip dislocation in combination with a left-sided femoral head fracture (Pipkin IV) while skiing in a "fun park". The accurate diagnosis and presurgical planning was made by means of a computed tomography (CT) scan and a subsequent 3D reconstruction. After a primarily executed shielded repositioning of the bilateral hip dislocationearly secondary and anatomical reconstruction of the double-sided acetabulum fracture was possible using the Kocher-Langenbeck approach. A consistent physiotherapy as well as rehabilitation finally led to a positive clinical result for the patient.

  11. Simultaneous bilateral patellar tendon rupture without

    Directory of Open Access Journals (Sweden)

    LU Hua-ding

    2012-04-01

    Full Text Available 【Abstract】There is a dearth of case reports de-scribing simultaneous bilateral patellar tendon ruptures in the medical literature. These ruptures are often associated with systemic disorders such as lupus erythematosus or chronic steroid use. The author describes a case of a 24-year-old man who sustained traumatic bilateral patellar ten-don ruptures without any history of systemic disease or steroidal medication. We repaired and reattached the rup-tured tendons to the patella and augmented our procedure with allogeneic tendon followed by wire loop reinforcement. One year after operation, the patient regained a satisfactory range of motion of both knees with good quadriceps strength and no extensor lag. The recurrent microtrauma from a history of intense sports activity and a high body mass index may have played an important role in this trauma event. Key words: Patella; Patellar ligament; Rupture; Ten-don injuries; Knee

  12. Bilateral hypoglossal schwannoma: a radiologic diagnosis.

    Science.gov (United States)

    Bektaş, Devrim; Caylan, Refik

    2004-01-01

    A 53-year-old woman presented with a complaint of a sore throat. Examination showed a left-sided atrophy of the tongue. Upon protrusion, the tongue deviated to the left, suggestive of a unilateral hypoglossal nerve palsy. Computed tomography revealed enlarged hypoglossal canals. Magnetic resonance imaging (MRI) demonstrated bilateral hypoglossal canal masses, with enhancement following gadolinium administration. Magnetic resonance angiography and MRI with fat suppression revealed nonvascular masses in both hypoglossal canals. Radiological diagnosis of bilateral hypoglossal nerve schwannoma was made and the patient was scheduled for MRI monitoring with six-month intervals. The size of the masses and the clinical manifestations remained unchanged during a two-year follow-up period.

  13. China-Pakistan Strengthen Bilateral Custom Cooperation

    Institute of Scientific and Technical Information of China (English)

    Guo Yan

    2008-01-01

    @@ Mr.Abdullah Yusuf,Secretary General/Chairman,Central Board Of Revenue of Pakistan,arrived Shenzhen on April 22 to meet with Mr.Sheng Guangzu,the Chinese Minister for Customs Administration for discussing the bilateral customs issues.During his two-day visit,China's Foreign Trade Magazine interviewed to Mr.Abdullah Yusuf in Beijing,he gave the high evaluation on this visit and China's great development in the recent years.

  14. [Bilateral pleural mesothelioma--case report].

    Science.gov (United States)

    Land, I; Knolle, H

    1990-08-01

    It is reported on the rare case of a 46-year-old female patient with a bilateral mesothelioma of the pleura without contact to asbest. Although the female was suspected in a malignant tumor and many diagnostic investigations were performed, diagnosis could be ensured morphologically only a short time before her death. Causes and development of mesothelioma, histological types, clinical symptoms and diagnostic procedures are described.

  15. Loss of heterozygosity in bilateral breast cancer.

    Science.gov (United States)

    Kollias, J; Man, S; Marafie, M; Carpenter, K; Pinder, S; Ellis, I O; Blamey, R W; Cross, G; Brook, J D

    2000-12-01

    Women who develop bilateral breast cancer at an early age are likely to harbour germline mutations in breast cancer susceptibility genes. The aim of this study was to test for concordant genetic changes in left and right breast cancer of young women (age < 50) with bilateral breast cancer that may suggest an inherited breast cancer predisposition. Microsatellite markers were used to test for loss of heterozygosity (LOH) in left and right tumours for 31 women with premenopausal bilateral breast cancer. Markers adjacent to or within candidate genes on 17p (p53), 17q (BRCA1), 13q (BRCA2), 11q (Ataxia Telangiectasia-ATM) and 3p (FHIT) were chosen. Mutational testing for BRCA1 and BRCA2 was performed for cases where blood was available. Concordant LOH in both left and right tumours was demonstrated for at least one of the markers tested in 16/31(54%) cases. Where allelic loss was demonstrated for both left and right breast cancer, the same allele was lost on each occasion. This may suggest a common mutational event. Four cases showed concordant loss of alleles in both left and right breast cancer at D17S791 (BRCA1). BRCA1 mutations were identified in two of these cases where blood was available. Four cases showed concordant LOH at D13S155 (BRCA2). Concordant LOH was further demonstrated in seven cases for D11S1778 (ATM) and four cases for D3S1300 (which maps to the FHIT gene), suggesting a possible role for these tumour suppressor genes in this subgroup of breast cancer patients. No concordant allelic loss was demonstrated for D17S786 suggesting that germline mutations in p53 are unlikely in such cases of bilateral breast cancer.

  16. A rare case of bilateral oral carcinoma

    Directory of Open Access Journals (Sweden)

    Sonia Behal

    2008-01-01

    Full Text Available Tobacco in different forms is an acknowledged etiologic factor in development of oral cancer. Due to the habit pattern, mostly a single malignant lesion develops. While multiple oral malignancies and second primaries are well reported in the literature, a truly bilateral oral malignancy seems to be a rare occurrence. We report such an occurrence in an individual with an unusual pattern of tobacco habit.

  17. Hypersexuality following bilateral thalamic infarction: case report

    OpenAIRE

    Mutarelli Eduardo G; Omuro Antonio M.P.; Adoni Tarso

    2006-01-01

    Hypersexuality is a rare but well recognized condition following brain injury. It has been described secondarily to dysfunction in the hypothalamus, the temporal and frontal lobes. We report a 63 year-old man that developed neuropsychological disturbances with hypersexuality as a prominent feature, disinhibition and moderate memory loss, hypersomnia and irritability after a bilateral paramedian thalamic infarction. A SPECT showed frontal hypoperfusion. We believe that these findings are expre...

  18. Bilateral germinoma of the basal ganglia.

    Science.gov (United States)

    Rossi, Andrea; Garrè, Maria Luisa; Ravegnani, Marcello; Nozza, Paolo; Abbruzzese, Arturo; Giangaspero, Felice; Tortori-Donati, Paolo

    2008-01-01

    Germinoma arising in the bilateral basal ganglia is exceedingly rare, with only five cases reported to date. Owing to non-specific clinical findings and the frequent presence of ill-defined abnormalities without a definite tumor mass on neuroimaging, the diagnosis can be difficult. We describe a case in which magnetic resonance spectroscopy (MRS) findings suggested a tumor and supported the decision to perform biopsy of the lesion.

  19. Bilateral Pseudoexfoliation Deposits on Intraocular Lens Implants

    OpenAIRE

    Elena Bonafonte Marquez; Sergio Bonafonte Royo

    2015-01-01

    We present a rare case of bilateral pseudoexfoliative deposits on both intraocular lens (IOL) implants in an 83-year-old woman with no other associated pathology, 5 years after cataract surgery. Pseudoexfoliation syndrome is the most common cause of secondary open-angle glaucoma worldwide and these deposits are usually found on the natural lens. The fact that pseudoexfoliative deposits have been found on IOL implants implies the need for a thorough examination in pseudophakic patients, for i...

  20. Bilateral accessory cleidohyoid in a human cadaver

    OpenAIRE

    Stark ME; Wu B; Bluth BE; Wisco JJ

    2009-01-01

    During routine anatomical dissection of the infrahyoid region, a muscle was found bilaterally originating from the sternal end of clavicle and inserting into the hyoid bone. The muscle coursed parallel and lateral to the sternohyoid muscle. The muscle was found in the presence of an intact omohyoid, thus being classified as an accessory cleidohyoid (cleidohyoideus accessorius) muscle. While other authors have reported the presence of a unilateral cleidohyoideus accessorius muscle, to our know...

  1. Erlotinib-related bilateral anterior uveitis

    Science.gov (United States)

    Ali, Kashif; Kumar, Indu; Usman-Saeed, Muniba; Usman Saeed, Muhammad

    2011-01-01

    The authors report the case of a 68-year-old woman with secondary adenocarcinoma of the lungs from an unknown primary. Erlotinib was started which produced symptoms suggestive of uveitis. Erlotinib was stopped and restarted a month later at a lower dose, which resulted in severe bilateral anterior uveitis. The uveitis settled after stopping erlotinib and treatment with topical steroids and cycloplegics. To the best of the authors’ knowledge, this is the first case of erlotinib-related anterior uveitis. PMID:22694887

  2. A rare case of bilateral aspergillus endophthalmitis

    Directory of Open Access Journals (Sweden)

    Saurabh Gupta

    2015-12-01

    Full Text Available Aspergillus endophthalmitis is a devastating inflammatory condition of the intraocular cavities that may result in irreparable loss of vision and rapid destruction of the eye. Almost all cases in the literature have shown an identified source causing aspergillus endophthalmitis as a result of direct extension of disease. We present a rare case of bilateral aspergillus endophthalmitis. A 72-year-old woman with a history of diabetes mellitus, congenital Hirschsprung disease, and recent culture-positive candida pyelonephritis with hydronephrosis status post-surgical stent placement presented with difficulty opening her eyes. She complained of decreased vision (20/200 with pain and redness in both eyes – right worse then left. Examination demonstrated multiple white fungal balls in both retinas consistent with bilateral fungal endophthalmitis. Bilateral vitreous taps for cultures and staining were performed. Patient was given intravitreal injections of amphotericin B, vancomycin, ceftazidime, and started on oral fluconazole. Patient was scheduled for vitrectomy to decrease organism burden and to remove loculated areas of infection that would not respond to systemic antifungal agents. Four weeks after initial presentation, the fungal cultures revealed mold growth consistent with aspergillus. Patient was subsequently started on voriconazole and fluconazole was discontinued due to poor efficacy against aspergillus. Further workup was conducted to evaluate for the source of infection and seeding. Transthoracic cardiogram was unremarkable for any vegetation or valvular abnormalities. MRI of the orbits and sinuses did not reveal any mass lesions or bony destruction. CT of the chest was unremarkable for infection. Aspergillus endophthalmitis may occur because of one of these several mechanisms: hematogenous dissemination, direct inoculation by trauma, and contamination during surgery. Our patient's cause of bilateral endophthalmitis was through an

  3. Occipital seizures presenting with bilateral visual loss

    Directory of Open Access Journals (Sweden)

    Hadjikoutis S

    2003-01-01

    Full Text Available Transient visual loss may occur with occipital seizures as an ictal or post-ictal phenomenon. Its duration varies from less than one minute to days, or can be permanent. We describe a 61-year-old man presenting with headache, vomiting and bilateral visual loss. EEG revealed persistent spike discharge in the occipital lobes suggesting occipital seizures. His vision improved with carbamazepine.

  4. Bilateral Brodie's abscess at the proximal tibia.

    Science.gov (United States)

    Buldu, Halil; Bilen, Fikri Erkal; Eralp, Levent; Kocaoglu, Mehmet

    2012-08-01

    Brodie's abscess is a form of subacute osteomyelitis, which typically involves the metaphyses of the long tubular bones, particularly in the tibia. The diagnosis is usually made incidentally, as there are no accompanying symptoms or laboratory studies. Bilateral involvement at the proximal tibia is unusual. However, orthopaedic surgeons should be aware of this entity, as it may present without symptoms. Checking the contralateral limb for concomitant Brodie's abscess is recommended.

  5. Open Wedge High Tibial Osteotomy and Combined Arthroscopic Surgery in Severe Medial Osteoarthritis and Varus Malalignment: Minimum 5-Year Results

    OpenAIRE

    Yoo, Moon-Jib; Shin, Yong-Eun

    2016-01-01

    Purpose To evaluate the radiologic and functional outcomes of medial open wedge high tibial osteotomy (HTO) combined with arthroscopic procedure in patients with medial osteoarthritis. Materials and Methods From June 1996 to March 2010, 26 patients (32 knees) who underwent medial open wedge osteotomy and arthroscopic operation for medial osteoarthritis were retrospectively reviewed. Measurements included hip-knee-ankle (HKA) angle, femorotibial angle, medial proximal tibial angle, posterior t...

  6. Multilateral, regional and bilateral energy trade governance

    Energy Technology Data Exchange (ETDEWEB)

    Leal-Arcas, Rafael; Grasso, Costantino; Rios, Juan Alemany (Queen Mary Univ. of London (United Kingdom))

    2014-12-01

    The current international energy trade governance system is fragmented and multi-layered. Streamlining it for greater legal cohesiveness and international political and economic cooperation would promote global energy security. The current article explores three levels of energy trade governance: multilateral, regional and bilateral. Most energy-rich countries are part of the multilateral trading system, which is institutionalized by the World Trade Organization (WTO). The article analyzes the multilateral energy trade governance system by focusing on the WTO and energy transportation issues. Regionally, the article focuses on five major regional agreements and their energy-related aspects and examines the various causes that explain the proliferation of regional trade agreements, their compatibility with WTO law, and then provides several examples of regional energy trade governance throughout the world. When it comes to bilateral energy trade governance, this article only addresses the European Union’s (EU) bilateral energy trade relations. The article explores ways in which gaps could be filled and overlaps eliminated whilst remaining true to the high-level normative framework, concentrating on those measures that would enhance EU energy security.

  7. Diagnosis and management of bilateral nasolabial cysts

    Directory of Open Access Journals (Sweden)

    Rajkumar Parwani

    2013-01-01

    Full Text Available Nasolabial cysts are painless, submucosal, non-odontogenic jaw cysts presenting as soft tissue swellings in the maxillary anterior mucolabial fold lateral to midline, leading to elevation of nasal ala. Present case documents bilateral nasolabial cysts in a 69-year-old Asian female patient. In the present case, extraoral swelling of maxillary lip and elevation of nasal ala was observed on right side of the face. Intraorally, soft and fluctuant bilateral cysts were observed. Straw-colored fluid was aspirated from the right cyst. Radiographically, erosion of bone in a "cupping" fashion was observed in the region of left cyst. The cysts were enucleated using intraoral approach. Histopathology of the right-sided cyst revealed a cystic cavity lined by stratified squamous cells along with a few mucosal cells. At few places, stratified squamous and pseudostratified columnar epithelia with many cilia and goblet cells were also evident. Capsule was loosely arranged with fibrous tissue and chronic inflammatory infiltrate. Left-sided cystic specimen showed two or more layered stratified squamous lining epithelium with thin capsule. Diagnosis of bilateral nasolabial/nasoalveolar cysts was confirmed.

  8. High Performance, Three-Dimensional Bilateral Filtering

    Energy Technology Data Exchange (ETDEWEB)

    Bethel, E. Wes

    2008-06-05

    Image smoothing is a fundamental operation in computer vision and image processing. This work has two main thrusts: (1) implementation of a bilateral filter suitable for use in smoothing, or denoising, 3D volumetric data; (2) implementation of the 3D bilateral filter in three different parallelization models, along with parallel performance studies on two modern HPC architectures. Our bilateral filter formulation is based upon the work of Tomasi [11], but extended to 3D for use on volumetric data. Our three parallel implementations use POSIX threads, the Message Passing Interface (MPI), and Unified Parallel C (UPC), a Partitioned Global Address Space (PGAS) language. Our parallel performance studies, which were conducted on a Cray XT4 supercomputer and aquad-socket, quad-core Opteron workstation, show our algorithm to have near-perfect scalability up to 120 processors. Parallel algorithms, such as the one we present here, will have an increasingly important role for use in production visual analysis systems as the underlying computational platforms transition from single- to multi-core architectures in the future.

  9. Bilateral ovarian fibroma associated with Gorlin syndrome

    Directory of Open Access Journals (Sweden)

    Shahnaz Aram

    2009-02-01

    Full Text Available

    • Gorlin syndrome (GS, also known as nevoid basal cell carcinoma syndrome (NBCCS, is a rare inherited multisystem disorder. This paper presents a 22-years-old Iranian woman with this syndrome whose past history was multiple keratocysts of maxillary bone. She was referred to gynecology clinic with the chief complaint of irregular menses and vaginal spotting. On examination, frontal bossing and hypertelorism were detected. Physical examination of genitalia disclosed bilateral adnexal masses. Pelvic ultrasound showed two solid, echogenous and calcified masses measuring 100*50*10 & 60*50*45 mm in the left and right ovaries, respectively. The patient underwent right oophorectomy and ovarian mass resection with preservation of intact ovarian tissue on the left side. On frozen and permanent histological sections, bilateral and calcified ovarian fibromas were diagnosed. Surprisingly, during the last follow-up one year after the surgery, we found that our patient was expecting a baby. It can be concluded that in the presence of bilateral and calcified ovarian fibromas, the possibility of GS should be considered. Accurate diagnosis is only possible with close attention to the familial and past medical history and physical examination. In these patients, careful follow up for detecting malignancies and other complications is highly recommended.
    • KEY WORDS: Gorlin syndrome, ovarian fibroma, multiple keratocysts.

  10. Gastric metastasis of bilateral breast cancer

    Science.gov (United States)

    Belaïd, Asma; Mghirbi, Fahmi; Béhi, Khalil; Doghri, Raoudha; Benna, Farouk

    2017-01-01

    Breast cancer is the most common malignancy in women. The most frequent metastatic sites are lung, bone, liver and brain. On the other hand, gastric metastases are rare. Synchronous bilateral breast cancer (SBBC) occurs rarely. Lobular carcinoma is the histological type most often associated with bilateral breast carcinomas and gastric metastases. We made a retrospective study including four patients followed in the Salah Azaiez Institute, for a bilateral breast cancer with gastric metastases. We analyzed the epidemiological, anatomoclinical and therapeutic particularities of this rare entity. Symptoms were unspecific. The diagnosis of gastric metastasis of the SBBC was confirmed by a histopathological examination of an endoscopic biopsy. The median age was 46.2 years (range, 36–51 years) and the median time until the gastric involvement was 19 months (range, 0–41 months). None of patients had a surgical treatment for the gastric location. All Patients received at least one line of chemotherapy and radiotherapy. Median survival following the detection of gastric involvement was 22 months (range, 1–56 months). Gastric metastases from breast cancer are rare and frequently associated with other distant metastasis. Symptoms are unspecific and endoscopy may not be contributive. Therefore, gastric involvement is underestimated. Lobular infiltrating carcinoma (LIC) is the most histological type incriminated in its occurrence. The supply of immunohistochemistry is crucial to distinguish between primary or metastatic gastric cancer. PMID:28280631

  11. Bilateral limbic system destruction in man

    Science.gov (United States)

    Feinstein, Justin S.; Rudrauf, David; Khalsa, Sahib S.; Cassell, Martin D.; Bruss, Joel; Grabowski, Thomas J.; Tranel, Daniel

    2010-01-01

    We report here a case study of a rare neurological patient with bilateral brain damage encompassing a substantial portion of the so-called “limbic system.” The patient, Roger, has been studied in our laboratory for over 14 years and the current article presents his complete neuroanatomical and neuropsychological profiles. The brain damage occurred in 1980 following an episode of herpes simplex encephalitis. The amount of destroyed neural tissue is extensive and includes bilateral damage to core limbic and paralimbic regions, including the hippocampus, amygdala, parahippocampal gyrus, temporal poles, orbitofrontal cortex, basal forebrain, anterior cingulate cortex, and insular cortex. The right hemisphere is more extensively affected than the left, although the lesions are largely bilateral. Despite the magnitude of his brain damage, Roger has a normal IQ, average to above average attention, working memory, and executive functioning skills, and very good speech and language abilities. In fact, his only obvious presenting deficits are a dense global amnesia and a severe anosmia and ageusia. Roger's case presents a rare opportunity to advance our understanding of the critical functions underlying the human limbic system, and the neuropsychological and neuroanatomical data presented here provide a critical foundation for such investigations. PMID:19763994

  12. Kişiye Özel ve Geleneksel Tibial Diz Protezi Bileşenlerinin Performans Analizi

    Directory of Open Access Journals (Sweden)

    İsmail Hakkı KORKMAZ

    2015-01-01

    Full Text Available Total Knee Arthroplasty (TKA treatment has been widely used for knee joint, having the most complex motion sequences and shape of the body, in case of loss of motion ability such as gonarthrosis. Lots of failures such as loosening, wear and instability have occurred as a result of increasing usage period. Instability is the most commonly seen failure associated with fixation. Especially loosening of tibial component is more common than that of femoral component. Evaluation of bone in terms of shape related with patient’s weight, height and gender is required to increase the success of TKAs comprising traditional tibial components. Most of the current commercially available knee prostheses are designed based on the anthropometric data of Caucasian knees. This means an accordance problem for the people in different regions having different joint size. In this study, a patient specific tibial component has been designed according to cutting surface of tibial bone obtained from the patient’s computed tomography images. This proposed design has been comparatively investigated with the traditional cemented tibial component by using the finite element analysis. In conclusion, more uniform stress distribution on the tibial trabecular bone related with stress shielding due to long term use was obtained in the patient specific prosthesis. The results have shown that the compatibility

  13. Increase in the Tibial Slope Reduces Wear after Medial Unicompartmental Fixed-Bearing Arthroplasty of the Knee

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    Patrick Weber

    2015-01-01

    Full Text Available Introduction. Unicompartmental arthroplasty of the knee in patients with isolated medial osteoarthritis gives good results, but survival is inferior to that of total knee prosthesis. Knees may fail because positioning of the prosthesis has been suboptimal. The aim of this study was to investigate the influence of the tibial slope on the rate of wear of a medial fixed-bearing unicompartmental knee arthroplasty. Materials and Methods. We simulated wear on a medial fixed-bearing unicompartmental knee prosthesis (Univation in vitro with a customised, four-station, and servohydraulic knee wear simulator, which exactly reproduced the walking cycle (International Organisation for Standardisation (ISO 14243-1:2002(E. The medial prostheses were inserted with 3 different posterior tibial slopes: 0°, 4°, and 8° (n = 3 in each group. Results. The wear rate decreased significantly between 0° and 4° slope from 10.4 (SD 0.62 mg/million cycles to 3.22 (SD 1.71 mg/million cycles. Increasing the tibial slope to 8° did not significantly change the wear rate. Discussion. As an increase in the tibial slope reduced the wear rate in a fixed-bearing prosthesis, a higher tibial slope should be recommended. However, other factors that are influenced by the tibial slope (e.g., the tension of the ligament must also be considered.

  14. Conventional radiographic examination in the evaluation of sequelae after tibial plateau fractures

    Energy Technology Data Exchange (ETDEWEB)

    Jensen, D.B.; Bjerg-Nielsen, A.; Laursen, N.

    1988-07-01

    Seventy patients with 72 conservatively treated tibial plateau fractures were re-examined after an average of 5 3/4 years. Among 55 fractured knees with a primary articular depression of 1-20 mm, the depression was still present radiographically in 47 knees. No correlation existed between the persistent radiographic depression and function of the knee. Moderate to severe osteoarthrosis was found in 10 knees; in five of these the osteoarthrosis was of clinical importance. More than 10 degrees of valgus/varus deformity was present in two knees. In two patients osteotomy had been performed to correct deformity. It is concluded that a persistent radiographic articular depression is of no clinical importance in tibial plateau fractures treated by conservative methods, which include early movement of the knee. The radiographic examination, however is, useful in the evaluation of valgus/varus deformity and osteoarthrosis.

  15. Sensory reinnervation of muscle spindles after repair of tibial nerve defects using autogenous vein grafts

    Institute of Scientific and Technical Information of China (English)

    Youwang Pang; Qingnan Hong; Jinan Zheng

    2014-01-01

    Motor reinnervation after repair of tibial nerve defects using autologous vein grafts in rats has previously been reported, but sensory reinnervation after the same repair has not been fully investigated. In this study, partial sensory reinnervation of muscle spindles was observed after repair of 10-mm left tibial nerve defects using autologous vein grafts with end-to-end anasto-mosis in rats, and functional recovery was conifrmed by electrophysiological studies. There were no signiifcant differences in the number, size, or electrophysiological function of reinnervated muscle spindles between the two experimental groups. These ifndings suggest that repair of short nerve defects with autologous vein grafts provides comparable results to immediate end-to-end anastomosis in terms of sensory reinnervation of muscle spindles.

  16. One-Stage Computer-Assisted Total Knee Arthroplasty and Tibial Osteotomy.

    Science.gov (United States)

    Denjean, S; Chatain, F; Tayot, O

    2017-03-02

    Same-stage tibial osteotomy may deserve consideration in candidates to total knee arthroplasty (TKA) who have severe bone deformities, particularly at extra-articular sites. This strategy obviates the need for either a major and technically difficult ligament release procedure, which may compromise ligament balancing, or the use of a semi-constrained prosthesis. This technical note describes a one-stage, computer-assisted technique consisting in TKA followed by corrective tibial osteotomy to obtain an overall mechanical axis close to 180° without extensive ligament balancing. This technique provided satisfactory outcomes in 8 patients followed-up for at least 3 years, with no specific complications or ligament instability and with a hip-knee-ankle angle close to 180°. After planning, intra-operative computer assistance ensures accurate determination of both implant position and the degree of correction achieved by the osteotomy.

  17. Partial resection of fibula in treatment of ununited tibial shaft fractures

    Directory of Open Access Journals (Sweden)

    Butt Mohd Farooq

    2006-01-01

    Full Text Available Background : In management of fracture of both tibia and fibula, intact fibula may delay union of tibial fractures. Method : Twenty five cases of ununited fractures of tibia were managed between 1997 and 2004, by partial fibulectomy done after 20 weeks after fracture and a POP cast given for 4 weeks which was changed to a PTB cast and weight bearing encouraged at the earliest. Result : All fractures united at an average time of 14 weeks (range 6 to 20 weeks after partial fibulectomy with acceptable alignment in coronal and sagittal planes. There was no neurovascular complication, limitation of joint motion or problem at the osteotomy site. Conclusion : Partial fibulectomy is a viable option in the management of tibial delayed and non-union.

  18. Preclinical computational models: predictors of tibial insert damage patterns in total knee arthroplasty: AAOS exhibit selection.

    Science.gov (United States)

    Morra, Edward A; Heim, Christine S; Greenwald, A Seth

    2012-09-19

    Computational models that predict clinical surface damage of the tibial insert during activities of daily living are emerging as powerful tools to assess the safety and efficacy of contemporary total knee arthroplasty designs. These models have the advantage of quickly determining the performance of new designs at low cost, and they allow direct comparison with the performance of classic, clinically successful designs. This study validated finite element and kinematic modeling predictions through comparison with preclinical physical testing results, damage patterns on retrieved tibial inserts, and clinically measured knee motion. There is a mounting body of evidence to support the role of computational modeling as a preclinical tool that enables the optimization of total knee arthroplasty designs and the auditing of component quality control before large-scale manufacturing is undertaken.

  19. Arthroscopic-Assisted Intraosseous Balloon-Assisted Repositioning of a Tibial Plateau Fracture: A Case Report.

    Science.gov (United States)

    Brinkmann, O; Rau, M; Maenz, S; Bungartz, M; Matziolis, G

    2015-01-01

    This is the first description of an arthroscopic-assisted intraosseous balloon-assisted repositioning and defect filling of a tibial plateau fracture. The bone defect was filled with calcium phosphate cement in a liquid/paste form. The described technique was therefore introduced in order to allow an arthroscopic control of reposition and intra-articular cement escape during defect filling. X-rays showed an exact reposition without cement escape and the clinical outcome was satisfactory.

  20. Internal fixation and bone grafting for intraarticular nonunion of tibial plateau: a report of four cases

    Institute of Scientific and Technical Information of China (English)

    Ramesh K Sen; Ashwani Soni; Uttam Chand Saini; Daljit Singh

    2011-01-01

    Intraarticular nonunion of tibial plateau is rare.In the literature,only 9 patients were found to be treated for intraarticular tibial plateau nonunion and they got varying results.Internal fixation along with bone grafting was done as a standard treatment in all cases.We treated 4 different profile cases of intraarticular tibial plateau nonunion in our institution by 4 different methods.We treated these cases with plaster of paris cast,internal fixation along with bone graft,arthrodesis with K-nail and total knee replacement.Case 1 was treated with plaster of paris (POP)cast as the patient refused surgery.The fracture was united and the patient was fully satisfied with full range of motion despite valgus malalignment.Case 2 was managed with open reduction internal fixation along with bone grafting.The patient had a good union and got full range of motion at the knee joint.Case 3 was treated with total knee arthroplasty due to her old age and got satisfactory result.Case 4 was an infected nonunion.Arthrodesis was done and the patient could walk with full weight bearing independently.We conclude that internal fixation along with bone grafting may not be suitable in all cases of intraarticular nonunion of tibial plateau.Causes of nonunion,present condition and range of motion of the knee joint,as well as the age of patient should be all considered and the treatment should be individualised according to each patient's situation.

  1. Post traumatic osteoma of tibial insertion of medial collateral ligament of knee joint.

    Science.gov (United States)

    Shanker, V S; Gadikoppula, S; Loeffler, M D

    1998-03-01

    Two cases are presented of post traumatic para-articular osteoma developing at the site of tibial attachment of the medial collateral ligament of knee joint. These occurred after injuries sustained while playing football and in one case the ossified mass was treated with surgical excision for unresolved symptoms after conservative measures. A comparison is made with Pellegrini Stieda disease, which is a similar affection of the femoral insertion of the medial ligament of the knee joint.

  2. Post traumatic osteoma of tibial insertion of medial collateral ligament of knee joint

    OpenAIRE

    Shanker, V. S.; Gadikoppula, S.; Loeffler, M. D.

    1998-01-01

    Two cases are presented of post traumatic para-articular osteoma developing at the site of tibial attachment of the medial collateral ligament of knee joint. These occurred after injuries sustained while playing football and in one case the ossified mass was treated with surgical excision for unresolved symptoms after conservative measures. A comparison is made with Pellegrini Stieda disease, which is a similar affection of the femoral insertion of the medial ligament of the knee joint....

  3. Internal tibial torsion correction study. [measurements of strain for corrective rotation of stressed tibia

    Science.gov (United States)

    Cantu, J. M.; Madigan, C. M.

    1974-01-01

    A quantitative study of internal torsion in the entire tibial bone was performed by using strain gauges to measure the amount of deformation occuring at different locations. Comparison of strain measurements with physical dimensions of the bone produced the modulus of rigidity and its behavior under increased torque. Computerized analysis of the stress distribution shows that more strain occurs near the torqued ends of the bones where also most of the twisting and fracturing takes place.

  4. Lesiones por sobrecarga del tibial posterior. Valoración funcional diferencial

    OpenAIRE

    Martín Urrialde, José Antonio

    2001-01-01

    El tibial posterior se halla sometido a diversas lesiones por sobrecarga durante la práctica deportiva: desde el cuerpo del tendón hasta la corredera del mismo pueden ser lugares de asiento de la lesión. Las alteraciones estáticas del pie, se revelan como una de las causas más comunes, siendo parte esencial del tratamiento. Terapia y Rehabilitación

  5. Combined anterior and posterior cruciate ligaments avulsion from the tibial side in adult patient: case report

    Directory of Open Access Journals (Sweden)

    Marcos George de Souza Leao

    2013-12-01

    Full Text Available The authors describe a rare case of a 28-year-old male patient, victim of motorcycle crash, with direct impact on the right knee, who sustained a bicruciate ligament fracture avulsion from the tibial side, dislocated and with large dimensions, without associated ligamentary lesions; he has undergone surgical treatment - open reduction and internal fixation, of the avulsions, and the follow up was at least six months, presenting good outcome using the Tegner -Lysholm scale.

  6. A CLINICAL STUDY ON SURGICAL MANAGEMENT OF TIBIAL PLATEAU FRACTURES - FUNCTIONAL AND RADIOLOGICAL EVALUATION

    Directory of Open Access Journals (Sweden)

    Bhavani

    2015-10-01

    Full Text Available BACKGROUND: Tremendous advance in mechanization and fastness of travel have been accompanied by steep increase in number and severity of fractures and those of tibial plateau are no exception. Knee being one of the major weight bearing joints of the body, fractures around it will be of paramount importance. AIM OF STUDY: This study is to analyze the functional outcome of CRIF or ORIF with or without bone grafting in tibial plateau fractures in adults. MATERIALS AND METHODS: 30 cases of tibial plateau fractures treated by various modalities were studied from 1 - 8 - 2012 to 31 - 1 - 2014 at our institution and followed for a minimum of 6 months. Fractures were evaluated using Modified Rasmussen’s Clinical, Radiological grading system. RESULTS : The selected patients were evaluated thoroughly and after the relevant investigations, were taken for surgery. The fractures were classified as per the SCHATZKER’S types and operated accordingly with CRIF with Percutaneous cannulated cancellous screws, ORIF with buttress plate/LCP with or without bone grafting. Immobilization of fractures continued for 3 weeks by POP slab. Early range of motion was then started. Weight bearing up to 6 - 8 weeks was not allowed. The full weight bearing deferred until 12 weeks or complete fracture union . The knee range of motion was excellent to very good, gait and weight bearing after complete union was satisfactory, knee stiffness in 3 cases , wound dehiscence and infection in 1 case and non - union in none of our cases was noted. CONCLUSION: Functional outcome is better in operatively treated tibial plateau fractures in adults, because it gives excellent anatomical reduction and rigid fixation to restore articular congruity and early motion thereby preventing knee stiffness.

  7. Improving clinical examination in acute tibial fractures by enhancing visual cues: the case for always 'cutting back' a tibial back-slab and marking the dorsalis pedis pulse.

    Science.gov (United States)

    Thomas, Alasdair; Kimber, Cheryl; Bramwell, Donald; Jaarsma, Ruurd

    2016-08-01

    Look, feel, move is a simple and widely taught sequence to be followed when undertaking a clinical examination in orthopaedics (Maher et al., 1994; McRae, 1999; Solomon et al., 2010). The splinting of an acute tibial fracture with a posterior back-slab is also common practice; with the most commonly taught design involving covering the dorsum of the foot with bandaging (Charnley, 1950; Maher et al., 1994; McRae, 1989). We investigated the effect of the visual cues provided by exposing the dorsum of the foot and marking the dorsalis pedis pulse. We used a clinical simulation in which we compared the quality of the recorded clinical examination undertaken by 30 nurses. The nurses were randomly assigned to assess a patient with either a traditional back-slab or one in which the dorsal bandaging had been cut back and the dorsalis pedis pulse marked. We found that the quality of the recorded clinical examination was significantly better in the cut-back group. Previous studies have shown that the cut-back would not alter the effectiveness of the back-slab as a splint (Zagorski et al., 1993). We conclude that all tibial back-slabs should have the bandaging on the dorsum of the foot cut back and the location of the dorsalis pedis pulse marked. This simple adaptation will improve the subsequent clinical examinations undertaken and recorded without reducing the back-slab's effectiveness as a splint.

  8. Bilateral congenital absence of anterior cruciate ligaments associated with the scoliosis and hip dysplasia: a case report and review of the literature

    Institute of Scientific and Technical Information of China (English)

    HU Jun; DU Shi-xin; HUANG Zhong-lian; XIA Xue

    2010-01-01

    @@ Congenital absence of the cruciate ligaments is an extremely rare condition with a prevalence of 0.017 per 1000 live births.~1 Niebauer and King~2 first reported this disease in 1960, and after that, similar cases have been reported. These cases are usually associated with other deformities of the knee joint, such as the joint dislocation, absence of the tibial intercondylar eminence, deformity of the meniscus, dysplasia of the distal femur, etc.~3 However, its association with multiple congenital abnormalities in other areas of the body has been rarely reported. Here, we report a patient with congenital deficiency of bilateral anterior cruciate ligaments associated with scoliosis and hip dysplasia, together with the result of four years follow-up along with a literature review.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2003-08-01

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

  10. Arthroscopically assisted treatment for Schatzker type I-V tibial plateau fractures

    Institute of Scientific and Technical Information of China (English)

    DUAN Xiao-jun; YANG Liu; GUO Lin; CHEN Guang-xing; DAI Gang

    2008-01-01

    Objective: To report the clinical outcome of arthroscopically assisted treatment for tibial plateau fractures.Methods: A total of 39 patients with tibial plateau fractures were treated by arthroscopic fixation from February 2002 to December 2005,including 11 patients with bony avulsion of the anterior cruciate ligament and 19 with meniscal injury.There were 4 cases of type I fracture,12 type II,9 type III,12 type IV and 2 type V according to Schatzker criteria.Firstly,the combined injuries were treated.Then the plateau fractures with the displacement over 3 mm or more were reduced and fixed.Finally,the internal fixation was observed by X-ray equipment.Postoperative management was early motion and delayed weight bearing.Results: All the fractures healed in 3 or 4 months.All patients were followed up for 1 to 5 years after operation.No case had severe complications,such as poor wound healing,infection,osteofascial compartment syndrome and osteoarthritis.According to the Rasmussen scoring system,36 cases obtained excellent or good results and the other 3 cases had moderate clinical results.The average score was 26 ± 3.Conclusions: As an adjuvant treatment of intraarticular fractures such as tibial plateau fracture,arthroscopy has many advantages.It can treat associated intraarticular soft tissue components,visualize the chondral surface reduction,lavage the hematoma and smaller loose fragments,decrease soft tissue dissection,reduce the risk of scarring and promote rapid recovery.

  11. Application of Minimally Invasive Treatment of Locking Compression Plate in SchatzkerⅠ~Ⅲ Tibial Plateau Fracture

    Institute of Scientific and Technical Information of China (English)

    Zhao Guohui

    2014-01-01

    Objective:To investigate the clinical effect of minimally invasive treatment of locking compression plate (LCP) in SchatzkerⅠ~Ⅲ tibial plateau fracture. Methods: Thirty-eight patients with SchatzkerⅠ~Ⅲtibial plateau fracture in our hospital were given minimally invasive treatment of LCP, and the artificial bone was transplanted to the depressed bone. Adverse responses, wound healing time and clinical efifcacy were observed. Results:All patients were followed-up for 14~20 months, and the mean duration was 16 months. Within 1 week after operation, 1 patient suffered from short-term rejection reaction to artiifcial bone, but he healed after corresponding measures were taken. There were no complications like skin necrosis and externally-exposed steel plate among the patients. In addition, all fractures were recovered, and the recovery time was 2.6~4.1 months, with the mean duration being 3.4 months. The recovery of knee function was favorable, in which 20 cases were excellent, 14 were good, and 4 were general. The excellent and good rate was 89.5%. Conclusion: Minimally invasive treatment of LCP for SchatzkerⅠ~Ⅲ tibial plateau fracture can reduce the postoperative relocation loss, and has small trauma and stable ifxation.

  12. The role of Esmarch bandage and percutaneous cannulated cancellous screws in tibial condylar fracture

    Directory of Open Access Journals (Sweden)

    Shete Kiran

    2006-01-01

    Full Text Available Background : Proximal tibial fractures involving the condyles are often a matter of debate with regards to surgical management. The purpose of this study was to evaluate the efficacy of using closed reduction with an eschmarch bandage, gentle hammering, and use of percutaneous cannulated cancellous screws for fixation and buttressing the fracture, as a treatment modality for specific tibial condyle fractures. Methods : We evaluated 90 closed upper end tibia fractures, Schatzker types I, III, and IV, treated with closed reduction using an esmarch bandage and minimally invasive percutaneus fixation with cannulated cancellous screws. Results : We achieved excellent results in 33.3% of the cases, good result in 50%, a fair result in 13.3 %, and a poor result in 3.3 % cases. Conclusion : This minimally invasive modality of treatment of upper end tibia fractures gives satisfactory results. The use of esmarch bandage and gentle hammering to help achieve acceptable reduction has the advantage of being relatively simple and easily reproducible, without the use of any expensive extra medical equipment. The percutaneous fixation with cancellous screws has minimal morbidity. Thus, this is a good modality of treatment of tibial condlyle fractures of Schatzker types I, III and IV.

  13. EMG and tibial shock upon the first attempt at barefoot running.

    Science.gov (United States)

    Olin, Evan D; Gutierrez, Gregory M

    2013-04-01

    As a potential means to decrease their risk of injury, many runners are transitioning into barefoot running. Habitually shod runners tend to heel-strike (SHS), landing on their heel first, while barefoot runners tend to mid-foot or toe-strike (BTS), landing flat-footed or on the ball of their foot before bringing down the rest of the foot including the heel. This study compared muscle activity, tibial shock, and knee flexion angle in subjects between shod and barefoot conditions. Eighteen habitually SHS recreational runners ran for 3 separate 7-minute trials, including SHS, barefoot heel-strike (BHS), and BTS conditions. EMG, tibial shock, and knee flexion angle were monitored using bipolar surface electrodes, an accelerometer, and an electrogoniometer, respectively. A one-way MANOVA for repeated measures was conducted and several significant changes were noted between SHS and BTS, including significant increases in average EMG of the medial gastrocnemius (p=.05), average and peak tibial shock (p<.01), and the minimum knee flexion angle (p<.01). Based on our data, the initial change in mechanics may have detrimental effects on the runner. While it has been argued that BTS running may ultimately be less injurious, these data indicate that habitually SHS runners who choose to transition into a BTS technique must undertake the process cautiously.

  14. Selective activation of the human tibial and common peroneal nerves with a flat interface nerve electrode

    Science.gov (United States)

    Schiefer, M. A.; Freeberg, M.; Pinault, G. J. C.; Anderson, J.; Hoyen, H.; Tyler, D. J.; Triolo, R. J.

    2013-10-01

    Objective. Electrical stimulation has been shown effective in restoring basic lower extremity motor function in individuals with paralysis. We tested the hypothesis that a flat interface nerve electrode (FINE) placed around the human tibial or common peroneal nerve above the knee can selectively activate each of the most important muscles these nerves innervate for use in a neuroprosthesis to control ankle motion. Approach. During intraoperative trials involving three subjects, an eight-contact FINE was placed around the tibial and/or common peroneal nerve, proximal to the popliteal fossa. The FINE's ability to selectively recruit muscles innervated by these nerves was assessed. Data were used to estimate the potential to restore active plantarflexion or dorsiflexion while balancing inversion and eversion using a biomechanical simulation. Main results. With minimal spillover to non-targets, at least three of the four targets in the tibial nerve, including two of the three muscles constituting the triceps surae, were independently and selectively recruited in all subjects. As acceptable levels of spillover increased, recruitment of the target muscles increased. Selective activation of muscles innervated by the peroneal nerve was more challenging. Significance. Estimated joint moments suggest that plantarflexion sufficient for propulsion during stance phase of gait and dorsiflexion sufficient to prevent foot drop during swing can be achieved, accompanied by a small but tolerable inversion or eversion moment.

  15. One-stage emergency treatment of open grade IIIB tibial shaft fractures with bone loss.

    Science.gov (United States)

    Tropet, Y; Garbuio, P; Obert, L; Jeunet, L; Elias, B

    2001-02-01

    The purpose of this study was to report the authors' experience with emergency reconstruction of severe tibial shaft fractures. Five male patients were admitted to the emergency room with a grade IIIB open tibial shaft fracture with bone loss (average age, 33 years; age range, 18-65 years). Injuries were the result of motorcycle accidents (N = 2), pedestrian accidents (N = 1), gunshot wound (N = 1), and paragliding fall (N = 1). Primary emergent one-stage management for all patients consisted of administration of antibiotics, debridement, stabilization by locked intramedullary nailing, bone grafting from the iliac crest, and coverage using free muscle flaps (four latissimus dorsi and one gracilis). The average follow-up was 21 months (range, 8 months-3.5 years). Partial weight bearing with no immobilization was started at 3 months, and full weight bearing began 5 months after trauma. No angular complications and no nonunions were observed. There was one case of superficial infection without osteitis. All fractures healed within 6 months in 4 patients and within 10 months in 1 patient. At the last follow-up examination, ankle and knee motion was normal and no pain was noted, except for 1 patient who had associated lesions (ankle motion reduced by 50%). Aggressive emergency management of severe open tibial fractures provides good results. It improves end results markedly, not only by reducing tissue loss from infection, but also reducing healing and rehabilitation times.

  16. Experiences and lessons about soft-tissue flaps covering of severe open tibial fracture

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Objective: To sum up experiences and lessons about management of soft-tissue reconstruction in open tibial fracture over a 6-year period.Methods: Twenty-two flap reconstructions were performed to treat soft-tissue defect of 22 patients with open tibial fracture Type IIIB (Gustilo) from 1993 to 1998. The cases were analyzed and discussed retrospectively after follow up of 12-61 months.Results: The size of the flap ranged from 6.6 cm2 to 28.18 cm2 and the rate of flap failure was 13.6%. Besides, 3 partial necrosis and 2 postoperative infections occurred in this series.Conclusions: For soft tissuedefect of delayed open tibial fracture Type HIB, flap reconstruction is still an optimal option. The experiences we obtained are ① to design a triangular skin extension or a small Z-plasty over the pedicle to reduce the flap tension; ② to select a unilateral external fixation to provide convenience for anysecondary manipulation; and ③ to use serial debridementto diminish flap failure. de

  17. Accelerated tibial fracture union in the third trimester of pregnancy: a case report

    Directory of Open Access Journals (Sweden)

    Ahmad Mudussar A

    2008-02-01

    Full Text Available Abstract Introduction We present a case of accelerated tibial fracture union in the third trimester of pregnancy. This is of particular relevance to orthopaedic surgeons, who must be made aware of the potentially accelerated healing response in pregnancy and the requirement for prompt treatment. Case presentation A 40 year old woman at 34 weeks gestational age sustained a displaced fracture of the tibial shaft. This was initially treated conservatively in plaster with view to intra-medullary nailing postpartum. Following an emergency caesarean section, the patient was able to fully weight bear without pain 4 weeks post injury, indicating clinical union. Radiographs demonstrated radiological union with good alignment and abundant callus formation. Fracture union occurred within 4 weeks, less than half the time expected for a conservatively treated tibial shaft fracture. Conclusion Long bone fractures in pregnancy require clear and precise management plans as fracture healing is potentially accelerated. Non-operative treatment is advisable provided satisfactory alignment of the fracture is achieved.

  18. Quadriceps muscle contraction protects the anterior cruciate ligament during anterior tibial translation.

    Science.gov (United States)

    Aune, A K; Cawley, P W; Ekeland, A

    1997-01-01

    The proposed skiing injury mechanism that suggests a quadriceps muscle contraction can contribute to anterior cruciate ligament rupture was biomechanically investigated. The effect of quadriceps muscle force on a knee specimen loaded to anterior cruciate ligament failure during anterior tibial translation was studied in a human cadaveric model. In both knees from six donors, average age 41 years (range, 31 to 65), the joint capsule and ligaments, except the anterior cruciate ligament, were cut. The quadriceps tendon, patella, patellar tendon, and menisci were left intact. One knee from each pair was randomly selected to undergo destructive testing of the anterior cruciate ligament by anterior tibial translation at a displacement rate of 30 mm/sec with a simultaneously applied 889 N quadriceps muscle force. The knee flexion during testing was 30 degrees. As a control, the contralateral knee was loaded correspondingly, but only 5 N of quadriceps muscle force was applied. The ultimate load for the knee to anterior cruciate ligament failure when tested with 889 N quadriceps muscle force was 22% +/- 18% higher than that of knees tested with 5 N of force. The linear stiffness increased by 43% +/- 30%. These results did not support the speculation that a quadriceps muscle contraction contributes to anterior cruciate ligament failure. In this model, the quadriceps muscle force protected the anterior cruciate ligament from injury during anterior tibial translation.

  19. Precision of tibial cartilage morphometry with a coronal water-excitation MR sequence

    Energy Technology Data Exchange (ETDEWEB)

    Hyhlik-Duerr, A. [Musculoskeletal Research Group, Institute of Anatomy, Ludwig-Maximilians-Universitaet, Muenchen (Germany); Klinik fuer Orthopaedie und Sportorthopaedie der Technischen Universitaet, Muenchen (Germany); Faber, S.; Reiser, M. [Klinik fuer Orthopaedie und Sportorthopaedie der Technischen Universitaet, Muenchen (Germany); Burgkart, R. [Institut fuer Medizinische Informatik und Systemforschung (MEDIS), GSF-Forschungszentrum fuer Umwelt und Gesundheit, Neuherberg, Oberschleissheim (Germany); Stammberger, T.; Englmeier, K.H. [Institut fuer Medizinische Informationsverarbeitung, Biometrie und Epidemiologie, Klinikum Grosshadern, Marchioninistrasse 15, D-81377 Munich (Germany); Maag, K.P. [Institut fuer Radiologische Diagnostik, Klinikum der Ludwig-Maximilians-Universitaet, Muenchen (Germany); Eckstein, F. [Musculoskeletal Research Group, Institute of Anatomy, Ludwig-Maximilians-Universitaet, Muenchen (Germany)

    2000-02-01

    The aim of this study was to analyze the precision of tibial cartilage morphometry, by using a fast, coronal water-excitation sequence with high spatial resolution, to compare the reproducibility of 3D thickness vs volume estimates, and to test the technique in patients with severe osteoarthritis. The tibiae of 8 healthy volunteers and 3 patients selected for total knee arthroplasty were imaged repeatedly with a water-excitation sequence (image time 6 h 19 min, resolution 1.2 x 0.31 x 0.31 mm{sup 3}), with the knee being repositioned between each replicate acquisition. After 3D reconstruction, the cartilage volume, the mean, and the maximal tibial cartilage thickness were determined by 3D Euclidean distance transformation. In the volunteers, the precision of the volume measurements was 2.3 % (CV%) in the medial and 2.6 % in the lateral tibia. The reproducibility of the mean cartilage thickness was similar (2.6 and 2.5 %, respectively), and that of the maximal thickness lower (6.5 and 4.4 %). The patients showed a considerable reduction in volume and thickness, the precision being comparable with that in the volunteers. We find that, using a new imaging protocol and computational algorithm, it is possible to determine tibial cartilage morphometry with high precision in healthy individuals as well as in patients with osteoarthritis. (orig.)

  20. Is it safe to place a tibial intramedullary nail through a traumatic knee arthrotomy?

    Science.gov (United States)

    Bauer, Jennifer M; Bible, Jesse E; Mir, Hassan R

    2014-03-01

    We conducted a study to compare postoperative infection and nonunion rates in tibial intramedullary nails (IMNs) placed through either uninjured knees or traumatic knee arthrotomies (KAs). We reviewed all adult tibial diaphyseal fractures (n = 1378) treated with an IMN between 1998 and 2010. Fourteen of these nails were placed through a traumatic KA. Each patient in the study group was assigned 4 separate matched controls for comparison. Controls were matched on age, sex, diabetes, smoking, and fracture classification (closed or open with Gustilo-Anderson). There were no postoperative infections (knee or fracture site) in the traumatic KA group and 2 (3.5%) in the control group (P = .473). One nonunion (7.1%) was noted in the traumatic KA group, and 9 (16%) were noted in the control group (P = .6694). To our knowledge, this is the first study to report outcomes of placing tibial IMNs through traumatic KAs. In our sample, the practice presented no increased risk either for infection (at the knee or the fracture site) or for nonunion with appropriate surgical debridement.

  1. Localization of the autonomic, somatic and sensory neurons innervating the cranial tibial muscle of the pig.

    Science.gov (United States)

    Botti, Maddalena; Gazza, Ferdinando; Ragionieri, Luisa; Minelli, Luisa Bo; Panu, Rino

    2011-01-01

    The location of sympathetic, somatic and sensory neurons projecting to the cranial tibial muscle of the pig hindlimb was studied with the neuronal non-transynaptic tracer Fast Blue. Additionally, the number and the size of these neurons were determinated. The Fast blue, randomly applied to the cranial tibial muscle belly of 3 pigs, labelled sympathetic neurons in the ipsilateral L5-S3 and contralateral S1 sympathetic trunk ganglia and in the prevertebral caudal mesenteric ganglia of both sides. The somatic motoneurons were identified in the ipsilateral ventral horn of the S1 segment of spinal cord, while the sensory neurons were located in the ipsilateral L7-S1 spinal ganglia. The diameter of the multipolar sympathetic neurons oscillated between 26 and 46 microm in the sympathetic trunk ganglia and between 18 and 42 microm in the caudal mesenteric ganglia. The size of the multipolar spinal motoneurons oscillated between 33 and 102 microm. The size of the pseudounipolar sensory neurons oscillated between 23 and 67 microm. In all ganglia, the labelled neurons were localized at random and did not show a somatotopic distribution. Our results document a conspicuous autonomic innervation projecting to the "classic" skeletal cranial tibial muscle. Probably this innervation is destined to the muscle vessels.

  2. Iatrogenic “buffalo chest” bilateral pneumothoraces following unilateral transbronchial lung biopsies in a bilateral lung transplant recipient

    Directory of Open Access Journals (Sweden)

    Leith Sawalha

    2015-01-01

    Full Text Available We present a 54 year old male patient who had a bilateral lung transplant sixteen years ago for Alpha-1 Antitrypsin Deficiency-related emphysema. He was referred for flexible bronchoscopy with transbronchial biopsies to evaluate new mild exertional dyspnea and worsening of his FEV1. Eight transbronchial biopsies were done from the right middle lobe and the right lower lobe. Post procedure he developed bilateral pneumothoces that required emergent bilateral pleural ‘pigtail’ catheters. To our knowledge, this is the first reported case of bilateral pneumothoraces that developed after a unilateral procedure in a bilateral lung transplant recipient relatively late after the transplant.

  3. Economic Diplomacy in Africa: The Impact of Regional Integration versus Bilateral Diplomacy on Bilateral Trade

    DEFF Research Database (Denmark)

    Afesorgbor, Sylvanus Kwaku

    The paper examines the impact of two main instruments of economic diplomacy — regional integration and commercial diplomacy on export flows among African states. We test whether there is any evidence of a trade-off or complementary interaction between these two instruments in trade facilitation. We...... compare the effects of these two instruments of economic diplomacy on bilateral trade by employing a gravity model for 45 African states over the period 1980-2005. The results show that bilateral diplomatic exchange is a relatively more significant determinant of bilateral exports among African states...... compared to regional integration. We also find a nuanced interaction between these two instruments of economic diplomacy: the trade–stimulating effect of diplomatic exchange is less pronounced among African countries that shared membership of the same regional bloc. Generally, this could mean...

  4. Ceratite bilateral por Acanthamoeba: relato de caso Bilateral Acanthamoeba keratitis: case report

    Directory of Open Access Journals (Sweden)

    Wilson Nahmatallah Obeid

    2003-12-01

    Full Text Available A ceratite por Acanthamoeba é uma infecção ocular grave que, apesar dos recentes progressos no diagnóstico e tratamento, ainda provoca prolongada morbidade e perda da acuidade visual. Relatamos um caso de ceratite bilateral por Acanthamoeba em usuário de lentes de contato, que é o primeiro caso descrito na literatura brasileira.Acanthamoeba keratitis is a severe ocular infection which even with recent progress in diagnosis and treatment still causes long morbidity and loss of visual acuity. We describe a case of bilateral Acanthamoeba keratitis in a user of contact lenses, which is the first case discussed in Brazilian literature.

  5. Aetiology and mechanisms of injury in medial tibial stress syndrome: Current and future developments

    Science.gov (United States)

    Franklyn, Melanie; Oakes, Barry

    2015-01-01

    Medial tibial stress syndrome (MTSS) is a debilitating overuse injury of the tibia sustained by individuals who perform recurrent impact exercise such as athletes and military recruits. Characterised by diffuse tibial anteromedial or posteromedial surface subcutaneous periostitis, in most cases it is also an injury involving underlying cortical bone microtrauma, although it is not clear if the soft tissue or cortical bone reaction occurs first. Nuclear bone scans and magnetic resonance imaging (MRI) can both be used for the diagnosis of MTSS, but the patient’s history and clinical symptoms need to be considered in conjunction with the imaging findings for a correct interpretation of the results, as both imaging modalities have demonstrated positive findings in the absence of injury. However, MRI is rapidly becoming the preferred imaging modality for the diagnosis of bone stress injuries. It can also be used for the early diagnosis of MTSS, as the developing periosteal oedema can be identified. Retrospective studies have demonstrated that MTSS patients have lower bone mineral density (BMD) at the injury site than exercising controls, and preliminary data indicates the BMD is lower in MTSS subjects than tibial stress fracture (TSF) subjects. The values of a number of tibial geometric parameters such as cross-sectional area and section modulus are also lower in MTSS subjects than exercising controls, but not as low as the values in TSF subjects. Thus, the balance between BMD and cortical bone geometry may predict an individual's likelihood of developing MTSS. However, prospective longitudinal studies are needed to determine how these factors alter during the development of the injury and to find the detailed structural cause, which is still unknown. Finite element analysis has recently been used to examine the mechanisms involved in tibial stress injuries and offer a promising future tool to understand the mechanisms involved in MTSS. Contemporary accurate diagnosis

  6. Aetiology and mechanisms of injury in medial tibial stress syndrome: Current and future developments.

    Science.gov (United States)

    Franklyn, Melanie; Oakes, Barry

    2015-09-18

    Medial tibial stress syndrome (MTSS) is a debilitating overuse injury of the tibia sustained by individuals who perform recurrent impact exercise such as athletes and military recruits. Characterised by diffuse tibial anteromedial or posteromedial surface subcutaneous periostitis, in most cases it is also an injury involving underlying cortical bone microtrauma, although it is not clear if the soft tissue or cortical bone reaction occurs first. Nuclear bone scans and magnetic resonance imaging (MRI) can both be used for the diagnosis of MTSS, but the patient's history and clinical symptoms need to be considered in conjunction with the imaging findings for a correct interpretation of the results, as both imaging modalities have demonstrated positive findings in the absence of injury. However, MRI is rapidly becoming the preferred imaging modality for the diagnosis of bone stress injuries. It can also be used for the early diagnosis of MTSS, as the developing periosteal oedema can be identified. Retrospective studies have demonstrated that MTSS patients have lower bone mineral density (BMD) at the injury site than exercising controls, and preliminary data indicates the BMD is lower in MTSS subjects than tibial stress fracture (TSF) subjects. The values of a number of tibial geometric parameters such as cross-sectional area and section modulus are also lower in MTSS subjects than exercising controls, but not as low as the values in TSF subjects. Thus, the balance between BMD and cortical bone geometry may predict an individual's likelihood of developing MTSS. However, prospective longitudinal studies are needed to determine how these factors alter during the development of the injury and to find the detailed structural cause, which is still unknown. Finite element analysis has recently been used to examine the mechanisms involved in tibial stress injuries and offer a promising future tool to understand the mechanisms involved in MTSS. Contemporary accurate diagnosis

  7. Bilateral maculopathy associated with Pierre Robin sequence.

    Science.gov (United States)

    Witmer, Matthew T; Vasan, Ryan; Levy, Richard; Davis, Jessica; Chan, R V Paul

    2012-08-01

    Pierre Robin sequence has been associated with a number of ocular complications, including myopia, strabismus, Möbius syndrome, nasolacrimal duct obstruction, glaucoma, cataract, microphthalmos, coloboma of choroid, and retinal detachment. We report a 10-day-old boy who presented with micrognathia, glossoptosis, and cleft palate as well as multiple congenital anomalies. Ophthalmic examination was notable for bilateral maculopathy, with focal areas of retinal and retinal pigment epithelial atrophy. The association of Pierre Robin sequence and maculopathy has been reported only twice previously.

  8. Bilateral Pseudoexfoliation Deposits on Intraocular Lens Implants

    Directory of Open Access Journals (Sweden)

    Elena Bonafonte Marquez

    2015-01-01

    Full Text Available We present a rare case of bilateral pseudoexfoliative deposits on both intraocular lens (IOL implants in an 83-year-old woman with no other associated pathology, 5 years after cataract surgery. Pseudoexfoliation syndrome is the most common cause of secondary open-angle glaucoma worldwide and these deposits are usually found on the natural lens. The fact that pseudoexfoliative deposits have been found on IOL implants implies the need for a thorough examination in pseudophakic patients, for it could be the only sign of secondary glaucoma.

  9. Bilateral amaurosis caused by Salmonella enteritidis infection.

    Science.gov (United States)

    Cerovski, Branimir; Barisić, Nina; Vidović, Tomislav; Petricek, Igor; Cerovski, Jasenka

    2004-12-01

    The aim of this paper was to show the potential of Salmonella enteritidis infection to eventually result in visual impairment. A case of salmonellosis in a 6-year-old boy, caused by intake of a cake made from eggs infected with Salmonella enteritidis, is presented. Prolonged duration of the disease was followed by complete remission of neurologic complications and persistent amaurosis with bilateral optic nerve atrophy. A severe form of Salmonella enterocolitis with neurologic involvement can lead to optic nerve lesion with consequential loss of vision.

  10. Primary amenorrhea with bilateral endometriotic cysts.

    Science.gov (United States)

    Jabeen, Sadaqat; Raees, Mehnaz

    2015-05-01

    Primary amenorrhea is a common problem. Diagnosis is usually by going through systematic approach of history, examination and investigations. This case had bilateral large endometriotic cysts in the adnexal region. Uterus was normal sized with well-formed endometrium. She underwent laparotomy followed by drainage of endometriotic cysts, stripping and reconstruction of ovaries was performed. Patient was given a trial of combined oral contraceptive pills for two consecutive cycles to observe withdrawal bleeding, but it failed. Till now we are unable to find out such case in literature. Exact case of primary amenorrhea could not be found.

  11. Spontan bilateral ekstrauterin graviditet efter kejsersnit

    DEFF Research Database (Denmark)

    Petersen, Jesper Friis; Ekelund, Charlotte; Settnes, Annette

    2015-01-01

    contralateral tube. The woman was readmitted three weeks later and had an additional salpingectomy on behalf of an unrecognized tubal pregnancy. Considering the rising caesarean section rates clinicians need to be certain of no additional ectopic pregnancy while performing the primary operation.......We describe a rare case of bilateral tubal pregnancy following natural conception in a woman with no other known risk factor than two former caesarean sections. Intraabdominal adhesions following the caesarean sections complicated the salpingectomy thus diminishing certainty of a healthy...

  12. Panuveite bilateral simultânea

    OpenAIRE

    RAMALHO, M.; Coutinho, I; Pina, S.; Santos, C.; Pedrosa, C; Vaz, F.; Chang, N; Bernardo, M.

    2013-01-01

    Introdução Tem sido descrito um ressurgimento da sífilis desde o final da década de 90. Descrevem-se dois casos clínicos de um casal homossexual com panuveite bilateral sifilítica simultânea. Métodos O primeiro caso clinico é de um homem de 31 anos, homossexual, com antecedentes de Hepatite C desde há 7 anos e diagnóstico de VIH-1 realizado 3 meses antes no contexto de úlcera peniana, VDRL negativo na altura, tendo iniciado terapêutica anti-retroviral mês e meio antes. Apresentou-se ...

  13. Hypersexuality following bilateral thalamic infarction: case report.

    Science.gov (United States)

    Mutarelli, Eduardo G; Omuro, Antonio M P; Adoni, Tarso

    2006-03-01

    Hypersexuality is a rare but well recognized condition following brain injury. It has been described secondarily to dysfunction in the hypothalamus, the temporal and frontal lobes. We report a 63 year-old man that developed neuropsychological disturbances with hypersexuality as a prominent feature, disinhibition and moderate memory loss, hypersomnia and irritability after a bilateral paramedian thalamic infarction. A SPECT showed frontal hypoperfusion. We believe that these findings are expression of frontal-subcortical circuits dysfunction, particularly the orbitofrontal circuit, secondary to dorso medial thalamic infarction which probably plays a role in the determination of human sexual behavior. This case favors a thalamic modulation of frontal function.

  14. Bilateral pneumothoraces secondary to acupuncture therapy.

    Science.gov (United States)

    Nguyen, Theresa M; Roy, Neil K; Zlupko, George R

    2011-09-01

    Acupuncture is becoming increasingly popular in the United States for a wide variety of uses, ranging from the treatment of chronic back pain to aiding in addiction therapy. As this form of complementary and alternative medicine becomes more prevalent in certain areas of the country, it is of paramount importance that the emergency physician be familiar with its methods and potential complications. In general, acupuncture is perceived as fairly safe. However, it is not without risks or side effects. In this case report, we discuss the history, methods, and common complications of acupuncture in the context of a patient who presented to the Emergency Department (ED) with bilateral pneumothoraces secondary to acupuncture therapy.

  15. Espasmo hemifacial bilateral: relato de caso

    OpenAIRE

    Machado Flavia Costa Nunes; Fregni Felipe; Campos Cynthia Resende; Limongi João Carlos Papaterra

    2003-01-01

    Espasmo hemifacial bilateral é um distúrbio de movimento raro geralmente associado à compressão vascular dos nervos faciais. Caracteriza-se clinicamente por contrações assimétricas e assíncronas da musculatura facial e por longa latência entre a instalação dos movimentos em cada hemiface. Deve ser diferenciado de outras condições como blefaroespasmo, miocimia facial, tiques faciais, distonia oromandibular e espasmo hemimastigatório. O tratamento sintomático mais eficaz e menos invasivo consis...

  16. Bilateral generating functions and operational methods

    Energy Technology Data Exchange (ETDEWEB)

    Dattoli, G. [ENEA, Divisione Fisica Applicata, Centro Ricerche Frascati, Frascati, RM (Italy)

    2000-07-01

    Bilateral generating functions are those involving products of different types of polynomials. It is showed that operational methods offer a powerful tool to derive these families of generating functions. Cases relevant to products of Hermite and Laguerre, Hermite and Legendre ... polynomials and propose further extensions of the method are studied in this report. [Italian] Le funzioni generatrici bilaterali sono quelle che coinvolgono prodotti di tipi differenti di polinomi, si dimostra che i metodi operazionali offrono uno strumento potente per derivare queste nuove famiglie di funzioni speciali. Si studiano casi relativi a prodotti di polinomi di Hermite e Laguerre, Hermite e Legendre. Si propongono infine possibili estensioni del metodo.

  17. Bilateral Nasoalveolar Cyst Causing Nasal Obstruction

    Directory of Open Access Journals (Sweden)

    Uzeyir Yildizoglu

    2016-01-01

    Full Text Available Nasoalveolar cysts, which originate from epithelial remnants of nasolacrimal duct, are nonodontogenic soft tissue lesions of the upper jaw. These cysts are thought to be developmental and are presented with fullness in the upper lip and nose, swelling on the palate, and sometimes nasal obstruction. Because of cosmetic problems, they are often diagnosed at an early stage. These lesions are mostly revealed unilaterally but also can be seen on both sides. In this case report, a patient who complained of nasal obstruction and then diagnosed with bilateral nasoalveolar cysts and treated by sublabial excision is presented and clinical features and treatment approaches are discussed with the review of literature.

  18. Bilateral Nasoalveolar Cyst Causing Nasal Obstruction

    Science.gov (United States)

    Yildizoglu, Uzeyir; Polat, Bahtiyar; Durmaz, Abdullah

    2016-01-01

    Nasoalveolar cysts, which originate from epithelial remnants of nasolacrimal duct, are nonodontogenic soft tissue lesions of the upper jaw. These cysts are thought to be developmental and are presented with fullness in the upper lip and nose, swelling on the palate, and sometimes nasal obstruction. Because of cosmetic problems, they are often diagnosed at an early stage. These lesions are mostly revealed unilaterally but also can be seen on both sides. In this case report, a patient who complained of nasal obstruction and then diagnosed with bilateral nasoalveolar cysts and treated by sublabial excision is presented and clinical features and treatment approaches are discussed with the review of literature. PMID:27980871

  19. Estudo do desvio rotacional da tíbia Study of the tibial rotational deviation

    Directory of Open Access Journals (Sweden)

    Pedro José Labronici

    2008-01-01

    Full Text Available OBJETIVO: avaliar o desvio rotacional pós-operatório das fraturas diafisárias da tíbia de pacientes tratadas com haste intramedular bloqueada não-fresada e placa em ponte, utilizando a tomografia computadorizada. MÉTODOS: foram tratados 113 pacientes com fraturas diafisárias da tíbia, sendo que em 42 fraturas os autores utilizaram haste intramedular bloqueada e em 71 foram utilizadas placa em ponte. O método tomográfico utilizado ara se obter as medidas da rotação tibial. Foi empregada a classificação AO das fraturas; à exposição: fechadas e expostas e a percentagem de desvios em rotação interna e externa. RESULTADOS: foi demonstrado não haver diferença significativa de rotação tibial nos seguintes parâmetros analisados: localização, rotação interna ou externa e nos tipos A e B da classificação AO. Porém, nas fraturas do tipo C e nas fraturas expostas, a haste intramedular bloqueada apresentou diferença rotacional significativamente menor (p = 0,028 e (p = 0,05, quando comparada à placa em ponte. CONCLUSÃO: independente da localização das fraturas diafisárias da tíbia, os desvios rotacionais estão relacionados à energia do trauma, apresentando uma maior dificuldade de controle com a técnica placa em ponte.OBJECTIVE: to evaluate the postoperative rotational deviation of diaphyseal tibial fractures in patients treated with non-reamed, interlocking intramedullary nailing and bridge plate, using computerized tomography for measurement. METHOD: one hundred and thirteen patients with diaphyseal tibial fractures were treated; 42 fractures were treated with non-reamed, interlocking intramedullary nailing, and 71 fractures were treated with bridge plate. Tibial rotation measurements were obtained by using the CT scan. All of the fractures were classified by the AO scale, by their presentation (closed and open and the percentage of deviation on internal and external rotation. RESULTS: no significant difference in

  20. Arthroscopic guided biopsy and radiofrequency thermoablation of a benign neoplasm of the tibial spines area: a treatment option

    Directory of Open Access Journals (Sweden)

    Zoccali Carmine

    2012-04-01

    Full Text Available Abstract Background Lesions located in the area of the tibial spines are rare. In most cases, treatment follows histological diagnosis, but when imaging and clinical data are considered to be "very" characteristic for benign lesions, such as chondroblastoma or osteoid osteoma, treatment may be performed without biopsy. Traditional curettage requires opening the joint, which presents a high risk of contamination of the joint itself and surrounding structures, such as the popliteal area, with possible contamination of the neurovascular bundle when performing curettage with the posterior approach. In this case, the re-excision of a local recurrence would be extremely difficult. Results We describe a technique using arthroscopic guidance for radiofrequency thermoablation of a benign lesion in the tibial spines area. We report on an illustrative case. The patient so treated, reported immediate relief from the pain, and after two weeks, was free of pain. The biopsy performed before the treatment confirmed the radiological diagnosis of chondroblastoma. At one year of follow-up, the patient is without pain, with a 0-130°range of motion, has no activity limitations and is apparently free of disease. Conclusion This technique allows a radiofrequency thermoablation of a lesion in the tibial spines area and in the posterior tibial surface to be performed without opening the joint, monitoring the tibial plateau surface, probably decreasing the risk of cartilage damage. Unfortunately, in the case presented, the high pressure from the arthroscopy's pump broke the tibial plateau surface creating a communication to the tibial tunnel used for thermoablation.

  1. Tibial-inlay技术重建合并胫骨干骨折膝关节后交叉韧带断裂8例%Tibial-inlay technique used in reconstruction of posterior cruciate ligament with concomitant ipsilateral tibial shaft fracture in 8 cases

    Institute of Scientific and Technical Information of China (English)

    张义龙; 李宁; 李志怀; 刘建丰; 宋有鑫; 孙志杰

    2011-01-01

    背景:胫骨干骨折伴有同侧的后交叉韧带损伤在行内固定后,行经胫骨隧道技术重建后叉韧带时常会引起金属内固定物与胫骨隧道发生冲突,使内固定物应用受到一定限制.目的:评估Tibial-inlay技术重建合并胫骨干骨折的膝关节后交叉韧带效果.方法:选择胫骨干骨折合并同侧后交叉韧带断裂患者8例,于胫骨骨折置入金属植入物内固定后1~6个月在关节镜辅助下行Tibial-inlay技术重建后交叉韧带,重建前、随访时记录膝关节Lysholm功能评分及胫骨后移程度.结果与结论:随访12~24个月,重建前患侧胫骨后移10~15 mm者 5例,>15 mm 者3例;末次随访时< 5 mm者 6例,5~10 mm 者2例;末次随访Lysholm膝关节功能评分由重建前的63.50±5.83提高到87.50±2.33,差异有显著性意义(P < 0.05).表明Tibial-inlay技术重建胫骨干骨折合并后交叉韧带损伤具有不受胫骨近端骨隧道的影响,对胫骨内固定干扰小,固定可靠的优点.%BACKGROUND: The reconstruction of posterior cruciate ligament (PCL) by tibial tunnel method is limited in treating PCL tear with concomitant ipsilateral tibial shaft fracture which is operated by internal fixation firstly, because there is the internal fixation in the proximal tibia, which can interfere with the making of tibial tunnel.OBJECTIVE: To evaluate the Tibial-inlay technique effects on reconstruction of PCL combined with concomitant ipsilateral tibial shaft fracture.METHODS: Eight knees with PCL tear and concomitant ipsilateral tibial shaft fracture in 8 patients were verified with physical examination, medical image and arthroscopy. All the damaged PCLs were reconstructed with allograft tendons by Tibial-inlay technique under a rth roscopy 1 -6 months after the first internal fixation. The instability degree of post draw test and the Lysholm score of the knees were recorded before operations and at follow-up.RESULTS AND CONCLUSION: All of them we re followed up for

  2. Bilateral osteoarthritis of the trapeziometacarpal joint treated by bilateral tendon interposition arthroplasty

    NARCIS (Netherlands)

    Damen, A; vanderLei, B; Robinson, PH

    1997-01-01

    Twenty-four flexor carpi radialis (FCR) tendon interposition arthroplasties of the trapezium for bilateral trapeziometacarpal osteoarthritis were reviewed. Pain was reduced in all cases. Function was improved in all right hands and in 92% of the left hands. FCR tendon interposition arthroplasty for

  3. Bilateral Electrical Cataract: A Case Report

    Directory of Open Access Journals (Sweden)

    Selçuk Sızmaz

    2011-06-01

    Full Text Available To present a rare complication, such as bilateral cataracts, in a man who sustained a high-voltage electrical injury. A 35- year-old man was admitted with a complaint of decrease in visual acuity. He had a history of a contact with a power line carrying 30.000 volts of electricity while working at a construction site. Examination at a burn center revealed second-degree facial, neck and left foot burns. One month later, the patient underwent amputation of fourth and fifth toes of his left foot. During the next 6 months, he noted decreasing vision in both eyes. Ocular examination 1 year after the accident revealed that the patient’s visual acuity had deteriorated to 1/10 in both eyes. The cornea on the left eye showed superficial punctate opacities. The lenses in both eyes had anterior subcapsular cortical lens opacities and posterior subcapsular opacities. Uncomplicated bilateral phacoemulsification surgery with intraocular lens implantation was performed and the patient’s visual acuity returned to 10/10 in both eyes. We noted that the fundus remained normal in both eyes. Electrical cataracts are still a serious potential complication that may occur after electrical injury. Awareness of this by burn team members is important for providing optimal treatment to those who have suffered an electrical injury. (Turk J Ophthalmol 2011; 41: 197-9

  4. Anaesthetic consideration during laparoscopic bilateral simultaneous nephrectomy

    Directory of Open Access Journals (Sweden)

    Manisha P Modi

    2014-01-01

    Full Text Available Study Objective: To assess outcome from anaesthesia during laparoscopic bilateral simultaneous nephrectomy. Design: Retrospective study. Measurements: Preoperative Hb%, serum potassium, coagulation profile electrocardiography (ECG changes, 2D Echography, x-ray chest, haemodynamic changes, end-tidal carbon dioxide (EtCO 2 , fluid management and postoperative analgesia. Results: The mean age was 24.75 ± 14.35 years. The mean duration of surgery was 120 ± 80 minutes. The Hb%, serum creatinine and serum potassium were 9.4 ± 1.04%, 6.79 ± 4.91 meq/L and 3.61 ± 0.51 meq/L, respectively. Pulse rate mean blood pressure and EtCO 2 were recorded after creation of pneumoperitoneum and at 15, 30, 45 and after exsufflation of pneumoperitoneum. After pneumoperitoneum, there was increase in pulse rate, systolic blood pressure, diastolic blood pressure and EtCO 2 . After 30 minutes and throughout the surgery, these variables remained stable. Four patients required nitroglycerine infusion for intraoperative hypertention. Only one patient required packed cell volume (PCV transfusion and total intravenous fluid was 1 ± 0.5 L. At the time of exsufflation, there was decrease in pulse rate, systolic and diastolic blood pressure and EtCO 2 . Conclusion: Because of advancement in anaesthetic agents and muscle relaxant, there is safe outcome from anaesthesia during laparoscopic bilateral simultaneous nephrectomy.

  5. A RARE CASE OF BILATERAL MICROSPHEREPHAKIA

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    Pandu

    2015-05-01

    Full Text Available Microspherophakia is rare bilateral congenital anamoly of the crystalline lens. The condition may be isolated , familial or it may be associated with systemic affections like Marfan's syndrome , Weil - Marchesani syndrome , hyperlysinemia and congenital rubella. Microspherophakia results in lenticular myopia , lens dislocation , usually inferiorly and inverse glaucoma. We present a case in a 8 year old child who presented with bilateral microspherophakia and anterior dislocation of lens of right eye. visual acuity in right eye was counting fingers close to face and i n left eye 6/60.IOP with perkins applanation tonometer was 30mmHg in right eye 22mmHg in left eye , cornea was hazy due to edema , anterior chamber was shallow in both eye patient was managed with emergency lens extraction of right eye and secondary ACIOL im plantation. Left eye was managed by laser peripheral iridotomy. IOP was within normal limits postoperatively in both eyes without any antiglaucoma medications. Postoperatively best corrected visual acuity in right was 6/18 and 6/9 in left eye.

  6. Unusual Bilateral Rim Fracture in Femoroacetabular Impingement

    Directory of Open Access Journals (Sweden)

    Claudio Rafols

    2015-01-01

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

  7. Bilateral Pneumothoraces Following Central Venous Cannulation

    Directory of Open Access Journals (Sweden)

    F. Pazos

    2009-01-01

    Full Text Available We report the occurrence of a bilateral pneumothoraces after unilateral central venous catheterization of the right subclavian vein in a 70-year-old patient. The patient had no history of pulmonary or pleural disease and no history of cardiothoracic surgery. Two days earlier, she had a median laparotomy under general and epidural anaesthesia. Prior to the procedure, the patient was hemodynamically stable and her transcutaneous oxygen saturation was 97% in room air. We punctured the right pleural space before cannulation of the right subclavian vein. After the procedure, the patient slowly became hemodynamically instable with respiratory distress. A chest radiograph revealed a complete left-side pneumothorax and a mild right-side pneumothorax. The right-side pneumothorax became under tension after left chest tube insertion. The symptoms finally resolved after insertion of a right chest tube. After a diagnostic work-up, we suspect a congenital “Buffalo chests” explaining bilateral pneumothoraces and a secondary tension pneumothorax.

  8. Bilateral acute retinal necrosis after herpetic meningitis

    Directory of Open Access Journals (Sweden)

    Katsura T

    2012-04-01

    Full Text Available Keisho Hirota1,2, Masayuki Akimoto1,3, Toshiaki Katsura21Department of Ophthalmology, Kyoto Medical Center, National Hospital Organization, 2Internal Medicine, Kyoto Medical Center, 3Clinical Research Center, Kyoto Medical Center, Kyoto, JapanPurpose: The report of a case of bilateral acute retinal necrosis after herpetic meningitis.Case report: A 47-year-old man was admitted with the chief complaint of persistent high fever and transient loss of consciousness. Although his general condition improved after intravenous acyclovir administration, the patient presented with visual loss in both eyes 4 days after admission. Visual acuity in his right eye was 20/200 and his left eye had light perception alone. Both eyes showed panretinal arteritis diagnosed as acute retinal necrosis. Panretinal photocoagulation was performed for both eyes. Progression of retinal detachment was prevented in both eyes; however, visual acuity of the left eye was totally lost because of neovascular glaucoma. Visual acuity of the right eye recovered to 20/20.Conclusion: Although cases of bilateral acute retinal necrosis have been reported after herpetic encephalitis, this condition is rare after herpetic meningitis. Prophylactic acyclovir therapy and early panretinal photocoagulation may prevent retinal detachment and improve the prognosis. Neurologists and ophthalmologists should be aware that not only herpetic encephalitis but also herpetic meningitis can lead to acute retinal necrosis within a very short interval.Keywords: acute retinal necrosis, herpetic meningitis, herpes simplex, varicella zoster virus

  9. [Synchronous bilateral breast cancer in a male].

    Science.gov (United States)

    García-Mejido, José Antonio; Delgado-Jiménez, Carmen; Gutiérrez-Palomino, Laura; Sánchez-Sevilla, Miguel; Iglesias-Bravo, Eva; Caballero-Fernández, Virginia

    2013-01-01

    antecedentes: el cáncer de mama en el hombre es una enfermedad con baja incidencia, que se reduce aún más cuando es bilateral sincrónica. Existen pocas publicaciones en los últimos años. Objetivo: establecer pautas para el tratamiento de este cáncer, aunque sea infrecuente. Caso clínico: paciente masculino de 75 años de edad, con tumores en ambas mamas, que se le resecaron completamente con exéresis de ganglios palpables. El estudio histopatológico informó que se trataba de un carcinoma ductal infiltrante no especificado. Se indicó tratamiento adyuvante con tamoxifeno y radioterapia; en la actualidad está libre de enfermedad. Conclusiones: el carcinoma mamario bilateral sincrónico en el varón es una enfermedad poco frecuente. Su tratamiento principal es la cirugía, de ahí la importancia del diagnóstico temprano. En la mayoría de los casos se requiere quimioterapia y radioterapia adyuvante porque suelen diagnosticarse en un estadio avanzado.

  10. Influence of unilateral weight on bilateral cyclograms

    Science.gov (United States)

    Pellicer Costa, Juan José; Dusza, Jacek J.

    2014-11-01

    The paper presents the results of gait parameters as a function of unilateral weight. The object of the research was a woman walking on a stationary surface and carrying in his hand weights from 0 to 15 kg. Her movement was recorded by 6 cameras recording the location of 34 markers placed at appropriate points in the body. 3D reconstruction was performed for each of the reflecting markers. Tested signals were changes in the value the joint angles of ankle, knee and hip. On the basis of about 6 cycles of movement of each load, a model for the average gait cycle was developed. The result of the experiments are graphs of changes the joint angles as a function of time, bilateral cyclograms, synchronized bilateral cyclograms and regression lines. The conclusion of the study is to determine how one-sided load affects gait asymmetry. Simple and easy to interpret method of presentation of results were also shown. Studies were conducted using VICON system.

  11. Clinical Subgroups in Bilateral Meniere Disease

    Science.gov (United States)

    Frejo, Lidia; Soto-Varela, Andres; Santos-Perez, Sofía; Aran, Ismael; Batuecas-Caletrio, Angel; Perez-Guillen, Vanesa; Perez-Garrigues, Herminio; Fraile, Jesus; Martin-Sanz, Eduardo; Tapia, Maria C.; Trinidad, Gabriel; García-Arumi, Ana María; González-Aguado, Rocío; Espinosa-Sanchez, Juan M.; Marques, Pedro; Perez, Paz; Benitez, Jesus; Lopez-Escamez, Jose A.

    2016-01-01

    Meniere disease (MD) is a heterogeneous clinical condition characterized by sensorineural hearing loss, episodic vestibular symptoms, and tinnitus associated with several comorbidities, such as migraine or autoimmune disorders (AD). The frequency of bilateral involvement may range from 5 to 50%, and it depends on the duration of the disease. We have performed a two-step cluster analysis in 398 patients with bilateral MD (BMD) to identify the best predictors to define clinical subgroups with a potential different etiology to improve the phenotyping of BMD and to develop new treatments. We have defined five clinical variants in BMD. Group 1 is the most frequently found, includes 46% of patients, and is defined by metachronic hearing loss without migraine and without AD. Group 2 is found in 17% of patients, and it is defined by synchronic hearing loss without migraine or AD. Group 3, with 13% of patients, is characterized by familial MD, while group 4, that includes 12% of patients, is associated by the presence of migraine in all cases. Group 5 is found in 11% of patients and is defined by AD. This approach can be helpful in selecting patients for genetic and clinical research. However, further studies will be required to improve the phenotyping in these clinical variants for a better understanding of the diverse etiological factors contributing to BMD. PMID:27822199

  12. The bilateral advantage for famous faces: interhemispheric communication or competition?

    Science.gov (United States)

    Baird, Lyndsay M; Burton, A Mike

    2008-04-01

    The bilateral advantage for the perception of famous faces was investigated using a redundant target procedure. In experiment 1 we compared simultaneous presentation of stimuli (a) bilaterally and (b) one above the other in the central field. Results showed a redundancy advantage, but only when faces were presented bilaterally. This result lends support to the notion of interhemispheric communication using cross-hemisphere representations. Experiment 2 examined the nature of such communication by comparing bilateral presentation of identical face images, with bilateral presentation of different images of the same person. When asked to make a familiar/unfamiliar face judgement, participants showed evidence for a redundancy advantage under both bilateral conditions. This suggests that the nature of the information shared in interhemispheric communication is abstract, rather than being tied to superficial stimulus properties.

  13. Combined common peroneal and tibial nerve injury after knee dislocation: one injury or two? An MRI-clinical correlation.

    Science.gov (United States)

    Reddy, Chandan G; Amrami, Kimberly K; Howe, Benjamin M; Spinner, Robert J

    2015-09-01

    OBJECT Knee dislocations are often accompanied by stretch injuries to the common peroneal nerve (CPN). A small subset of these injuries also affect the tibial nerve. The mechanism of this combined pattern could be a single longitudinal stretch injury of the CPN extending to the sciatic bifurcation (and tibial division) or separate injuries of both the CPN and tibial nerve, either at the level of the tibiofemoral joint or distally at the soleal sling and fibular neck. The authors reviewed cases involving patients with knee dislocations with CPN and tibial nerve injuries to determine the localization of the combined injury and correlation between degree of MRI appearance and clinical severity of nerve injury. METHODS Three groups of cases were reviewed. Group 1 consisted of knee dislocations with clinical evidence of nerve injury (n = 28, including 19 cases of complete CPN injury); Group 2 consisted of knee dislocations without clinical evidence of nerve injury (n = 19); and Group 3 consisted of cases of minor knee trauma but without knee dislocation (n = 14). All patients had an MRI study of the knee performed within 3 months of injury. MRI appearance of tibial and common peroneal nerve injury was scored by 2 independent radiologists in 3 zones (Zone I, sciatic bifurcation; Zone II, knee joint; and Zone III, soleal sling and fibular neck) on a severity scale of 1-4. Injury signal was scored as diffuse or focal for each nerve in each of the 3 zones. A clinical score was also calculated based on Medical Research Council scores for strength in the tibial and peroneal nerve distributions, combined with electrophysiological data, when available, and correlated with the MRI injury score. RESULTS Nearly all of the nerve segments visualized in Groups 1 and 2 demonstrated some degree of injury on MRI (95%), compared with 12% of nerve segments in Group 3. MRI nerve injury scores were significantly more severe in Group 1 relative to Group 2 (2.06 vs 1.24, p knee dislocations

  14. Finite Element Analysis of Mobile-bearing Unicompartmental Knee Arthroplasty: The Influence of Tibial Component Coronal Alignment

    Institute of Scientific and Technical Information of China (English)

    Guang-Duo Zhu; Wan-Shou Guo; Qi-Dong Zhang; Zhao-Hui Liu; Li-Ming Cheng

    2015-01-01

    Background:Controversies about the rational positioning of the tibial component in unicompartmental knee arthroplasty (UKA) still exist.Previous finite element (FE) studies were rare,and the results varied.This FE study aimed to analyze the influence of the tibial component coronal alignment on knee biomechanics in mobile-bearing UKA and find a ration range of inclination angles.Methods:A three-dimensional FE model of the intact knee was constructed from image data of one normal subject.A 1000 N compressive load was applied to the intact knee model for validating.Then a set of eleven UKA FE models was developed with the coronal inclination angles of the tibial tray ranging from l0° valgus to 10° varus.Tibial bone stresses and strains,contact pressures and load distribution in all UKA models were calculated and analyzed under the unified loading and boundary conditions.Results:Load distribution,contact pressures,and contact areas in intact knee model were validated.In UKA models,von Mises stress and compressive strain at proximal medial cortical bone increased significantly as the tibial tray was in valgus inclination >4°,which may increase the risk of residual pain.Compressive strains at tibial keel slot were above the high threshold with varus inclination >4°,which may result in greater risk of component migration.Tibial bone resection comer acted as a strain-raiser regardless of the inclination angles.Compressive strains at the resected surface slightly changed with the varying inclinations and were not supposed to induce bone resorption and component loosening.Contact pressures and load percentage in lateral compartment increased with the more varus inclination,which may lead to osteoarthritis progression.Conclusions:Static knee biomechanics after UKA can be greatly affected by tibial component coronal alignment.A range from 4° valgus to 4° varus inclination of tibial component can be recommended in mobile-bearing UKA.

  15. Unilateral versus Bilateral Instrumentation in Spinal Surgery: A Systematic Review

    OpenAIRE

    2015-01-01

    Study Design Systematic review. Clinical Questions (1) What is the comparative efficacy of unilateral instrumentation compared with bilateral instrumentation in spine surgery? (2) What is the safety of unilateral instrumentation compared with bilateral instrumentation in spine surgery? Methods Electronic databases and reference lists of key articles were searched up to September 30, 2014, to identify studies reporting the comparative efficacy and safety of unilateral versus bilateral instrume...

  16. Bilateral angiosarcoma of breast in a young lady

    Directory of Open Access Journals (Sweden)

    Sanjoy Roy

    2011-01-01

    Full Text Available We report a young lady with bilateral angiosarcoma of breast because of its rarity. A 29 year old unmarried female presented with bilateral breast lump. She underwent bilateral mastectomy with axillary dissection histopathology of which showed low grade angiosarcoma of left breast and high grade angiosarcoma of right breast. CT Thorax revealed right hilar and right mediastenal lymph nodes. She was treated with radiotherapy and chemotherapy postoperatively.

  17. Measurement of tibial nerve excursion during ankle joint dorsiflexion in a weight-bearing position with ultrasound imaging

    Directory of Open Access Journals (Sweden)

    Carroll Matthew

    2012-03-01

    Full Text Available Abstract Background The ability of peripheral nerves to stretch and slide is thought to be of paramount importance to maintain ideal neural function. Excursion in peripheral nerves such as the tibial can be measured by analysis of ultrasound images. The aim of this study was to assess the degree of longitudinal tibial nerve excursion as the ankle moved from plantar flexion to dorsiflexion in a standardised weight-bearing position. The reliability of ultrasound imaging to measure tibial nerve excursion was also quantified. Methods The tibial nerve was imaged over two separate sessions in sixteen asymptomatic participants in a weight-bearing position. Longitudinal nerve excursion was calculated from a three-second video loop captured by ultrasound imaging using frame-by-frame cross-correlation analysis. Intraclass correlation coefficients (ICC with 95% confidence intervals (CI were used to assess the intra-rater reliability. Standard error of the measurement (SEM and smallest real difference (SRD were calculated to assess measurement error. Results Mean nerve excursion was 2.99 mm SEM ± 0.22 mm. The SRD was 0.84 mm for session 1 and 0.66 mm for session 2. Intra-rater reliability was excellent with an ICC = 0.93. Conclusions Assessment of real-time ultrasound images of the tibial nerve via frame-by-frame cross-correlation analysis is a reliable non-invasive technique to assess longitudinal nerve excursion. The relationship between foot posture and nerve excursion can be further investigated.

  18. Use of All-polyethylene Tibial Components in Unicompartmental Knee Arthroplasty Increases the Risk of Early Failure.

    Science.gov (United States)

    Koh, In Jun; Suhl, Kyung Hwan; Kim, Min Woo; Kim, Man Soo; Choi, Keun Young; In, Yong

    2017-01-13

    All-polyethylene (all-poly) tibial designs in primary total knee arthroplasty (TKA) have been reconsidered with excellent clinical outcomes, survivorship, and cost-effectiveness. However, whether all-poly tibial components provided comparable results to metal-backed modular components during unicompartmental knee arthroplasty (UKA) remains unclear. This study compared the clinical outcomes and prevalence of early failure between all-poly and metal-backed modular components in UKA. We retrospectively reviewed the records and radiographs of 101 consecutive UKAs. In total, 51 UKAs were performed using all-poly tibial components; 50 others used metal-backed modular components. Clinical and radiographic outcomes, adaptive bone remodeling assessed by radiographic bone density, and early failure prevalence rates were compared. Despite a lack of group differences in clinical and radiographic outcomes (p > 0.1 in all comparisons), adaptive bone remodeling at 2 years after surgery of all-poly UKAs was more progressive compared with metal-backed UKAs (1.2 in all-poly UKA group vs. 0.9 in metal-backed UKA group, p In addition, 6 of 51 all-poly UKAs failed within 2 years postoperatively, whereas no metal-backed UKAs failed (11% in all-poly UKA group vs. 0% in metal-backed UKA group, p = 0.027). All-poly tibial component use during UKA increased the risk of early failure, which may be due to a failure in tibial loading distribution.

  19. Reconstruction of large tibial bone defects following osteosarcoma resection using bone transport distraction: A report of two cases

    Science.gov (United States)

    Yang, Zhengming; Jin, Libin; Tao, Huimin; Yang, Disheng

    2016-01-01

    The clinical efficiency of bone transport distraction osteogenesis in the reconstruction of large tibial defects following resection of osteosarcoma remains unclear. The current study presents two cases of large tibial defects treated with bone transport distraction using an Orthofix external fixator. Case 1 was a 29-year-old man with a tibial defect 11 cm in length, while case 2 was a 16-year-old girl with a 15-cm-long defect. Bone transport distraction osteogenesis was initiated for the both cases on day 14 following resection of the tibial osteosarcoma. Bone transport distraction in case 1 and 2 was continued for 16 and 28 months, respectively, and the patients were followed up for 51 and 56 months, respectively. The two patients did not exhibit any signs of tumor recurrence or tumor metastasis during the follow-up period. The Musculoskeletal Tumor Society functional scores at final follow-up visits were 22 and 18 for case 1 and 2, respectively. Based on the experience gained in these 2 cases, a bone transport is a viable option for the reconstruction of large tibial defects following osteosarcoma resection. PMID:27446450

  20. Characteristics of unilateral tibial plateau fractures among adult patients hospitalized at an orthopaedic trauma centre in China

    Science.gov (United States)

    Liu, Yong; Liao, Zhengwen; Shang, Lei; Huang, Wenhua; Zhang, Dawei; Pei, Guoxian

    2017-01-01

    The aim of this study was to investigate the characteristics of unilateral tibial plateau fractures among hospitalized adult patients in Xijing Hospital, to evaluate the accuracy of Schatzker classification system and AO/OTA classification system to tibial plateau fractures. We retrospectively analysed clinical data on 274 patients admitted to Xijing Hospital between September 2006 and August 2015. The patients’ demographic characteristics, admission periods and seasons, external causes and fracture types were recorded and summarized. Then the characteristics of tibial plateau fractures and the accuracy rate of these two classification systems were analysed. Schatzker type II fractures and AO/OTA type 41-B3 fractures were the most common types. The external causes differed between genders, types of employment, urban-rural residents and both two systems. In addition, some fractures were difficult to classify using Schatzker or AO/OTA classification system. Rural male physical labourers aged between 30–59 years-old were most likely to suffer from unilateral tibial plateau fractures, due to traffic accidents, falls and indoor activity injuries, or falls from height. We should pay more attention to the related people and professions, which contributed to the high occurrence of tibial plateau fractures. Besides that, further improvements are required for both Schatzker and AO/OTA classification systems. PMID:28074894

  1. Bilateral Filtering using Modified Fuzzy Clustering for Image Denoising

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    G.Vijaya,

    2011-01-01

    Full Text Available This paper presents a novel bilateral filtering using weighed fcm algorithm based on Gaussian kernel unction for image manipulations such as segmentation and denoising . Our proposed bilateral filteringconsists of the standard bilateral filter and the original Euclidean distance is replaced by a kernel – induced distance in the algorithm. We have applied the proposed filtering for image denoising with both the impulse and Gaussian random noise, which achieves better results than the bilateral filtering based denoising approaches, the Perona-Maliks anisotropic diffusion filter, the fuzzy vector median filter and the Non-Local Means filter.

  2. Bilateral cerebral hemispheric infarction associated with sildenafil citrate (Viagra) use.

    Science.gov (United States)

    Kim, K-K; Kim, D G; Ku, Y H; Lee, Y J; Kim, W-C; Kim, O J; Kim, H S

    2008-03-01

    Sildenafil citrate (Viagra) is one of the frequently prescribed drugs for men with erectile dysfunction. We describe a 52-year-old man with bilateral middle cerebral artery (MCA) territory infarction after sildenafil use. He ingested 100 mg of sildenafil and about 1 h later, he complained of chest discomfort, palpitation and dizziness followed by mental obtundation, global aphasia and left hemiparesis. Brain magnetic resonance imaging documented acute bilateral hemispheric infarction, and cerebral angiography showed occluded bilateral MCA. Despite significant bilateral MCA stenosis and cerebral infarction, systemic hypotension persisted for a day. We presume that cerebral infarction was caused by cardioembolism with sildenafil use.

  3. Interocular symmetry analysis of bilateral eyes.

    Science.gov (United States)

    Li, Yi; Bao, Fang Jun

    2014-05-01

    The purpose of this study was to evaluate the interocular symmetry of several biometric parameters between both eyes. The symmetry between the right and left eye of 397 subjects in 14 biometric parameters, spherical equivalent of refractive error (SE), Jackson crossed cylinder power of refractive error astigmatism with axes at 90° and 180° (RJ0) and at 45° and 135° (RJ45), best-corrected visual acuity (BCVA), average corneal curvature (CC), Jackson crossed cylinder power of corneal astigmatism (CJ0 and CJ45), corneal asphericity coefficient (Q), intraocular pressure (IOP), central corneal thickness (CCT), axial length (AL), anterior chamber depth (ACD), lens thickness (LT) and vitreous chamber depth (VCD), was assessed by comparative data analysis. Aside from RJ0 (p = 0.00), RJ45 (p = 0.02) and Q (p = 0.00), the overall interocular differences of other biometric parameters between fellow eyes were not significant (p > 0.05). The interocular correlation and Bland-Altman plots showed a good agreement between fellow eyes in 14 biometric parameters. Correlations between interocular differences in SE and that in RJ0 (p = 0.03), CC (p = 0.00), AL (p = 0.00) and VCD (p = 0.00) were statistically significant. There were similar strong linear relationships between refractive error astigmatism vectors and corneal astigmatism vectors in bilateral eyes. There were negative correlations of RJ45 and CJ45 between bilateral eyes. A potentially clinically important interocular symmetry in SE, BCVA, CC, CJ0, CJ45, IOP, CCT, AL, ACD, LT and VCD is found in this research, while the differences of RJ0, RJ45 and Q between left and right eyes seem a bit large. The negative interocular relationships of RJ45 and CJ45 demonstrate moderate mirror symmetry exists among fellow eyes. High interocular symmetry in bilateral eyes may be helpful in intraocular lens power calculation, intraocular pressure evaluation, post-operative visual acuity and refraction

  4. Tibial plato leveling osteotomy / Osteotomia de nivelamento do plato da tíbia

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    Julia Maria Matera

    2008-08-01

    Full Text Available The tibial plateau leveling osteotomy (TPLO is a relatively new and innovative surgical treatment for the cranial cruciate ligament rupture in the canine species. The real intent of the procedure is to provide functional stability to the stifle joint by eliminating or neutralizing the cranial tibial thrust during weight bearing instead to restore the cranial cruciate ligament function. The proposal of this study is to report a review of the TPLO procedure, emphasizing procedure, surgical technique, post operative care and complications. The TPLO procedure consists in a radial osteotomy in the tibial plato and rotation of the caudal plateau in order to obtain a desired angle. After the leveling of the tibial plateau, a bone plate and screws are used to stabilize the osteotomy until bone is healed up. The complications that have been associated with the procedure include tibial tuberosity fracture and patellar tendon tendinosis. This procedure has become increasingly more popular for surgical treatment of cranial cruciate ligament injuries in large breed dog. The long term clinical results have not been completely elucidated yet. It has been showed that this technique doesn’t halt the degenerative joint disease.A osteotomia do platô da tíbia (TPLO é um tratamento relativamente novo e inovador para a ruptura do ligamento cruzado cranial (RLCC na espécie canina. Ao invés de restaurar a função do ligamento, o procedimento promove estabilidade funcional para a articulação do joelho, por eliminar ou neutralizar a força tibial cranial durante a sustentação de peso. A proposta do presente estudo é revisar a técnica de TPLO, enfatizando o procedimento, técnica cirúrgica, cuidados pós-operatórios e complicações. A técnica da TPLO consiste na realização de uma osteotomia circular do platô da tíbia com rotação de sua porção caudal até a obtenção do ângulo desejado. Após o nivelamento do platô da tíbia, placa e parafusos

  5. Octyl-a-cyanoacrylate adhesive in the treatment of tibial transverse fracture in rabbits

    Institute of Scientific and Technical Information of China (English)

    Lü Bo; TU Zhong-qi; PEI Fu-xing; LIU Lei

    2005-01-01

    Objective: To observe the effect of octyl-a-cyanoacrylate upon bone healing and its degradation in vitro after middle tibial transverse fracture in rabbits, and to establish treatment of higher efficacy with the application of octyl-a-cyanoacrylate.Methods: Middle tibial transverse fracture model of New Zealand rabbits was established. In the experimental group, internal fixation with 2 mm Kirschner wires was performed and the broken ends were fixed with octyl-a-cyanoacrylate. In the control group, only internal fixation with 2 mm Kirschner wires was conducted. Animals were killed at preset time intervals of 2, 4, 6, 8, 10 and 12 weeks postoperatively and samples were harvested.Results: Two weeks after operation, clear fracture lines were observed in both the experimental and the control groups. Fibrous soft tissue connection was noted between the broken ends and there was soft tissue adhesion around the fracture site. There was no callus formation and the broken ends were surrounded by adhesive soft tissues. Obvious external callus formation was confirmed at 8 weeks after operation in both groups with partial disappearance of fracture lines. Ten and twelve weeks after the operation, fracture lines disappeared completely and there was obvious external callus formation and bone union. In the fourth week, fibrous cells and chondrocytes were found to grow into the colloid and surround it at the 6th week. The adhesive material was degraded and gradually absorbed at the 8th week. Chondrification was observed.Conclusions: Two weeks after fixation for tibial fracture in rabbits, octyl-a-cyanoacrylate begins in vivo degradation. Chondrocytes and fibrocytes gradually grow into the degradation area and surround the adhesive material, which broke into pieces at 8 weeks. Complete degradation and disappearance of the adhesive material is present between 10 and12 weeks. No barrier effect hampering fracture healing is noted.

  6. Association Between Lateral Posterior Tibial Slope, Body Mass Index, and ACL Injury Risk

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    Bojicic, Katherine M.; Beaulieu, Mélanie L.; Imaizumi Krieger, Daniel Y.; Ashton-Miller, James A.; Wojtys, Edward M.

    2017-01-01

    Background: While body mass index (BMI), a modifiable parameter, and knee morphology, a nonmodifiable parameter, have been identified as risk factors for anterior cruciate ligament (ACL) rupture, the interaction between them remains unknown. An understanding of this interaction is important because greater compressive axial force (perhaps due to greater BMI) applied to a knee that is already at an increased risk because of its geometry, such as a steep lateral posterior tibial slope, could further increase the probability of ACL injury. Purpose: To quantify the relationship between BMI and select knee morphological parameters as potential risk factors for ACL injury. Study Design: Case-control study; Level of evidence, 3. Methods: Sagittal knee magnetic resonance imaging (MRI) files from 76 ACL-injured and 42 uninjured subjects were gathered from the University of Michigan Health System’s archive. The posterior tibial slope (PTS), middle cartilage slope (MCS), posterior meniscus height (PMH), and posterior meniscus bone angle (MBA) in the lateral compartment were measured using MRI. BMI was calculated from demographic data. The association between the knee structural factors, BMI, and ACL injury risk was explored using univariate and multivariate logistic regression. Results: PTS (P = .043) and MCS (P = .037) significantly predicted ACL injury risk. As PTS and MCS increased by 1°, odds of sustaining an ACL injury increased by 12% and 13%, respectively. The multivariate logistic regression analysis, which included PTS, BMI centered around the mean (cBMI), and their interaction, showed that this interaction predicted the odds of ACL rupture (P = .050; odds ratio, 1.03). For every 1-unit increase in BMI from the average that is combined with a 1° increase in PTS, the odds of an ACL tear increased by 15%. Conclusion: An increase in BMI was associated with increased risk of ACL tear in the presence of increased lateral posterior tibial slope. Larger values of PTS or

  7. Results of bypasses to the anterior tibial artery through the interosseous membrane.

    Science.gov (United States)

    Illuminati, G; Calio, F G; Bertagni, A; Martinelli, V

    1998-08-01

    The purpose of the present study was to retrospectively evaluate the results of anatomically tunneled grafts to the anterior tibial artery for distal revascularization in terms of patency and limb salvage rates as well as local morbidity, which can lengthen the postoperative hospital stay. Twenty-three patients received 24 bypasses to the anterior tibial artery, with grafts tunneled through the interosseous membrane. The mean age was 67 years; 10 patients were diabetic, 12 were smokers, 9 presented with significant coronary artery disease, and 2 with chronic renal insufficiency. The donor vessel was the common femoral artery in 17 cases, the superficial femoral artery in 4, and the infra-articular popliteal artery in 3. The graft material consisted in the reversed saphenous vein in 4 cases, the non-reversed devalvulated ex situ saphenous vein in 11, composite polytetrafluoroethylene (PTFE) + inversed saphenous vein in 6, and PTFE alone in 3 cases. No postoperative mortality was observed, nor was there postoperative graft occlusion or need for major amputation. The average postoperative length of stay in the hospital was 9.7 days. Two local surgical wound complications were observed, which did not necessitate a postoperative hospital stay exceeding 15 days. Cumulative primary patency and limb salvage rates at 3 years were 50% and 70%, respectively. Anatomic tunneling of grafts to the anterior tibial artery yields patency and limb salvage rates comparable to those reported in the literature for distal bypasses and, considered overall, an acceptably low local morbidity and short hospital stay. Definitive superiority over externally tunneled grafts, however, is not definitely demonstrated by this study and should be prospectively tested.

  8. ANTERIOR KNEE PAIN IN TRANSTENDINOUS AND PARATENDINOUS APPROACHES OF TIBIAL INTERLOCKING NAIL: A COMPARATIVE STUDY

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    Gyaneshwar

    2014-07-01

    Full Text Available BACKGROUND: Anterior knee pain has been described as the most common complication after intramedullary nailing of fracture shaft of tibia. Dissection of the patellar tendon and its sheath during transtendinous nailing is thought to be as one of the contributing causes of chronic anterior knee pain. The purpose of this prospective, randomized study was to compare the incidence of anterior knee pain after intramedullary nailing of a tibial shaft fracture with transtendinous and paratendinous incision technique. MATERIAL AND METHODS: From April 2012 to October 2013 eighty patients with closed tibial shaft fractures were admitted and treated in our institution. Patients were randomized for treatment with paratendinous or transtendinous nailing (as 24 patients did not complete their follow up or were lost in follow up, so 56 patients were analyzed finally. For assessment we used visual analogue scales to report the level of anterior knee pain. The scales described by Lysholm and Gillquist and by Tegner et al., were also used to quantitate the functional results. RESULTS: 12 of the 28 (42% patients treated with transtendinous nailing. reported anterior knee pain whereas 8 patients out of 28 (28%, in which paratendinous technique was used had persistent anterior knee pain after minimum final follow up of 24 weeks, with no significant statistical difference. The Lysholm, Tegner functional scoring systems showed a significant difference between the two groups. CONCLUSION: Compared with a transtendinous approach, a paratendinous approach for nail insertion does not reduce the incidence of chronic anterior knee pain or functional impairment after intramedullary nailing of a tibial shaft fracture. In long term, anterior knee pain seems to disappear from many patients. Since our study is small and have short duration of follow up, further larger studies and long duration of follow up is needed to establish the results

  9. A staged surgical treatment outcome of type 3 open tibial fractures.

    Science.gov (United States)

    Aslan, Ahmet; Uysal, Emin; Ozmeriç, Ahmet

    2014-01-01

    Aim. In these case series which are about type 3 open tibial fractures formed with three different high energy trauma etiologies in different parts of tibia. We aimed to assess our three-stage treatment approach and discuss final results of our elective surgery management with three different fixation methods. Patients and Methods. We assessed 19 patients with type 3 open tibial fractures between 2009 and 2012. Our treatment protocol consisted of three stages. Early intervention in operating room, which including vascular repairs or soft tissue closure, was done if necessary. Definitive surgery was performed using internal or external fixation in the first 15 days. Patients were followed up for at least one year. Last conditions of all our cases were evaluated according to modified Johner and Wruhs criteria. Results. Nine cases were type 3A, seven cases were type 3B, and three cases were type 3C in terms of fracture typing. All patients were followed up for at least one year and mean follow up time was 15 months. In terms of functional and clinical outcome, six cases were evaluated as excellent, eight cases as good, two cases as fair, and three cases as poor. Discussion. Staged treatment option in type 3 open tibial fractures seems to be a good method in reducing complication and achieving the best result. We think that definitive staged treatment protocol including internal fixation with plating or intramedullary nailing (IMN) of the fractures is a reliable method, especially to avoid complications as a result of external fixator and to provide patient rapport.

  10. Limited open reduction is better for simple- distal tibial shaft fractures than minimally invasive plate osteosynthesis.

    Science.gov (United States)

    Li, Q; Zeng, B F; Luo, C F; Song, S; Zhang, C Q; Kong, W Q

    2014-07-24

    The aim of this study was to compare the effects and indications of minimally invasive plate osteosynthesis (MIPO) and limited open reduction (LOR) for managing distal tibial shaft fractures. A total of 79 cases of distal tibial shaft fractures were treated surgically in our trauma center. The 79 fracture cases were classified into type A, B, and C (C1) according to the Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification, with 28, 32, and 19 cases, respectively. Among the 79 fracture cases, 52 were closed fractures and 27 were open fractures (GUSTILO, I-II). After adequate preparation, 48 cases were treated with LOR and 31 cases were treated with MIPO. All cases were followed up for 12 to 18 months, with an average of 16.4 months. During the follow-up period, 76 fracture cases were healed in the first stage, whereas the 3 cases that developed non-union were treated by changing the fixation device and autografting. For types A, B, and some of C simple fractures (C1), LOR accelerated the fracture healing and lowered the non-union rate. One case suffered from regional soft tissue infection, which was controlled by wound dressing and intravenous antibiotics. Another case that developed local skin necrosis underwent local flap transplant. LOR promoted bone healing and lowered the non-union rate of several simple-distal tibial shaft fractures. Thereafter, the incidence of soft tissue complication was not significantly increased. However, for complex and comminuted fractures, MIPO was the preferred method for correcting bone alignment and protecting soft tissue, leading to functional recovery.

  11. Taylor spatial frame in the treatment of open tibial shaft fractures

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    Al-Sayyad Mohammed

    2008-01-01

    Full Text Available Background: The Taylor spatial frame (TSF is a modern multiplanar external fixator that combines the ease of application and computer accuracy in the reduction of fractures. A retrospective review of our prospective TSF database for the use of this device for treating open tibial fractures in pediatric, adolescent, and adult patients was carried out to determine the effectiveness and complications of TSF in the treatment of these fractures. Materials and Methods: Nineteen male patients with open tibial fractures were included. Of these fractures, 10 were Gustilo Type II, five were Gustilo Type IIIA (two had delayed primary closure and three had split thickness skin grafting, and four were Gustilo Type IIIB (all had rotational flaps. Twelve of our patients presented immediately to the emergency room, and the remaining seven cases presented at a mean of 3 months (range, 2.2-4.5 months after the initial injury. The fractures were located in proximal third (n=1, proximal/middle junction (n=2, middle third (n=3, middle/distal junction (n=8, distal third (n=3, and segmental fractures (n=2. Patients were of an average age of 26 years (range, 6-45years. Mean duration of follow-up was 3.5 years. Results: All fractures healed over a mean of 25 weeks (range, 9-46 weeks. All were able to participate in the activities of daily living without any difficulty and most were involved in sports during the last follow-up. Postoperative complications included pin tract infection in 12 patients. Conclusion: The TSF is an effective definitive method of open tibial fracture care with the advantage of early mobilization, ease of soft tissue management through gradual fracture reduction, and the ability to postoperatively manipulate the fracture into excellent alignment.

  12. Comparative study on treatment of midshaft tibial fracture with expandable and interlocking intramedullary nails

    Institute of Scientific and Technical Information of China (English)

    BI Qing; ZHU Dan-jie; QIU Bin-song; HONG Jian-fei; ZHANG Shui-jun; XIA Bing

    2007-01-01

    Objective:To evaluate the clinical results of treatment of midshaft tibial fracture with expandable intramedullary nails compared with interlocking intramedullary nails.Methods: From June 2003 to August 2005, 46 patients (27 males and 19 females, aged 20-74 years, mean = 38. 4 years) with midshaft tibial fracture were treated surgically in our department. The causes of fractures were traffic injury in 21 patients, fall injury in 6, tumbling injury in 11 and crushing injury in 8. According to AO/ ASIF classification, Type A fracture was found in 16 patients, Type B in 11, Type C, in 5, and Type C2 in 2. Open fractures were found in 12 patients, according to Gustilo classification, Type Ⅰ in 9 patients and Type Ⅱ in 3 patients. Based on the patients'consent, 24 patients were treated with expandable intramedullary nails (Group A) and 22 with interlocking intramedullary nails (Group B). The operation time, blood loss during operation, X-ray fluoroscopic times, hospitalization time, weight bearing time after operation, healing time of fracture andcomplications of all the patients were recorded. The clinical effects of all the cases were evaluated according to the criteria of Johner-Wruhs.Results: All the patients were followed up for 12-34 months (mean =16.2 months). The time of operation, the blood loss, X-ray fluoroscopic times, hospitalization time and healing time of fracture of Group A significantly decreased (P < 0.05) compared with those of Group B, but the time for weight bearing after operation, the Johner-Wruhs degree of clinical effects and complications had no significant difference between Group A and Group B (P>0.05).Conclusions: Expandable intramedullary nail can shorten operation time, decrease blood loss and reduce invasion, which is a safe and effective treatment method for tibial midshaft fracture.

  13. FUNCTIONAL OUTCOME OF SURGICAL MANAGEMENT OF CLOSED TIBIAL CONDYLAR FRACTURES IN ADULTS

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    Ravish

    2014-02-01

    Full Text Available BACKGROUND AND OBJECTIVE: Tibial plateau fractures are one of the commonest intra-articular fractures. It results from indirect coronal or direct axial compressive forces. It comprises of 1% of all fractures. These fractures encompass many and varied fracture configurations that involve medial, lateral or both plateaus with many degrees of articular depressions and displacements. Being one of the major weight bearing joints of the body, fractures around it will be of paramount importance. METHODS: 30 cases of tibial plateau fractures treated by various modalities were studied from September 2009 to september 2011 at Kempegoda Institute of Medical Sciences and followed for minimum of 6 months. RESULTS: The selected patients evaluated thoroughly clinically and radiologically, after the relevant lab investigations, were taken for surgery. The indicated fractures treated as per the SCHATZKER’S types, accordingly with CRIF with percutaneous cannulated cancellous screws, MIPPO with LCP/ Butress plate and screw, ORIF with buttress plate/ LCP and screw. Early range of motion started soon after the surgery. No weight bearing upto 6 weeks. The full weight bearing deferred until 12 weeks or complete fracture union. Immobilization in insecurely fixed fractures continued for 3-6 weeks by POP cast. The knee range of motion was excellent to very good, gait and weight bearing after complete union was satisfactory. Infection in two cases and stiffness in 2 cases were seen and there was no non-union in our cases. CONCLUSION: Surgical management of tibial condylar fractures will give excellent anatomical reduction and rigid fixation to restore articular congruity, facilitate early motion, hence to achieve optimal knee function and reducing post-traumatic osteo arthritis

  14. Body Mass Index, Modulated by Lateral Posterior Tibial Slope, Predicts ACL Injury Risk

    Science.gov (United States)

    Bojicic, Katherine M.; Beaulieu, Melanie L.; Krieger, Daniel Imaizumi; Ashton-Miller, James A.; Wojtys, Edward M.

    2016-01-01

    Objectives: Intervention strategies to prevent ACL injury rely on increasing knowledge of risk factors. While several modifiable and non-modifiable risk factors for ACL rupture have been identified, the interaction between them remains unknown. The aim of this study was to quantify the relationship between BMI and several knee geometries as potential risk factors for ACL injury. We hypothesized that an increased BMI in the presence of an increased posterior tibial slope or middle cartilage slope would increase risk of ACL injury. We also hypothesized that an increased BMI in the presence of a decreased posterior meniscal height or meniscal bone angle would result in an increased risk of ACL injury. Methods: Sagittal knee MRI files from 76 ACL-injured and 42 non-injured subjects were gathered from the institution’s archive. The PTS, MCS, PMH, and MBA were measured using the circle method and compared with BMI from the subject demographic. Data were analyzed using univariate and multivariate logistical regression. Figure 1 details measurements made for each knee geometry. Results: Univariate analysis of PTS showed increases in PTS significantly increase the odds of ACL tear (p = 0.043, OR =1.12). Univariate analysis of MCS showed increases of MCS significantly increase the odds of ACL tear (p = 0.037, OR = 1.12). Multivariate analysis of PTS and BMI centered around the mean (PTS*cBMI) showed increases of PTS in combination with increases in cBMI significantly increases the odds of ACL rupture (p value = .050, OR = 1.03). Table 1 shows predicted increases in ACL injury risk for combinations of increases in PTS and BMI. Conclusion: An increase in BMI will increase the risk of ACL tear when an increase in lateral posterior tibial slope is present. An increase in lateral posterior tibial slope or lateral middle cartilage slope increases the risk of an ACL tear.

  15. Biomechanical analysis of the anterior displacement of Tibial tuberosity (Maquet operation: A computer model study

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    Farahmand F

    2000-08-01

    Full Text Available Computer model of the patellofemoral joint was developed and the effects on the anterior displacement of the tibial tuberosity were investigated. The input geometrical and verification data for the model were obtained form an experimental study on a cadaver knee, mounted in an instron machine. The computer program found the configuration of the patellofemoral joint which satified both the geometrical and force equilibrium conditions, simultaneously, using a trial graphical approach.verification of the model was achieved by determining the patellar sagittal plane motion and patellofemoral contact locations and comparing the results with the experimental results of the same specimen and published data. Simulation of the anterior displacement of the tibial tuberosity by the model showed that the location of contact area migrates distally on the femur and proximally on the patella following operation. The contact force of the patellofemoral joint decreased significantly by 70% at full extension, 30% at 30 degrees flexion and around 15% at higher flexion angles for a 1 cm anterior displacement of the tibial tuberosity and nearly doubled for a 2cm anterior displacement. The change of the effective moment are of the quadriceps was not considerable. The results suggest that the major effect of the Maquet operation on the contact force appears in extension and mid-flexion rather than deep flexion amgles. Further displacement of the tuberosity enhances the reduction of the contact force, however, the total reduction is less than what was predicted by Maquet. The change of the contact location relieves pain in short term but causes hyperpressure in the proximal retropatellar surface which might be detrimental in long term

  16. Bilateral pigmented villonodular synovitis of the knee

    Science.gov (United States)

    Shah, Samir H.; Porrino, Jack A.; Green, John R.; Chew, Felix S.

    2015-01-01

    Pigmented villonodular synovitis is a disorder resulting in a villous, nodular, or villonodular proliferation of the synovium, with pigmentation related to the presence of hemosiderin. These lesions are almost exclusively benign with rare reports of malignancy. Pigmented villonodular synovitis can occur in a variety of joints and at any age but most often occurs within the knee in the young adult. Pigmented villonodular synovitis is a rare disease entity, and bilateral synchronous or metachronous involvement of a joint is even more uncommon, with few reports previously described in the literature. We present a case of pigmented villonodular synovitis involving both the right and left knee in the same patient, with radiographic imaging, magnetic resonance imaging, photograph and video intraoperative imaging, and pathologic correlation. PMID:26649121

  17. Bilateral pigmented villonodular synovitis of the knee

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    Samir H. Shah

    2015-12-01

    Full Text Available Pigmented villonodular synovitis is a disorder resulting in a villous, nodular, or villonodular proliferation of the synovium, with pigmentation related to the presence of hemosiderin. These lesions are almost exclusively benign with rare reports of malignancy. Pigmented villonodular synovitis can occur in a variety of joints and at any age but most often occurs within the knee in the young adult. Pigmented villonodular synovitis is a rare disease entity, and bilateral synchronous or metachronous involvement of a joint is even more uncommon, with few reports previously described in the literature. We present a case of pigmented villonodular synovitis involving both the right and left knee in the same patient, with radiographic imaging, magnetic resonance imaging, photograph and video intraoperative imaging, and pathologic correlation.

  18. CASE OF BILATERAL ANTERIOR SEGMENT TUBERCULOSIS

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    Gopal Kishan

    2015-04-01

    Full Text Available Tuberculosis is an important cause of uveitis in our country. India has been declared the country with the highest tuberculosis burden with 25 % of the cases . (1 This is especially true in Andhra Pradesh and Telangana which have a high percentage of affected patients. However , tuberculous uveitis is usually a unilateral presen tation. We report a case of bilateral uveitis of tuberculous origin in a 55 year old woman. She presented with different tuberculous manifestations in the two eyes. While the RE showed non granulomatous uveitis with sclerosing keratitis , the LE showed gran ulomatous uveitis with mutton fat keratic precipitates. Systemic examination revealed an enlarged lymph node which was positive for tuberculosis on biopsy. She was hence diagnosed as extra pulmonary tuberculosis and was treated with ATT regimen. In this pa tient , uveitis was the initial manifestation and resulted in a systemic diagnosis.

  19. Bilateral adrenal hemorrhage in polycythemia vera

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    Shruti Bhandari

    2016-09-01

    Full Text Available Bilateral adrenal hemorrhage (BAH is a rare complication typically seen in critically ill patients, which can lead to acute adrenal insufficiency and death unless it is recognized promptly and treated appropriately. We describe the case of a 64-year-old man with polycythemia vera found to be unresponsive with fever, hypotension, tachycardia, and hypoglycemia. Electrocardiogram showed ST-elevation with elevated troponin, hemoglobin, prothrombin time, and partial thromboplastin time. He required aggressive ventilator and vasopressor support. Despite primary coronary intervention, he remained hypotensive. Random cortisol level was low. He received stress dose hydrocortisone with immediate hemodynamic stability. BAH was highly suspected and was confirmed by non-contrast abdominal computed tomography. Prompt recognition and timely initiated treatment remain crucial to impact the mortality associated with acute adrenal insufficiency.

  20. Framing effect following bilateral amygdala lesion.

    Science.gov (United States)

    Talmi, Deborah; Hurlemann, René; Patin, Alexandra; Dolan, Raymond J

    2010-05-01

    A paradigmatic example of an emotional bias in decision making is the framing effect, where the manner in which a choice is posed--as a potential loss or a potential gain--systematically biases an ensuing decision. Two fMRI studies have shown that the activation in the amygdala is modulated by the framing effect. Here, contrary to an expectation based on these studies, we show that two patients with Urbach-Wiethe (UW) disease, a rare condition associated with congenital, complete bilateral amygdala degeneration, exhibit an intact framing effect. However, choice preference in these patients did show a qualitatively distinct pattern compared to controls evident in an increased propensity to gamble, indicating that loss of amygdala function does exert an overall influence on risk-taking. These findings suggest either that amygdala does contribute to decision making but does not play a causal role in framing, or that UW is not a pure lesion model of amygdala function.

  1. Bilateral foveal retinoschisis accompanying unilateral peripheral retinoschisis

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    Nilufer Kocak

    2014-01-01

    Full Text Available X-linked juvenile retinoschisis is a rare hereditary retinal disease characterized by a tangential splitting of the neurosensory retina which may cause early-onset visual impairment. Existence of the retinal neurosensory layer splitting on cross-sectional images of optical coherance tomography (OCT and the absence of leakage on fluorescein angiography (FA help confirming the diagnosis. Such diagnostic tests are also helpful in determining the management of the disease. However, most of the retinoschisis cavities remain stable and rarely extend to the posterior pole, many authors suggest laser prophylaxis to avoid the potential risk of retinal detachment due to holes in the outer retinal layer. Herein, we report a case with bilateral foveal retinoschisis accompanying unilateral peripheral retinoschisis who was evaluated with detailed ophthalmologic examination. Visual acuity, fundoscopy, OCT, and FA remained stable in the second year of follow-up after prophylactic argon laser treatment.

  2. Rare cause of bilateral sudden deafness.

    Science.gov (United States)

    Vos, F I; Merkus, P; van Nieuwkerk, E B J; Hensen, E F

    2016-10-08

    In this paper, we describe the case of a 62-year-old female with recurring episodes of sudden deafness with vertigo and facial paresis. Within a month's time, this resulted in bilateral deafness and vestibular areflexia. Erroneously, the patient was diagnosed with sudden deafness of unknown origin and subsequently with neuroborreliosis (Lyme disease). The true diagnosis of relapsing polychondritis (RP) was revealed 9 months after initial presentation. The diagnostic delay is in part explained by the fact that, by definition, the disease has to relapse before the diagnosis can be made, but also by its pluriform clinical presentation. Timely identification of RP as the cause of this profound sensorineural hearing loss proved to be important. It was key in instigating adequate follow-up, and allowed for cochlear implantation before total cochlear obliteration, which might have hampered optimal hearing rehabilitation.

  3. An Unusual Case of Bilateral Granulomatous Mastitis

    Directory of Open Access Journals (Sweden)

    C. A. Pistolese

    2013-01-01

    Full Text Available Idiopathic granulomatous mastitis (IGM is an uncommon benign disorder of the breast. At clinical examination, IGM is characterized by an inflammatory process of the breast, usually unilateral. Possible clinical findings are palpable mass with erythematous skin, pain, sterile abscesses, fistula and nipple retraction. Mammography and ultrasound findings are not specific for IGM. Magnetic resonance imaging (MRI is a useful tool for the differential diagnosis; it is also necessary to delineate the exact extension of the disease and to plan the correct treatment. Final diagnosis is histological. We described an unusual case of IGM with bilateral involvement in a patient with history of pacemaker implantation and IGM typical clinical symptoms. Mammography, ultrasound, and MRI examinations were performed to identify the inflammatory disorder and to plan the correct therapy. Imaging features were correlated with final histological diagnosis of IGM.

  4. Bilateral Trade Flows and Income Distribution Similarity.

    Science.gov (United States)

    Martínez-Zarzoso, Inmaculada; Vollmer, Sebastian

    2016-01-01

    Current models of bilateral trade neglect the effects of income distribution. This paper addresses the issue by accounting for non-homothetic consumer preferences and hence investigating the role of income distribution in the context of the gravity model of trade. A theoretically justified gravity model is estimated for disaggregated trade data (Dollar volume is used as dependent variable) using a sample of 104 exporters and 108 importers for 1980-2003 to achieve two main goals. We define and calculate new measures of income distribution similarity and empirically confirm that greater similarity of income distribution between countries implies more trade. Using distribution-based measures as a proxy for demand similarities in gravity models, we find consistent and robust support for the hypothesis that countries with more similar income-distributions trade more with each other. The hypothesis is also confirmed at disaggregated level for differentiated product categories.

  5. Marfan Syndrome Presenting with Bilateral Retinal Detachment

    Directory of Open Access Journals (Sweden)

    Subrata Chakrabarti

    2014-02-01

    Full Text Available Marfan syndrome is an autosomal dominant systemic disorder of the connective tissue. Marfan syndrome affects most organs and tissues, especially the skeleton, lungs, eyes, heart, and the large blood vessels. Eye involvement may be in the form of retinal detachment which is a potentially dangerous manifestation for its sight threatening nature .We report a case where a 17 year old male developed sudden blindness due to spontaneous bilateral retinal detachment. Examination revealed features of Marfan syndrome and was stamped as a case of Marfan syndrome by Ghent criteria . The point to stress upon is that a young male developing spontaneous retinal detachment, a diagnosis of underlying Marfan syndrome should be kept in mind if appropriate clinical stigmata are present. [Natl J Med Res 2014; 4(1.000: 104-105

  6. Computed tomography findings in bilateral perinephric lymphangiomatosis

    Directory of Open Access Journals (Sweden)

    Hakeem Aijaz

    2010-01-01

    Full Text Available Perinephric lymphangioma is rare disorder that may be confused with various forms of renal cystic diseases and urinomas. In this disorder a developmental malformation results in failure of developing lymphatic tissue to establish normal communication with the rest of lymphatic system. Once there is restricted drainage of lymphatic fluid the lymphatic channels dilate to form cystic masses that may be unilocular or multilocular and may be seen unilaterally or bilaterally .This condition presents with various signs and symptoms or can be just an incidental finding which in presence of misleading clinical history may be confused with other diseases. CT scan with delayed cuts and USG guided aspiration with biochemical analysis of fluid will help us in arriving to final diagnosis.

  7. Computed tomography findings in bilateral perinephric lymphangiomatosis.

    Science.gov (United States)

    Hakeem, Aijaz; Gojwari, Tariq A; Reyaz, Sheikh; Rasool, Shubana; Shafi, Hakim; Mufti, Shahida

    2010-01-01

    Perinephric lymphangioma is rare disorder that may be confused with various forms of renal cystic diseases and urinomas. In this disorder a developmental malformation results in failure of developing lymphatic tissue to establish normal communication with the rest of lymphatic system. Once there is restricted drainage of lymphatic fluid the lymphatic channels dilate to form cystic masses that may be unilocular or multilocular and may be seen unilaterally or bilaterally .This condition presents with various signs and symptoms or can be just an incidental finding which in presence of misleading clinical history may be confused with other diseases. CT scan with delayed cuts and USG guided aspiration with biochemical analysis of fluid will help us in arriving to final diagnosis.

  8. Bilateral vision loss associated with radiofrequency exposure

    Directory of Open Access Journals (Sweden)

    Liu D

    2012-12-01

    Full Text Available Dianna Liu, Franz Marie Cruz, Prem S SubramanianWilmer Eye Institute, The Johns Hopkins School of Medicine, Baltimore, Maryland, USAAbstract: A 57-year-old otherwise healthy woman presented with painless binocular vision loss 1 week after direct application of radiofrequency energy to her orbits. She had no light perception bilaterally. Pupils were dilated and not reactive to light. Fundoscopic exam initially showed optic disc swelling in the right eye and a normal-appearing disc in the left eye. Magnetic resonance imaging of the brain and orbits showed gadolinium enhancement of both intraorbital optic nerves. She underwent a course of high-dose steroid treatment without recovery of vision. Optic discs were pale 11 weeks after injury. With exclusion of other possible causes, this represents a unique case of irreversible binocular optic nerve damage and blindness secondary to radiofrequency exposure.Keywords: optic neuropathy, blindness, radiofrequency, vision loss

  9. Bilaterally Weighted Patches for Disparity Map Computation

    Directory of Open Access Journals (Sweden)

    Laura Fernández Julià

    2015-03-01

    Full Text Available Visual correspondence is the key for 3D reconstruction in binocular stereovision. Local methods perform block-matching to compute the disparity, or apparent motion, of pixels between images. The simplest approach computes the distance of patches, usually square windows, and assumes that all pixels in the patch have the same disparity. A prominent artifact of the method is the "foreground fattening effet" near depth discontinuities. In order to find a more appropriate support, Yoon and Kweon introduced the use of weights based on color similarity and spatial distance, analogous to those used in the bilateral filter. This paper presents the theory of this method and the implementation we have developed. Moreover, some variants are discussed and improvements are used in the final implementation. Several examples and tests are presented and the parameters and performance of the method are analyzed.

  10. Bilateral diaphragmatic paralysis after kidney surgery.

    Science.gov (United States)

    Sozzo, S; Carratù, P; Damiani, M F; Falcone, V A; Palumbo, A; Dragonieri, S; Resta, O

    2012-06-01

    A 57-year-old woman underwent an enucleoresection of her right kidney angiomyolipoma. Two weeks later she was admitted to our hospital because of dyspnea at rest with orthopnea. The chest x-ray showed the elevation of both hemidiaphragms and the measurement of the sniff transdiaphragmatic pressure confirmed the diagnosis of bilateral diaphragmatic paralysis. A diaphragm paralysis can be ascribed to several causes, i.e. trauma, compressive events, inflammations, neuropathies, or it can be idiopathic. In this case, it was very likely that the patient suffered from post-surgery neuralgic amyotrophy. To our knowledge, there are only a few reported cases of neuralgic amyotrophy, also known as Parsonage-Turner Syndrome, which affects only the phrenic nerve as a consequence of a surgery in an anatomically distant site.

  11. 钢板固定治疗胫骨平台骨折231例临床疗效观察%Observation on Clinical Effect of Plate Fixation for Tibial Plateau Fracture in 231 Cases

    Institute of Scientific and Technical Information of China (English)

    王春鹏

    2015-01-01

    Objective To discuss the clinical effect of different plate ifxation methods for tibial plateau fracture. Methods 231 patients with tibial plateau fracture were given plate ifxation in our hospital from 2012 to 2014. The clinical effects were made a retrospective analysis. 112 cases with unilateral locking plate ifxation was A group, 119 cases with bilateral anatomic plate ifxation was B group. The healing time of patients with fracture ifxation and their function of knee joint were compared between the two groups. Results The healing time and knee function in group A were signiifcantly better than the control group, P<0.05, there were differences. Conclusion Unilateral locking plate fixation for tibial plateau fracture can shorten the fracture healing time, make knee joint rehabilitation early and the knee functions are better.%目的:探讨不同钢板固定方式治疗胫骨平台骨折的效果。方法回顾性分析2012~2014年在我院进行胫骨平台骨折内固定治疗的患者231例,其中112例采用单侧锁定钢板内固定为A组,119例采用双侧解剖钢板内固定为B组,对比两组不同内固定方式患者的骨折愈合时间,膝关节功能。结果 A组患者的骨折愈合时间,以及膝关节功能优于对照组,P<0.05,差异有统计学意义。结论单侧锁定钢板内固定治疗胫骨平台骨折,骨折能够较早的愈合,膝关节得到较早的康复锻炼,膝关节功能较好。

  12. Simultaneous bilateral tibal tubercle avulsion: A rare fracture

    Directory of Open Access Journals (Sweden)

    Hasan Metineren

    2013-12-01

    Full Text Available Tibial tuberosity avulsion is a rare fracture in adolescence.Due to the shear forces on the immature epiphysis. Thirteenyears old girl was admitted to the emergency departmentwith knee pain and tenderness in both knees afterjumping from a height of about one meter. İn examinationshe had tenderness and swelling over both tibial tuberosities.The patient could not do active knee extension. TypeIIA fracture on the left and type IIIA fracture on the rightknee were detected. For the patient’s fractures, closedreduction and fixation with 3 smooth Kirschner wires wasperformed. After immobilization in long-leg brace for threeweeks the brace was removed and she include in therehabilitation program. In this report, we discuss similarcases in the literature and the results of the treatment appliedto our patient.Key words: Tuberositas tibia, avulsion fracture, percutaneouspinning

  13. [Bilateral ovarian Burkitt's lymphoma. A case presentation].

    Science.gov (United States)

    Briseño-Hernández, Andrés Alejandro; Quezada-López, Deissy Roxana; Castañeda-Chávez, Agar; Dassaejv Macías-Amezcua, Michel; Pintor-Belmontes, Julio Cesar

    2014-01-01

    Antecedentes: el linfoma de Burkitt es una forma agresiva de los linfomas no Hodgkin de células B que ocurre con mayor frecuencia en niños y adultos jóvenes; el linfoma de ovario puede aparecer como lesión primaria o, más comúnmente, como una metástasis. Las lesiones primarias de ovario son manifestaciones raras que corresponden a 0.5% de los linfomas no Hodgkin y 1.5% de los tumores de ovario. Caso clínico: paciente femenina de 31 años de edad, con debilidad generalizada, incapacidad para la marcha, disnea, hiporexia, fiebre, diaforesis, pérdida de 20 kg de peso, abdomen plano, con dolor abdominal; Ca125 610 U/mL. La tomografía computada abdominal mostró un gran tumor de aspecto sólido que afectaba a la cavidad pélvica derecha. Se extirparon los tumores ováricos bilaterales. Desde el punto de vista microscópico ambas lesiones muestran una imagen en "cielo estrellado" compuesta por un patrón de infiltrado monótono de linfocitos mezclada con macrófagos de citoplasma amplio y claro, abundantes mitosis atípicas, zonas de necrosis y hemorragia. La inmunohistoquímica reveló positividad para CDI0 y CD20, negativo con CD3, índice de proliferación Ki67 alto. Se diagnosticó linfoma tipo Burkitt bilateral de ovario. Conclusiones: el linfoma de Burkitt de ovario bilateral es poco frecuente, con variabilidad de presentación; el dolor abdominal y los tumores abdominales son lo más frecuente. El pronóstico a corto plazo de las pacientes es malo, por lo que es necesario conocer esta afección para poder establecer el diagnóstico temprano.

  14. Conscious attention, meditation, and bilateral information transfer.

    Science.gov (United States)

    Bob, Petr; Zimmerman, Elizabeth M; Hamilton, Elizabeth A; Sheftel, Jenna G; Bajo, Stephanie D; Raboch, Jiri; Golla, Megan; Konopka, Lukasz M

    2013-01-01

    Recent findings indicate that conscious attention is related to large-scale information integration of various brain regions, including both hemispheres, that enables integration of parallel distributed modalities of processed information. There is also evidence that the level of information transference related to integration or splitting among brain regions, and between hemispheres, establishes a certain level of efficiency of the information processing. The level of information transference also may have modulatory influences on attentional capacity that are closely linked to the emotional arousal and autonomic response related to a stimulus. These findings suggest a hypothesis that changes in conscious attention, specifically during meditation could be reflected in the autonomic activity as the left-right information transference calculated from bilateral electrodermal activity (EDA). With the aim to compare conscious attention during meditation with other attentional states (resting state, Stroop task, and memory task), we performed bilateral EDA measurement in 7 healthy persons during resting state, Stroop task, neurofeedback memory test, and meditation. The results indicate that the information transference (ie, transinformation) is able to distinguish those attentional states, and that the highest level of the transinformation has been found during attentional processing related to meditation, indicating higher level of connectivity between left and right sides. Calculations other than pointwise transinformation (PTI) performed on EDA records, such as mean skin conductance level or laterality index, were not able to distinguish attentional states. The results suggest that PTI may present an interesting method useful for the assessment of information flow, related to neural functioning, that in the case of meditation may reflect typical integrative changes in the autonomic nervous system related to brain functions and focused attentional processing.

  15. Osteotomía tibial alta con placa VCO: Resultados a medio plazo

    OpenAIRE

    Panisello Sebastiá, Juan José; Martínez Martín, Angel Antonio; Herrera Rodríguez, Antonio; Cuenca Espiérrez, Jorge; Canales Cortés, Vicente

    2000-01-01

    Se realiza un estudio retrospectivo de 31 pacientes afectos de genu varo artrósico tratados mediante osteotomía tibial alta y posterior estabilización con placa VCO. Este material permite la movilización y carga precoz de la rodilla, acortando el tiempo de recuperación y las necesidades de rehabilitación. El seguimiento a 4 años muestra una evolución clínica y radiológica satisfactoria en el 80,5% de los pacientes. We report a retrospective análisis of 31 patients presenting varus deformit...

  16. Reamed or unreamed intramedullary nailing for tibial fractures: a meta-analysis

    Institute of Scientific and Technical Information of China (English)

    Yu Guangshu; Lin Yanbin; Wang Yu; Xu Zhiqing

    2014-01-01

    Objective:To compare the treating effects of different intramedullary nailing methods on tibial fractures in adults.Methods:Literature reports in both Chinese and English languages were retrieved (from the earliest available records to October 1,2013) from the PubMed,FMJS,CNKI,Wanfang Data using randomized controlled trials (RCTs) to compare reamed and unreamed intramedullary nailing for treatment of tibial fractures.Methodological quality of the trials was critically assessed,and relevant data were extracted.Statistical software Revman 5.0 was used for data-analysis.Results:A total of 12 randomized controlled trials,comprising 985 patients (475 in the unreamed group and 510 in the reamed group),were eligible for inclusion in this meta-analysis.The results of metaanalysis showed that there were no statistically significant differences between the two methods in the reported outcomes of infection (RR=0.64; 95%CI,0.39 to 1.07;P=0.09),compartment syndrome (RR=1.44; 95%CI,0.8to 2.41; P=0.16),thrombosis (RR=1.29; 95%CI,0.43to 3.87; P=0.64),time to union (WMD=5.01; 95%CI,-1.78 to 11.80; P=0.15),delayed union (nonunion)(RR=1.56; 95%CI,0.97 to 2.49; P=0.06),malunion (RR=1.75; 95%CI,1.00 to 3.08; P=0.05) and knee pain (RR=0.94; 95%CI,0.73 to 1.22; P=0.66).But there was a significantly higher fixation failure rate in the unreamed group than in the reamed group (RR=4.29; 95%CI,2.58to 7.14; P<0.00001).Conclusion:There is no significant difference in the reamed and unreamed intramedullary nailing for the treatment of tibial fractures,but our result recommends reamed nails for the treatment of closed tibial fractures for their lower fixation failure rate.

  17. Effect of triple tibial osteotomy on femorotibial stability in canine cranial cruciate ligament deficient stifles

    DEFF Research Database (Denmark)

    Kristiansen, S.; Vedel, T.; Jensen, B. R.

    leveling osteotomy (TPLO), have been biomechanically evaluated (Kipfer et al. (2008), Apelt et al. (2007), Butler et al. (2011), Pozzi et al. (2006) and Rey et al. (2014)), experimental studies on TTO are lacking. The aim of this study was to evaluate the effect of TTO on cadaveric stifle stability....... Limbs were mounted on a custom-made frame, which permitted controlled movement of the tibia relative to the femur, and extended from full flexion whilst recording the stifle region fluoroscopically. Metal markers placed at the CrCL attachment sites were used to monitor cranial tibial subluxation (CTS...

  18. Co-contraction patterns of trans-tibial amputee ankle and knee musculature during gait

    Directory of Open Access Journals (Sweden)

    Seyedali Mahyo

    2012-05-01

    Full Text Available Abstract Background Myoelectric control of upper extremity powered prostheses has been used clinically for many years, however this approach has not been fully developed for lower extremity prosthetic devices. With the advent of powered lower extremity prosthetic components, the potential role of myoelectric control systems is of increasing importance. An understanding of muscle activation patterns and their relationship to functional ambulation is a vital step in the future development of myoelectric control. Unusual knee muscle co-contractions have been reported in both limbs of trans-tibial amputees. It is currently unknown what differences exist in co-contraction between trans-tibial amputees and controls. This study compares the activation and co-contraction patterns of the ankle and knee musculature of trans-tibial amputees (intact and residual limbs, and able-bodied control subjects during three speeds of gait. It was hypothesized that residual limbs would have greater ankle muscle co-contraction than intact and able-bodied control limbs and that knee muscle co-contraction would be different among all limbs. Lastly it was hypothesized that the extent of muscle co-contraction would increase with walking speed. Methods Nine unilateral traumatic trans-tibial amputees and five matched controls participated. Surface electromyography recorded activation from the Tibialis Anterior, Medial Gastrocnemius, Vastus Lateralis and Biceps Femoris of the residual, intact and control limbs. A series of filters were applied to the signal to obtain a linear envelope of the activation patterns. A co-contraction area (ratio of the integrated agonist and antagonist activity was calculated during specific phases of gait. Results Co-contraction of the ankle muscles was greater in the residual limb than in the intact and control limbs during all phases of gait. Knee muscle co-contraction was greater in the residual limb than in the control limb during all phases

  19. Síndrome compartimental pós-fratura de platô tibial

    OpenAIRE

    Guilherme Benjamin Brandão Pitta; Thays Fernanda Avelino dos Santos; Fernanda Thaysa Avelino dos Santos; Edelson Moreira da Costa Filho

    2014-01-01

    As fraturas de platô tibial são relativamente raras e representam, aproximadamente, 1,2% de todas as fraturas. A tíbia, por sua localização subcutânea e pobre cobertura muscular, está exposta a sofrer grandes quantidades de traumatismos, que não são somente fraturas, mas também lesões por achatamento, contusões severas, entre outras que, em um determinado momento, podem causar no enfermo a síndrome compartimental. É relatad...

  20. Fratura avulsão do planalto tibial medial (Segond reverso)

    OpenAIRE

    2007-01-01

    Descreve-se neste artigo um padrão de lesão descrito na literatura apenas duas vezes, num total de quatro casos, denominado Segond reverso por apresentar achados clínicos e radiológicos exatamente opostos aos da clássica lesão de Segond. Semelhantemente aos casos previamente descritos, apresentou fratura avulsão do planalto tibial medial, na inserção do ligamento colateral medial profundo, associada a lesão do ligamento cruzado posterior. Assim como em um dos casos prévios, foi constatada les...

  1. Growth hormone induces multiplication of the slowly cycling germinal cells of the rat tibial growth plate.

    OpenAIRE

    Ohlsson, C.; Nilsson, A; Isaksson, O; Lindahl, A

    1992-01-01

    To study the effect of locally infused growth hormone (GH) or insulin-like growth factor I(IGF-I) on slowly cycling cells in the germinal cell layer of the tibial growth plate, osmotic minipumps delivering 14.3 microCi of [3H]thymidine per day were implanted s.c. into hypophysectomized rats, and GH (1 microgram) or IGF-I (10 micrograms) was injected daily through a cannula implanted in the proximal tibia. The opposite leg served as a control. After 12 days of treatment, the osmotic minipumps ...

  2. Tibial inlay press-fit fixation versus interference screw in posterior cruciate ligament reconstruction

    Directory of Open Access Journals (Sweden)

    Max Ettinger

    2013-11-01

    Full Text Available Reconstruction of the posterior cruciate ligament (PCL by a tibial press-fit fixation of the patellar tendon with an accessory bone plug is a promising approach because no foreign materials are required. Until today, there is no data about the biomechanical properties of such press-fit fixations. The aim of this study was to compare the biomechanical qualities of a bone plug tibial inlay technique with the commonly applied interference screw of patellar tendon PCL grafts. Twenty patellar tendons including a bone block were harvested from ten human cadavers. The grafts were implanted into twenty legs of adult German country pigs. In group P, the grafts were attached in a press-fit technique with accessory bone plug. In group S, the grafts were fixed with an interference screw. Each group consisted of 10 specimens. The constructs were biomechanically analyzed in cyclic loading between 60 and 250 N for 500 cycles recording elongation. Finally, ultimate failure load and failure mode were analyzed. Ultimate failure load was 598.6±36.3 N in group P and 653.7±39.8 N in group S (not significant, P>0.05. Elongation during cyclic loading between the 1st and the 20th cycle was 3.4±0.9 mm for group P and 3.1±1 mm for group S. Between the 20th and the 500th cycle, elongation was 4.2±2.3 mm in group P and 2.5±0.9 mm in group S (not significant, P>0.05. This is the first study investigating the biomechanical properties of tibial press-fit fixation of the patellar tendon with accessory bone plug in posterior cruciate ligament reconstruction. The implant-free tibial inlay technique shows equal biomechanical characteristics compared to an interference screw fixation. Further in vivo studies are desirable to compare the biological behavior and clinical relevance of this fixation device.

  3. PCL tibial avulsion with an associated medial meniscal tear in a child: a case report on diagnosis and management.

    LENUS (Irish Health Repository)

    2012-02-01

    Posterior cruciate ligament (PCL) injuries from tibial avulsions are rare in the paediatric setting. One would need a high index of suspicion as clinical examination may be difficult, especially in the early period. Magnetic resonance imaging is an excellent diagnostic modality for this condition and other associated injuries within the knee. We report a rare case in which the patient had a PCL avulsion off the tibial insertion site with an associated posterior horn medial meniscal tear off the posterior capsule. He was treated through open reduction and internal fixation of the avulsed fragment with suture repair of the meniscal tear. We emphasize the importance of diagnosing and managing associated intra-articular injuries when dealing with the rare condition of PCL tibial avulsion in the paediatric setting.

  4. 复杂型胫骨平台骨折手术策略及疗效分析%Surgical Strategy and Efficacy Analysis of Complex Tibial Plateau Fractures

    Institute of Scientific and Technical Information of China (English)

    李军; 张兴睿; 胡文勇

    2011-01-01

    Objective To study the clinical efficacy of modified surgical approach and bilateral double-plate fixation in the cases of complex tibial plateau fracture. Methods From March 2006 to December 2008, 21 patients with complex tibial plateau fracture, including 14 males and seven females, were treated in our hospital. The average age of them was 37 years old. Based on Schatzker fracture classification, there were 10 cases of type V and 11 cases of type Ⅵ fracture. All the cases were treated by the combined anterolateral and posteromedial or posterior approaches and bilateral double-plate fixation. In the operation, we explored injuries on the meniscus and cruciate ligament, and carried out the one-stage rehabilitation and cruciate ligament reconstruction. Results There were 19 cases of one-stage healing, and one case of secondary healing. One patient suffered skin flap necrosis 10 days after the operation, and was cured after changing the medicine. All the patients were followed up for one to three years, averaging at 19. 5 months. Bone healing occurred within 5 to 10 months averaging at 7. 4 months. Two patients suffered traumatic arthritis; articular surface collapse was found in two patients; and one patient had mild varus knee. According to the scoring system from Hospital for Special Surgery, there were 18 cases of excellent efficacy, two of good efficacy, one of fair efficacy, with an excellence rate of 85. 2%. Conclusion Combined anterolateral and posteromedial or posterior approaches and bilateral double-plate fixation for complex tibial plateau fractures is beneficial to protect the soft tissue blood supply and give reliable fixation stability. Thus, it is a feasible and effective method and is worth further research and popularizing in clinical practices.%目的 探讨复杂型胫骨平台骨折改良手术入路及双侧双钢板固定临床疗效.方法 2006年3月-2008年12月,收治复杂型胫骨平台骨折21例,其中男14例,女7例;平均年龄37

  5. Bilateral adrenal histoplasmosis in an immunocompetent man Histoplasmose adrenal bilateral em um homem imunocompetente

    Directory of Open Access Journals (Sweden)

    Carlos Frederico Lopes Benevides

    2007-04-01

    Full Text Available Histoplasmosis is a fungal disease that is endemic in Brazil. It may present as chronic pulmonary infection or in disseminated form. Disseminated histoplasmosis frequently affects the adrenal gland; however, unilateral involvement in immunosuppressed patients is the usual presentation. We report a case of an elderly immunocompetent male with history of weight loss, fever and bilateral adrenal mass who was successfully treated with itraconazole.Histoplasmose é uma doença fúngica endêmica no Brasil que pode se apresentar como infecção pulmonar crônica ou na forma disseminada. A histoplasmose disseminada freqüentemente acomete a glândula adrenal; entretanto, ocorre mais em pacientes imunossuprimidos e de forma unilateral. Relatamos um caso de um homem idoso imunocompetente com história de perda de peso, febre e massa adrenal bilateral que foi tratada com itraconazol, com sucesso.

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

    Institute of Scientific and Technical Information of China (English)

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

    2016-01-01

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

  7. Treatment of tibial defect and bone nonunion with limb shortening with external fixator and reconstituted bone xenograft

    Institute of Scientific and Technical Information of China (English)

    王志刚; 刘建; 胡蕴玉; 孟国林; 金格勒; 袁志; 王海强; 戴先文

    2003-01-01

    Objective: To explore the effect of external fixator and reconstituted bone xenograft (RBX) in the treatment of tibial bone defect, tibial bone nonunion and congenital pseudarthrosis of the tibia with limb shortening. Methods: Twenty patients ( 13 males and 7 females) with tibial bone defect, tibial bone nonunion or congenital pseudarthrosis of the tibia with limb shortening were treated with external fixation. Two kinds of external fixators were used: a half ring sulcated external fixator used in 13 patients and a combined external fixator in 7 patients. Foot-drop was corrected at the same time with external fixation in 4 patients. The shortened length of the tibia was in the range of 2-9 cm, with an average of 4.8 cm. For bone grafting, RBX was used in 12 patients, autogenous ilium was used in 3 patients and autogenous fibula was implanted as a bone plug into the medullary canal in 1 case, and no bone graft was used in 4 patients. Results: All the 20 patients were followed-up for 8 months to 7 years, averaging 51 months. Satisfactory function of the affected extremities was obtained. All the shortened extremities were lengthened to the expected length. For all the lengthening area and the fracture sites, bone union was obtained at the last. The average healing time of 12 patients treated with RBX was 4.8 months. Conclusions: Both the half ring sulcated external fixator and the combined external fixator have the advantages of small trauma, simple operation, elastic fixation without stress shielding and non-limitation from local soft tissue conditions, and there is satisfactory functional recovery of affected extremities in the treatment of tibial bone defects, tibial bone nonunion and congenital pseudarthrosis of the tibia combined with limb shortening. RBX has good biocompatibility and does not cause immunological rejections. It can also be safely used in treatment of bone nonunion and has reliable effect to promote bone healing.

  8. Bilateral psoas and bilateral perinephric abscesses complicating acute pyelonephritis in pregnancy

    OpenAIRE

    2013-01-01

    Acute pyelonephritis complicates 1-2% of pregnancies and causes significant maternal and fetal morbidity and mortality. The diagnosis of renal tuberculosis (TB) is often delayed and commonly presents with sterile pyuria or along with other pyogenic organisms. We report a case where the diagnosis of renal TB was missed in a pregnant woman when she presented with acute pyelonephritis, septic shock, and acute renal failure. There was clinical recovery with antibiotics, but bilateral psoas and pe...

  9. Paresia diafragmática bilateral idiopática Idiopathic bilateral diaphragmatic paresis

    Directory of Open Access Journals (Sweden)

    Mônica Corso Pereira

    2006-10-01

    Full Text Available Relata-se o caso de um paciente com dispnéia intensa ao se deitar, em que foram excluídas doenças pulmonares, neuromusculares ou cardíacas, cuja investigação revelou paresia diafragmática bilateral. Um sinal chave para o diagnóstico foi a evidência de respiração paradoxal com o doente em decúbito supino. Havia piora da oxigenação e da capacidade vital forçada com a mudança da posição ortostática para supina. A fluoroscopia ortostática foi normal. A pressão inspiratória máxima estava muito reduzida. A estimulação elétrica transcutânea do diafragma foi normal, e a eletroestimulação do nervo frênico mostrou ausência de resposta, permitindo o diagnóstico de paresia bilateral do diafragma.We report the case of a patient with severe dyspnea upon reclining. Lung disease, neuromuscular disorders and heart disease were ruled out. However, during the course of the investigation, bilateral diaphragmatic paresis was discovered. A key sign leading to the diagnosis was evidence of paradoxical respiration in the dorsal decubitus position. When the patient was moved from the orthostatic position to the dorsal decubitus position, oxygenation and forced vital capacity worsened. The orthostatic fluoroscopy was normal. Maximal inspiratory pressure was severely reduced. The responses to transcutaneous electric stimulation of the diaphragm were normal. However, electric stimulation of the phrenic nerve produced no response, leading to the diagnosis of bilateral diaphragmatic paresis.

  10. Espasmo hemifacial bilateral: relato de caso Bilateral hemifacial spasm: case report

    Directory of Open Access Journals (Sweden)

    Flavia Costa Nunes Machado

    2003-03-01

    Full Text Available Espasmo hemifacial bilateral é um distúrbio de movimento raro geralmente associado à compressão vascular dos nervos faciais. Caracteriza-se clinicamente por contrações assimétricas e assíncronas da musculatura facial e por longa latência entre a instalação dos movimentos em cada hemiface. Deve ser diferenciado de outras condições como blefaroespasmo, miocimia facial, tiques faciais, distonia oromandibular e espasmo hemimastigatório. O tratamento sintomático mais eficaz e menos invasivo consiste em aplicações de toxina botulínica mas abordagem cirúrgica de descompressão microvascular é outra alternativa terapêutica. Relatamos o caso de homem de 70 anos com espasmo hemifacial bilateral e fazemos uma breve revisão da literatura.Bilateral hemifacial spasm (BHS is a rare focal movement disorder often associated with vascular compression of both facial nerves. The contractions are usually asymmetric and asynchronous. Typically, one side is affected first and there is a long but variable interval for the symptoms on the other side to occur. BHS must be differentiated from other conditions including blefarospasm, facial myokymia, facial tics, oromandibular dystonia, and hemimasticatory spasm. The most successful and non-invasive symtomatic treatment is botulinum toxin injections but microvascular decompression surgery is another therapeutic option. We report the case of a 70 years old man with bilateral hemifacial spasms and present a brief review of the literature.

  11. Bilateral congenital pseudoarthrosis of the clavicles in a newborn

    Science.gov (United States)

    Kalagiri, Ram R.; Hemingway, Martha; Beeram, Madhava R.

    2016-01-01

    Bilateral congenital pseudoarthrosis of the clavicles is extremely rare. We report a case of this entity presenting in the neonatal period. We highlight the importance of the differential diagnosis when clavicular fracture shows no evidence of healing or occurs bilaterally. PMID:27695169

  12. [Bilateral anterior uveiopapillitis, suspicious of Lyme disease--case report].

    Science.gov (United States)

    Nicula, Cristina; Nicula, D; Rusu, Ioana; Popescu, Raluca

    2013-01-01

    We present the case of a patient which associated bilateral anterior uveitis manifestations with those of bilateral anterior inflammatory optic neuropathy. We followed the evolution of the case under treatment and we discussed the differential diagnosis and the association of the two ocular pathologies.

  13. Bilateral ganglion cyst of the common peroneal nerve

    Energy Technology Data Exchange (ETDEWEB)

    Pedrazzini, Massimo; Cusmano, Ferdinando; Armaroli, Sara; Pavone, Paolo [Institute of Radiology, University of Parma, Viale Gramsci 14, 43100 Parma (Italy); Pogliacomi, Francesco; Rinaldi, Elio [Institute of Clinical Orthopedics and Traumatology, University of Parma, Viale Gramsci 14, 43100 Parma (Italy)

    2002-11-01

    Ganglion cysts of the common peroneal nerve are rarely described in the literature and a bilateral lesion has not been previously reported. We present a case of a 41-year-old man with a bilateral cyst of the common peroneal nerve diagnosed with ultrasound and magnetic resonance imaging. (orig.)

  14. Bilateral polymicrobial osteomyelitis with Candida tropicalis and Candida krusei

    DEFF Research Database (Denmark)

    Kaldau, Niels Christian; Brorson, Stig; Jensen, Poul Einar

    2012-01-01

    We present a case of bilateral polymicrobial osteomyelitis with Candida tropicalis and Candida krusei, and review the literature on Candida osteomyelitis.......We present a case of bilateral polymicrobial osteomyelitis with Candida tropicalis and Candida krusei, and review the literature on Candida osteomyelitis....

  15. Effects of Bilateralism and the MFN Clause on International Trade

    DEFF Research Database (Denmark)

    Lampe, Markus

    2009-01-01

    This study contributes to a revised picture of nineteenth-century bilateralism. Employing a new disaggregated data set, it argues that bilateral treaties did not implement general free trade, but instead reduced tariffs unevenly through commodity-specific preferences, especially favoring manufact...

  16. Simultaneous Bilateral Transient Osteoporosis of the Hip without Pregnancy

    Directory of Open Access Journals (Sweden)

    Yasuaki Okada

    2016-01-01

    Full Text Available Transient osteoporosis of the hip (TOH is a rare disorder characterized by acute severe coxalgia and temporary osteopenia in the proximal femur. Although most cases were unilateral or staged bilateral TOH, some authors reported that the pregnant patients simultaneously had TOH in their bilateral hips. However, there has been no report of simultaneous bilateral TOH in the patient without pregnancy. A 25-year-old Japanese woman without pregnancy had acute simultaneous bilateral hip pain. Plain X-ray of the bilateral hips did not show a periarticular osteopenia. However, magnetic resonance image obtained one week after the onset demonstrated increased T2-weighted signal intensity and decreased T1-weighted signal intensity in the bilateral femoral heads. She was treated conservatively, and follow-up magnetic resonance image at seven weeks after the onset returned to normal bone marrow signal intensity. Her bilateral coxalgia subsided gradually. At one year after the onset, she had no sign of symptomatic flair. Our experience with this case indicates that recognizing the possibility of simultaneous bilateral TOH is important unless the patient is pregnant, and magnetic resonance image is predictable test to make a diagnosis of TOH, even in the absence of abnormal finding on plain X-ray.

  17. [Bilateral hyperplasia of the coronoid apophyses. A clinical case].

    Science.gov (United States)

    Parascandolo, S; Rusciano, A; Tamai, M; Morlino, M

    1993-03-01

    The authors report on the case of a young patient affected with bilateral hyperplasia of the coronoid apophyses, who presented a serious reduction of the mandibular excursion. Normal mouth opening was re-established by a bilateral osteotomy with endoral removal of the coronoid apophyses.

  18. Fast-track surgery for bilateral total knee replacement

    DEFF Research Database (Denmark)

    Husted, H; Troelsen, A; Otte, K S;

    2011-01-01

    Bilateral simultaneous total knee replacement (TKR) has been considered by some to be associated with increased morbidity and mortality. Our study analysed the outcome of 150 consecutive, but selected, bilateral simultaneous TKRs and compared them with that of 271 unilateral TKRs in a standardised...

  19. FUNCTIONAL OUTCOME OF LOCKING COMPRESSION PLATE OSTEOSYNTHESIS IN SCHATZKER’S TYPE V AND VI TIBIAL PLATEAU FRACTURES

    Directory of Open Access Journals (Sweden)

    Deependra

    2015-11-01

    Full Text Available : Tibial plateau fractures are the common injuries that may be associated with poor outcomes and a high rate of complications. The problem rise significantly in high energy trauma and severe soft tissue injuries. Early technique of osteosysnthesis were based on extensive surgical approach. Introduction of minimally invasive plate osteosynthesis using locking compression plate conserves the vascularity of the bone but also leads to the overall improvement in the values of bone healing. MATERIALS AND METHODS: Inclusion criteria for this study were patients of either sex, tibial plateau fractures Schatzker’s Type V and VI, age group 15 to 60 years and compounding upto Gustilo and Anderson’s Grade II and excluded the patients where the compounding was grade III and displacement <2mm. The fractures were treated applying LCP percutaneously either medially or laterally depending on the side of comminution. RESULTS: In our study conducted on 45 patients 4 lost to follow up in first 6 months with displaced tibial plateau overall the functional result using Rasmussen’s criteria was acceptable in all of the cases with an average score of 26.38. All the patients in our series showed union with average time for union being 13.3 weeks. DISCUSSION: Our study confirms that minimally invasive locking compression plate osteosynthesis is a viable alternative as a treatment for open tibial plateau fractures Gustilo and Anderson’s type I and II. The incidence of infection in our study wad 10% which is comparable with most of the series in literature that select the high energy tibial plateau fractures. None of the patients had nonunion only one had delayed union and does not required bone grafting as the metaphyseal area has a good blood supply. There were superficial infection in 4 cases which resolved to the dressing and antibiotic treatment within 3 weeks. The mean range motion at knee joint was 5 degree to 130 degree.(1 CONCLUSION: This paper reports the

  20. Bilateral Tubal Gestation Associated with Schistosomiasis in an African Woman

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    K. H. Odubamowo

    2014-01-01

    Full Text Available Background. The incidence of tubal ectopic gestation caused by schistosomiasis induced tubal pathology is undocumented in this environment, which may be due to rarity of this pathology. Bilateral tubal gestation is common in patients that have undergone in vitro fertilization. We report a hitherto undocumented case of spontaneous bilateral ectopic gestation following tubal schistosomiasis. Case Report. Mrs. OB was a 32-year-old G4P3+0 (3 alive woman who complained of abdominal pain and bleeding per vaginam of 4 and 2 days’ duration respectively following 8 weeks of amenorrhea. A clinical impression of ruptured ectopic gestation was confirmed by ultrasound scanning. She had bilateral salpingectomy with histology of specimens showing bilateral ectopic gestation with Schistosoma haematobium induced salpingitis (findings of Schistosoma haematobium ova noted on slide. Conclusion. Schistosoma induced salpingitis is a rare but possible cause of bilateral tubal gestation.