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Sample records for bilateral tibial metaphysis

  1. A Model of Implant-Associated Infection in the Tibial Metaphysis of Rats

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    Maximilian Haenle

    2013-01-01

    Full Text Available Objective. Implant-associated infections remain serious complications in orthopaedic and trauma surgery. A main scientific focus has thus been drawn to the development of anti-infective implant coatings. Animal models of implant-associated infections are considered helpful in the in vivo testing of new anti-infective implant coatings. The aim of the present study was to evaluate a novel animal model for generation of implant-associated infections in the tibial metaphysis of rats. Materials and Methods. A custom-made conical implant made of Ti6Al4V was inserted bilaterally at the medial proximal tibia of 26 female Sprague-Dawley rats. Staphylococcus aureus in amounts spanning four orders of magnitude and each suspended in 15 μl phosphate buffered saline (PBS was inoculated into the inner cavity of the implant after the implantation into the defined position. Controls were treated accordingly with PBS alone. Animals were then followed for six weeks until sacrifice. Implant-associated infection was evaluated by microbiological investigation using swabs and determination of viable bacteria in the bone around the implant and the biofilm on the implants after sonification. Results. Irrespective of the initial inoculum, all animals in the various groups harbored viable bacteria in the intraoperative swabs as well as the sonication fluid of the implant and the bone samples. No correlation could be established between initially inoculated CFU and population sizes on implant surfaces at sacrifice. However, a significantly higher viable count was observed from peri-implant bone samples for animals inoculated with 106 CFU. Macroscopic signs of animal infection (pus and abscess formation were only observed for implants inoculated with at least 105 CFU S. aureus. Discussion/Conclusion. The results demonstrate the feasibility of this novel animal model to induce an implant-associated infection in the metaphysis of rats, even with comparatively low

  2. Bilateral Tibial Tubercle Sleeve Fractures in a Skeletally Immature Patient

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    Rasesh R. Desai

    2013-01-01

    Full Text Available Tibial tubercle sleeve fracture is a rare injury. In concept, it is similar to the patellar sleeve fracture in a skeletally immature patient. We describe a unique case of simultaneous bilateral tibial tubercle sleeve fractures in a 12-year-old boy. Radiographs and MRI confirmed the injury. The patient underwent open surgical repair of bilateral sleeve fractures with suture anchor fixation. At the final followup, 3 years after his initial injury, the patient demonstrated full knee function bilaterally without radiographic evidence of growth disturbances.

  3. Chronic Bilateral Tibial Stress Fractures with Valgus Treated with Bilateral Intramedullary Nailing: A Case Report

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    Steven K Dailey

    2014-01-01

    Full Text Available Introduction: Stress fractures are overuse injuries most commonly seen in athletes, military recruits, and individuals with endocrine abnormalities. It has been demonstrated that chronic cases of anterior tibial stress fractures refractory to conservative management respond well to intramedullary nailing. To our knowledge, only one report has been published concerning patients with bilateral tibial stress fractures treated with bilateral intramedullary nailing. All patients in the series were high-level athletes. We present the case of a non-athletic patient with chronic bilateral tibial stress fractures and associated deformity successfully treated with bilateral intramedullary nails. Case Report: A 23-year-old Caucasian female full-time student presented with chronic bilateral shin pain for approximately five years. She had failed an extensive regimen of conservative management. She was diagnosed with chronic bilateral tibial stress fractures based on history, physical examination, and radiologic findings. She subsequently underwent sequential intramedullary nailing of her tibiae. Both tibiae were in valgus alignment; however, this did not preclude nail placement. The nails deformed upon insertion into the sclerotic canals to conform to the deformation. Post operatively the tibiae united and patient was relieved of her symptoms. Conclusion: Bilateral intramedullary nailing of chronic bilateral tibial stress fractures should be considered as a treatment option for all patients, not just high-level athletes, who fail a trial of conservative management. Additionally, mild to moderate tibial malalignment does not necessarily preclude tibial nailing as the smaller nails placed in sclerotic canals will likely deform on insertion and conform to the canal. Keywords: Bilateral intramedullary nailing, bilateral tibial stress fractures, valgus

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

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

    International Nuclear Information System (INIS)

    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

  6. 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.

  7. Bilateral atraumatic tibial tubercle avulsion fractures: case report and review of the literature.

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    Khoriati, Al-Achraf; Guo, Shigong; Thakrar, Raj; Deol, Rupinderbir S; Shah, Khalil Y

    2015-04-01

    An avulsion fracture of the tibial tubercle is an uncommon injury, comprising less than 1% of all physeal injuries. The occurrence of such injuries bilaterally is even rarer. We report a case of bilateral atraumatic tibial tubercle avulsion fractures and its presentation, mechanism of injury, surgical management, post-operative rehabilitation and implications for clinical practice. A 17-year-old healthy male presented to the emergency department with severe pain on the anterior aspect of both knees and was unable to walk, having been brought in by ambulance after hearing a crack whilst jogging. On examination, there was significant swelling of both knees which were held in extension. On both sides there was a prominent deformity on the region of the tibial tubercle with a palpable gap, although no open skin wound. He was unable to actively move either knee joint. No neurovascular deficit was present. Plain radiographs revealed bilateral tibial tubercle avulsion fractures. Gentle manipulation was performed in the emergency department to the fragments in order to remove the tension from the skin. The fragments were reduced and fixed surgically with 4mm cannulated screws in an anterior to posterior direction. Both limbs were placed in temporary casts in 20 degrees of flexion. Postoperatively, the patient was kept non-weight bearing for four weeks then placed into a range of motion brace and movement commenced. Full weight bearing was permitted at the one month stage and he was advised to avoid any sporting activity until the 8 week stage and contact sports until the 10 week stage. Full movement of both joints was regained and the patient returned to full sporting activity in the absence of symptoms. This case emphasises the need for a high degree of vigilance when faced with such a presentation and a low threshold for further investigation and surgical intervention. PMID:25638599

  8. [Bilateral tibial compartment syndrome with crush symptoms after cannabis abuse].

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    Huber, F X; Eckstein, H H; Allenberg, J R

    1997-08-01

    Acute compartmental syndrome (CS) is a surgical emergency. Different conditions in which high non-physiological pressure appears within a closed fascial space reduce the necessary blood perfusion. CS is caused by trauma, burns, bleeding in patients with coagulopathies arterial injuries, nephrotic syndrome or unusual physical exercise with secondary compartmental swelling. When decompression occurs too late, permanent loss of function and limb contracture may result. In the following paper we report on a case of four-compartmental syndrome in the lower legs of a patient with drug intoxication. After cannabis consumption, the patient fell asleep sitting cross-legged. During our first examination several hours later, the signs of compartmental syndrome with spontaneous pain, turgid swelling and paresis were present. Bilateral skin incision technique was used to gain entrance into the four compartments in both lower legs. Immediately after the operation, the patient showed crush syndrome with high serum creatine kinase activity 140.501 U/l and acute renal failure caused by rhabdomyolysis. Within 2 weeks of haemofiltration and dialysis, a full recovery to a normal serum creatinine level of 0.7 mg/dl was achieved. After emergency treatment and rehabilitation, the patient showed neither vascular nor neural defects. PMID:9377997

  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. Successful stabilisation of a type III paediatric tibial eminence fracture using a tensioned wire technique.

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    Archer, Matthew; Parkin, Tom; Latimer, Mark David

    2016-01-01

    We report the case of an 11-year-old boy presenting with a type III tibial eminence fracture. The fracture fragment was reduced arthroscopically. Two 1.6 mm retrograde K-wires were inserted from the tibial metaphysis across the physis and into the fracture fragment using a standard anterior cruciate ligament tibial tunnel guide. Once the wires were clearly visible within the joint the tips were bent over by ∼120°. The wires were then tensioned around a single small fragment screw inserted into the tibial metaphysis. An exceptionally strong fixation was achieved. The boy was mobilised without a brace. The wires were removed at 12 weeks and he returned to full activity at 14 weeks. PMID:27646317

  11. Physeal growth arrest after tibial lengthening in achondroplasia

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

    International Nuclear Information System (INIS)

    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.)

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

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    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. Valgus rotational -dome shaped -tibial osteotomy in treatment of tibia vara

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    Hossam Kandil MD

    2001-09-01

    Full Text Available The choice of surgical treatment of tibia vara depends upon the age of child, and !"#$%! &""!"#$" ''! #$! &!(!' ­!years .All patients were evaluated clinically . Radiographic measurement of tibio-! *were treated by dome shaped valgus rotational proximal tibial osteotomy and followed %( ­ '! +the varus deformity and improvement of alignment of lower extremities .The mean %'! #$had full correction . No pain or ligamentous laxity of the knee was recorded and the ,! '"!"#$alignment as positive angle . Valgus rotational dome shaped tibial osteotomy is a safe, stable and reliable method to accurately achieve angular and rotational correction of late onset form of Blount disease. There were no complication, and the healing was rapid. Introduction Blount disease is an uncommon growth proximal tibial epiphysis because of disorder characterized by disordered growth disturbances of the subjacent ossification of the medial aspect of the physis. The etiology remains controv -proximal tibial physis, epiphysis, and ersial, but it is most likely secondary to metaphysis. This progressive deformity a combination of hereditary and is manifested by varus angulation, ! '"$ &internal rotation of the tibial, and genu path physiology of Blount disease most recurvatum in the proximal metaphyseal likely is due to a combination of region immediately below the knee. Fig excessive compressive forces on the $ &proximal medial metaphysis of the tibia irreversible pathologic changes, espec ­and altered endochondral bone ially at the medial portion of the

  16. Longitudinal tibial epiphyseal bracket in Nievergelt syndrome

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    Burnstein, M.I.; De Smet, A.A.; Breed, A.L.; Thomas, J.R.; Hafez, G.R.

    1989-04-01

    A patient is described with lower extremity mesomelic dwarfism associated with bilateral congenital elbow, hip, and knee dislocations. Rhomboid-shaped tibiae and delayed ossification of the primary fibular ossification centers were demonstrated at birth. Plain films and magnetic resonance imaging revealed that the tibial deformities were due to the presence of longitudinal epiphyseal brackets. These brackets were observed at surgery and confirmed histologically. Recognition of the longitudinal epiphyseal bracket and its relationship to the tibial deformities seen in this patient with Nievergelt syndrome is important for planning surgical treatment. (orig.).

  17. 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

  18. Proximal Tibial Bone Graft

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    ... Complications Potential problems after a PTBG include infection, fracture of the proximal tibia and pain related to the procedure. Frequently Asked Questions If proximal tibial bone graft is taken from my knee, will this prevent me from being able to ...

  19. 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.)

  20. Tibial Plateau Fractures

    DEFF Research Database (Denmark)

    Elsøe, Rasmus

    This PhD thesis reported an incidence of tibial plateau fractures of 10.3/100,000/year in a complete Danish regional population. The results reported that patients treated for a lateral tibial plateau fracture with bone tamp reduction and percutaneous screw fixation achieved a satisfactory level of...... radiological outcomes and a level of health related quality of life (Eq5d) below but not significantly different from the Danish reference population at a mean of 5.2 years follow-up. Furthermore, a knee injury-specific questionnaire (KOOS) reported a level of disability close to a reference population with...... only the subgroup Sport significantly below the age matched reference population. The thesis reports a level of health related quality of life (Eq5d) and disability (KOOS) significantly below established reference populations for patients with bicondylar tibial plateau fracture treated with a ring...

  1. How to Minimize Rotational Conflict between Femoral & Tibial Component in Total Knee Arthroplasty: The Use of Femoro-Tibial Axial Synchronizer (Linker)

    OpenAIRE

    Seo, Jai-Gon; Moon, Young-Wan; Kim, Sang-Min; Park, Sang-Hoon

    2015-01-01

    Purpose The purpose of this study was to investigate the correlation between rotational axes of femur and tibia with the use of Linker. Materials and Methods This study was carried out from August 2009 to February 2010 on 54 patients (106 knees), who were diagnosed with simultaneous bilateral total knee arthroplasty. With the use of postoperative computed tomography scans, it was investigated how much the rotational angle of femoral and tibial components matched. Results The tibial component ...

  2. Open Reduction and Internal Fixation of the Tibial Plateau Through the Anterolateral Approach.

    Science.gov (United States)

    Hake, Mark E; Goulet, James A

    2016-08-01

    Fractures of the tibial plateau are challenging injuries to treat. The lateral tibial plateau is fractured more commonly than the medial plateau and the workhorse approach for these fractures is the anterolateral approach. This approach allows visualization of the lateral joint, metaphysis, and can be extensile if there is shaft extension. We present our technique for performing the anterolateral approach while treating a Schatzker III tibial plateau fracture. Special attention is given to performing a submeniscal arthrotomy to view the joint surface and judge the reduction. A femoral distractor is placed to assist with elevation the joint surface and visualization of the lateral plateau. A cortical window is created using a triple reamer from the sliding hip screw set. The reduction is performed and supported with cancellous bone chips. Finally, a lateral locking plate with rafting screws is placed. Knowledge of this approach and the strategies needed to address lateral and some bicondlar tibial plateau fractures are crucial to good patient outcomes. PMID:27441932

  3. Tibial shaft fracture

    DEFF Research Database (Denmark)

    Larsen, Peter

    The overall purpose of the present PhD thesis was to provide up-to-date information of the epidemiology of tibial shaft fractures and to investigate the development in quality of life, pain and functional outcomes from surgery and onwards, following a tibial shaft fracture treated with...... intramedullary nailing. Study I reported an incidence of 16.9/100,000/year from a complete population. Study II reported the long-term patient-reported outcomes and showed that approximately 8 years after the fracture patients reported significantly worse outcome for 4 of the 5 KOOS subscales compared to the...... 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...

  4. TIBIAL SHAFT FRACTURES

    OpenAIRE

    Kojima, Kodi Edson; Ferreira, Ramon Venzon

    2015-01-01

    The long-bone fractures occur most frequently in the tibial shaft. Adequate treatment of such fractures avoids consolidation failure, skewed consolidation and reoperation. To classify these fractures, the AO/OTA classification method is still used, but it is worthwhile getting to know the Ellis classification method, which also includes assessment of soft-tissue injuries. There is often an association with compartmental syndrome, and early diagnosis can be achieved through evaluating clinical...

  5. 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

  6. High tibial osteotomy

    OpenAIRE

    F.Taser, Omer; Aydinok, Hilmi C.; Asik, Mehmet; Sar, Cuneyt; Sahinkaya, Sabahattin

    2004-01-01

    We have revieved 16 knees of 13 patients who had been treated with high tibial osteotomy for gonarthrosis in Department of Orthopaedics and traumatology, Istanbul Faculty of Medicine between 1970 and 1987, and who were available for final follow-up we report the short-term and the long-term results. When the group with a follow-up of 9.6 years was compared to the one with 16.2 months follow-up, we observed that the initial satisfactory results coult not be maintained in %17.5 of the cases. G...

  7. 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.

  8. 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. PMID:22341017

  9. Genetics Home Reference: tibial muscular dystrophy

    Science.gov (United States)

    ... Names for This Condition tardive tibial muscular dystrophy TMD Udd distal myopathy Udd-Markesbery muscular dystrophy Udd ... titin may cause more severe tibial muscular dystrophy (TMD). Neuromuscul Disord. 2008 Dec;18(12):922-8. ...

  10. Tibial Tubercle Osteotomy for Anterior Knee Pain

    Science.gov (United States)

    Bonasia, Davide; Rosso, Federica; Cottino, Umberto; Governale, Giorgio; Cherubini, Valeria; Dettoni, Federico; Bruzzone, Matteo; Rossi, Roberto

    2016-01-01

    Objectives: The aim of this study was to evaluate the mid-term radiological and clinical outcomes of tibial tubercle osteotomy in patients affected by anterior knee pain. In addition, prognostic factors correlated with the outcomes were evaluated. Methods: The patients treated with tibial tubercle osteotomy (anteromedialization) for anterior knee pain between 2002 and 2014 were included. Exclusion criteria: 1) previous knee surgeries; 2) different procedures to treat anterior knee pain; 3) history of patellar dislocation, 4) Rheumatic conditions. Different variables were collected, as shown in. The patients were prospectively evaluated using the WOMAC short form and Kujala scores. An objective evaluation was performed looking for different potential risk factors and using part of the International Knee Documentation Committee (IKDC) score. Radiological evaluation was performed, including the congruence angle, the grade of osteoarthritis (Kellegren-Lawrence) and the patellar tilt angle. Three main outcomes were identified. The multiple logistic regression was used to analyze the correlation between the variables and a worse outcome. Results: 72 cases were included in the study (9 bilateral). 72.2% of the cases were female, and the average age was 42,2 years (SD15,9). The average BMI was 24.4 kg/m2 (SD5,2). In 70.8% of patients a lateral release was associated to the tibial tubercle osteotomy. 77.8% of patients were evaluated clinically, the remaining, who were unable to come for the visits, were interviewed and the subjective scores were administered by phone. The average follow-up was 68.4 months (SD35.5).In 62.5% of cases a valgus lower limb alignment was detected, with 25% and 39.3% of patients having respectively an increased femoral antiversion and foot pronation. Post-operatively there was a statistical significant improvement in all the scores. No differences in the pre-operative and post-operative congruence angle or patellar tilt were detected (p>0.05). All

  11. 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...... postoperatively after intramedullary nailing of tibial shaft fracture. METHODS: A total of 39 patients were included in this 12-month follow-up study. After 6 weeks, 3, 6, and 12 months postoperatively the pain intensity was measured on a visual analog scale (VAS) and the pressure pain sensitivity was assessed...... bilaterally by pain pressure thresholds (PPTs). RESULTS: The mean age at the time of fracture was 42.9 years. Twelve months after surgery, the pain intensity for worst pain during the last 24 hours was 1.8 ± 2.7 cm. The PPTs progressively increased from 6 weeks after surgery to 12 months postoperatively for...

  12. 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.

  13. 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.

  14. Effect of Hydroxyapatite on Bone Integration in a Rabbit Tibial Defect Model

    OpenAIRE

    Lee, Myung-Jin; Sohn, Sung-Keun; Kim, Kyung-Taek; Kim, Chul-Hong; Ahn, Hee-Bae; Rho, Mee-Sook; Jeong, Min-Ho; Sun, Sang-Kyu

    2010-01-01

    Background The aim of the present study was to prepare hydroxyapatite (HA) and then characterize its effect on bone integration in a rabbit tibial defect model. The bone formation with different designs of HA was compared and the bony integration of several graft materials was investigated qualitatively by radiologic and histologic study. Methods Ten rabbits were included in this study; two holes were drilled bilaterally across the near cortex and the four holes in each rabbit were divided in...

  15. 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.

  16. Tibial hyperostosis: A diagnostic approach

    International Nuclear Information System (INIS)

    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

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

    Directory of Open Access Journals (Sweden)

    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

  18. Bilateral Tarsal Tunnel Syndrome Due To Bilateral Lipoma: A Case Report

    Directory of Open Access Journals (Sweden)

    C. Eren CANSÜ, İstemi YÜCEL, Kutay ÖZTURAN

    2010-11-01

    Full Text Available Tarsal tunnel syndrome is an entrapment neuropathy of posterior tibial nerve under the flexorretinaculum. Patients generally present with paresthesias on the plantar side of foot and fingersand in the distal kruris.The causes of tarsal tunnel syndrome are space occupying lesions within or around the tunnelwhich exert pressure to the nerve, ankle deformities, systemic illnesses, trauma or lesions ofthe nerve itself.In this study a case of tarsal tunnel syndrome due to bilateral lipoma which was treated surgicallyis presented.

  19. Incidence and epidemiology of tibial shaft fractures

    DEFF Research Database (Denmark)

    Larsen, Peter; Elsøe, Rasmus; Hansen, Sandra Hope;

    2015-01-01

    Introduction: The literature lacks recent population-based epidemiology studies of the incidence, trauma mechanism and fracture classification of tibial shaft fractures. The purpose of this study was to provide up-to-date information on the incidence of tibial shaft fractures in a large and compl......Introduction: The literature lacks recent population-based epidemiology studies of the incidence, trauma mechanism and fracture classification of tibial shaft fractures. The purpose of this study was to provide up-to-date information on the incidence of tibial shaft fractures in a large...... the highest frequency between the age of 30 and 40. AO-type 42-A1 was the most common fracture type, representing 34% of all tibial shaft fractures. The majority of tibial shaft fractures occur during walking, indoor activity and sports. The distribution among genders shows that males present a higher...... frequency of fractures while participating in sports activities and walking. Women present the highest frequency of fractures while walking and during indoor activities. Conclusion: This study shows an incidence of 16.9/100,000/year for tibial shaft fractures. AO-type 42-A1 was the most common fracture type...

  20. Bilateral anterior shoulder dislocation

    OpenAIRE

    Meena, Sanjay; Saini, Pramod; Singh, Vivek; Kumar, Ramakant; Trikha, Vivek

    2013-01-01

    Shoulder dislocations are the most common major joint dislocations encountered in the emergency departments. Bilateral shoulder dislocations are rare and of these, bilateral posterior shoulder dislocations are more prevalent than bilateral anterior shoulder dislocations. Bilateral anterior shoulder dislocation is very rare. We present a case of 24-year-old male who sustained bilateral anterior shoulder dislocation following minor trauma, with associated greater tuberosity fracture on one side...

  1. 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.

  2. A STUDY ON ROLE OF INTERLOCK NAILING IN THE MANAGEMENT OF TIBIAL DIAPHYSEAL FRACTURES

    Directory of Open Access Journals (Sweden)

    Venkateswara Rao

    2015-09-01

    Full Text Available Tibial fractures are one of the commonest orthopedic injuries. Tibial fractures are one of the commonest orthopedic injuries. In the past several years there has been a trend towards by use of small diameter nails without remaining in the management of unstable tibial shaft fractures. However it is important to remember that many closed fractures with less severe soft tissue injury, Treatment with an intramedullary nail with reaming allows placement of larger implant, thereby minimizing the incidence of mechanical failure. While maintain high rates of union. METHODS: In our study, 100 cases of tibial diaphyseal fracture s were treated with Interlocking nailing in between May - 2012 to April 2015 at Siddhartha Medical College/Government General Hospital, Vijayawada. RESULTS: In our study, among 100 cases 86 were closed fractures, and 8 were open fractures and 6 non - unions. O f the 100 cases 56 (56% on right side, 38 (38% on left side, 6 cases (6% were bilateral. The commonest type of fracture is spiral or long oblique in 40 cases (40%. Transverse or short oblique in 28 cases (28%, comminuted in 24 cases (24% and segmenta l in 8 cases (8%. The average time for union is 14 weeks with a range of 12 - 40 weeks. . 2 patients developed delayed union due to distraction at the fracture site.

  3. 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

  4. Pseudoaneurysm of the Posterior Tibial Artery After Posterior Tibial Tendon Transfer.

    Science.gov (United States)

    Elabdi, Monsef; Roukhsi, Redouane; Tijani, Youssef; Chtata, Hassan; Jaafar, Abdeloihab

    2016-01-01

    Pseudoaneurysm of the posterior tibial artery is an uncommon condition that, left untreated, can lead to hemorrhage, thrombosis, or emboli. We present the case of a 54-year-old male who developed pseudoaneurysm of the posterior tibial artery 4 months after undergoing tibialis posterior tendon transfer for management of peroneal nerve palsy, which had developed as a complication of hip arthroplasty. PMID:26972754

  5. 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.

  6. 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.

  7. Epidemiology of tibial shaft fractures

    Directory of Open Access Journals (Sweden)

    Grecco Marco Aurélio Sertório

    2002-01-01

    Full Text Available In this work an epidemiological analysis on tibial shaft fractures was performed. During four years, our service treated 179 fractures, 132 in male, 47 in female, aged 14 to 83 years. The 21 to 30-year-old patiens were the more injured. Of these, 120 were open and 59 close fractures of which prevailing cause was road traffic accident. The study based on patients promptuaries analyses and radiographs. The fractures occurred 97 times in the middle third (54.18%; 102 times (56.98% presented simple fragments, and 57 (31.38% oblique lines. We treated close and open fractures, respectively, 48 and 38 cases with plaster cast immobilization; 3 and 67 with external fixation after plaster cast immobilization; 5 and 12 with osteosynthesis by means of plate and screws, and 2 and 3 with external fixation only. In both close and open fractures, respectively, 7 and 20 cases of pseudarthrosis and 1 and 11 of infections have occurred. With the data obtained we verified an actual validity of the epidemiological studies as a contribution for better identifying lesions features and their treatment and complications. This allows proceedings and apprenticeship refinement.

  8. Osteochondritis of the Distal Tibial Epiphysis

    Directory of Open Access Journals (Sweden)

    Firass EL Hajj

    2012-01-01

    Full Text Available Osteochondritis of the distal tibial epiphysis is a very rare entity. 9 cases have been described in 7 articles and 8 other cases have been mentioned in textbooks. This paper describes the 10th case of osteochondritis of the distal tibial epiphysis and summarizes the clinical and radiological presentations of the 9 other cases. The etiology of this entity is well debated in the literature. We believe that it results from a vascular abnormality in the distal tibial epiphysis associated with a mechanical stress (trauma, excessive overload, etc.. Since it is a self-limited disease, the prognosis is good and the younger the patient is the better the prognosis will be. In general, this entity responds well to conservative treatment.

  9. Bifurcation of the femur with tibial agenesis and additional anomalies

    NARCIS (Netherlands)

    van der Smagt, JJ; Bos, CFA; van Haeringen, A; Hogendoorn, PCW; Breuning, MH

    2005-01-01

    Bifurcation of the femur and tibial agenesis are rare anomalies and have been described in both the Gollop-Wolfgang Complex and the tibial agenesis-ectrodactyly syndrome. We report on two patients with bifurcation of the femur and tibial agenesis. Hand ectrodactyly was seen in one of these patients.

  10. Fracture of tibial tuberosity in an adult

    OpenAIRE

    Rodrigo Pires e Albuquerque; Campos, André Siqueira; de Araújo, Gabriel Costa Serrão; Gameiro, Vinícius Schott

    2013-01-01

    The fracture of tibial tuberosity is a rare lesion and still more unusual in adults. We describe a case in an adult who suffered a left knee injury due to a fall from height. No risk factors were identified. The lesion was treated with surgical reduction and internal fixation. The rehabilitation method was successful, resulting in excellent function and rage of motion of the knee. The aim of this study was to present an unusual case of direct trauma of the tibial tuberosity in an adult and th...

  11. 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

  12. 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.

  13. Comparisons of tibial accelerations when walking on a wood composite vs. a concrete mezzanine surface.

    Science.gov (United States)

    Lavender, Steven A; Mehta, Jay P; Allread, W Gary

    2013-09-01

    Mezzanine surfaces can be made from concrete, bar grate, or composite materials. Anecdotal data indicate that mezzanines in distribution centers made from composite materials, due to their increased compliance, may be a more comfortable working surface. Prior research suggested that a measure of tibial shock, peak tibial acceleration, could potentially discriminate the biomechanical differences between these surfaces. The objective of this study was to quantify differences in tibial accelerations as 27 people walked on mezzanines constructed from concrete and a wood composite material. Accelerometers were attached bilaterally to the shins of volunteers, and data were collected as they walked 30.5 m on each surface at their normal walking speed, a faster-than-normal walking speed, and a slower-than-normal walking speed. Peak acceleration values obtained from the leg with the highest values were compared. On average, the peak acceleration values were 5% higher on the concrete mezzanine as compared with the wood composite mezzanine (p = .036). These findings suggest that individuals working on mezzanines in distribution centers constructed from composite surfaces would potentially experience less discomfort associated with long exposure periods on these surfaces. PMID:23601691

  14. TIBIAL PERIPROSTHETIC FRACTURE COMBINED WITH TIBIAL STEM STRESS FRACTURE FROM TOTAL KNEE ARTHROPLASTY

    OpenAIRE

    Fonseca, Fernando; Rebelo, Edgar; Completo, Antonio

    2015-01-01

    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 CA...

  15. Modified Technique of Tibial Tuberosity Transfer.

    Science.gov (United States)

    Pemmaraju, Gopalakrishna; Raad, Abbas; Kotecha, Amit; Chugh, Sanjiv; Mughal, Ejaz

    2015-08-01

    Tibial tuberosity transfer is a well-established procedure in the treatment of patellar instability and in selected cases of anterior knee pain. Several techniques have been advocated in the literature. Some of the common complications associated with this procedure have been pain and discomfort due to prominent screw heads, necessitating their removal; nonunion and delayed union of the osteotomy; and failure of fixation. Tibial fractures have also been reported in some case reports. We present our technique of tibial tuberosity transfer using two 4-mm cannulated screws for stabilization of the tuberosity fragment. We have used this technique either for isolated tibial tuberosity transfer or as part of a combined procedure along with medial patellofemoral ligament reconstruction in treating patellar instability. Using this technique, we have encountered no patients with wound problems, nonunion, delayed union, or loss of fixation and only 1 patient with a metal work problem needing a second procedure for its removal. We attribute our good outcomes to the preservation of the soft-tissue attachments to the tuberosity fragment; minimal soft-tissue dissection, which allows rapid bony consolidation of the osteotomy, which in turn allows accelerated rehabilitation; and the use of 4-mm cannulated screws for fixation of the osteotomy, minimizing the potential for metal work problems. PMID:26759775

  16. Tibial shaft fractures in football players

    Directory of Open Access Journals (Sweden)

    Daisley Susan

    2007-06-01

    Full Text Available Abstract Background Football is officially the most popular sport in the world. In the UK, 10% of the adult population play football at least once a year. Despite this, there are few papers in the literature on tibial diaphyseal fractures in this sporting group. In addition, conflicting views on the nature of this injury exist. The purpose of this paper is to compare our experience of tibial shaft football fractures with the little available literature and identify any similarities and differences. Methods and Results A retrospective study of all tibial football fractures that presented to a teaching hospital was undertaken over a 5 year period from 1997 to 2001. There were 244 tibial fractures treated. 24 (9.8% of these were football related. All patients were male with a mean age of 23 years (range 15 to 29 and shin guards were worn in 95.8% of cases. 11/24 (45.8% were treated conservatively, 11/24 (45.8% by Grosse Kemp intramedullary nail and 2/24 (8.3% with plating. A difference in union times was noted, conservative 19 weeks compared to operative group 23.9 weeks (p Conclusion Our series compared similarly with the few reports available in the literature. However, a striking finding noted by the authors was a drop in the incidence of tibial shaft football fractures. It is likely that this is a reflection of recent compulsory FIFA regulations on shinguards as well as improvements in the design over the past decade since its introduction.

  17. 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

  18. 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...

  19. Contact stress analysis of the anterior tibial post in bi-cruciate stabilized and mobile-bearing posterior stabilized total knee arthroplasty designs.

    Science.gov (United States)

    Kuwashima, Umito; Hamai, Satoshi; Okazaki, Ken; Ikebe, Satoru; Higaki, Hidehiko; Mizu-Uchi, Hideki; Akasaki, Yukio; Murakami, Koji; Iwamoto, Yukihide

    2016-07-01

    In posterior-stabilized (PS) total knee arthroplasty (TKA), unexpected wear and fracture of the tibial post due to anterior post impingement have been reported. The purpose of this study was to determine the contact stress on the anterior aspect of the tibial post in four contemporary TKA designs. We evaluated one bi-cruciate stabilized design (Journey II) and three mobile-bearing PS designs (Vanguard RP, PFC Sigma RP, and NexGen LPS Mobile). The contact conditions at the anterior aspect of the tibial post were determined upon application of a posterior force of 100N to individual implants. Each measurement was sequentially performed five times, and the data were compared within and across designs using analysis of variance and a post-hoc test. The contact stress of the Journey II and Vanguard RP was less than the compressive yield stress for polyethylene (10MPa) at all tested flexion angles and degrees of rotation. The PFC Sigma RP did not show anterior tibial post impingement under any experimental conditions. The NexGen LPS Mobile demonstrated bilateral edge loading at the anterior tibial post and exceeded 10MPa of contact stress in some test conditions. Thus, the differences among implants in terms of the dimensions of the femoral anterior cam or intercondylar notch and the anterior aspect of the tibial post in the axial and sagittal planes led to significant differences in contact conditions. The present study helps the surgeon to be more aware that various contact conditions of the anterior aspect of the tibial post can occur in individual TKA designs. PMID:26999701

  20. 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...... 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...

  1. Intriguing variations of the tibial arteries and their clinical implications

    Directory of Open Access Journals (Sweden)

    Jelev L

    2011-03-01

    Full Text Available Unusual course and branching pattern of the tibial arteries were discovered during routine anatomical dissection of the right lower extremity of a 61-year-old female cadaver. The arteries of the crural region arose from the popliteal artery, as usual. However, the anterior tibial artery was hypoplastic and supplying the anterior calf muscles ended above the ankle joint. Instead, the posterior tibial artery gave off a large anterior branch, which crossed the lowest portion of the interosseous membrane and prolonged as the most distal continuation of the anterior tibial artery –the dorsalis pedis artery. The rest of the posterior tibial artery continued its course distally and divided into the usual medial and lateral plantar arteries. We briefly review the reported variations of the tibial arteries and discussed their clinical relevance.

  2. Bilateral Primary Intraocular Lymphoma

    OpenAIRE

    Mehrdad Karimi; Masoud Soheilian; Mozhgan Rezaei Kanavi

    2011-01-01

    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 lympho...

  3. 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

  4. 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

  5. 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.

  6. 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

  7. 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.

  8. Bilateral Primary Intraocular Lymphoma

    Directory of Open Access Journals (Sweden)

    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.

  9. BILATERAL IMMATURE OVARIAN TERATOMA

    OpenAIRE

    Vinay; Aditya Pratap; Chetan; Ramesh; Rajlaxmi Jaysing

    2014-01-01

    : Immature teratoma (IMT) is tumor composed of tissues from ectoderm, mesoderm and endoderm and is considered the second most common germ cell tumor. IMT account for 10-20% of all ovarian neoplasias in women less than 20 years of age, with peak incidence between 15 and 19 years old. IMT rarely occurs during menopause. We herein reporting a rare case in a 3 years old girl with bilateral immature ovarian teratoma which is very rare in bilateralism of tumor as well as the fac...

  10. BILATERAL IMMATURE OVARIAN TERATOMA

    Directory of Open Access Journals (Sweden)

    Vinay

    2014-10-01

    Full Text Available : Immature teratoma (IMT is tumor composed of tissues from ectoderm, mesoderm and endoderm and is considered the second most common germ cell tumor. IMT account for 10-20% of all ovarian neoplasias in women less than 20 years of age, with peak incidence between 15 and 19 years old. IMT rarely occurs during menopause. We herein reporting a rare case in a 3 years old girl with bilateral immature ovarian teratoma which is very rare in bilateralism of tumor as well as the fact that the patient age is below the average for the occurrence of these tumors.

  11. Operative results of closed tibial plateau fractures

    Directory of Open Access Journals (Sweden)

    Mathur Hitin

    2005-01-01

    Full Text Available Background: Management of tibial plateau fractures remains challenging because of their number, variety and associated soft tissue injuries that further augment their complexity. Comparison of operative results in recent reports has been difficult due to a lack of standard fracture classification scheme and uniform standardized objective criteria for evaluating results. Methods: Between August 1998 to December 2002, 27 closed tibial plateau fractures were treated operatively using methods and principles advocated by AO/ASIF and followed up for an average of 35.74 months (range 24-68 months. Fractures were classified according to Schatzker′s staging system and results evaluated using Rasmussen′s 30-point clinical grading system and Rasmussen′s radiological evaluation of the knee at a minimum follow up of 2 years. Results: Type II was the most common fracture type (9 cases followed by type I (6 cases. There were 37% excellent and 51.85% good functional results with only 3 patients having unacceptable results. The mean Rasmussen′s functional score was 25.062 (range 15-30. Minimal fixation in comminuted or depressed fractures as compared to rigid fixation was the cause of unacceptable results. Loss of knee range of motion in a few cases was attributed to delayed knee mobilization in these cases. Using Rasmussen′s radiological grading, 2 patients had excellent results and 81.48 % patients had good results. Only 3 patients had poor radiological results. The mean Rasmussen′s radiological score was 15.33 (range 10-18. Moreover, clinical evaluation did not correlate with the follow up radiograph. Conclusion: Anatomic reduction and rigid internal fixation followed by early knee motion and partial weight bearing during bone healing are the cornerstones in the treatment of tibial plateau fractures. Standard fracture classification, uniform reporting and evaluating criteria, along with detailed analysis of uniform treatment methods, has helped us

  12. Classification to guide internal fixation for tibial fracture

    Institute of Scientific and Technical Information of China (English)

    ZHANG Wen-xi; ZHENG Zhi-liang; JI Yue-ping; QIAO Zhi-jun

    2008-01-01

    Objective: To explore a classification method which can provide the clinical guidance for internal fixation of tibial fracture. Methods: The different fractures were fixed according to their mechanical classification. Totally, 71 cases of tibial plateau fracture, tibial proximal fracture, tibial distal fracture and Pilon fracture were analyzed to test this selective principle. Results: All 71 patients were followed up for 6-32 months. The displacement was seldomly observed in cases treated acccording to the classification principle, while some cases against the principle had postoperative displacement. The difference was statistically significant (P<0.05). It was proved that there was remarkable correlation between tibial fracture classification, internal fixator and fixation methods. Conclusion: Types IIIa3, IIIbl and IIIb2 fractures without eccentric moment should be fixed with double plates or anglestable materials combined with locking structure, otherwise displacement may occur.

  13. Bilateral endogenous fungal endophthalmitis

    OpenAIRE

    Michal, Wilczynski; Olena, Wilczynska; Wojciech, Omulecki

    2013-01-01

    Endogenous endophthalmitis is a rare and severe intraocular infection which can be vision-threatening. We describe a case of bilateral fungal endogenous endophthalmitis in a 64-year-old male which was successfully treated with systemic administration of fluconazole followed by pars plana vitrectomy with an intravitreous injection of amphotericin B.

  14. 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 comp...

  15. Bilateral chronic subdural hematoma

    DEFF Research Database (Denmark)

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

    2016-01-01

    ) surgery. The overall retreatment rate was 21.6% (57 of 264 patients). Cases treated with unilateral surgery had twice the risk of retreatment compared with cases undergoing bilateral surgery (28.7% vs 14.1%, respectively, p = 0.002). In accordance with previous studies, the data also showed...

  16. Bilateral meandering pulmonary veins

    Energy Technology Data Exchange (ETDEWEB)

    Thupili, Chakradhar R.; Udayasankar, Unni [Pediatric Imaging, Imaging Institute Cleveland Clinic, Cleveland, OH (United States); Renapurkar, Rahul [Imaging Institute Cleveland Clinic, Thoracic Imaging, L10, Cleveland, OH (United States)

    2015-06-15

    Meandering pulmonary veins is a rare clinical entity that can be mistaken for more complex congenital syndromes such as hypogenetic lung syndrome. We report imaging findings in a rare incidentally detected case of bilateral meandering pulmonary veins. We briefly discuss the role of imaging in diagnosing this condition, with particular emphasis on contrast-enhanced CT. (orig.)

  17. 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.

  18. Bilateral Tibial Stress Fractures in a Young Man Associated with Idiopathic Osteoporosis - Case Report

    OpenAIRE

    Selahattin Özyürek; Erkan Kaya; Cengiz Yıldırım; Özkan Köse; Kenan Koca; Kenan Keklikci

    2010-01-01

    Stress fractures are defined as a partial or complete fracture of bone due to an inability to endure a non-violent stress. Two factors have been proposed to explain the aetiology of stress fractures: muscle fatigue, and direct muscle action. We want to point to third factor with our case report: Osteoporosis. (From the World of Osteoporosis 2010;16:58-60)

  19. Bilateral Tibial Stress Fractures in a Young Man Associated with Idiopathic Osteoporosis - Case Report

    Directory of Open Access Journals (Sweden)

    Selahattin Özyürek

    2010-12-01

    Full Text Available Stress fractures are defined as a partial or complete fracture of bone due to an inability to endure a non-violent stress. Two factors have been proposed to explain the aetiology of stress fractures: muscle fatigue, and direct muscle action. We want to point to third factor with our case report: Osteoporosis. (From the World of Osteoporosis 2010;16:58-60

  20. Surgical Treatment of the Accessory Navicular (Os Tibiale Externum) in Dancers: A Retrospective Case Series.

    Science.gov (United States)

    Rietveld, A B M Boni; Diemer, Willemijn M

    2016-01-01

    This study is to draw attention to a relatively common anatomical anomaly and its possible operative treatment in dancers. The accessory navicular, or os tibiale externum, is an accessory bone on the medial side of the navicular of the foot at the insertion of the posterior tibial tendon (PTT). It can cause obvious hyperpronation, medial foot pain, and a limited and painful relevé in dancers. To the best of our knowledge, this is the first report on the operative treatment of the accessory navicular exclusively in dancers. Six dancers (10 feet) were treated in our clinic for a symptomatic accessory navicular Type II. Five of them (eight feet) underwent surgery, two unilaterally and three bilaterally (at the same time). All five had an excellent result at mean follow-up of 4.7 years, given that they fully resumed their professional dance activities without restriction, discomfort, or residual symptoms. One patient stopped dancing for unrelated reasons and became symptom free without further (surgical) treatment. Although no conclusions can be drawn from a retrospective case series and other treatment modalities were not considered, simple excision of a symptomatic accessory navicular Type II seems to be a good choice in dancers. PMID:27661622

  1. 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.

  2. 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]...

  3. Trabecular metal tibial knee component still stable at 10 years.

    Science.gov (United States)

    Henricson, Anders; Nilsson, Kjell G

    2016-10-01

    Background and purpose - Total knee replacement (TKR) in younger patients using cemented components has shown inferior results, mainly due to aseptic loosening. Excellent clinical results have been reported with components made of trabecular metal (TM). In a previous report, we have shown stabilization of the TM tibial implants for up to 5 years. In this study, we compared the clinical and RSA results of these uncemented implants with those of cemented implants. Patients and methods - 41 patients (47 knees) aged ≤ 60 years underwent TKR. 22 patients (26 knees) received an uncemented monoblock cruciate-retaining (CR) tibial component (TM) and 19 patients (21 knees) received a cemented NexGen Option CR tibial component. Follow-up examination was done at 10 years, and 16 patients (19 knees) with TM tibial components and 17 patients (18 knees) with cemented tibial components remained for analysis. Results - 1 of 19 TM implants was revised for infection, 2 of 18 cemented components were revised for knee instability, and no revisions were done for loosening. Both types of tibial components migrated in the first 3 months, the TM group to a greater extent than the cemented group. After 3 months, both groups were stable during the next 10 years. Interpretation - The patterns of migration for uncemented TM implants and cemented tibial implants over the first 10 years indicate that they have a good long-term prognosis regarding fixation. PMID:27357222

  4. 神经母细胞瘤股骨远端干骺端骨转移全身骨显像分析%Application of semiquantitative analysis of whole body bone imaging on distal femoral metaphysis osseous metastasis of neuroblastoma

    Institute of Scientific and Technical Information of China (English)

    刘阳; 王会祥; 周涛

    2012-01-01

    Objective To evaluate the value of semiquantitative analysis of whole body bone imaging on distal femoral metaphysis osseous metastasis of neuroblastoma.Methods Twenty-nine patients with confirmed neuroblastoma by pathological reports were divided into group of metastasis and group of no metastasis by bone marrow slides,X-ray,CT,MRI or clinical follow-up.Whole body bone imaging was performed pre-or postoperation.All cases were analysed by two methods:① Semi-quautitative analysis:Regions of interest on bilateral distal femoral metaphysic and middle of femoral were drawn,and their average counts were measured.The ratio of radioactivity of distal femoral metaphysic to middle of femoral was calculated; ② Visual analysis:Bilateral distal femoral metaphysic metastasis were diagnosed by visual analysis according to whole body bone imaging.The differences between this two methods were compared.Results There were differences of the ratio of radioactivity of distal femoral metaphysic to middle of femoral between group of metastasis and group of no metastasis(t =8.334, P<0.01),and there was no significant difference betweent the two methods(x2 =0.68, P>0.05).The sensitivivy,specificity,accuracy,positive predictive value and negative predictive value of semiquantitative analysis in detecting osseous metastasis were 90.5%,95.7%,94.4%,86.4% and 97.1%,while visual analysis were 81%,100%,95.6%,100% and 94.5%.Conclusions Radionuclide whole body bone imaging was of great importance in diagnosis of osseous metastasis of neuroblastoma.The diagnostic accuracy was improved by combination of visual analysis and semi-quantitative analysis.%目的 评价全身骨显像半定量分析在神经母细胞瘤股骨远端干骺端骨转移中的应用价值.方法 45例经病理证实的神经母细胞瘤患儿,按骨髓涂片、X线片、CT、MRl或临床随访结果等将其分为股骨远端干骺端转移组和无转移组,术前或术后行99Tcm-MDPSPECT全

  5. [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.

  6. Bilateral intraocular dirofilariasis

    Directory of Open Access Journals (Sweden)

    Viney Gupta

    2014-01-01

    Full Text Available Ocular dirofilariasis mostly presents as a subconjunctival or eyelid lesion. [1] Intraocular dirofilarial infestation is rare. [2],[3] We report a case of a young woman who was accidentally detected to have a live motile worm in the anterior segment in one eye and a cystic lesion on the optic disc in the other eye. To our knowledge, bilateral intraocular dirofilariasis has never been reported.

  7. Compressive Bilateral Filtering.

    Science.gov (United States)

    Sugimoto, Kenjiro; Kamata, Sei-Ichiro

    2015-11-01

    This paper presents an efficient constant-time bilateral filter that produces a near-optimal performance tradeoff between approximate accuracy and computational complexity without any complicated parameter adjustment, called a compressive bilateral filter (CBLF). The constant-time means that the computational complexity is independent of its filter window size. Although many existing constant-time bilateral filters have been proposed step-by-step to pursue a more efficient performance tradeoff, they have less focused on the optimal tradeoff for their own frameworks. It is important to discuss this question, because it can reveal whether or not a constant-time algorithm still has plenty room for improvements of performance tradeoff. This paper tackles the question from a viewpoint of compressibility and highlights the fact that state-of-the-art algorithms have not yet touched the optimal tradeoff. The CBLF achieves a near-optimal performance tradeoff by two key ideas: 1) an approximate Gaussian range kernel through Fourier analysis and 2) a period length optimization. Experiments demonstrate that the CBLF significantly outperforms state-of-the-art algorithms in terms of approximate accuracy, computational complexity, and usability. PMID:26068315

  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. Tibial Tuberosity-Posterior Cruciate Ligament Distance.

    Science.gov (United States)

    Daynes, Jake; Hinckel, Betina Bremer; Farr, Jack

    2016-08-01

    When trochlear dysplasia is present, it is difficult to measure the tibial tuberosity to trochlear groove (TT-TG) distance. A new measurement to assess tuberosity position was recently described by Seitlinger et al, which avoids the difficulty of identifying the TG as it references the posterior cruciate ligament (PCL). To evaluate the reproducibility of the Seitlinger et al findings, 42 knees in 41 patients with a documented history of recurrent patellar instability and 84 knees in patients with no history of patellar instability or patellofemoral symptoms were evaluated with magnetic resonance imaging. The TT-PCL distance was increased in the instability group (mean, 21.6 mm) compared with the control group (mean, 19.0 mm). The TT-PCL distance is an independent risk factor for patients with recurrent patellar instability. Its role in surgical planning remains to be determined. PMID:26509659

  10. 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

  11. 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.

  12. MOBILE TIBIAL POLYETHYLENE BEARING IN TOTAL KNEE ARTHROPLASTY

    OpenAIRE

    de Araújo Barros Cobra, Hugo Alexandre; da Palma, Idemar Monteiro

    2015-01-01

    Debris of polyethylene tibial bearings have been recognized as a major cause for the onset of the cascade of biological events leading to osteolysis and loosening of prosthetic components after total knee arthroplasty. Since then, research has been focused on alternative bearing surfaces in order to minimize the amount and rate of polyethylene wear off and, in doing so, increasing the survivorship rate for knee arthroplasties. One such option is to have a mobile tibial bearing allowing more c...

  13. Tibial Torsion in Cerebral Palsy: Validity and Reliability of Measurement

    OpenAIRE

    Lee, Sang Hyeong; Chung, Chin Youb; Park, Moon Seok; Choi, In Ho; Cho, Tae-Joon

    2009-01-01

    Physical examinations of tibial torsion are used for preoperative planning and to assess outcomes of tibial osteomy in patients with cerebral palsy (CP). The thigh-foot angle (TFA) and transmalleolar axis (TMA) are commonly used, and the second toe test recently was introduced. However, the validity and reliability of the three methods have not been clarified. This study was performed to evaluate the validity and reliability of these physical measures. We recruited 18 patients (36 limbs) with...

  14. TIBIAL TUBERCLE AVULSION FRACTURE IN A MALE ADOLESCENT.

    Science.gov (United States)

    Matoković, Damir; Šimić-Klarić, Andrea; Rajić, Marijana Tomić; Crnković, Helena Tesari; Jurinić, Mislav; Jovanović, Savo

    2015-06-01

    Tibial tuberosity fractures are rare in childhood, most frequently due to excessive quadriceps muscle contraction. On performing long jump, a 15-year-old boy sustained tibial tuberosity avulsion fracture type II according to Watson-Jones. The patient was treated operatively with fragment repositioning and screw fixation. Ten months after the injury and rehabilitation, he resumed his sports activities with full range knee motion. PMID:26415319

  15. Treatment of open infected tibial fracture with microsurgery

    Institute of Scientific and Technical Information of China (English)

    田青业; 张祚勇; 谢红; 王剑利

    2003-01-01

    @@ We used Bastiani monoarm external frame fixator to fix open tibial fracture, a composite flap transfer to cover and repair the defects of the skin and an irrigation device to drain the wound area in patients with infected open tibial fractures induced by internal fixation. Satisfactory function was obtained and the cosmetic results of both the doner and the receptor sites were also satisfactory after operation.

  16. Displaced tibial shaft fractures treated with ASIF compression internal fixation

    DEFF Research Database (Denmark)

    Gebuhr, Peter Henrik; Larsen, T K; Petersen, O C

    1990-01-01

    Fifty-one tibial shaft fractures treated by ASIF compression osteosynthesis were seen at follow-up at a median time of 46 weeks after injury. Twenty-four were open fractures and the patients received prophylactic antibiotics. The median stay in hospital was 15 days for open fractures and 6 days...... for closed fractures. There were complications in 26 cases, with deep infection in 9 cases. At present we cannot advocate the use of ASIF compression osteosynthesis for displaced tibial fractures....

  17. Stress fracture of the mid-tibial shaft.

    Science.gov (United States)

    Orava, S; Hulkko, A

    1984-02-01

    In a series of 151 tibial stress fractures in athletes and joggers, seven were located at the mid-third of the diaphysis. The diagnosis was made radiographically several months after the onset of symptoms; a transverse fissure line or gap was noted in the middle of the hypertrophied anterior tibial cortex. Histologic examination of a biopsy of the fracture line showed features resembling pseudoarthrosis. All the patients returned to physical activities. PMID:6702426

  18. Understanding the etiology of the posteromedial tibial stress fracture.

    Science.gov (United States)

    Milgrom, Charles; Burr, David B; Finestone, Aharon S; Voloshin, Arkady

    2015-09-01

    Previous human in vivo tibial strain measurements from surface strain gauges during vigorous activities were found to be below the threshold value of repetitive cyclical loading at 2500 microstrain in tension necessary to reduce the fatigue life of bone, based on ex vivo studies. Therefore it has been hypothesized that an intermediate bone remodeling response might play a role in the development of tibial stress fractures. In young adults tibial stress fractures are usually oblique, suggesting that they are the result of failure under shear strain. Strains were measured using surface mounted unstacked 45° rosette strain gauges on the posterior aspect of the flat medial cortex just below the tibial midshaft, in a 48year old male subject while performing vertical jumps, staircase jumps and running up and down stadium stairs. Shear strains approaching 5000 microstrain were recorded during stair jumping and vertical standing jumps. Shear strains above 1250 microstrain were recorded during runs up and down stadium steps. Based on predictions from ex vivo studies, stair and vertical jumping tibial shear strain in the test subject was high enough to potentially produce tibial stress fracture subsequent to repetitive cyclic loading without necessarily requiring an intermediate remodeling response to microdamage. PMID:25933941

  19. Distal Locking Screws for Intramedullary Nailing of Tibial Fractures.

    Science.gov (United States)

    Agathangelidis, Filon; Petsatodis, Georgios; Kirkos, John; Papadopoulos, Pericles; Karataglis, Dimitrios; Christodoulou, Anastasios

    2016-01-01

    Recently introduced tibial intramedullary nails allow a number of distal screws to be used to reduce the incidence of malalignment and loss of fixation of distal metaphyseal fractures. However, the number of screws and the type of screw configuration to be used remains obscure. This biomechanical study was performed to address this question. Thirty-six Expert tibial nails (Synthes, Oberdorf, Switzerland) were introduced in composite bone models. The models were divided into 4 groups with different distal locking configurations ranging from 2 to 4 screws. A 7-mm gap osteotomy was performed 72 mm from the tibial plafond to simulate a 42-C3 unstable distal tibial fracture. Each group was divided in 3 subgroups and underwent nondestructive biomechanical testing in axial compression, coronal bending, and axial torsion. The passive construct stiffness was measured and statistically analyzed with one-way analysis of variance. Although some differences were noted between the stiffness of each group, these were not statistically significant in compression (P=.105), bending (P=.801), external rotation (P=.246), and internal rotation (P=.370). This in vitro study showed that, when using the Expert tibial nail for unstable distal tibial fractures, the classic configuration of 2 parallel distal screws could provide the necessary stability under partial weight-bearing conditions. PMID:26840700

  20. 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.

  1. 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.

  2. Complications of tibial eminence and diaphyseal fractures in children: prevention and treatment.

    Science.gov (United States)

    Herman, Martin J; Martinek, Melissa A; Abzug, Joshua M

    2015-01-01

    Fractures of the tibial eminence and the diaphyseal tibia are common pediatric orthopaedic injuries. Although most tibial fractures can be treated nonsurgically, those that require surgical intervention may encounter specific complications. Surgical treatment of fractures of the tibial eminence may be complicated by failed fixation, knee joint stiffness, and arthrofibrosis of the knee, a complication rarely seen in children but occurring most frequently after tibial eminence injuries. Complications of healing after tibial fractures in pediatric patients are uncommon, although some tibial shaft fractures exhibit delayed union or nonunion, infection, and soft-tissue complications. PMID:25745930

  3. 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.

  4. 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.

  5. Isolated bilateral ectopic microspherophakia

    Directory of Open Access Journals (Sweden)

    André Omgbwa Eballe

    2010-02-01

    Full Text Available André Omgbwa Eballe1, Godefroy Koki2, Emilienne Epée2, Didier Owono2, Lucienne Bella Asumpta2, Côme Ebana Mvogo21Faculty of Medicine and Pharmaceuticals Sciences, University of Douala Cameroon; 2Faculty of Medicine and Biomedical Sciences, University of Yaoundé CameroonSummary: An eight-year-old school girl presented to us with a bilateral ectopic microspherophakia. She was surgically managed in the ophthalmology unit of the Gynaeco-Obstetric and Pediatric Hospital of Yaoundé in Cameroon. The postoperative follow up was uneventful, and the patient returned to school with a best corrected visual acuity of 4/10 in both eyes to the great satisfaction of her parents.Keywords: ectopic, microspherophakia, surgery

  6. 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.

  7. 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.

  8. Silicosis with bilateral spontaneous pneumothorax

    OpenAIRE

    Fotedar Sanjay; Chaudhary Dhruva; Singhla Vikas; Narang Rajat

    2010-01-01

    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.

  9. 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.

  10. 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.)

  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. 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

  13. Landing on your own two feet: a case report of bilateral calcaneus and open pilon fractures.

    Science.gov (United States)

    Tiedeken, Nathan C; Hampton, David; Shaffer, Gene

    2014-01-01

    High energy fractures of the distal tibial plafond and calcaneus have been associated with high functional morbidity and wound complications. Although both of these fractures result from a similar mechanism, they have rarely been reported to occur on an ipsilateral extremity. The combination of these 2 injuries on the same extremity would increase the likelihood of an adverse surgical or functional outcome. We present the case and management strategy of a 43-year-old male with bilateral open pilon fractures and closed calcaneal fractures after falling from a height. A staged protocol was used for the bilateral pilon fractures, with external fixation until operative fixation on day 9. Nonoperative management of the calcaneal fractures resulted in a successful functional outcome at 10 months of follow-up. Treatment of this fracture pattern must incorporate the condition of the soft tissues, an understanding of the fractures, and minimize patient risk factors to optimize the functional and surgical outcomes. PMID:24856663

  14. Acute silicosis with bilateral pneumothorax.

    Science.gov (United States)

    Srivastava, G N; Prasad, Rajniti; Meena, Manoj; Hussain, Moosa

    2014-01-01

    We present a case of acute silicosis with bilateral pneumothorax of a 28-year-old man working at a stone crusher factory for 1 year. He presented to the emergency department with cough, respiratory distress and diffuse chest pain. The patient was managed with bilateral intercostal tube drainage under water seal, oxygen inhalation and conservative therapy. On follow-up he showed improvement of resting dyspnoea and was doing well. This case is being reported because of the rare complications of acute silicosis as bilateral pneumothorax. PMID:24862410

  15. 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.

  16. Upper tibial hyperextension fractures in infants: another occult toddler's fracture

    International Nuclear Information System (INIS)

    We describe the radiographic findings associated with occult upper tibial fractures in infants and young children and offer an explanation for the underlying mechanism from which they result. These fractures tend to be subtle, just as the classic spiral tibial fracture originally described by Dunbar et al. (1964, J Can Assoc Radiol 15: 136-144). The fracture we describe results from a hyperextension injury to the knee, and the knowledge of the mechanism of injury, the subtle radiographic findings, and the findings on physical examination allow one to diagnose this fracture with confidence. Otherwise, it easily can go undetected. (orig.)

  17. 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

  18. 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...

  19. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  1. Bilateral Polydactyly in a foal

    OpenAIRE

    Carstanjen, Bianca; Abitbol, Marie; Desbois, Christophe

    2007-01-01

    The following case report describes the diagnosis and surgery of bilateral polydactyly of unknown origin in a colt. A 7-month-old Berber colt was referred for cosmetic and curative excision of supernumerary digits. Radiographic examination revealed bilateral polydactyly and well-developed first carpal bones. Surgery consisted of an osteotomy of both second metacarpal bones combined with an amputation of the supernumerary digits. The follow-up at 18 months after surgery revealed a sound horse ...

  2. Bilateral cleft lip nasal deformity

    OpenAIRE

    Singh Arun; Nandini R.

    2009-01-01

    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 li...

  3. Induction of Tibial Dyschondroplasia by Carbamate and Thiocarbamate Pesticides

    Science.gov (United States)

    Tibial dyschondroplasia (TD) is a major poultry leg problem the natural etiology of which is unknown. Certain dithiocarbamate pesticides such as tetramethyl thiuram disulfide (thiram) have been shown to induce the disease in chickens. Since many different carbamate and thiocarbamate chemicals are ...

  4. 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.

  5. Tibialis Anterior Tendon Transfer for Posterior Tibial Tendon Insufficiency.

    Science.gov (United States)

    Ramanujam, Crystal L; Stapleton, John J; Zgonis, Thomas

    2016-01-01

    The Cobb procedure is useful for addressing stage 2 posterior tibial tendon dysfunction and is often accompanied by a medial displacement calcaneal osteotomy and/or lateral column lengthening. The Cobb procedure can also be combined with selected medial column arthrodesis and realignment osteotomies along with equinus correction when indicated. PMID:26590721

  6. 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....

  7. Olanzapine-induced tender pitting pre-tibial edema

    OpenAIRE

    Kaliaperumal Mathan; Venkatesan Muthukrishnan; Vikas Menon

    2015-01-01

    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.

  8. 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

  9. 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.

  10. 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

  11. 38 CFR 4.26 - Bilateral factor.

    Science.gov (United States)

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Bilateral factor. 4.26... DISABILITIES General Policy in Rating § 4.26 Bilateral factor. When a partial disability results from disease... disability. The bilateral factor will be applied to such bilateral disabilities before other combinations...

  12. 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.

  13. Fatigue behavior of Ilizarov frame versus tibial interlocking nail in a comminuted tibial fracture model: a biomechanical study

    Directory of Open Access Journals (Sweden)

    Stahel Philip F

    2006-12-01

    Full Text Available Abstract Background Treatment options for comminuted tibial shaft fractures include plating, intramedullary nailing, and external fixation. No biomechanical comparison between an interlocking tibia nail with external fixation by an Ilizarov frame has been reported to date. In the present study, we compared the fatigue behaviour of Ilizarov frames to interlocking intramedullary nails in a comminuted tibial fracture model under a combined loading of axial compression, bending and torsion. Our goal was to determine the biomechanical characteristics, stability and durability for each device over a clinically relevant three month testing period. The study hypothesis was that differences in the mechanical properties may account for differing clinical results and provide information applicable to clinical decision making for comminuted tibia shaft fractures. Methods In this biomechanical study, 12 composite tibial bone models with a comminuted fracture and a 25 mm diaphyseal gap were investigated. Of these, six models were stabilized with a 180-mm four-ring Ilizarov frame, and six models were minimally reamed and stabilized with a 10 mm statically locked Russell-Taylor Delta™ tibial nail. After measuring the pre-fatigue axial compression bending and torsion stiffness, each model was loaded under a sinusoidal cyclic combined loading of axial compression (2.8/28 lbf; 12.46/124.6 N and torque (1.7/17 lbf-in; 0.19/1.92 Nm at a frequency of 3 Hz. The test was performed until failure (implant breakage or ≥ 5° angulations and/or 2 cm shortening occurred or until 252,000 cycles were completed, which corresponds to approximately three months testing period. Results In all 12 models, both the Ilizarov frame and the interlocking tibia nail were able to maintain fracture stability of the tibial defect and to complete the full 252,000 cycles during the entire study period of three months. A significantly higher stiffness to axial compression and torsion was

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

    Directory of Open Access Journals (Sweden)

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

    Directory of Open Access Journals (Sweden)

    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

  16. Bilateral spontaneous hemotympanum: Case report

    Directory of Open Access Journals (Sweden)

    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.

  17. [Post-traumatic pseudoaneurysm of the anterior tibial artery secondary to tibial shaft fracture. Case report].

    Science.gov (United States)

    Gómez-Salazar, J; Tovar-López, J; Hernández-Rodríguez, G; De la Concha-Ureta, H

    2016-01-01

    Arterial pseudoaneurysm of the lower limb is an infrequent entity, particularly in the infrapopliteal segment. It is commonly associated to vascular repairs or follows a localized arterial lesion, a fracture or a surgical procedure. There is little information in Mexico about this entity in cases involving the anterior tibial artery, and secondary to trauma and osteosynthesis. Given that sudden bleeding due to rupture of the pseudoaneurysm is a possible catastrophic outcome for the viability of the segment, it is important to timely detect and diagnose the pseudoaneurysm. Treatment indications contained in the international literature are controversial. Solution-oriented approaches may be either surgical or endovascular. Current reports show that the best treatment option is an autologous saphenous vein graft, which maintains blood flow and minimizes the risk of peripheral ischemia. The purpose of this paper is to report the case of a patient who sustained the above mentioned complication and provide a literature review. This topic should be further investigated, as this condition may go unnoticed in a large number of cases, given that its symptoms are silent. PMID:27627775

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

    Directory of Open Access Journals (Sweden)

    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.

  19. Acute silicosis with bilateral pneumothorax

    OpenAIRE

    Srivastava, G. N.; Prasad, Rajniti; Meena, Manoj; Hussain, Moosa

    2014-01-01

    We present a case of acute silicosis with bilateral pneumothorax of a 28-year-old man working at a stone crusher factory for 1 year. He presented to the emergency department with cough, respiratory distress and diffuse chest pain. The patient was managed with bilateral intercostal tube drainage under water seal, oxygen inhalation and conservative therapy. On follow-up he showed improvement of resting dyspnoea and was doing well. This case is being reported because of the rare complications of...

  20. 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.)

  1. 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

  2. [Minimally invasive treatment of tibial plateau fracture under arthroscopy monitoring].

    Science.gov (United States)

    Chen, Lixin; Ma, Shaoyun; Li, Xianpeng

    2014-05-01

    Twenty six patients with fracture of tibial plateau was under arthroscopy assisted reduction, the joint surface of bone graft, and USES the steel plate fixation treatment. Average surgery time was 65 min (70-120 min), average fracture healing time was 15 weeks (12-17 weeks), joint surface anatomical reattachment rate was 92.9%. Using break knee function criteria evaluation of curative effect: 18 cases great 6 cases wed, 2 cases ok, fine rate was 92.3%. No infection, deep venous thrombosis and small leg fascia chamber syndrome and other complications. Conclusion is that treatment of tibial plateau fractures under arthroscope has advantages of small trauma, check intuitively and reset accurately, functional recovery of patients are satisfied, the treatment has certain clinical application value. PMID:25241526

  3. 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......Reliable, validated objective criteria for preoperative and postoperative evaluation of medial patellar luxation in the dog are lacking. The tibial tuberosity-trochlear groove distance (TTTG) is a sensitive, reliable CT or MRI measurement of distal quadriceps mechanism alignment in humans that can...... the typical TTTG in normal and patellar luxation affected dogs, and identify the optimal position for CT scanning. TTTG measurement, if refined, may prove useful in patient selection for procedures such as distal femoral osteotomy in management of medial patellar luxation in large breed dogs....

  4. Primary synchronous bilateral breast cancer

    Directory of Open Access Journals (Sweden)

    R Krishnappa

    2014-01-01

    Full Text Available Background: Primary synchronous bilateral breast cancer (PSBBC is a rare clinical entity. The reported incidence ranges between 0.3% and 12%. There are several controversial issues regarding PSBBC pertaining to the diagnostic criteria, nomenclature, and management policies. Materials and Methods: Fourteen cases of PSBBC treated between 2001 to 2010 at our institute were retrospectively analysed in regards to demographic data, management and follow up. Results: PSBBC constituted 0.19% of total breast cancer patients at our institute. Age ranged from 28 to 78 years. PSBBC were detected by clinical examination in eight cases and by mammography in six cases. Twelve patients underwent bilateral modified radical mastectomy, one had unilateral mastectomy on one side and breast conservation on the other side and one patient has bilateral breast conservation. Majority of patients belonged to stage 2 and stage 3. All patients were found to have invasive ductal carcinoma. Five cases were ER/PR positive and 8 patients were triple hormone receptor negative. Eight patients received unilateral and six received bilateral adjuvant radiotherapy. Nine patients received adjuvant chemotherapy. 5 patients received adjuvant hormonal therapy. Median follow up of patients was 15.4 months. Conclusion: PSBBC is a rare event warranting awareness and screening of the contralateral breast in patients with unilateral breast cancer. These patients require individualized treatment planning based on the tumor factors of the index lesion. Further multi institutional prospective studies are needed for adequate understanding of management of PSBBC.

  5. 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.

  6. 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.

  7. 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 ...

  8. Human tibial torsion - Morphometric assessment and clinical relevance

    Directory of Open Access Journals (Sweden)

    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.

  9. Detrusor instability responses to transvaginal versus posterior tibial nerve stimulation

    Directory of Open Access Journals (Sweden)

    Adly AS

    2012-01-01

    Full Text Available Background: This study aimed at comparing the effects of transvaginal electrical stimulation versus posterior tibial nerve electrical stimulation on urodynamic measurements in detrusor instability.Methods: Forty patients were randomly assigned to transvaginal electrical stimulation (Group A and posterior tibial nerve electrical stimulation (Group B. All patients were assessed before and after the treatment course (36 sessions according to the urodynamic parameters. These parameters included first sensation to void and bladder capacity.Results: Regarding first sensation to void, Group A showed improvement with 45.9% after the end of the treatment compared to the baseline while, Group B showed 2.72 % improvement. Regarding bladder capacity both groups showed highly significant (p>0.0001 increase in the bladder capacity. Group A showed significant improvement in the first desire to void and bladder capacity (p>0.0001& p>0.05 respectively compared to Group B.Conclusions: Both transvaginal electrical stimulation and posterior tibial nerve electrical stimulation restore normal detrusor capacity in cases of idiopathic detrusor instability. However, the transvaginal electrical stimulation seems to be more effective.

  10. Dual locked plating of unstable bicondylar tibial plateau fractures.

    Science.gov (United States)

    Ozkaya, Ufuk; Parmaksizoglu, Atilla Sancar

    2015-07-01

    The operative treatment of displaced bicondylar tibial plateau fractures is challenging. The displaced condyles must be reduced, depressed plateaus must be elevated and adequately supported and early rehabilitation must be encouraged in order to obtain good clinical results. This retrospective study was designed to evaluate the clinical outcomes of patients with bicondylar tibial plateau fractures treated with dual locked plates using raft screws with MIPO technique and autologous bone grafting. We hypothesized that in this group of patients dual locked plating reduces the complication rates by avoiding loss of reduction due to the accomplished rigid fixation. Twenty-two consecutive patients with bicondylar tibial plateau fractures (AO Type C) were included in this study. The mean follow up was 26 months. Bone healing was achieved in all patients with 3 cases of superficial and 1 case of deep infection. Secondary loss of reduction, secondary loss of alignment, early post-traumatic arthritis were not observed in this study. The Lysholm knee score showed an average of 80.5 points (range: 61.5-90) at the final follow up assessment. Optimal fixation of the fracture with dual locked plating which allows immediate motion and partial weight bearing may be an alternative concept to prevent secondary loss of reduction to obtain a good clinical outcome. PMID:26021666

  11. The new “dual osteotomy”: combined open wedge and tibial tuberosity anteriorisation osteotomies

    OpenAIRE

    Megied, Wael Samir Abdel; Mahran, Mahmoud A.; Thakeb, Mootaz F.; Abouelela, Amr A. K. H.; Elbatrawy, Yasser

    2009-01-01

    The high frequency with which medial compartment osteoarthritis is associated with patellofemoral osteoarthritis makes the addition of tibial tuberosity anteriorisation to high tibial osteotomy an appealing solution, despite the discouraging previously reported long-term results when tubercle anteriorisation was combined with a Coventry closed wedge technique. We conducted a prospective study of a new osteotomy combination: “the dual osteotomy”. An open wedge high tibial osteotomy was combine...

  12. Posterior Cruciate Ligament Reconstruction Using Single-Bundle Achilles Allograft with Open Tibial Inlay Fixation

    OpenAIRE

    Zehir, Sinan; Elmalı, Nurzat; Çalbıyık, Murat; Taşdemir, Zeki; Sağlam, Fevzi

    2014-01-01

    Objectives: PCL reconstruction research has shown that the tibial inlay and transtibial tunnel procedures offer similar biomechanical results. The purpose of this study was to evaluate the early results of PCL reconstruction using a single-bundle Achilles allograft and tibial inlay fixation. Methods: We retrospectively studied 14 patients who had undergone PCL reconstruction using the direct tibial inlay fixation technique from 2009 to 2013, with a mean follow-up of 13.4 months. (6-28 months)...

  13. Posterior tibial nerve as a tendon transfer for drop foot reconstruction: a devastating complication.

    Science.gov (United States)

    Armangil, Mehmet; Basat, H Çağdaş; Bilgin, S Sinan

    2015-01-01

    Iatrogenic peripheral nerve injuries can result from numerous medical procedures, particularly transection, stretching, compression, injections, heat, radiation, and the use of anticoagulant agents. Late diagnosis may lead to atrophy of the motor endplate and result in poor outcomes. We report a case in which the posterior tibial nerve was accidentally sectioned as the posterior tibial tendon for transfer to the anterior tibial tendon in the reconstruction of drop foot. This iatrogenic complication ultimately required foot amputation. Physicians must be aware of the anatomy of the posterior tibial nerve in order to avoid such complications. PMID:25803264

  14. Tratamiento conservador en pacientes con retinoblastoma bilateral

    OpenAIRE

    Juan C. Suárez; Mabel C. Ospina; Sandra A. Arias; González, María E

    2008-01-01

    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 Vicen...

  15. Laparoscopic Adrenalectomy for Bilateral Metachronous Aldosteronomas

    OpenAIRE

    Rizek, Philippe; Gorecki, Piotr; Lindenmayer, Aristid; Moktan, Sabita

    2011-01-01

    Introduction: Primary aldosteronism affects 5% to 13% of patients with hypertension. Idiopathic bilateral hyperplasia (IHA) and unilateral aldosterone-producing adenoma (APA) are the most common types of primary aldosteronism. Bilateral APA is a very rare entity with only a few reports in the literature. We present the case of a patient with metachronous bilateral APA treated with metachronous bilateral total and near total adrenalectomy. Case Report: A 66-year-old female was evaluated for hy...

  16. Simultaneous and staged bilateral total hip arthroplasty

    DEFF Research Database (Denmark)

    Lindberg-Larsen, Martin; Joergensen, Christoffer Calov; Husted, Henrik;

    2013-01-01

    Bilateral total hip arthroplasty (BTHA) and bilateral simultaneous total hip arthroplasty (BSTHA) are done increasingly. Previous studies evaluating outcomes after bilateral procedures have found different results. The aim of this study was to investigate length of hospital stay (LOS), 30 days...

  17. 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

  18. 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.

  19. 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...

  20. Bilateral Molariform Mandibular Second Premolars

    OpenAIRE

    Sonu Acharya; Pradip Kumar Mandal; Chiranjit Ghosh

    2015-01-01

    Macrodontia is a rare dental anomaly that refers to teeth that appear larger than normal. Generalised macrodontia can be associated with certain medical conditions and syndromes. This case report presents clinical and radiographic findings of isolated bilateral macrodontia in a 14-year-old child. The patient was referred to the clinic with local crowding of maxillary and mandibular teeth. Radiographic findings revealed the presence of impacted macrodont mandibular second premolar on one side ...

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

    Directory of Open Access Journals (Sweden)

    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.

  2. 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.

  3. Chemotherapy affects the pattern of failure after shear loading of the proximal tibial growth plate

    NARCIS (Netherlands)

    van Leeuwen, BL; Hartel, R; Jansen, HWB; Verkerke, GJ; Veth, RPH; Kamps, WA; Hoekstra, HJ

    2004-01-01

    Introduction: Tibial bones are shorter and less resistant to shear forces after treatment with doxorubicin, methotrexate, or cisplatin. We investigated the pattern of failure after shear loading of the proximal tibial growth plate in rats treated with these chemotherapeutic agents. Materials and met

  4. Chemotherapy affects the pattern of failure after shear loading of the proximal tibial growth plate.

    NARCIS (Netherlands)

    Leeuwen, B.L.; Hartel, R.M.; Jansen, H.W.B.; Verkerke, G.J.; Veth, R.P.H.; Kamps, W.A.; Hoekstra, H.J.

    2004-01-01

    INTRODUCTION: Tibial bones are shorter and less resistant to shear forces after treatment with doxorubicin, methotrexate, or cisplatin. We investigated the pattern of failure after shear loading of the proximal tibial growth plate in rats treated with these chemotherapeutic agents. MATERIALS AND MET

  5. 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....

  6. 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

  7. Tibial component with and without stem extension in a trabecular metal cone construct

    NARCIS (Netherlands)

    Meijer, Marrigje F; Boerboom, Alexander L; Stevens, Martin; Reininga, Inge H F; Janssen, Dennis W; Verdonschot, N; Bulstra, Sjoerd K

    2016-01-01

    PURPOSE: The purpose of this study was to investigate stability and strain distribution of a tibial plateau reconstruction with a trabecular metal cone while the tibial component is implanted with and without a stem, and whether prosthetic stability was influenced by bone mineral density. Trabecular

  8. 21 CFR 888.3590 - Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis.

    Science.gov (United States)

    2010-04-01

    ... uncemented prosthesis. 888.3590 Section 888.3590 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... 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...

  9. Initial stability of type-2 tibial defect treatments.

    Science.gov (United States)

    Frehill, B; Crocombe, A; Cirovic, S; Agarwal, Y; Bradley, N

    2010-01-01

    Treatment of proximal tibial defects is important to the survival of tibial prosthesis after total knee replacement. The objective of this finite element study was to determine a better understanding of the stresses produced by different treatment options for moderate uncontained type-2 defects. Methods analysed were the use of metal wedges, metal blocks, cement wedges, and cement blocks for the two defect angles 15 degrees and 30 degrees. The effect of a stem extension on the stress profiles was also analysed for each defect treatment and angle to establish the necessity of these extensions and consequent bone removal on the stability of the augments. Equivalent stresses in two regions of interest (ROIs) adjacent to the augments and shear stresses along the bone-cement interface of the defect were investigated. The lowest equivalent stresses were found in the metal block augment for both defect angles and ROIs. The highest equivalent stress in the ROIs and shear stress values along the bone-cement interface of the defect were found in the cement wedge augment model for both defect angles. Stem extensions were shown to increase equivalent stresses in the bone closer to the tibial stem but to decrease equivalent stresses closer to the cortical bone. The use of a stem extension significantly increased the shear stresses in the cement in all cases except in the metal block model. It is recommended that metal block augments are used without a stem extension in small-defect (i.e. peripheral defect angle of 15 degrees) total knee replacement procedures. PMID:20225459

  10. Fracture of the os tibiale externum in a decathlete.

    Science.gov (United States)

    Lepore, L; Francobandiera, C; Maffulli, N

    1990-01-01

    The upsurge in popularity in sports activities has produced a large number of lower extremity injuries. This article describes acute fracture of the os tibiale externum in a 28-year-old decathlete. The injury was treated conservatively, and excellent functional recovery was obtained. This is the second case of traumatic fracture of this accessory bone of the foot described in the English literature. When dealing with the feet of an athlete, supernumerary bones must be taken into consideration as a possible cause of serious discomfort. PMID:1977791

  11. 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.

  12. 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...... amount of collagen) varied with failure energy. Collagen concentration was maximal at younger ages but varied little with age. Our results suggest that the decrease in mechanical properties of trabecular bone such as Young's modulus and ultimate stress is mainly a consequence of the loss of trabecular...

  13. 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.

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

    Directory of Open Access Journals (Sweden)

    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

  15. 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 trabecular...... region and a preliminary radiological reading of the knees with high and low risks of cartilage loss suggested the prognosis marker captured aspects of the tibia vertical trabecularization to define the prognosis. Besides presenting a bone marker able to predict disease progression and diagnostic marker...

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

    Directory of Open Access Journals (Sweden)

    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.

  17. Combined Tibial Tubercle Avulsion Fracture and Patellar Avulsion Fracture: An Unusual Variant in an Adolescent Patient.

    Science.gov (United States)

    Stepanovich, Matthew T; Slakey, Joseph B

    2016-01-01

    Traumatic extensor dysfunction of the knee in children is a rare injury, with the majority resulting from tibial tubercle avulsion fracture or patellar sleeve fracture. We report a rare case of combined patellar avulsion fracture and tibial tubercle fracture. With open anatomic reduction, both injuries were successfully treated. While many variations of tibial tubercle fracture have been reported, the authors believe this to be the first report in the English-language literature of this particular combined injury to the knee extensor mechanism in an adolescent. Advanced imaging with computed tomography provided vital information to aid with operative planning, especially since the majority of the unossified tubercle was not seen on plain radiographs, and all fracture fragments were originally believed to be from the tibial tubercle. Computed tomography distinguished the patellar fracture from the tibial tubercle fragments, verifying preoperatively the complexity of the injury. PMID:26761925

  18. 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.)

  19. Bilateral ECT induces bilateral increases in regional cortical thickness.

    Science.gov (United States)

    van Eijndhoven, P; Mulders, P; Kwekkeboom, L; van Oostrom, I; van Beek, M; Janzing, J; Schene, A; Tendolkar, I

    2016-01-01

    Electroconvulsive therapy (ECT) is the most effective treatment for patients suffering from severe or treatment-resistant major depressive disorder (MDD). Unfortunately its underlying neurobiological mechanisms are still unclear. One line of evidence indicates that the seizures produced by ECT induce or stimulate neuroplasticity effects. Although these seizures also affect the cortex, the effect of ECT on cortical thickness is not investigated until now. We acquired structural magnetic resonance imaging data in 19 treatment-resistant MDD patients before and after a bilateral ECT course, and 16 healthy controls at 2 time points, and compared changes in cortical thickness between the groups. Our results reveal that ECT induces significant, bilateral increases in cortical thickness, including the temporal pole, inferior and middle temporal cortex and the insula. The pattern of increased cortical thickness was predominant in regions that are associated with seizure onset in ECT. Post hoc analyses showed that the increase in thickness of the insular cortex was larger in responders than in non-responders, which may point to a specific relationship of this region with treatment effects of ECT. PMID:27552587

  20. Bilateral cleft lip nasal deformity

    Directory of Open Access Journals (Sweden)

    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

  1. BILATERAL DUPLICATION OF RENAL ARTERIES

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    Prajkta A Thete

    2014-09-01

    Full Text Available Routine dissection of a male cadaver revealed the presence of bilateral double renal arteries. On the right side the accessory renal artery originated from the abdominal aorta just above the main renal artery. On the left side the accessory renal artery originated from the abdominal aorta about 1 cm above the main renal artery. Knowledge of the variations of renal vascular anatomy has importance in exploration and treatment of renal trauma, renal transplantation, renal artery embolization, surgery for abdominal aortic aneurysm and conservative or radical renal surgery

  2. Bilateral molariform mandibular second premolars.

    Science.gov (United States)

    Acharya, Sonu; Kumar Mandal, Pradip; Ghosh, Chiranjit

    2015-01-01

    Macrodontia is a rare dental anomaly that refers to teeth that appear larger than normal. Generalised macrodontia can be associated with certain medical conditions and syndromes. This case report presents clinical and radiographic findings of isolated bilateral macrodontia in a 14-year-old child. The patient was referred to the clinic with local crowding of maxillary and mandibular teeth. Radiographic findings revealed the presence of impacted macrodont mandibular second premolar on one side and erupted macrodontic premolar on the other side and their distinct morphological appearance, characterized by large, multitubercular, and molariform crowns and tapering, single roots. PMID:25685564

  3. 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.

  4. 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.

  5. Surgical Technique of Anterolateral Approach for Tibial Plateau Fracture.

    Science.gov (United States)

    Wang, Peng-cheng; Ren, Dong; Zhou, Bing

    2015-11-01

    A 66-year-old woman had sustained crush injury 3 hours prior to her presentation to our hospital. The diagnosis was defined as lateral tibial plateau fracture of the right knee (Schatzker III). Supine position was set up and a pad was put under the affected hip. After sterilization of the surgical field the sterilized sheets were placed beneath the leg in order to be higher than the other side. A rolled sheet was put under the knee joint so that the knee joint was flexed around 30° to 40°. After the surgical field was draped the skin was incised. Iliotibial band was incised by blade (not by electrotomy) and sharp dissection was performed in the Gerdy's tubercle. Capsulotomy was made by cutting the tibial meniscal ligament. Then the meniscus was tagged superiorly and the articular surface was clearly visualized. A window was made in the lateral cortex beneath the plateau, so the impacted fragment was elevated through the window. The metaphyseal void was filled by bone allograft. The placement of the raft-screw plate must be ensured that the raft screws passing the plate could purchase the subchondral bone. After perfect placement of the plate was defined, the femoral distractor was removed and the knee joint was relaxed. It was ensured that the alignment of the lower leg was normal, and then the other screws were inserted. Following placing drainage in the wound the iliotibial band was closed and the subcutaneous soft tissue and skin were closed in layer. PMID:26791810

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

    Directory of Open Access Journals (Sweden)

    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.

  7. Bilateral Monteggia fracture in adults

    Directory of Open Access Journals (Sweden)

    Ristić Dejan

    2011-01-01

    Full Text Available Introduction. In 1814 Giovanni Monteggia first described two cases of fractures of the proximal third of ulna with dislocation of the radial head. These fractures are more common in children than in adults, and mutual Monteggia fracture is a rare complication. This study presents a treatment course of a patient with bilateral Monteggia fracture. Case report. A 55- year-old patient was injured by falling in the yard. Radiography showed bilateral Monteggia fracture type II (by the Badon classification. Operative treatment of fracture was done by a compression plate on the right side and by the zuggurtung technique on the left one. Closed repositioning of the radial head was done on both sides. The patient was wearing a plaster splint for the upper arm for 21 days. After removing the fixation, the function of the elbow was determined by the Broberg Morrey score (BM which was on the right side 45.5 and on the left side 47.5. After the proper physical therapy, four months after the surgery, BM score was 100 on the right side, and 93 on the left one. Conclusion. Surgical treatment and early rehabilitation is the key for the return of good function of both elbows.

  8. [Simultaneous bilateral pneumothorax. Case report].

    Science.gov (United States)

    Paolini, A; Caminiti, F; Tosato, F; Ruggieri, M; Paolini, G; Carnevale, L; Corsini, F; Marano, S; Monsellato, I

    2001-04-01

    A case report of a 44 year-old white man admitted to the surgical unit for a bilateral simultaneous pneumothorax is presented. The pneumothorax occurred on day one after a surgical operation for discal hernia; in the past the patient already presented a right spontaneous pneumothorax at 32 years of age and a left pneumothorax at 37 years of age, both treated with a pleural drainage. A thoracic drain was bilaterally positioned with a good result only in the right side. The persistence of the left pneumothorax induced the authors to perform a postero-lateral thoracotomy bullae excision and pleurectomy with a good postoperative course. After a few months a new right pneumothorax occurred and the patient was treated with a right postero-lateral thoracotomy, bullae resection and pleurectomy. On the basis of the case reported, the authors consider the different opportunities in the treatment of spontaneous pneumothorax in relation to the present knowledges and technologies. Surgical procedure is to be preferred in case of persistence of pneumothorax despite a pleural drain and in case of pneumothorax in high risk subjects. Even if thoracoscopy seems to give better results regarding postoperative pain, it is not always possible with such a method to perform a careful pleurectomy neither to obtain it in all cases (above all in secondary pneumothorax). Every case must then be carefully studied to choose the best treatment at present available. PMID:11353349

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

    Science.gov (United States)

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

    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. PMID:25293902

  10. 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.

  11. 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...

  12. 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.

  13. Bilateral Clavicle Fracture in Two Newborn Infants

    Directory of Open Access Journals (Sweden)

    Esra Arun Ozer

    2011-12-01

    Full Text Available Background: The fracture of clavicle is the most frequently observed bone fracture as birth trauma and it is usually unilateral. It is seen following shoulder dystocia deliveries or breech presentation of macrosomic newborns.Case Presentation: We report two macrosomic newborns with bilateral clavicle fracture and brachial plexus palsy due to birth trauma. Chest X-rays confirmed bilateral fracture of clavicles. Both patients were recovered without any sequel.Conclusion: Bilateral clavicular fracture should be considered in any neonate with bilateral absent Moro reflexes.

  14. 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.

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

    Science.gov (United States)

    Nishimura, Akinobu; Nakazora, Shigeto; Fukuda, Aki; Kato, Ko; Sudo, Akihiro

    2016-01-01

    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. PMID:27478666

  16. A COMPREHENSIVE STUDY ON MANAGEMENT OF TIBIAL PLATEAU FRACTURES IN ADULTS

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    Amardeep

    2015-04-01

    Full Text Available BACKGROUND : Tibial plateau fractures have proved to be fascinating therapeutic challenges during nearly two centuries of written experience. These are serious injuries that frequently result in functional impairment as they affect knee alignment, stability and movemen ts. The principles of treatment of joint fractures included accurate reduction of articular surfaces with early movement of the joint. Our prospective study compared results of surgical vs. conservative management of tibial plateau fractures & evaluated th at displaced fractures of the tibial plateau should be treated by surgical methods which give more stable fixation, better anatomical reduction & good results with minimal complication. MATERIALS & METHODS: In our series, 41cases of tibial plateau fracture s in adults treated by various methods [including conservative & operative methods] between February 2007 to August 2008 at our institution and followed up for a 12 months (average with radiological & clinical evaluation. RESULTS: Functional evaluation of the knees of 20 tibial plateau fractures treated by surgical methods showed 91% good to excellent results and 9% poor to fair results. 22 tibial plateau fractures were treated by conservative methods showed 82.6% excellent to good results and 17.4% fair t o poor results. CONCLUSIONS: Displaced tibial plateau fractures should be treated by surgical methods. It gives more stable fixation, better anatomical reduction & good results with minimal complication. The depressed plateau fractures had good results following elevation and bone grafting.

  17. 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.

  18. Extramedullary versus intramedullary tibial cutting guides in megaprosthetic total knee replacement

    Directory of Open Access Journals (Sweden)

    Karade Vikas

    2012-10-01

    Full Text Available Abstract Background In a standard total knee replacement, tibial component alignment is a key factor for the long term success of the surgery. The purpose of this study is to compare the accuracy of extramedullary and intramedullary tibial cutting guides used in indigenous and imported implants respectively, in positioning of the tibial components in megaprosthetic knee replacements. Methods A comparative study of the accuracy of extramedullary and intramedullary tibial cutting guides was carried out in 92 megaprosthetic knee replacements for distal femoral tumors. For the proximal tibia cut for tibial component placement, an extramedullary guide was used in 65 patients and an intramedullary guide was used in 27 patients. Tibial component alignment angles were measured in postoperative X-rays with the help of CAD software. Results There was more varus placement in coronal plane with extramedullary cutting guide (−1.18 +/− 2.4 degrees than the intramedullary guide (−0.34 +/− 2.31 degrees but this did not reach statistical significance. The goal of 90 +/− 2 degrees alignment of tibial component was achieved in 54% of patients in the extramedullary group versus 67% in the intramedullary group. In terms of sagittal plane alignment, extramedullary guide showed less accurate results (2.09 +/− 2.4 degrees than intramedullary guide (0.50 +/− 3.80 degrees for tibial component alignment, though 78% of patients were aligned within the goal of 0–5 degrees of tibial slope angle in extramedullary group versus 63% in intramedullary group. The mean error in the measurements due to rotation of the knee during taking the X-rays was less than 0.1 degrees and distribution of the X-rays with the rotation of knee was similar in both the groups. Conclusions Overall, in megaprosthetic knee replacement intramedullary guides gave more accurate results in sagittal plane and exhibited similar variability as of extramedullary guides in coronal plane.

  19. Clock face model applied to tibial intraneural ganglia in the popliteal fossa

    Energy Technology Data Exchange (ETDEWEB)

    Spinner, Robert J. [Mayo Clinic, Department of Neurologic Surgery, Rochester, MN (United States); Mayo Clinic, Department of Orthopedics, Rochester, MN (United States); Mayo Clinic, Rochester, MN (United States); Hebert-Blouin, Marie-Noelle [Mayo Clinic, Department of Neurologic Surgery, Rochester, MN (United States); Maniker, Allen H. [Beth Israel Hospital, Department of Neurosurgery, New York, NY (United States); Amrami, Kimberly K. [Mayo Clinic, Department of Neurologic Surgery, Rochester, MN (United States); Mayo Clinic, Department of Radiology, Rochester, MN (United States)

    2009-07-15

    Tibial intraneural ganglia occurring in the popliteal fossa are often misdiagnosed because of their relative rarity. Their joint connection is typically not recognized and therefore not treated, leading to recurrence. This is a retrospective clinical study. Magnetic resonance images (MRIs) of six patients with confirmed tibial intraneural ganglia arising from the superior tibiofibular joint were analyzed and were compared to ten individuals with normal tibial nerves who were imaged with MRI. All studies were interpreted as left-sided. A previously designed clock face model introduced for peroneal intraneural ganglia was used to describe the superior tibiofibular joint connection (tail sign). A single axial image was sought to determine the normal anatomic and pathologic relationships of the tibial nerve and tibial articular branch to the superior tibiofibular joint. In all patients with intraneural ganglia, a single conventional axial image at the mid-fibular head level could reliably demonstrate: (1) intraneural cyst within the articular branch at the superior tibiofibular joint connection (tail sign) between 8 and 9 o'clock and intraneural cyst within the tibial nerve, (2) the central location of the tibial nerve posterior to the tibia, and (3) popliteus muscle denervation changes and atrophy (popliteus sign). This technique can provide radiologists and surgeons with rapid and reproducible information for diagnosis and treatment planning of tibial intraneural ganglia. Similar to its use with the clock face model in peroneal intraneural ganglia, a standard axial image at the mid-fibular head level can be used to interpret key features of tibial intraneural ganglia and identify the joint connection. Improved identification of the presence of a joint connection will change the therapeutic approach of this pathology and reduce cyst recurrences. (orig.)

  20. 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.

  1. 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.

  2. Bilateral fracture in atrophic mandible

    Directory of Open Access Journals (Sweden)

    Luciana SIGNORINI

    2006-11-01

    Full Text Available The increase of the elderly population in Brazil has brought a higher number of patients of this age level for dental treatment in several areas of dentistry.Elderly patients are exposed to many kinds of aggressor agents, such as falling down and accidents that cause maxillofacial fractures, which require the specialized assistance of a maxillofacial surgeon. The elderly present a differentiated condition involving systemic changes and use of several drugs that must be taken into consideration when planning the therapeutics ofeach case. The treatment of facial trauma must aim fast recovery along with minimal morbidity. The authors present a case of mandible bilateral fracture in edentulous elderly patient with severe atrophy, treated with titanium plate and screws osteosynthesis. The healing period was satisfactory, without postoperative complications in 18 months follow up.

  3. 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.

  4. 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.

  5. Measurement of femoral torsion and tibial torsion using magnetic resonance imaging (MRI)

    International Nuclear Information System (INIS)

    A new MRI method for the measurement of femoral torsion and tibial torsion is presented. Axial images were generated using a standard gradient echo sequence (FLASH 2D). Otherwise measurement of femoral and tibial torsion was performed according to an established CT method. The torsion angles measured using MRI were in accordance with the angles measured using the CT method. The MRI method was not more time-consuming than the CT method. In respect of radiation exposure, MRI determination of femoral and tibial torsion should be considered particularly in children and patients who have to undergo repeated torsion measurements. (orig.)

  6. Effect of triple tibial osteotomy on femorotibial stability in canine cranial cruciate ligament deficient stifles

    DEFF Research Database (Denmark)

    Kristiansen, Signe Søndergaard; Jensen, Tanja Vedel; Jensen, Bente Rona;

    .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......° (± 8.5°). Two different complications were observed during TTO. These were fracture of the caudal tibial cortex and fracture of the distal tibial tuberosity. The complication rate was respectively 100% and 44%.ConclusionTTO significantly reduced CTS in this CrCl and medial meniscus deficient stifle...

  7. Effects of P-15 Peptide Coated Hydroxyapatite on Tibial Defect Repair In Vivo in Normal and Osteoporotic Rats.

    Science.gov (United States)

    Hestehave Pedersen, Rasmus; Rasmussen, Marina; Overgaard, Søren; Ding, Ming

    2015-01-01

    This study assessed the efficacy of anorganic bone mineral coated with P-15 peptide (ABM/P-15) on tibia defect repair longitudinally in both normal and osteoporotic rats in vivo. A paired design was used. 24 Norwegian brown rats were divided into normal and osteoporotic groups. 48 cylindrical defects were created in proximal tibias bilaterally. Defects were filled with ABM/P-15 or left empty. Osteoporotic status was assessed by microarchitectural analysis. Microarchitectural properties of proximal tibial defects were evaluated at 4 time points. 21 days after surgery, tibias were harvested for histology and histomorphometry. Significantly increased bone volume fraction, surface density, and connectivity were seen in all groups at days 14 and 21 compared with day 0. Moreover, the structure type of ABM/P-15 group was changed toward typical plate-like structure. Microarchitectural properties of ABM/P-15 treated newly formed bones at 21 days were similar in normal and osteoporotic rats. Histologically, significant bone formation was seen in all groups. Interestingly, significantly increased bone formation was seen in osteoporotic rats treated with ABM/P-15 indicating optimized healing potential. Empty defects showed lower healing potential in osteoporotic bone. In conclusion, ABM/P-15 accelerated bone regeneration in osteoporotic rats but did not enhance bone regeneration in normal rats. PMID:26509146

  8. Effects of P-15 Peptide Coated Hydroxyapatite on Tibial Defect Repair In Vivo in Normal and Osteoporotic Rats

    Directory of Open Access Journals (Sweden)

    Rasmus Hestehave Pedersen

    2015-01-01

    Full Text Available This study assessed the efficacy of anorganic bone mineral coated with P-15 peptide (ABM/P-15 on tibia defect repair longitudinally in both normal and osteoporotic rats in vivo. A paired design was used. 24 Norwegian brown rats were divided into normal and osteoporotic groups. 48 cylindrical defects were created in proximal tibias bilaterally. Defects were filled with ABM/P-15 or left empty. Osteoporotic status was assessed by microarchitectural analysis. Microarchitectural properties of proximal tibial defects were evaluated at 4 time points. 21 days after surgery, tibias were harvested for histology and histomorphometry. Significantly increased bone volume fraction, surface density, and connectivity were seen in all groups at days 14 and 21 compared with day 0. Moreover, the structure type of ABM/P-15 group was changed toward typical plate-like structure. Microarchitectural properties of ABM/P-15 treated newly formed bones at 21 days were similar in normal and osteoporotic rats. Histologically, significant bone formation was seen in all groups. Interestingly, significantly increased bone formation was seen in osteoporotic rats treated with ABM/P-15 indicating optimized healing potential. Empty defects showed lower healing potential in osteoporotic bone. In conclusion, ABM/P-15 accelerated bone regeneration in osteoporotic rats but did not enhance bone regeneration in normal rats.

  9. 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.

  10. Tibial dyschondroplasia in growing chickens experimentally intoxicated with tetramethylthiuram disulfide.

    Science.gov (United States)

    Vargas, M I; Lamas, J M; Alvarenga, V

    1983-07-01

    Graded levels of tetramethylthiuram disulfide (0, 30, 60, 120, and 240 ppm) were incorporated into a broiler starter ration fed to chickens from one day old to 8 weeks of age. Clinical signs of leg abnormalities were observed as early as 5 days after the beginning of the trial. After the 3rd week, the joints were shown to present lesions, especially in the femorotibial articulation, comparable to the ones found in perosis. Tibiotarsus and other organs from the birds were examined for pathological changes at weekly intervals. Histologically, the tibiotarsus has shown an osteochondrodystrophy identical to that of tibial dyschondroplasia (TD), although it varied according to the level of tetramethylthiuram disulfide. The histopathology of the thyroid gland of the chickens involved in the present experiment will be reported in a separate manuscript. PMID:6622364

  11. 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....

  12. 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.

  13. 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

  14. Marfan's syndrome presenting as bilateral spontaneous pneumothorax.

    OpenAIRE

    Gawkrodger, D J

    1981-01-01

    A case of bilateral spontaneous pneumothorax in a 14-year-old girl with previously undiagnosed Marfan's syndrome is described. The pulmonary abnormalities of Marfan's syndrome are not commonly encountered and bilateral pneumothorax is itself a rare event which, in most instances, has been reported following invasive procedures.

  15. Bilateral failure of adduction following orbital decompression.

    OpenAIRE

    Kinsella, F; Kyle, P.; Stansfield, A

    1990-01-01

    We report a case of bilateral complete failure of adduction following bilateral translid antralethmoidal orbital decompression. We believe the probable mechanism is neuropraxia (temporary dysfunction) of the third cranial nerves' supply to the medial recti, owing to these nerves' occupying an anatomically abnormal position. Partial recovery of adduction occurred over the ensuing six months.

  16. Secondary polycythaemia associated with bilateral renal lymphocoeles.

    OpenAIRE

    Burton, I E; Sambrook, P.; McWilliam, L J

    1994-01-01

    A patient with a 15 year history of secondary polycythaemia due to renal erythropoietin hypersecretion is presented. Subsequent spontaneous development of bilateral renal lymphocoeles, which contained high erythropoietin levels, was shown by computerized tomography. The lymphocoeles were successfully treated by bilateral peritoneal marsupialization. No cause for the persistent polycythaemia or lymphocoeles was found at laparotomy or on renal biopsy.

  17. 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.

  18. Bilateral spontaneous adrenal haemorrhage complicating acute pancreatitis

    International Nuclear Information System (INIS)

    Bilateral adrenal haemorrhage is an event that mandates prompt diagnosis and treatment to prevent primary adrenocortical insufficiency and potential death. Presentation can be non-specific and incidentally diagnosed with imaging alone, primarily CT. We present a case of acute pancreatitis with spontaneous bilateral adrenal haemorrhage and briefly discuss imaging and treatment implications

  19. Bilateral breast involvement in acute myeloid leukemia

    Directory of Open Access Journals (Sweden)

    Hakeem A, Mandakini BT, Asif K, Firdaus, Shagufta RC

    2013-04-01

    Full Text Available Breast involvement by leukemic infiltration is usually bilateral, but may be unilateral. Clinically patients can present with either single or multiple masses, or with diffuse breast engorgement, with or without nodularity. The affected patients are predominantly young adults. We present a case of an adolescent girl with acute myeloid leukemia having bilateral breast infiltration by leukemic cells.

  20. 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

  1. 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.

  2. 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. PMID:22561379

  3. 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

    OpenAIRE

    Fernando Fonseca; Edgar Rebelo; António Completo

    2011-01-01

    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...

  4. The Guided Bilateral Filter: When the Joint/Cross Bilateral Filter Becomes Robust

    OpenAIRE

    Caraffa, Laurent; Tarel, Jean Philippe; Charbonnier, Pierre

    2015-01-01

    The bilateral filter and its variants such as the Joint/Cross bilateral filter are well known edge-preserving image smoothing tools used in many applications. The reason of this success is its simple definition and the possibility of many adaptations. The bilateral filter is known to be related to robust estimation. This link is lost by the ad hoc introduction of the guide image in the Joint/Cross bilateral filter. We here propose a new way to derive the Joint/Cross bilateral filter as a part...

  5. Removal of a bent tibial intramedullary nail: a rare case report and review of the literature

    Institute of Scientific and Technical Information of China (English)

    Sameer Aggerwal; Ashwani Soni; Uttam C. Saini; Nitesh Gahlot

    2011-01-01

    Intramedullary interlocking nailing is a gold standard for treatment of tibial shaft fractures. Bending of a nail secondary to trauma is a rare complication,which may be encountered in healed or unhealed tibial shaft fractures. Removal of such bent nail is always a challenge.We reported this case to discuss various techniques for removal of bent nails and to share our experience in removing a bent tibial intramedullary nail in a 30-year-old man,who was admitted in our department with re-fracture of the right tibial shaft due to a roadside accident two years after the initial surgical treatment. The intramedullary nail, bent by 30 degrees and visible on anterioposterior as well as on lateral radiographs, was firstly weakened by partially cutting the convex wall, then straightened by applying extemal force,and finally removed by using the standard nail removal method.

  6. 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.

  7. Cost implications of the physiotherapy management of complex tibial fractures treated with circular frames

    OpenAIRE

    Barron, E; Rambani, R; Bailey, H; H. K. Sharma

    2013-01-01

    Seventy-three consecutive patients with complex tibial fractures treated with an Ilizarov frame or Taylor Spatial Frame received physiotherapy between April 2008 and April 2010. Data were collected prospectively, and physiotherapy input was recorded (in minutes) for the patients identified. This included treatment received as an inpatient as well as an outpatient. The data were categorized for proximal, middle and distal third tibial fractures for analysis. The average cost of physiotherapy f...

  8. Minimally invasive reconstruction of lateral tibial plateau fractures using the jail technique: a biomechanical study

    OpenAIRE

    Weimann, A; Heinkele, T; Herbort, M. (Mirco); Schliemann, B. (Benedikt); Petersen, W.; Raschke, M. J.

    2013-01-01

    Background: This study described a novel, minimally invasive reconstruction technique of lateral tibial plateau fractures using a three-screw jail technique and compared it to a conventional two-screw osteosynthesis technique. The benefit of an additional screw implanted in the proximal tibia from the anterior at an angle of 90° below the conventional two-screw reconstruction after lateral tibial plateau fracture was evaluated. This new method was called the jail technique. Methods: The two r...

  9. “Surgical Management of Tibial Plateau Fractures – A Clinical Study”

    OpenAIRE

    Vasanad, Girish H.; Antin, S.M.; Akkimaradi, R.C.; Policepatil, Prasad; Naikawadi, Girish

    2013-01-01

    Background: Advance in mechanization and acceleration of travel have been accompanied by increase in number and severity of fractures and those of tibial plateau are no exception. Being one of the major weight bearing joints of the body, fractures around it are of paramount importance. The study was aimed to identify the role of surgical treatment of tibial plateau fractures, its functional outcome and complications.

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

    OpenAIRE

    Edmar Stieven Filho; Mariane Henseler Damaceno Mendes; Stephanie Claudino; Filipe Baracho; Paulo César Borges; Luiz Antonio Munhoz da Cunha

    2015-01-01

    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 combina...

  11. Bilateral panophthalmitis in dengue fever

    Directory of Open Access Journals (Sweden)

    Sangeetha Sriram

    2015-01-01

    Full Text Available We report the case of a 25-year-old male patient who presented with bilateral panophthalmitis as the initial ocular manifestation of dengue fever. The diagnosis was a little confusing as he initially presented with features suggestive of retrobulbar hemorrhage secondary to his very low platelet count, which is a common feature of dengue fever. Ophthalmic complications are usually seen in young adults who often present at the nadir of thrombocytopenia. Ocular findings may include anterior uveitis, vitritis, retinal hemorrhages, retinal vascular sheathing, yellow subretinal dots, retinal pigment epithelium (RPE mottling, foveolitis that is clinically seen as a round subretinal yellowish lesion at the fovea, retinochoroiditis, choroidal effusion, optic disc swelling, optic neuritis, neuroretinitis, and oculomotor nerve palsy. [1] There is only one reported case of unilateral endogenous panophthalmitis due to dengue fever. Hence, clinicians and ophthalmologists have to be aware of this vision-threatening complication of dengue for early recognition and prompt treatment to save the vision of these young patients and prevent morbidity.

  12. Bilateral inferior petrosal sinus sampling

    Science.gov (United States)

    Grossrubatscher, Erika; Dalino Ciaramella, Paolo; Boccardi, Edoardo

    2016-01-01

    Simultaneous bilateral inferior petrosal sinus sampling (BIPSS) plays a crucial role in the diagnostic work-up of Cushing’s syndrome. It is the most accurate procedure in the differential diagnosis of hypercortisolism of pituitary or ectopic origin, as compared with clinical, biochemical and imaging analyses, with a sensitivity and specificity of 88–100% and 67–100%, respectively. In the setting of hypercortisolemia, ACTH levels obtained from venous drainage of the pituitary are expected to be higher than the levels of peripheral blood, thus suggesting pituitary ACTH excess as the cause of hypercortisolism. Direct stimulation of the pituitary corticotroph with corticotrophin-releasing hormone enhances the sensitivity of the procedure. The procedure must be undertaken in the presence of hypercortisolemia, which suppresses both the basal and stimulated secretory activity of normal corticotrophic cells: ACTH measured in the sinus is, therefore, the result of the secretory activity of the tumor tissue. The poor accuracy in lateralization of BIPSS (positive predictive value of 50–70%) makes interpetrosal ACTH gradient alone not sufficient for the localization of the tumor. An accurate exploration of the gland is recommended if a tumor is not found in the predicted area. Despite the fact that BIPSS is an invasive procedure, the occurrence of adverse events is extremely rare, particularly if it is performed by experienced operators in referral centres. PMID:27352844

  13. [True hermaphroditism with bilateral ovotestis].

    Science.gov (United States)

    Güitrón, A; Forsbach, G; González, J M; Garza, J G; Vázquez, J; Espinoza, G

    1998-01-01

    A nineteen years old woman with ambiguous external genitalia was studied. This condition had been previously identified as a newborn, but her parents refused medical attention and it was reared as a girl. At 12-years, she began spontaneous mammary development, appearing pubic and axillary hair, and clitoral enlargement. The menarche occurred at 15-years and it was followed by irregular periods. Physical examination, showed absence of hirsutism and acne, normal mammary development equivalent to grade V of Tanner. The external genitalia showed fused labio-scrotal folds with an small introitus. The urethral meatus was absent and was later located inside the introitus. There was a big phallus similar to an adult penis with a normal glans, flexed by a chordee. Hormonal determinations discarded congenital adrenal hyperplasia. The karyotype was 46,XX and testosterone levels were in adult male range. Pelvic ultrasonography disclosed a normal uterus and both gonads in confirmed by laparoscopy identifying bilateral ovotestis. Testicular tissue was removed and plastic reconstruction of female genitals was done. PMID:9528217

  14. Bilateral inferior petrosal sinus sampling.

    Science.gov (United States)

    Zampetti, Benedetta; Grossrubatscher, Erika; Dalino Ciaramella, Paolo; Boccardi, Edoardo; Loli, Paola

    2016-07-01

    Simultaneous bilateral inferior petrosal sinus sampling (BIPSS) plays a crucial role in the diagnostic work-up of Cushing's syndrome. It is the most accurate procedure in the differential diagnosis of hypercortisolism of pituitary or ectopic origin, as compared with clinical, biochemical and imaging analyses, with a sensitivity and specificity of 88-100% and 67-100%, respectively. In the setting of hypercortisolemia, ACTH levels obtained from venous drainage of the pituitary are expected to be higher than the levels of peripheral blood, thus suggesting pituitary ACTH excess as the cause of hypercortisolism. Direct stimulation of the pituitary corticotroph with corticotrophin-releasing hormone enhances the sensitivity of the procedure. The procedure must be undertaken in the presence of hypercortisolemia, which suppresses both the basal and stimulated secretory activity of normal corticotrophic cells: ACTH measured in the sinus is, therefore, the result of the secretory activity of the tumor tissue. The poor accuracy in lateralization of BIPSS (positive predictive value of 50-70%) makes interpetrosal ACTH gradient alone not sufficient for the localization of the tumor. An accurate exploration of the gland is recommended if a tumor is not found in the predicted area. Despite the fact that BIPSS is an invasive procedure, the occurrence of adverse events is extremely rare, particularly if it is performed by experienced operators in referral centres. PMID:27352844

  15. Bilateral inferior petrosal sinus sampling

    Directory of Open Access Journals (Sweden)

    Benedetta Zampetti

    2016-08-01

    Full Text Available Simultaneous bilateral inferior petrosal sinus sampling (BIPSS plays a crucial role in the diagnostic work-up of Cushing’s syndrome. It is the most accurate procedure in the differential diagnosis of hypercortisolism of pituitary or ectopic origin, as compared with clinical, biochemical and imaging analyses, with a sensitivity and specificity of 88–100% and 67–100%, respectively. In the setting of hypercortisolemia, ACTH levels obtained from venous drainage of the pituitary are expected to be higher than the levels of peripheral blood, thus suggesting pituitary ACTH excess as the cause of hypercortisolism. Direct stimulation of the pituitary corticotroph with corticotrophin-releasing hormone enhances the sensitivity of the procedure. The procedure must be undertaken in the presence of hypercortisolemia, which suppresses both the basal and stimulated secretory activity of normal corticotrophic cells: ACTH measured in the sinus is, therefore, the result of the secretory activity of the tumor tissue. The poor accuracy in lateralization of BIPSS (positive predictive value of 50–70% makes interpetrosal ACTH gradient alone not sufficient for the localization of the tumor. An accurate exploration of the gland is recommended if a tumor is not found in the predicted area. Despite the fact that BIPSS is an invasive procedure, the occurrence of adverse events is extremely rare, particularly if it is performed by experienced operators in referral centres.

  16. 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.

  17. 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.

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

    Directory of Open Access Journals (Sweden)

    TONG Da-ke

    2012-02-01

    Full Text Available 【Abstract】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 opera- tion 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. Key words: Internal fixator; Tibial fractures; Fracture fixation, intramedullary; Bone plates

  19. 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.

  20. 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.

  1. 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

  2. Insufficiency fracture of the tibial plateau after anterior cruciate ligament reconstructive surgery: a case report and review of the literature

    OpenAIRE

    Wong, Jessica J.; Muir, Brad

    2013-01-01

    Peri-articular fractures after anterior cruciate ligament (ACL) reconstructive surgery are rare. To our knowledge, this case documents the first insufficiency fracture of the tibial plateau after ACL reconstruction, which presented three weeks after the procedure. A 25-year-old female recreational soccer player suffered an insufficiency fracture of the tibial plateau, extending 1.5 mm into the anterior wall of tibial tunnel and medial compartment under the anterior horn of medial meniscus, wh...

  3. Experimental study on the repair of tibial plateau defect

    Institute of Scientific and Technical Information of China (English)

    XU Hai-lin; HAN Na; KOU Yu-hui; WANG Yan-hua; ZHANG Hong-bo; JIANG Bao-guo

    2012-01-01

    Objective: To evaluate the effect of autograft bone,allograft bone,calcium sulfate bone cement,and calcium phosphate bone cement on the repair of tibial plateau defect in rabbits.Methods: We used autograft bone,allograft bone,calcium sulfate bone cement,and calcium phosphate bone cement to repair tibial plateau defect in rabbits.Gross and histologic observations,X-ray examination,and biomechanical test were conducted at 1,2,4,8 weeks after operation.Results: X-ray examination found that the bone density was evidently reduced in calcium sulfate group at 8 weeks after operation; there were no marked changes in other groups.The maximal load measurements showed that autograft and allograft groups were greater than calcium sulfate and calcium phosphate groups at 1 and 2 weeks after operation.However at 4 and 8 weeks after operation,no significant difference was found among the four groups.In autograft and allograft groups,there was no significant difference in biomechanical intensity at 2,4,and 8 weeks,but it was significantly higher than that at 1 week.In calcium sulfate and calcium phosphate groups,the outcome was ranked in descending order as 1 week< 2 week< 4 week =8week.Histologic examination found a great amount of new bones at 8 week in both autograft and allograft groups.In calcium sulfate group,calcium sulfate was almost absorbed and there were numerous bone trabeculations.There was a large amount of unabsorbed calcium phosphate in calcium phosphate group.Conclusion: At 1-2 weeks postoperatively,the biomechanical intensity is higher in autograft and allograft groups than calcium sulfate and calcium phosphate groups,but after 4-8 weeks,there is no significant difference among groups.At 1-2 weeks,the biomechanical intensity in all groups is increased,but at 4-8 weeks,there is no significant increase.The rates of absorption and bone formation are quicker in calcium sulfate group than calcium phosphate group.

  4. Exposed tibial bone after burns: Flap reconstruction versus dermal substitute.

    Science.gov (United States)

    Verbelen, Jozef; Hoeksema, Henk; Pirayesh, Ali; Van Landuyt, Koenraad; Monstrey, Stan

    2016-03-01

    A 44 years old male patient had suffered extensive 3rd degree burns on both legs, undergoing thorough surgical debridement, resulting in both tibias being exposed. Approximately 5 months after the incident he was referred to the Department of Plastic and Reconstructive Surgery of the University Hospital Gent, Belgium, to undergo flap reconstruction. Free flap surgery was performed twice on both lower legs but failed on all four occasions. In between flap surgery, a dermal substitute (Integra(®)) was applied, attempting to cover the exposed tibias with a layer of soft tissue, but also without success. In order to promote the development of granulation tissue over the exposed bone, small holes were drilled in both tibias with removal of the outer layer of the anterior cortex causing the bone to bleed and subsequently negative pressure wound therapy (NPWT) was applied. The limited granulation tissue resulting from this procedure was then covered with a dermal substitute (Glyaderm(®)), consisting of acellular human dermis with an average thickness of 0.25mm. This dermal substitute was combined with a NPWT-dressing, and then served as an extracellular matrix (ECM), guiding the distribution of granulation tissue over the remaining areas of exposed tibial bone. Four days after initial application of Glyaderm(®) combined with NPWT both tibias were almost completely covered with a thin coating of soft tissue. In order to increase the thickness of this soft tissue cover two additional layers of Glyaderm(®) were applied at intervals of approximately 1 week. One week after the last Glyaderm(®) application both wounds were autografted. The combination of an acellular dermal substitute (Glyaderm(®)) with negative pressure wound therapy and skin grafting proved to be an efficient technique to cover a wider area of exposed tibial bone in a patient who was not a candidate for free flap surgery. An overview is also provided of newer and simpler techniques for coverage of

  5. 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”.

  6. 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.

  7. 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.

  8. An unusual cause of bilateral diaphragmatic paralysis.

    OpenAIRE

    Pandit, A; Kalra, S.; Woodcock, A

    1992-01-01

    In a patient who had a sudden onset of bilateral diaphragmatic paralysis after forceful neck manipulation complete, though gradual, recovery in lung function and transdiaphragmatic pressures was seen over three years. This is a previously unrecognised risk of neck osteopathy.

  9. A Finite-Element Study of Metal Backing and Tibial Resection Depth in a Composite Tibia Following Total Knee Arthroplasty.

    Science.gov (United States)

    Tokunaga, Susumu; Rogge, Renee D; Small, Scott R; Berend, Michael E; Ritter, Merrill A

    2016-04-01

    Prosthetic alignment, patient characteristics, and implant design are all factors in long-term survival of total knee arthroplasty (TKA), yet the level at which each of these factors contribute to implant loosening has not been fully described. Prior clinical and biomechanical studies have indicated tibial overload as a cause of early TKA revision. The purpose of this study was to determine the relationship between tibial component design and bone resection on tibial loading. Finite-element analysis (FEA) was performed after simulated implantation of metal backed (MB) and all-polyethylene (AP) TKA components in 5 and 15 mm of tibial resection into a validated intact tibia model. Proximal tibial strains significantly increased between 13% and 199% when implanted with AP components (p < 0.05). Strain significantly increased between 12% and 209% in the posterior tibial compartment with increased bone resection (p < 0.05). This study indicates elevated strains in AP implanted tibias across the entirety of the proximal tibial cortex, as well as a posterior shift in tibial loading in instances of increased resection depth. These results are consistent with trends observed in prior biomechanical studies and may associate the documented device history of tibial collapse in AP components with increased bone strain and overload beneath the prosthesis. PMID:26810930

  10. 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.

  11. Bilateral synchronous plasmacytoma of the testis.

    Science.gov (United States)

    Narayanan, Geetha; Joseph, Rona; Soman, Lali V

    2016-04-01

    Extramedullary plasmacytoma (EMP) is usually seen in the head and neck regions and in the upper respiratory, gastrointestinal, and central nervous systems. Testis is a rare site for EMP, and bilateral synchronous testicular plasmacytoma occurring as an isolated event at initial presentation has been reported only once previously. We present herein the second such report in a 70-year-old man who underwent bilateral orchidectomy. PMID:27034568

  12. 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.

  13. MODERN VIEWS ON BILATERAL BREAST CANCER

    Directory of Open Access Journals (Sweden)

    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.

  14. 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.

  15. Effect of tibial tuberosity advancement on cranial tibial subluxation in the feline cranial cruciate deficient stifle joint: An ex vivo experimental study.

    Science.gov (United States)

    Retournard, M; Bilmont, A; Asimus, E; Palierne, S; Autefage, A

    2016-08-01

    The effects of Tibial Tuberosity Advancement (TTA) on Cranial Tibial Subluxation (CTS) and Tibial Rotation Angle (TRA) were evaluated in a model of feline Cranial Cruciate Ligament (CrCL)-deficient stifle joint. Ten hindlimbs of adult cats were used. Quadriceps and gastrocnemius muscles were simulated using cables, turnbuckles and a spring. An axial load of 30% body weight was applied. The stifle and talocrural joint angles were adjusted to 120°. Patellar tendon angle (PTA), CTS and TRA were measured radiographically before and after CrCL section, after TTA and after additional advancement by 1 and 2mm. CrCL section resulted in a CTS of 8.1±1.5mm and a TRA of 18.4±5.7 °. After TTA, PTA was significantly decreased from 99.1±1.7° to 89.1±0.7°; CTS and TRA did not change significantly (7.8±1.0mm and 15.9±5.7° respectively). Additional advancement of the tibial tuberosity by 1mm did not significantly affect CTS and TRA. Additional advancement of the tibial tuberosity by 2mm significantly reduced the PTA to 82.9±0.9°. A significant decrease of CTS (6.9±1.3mm) and TRA (14.7±3.6°) was also observed. A lack of stabilization of the CrCL deficient stifle was observed after TTA in this model of the feline stifle. Even though the validity of the model can be questioned, simple transposition of the technique of TTA from the cat to the dog appeared hazardous. PMID:27474002

  16. 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.)

  17. 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.)

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

    International Nuclear Information System (INIS)

    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.)

  19. Tibial stress fractures in racing Standardbreds: 13 cases (1989-1993)

    International Nuclear Information System (INIS)

    To determine clinical signs, radiographic and scintigraphic findings, and performance outcome of racing Standardbreds with tibial stress fractures. Retrospective case series. 13 racing Standardbreds with tibial stress fractures. Information concerning clinical signs, diagnostic evaluation, and recommendations was obtained by review of the medical records. Performance information before and after diagnosis of the fracture was collected from racing records, and follow-up information was obtained from the owners or trainers by use of a telephone questionnaire. Horses with tibial stress fractures were moderately lame, and diagnosis was made by nuclear scintigraphy and radiography. Fractures were more likely to occur in 2-year-old horses than in older horses. The fracture location was unique for Standardbreds; 11 of 13 developed stress fractures in the mid-diaphysis of the tibia, whereas fractures in Thoroughbreds are usually in the proximal caudal or caudolateral cortex. Fractures occurred in young horses that had raced or were in advanced race training. All horses were treated with rest alone, and 10 of 13 horses raced after injury. The horses that raced after injury were able to return to a level of performance that was equal to or better than the level raced before injury. 8 of 10 horses established a lifetime-best winning time after injury. Tibial stress fractures are a cause of lameness in young racing Standardbreds. Diagnosis is aided by nuclear scintigraphy. The prognosis for return to previous level of performance after a tibial stress fracture is good

  20. Minimally invasive osteosynthesis of distal tibial fractures using anterolateral locking plate: Evaluation of results and complications

    Institute of Scientific and Technical Information of China (English)

    Devendra Lakhotia; Gaurav Sharma; Kavin Khatri; G.N.Kiran Kumar; Vijay Sharma; Kamran Farooque

    2016-01-01

    Purpose:Soft tissue healing is of paramount importance in distal tibial fractures for a successful outcome.There is an increasing trend of using anterolateral plate due to an adequate soft tissue cover on anterolateral distal tibia.The aim of this study was to evaluate the results and complications of minimally invasive anterolateral locking plate in distal tibial fractures.Methods:This is a retrospective study of 42 patients with distal tibial fractures treated with minimally invasive anterolateral tibial plating.This study evaluates the bone and soft tissue healing along with emphasis on complications related to bone and soft tissue healing.Results:Full weight bearing was allowed in mean time period of 4.95 months (3-12 months).A major local complication of a wound which required revision surgery was seen in one case.Minor complications were identified in 9 cases which comprised 4 cases of marginal necrosis of the surgical wound,1 case of superficial infection,1 case of sensory disturbance over the anterolateral foot,1 case of muscle hernia and 2 cases of delayed union.Mean distance between the posterolateral and anterolateral incision was 5.7 cm (4.5-8 cm).Conclusion:The minimally invasive distal tibial fixation with anterolateral plating is a safe method of stabilization.Distance between anterolateral and posterolateral incision can be placed less than 7 cm apart depending on fracture pattern with proper surgical timing and technique.

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

    Directory of Open Access Journals (Sweden)

    Bruno Testoni Lins

    2009-04-01

    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.

  2. Effect of different collapse heights of tibial plateau on contact stress of knee joint

    Institute of Scientific and Technical Information of China (English)

    Zhe Li

    2015-01-01

    Objective:To explore the effect of different collapse heights of tibial plateau on contact stress of knee joint so as to provide reference for choosing proper clinical treatment.Methods: 6 specimens of preserved adult knees were selected and fracture collapse models of artificial lateral tibial plateau collapse by 0, 1, 2, 3 mm were established. Then contact areas and contact stresses of different models were measured.Results:Average contact area tended to decrease with the increase of fracture collapse height; the value had displayed statistical The difference from collapse height of 1 mm, contact area reduced by about 25.71%. Although the average contact area of medial tibial plateau area trended to increase, there was no statistical significance. The contact stress of medial tibial plateau had displayed statistical The difference from collapse height of 2 mm, average contact stress and peak stress increased by 26.12% and 28.10% respectively. The average contact stress and peak stress of lateral tibial plateau had displayed statistical The difference from collapse height of 1 mm, average contact stress and peak stress increased by 20.23% and 23.43% respectively.Conclusion:When collapse height of weight-bearing facet joint exceeded 1 mm, the contact area and contact stress both significantly changed. Open reduction should be performed and anatomical reduction should be approached as far as possible.

  3. 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.

  4. Bilateral ovarian cystic teratomata mimicking bilateral pure ovarian hemangiomata: case report.

    Science.gov (United States)

    Feuerstein, I M; Aronson, B L; McCarthy, E F

    1984-01-01

    This report describes a case of bilateral, benign cystic ovarian teratomata which were composed predominantly of cavernous hemangiomatous elements. The right-sided lesion, in particular, mimicked a pure ovarian hemangioma. The clinical presentation, bilaterality of the lesions, the sizes of the hemangiomata, and the subsequent hemangioma of the leg are all of interest in this very rare lesion. PMID:6511164

  5. Bilateral electric energy contracts: return and risk

    Energy Technology Data Exchange (ETDEWEB)

    Gunn, Laura K.; Silva, Elisa B.; Correia, Paulo B. [State University of Campinas (UNICAMP), SP (Brazil). College of Mechanical Engineering

    2009-07-01

    In Brazil electricity is traded through three segments: the spot market that balances offer and demand, with prices calculated by a cost-based computational model; the regulated market , where prices are settled in public auctions, and the free market for bilateral contracts. As spot and regulated market prices are public information, a seller is able to calculate his opportunity price to trade a bilateral contract in the free market by using the non-arbitrage principle. Thus, the seller searches the price of a bilateral contract in the free market that balances his/her revenues with the value expected in case it were negotiated in the regulated and the spot market. Besides the expected revenue, the seller may also consider the CVaR to measure the risk of her/his bilateral contract in the free market. So this paper develops a binomial lattice approach to price bilateral contracts in the free market, considering the seller's opportunity of negotiations in both regulated and spot markets, and measuring the contract risk directly. (author)

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

    International Nuclear Information System (INIS)

    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

  7. 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

  8. Double tibial osteotomy for bow leg patients: A case series

    Directory of Open Access Journals (Sweden)

    Khalilollah Nazem

    2013-01-01

    Full Text Available Background: High tibia osteotomy (HTO is a common surgical operation for correction of genu varum deformity. In some patients, there are concurrent tibia vara and genu varum (bow leg. This study aimed to consider the possibility of better correction of bow leg deformity after double level tibial osteotomy (DLTO. Materials and Methods: A case series of 10 patients of genu varum in addition to tibia vara (bow leg deformity who were referred to orthopedic ward of an academic hospital of Isfahan- Iran during 2009-2011 were included in the study. The mean age was 17.3 ± 3.1 years and all of them underwent DLTO. The results of treatment have been assessed based on clinical and radiological parameters before and after surgery. Results: The mean pre- and post operative values for Tibia-Femoral Angle, Medial Proximal of Tibia Angle (MPTA, and Lateral Distal of Tibia Angle (LDTA were 18.13 ± 3.05° vs. 3.93 ± 0.66°, 79.13 ± 3.4° vs. 89.7 ± 1.8° and 96.40 ± 1.8° vs. 88.73 ± 3.0° respectively (P < 0.05. Improvement of all radiological parameters was meaningful. Seventy three percent of patients had normal mechanical axis of limb after surgery. The remaining cases had varus deformity in distal femur that was corrected by valgus supracondylar osteotomy in an additional operation. Limited range of motion (ROM near knee and ankle was not observed. Conclusion : DLTO correct bow leg deformity in the point of alignment of limb and paralleling of knee and ankle joint more effectively. This method can be used in metabolic and congenital bow leg which deformities are present in throughout of the lower limb. We described this technique for the first time.

  9. The influence of tibial component fixation techniques on resorption of supporting bone stock after total knee replacement

    NARCIS (Netherlands)

    Chong, D.Y.; Hansen, U.N.; Venne, R. van der; Verdonschot, N.J.J.; Amis, A.A.

    2011-01-01

    Periprosthetic bone resorption after tibial prosthesis implantation remains a concern for long-term fixation performance. The fixation techniques may inherently aggravate the "stress-shielding" effect of the implant, leading to weakened bone foundation. In this study, two cemented tibial fixation ca

  10. The arthroscopic treatment of displaced tibial spine fractures in children and adolescents using Meniscus Arrows(A (R))

    NARCIS (Netherlands)

    Wouters, Diederick B.; de Graaf, Joost S.; Hemmer, Patrick H.; Burgerhof, Johannes G. M.; Kramer, William L. M.

    2011-01-01

    This article summarises the results of a newly developed technique that utilises Meniscus Arrows(A (R)) for the arthroscopic fixation of displaced tibial spine fractures in children and adolescents. Twelve tibial spine fractures in the knees of eleven children between 6 and 15 years old, with an ave

  11. 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.

  12. 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.

  13. 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. PMID:11430739

  14. Tibial Tunnel Cyst Formation after Anterior Cruciate Ligament Reconstruction Using a Non-Bioabsorbable Interference Screw.

    Science.gov (United States)

    Joshi, Yogesh V; Bhaskar, Deepu; Phaltankar, Padmanabh M; Charalambous, Charalambos P

    2015-12-01

    Tibial cyst formation following the use of bioabsorbable interference screws in anterior cruciate ligament (ACL) reconstruction is well-described; however, cyst formation after the use of metallic interference screws is not well-documented. We describe a case of osteolytic lesion of the proximal tibia presenting to us 20 years after ACL reconstruction using an autologous bone-tendon-bone graft. The original graft fixation technique was interference fixation with a metal screw in the tibial and femoral tunnels. A two-stage revision reconstruction of the ACL was undertaken with curettage and bone grafting of the tibial lesion in the first stage and reconstruction using a four-strand hamstring tendon in the second stage. The patient recovered satisfactorily with complete healing of the cyst and returned to pre-injury level of activities. We have reviewed case reports and case series that describe the aetiology of intra-osseous cyst formation following ACL reconstruction. PMID:26673117

  15. 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.

  16. 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.

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

    DEFF Research Database (Denmark)

    Ding, Ming

    2000-01-01

    focused on the central vertebral trabecular bone, while little is known about age-related changes in the properties of human peripheral (tibial) trabecular bone. Knowledge of the properties of peripheral (tibial) trabecular bone is of major importance for the understanding of degenerative diseases...... 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...... in the properties of trabecular bone and the cartilage-bone complex, and osteoarthrotic specimens were used for the investigation of changes in the mechanical properties of the cartilage-bone complex induced by this disease process. The mechanical properties and physical/compositional properties of trabecular bone...

  18. 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.)

  19. 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...

  20. Bilateral Sequential Pneumolabyrinth Resulting from Nose Blowing.

    Science.gov (United States)

    Lee, Joong Seob; Kwon, Sae Young; Kim, Ji Heui; Kim, Hyung-Jong

    2015-12-01

    Pneumolabyrinth describes a condition with entrapped air in the labyrinth and usually occurs in temporal bone fractures that involve the otic capsule. While sporadic cases of bilateral pneumolabyrinth have been reported, cases lacking head trauma are very rare. We report the case of a 43-year-old man who had sudden hearing loss bilaterally after blowing his nose at an interval of 1 year. Although conservative management for the right ear and exploratory tympanotomy with sealing of the possible site of perilymphatic leakage in the left ear were performed, hearing outcome was poor in both ears. To our knowledge, this is the first case of bilateral pneumolabyrinth occurring as a result of nose blowing. PMID:26771019

  1. 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.

  2. Congenital bilateral perisylvian syndrome with hydrocephalus

    Directory of Open Access Journals (Sweden)

    Salih Hattapoğlu

    2012-12-01

    Full Text Available Congenital bilateral perisylvian syndrome (CBPS, whichis seen by indications of mental retardasyon, epilepsi,speech disorder and pseudobulbar palsy, is a diseasewhich comes up with genetic and non-genetic reasons.Revealing characteristic indications (like polymicrogyriawith MR imaging and clinic indications contributes makingdiagnosis. In present paper, we aimed to present 18month girl case report who diagnosed as CBPS with hydrocephaliindication. J Clin Exp Invest 2012; 3(4: 552-554Key words: Epilepsy, congenital bilateral perisylviansyndrome, polymicrogyria, hydrocephalus, pseudobulbarpalsy

  3. [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.

  4. Bilateral hypertrophic olivary degeneration in Wilson disease

    Energy Technology Data Exchange (ETDEWEB)

    Otto, Josephin; Guenther, Pete; Hoffmann, Karl Titus [Leipzig University Hospital, Leipzig (Greece)

    2013-04-15

    Hypertrophic olivary degeneration resulting from lesions of the dento-rubro-olivary pathway, also called Guillain-Mollaret-triangle, has been described previously in a number of cases. Reports about bilateral hypertrophic olivary degeneration of the inferior olivary nuclei are very limited, and the magnetic resonance imaging findings of hypertrophic olivary degeneration in Wilson disease have not yet been described to the best of our knowledge. Herein, we present the first report of bilateral hypertrophic olivary degeneration diagnosed by magnetic resonance imaging in a patient suffering from Wilson disease.

  5. Poststimulation inhibition of the micturition reflex induced by tibial nerve stimulation in rats

    OpenAIRE

    Matsuta, Yosuke; Roppolo, James R.; de Groat, William C.; Tai, Changfeng

    2014-01-01

    Abstract The purpose of this study was to determine the effect of tibial nerve stimulation (TNS) on the micturition reflex. Experiments were conducted in 24 rats under urethane anesthesia. A catheter was inserted into the bladder via the bladder dome for saline infusion. A cuff electrode was placed around right tibial nerve for stimulation. TNS (5 Hz, 0.2 msec pulse width) at 2–4 times the threshold (T) intensity for inducing a toe movement was applied either during slow (0.08 mL/min) infusio...

  6. The Availability of Radiological Measurement of Tibial Torsion: Three-Dimensional Computed Tomography Reconstruction

    OpenAIRE

    Shin, Sang-yeop; Yoon, Chul Ho; Lee, Eun Shin; Oh, Min-Kyun; Kim, A Ram; Park, Jong Moon; Shin, Jun-Hwa; Shin, Hee Suk

    2011-01-01

    Objective To assess the intra-rater and inter-rater reliability for measuring tibial torsion measurements by a radiographic method using three-dimensional computed tomography reconstruction (3D-CT) and to compare the physical measures to those of 3D-CT. Method The study included 33 children who presented with intoeing gait. Tibial torsion was measured by 3D-CT. Distal reference point was the bimalleolar axis. Proximal reference points were the transtibial axis and posterior condylar axis. Phy...

  7. 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.

  8. 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.

  9. Bilateral Diabetic Papillopathy and Metabolic Control

    DEFF Research Database (Denmark)

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

    2010-01-01

    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...

  10. Bilateral breast cancer : mammographic and clinical findings

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Eun Kyung; Oh, Ki Keun; Jun, Hwang Yoon; Lee, Byung Chan; Lee, Kyong Sik; Lee, Yong Hee [Yonsei Univ. College of Medicine, Seoul (Korea, Republic of)

    1997-06-01

    To evaluate the mammographic and clinical features of bilateral breast cancer. We retrospectively reviewed clinical records(n=23) and mammograms (n=15) of 23 patients with bilateral breast cancer. Patients' age, location of the tumor and pathologic staging were determined from clinical records. Mammographic features were classified as spiculated mass, nonspiculated mass, mass with microcalcification, microcalcification only, asymmetric density, and normal. Of the 23 cases of bilateral breast cancer, 8(34.8%) were synchronous and 15(65.2%) were metachronous. Age at diagnosis of cancer in the first breast was between 27 and 59(mean 43) years ; there was no statistically significant difference in mean age between patients with synchronous and metachronous cancer. The mean interval between the diagnosis of each lesion of the metachronous pairs was 9.1 years. In 11 of 23 cases(48%), tumors were locaated in the same quadrant, and in the other 12 cases(52%), they were in different quadrant. At mammography, five of 15 metachronous cancers(33%) were similar in appearance and 10 pairs(67%) were different. In 4 of 23 cases(17%), cancer in the first breast was at stage 0 and stage 1, and in 13 of 23(57%), cancer in the second breast was at this same stage. In bilateral breast cancer, the two breasts frequently show different mammographic features. Cancer of the second breast was at an early stage; this suggest that regular examination and mammography are important and can allow early detection of contralateral breast cancer.

  11. Occipital seizures presenting with bilateral visual loss

    OpenAIRE

    Hadjikoutis S; Sawhney I

    2003-01-01

    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.

  12. Simulations of bilateral energy markets using MATLAB

    International Nuclear Information System (INIS)

    This paper presents simulation results of energy bilateral markets using MATLAB/SIMULINK. The algorithm for congestion management and transmission pricing is implemented by means of DC load flow. The simulation results show how elasticity of market participants to transmission usage charges can affect the overall network usage and its cost. (Author)

  13. 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

  14. A Bilateral Traumatic Hip Obturator Dislocation

    Science.gov (United States)

    Karaarslan, Ahmet Adnan; Acar, Nihat; Karci, Tolga; Sesli, Erhan

    2016-01-01

    A case of a bilateral simultaneous traumatic obturator dislocation of both hip joints in an 18-year-old young man following a traffic accident is presented. We reduced the dislocated femoral heads immediately under general anesthesia followed by passive and active exercises and early full-weight bearing mobilization. After 5 years, the result was excellent. PMID:26977327

  15. 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.

  16. 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. PMID:27093722

  17. Bilateral segmental neurofibromatosis diagnosed during pregnancy.

    Science.gov (United States)

    Maldonado Cid, P; Sendagorta Cudós, E; Noguera Morel, L; Beato Merino, M J

    2011-01-01

    Bilateral segmental neurofibromatosis is a rare subtype of neurofibromatosis type 1 defined by lesions affecting a single segment of the body and crossing the midline, with no systemic involvement. We present a case diagnosed during pregnancy because of the characteristic increase in size of the lesions during this period. PMID:21635828

  18. [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.

  19. Synchronous bilateral breast cancer in a male

    OpenAIRE

    Rubio Hernández, María Caridad; Díaz Prado, Yenia Ivet; Pérez, Suanly Rodríguez; Díaz, Ronald Rodríguez; Aleaga, Zaili Gutiérrez

    2013-01-01

    Male breast cancer, which represents only 1% of all breast cancers, is occasionally associated with a family history of breast cancer. Sporadic male breast cancers presenting with another primary breast cancer are extremely rare. In this article, we report on a 70-year-old male patient with bilateral multifocal and synchronous breast cancer and without a family history of breast cancer.

  20. Bilateral renal agenesis in an alpaca cria

    OpenAIRE

    Poulsen, Keith P; Gerard, Mathew P.; Spaulding, Kathy A.; Geissler, Kyleigh A.; Anderson, Kevin L.

    2006-01-01

    A 3-day-old male alpaca cria was presented for lack of vigor and failure to urinate since birth. Based on the history, laboratory data, ultrasonographs, surgical findings, and postmortem examination, the cria was diagnosed with bilateral renal agenesis and hypoplastic bladder, a congenital condition rarely seen in veterinary medicine.

  1. 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.

  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. 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.

  4. 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.

  5. 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.

  6. 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.

  7. Laparoscopic total extraperitoneal repair of preoperatively diagnosed bilateral obturator and incidental bilateral femoral herniae.

    Science.gov (United States)

    Malik, Muhammad Usman; Connelly, Tara M; Hamid, Mustafa; Pretorius, Frederik

    2016-01-01

    Obturator hernia (OH), a rare type of hernia, is associated with high morbidity and mortality. Diagnosis is often delayed as clinical symptoms are typically non-specific. OH is frequently associated with other occult inguinopelvic herniae. Early diagnosis is vital to decrease morbidity and mortality. We report the case of a 75-year-old woman who presented to the surgical outpatients' department with non-specific bilateral groin pain radiating to the thighs. CT of the pelvis demonstrated bilateral OH with no radiological evidence of bowel obstruction. Semiurgent elective laparoscopic total extraperitoneal mesh repair was performed. Intraoperative findings confirmed bilateral obturator herniae as well as incidental bilateral femoral herniae. This case highlights the need for a high index of suspicion for such concomitant hernias that, in the presence of OH, may only be identified intraoperatively. PMID:27113790

  8. 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.

  9. 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 ha...

  10. 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.

  11. 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.

  12. Tibial lengthening for unilateral Crowe type-IV developmental dysplasia of the hip

    Directory of Open Access Journals (Sweden)

    Jun Wan

    2014-01-01

    Conclusions: Tibial lengthening may effectively correct gait and satisfactorily improve body image in young patients with unilateral Crowe type-IV DDH. Mono-lateral external fixator allows for accelerated postoperative rehabilitation and optimal preservation of ankle movements. Lengthening along with intramedullary nails may significantly reduce the external fixation time and the risk of fixator-related complications.

  13. 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...

  14. Flexor Digitorum Longus Tendon Transfer and Modified Kidner Technique in Posterior Tibial Tendon Dysfunction.

    Science.gov (United States)

    Maskill, James T; Pomeroy, Gregory C

    2016-01-01

    The modified Kidner procedure and flexor digitorum longus tendon transfer are common procedures used today when addressing posterior tibial tendon dysfunction. These techniques are often used in conjunction with a combination of osteotomies to correct flatfoot deformity, and have been proved to be reliable and predictable. PMID:26590720

  15. 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. PMID:27095088

  16. 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. PMID:18729154

  17. 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

  18. The functional results of tibial shaft fractures treated with intramedullary nail compressed by proximal tube.

    Science.gov (United States)

    Karaarslan, Ahmet Adnan; Acar, Nihat; Aycan, Hakan; Sesli, Erhan

    2016-04-01

    Nailing of tibial shaft fractures is considered the gold standard surgical method by many surgeons. The aim of this retrospective study was to investigate and compare the clinical outcome of tibial shaft fractures treated with intramedullary nails compressed by proximal tube and conventional intramedullary interlocking nails. Fifty-seven patients with tibial shaft fractures, treated with intramedullary nails compressed by proximal tube (n = 32) and the conventional interlocking nails (n = 25), were reviewed. All fractures except for one were united without any additional surgical intervention in the proximal compression tube nail group, whereas in the conventional interlocking nail group, six patients needed dynamization surgery (p = 0.005) and three cases of nonunion were recorded. In the proximal compression tube nail group, faster union occurred in 20 ± 2 (16-24) weeks (mean ± SD; range) without failure of locking screws and proximal nail migration, whereas in the conventional interlocking nail group, union occurred in 22 ± 2.5 (17-27) weeks (p = 0.001) with two failures of locking screws and two proximal nail migration. The proximal compression tube nail system is safer than the conventional nailing methods for the treatment for transverse and oblique tibial shaft fractures with a less rate of nonunion, proximal locking screw failure and proximal nail migration. PMID:26837377

  19. COMBINED TIBIAL AVULSION OF ANTERIOR AND POSTERIOR CRUCIATE LIGAMENT OF KNEE JOINT: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Ajaybir

    2015-01-01

    Full Text Available Avulsion fractures of tibial intercondylar eminence is a rare injury mainly affecting the pediatric population between 8 to 14 and is even rarer in adults with very few cases reported in literature. It occurs with high energy trauma in adults and may be associated with knee dislocation and neurovascular injuries. A 30 yr old male presented with a painful swollen left knee , limite d knee motion , and difficulty with weight bearing after a history of fall from motorcycle. Imaging revealed Type 3 Meyers and McKeever tibial spine avulsion of both ACL and PCL. A two staged surgical procedure was performed : (a Arthroscopic reduction and fixation with headed cannulated sc r ew of ACL tibial fragment; (b ORIF with headed cannulated screw of PCL tibial fragment via posterior approach to knee. Good functional outcome and early mobilization was achieved. Diagnostic arthroscopic helps to evaluat e the condition of the cruciate ligaments as well as fracture bed. Simultaneously fixation of ACL fragment with cannulated screw can be done , which is a simpler procedure to suture fixation. ORIF of PCL fragment in a staged manner has helped to address the injury in a detailed manner achieving goal of anatomical reduction and early mobilization.

  20. 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

  1. 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.

  2. 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.

  3. Functional outcome of surgical management of tibial plateau fractures in adults

    Directory of Open Access Journals (Sweden)

    Arunim Swarup

    2016-03-01

    Conclusions: Surgical management of tibial condylar fracture will give excellent anatomical reduction and rigid fixation to restore anatomical congruity, facilitate early motion, hence to achieve optimal knee function and reducing post traumatic osteo-arthritis. [Int J Res Med Sci 2016; 4(3.000: 908-912

  4. Results of a modified posterolateral approach for the isolated posterolateral tibial plateau fracture

    Directory of Open Access Journals (Sweden)

    Guan-Yi Liu

    2016-01-01

    Conclusions: The modified posterolateral approach through a long skin incision without exposing the CPN could help to expand the surgical options for an optimal treatment of this kind of fracture, and plating of posterolateral tibial plateau fractures would result in restoration and maintenance of alignment. This approach demands precise knowledge of the anatomic structures of this region.

  5. Limb salvage treatment for Gollop-Wolfgang complex (femoral bifurcation, complete tibial hemimelia, and hand ectrodactyly).

    Science.gov (United States)

    Wada, Akifusa; Nakamura, Tomoyuki; Fujii, Toshio; Urano, Noriko; Yanagida, Haruhisa; Takamura, Kazuyuki; Taketa, Mayuki; Oketani, Yutaka; Kubota, Hideaki

    2013-09-01

    We reported the findings from three patients with Gollop-Wolfgang complex and demonstrated the results of five limb salvage treatments for this condition. All three femoral bifurcations were accompanied by ipsilateral complete tibial hemimelia. Two patients showed contralateral complete or partial tibial hemimelia, and one patient had hand ectrodactyly. The five limb salvage treatments included resection of the anteromedial bifurcated femur in three limbs, foot centralization in five limbs, tibiofibular fusion in one limb with partial tibial hemimelia, fibular transfer (Brown's procedure) in three limbs with complete tibial hemimelia, and callus distraction lengthening in one limb. The duration from the first operation to the final follow-up ranged from 3.5 to 5.4 years. None of the three knees treated by fibular transfer achieved a successful functional result, but all of the knees were ultimately able to withstand weight bearing. Early knee disarticulation and resection of the protruded bifurcated femur, followed by fitting of a modern prosthesis is likely to be the best treatment for patients with Gollop-Wolfgang syndrome. We note that limb salvage treatment is an alternative in patients who opt to retain their feet and refuse amputation. PMID:23660549

  6. 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.

  7. 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.

  8. 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. PMID:20886622

  9. 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.

  10. Hardware Implementation of a Bilateral Subtraction Filter

    Science.gov (United States)

    Huertas, Andres; Watson, Robert; Villalpando, Carlos; Goldberg, Steven

    2009-01-01

    A bilateral subtraction filter has been implemented as a hardware module in the form of a field-programmable gate array (FPGA). In general, a bilateral subtraction filter is a key subsystem of a high-quality stereoscopic machine vision system that utilizes images that are large and/or dense. Bilateral subtraction filters have been implemented in software on general-purpose computers, but the processing speeds attainable in this way even on computers containing the fastest processors are insufficient for real-time applications. The present FPGA bilateral subtraction filter is intended to accelerate processing to real-time speed and to be a prototype of a link in a stereoscopic-machine- vision processing chain, now under development, that would process large and/or dense images in real time and would be implemented in an FPGA. In terms that are necessarily oversimplified for the sake of brevity, a bilateral subtraction filter is a smoothing, edge-preserving filter for suppressing low-frequency noise. The filter operation amounts to replacing the value for each pixel with a weighted average of the values of that pixel and the neighboring pixels in a predefined neighborhood or window (e.g., a 9 9 window). The filter weights depend partly on pixel values and partly on the window size. The present FPGA implementation of a bilateral subtraction filter utilizes a 9 9 window. This implementation was designed to take advantage of the ability to do many of the component computations in parallel pipelines to enable processing of image data at the rate at which they are generated. The filter can be considered to be divided into the following parts (see figure): a) An image pixel pipeline with a 9 9- pixel window generator, b) An array of processing elements; c) An adder tree; d) A smoothing-and-delaying unit; and e) A subtraction unit. After each 9 9 window is created, the affected pixel data are fed to the processing elements. Each processing element is fed the pixel value for

  11. A review of bilateral training for upper extremity hemiparesis.

    Science.gov (United States)

    Stoykov, Mary Ellen; Corcos, Daniel M

    2009-01-01

    Upper extremity hemiparesis is the most common post-stroke disability. Longitudinal studies have indicated that 30-66% of stroke survivors do not have full arm function 6 months post-stroke. The current gold standard for treatment of mild post-stroke upper limb impairment is constraint-induced therapy but, because of the inclusion criteria, alternative treatments are needed which target more impaired subjects. Bilateral arm training has been investigated as a potential rehabilitation intervention. Bilateral arm training encompasses a number of methods including: (1) bilateral isokinematic training; (2) mirror therapy using bilateral training; (3) device-driven bilateral training; and (4) bilateral motor priming. Neural mechanisms mediating bilateral training are first reviewed. The key bilateral training studies that have demonstrated evidence of efficacy will then be discussed. Finally, conclusions are drawn concerning clinical implications based on the reviewed literature. PMID:19517519

  12. Bilateral spontaneous pneumothorax with pulmonary metastases of synovial sarcoma

    International Nuclear Information System (INIS)

    The association of bilateral spontaneous pneumothorax with pulmonary tumor is uncommon and with pulmonary metastases is rare. The clinical and radiological features of bilateral spontaneous pneumothorax from a synovial sarcoma in a 14 years old boy are described. (author)

  13. 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.

  14. 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.

  15. 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. PMID:27489768

  16. Are somatosensory evoked potentials of the tibial nerve the most sensitive test in diagnosing multiple sclerosis?

    Directory of Open Access Journals (Sweden)

    Djuric S

    2010-01-01

    Full Text Available Background : Multiple sclerosis (MS is mostly diagnosed clinically, but the diagnosis has significantly improved through the use of brain magnetic resonance imaging (MRI, testing of cerebrospinal fluid, and multimodal evoked potentials (MEPs. Even though MRI is the superior method in diagnosing this illness, MEPs remain important because they can detect clinically silent lesions in the sensory and motor pathways of the central nervous system (CNS. Aim : The aim of the study is to test the diagnostic sensitivity of MEPs and MRI and the ratio of their sensitivity in patients with MS. Materials and Methods : The study subjects included 293 patients with MS with disease duration of two to six years: 249 patients with relapsing-remitting (RR MS and 44 with primary-progressive (PP MS. All patients were subjected to an MRI brain scan, visual evoked potentials (VEPs, median somatosensory evoked potentials (SEPs, tibial somatosensory evoked potentials (SEPs, and auditory evoked potentials (AEPs. Abnormal Findings Included : changed wave morphology, interside difference in wave amplitude, absolute and interwave latency increased by 2.5 SD as compared with the control group. The control group comprised of 35 healthy subjects. Results : In this study the most abnormal findings were tibial SEPs, median SEPs, and VEPs. Our results suggest different sensitivity of MEPs in patients suffering from different forms of MS. In RR-MS the sensitivity of tibial SEPs was statically significant (Fischer′s exact probability test as compared to other evoked potential modalities. Similarly VEPs were more sensitive as compared to AEPs. In the PP-MS, median SEPs have been found to be more sensitive than VEPs, while tibial SEPs have been found to be more sensitive than AEPs. There was no significant difference in the sensitivity of MRI and MEPs both the forms of MS. Conclusion : Tibial SEPs produce the most abnormal results and the highest sensitivity in the RR-MS. We

  17. 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

  18. Treatment methods and its curative effect for the complex fracture of tibial plateau%复杂胫骨平台骨折的治疗

    Institute of Scientific and Technical Information of China (English)

    李进波; 李奕标; 刘晓初; 蔡瑞歆; 黄维; 程培楷; 郑贤彬

    2011-01-01

    Objective To evaluate the clinical efficacy for the complex fracture of tibial plateau.Methods 34 patients with complex fractures of tibial plateau from March 2005 to March 2011 were treated and according to the Schatzker classification,13 cases were Ⅳ type,15 type Ⅴ and 6 type Ⅵ.According to the condition of the soft tissue and the type of fracture all cases were operated treatment by selecting time.The best operation times of the fracture of tibial plateau were 5 to 10 days after injury.Bilateral incisions and dual plating were adopted in 16 cases,18 cases were fixed by plating at one side.All cases should be directed periodic rehabilitation.Results All patients were followed up for a mean duration average of 14.6 months.Bone union was observed in all cases after an average of 5.8 months with noninfection.According to HOHL scoring,the knee functions were excellent in 20,good in 9,fare in4 and poor in The excellent to good rate was 85.3%.Concltsion The treatment for the complex fracture of tibial plateau was difficult.It was the key to correct judgment of the injury of soft tissue and the types of fractures,and provide protection for biomechanical performance of fractures with a good internal fixation,effective bone graft,and strict postoperative rehabilitation.%目的 探讨复杂胫骨平台骨折治疗方法及疗效.方法 收集2005年3月-2011年3月复杂胫骨平台骨折患者34例,骨折按Schatzker分型:Ⅳ型13例,Ⅴ型15例,Ⅵ型6例.根据软组织条件、骨折的类型等,所有病例择期手术治疗,手术最好在损伤后5~10天,双侧钢板螺钉内固定16例,单侧钢板螺钉内固定18例,并进行阶段性的康复指导.结果 34例患者无关节感染,术后随访平均14.6个月,骨折愈合时间平均5.8个月,膝关节HOHL临床评分法评定疗效:优20例,良9例,可4例,差1例,优良率为85.3%.结论 复杂胫骨平台骨折治疗困难,正确评估软组织损伤的程度和骨折分型、保护骨折的生

  19. Inverse relationship between the complexity of midfoot kinematics and muscle activation in patients with medial tibial stress syndrome

    DEFF Research Database (Denmark)

    Rathleff, M S; Samani, Afshin; Olesen, C G;

    2011-01-01

    Medial tibial stress syndrome is a common overuse injury characterized by pain located on the medial side of the lower leg during weight bearing activities such as gait. The purpose of this study was to apply linear and nonlinear methods to compare the structure of variability of midfoot kinematics...... and surface electromyographic (SEMG) signals between patients with medial tibial stress syndrome and healthy controls during gait. Fourteen patients diagnosed with medial tibial stress syndrome and 11 healthy controls were included from an orthopaedic clinic. SEMG from tibialis anterior and the soleus muscles...

  20. 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

  1. 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

  2. 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

  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. Nocturnal seizure and simultaneous bilateral shoulder fracture-dislocation.

    Science.gov (United States)

    Sahbudin, Ilfita; Filer, Andrew

    2016-01-01

    An otherwise fit and well 27-year-old man presented with acute onset unexplained bilateral shoulder pain, and was found to have bilateral shoulder fractures and dislocations on imaging. Although features were atypical, a nocturnal seizure causing the bilateral shoulder fractures was suspected and EEG showed features compatible with epilepsy. PMID:26838296

  5. Bilateral Nocardia Keratitis after Photorefractive Keratectomy

    Directory of Open Access Journals (Sweden)

    Amir Faramarzi

    2012-01-01

    Full Text Available Purpose: To report the clinical, confocal scan, and histopathologic features of Nocardia keratitis in a patient who developed bilateral infection following photorefractive keratectomy (PRK. Case Report: A 23-year-old woman underwent bilateral PRK for low myopia. On postoperative day 3, dense central stromal infiltrates were noticed in both eyes. Empirical antibiotic therapy was initiated which was converted into specific therapy after a definite diagnosis was made based on clinical features and confirmed by confocal scan and histopathologic findings. Clinical and confocal scan features were consistent with the diagnosis of Nocardia keratitis, and topical 2% amikacin eye drops were started. Because of poor response to medical therapy, lamellar keratectomy was performed in both eyes which shortened the treatment course. Histopathologic examination reconfirmed the initial diagnosis. Conclusion: Familiarity with clinical and confocal scan features facilitates early diagnosis of Nocardia keratitis leading to proper management and hence a rapid therapeutic response.

  6. Bilateral Nocardia Keratitis after Photorefractive Keratectomy

    Science.gov (United States)

    Faramarzi, Amir; Feizi, Sepehr; Javadi, Mohammad-Ali; Rezaei Kanavi, Mozhgan; Yazdizadeh, Forouzan; Moein, Hamid-Reza

    2012-01-01

    Purpose To report the clinical, confocal scan, and histopathologic features of nocardia keratitis in a patient who developed bilateral infection following photorefractive keratectomy (PRK). Case Report A 23-year-old woman underwent bilateral PRK for low myopia. On postoperative day 3, dense central stromal infiltrates were noticed in both eyes. Empirical antibiotic therapy was initiated which was converted into specific therapy after a definite diagnosis was made based on clinical features and confirmed by confocal scan and histopathologic findings. Clinical and confocal scan features were consistent with the diagnosis of Nocardia keratitis, and topical 2% amikacin eye drops were started. Because of poor response to medical therapy, lamellar keratectomy was performed in both eyes which shortened the treatment course. Histopathologic examination reconfirmed the initial diagnosis. Conclusion Familiarity with clinical and confocal scan features facilitates early diagnosis of Nocardia keratitis leading to proper management and hence a rapid therapeutic response. PMID:23275825

  7. 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

  8. Bilateral Psoas Abscess in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Tomich, Eric B

    2009-11-01

    Full Text Available We present the case of a 45-year-old female who presented multiple times to the emergency department with acute low back pain and was subsequently diagnosed with bilateral psoas muscle abscess. Psoas abscess is an uncommon cause of acute low back pain that is associated with high morbidity and mortality. The onset of symptoms is frequently insidious and the clinical presentation vague. Proper diagnosis requires vigilance of the physician to recognize signs in the history and physical examination that are suggestive of a potentially serious spinal condition and initiate further workup. While most patients with acute low back pain have a benign etiology, this case report demonstrates the challenge of diagnosing a patient with bilateral psoas abscess who had few known risk factors and symptoms typical of mechanical low back pain.[West J Emerg Med. 2009;10(4:288-291.

  9. Marfan Syndrome Presenting with Bilateral Retinal Detachment

    OpenAIRE

    Subrata Chakrabarti; Koushik Pan

    2014-01-01

    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...

  10. Frequency and causes of bilateral ocular trauma

    International Nuclear Information System (INIS)

    To determine the frequency and causes of bilateral ocular trauma. All patients coming to the hospital with bilateral eye trauma and requiring admission were recruited into the study. The details of patients demographics, risk factors, ocular examination, treatment offered and final visual acuity were noted and described as frequency and percentages. Out of a total of 1551 patients of hospitalized ocular trauma, 46 (2.9%, 92 eyes) had bilateral ocular trauma. The majority (54.3%) were due to landmine blast injuries followed by dynamite blast in 10.8%, coalmine blast and firearm injury in 6.5% each. Pressure cooker explosion and road traffic accident was the cause in 4.3% each. Gas cylinder and automobile battery explosion, alkali and acid burn, assault and incidental trauma occurred in 2.1%. Sixty three percent were between 16 and 40 years of age. Males were affected in 93.4%. Corneal and / or scleral repair was done in 58.6%, conjunctival and or corneal foreign body removal in 26% and extracapular cataract extraction with intraocular lens implantation in 16.3%. The visual acuity was in the range of 6/60 and perception of light in 54.3%, while in 21.7%, there was no perception of light at the time of admission. Due to severity of injury, the final visual acuity was poor and only 28.2% regained vision between 6/18 and 6/60. In this series, landmine, dynamite and coalmine blasts were the major causes of bilateral ocular trauma. Victims were usually young males. Due to severity of ocular trauma, majority had poor visual outcome. (author)

  11. BILATERAL LUXATIO ERECTA, A CASE REPORT

    OpenAIRE

    Acosta, César Augusto Xavier; da Silva Resch, Elemar; Rodrigues, Rafael

    2015-01-01

    Inferior shoulder dislocation (luxactio erecta) is a rare lesion affecting approximately 0.5% of dislocations of this joint. The vast majority of these cases occur unilaterally. In September 2004, a 43 year old man was brought to the emergency room of the University Hospital of Santa Maria (HUSM) complaining of bilateral shoulder pain and inability to lower the arms, as a result of a fall with the arms abducted, while carrying out work activities. After physical examination and radiological e...

  12. Erlotinib-related bilateral anterior uveitis

    OpenAIRE

    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 anterio...

  13. Bilateral anterior uveitis secondary to erlotinib

    OpenAIRE

    Lim, Lik Thai; Blum, Robert Alexander; Cheng, Chee Peng; Hanifudin, Abdul

    2010-01-01

    Bilateral anterior uveitis secondary to erlotinib phone: +44-784-3617788 (Lim, Lik Thai) (Lim, Lik Thai) Ophthalmology Department, Gartnavel General Hospital - Great Western Road - G12 0YN - Glasgow - UNITED KINGDOM (Lim, Lik Thai) Ophthalmology Department, Gartnavel General Hospital - Great Western Road - G12 0YN - Glasgow - UNITED KINGDOM (Blum, Robert Alexander) Ophthalmology Department, Gartnavel General Hospital - Great Western Road - G12 0YN - G...

  14. Bilateral Pregnancy Luteoma: A Case Report

    OpenAIRE

    Annu Nanda; Uday A. Gokhale; G Rajasekharan Pillai

    2014-01-01

    Pregnancy luteoma is a non-neoplastic lesion of the ovary occurring during pregnancy and is usually discovered incidentally at the time of a cesarean section or during postpartum tubal ligation. An accurate diagnosis is important for the mother and the fetus as it can be confused with ovarian malignancy leading to unnecessary surgery. We report a case of a pregnant female who was discovered to have bilateral enlarged ovaries at the time of emergency cesarean section.

  15. Bilateral exposures and systemic solvency risk

    OpenAIRE

    Gouriéroux, Christian; Héam, Jean-Cyprien; Monfort, Alain

    2012-01-01

    By introducing a structure of the balance sheets of the banks, which takes into account their bilateral exposures in terms of stocks or lendings, we get a structural model for default analysis. This model allows us to distinguish the exogenous and endogenous default dependence. We prove the existence and uniqueness of the liquidation equilibrium, we study the consequences of exogenous shocks on the banking system and we measure contagion phenomena. This approach is illustrated by an applicati...

  16. Bilateral Filter Evaluation Based on Exponential Kernels

    OpenAIRE

    Al Ismaeil, Kassem; Aouada, Djamila; Mirbach, Bruno; Ottersten, Björn

    2012-01-01

    The well-known bilateral filter is used to smooth noisy images while keeping their edges. This filter is commonly used with Gaussian kernel functions without real justification. The choice of the kernel functions has a major effect on the filter behavior. We propose to use exponential kernels with L1 distances instead of Gaussian ones. We derive Stein's Unbiased Risk Estimate to find the optimal parameters of the new filter and compare its performance with the conventional one. We show that t...

  17. 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

  18. 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.

  19. Characteristics of immigrants and bilateral trade

    OpenAIRE

    José Vicente Blanes-Cristóbal

    2008-01-01

    This paper tests the impact of immigration on bilateral trade using Spanish data from 1995 to 2003. It also explores some possible mechanisms behind this link. It uses a gravity equation for trade augmented with an immigrant’s stock variable and a set of control variables. The immigrants variable enters the estimated equation in different ways depending on immigrant relevant characteristics both individual and non individualspecific. Results show that there is a positive link between immigrat...

  20. 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...

  1. Psychosocial Outcomes after Bilateral Hand Transplantation

    OpenAIRE

    Singh, Mansher; Oser, Megan; Zinser, Jennifer; Sisk, Geoffroy; Carty, Matthew J; Sampson, Christian; Pribaz, Julian J.; Pomahac, Bohdan; Talbot, Simon G

    2015-01-01

    Background: Since the first successful hand transplantation in 1998, there have been multiple reports about surgical technique, transplant survival, and immunosuppression. However, very limited published data exist on psychosocial outcomes following hand transplantation. Methods: We report psychosocial outcomes in a patient with bilateral hand transplants at the midforearm level with serial follow-ups over 3.5 years. Different metrics used to study psychosocial outcomes included the following...

  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. 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.

  4. 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.

  5. 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

  6. High Performance, Three-Dimensional Bilateral Filtering

    International Nuclear Information System (INIS)

    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.

  7. Bilateral femoral neck fractures following pelvic irradiation

    International Nuclear Information System (INIS)

    Over 300 cases of femoral neck fractures following radiotherapy for intrapelvic malignant tumor have been reported in various countries since Baensch reported this disease in 1927. In Japan, 40 cases or so have been reported, and cases of bilateral femoral neck fractures have not reached to ten cases. The authors experienced a case of 75 year-old female who received radiotherapy for cancer of the uterus, and suffered from right femoral neck fracture 3 months after and left femoral neck fracture one year and half after. As clinical symptoms, she had not previous history of trauma in bilateral femurs, but she complained of a pain in a hip joint and of gait disturbance. The pain in left femoral neck continued for about one month before fracture was recognized with roentgenogram. As histopathological findings, increase of fat marrow, decrease of bone trabeculae, and its marked degeneration were recognized. Proliferation of some blood vessels was found out, but thickness of the internal membrane and thrombogenesis were not recognized. Treatment should be performed according to degree of displacement of fractures. In this case, artificial joint replacement surgery was performed to the side of fracture of this time, because this case was bilateral femoral neck fractures and the patient had received artificial head replacement surgery in the other side of fracture formerly. (Tsunoda, M.)

  8. 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.

  9. Bilateral spontaneous rupture of 'hale' kidneys

    International Nuclear Information System (INIS)

    A rare case of spontaneous bilateral rupture of the kidneys, occurring consecutively over a one-year period in a young male patient with 'hale' kidneys until then, is described. The patient's past history and thorough examination performed do not justify to assign the case under the heading of some of the etiological factors as the underlying cause of spontaneous kidney rupture. The literature survey on spontaneous bilateral non-tumor ruptures of kidneys shows that over a 20-year period, only 3 cases of bilateral spontaneous ruptures have been reported. It is pointed out that panarteritis nodosa followed by hemorrhagic fever with renal syndrome is the commonest underlying cause of such ruptures. Clinically spontaneous ruptures become manifest with emergency condition presenting severe renal colic, impaired to serious general condition, often with acute abdomen and hemodynamic breakdown, and no past history evidence of renal disease or injury. In the initial phase diagnosing is not always easy; it is usually made on the ground of physical examination and the full range of imaging studies used in urological practice and during operative treatment. Emphasis is laid on the fact that the imaging methods are not invariably sufficient to identify the exact etiological factor giving rise to such a severe condition, but nevertheless these methods have an essential practical bearing on diagnosing a rupture. (authors)

  10. A case misdiagnosed as bilateral abducens palsy

    International Nuclear Information System (INIS)

    A 66-year-old male was admitted to our neurosurgical floor because of double vision and gait disturbance. Neurological examinations revealed bilateral 6th nerve palsy with both eyes pointing toward the midline. Initially, using a tentative diagnosis of intracranial mass lesions, especially localized at the base of the skull, computerized tomography of the head, cerebral angiography, orbital venography, and metrizamide CT cisternography were performed; the findings were normal. An orbital CT scan showed an enlargement of the bilateral medial rectus muscles, and the thyroid functions of T3 and T4 and the T3 uptake were all elevated, which was compatible with the diagnosis of Graves' disease. The limitations of both eyeballs were considered to be due not to the 6th nerve palsy, but to the hypertrophy of the bilateral medial rectus muscles. We neurosurgeons should recall Graves' disease as well as intracranial lesions, cerebrovascular disease, and post-traumatic sequelae when examining a patient who presents limitations of external ocular movement. (author)

  11. 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.

  12. FEATURES OF BILATERAL BREAST CANCER NODAL METASTASIS

    Directory of Open Access Journals (Sweden)

    Ye. A. Fesik

    2014-01-01

    Full Text Available This article focuses on issues related to the identification and investigation of the lymph node metastases with bilateral breast cancer. The presence of metastases in the lymph nodes determines the stage of the disease, and introducing a form of tumor progression, characterizes the course and prognosis for the future in a specific patient. Thus, the identification of possible morphological and immunohistochemical characteristics of the tumor tissue and their comparison with the frequency and severity of regional lymph nodes would help to solve the problem of the identification of prognostic factors and markers associated with the risk of nodal metastasis in bilateral breast cancer. This work is relevant due to the fact that the literature on this issue to date are treated ambiguously, and answers to many questions, unfortunately, no.The authors performed a morphological study of the tumor tissue from 600 patients suffering from unilateral and bilateral breast cancer. To avoid false results were studied only cases corresponding to the histological type of invasive carcinoma of non-specific type. The study found that a greater number and a greater percentage of the affected lymph node metastases were observed in patients with bilaterally synchronous tumors. The patients of this group of metastatic lymph nodes was detected more frequently in the presence of infiltrative component of three or more types of structures with the presence of these discrete groups of tumor cells, and the observed maximum degree of inflammatory infiltration of the tumor stroma. In the group of patients with unilateral breast cancer nodal metastasis often detects when triple negative molecular genetic type of the lesion, with large amounts of tumor site, in the presence of infiltrative component of three or more types of structures with the obligatory presence of these microalveolar structures and discretely spaced groups of tumor cells and the highest severity of

  13. Radiological assessment of the position of the tibial tuberosity by means of a marking wire in knees with patellofemoral arthritis

    International Nuclear Information System (INIS)

    Objective. To assess the usefulness of a new axial radiographic technique in knees with patellofemoral arthritis (PF-OA). Design and patients. After a marking wire had been attached to the skin on the tibial tuberosity so that the wire matched the width of the patellar tendon, an axial radiograph was taken at 30 of flexion in 16 normal knees and 14 PF-OA knees in which computed tomographic analysis had revealed a laterally positioned tibial tuberosity at 30 of flexion. The distance of the marking wire from the lateral condyle and from the patellar groove was compared between the two groups. Results. The marking wire was located significantly laterally in PF-OA knees compared with normal knees. Conclusion. An axial radiograph with a marking wire on the tibial tuberosity is useful for assessing the position of the tibial tuberosity in PF-OA knees. (orig.)

  14. 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.

  15. 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...... that there exists a trade-off between regional integration and commercial diplomacy in facilitating exports or a lack of complementarity between these two instruments of economic diplomacy....

  16. 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

  17. 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.

  18. 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.

  19. Freehand 'figure 4' technique for tibial intramedullary nailing: introduction of technique and review of 87 cases.

    Science.gov (United States)

    Granville-Chapman, J; Nawaz, S Z; Trompeter, A; Newman, K J; Elliott, D S

    2014-10-01

    Intramedullary nailing of tibial fractures is commonplace, and freehand operative techniques are increasingly popular. The standard freehand method has the knee of the injured leg flexed over a radiolucent bolster. This requires the theatre fluoroscope to swing from antero-posterior to lateral position several times. Furthermore, guide wire placement, reaming and nail insertion are all performed well above most surgeons' shoulder height. Alternatively the leg is hung over the edge of the table, and the assistant must crouch and hold the leg until the nail is passed beyond the fracture. We describe a freehand figure 4 position technique for tibial nailing which is easier both for the surgeons and the radiographer, and present a series of 87 consecutive cases utilising this method. PMID:24013812

  20. Posterolateral Corner Injury Associated with a Schatzker Type 2 Tibial Plateau Fracture

    Directory of Open Access Journals (Sweden)

    Boris A. Zelle

    2015-01-01

    Full Text Available Isolated posterolateral corner (PLC injuries are rarely seen with tibial plateau fractures and can be missed during the initial assessment. The objective of this paper is to present a case of a Schatzker type 2 tibial plateau fracture with associated isolated PLC injury and give a discussion on physical exam, diagnostic studies, and treatment options. A twenty-five-year-old female sustained a concomitant Schatzker type 2 fracture and PLC injury. Magnetic Resonance Imaging showed an isolated PLC disruption. Open reduction-internal fixation was performed with subsequent PLC repair. At sixteen months postoperatively, the patient had full range of motion and strength of her knee and no signs of laxity. This case emphasizes the importance of physical exam and appropriate imaging modalities in order to diagnose and treat this significant injury in a prompt fashion. In this case, surgical fracture fixation and subsequent repair of the PLC provided a good clinical outcome.

  1. What is the optimal alignment of the tibial and femoral components in knee arthroplasty?

    DEFF Research Database (Denmark)

    Gromov, Kirill; Korchi, Mounim; Thomsen, Morten G;

    2014-01-01

    Background - Surgeon-dependent factors such as optimal implant alignment are thought to play a significant role in outcome following primary total knee arthroplasty (TKA). Exact definitions and references for optimal alignment are, however, still being debated. This overview of the literature...... components and their role in outcome and implant survival. Methods - We performed a literature search for original and review articles on implant positioning following primary TKA. Definitions for coronal, sagittal, and rotational placement of femoral and tibial components were summarized and the influence...... of positioning on survival and functional outcome was considered. Results - Many definitions exist when evaluating placement of femoral and tibial components. Implant alignment plays a role in both survival and functional outcome following primary TKA, as component malalignment can lead to increased failure...

  2. Bilateral inferior petrosal sinus sampling using vasopressin

    Directory of Open Access Journals (Sweden)

    Narendra Kotwal

    2016-01-01

    Full Text Available Context: Anatomical localization of pituitary adenoma can be challenging in adrenocorticotropic hormone (ACTH-dependent Cushing's syndrome, and bilateral inferior petrosal sinus sampling (BIPSS is considered gold standard in this regard. Stimulation using corticotrophin-releasing hormone (CRH improves the sensitivity of BIPSS, however, same is not easily available in India. Therefore, we undertook this study of BIPPS using vasopressin as agent for stimulation owing to its ability to stimulate V3 receptors present on corticotrophs. Aims: To study the tumor localization and lateralization in difficult to localize cases of ACTH-dependent Cushing's syndrome by bilateral inferior petrosal sinus sampling using vasopressin for corticotroph stimulation. Settings and Design: Prospective observational study. Subjects and Methods: Six patients (5 females meeting inclusion criteria underwent BIPSS using vasopressin for stimulation. Results: All six patients had nonsuppressible overnight and low dose dexamethasone suppression test with elevated plasma ACTH levels suggestive of ACTH-dependent Cushing's syndrome. High dose dexamethasone suppression test showed suppressible cortisol in two cases, and microadenoma was seen in two patients on magnetic resonance imaging pituitary. Contrast enhanced computed tomography of the abdomen showed left adrenal hyperplasia in one case and anterior mediastinal mass with bilateral adrenal hyperplasia another. Using BIPSS four patients were classified as having Cushing's disease that was confirmed histopathologically following surgery. Of the remaining two, one had primary pigmented nodular adrenocortical disease, and another had thymic carcinoid with ectopic ACTH production as the cause of Cushing's syndrome. No serious adverse events were noted. Conclusions: Vasopressin may be used instead of CRH and desmopressin for stimulation in BIPSS.

  3. 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.

  4. 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.

  5. Bilateral internuclear ophthalmoplegia following mild head injury.

    Science.gov (United States)

    Muthukumar, N; Veerarajkumar, N; Madeswaran, K

    2001-05-01

    A 7-year-old child presented with bilateral internuclear ophthalmoplegia (INO) following a trivial head injury. CT was normal. MRI revealed a pontine lesion. Two months after the injury the patient was neurologically normal. INO following head injury is rare. Rarer still is INO following mild head injury. To date, only four cases of INO had been reported following mild head injury; the present case is the fifth and the first in which the lesion was documented using MRI. The relevant literature is reviewed. PMID:11417420

  6. 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.

  7. 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...... 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....

  8. Bilateral pulmonary sequestration: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Koo, Ja Hong; Jeon, Eui Yong; Seo, Heung Suk; Choi, Yo Won; Jeon, Seok Chol; Hahm, Chang Kok [College of Medicine, Hanyang University, Seoul (Korea, Republic of)

    1995-05-15

    A 21-year-old woman presented with productive cough and hemoptysis. Chest radiograph shows a large thin-walled cystic lesion with an air-fluid level in medial portion of the left lower lung zone and opacity in paravertebral area of the right lower lung zone. Chest CT scan shows a thin-walled cavitary lesion in the posterior basal segment of left lower lobe with an air-fluid level. Area of consolidation containing air-filled cysts was also observed in medial aspect of right lower lobe. Selective angiogram obtained from aberrant artery arising from descending abdominal aorta showed two main branches of the artery supplying bilateral pulmonary lesions.

  9. 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.

  10. 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.

  11. Treatment of Infected Tibial Nonunion with Bone Defect Using Central Bone Grafting Technique

    OpenAIRE

    Gulan, Gordan; Jotanović, Zdravko; Jurdana, Hari; Šestan, Branko; Rapan, Saša; Rubinić, Dušan; Ravlić-Gulan, Jagoda

    2012-01-01

    Treatment of infected tibial nonunion with bone defect represents a challenge for every orthopaedic surgeon. Various methods of treatment have been described for nonunions with infection, bone loss or both. One of them is the central bone grafting technique, which is a safe and effective treatment for nonunions of the tibia. The technique involves placement of autogenous cancellous bone from the iliac crest on the anterior surface of the interosseous membrane with the aim of creating...

  12. Prevention of arthrofibrosis after arthroscopic screw fixation of tibial spine fracture in children and adolescents.

    Science.gov (United States)

    Parikh, Shital N; Myer, David; Eismann, Emily A

    2014-01-01

    Arthrofibrosis is a major complication of tibial spine fracture treatment in children, potentially resulting in knee pain, quadriceps weakness, altered gait, decreased function, inability to return to sports, and long-term osteoarthritis. Thus, prevention rather than treatment of arthrofibrosis is desirable. The purpose of this study was to evaluate an aggressive postoperative rehabilitation and early intervention approach to prevent permanent arthrofibrosis after tibial spine fracture treatment and to compare epiphyseal and transphyseal screws for fixation. A consecutive series of 24 patients younger than age 18 with displaced type II and III tibial spine fractures who underwent arthroscopic reduction and screw fixation between 2006 and 2011 were retrospectively reviewed. Final range of motion was compared between patients with epiphyseal (n=12) and transphyseal (n=9) screws. One-third (4 of 12) of patients with epiphyseal screws underwent arthroscopic debridement and screw removal approximately 3 months postoperatively; 3 patients lacked 5° to 15° of extension, 1 experienced pain with extension, and 1 had radiographic evidence of screw pullout, loss of reduction, and resultant malunion. In the transphyseal screw group, 3 patients had 10° loss of extension, and all corrected after arthroscopic debridement and screw removal. The two groups did not significantly differ in time to hardware removal or return to sports or final range of motion. No growth disturbances were identified in patients after transphyseal screw removal. An aggressive approach of postoperative rehabilitation and early intervention after arthroscopic reduction and screw fixation of tibial spine fractures in children was successful in preventing permanent arthrofibrosis. PMID:24683658

  13. Mid-term outcome of opening-wedge high tibial osteotomy for varus arthritic knees.

    Science.gov (United States)

    Haviv, Barak; Bronak, Shlomo; Thein, Ran; Kidron, Amos; Thein, Rafael

    2012-02-01

    Gonarthrosis in the relatively young and active population causes major daily discomfort and disability. If the arthritic process is mainly limited to the medial compartment, the axis of a varus knee can be realigned laterally with high tibial osteotomy to unload the medial compartment and allow some cartilage regeneration and pain relief. This study describes the outcomes of patients who underwent opening-wedge high tibial osteotomies using Puddu plate (Arthrex, Naples, Florida) fixation. Eighteen patients (22 knees) with genu varum and medial compartment osteoarthritis were followed-up for an average of 6.3±2.3 years after high tibial osteotomy with Puddu plate fixation and iliac crest allograft. Clinical outcome was assessed by the Oxford Knee Score and subjective satisfaction rating. Pre- and postoperative radiographs were evaluated for tibiofemoral angle, Insall-Salvati index, and Kellgren-Lawrence Grading Scale for osteoarthritis. Mean patient age at surgery was 44±13.7 years, and mean body mass index was 29.1±4.7 kg/m(2). At last follow-up, mean Oxford Knee Score improved from 22.4±13.5 to 37.2±13.7 (P=.002). Average subjective satisfaction rate at last follow-up was 8±3. The measured tibiofemoral angle was corrected to an average genu valgum of 3.3°±4.8° (P=.001). No patient showed severe postoperative osteoarthritis (ie, Kellgren-Lawrence grade 4) at last follow-up. All radiographs showed full incorporation of the bone grafts. At the end of the study, 2 patients underwent total knee replacement. Opening-wedge high tibial valgus osteotomy with Puddu plate fixation can be a reliable procedure for the treatment of medial-compartment osteoarthritis of the knee associated with varus deformity. PMID:22310405

  14. The new "dual osteotomy": combined open wedge and tibial tuberosity anteriorisation osteotomies.

    Science.gov (United States)

    Abdel Megied, Wael Samir; Mahran, Mahmoud A; Thakeb, Mootaz F; Abouelela, Amr A K H; Elbatrawy, Yasser

    2010-02-01

    The high frequency with which medial compartment osteoarthritis is associated with patellofemoral osteoarthritis makes the addition of tibial tuberosity anteriorisation to high tibial osteotomy an appealing solution, despite the discouraging previously reported long-term results when tubercle anteriorisation was combined with a Coventry closed wedge technique. We conducted a prospective study of a new osteotomy combination: "the dual osteotomy". An open wedge high tibial osteotomy was combined with 1- to 1.5-cm Maquet-like tibial tuberosity anteriorisation. Thirty-four knees in 30 patients underwent surgery, including ten knees in nine male patients and 24 knees in 21 female patients with a mean age of 45 years (age range 34-58 years). All patients had varus medial compartment osteoarthritis and patellofemoral osteoarthritis with preoperative anatomical tibiofemoral angle exceeding 5 degrees . Twenty-four months after surgery, final evaluation detected improvement in the Knee Society clinical rating system function score from a mean of 61.3 (range 30-80) preoperatively to a mean of 87.3 (range 50-100) postoperatively and in the knee pain score from 27.3 (range 10-30) to 47 (range 30-50) postoperatively. Based on the rating system, at final follow-up, 70% of patients experienced no pain, 13% had mild or occasional pain, 10% had pain on stairs only, and 7% had pain during walking and on stairs. Anatomical tibiofemoral angles from 0 to 10 degrees valgus were achieved in 91% of operated knees, and union was achieved in all cases within six to twelve weeks after surgery. The dual osteotomy was effective in the short term in cases of medial compartment osteoarthritis associated with patellofemoral osteoarthritis. PMID:19998035

  15. Surface effects on in-shoe plantar pressure and tibial impact during running

    OpenAIRE

    Weijie Fu; Ying Fang; David Ming Shuo Liu; Lin Wang; Sicong Ren; Yu Liu

    2015-01-01

    Purpose: This study aims to explore the effects of running on different surfaces on the characteristics of in-shoe plantar pressure and tibial acceleration. Methods: Thirteen male recreational runners were required to run at 12 km/h velocity on concrete, synthetic track, natural grass, a normal treadmill, and a treadmill equipped with an ethylene vinyl acetate (EVA) cushioning underlay (treadmill_EVA), respectively. An in-shoe plantar pressure system and an accelerometer attached to the ti...

  16. Head and Tibial Acceleration as a Function of Stride Frequency and Visual Feedback during Running

    OpenAIRE

    Busa, Michael A.; Jongil Lim; van Emmerik, Richard E.A.; Joseph Hamill

    2016-01-01

    Individuals regulate the transmission of shock to the head during running at different stride frequencies although the consequences of this on head-gaze stability remain unclear. The purpose of this study was to examine if providing individuals with visual feedback of their head-gaze orientation impacts tibial and head accelerations, shock attenuation and head-gaze motion during preferred speed running at different stride frequencies. Fifteen strides from twelve recreational runners running o...

  17. Rotational Position of Femoral and Tibial Components in TKA Using the Femoral Transepicondylar Axis

    OpenAIRE

    Aglietti, Paolo; Sensi, Lorenzo; Cuomo, Pierluigi; Ciardullo, Antonio

    2008-01-01

    Proper femoral and tibial component rotational positioning in TKA is critical for outcomes. Several rotational landmarks are frequently used with different advantages and limitations. We wondered whether coronal axes in the tibia and femur based on the transepicondylar axis in the femur would correlate with anteroposterior deformity. We obtained computed tomography scans of 100 patients with arthritis before they underwent TKA. We measured the posterior condylar angle on the femoral side and ...

  18. The results of high tibial open wedge osteotomy in patients with varus deformity

    Directory of Open Access Journals (Sweden)

    Mahmood Jabalameli

    2013-07-01

    Full Text Available Background: High tibial open wedg osteotomy is one of the most important modality for treatment of varus deformity in order to correct deformity and improving signs and symptoms of patients with primary degenerative osteoarthritis. The aim of this study was to investigate the results of high tibial open wedge osteotomy in patients with varus deformities.Methods: This retrospective study conducted on twenty nine patients (36 knees undergone proximal tibial osteotomy operation in Shafa Yahyaian University Hospital from 2004 to 2010. Inclusion criteria were: age less than 60 years, high physical activity, varus deformity and involvement of medical compartment of knee. Patients with obesity, smoking, patelofemoral pain, lateral compartment lesion, deformity degree more than 20 degree, extension limitation and range of motion less than 90 degree were excluded. The clinical and radiologic characteristics were measured before and after operation.Results: Fourteen patients were females. All of them were younger than 50 years, with mean (±SD 27.64 (±10.88. The mean (±SD of follow up time was 4.33 (±1.7. All the patients were satisfied with the results of operation. Tenderness and pain decreased in all of them. In all patients autologus bone graft were used, in 15 cases (42.5% casting and in the rest T.Buttress plate were used for fixation of fractures. In both groups of primary and double varus the International knee documentation committee (IKDC and modified Larson indices were improved after operation, but there was no significant difference between two groups.Conclusion: High tibial open wedge osteotomy can have satisfying results in clinical signs and symptoms of patients with primary medial joint degenerative osteoarthritis. This procedure also may correct the deformity and improves the radiologic parameters of the patients.

  19. 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.

  20. Surgical Technique: Tscherne-Johnson Extensile Approach for Tibial Plateau Fractures

    OpenAIRE

    Johnson, Eric E.; Timon, Stephen; Osuji, Chukwunenye

    2013-01-01

    Background The standard approach to lateral tibial plateau fractures involves elevation of the iliotibial band (IT) and anterior tibialis origin in continuity from Gerdy’s tubercle and metaphyseal flare. We describe an alternative approach to increase lateral plateau joint exposure and maintain iliotibial band insertion to Gerdy’s tubercle. Description of Technique The approach entails a partial tenotomy of the anterior half of the IT band leaving the posterior IT band insertion attached to G...

  1. Immediate ipsilateral fibular transfer in a large tibial defect using a ring fixator : A case report

    OpenAIRE

    Kim, H S; Jahng, J. S.; Han, D. Y.; Park, H. W.; Chun, C. H.

    1998-01-01

    Massive segmental bony defects in open tibial fractures are generally treated with conventional bone grafting, a free vascularised fibular graft or the ring fixator technique. A vascularised fibular graft may be superior to a conventional bone graft, but it is technically difficult and occasionally impossible. In such circumstances, fibular transfer in conjunction with a ring fixator is an alternative method. This procedure can be accomplished by transferring the osteotomised part of the fibu...

  2. An Important Cause of Pes Planus: The Posterior Tibial Tendon Dysfunction

    OpenAIRE

    Kemal Erol; Ali Yavuz Karahan; Ülkü Kerimoğlu; Banu Ordahan; Levent Tekin; Muhammed Şahin; Ercan Kaydok

    2015-01-01

    Posterior tibial tendon dysfunction (PTTD) is an important cause of acquired pes planus that frequently observed in adults. Factors that play a role in the development of PTTD such as age-related tendon degeneration, inflammatory arthritis, hypertension, diabetes mellitus, obesity, peritendinous injections and more rarely acute traumatic rupture of the tendon. PTT is the primary dynamic stabilizer of medial arch of the foot. Plantar flexion and inversion of the foot occurs with contraction of...

  3. 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.

  4. 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.

  5. Polyurethane resins derived from castor oil (Ricinus communis) for tibial crest deviation in dogs

    International Nuclear Information System (INIS)

    Medial patellar luxation is one of the most common orthopedic problems in small breeds of dogs and tibial crest deviation is a frequent accompaining anatomical abnormality. For that reason, the purpose of this study was to evaluate the behavior of castor oil derived polyurethane implants when apllied to experimental defects created on the medial side of the proximal tibia of normal puppies. Twelve dogs were randomly divided in 3 groups of 4 animals and were submitted to the same treatment. Histopathological study was performed respectively at 30 (GI), 60 (GII) and 90 (GIII) days post-surgery. Evaluations methods included clinical assessment, radiology, gross and macroscopic study, tomography and statistical analysis. Clinically, there were no signs of implant rejection. Radiology revealed intense periosteal reaction and new bone formation. On gross examination, there was thickening and lateral deviation of the tibial crest and new bone neoformation. On microscopic examination, there was fibrous tissue around the polyurethane, periosteal proliferation on the medial side of the tibia and no bone proliferation towards the implant. Cat scans reveled lateral deviation of the tibial crest in eleven animals, which was statistically significant (p<5; pared T test)

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

    International Nuclear Information System (INIS)

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

  7. Patellofemoral pain in female ballet dancers: correlation with iliotibial band tightness and tibial external rotation.

    Science.gov (United States)

    Winslow, J; Yoder, E

    1995-07-01

    Review of the literature reveals that ballet dancers have a high incidence of idiopathic patellofemoral pain. Twenty-four female ballet dancers were subjects in a study of the relationship between: 1) iliotibial band (ITB) tightness and patellofemoral pain, and 2) ITB tightness and degrees of tibial external rotation used in the dance demi-plie. Dancers were initially assessed by questionnaire to determine if any had knee pain. Twelve subjects met the study criteria for patellofemoral pain, and 12 dancers without knee pain served as controls for the study, Iliotibial band tightness was measured (Ober test), and degrees of tibial external rotation used during knee flexion (demi-plie) in standing were measured in both legs of all 24 subjects (48 legs). Chi-square analysis of the collected data revealed that there was an association between ITB tightness and patellofemoral pain in the dancers. Data analysis using the Wilcoxon Rank Sum test revealed that the degree of tibial external rotation used by dancers with iliotibial band tightness was significantly greater than those without ITB tightness. This study confirms the assumption that ITB tightness in dancers may be a contributing factor to patellofemoral pain. Follow-up study is indicated to determine if the preservation or restoration of functional ITB length is effective in the prevention and/or treatment of patellofemoral pain in ballet dancers. PMID:7550298

  8. Isolated dislocation of the posterior tibial tendon in an amateur snowboarder: a case report.

    Science.gov (United States)

    Gambardella, Gabriel V; Donegan, Ryan; Caminear, David S

    2014-01-01

    Isolated dislocation of the posterior tibial tendon is an uncommon pathologic entity that typically occurs in the setting of acute trauma. The diagnosis remains challenging and is often delayed second to the rarity of the injury and symptoms similar to that of medial ankle sprains and other routinely diagnosed injuries about the ankle. The factors that predispose this tendon to dislocation include a hypoplastic retromalleolar groove, flexor retinaculum insufficiency, chronic repetitive trauma, and a structural abnormality from a previous medial malleolar fracture, or a combination thereof. Dislocation has also been cited as a complication of multiple local steroid injections and tarsal tunnel release. The mechanism of injury appears to involve forced dorsiflexion and eversion of the ankle when the posterior tibial tendon is contracted. Most cases do not respond well to conservative treatment and will require surgery to restore function and eliminate symptoms. We report a case of posterior tibial tendon dislocation related to a snowboarding injury and offer our technique for surgical correction. PMID:24361009

  9. 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.

  10. Cadaveric limb analysis of tendon length discrepancy of posterior tibial tendon transfer through the interosseous membrane.

    Science.gov (United States)

    Pappas, Alexander J; Haffner, Kyle E; Mendicino, Samuel S

    2013-01-01

    The posterior tibial tendon transfer through the interosseous membrane, as popularized by Watkins in 1954, is a procedure for treating reducible eversion and dorsiflexory paresis used by lower extremity foot and ankle surgeons. The posterior tibial tendon has been transferred to various locations on the midfoot for equinus and equinovarus deformities. Dorsiflexory paresis is a common symptom in equinovarus deformity, clubfoot deformity, Charcot-Marie-Tooth disease, leprosy, mononeuropathy, trauma to the common peroneal nerve, cerebrovascular accident, and Duchenne's muscular dystrophy. The main difficulty with this procedure, often discussed by surgeons, is inadequate tendon length, making anchoring to the cuneiforms or cuboid difficult. The goal of our cadaveric study was threefold. First, we sought to determine whether the tendon length is sufficient when transferring the posterior tibial tendon to the dorsum of the foot through the interosseous membrane for a dynamic or a static transfer. Second, we wished to describe the surgical technique designed to obtain the maximal length. Finally, we sought to discuss the strategies used when the tendon length for transfer is insufficient. PMID:23369302

  11. 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.

  12. Delayed presentation is no barrier to satisfactory outcome in the management of open tibial fractures.

    Science.gov (United States)

    Ashford, Robert U; Mehta, Janak A; Cripps, Robin

    2004-04-01

    The management of open tibial fractures is a challenge to all orthopaedic trauma surgeons. The major goals are fracture union, uncomplicated soft tissue healing and return to pre-injury level of function. The geographical isolation and vastness of the Northern Territory of Australia complicates the management of these injuries by adding a significant delay to treatment. Forty-five patients sustained 48 open tibial fractures over the 30-month period of the study. Twelve received primary surgical treatment within 6h of injury but 33 were treated more than 6h after injury. The mean time to treatment in this latter group was 12h 15min (median 9h 45min, range 6-37h). The majority of injuries were high energy, with 23 patients having multiple injuries and 29 fractures (60%) being classified as AO C3 with 35 (73%) having Gustilo III soft tissue injuries. There was a mean time to union of 7.5 months and an overall complication rate of 42.2%. Thirteen patients (29%) required additional (late) surgical procedures subsequent to definitive fracture and soft tissue management. The zone of injury infection rate was 12.5%. The high incidence of open tibial fractures places a large financial burden on the state. However, despite the absence of a plastic surgical service and delays in presentation, satisfactory outcomes can be obtained by the application of the established surgical principles of thorough debridement, soft tissue management and fracture stabilisation. PMID:15037377

  13. Superficial peroneal neurocutaneous flap based on an anterior tibial artery perforator for forefoot reconstruction.

    Science.gov (United States)

    Wang, Chun-Yang; Chai, Yi-Min; Wen, Gen; Han, Pei; Cheng, Liang

    2015-06-01

    The distally based superficial peroneal neurocutaneous (SPNC) island flap has been widely used for foot reconstruction. It is based on the descending branch of the peroneal artery perforator. However, damage to the perimalleolar vascularization or anatomic variations of the descending branch often causes flap necrosis. Because septocutaneous perforators from the anterior tibial artery participate in the vascular network of superficial peroneal nerve in the distal lower leg, a modified SPNC flap is designed based on the anterior tibial artery perforator. Seven patients with soft tissue defect over the forefoot were treated by this modified technique. Six patients had accompanied injuries at the lateral perimalleolar region, and 1 patient had an anatomic variation of the descending branch of the peroneal artery perforator. The size of defect ranged from 12 × 5 to 15 × 9 cm. All 7 flaps survived completely without complications. The size of the flaps ranged from 13 × 6 to 16 × 10 cm. No severe venous congestion occurred. The mean follow-up was 9.4 months (range, 6-14 months). All patients were satisfied with the texture and color of the flaps. Two patients complained about the thickness of the flaps, but did not want further operation. The donor sites healed uneventfully and no painful neuroma occurred. In conclusion, the modified SPNC flap based on an anterior tibial artery perforator is a feasible salvage procedure when the traditional design is unreliable. It can provide sufficient and superior coverage for large forefoot defect. PMID:25969973

  14. 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

  15. Open Reduction and Internal Fixation of the Posteromedial Tibial Plateau via the Lobenhoffer Approach.

    Science.gov (United States)

    Hake, Mark E; Goulet, James A

    2016-08-01

    Posteromedial fractures of the tibial plateau are often encountered after high-energy injuries. They can be seen in isolation or in combination with lateral column fractures. These fractures must be recognized and stabilized independently of any lateral sided fracture to ensure the stability of the final construct. First described in 1997, the Lobenhoffer approach provides access to the posteromedial and posterior aspects of the proximal tibia, allowing for reduction and stabilization of fractures in this location with a posteromedial plate. We present our technique for this approach for the treatment of an isolated posteromedial tibial plateau fracture. The procedure is performed in the prone position. An interval between the gastrocnemius and pes anserine is developed and the fracture apex visualized. The reduction maneuver involves extension and valgus of the knee along with direct manipulation of the fracture fragment. A small fragment antiglide plate is then placed to stabilize the fracture. This relatively straightforward approach is of great use when treating complex tibial plateau fractures involving the medial and posterior columns. PMID:27441936

  16. 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. PMID:27236718

  17. 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.

  18. Timpanismo bilateral de bolsa gutural em potro Bilateral tympany of a guttural pouch in foal

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    Carlos Augusto Araújo Valadão

    2004-08-01

    Full Text Available Uma potra da raça Quarto de Milha com dois meses de idade apresentava aumento de volume bilateral na região da parótida desde algumas horas após o nascimento. Por exame radiográfico diagnosticou-se timpanismo bilateral de bolsa gutural. Realizou-se a abertura cirúrgica da bolsa gutural esquerda e fenestrou-se o septo medial das bolsas guturais. Adicionalmente, procedeu-se à ressecção parcial da mucosa na abertura do orifício guturo-faríngeo. A afecção foi debelada, sem recidivas.A 2-month old Quarter Horse filly presented, since few hours after birth, increased bilateral volume in the parotid gland region, with progressive enlargement. The radiographic examination revealed bilateral tympany of guttural pouch. Surgery was performed by medial septal fenestration. In addition, partial ressection of mucous membrane of the pharingeal orifice was performed. The disease was healed without recurrences.

  19. Unusual Bilateral Rim Fracture in Femoroacetabular Impingement

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    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.

  20. 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.

  1. [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.

  2. Bilateral Electrical Cataract: A Case Report

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    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

  3. Hiatus Hernia Repair with Bilateral Oesophageal Fixation.

    Science.gov (United States)

    Mendis, Rajith; Cheung, Caran; Martin, David

    2015-01-01

    Background. Despite advances in surgical repair of hiatus hernias, there remains a high radiological recurrence rate. We performed a novel technique incorporating bilateral oesophageal fixation and evaluated outcomes, principally symptom improvement and hernia recurrence. Methods. A retrospective study was performed on a prospective database of patients undergoing hiatus hernia repair with bilateral oesophageal fixation. Retrospective and prospective quality of life (QOL), PPI usage, and patient satisfaction data were obtained. Hernia recurrence was assessed by either barium swallow or gastroscopy. Results. 87 patients were identified in the database with a minimum of 3 months followup. There were significant improvements in QOL scores including GERD HRQL (29.13 to 4.38, P < 0.01), Visick (3 to 1), and RSI (17.45 to 5, P < 0.01). PPI usage decreased from a median of daily to none, and there was high patient satisfaction (94%). 57 patients were assessed for recurrence with either gastroscopy or barium swallow, and one patient had evidence of recurrence on barium swallow at 45 months postoperatively. There was an 8% complication rate and no mortality or oesophageal perforation. Conclusions. This study demonstrates that our technique is both safe and effective in symptom control, and our recurrence investigations demonstrate at least short term durability. PMID:26065030

  4. Hiatus Hernia Repair with Bilateral Oesophageal Fixation

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    Rajith Mendis

    2015-01-01

    Full Text Available Background. Despite advances in surgical repair of hiatus hernias, there remains a high radiological recurrence rate. We performed a novel technique incorporating bilateral oesophageal fixation and evaluated outcomes, principally symptom improvement and hernia recurrence. Methods. A retrospective study was performed on a prospective database of patients undergoing hiatus hernia repair with bilateral oesophageal fixation. Retrospective and prospective quality of life (QOL, PPI usage, and patient satisfaction data were obtained. Hernia recurrence was assessed by either barium swallow or gastroscopy. Results. 87 patients were identified in the database with a minimum of 3 months followup. There were significant improvements in QOL scores including GERD HRQL (29.13 to 4.38, P<0.01, Visick (3 to 1, and RSI (17.45 to 5, P<0.01. PPI usage decreased from a median of daily to none, and there was high patient satisfaction (94%. 57 patients were assessed for recurrence with either gastroscopy or barium swallow, and one patient had evidence of recurrence on barium swallow at 45 months postoperatively. There was an 8% complication rate and no mortality or oesophageal perforation. Conclusions. This study demonstrates that our technique is both safe and effective in symptom control, and our recurrence investigations demonstrate at least short term durability.

  5. Bilateral acute retinal necrosis after herpetic meningitis

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    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

  6. 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.

  7. A case of bilateral aldosterone-producing adenomas differentiated by segmental adrenal venous sampling for bilateral adrenal sparing surgery.

    Science.gov (United States)

    Morimoto, R; Satani, N; Iwakura, Y; Ono, Y; Kudo, M; Nezu, M; Omata, K; Tezuka, Y; Seiji, K; Ota, H; Kawasaki, Y; Ishidoya, S; Nakamura, Y; Arai, Y; Takase, K; Sasano, H; Ito, S; Satoh, F

    2016-06-01

    Primary aldosteronism due to unilateral aldosterone-producing adenoma (APA) is a surgically curable form of hypertension. Bilateral APA can also be surgically curable in theory but few successful cases can be found in the literature. It has been reported that even using successful adrenal venous sampling (AVS) via bilateral adrenal central veins, it is extremely difficult to differentiate bilateral APA from bilateral idiopathic hyperaldosteronism (IHA) harbouring computed tomography (CT)-detectable bilateral adrenocortical nodules. We report a case of bilateral APA diagnosed by segmental AVS (S-AVS) and blood sampling via intra-adrenal first-degree tributary veins to localize the sites of intra-adrenal hormone production. A 36-year-old man with marked long-standing hypertension was referred to us with a clinical diagnosis of bilateral APA. He had typical clinical and laboratory profiles of marked hypertension, hypokalaemia, elevated plasma aldosterone concentration (PAC) of 45.1 ng dl(-1) and aldosterone renin activity ratio of 90.2 (ng dl(-1) per ng ml(-1 )h(-1)), which was still high after 50 mg-captopril loading. CT revealed bilateral adrenocortical tumours of 10 and 12 mm in diameter on the right and left sides, respectively. S-AVS confirmed excess aldosterone secretion from a tumour segment vein and suppressed secretion from a non-tumour segment vein bilaterally, leading to the diagnosis of bilateral APA. The patient underwent simultaneous bilateral sparing adrenalectomy. Histopathological analysis of the resected adrenals together with decreased blood pressure and PAC of 5.2 ng dl(-1) confirmed the removal of bilateral APA. S-AVS was reliable to differentiate bilateral APA from IHA by direct evaluation of intra-adrenal hormone production. PMID:26538381

  8. 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.

  9. Reamed or unreamed intramedullary nailing for tibial fractures: a meta-analysis

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    Yu Guangshu

    2014-07-01

    Full Text Available 【Abstract】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, 0.8 to 2.41; P=0.16, thrombosis (RR=1.29; 95%CI, 0.43 to 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, 2.58 to 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. Key words: Fracture fixation, intramedullary; Tibial fractures; Meta-analysis

  10. Simultaneous bilateral spontaneous pneumothorax with congenital pleuro-pleural communication

    OpenAIRE

    HATA, YOSHINOBU; Suzuki, Takashi; Yokoi, Masahide; Yoshida, Shuji; Takeyama, Teruaki; Nakazaki, Haruhiro; Goto, Hidenori; Sato, Fumitomo; Takagi, Keigo; Otsuka, Hajime

    2013-01-01

    A single pleural space can lead to serious simultaneous bilateral pneumothorax in cases of congenital or acquired pleuro-pleural communication. Here we report a 35-year-old man with bilateral pneumothorax. Chest computed tomography scans revealed a small air space between the esophagus and aorta, suggesting pleuro-pleural communication. Bilateral thoracoscopic bullectomy was performed. Repeated inspection revealed a 2-cm-long pleural window between the aorta and esophagus, which was closed wi...

  11. Bilateral Traumatic Anterior Dislocation of Shoulder – a rare entity

    OpenAIRE

    Yashavantha Kumar C; Nalini K B; Lalit Maini; Prashanth Nagaraj

    2013-01-01

    Introduction: Bilateral shoulder dislocation are most commonly posterior type. These are most commonly due to seizure disorder and electrocution. Anterior shoulder dislocations occurring bilaterally without any predisposing factors are very rare. These types of injuries are due to trauma with a unique mechanism of injury. To best of our knowledge there are only few cases of similar kind are reported in literature. We hereby report a interesting case of posttraumatic, bilateral anterior dislo...

  12. Bilateral fat necrosis of the breast: report of a case.

    OpenAIRE

    Sonobe,Hiroshi; SATO, Yasuo; Suzuki,Yoshihide; Hayashi, Kazuhiko; Kawabata, Kenji

    1980-01-01

    A rare case of bilateral fat necrosis of the breast is reported. The patient was a 50-year-old unmarried woman having no history of trauma, disease or surgery of the breast. In the bilateral breasts, ill-defined, firm masses with skin retraction were noted. Bilateral breast cancer was diagnosed clinically. However, both lesions showed histologically chronic granulomatous inflammation with foci of fatty necrosis, infiltration of lymphocytes, plasma cells, lipid containing foamy cells, foreign ...

  13. Unilateral versus Bilateral Instrumentation in Spinal Surgery: A Systematic Review

    OpenAIRE

    Molinari, Robert W.; Saleh, Ahmed; Molinari, Robert; Hermsmeyer, Jeff; Dettori, Joseph R.

    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...

  14. Bilateral pneumothoraces complicating reduction mammoplasty: a case report

    OpenAIRE

    Mavridis, Stylianos; Gnauk, Hans Georg; Schumacher, Martina; Wagner, Roland

    2013-01-01

    Background Bilateral pneumothoraces after cosmetic breast surgery are rare and sporadically reported in the literature. Case presentation A 65-year-old female patient developed bilateral pneumothoraces after bilateral breast reduction surgery. Emergent chest tube thoracostomy was performed on both sides. The chest drains were removed on the fourth day (left side) and sixth day (right side), and the patient was discharged after 7 days of hospitalization without any further complications. Concl...

  15. 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.

  16. 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.

  17. 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

  18. Bilateral pulmonary emboli after bilateral mastectomy in a 15-year-old boy with hypogonadism: A case report

    OpenAIRE

    Piggott, JR; Yazdani, Arjang

    2010-01-01

    Pulmonary emboli are rare, yet serious, complications of body contouring surgery. When they occur, they more often follow as complications of long, invasive procedures in adults. The present report details a case of bilateral pulmonary emboli in an obese 15-year-old boy with hypogonadism undergoing bilateral mastectomy for gynecomastia. The diagnosis of bilateral pulmonary emboli was made on the basis of clinical presentation and positive ventilation/perfusion scan. The patient responded well...

  19. Marfan Syndrome Presenting with Bilateral Retinal Detachment

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    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

  20. Bilateral Trade Flows and Income Distribution Similarity

    Science.gov (United States)

    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. PMID:27137462

  1. 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. PMID:27137462

  2. 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.

  3. Bilateral adrenal hemorrhage in polycythemia vera.

    Science.gov (United States)

    Bhandari, Shruti; Agito, Katrina; Krug, Esther I

    2016-01-01

    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. PMID:27609733

  4. Bilateral adrenal hemorrhage in polycythemia vera

    Directory of Open Access Journals (Sweden)

    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.

  5. Bilaterally Microstructured Thin Polydimethylsiloxane Film Production

    DEFF Research Database (Denmark)

    Vudayagiri, Sindhu; Yu, Liyun; Hassouneh, Suzan Sager;

    2015-01-01

    /S produces films with a one-sided microstructured surface only. It would be advantageous to produce a film with both surfaces microstructured, as this increases the film’s performance efficiency. The new technique introduced herein produces bilaterally microstructured film by combining an embossing method...... retain an imprint made on it. The preheated film at gel point is embossed between the rolls of a gravure lab coater, which corrugates the top surface of the film. The films are then heated, in order to cure completely. For the LSR systems used in this process, the optimum conditions for preheating...... are 110°C for 4–7 s, while for embossing the temperature is 110°C with 25 psi pressure between the rolls at a speed of 1.4 rpm. Scanning electron microscope (SEM) images confirm the formation of microstructures on both the surfaces of the film....

  6. 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.

  7. Bilateral Scapulohumeral Ankylosis after Prolonged Mechanical Ventilation.

    Science.gov (United States)

    van Lotten, Manon L; Schreinemakers, J Rieneke; van Noort, Arthur; Rademakers, Maarten V

    2016-09-01

    This case demonstrates a rarely reported bilateral scapulohumeral bony ankylosis. A young woman developed extensive heterotopic ossifications (HOs) in both shoulder joints after being mechanically ventilated for several months at the intensive care unit in a comatose status. She presented with a severe movement restriction of both shoulder joints. Surgical resection of the bony bridges was performed in 2 separate sessions with a significant improvement of shoulder function afterwards. No postoperative complications, pain, or recurrence of HOs were noted at 1-year follow-up. Mechanical ventilation, immobilization, neuromuscular blockage, and prolonged sedation are known risk factors for the development of HOs in the shoulder joints. Relatively early surgical resection of the HOs can be performed safely in contrary to earlier belief. Afterwards, nonsteroidal anti-inflammatory drugs and/or radiation therapy can be possible treatment modalities to prevent recurrence of HOs. PMID:27583120

  8. Bilateral stony lung: pulmonary alveolar microlithiasis.

    Science.gov (United States)

    Chandra, Subhash; Mohan, Anant; Guleria, Randeep; Das, Prasenjit; Sarkar, Chitra

    2009-01-01

    A 40-year-old male paddy field worker was referred for exertional shortness of breath and non-productive cough for 4 years. He had been treated for pulmonary tuberculosis twice. Chest radiograph showed extensive bilateral nodular opacities ("sandstorm-like") in the middle and lower lobe. Pulmonary function tests revealed a restrictive ventilatory defect. High resolution CT showed widespread nodular infiltration with "crazy paving" appearance and interrupted black pleura sign. This was confirmed as pulmonary alveolar microlithiasis (PAM) by trans-bronchial lung biopsy, which showed normal respiratory lining epithelium with dilated alveolar spaces containing many calcific bodies, some of which showed concentric calcification. The possibilities of silicosis (due to exposure to husk) and tuberculosis, both of which can mimic PAM clinically and radiologically, made this case a diagnostic challenge. PMID:21686505

  9. 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

  10. 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

  11. 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.

  12. [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.

  13. 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.

  14. Intrusion Characteristics of Three Bone Cements for Tibial Component of Total Knee Arthroplasty in a Cadaveric Bone Model.

    Science.gov (United States)

    Walden, Justin K; Chong, Alexander C M; Dinh, Nam L; Adrian, Scott; Cusick, Robert; Wooley, Paul H

    2016-01-01

    The purpose of this study was to evaluate and compare the intrusion characteristics of Simplex-HV to Simplex-P and Palacos-R in cadaveric proximal tibial bone. Eighteen fresh-frozen cadaver proximal tibiae were examined with standard arthroplasty tibial cuts. Each tibia was randomly assigned to receive one of the three bone cements for use with finger packing technique. Sagittal sections were prepared and analyzed using digital photography and stereoscopic micrographs to evaluate cement intrusion characteristics. The cement penetration depth was measured from the tibial bone cut surface, which did not include the cement thickness under the tibial base plate. Significant differences were detected in the bone cement penetration between the three cements. Penetration was increased using the Simplex-HV (average, 2.7 mm; range, 2.0-3.0 mm) compared with Simplex-P (average, 2.2 mm) and Palacos-R (average, 1.8 mm). These depths approximate to 3.7, 3.2, and 2.8 mm of total cement penetration, respectively. The data suggest that high-viscosity bone cement may provide good fixation of the tibial component of a total knee arthroplasty when using the finger packing technique. PMID:27518289

  15. 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

  16. Applying Cross-Pin System in Both Femoral and Tibial Fixation in Anterior Cruciate Ligament Reconstruction Using Hamstring Tendons.

    Science.gov (United States)

    Qi, Wei; Liu, Yujie; Xue, Jing; Li, Haifeng; Wang, Junliang; Qu, Feng

    2015-10-01

    Use of the RigidFix Cross Pin System (DePuy Mitek, Raynham, MA) is a popular technique for femoral fixation of grafts in anterior cruciate ligament reconstruction (ACLR). However, tibial fixation is still limited to the use of interference screws and post fixation, and few surgeons apply the femoral RigidFix system in tibial fixation. Meanwhile, tunnel enlargement is still a problem that affects the outcome of ACLR with hamstring grafts. We have used the femoral RigidFix system in femoral and tibial fixation. The rod top of the guide frame should be placed under the level of the subchondral bone at the proximal end of the tibial tunnel to ensure that the pins will not be inserted into the joint. The pins are inserted through the center of the lateral tibia. Using our technique, the fixation points of the femur and tibia are close to the anterior cruciate ligament insertions, and full contact of the graft with the tunnel wall can be accomplished. On the basis of our preliminary observations and investigation, we are optimistic about the prospect of performing ACLR using the RigidFix system in femoral and tibial fixation. PMID:26697293

  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. Timpanismo bilateral de bolsa gutural em potro Bilateral tympany of a guttural pouch in foal

    OpenAIRE

    Carlos Augusto Araújo Valadão; Júlio Carlos Canola; Roberta Ferro de Godoy

    2004-01-01

    Uma potra da raça Quarto de Milha com dois meses de idade apresentava aumento de volume bilateral na região da parótida desde algumas horas após o nascimento. Por exame radiográfico diagnosticou-se timpanismo bilateral de bolsa gutural. Realizou-se a abertura cirúrgica da bolsa gutural esquerda e fenestrou-se o septo medial das bolsas guturais. Adicionalmente, procedeu-se à ressecção parcial da mucosa na abertura do orifício guturo-faríngeo. A afecção foi debelada, sem recidivas.A 2-month old...

  19. 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.

  20. 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.

  1. 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。

  2. [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.

  3. Bilateral Occipital Condyle Fracture: Report of Two Cases

    OpenAIRE

    Schrödel, Markus H.; Kestlmeier, Ralph; Trappe, Anna E.

    2002-01-01

    Occipital condyle fractures are a rare finding in trauma victims. Bilateral fractures are even more unusual and have typically been reported in autopsy studies. We treated two patients with bilateral occipital condyle fractures who had only minor symptoms. Anderson and Montesano's classification,1 possible cranial nerve palsies, diagnosis, and treatment of this rare fracture are discussed.

  4. 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....

  5. Hierarchical bilateral filtering based disparity estimation for view synthesis

    Science.gov (United States)

    Shin, Hong-Chang; Lee, Gwangsoon; Cheong, Won-Sik; Hur, Namho

    2016-06-01

    In this paper, we introduce a high efficient and practical disparity estimation using hierarchical bilateral filtering for real-time view synthesis. The proposed method is based on hierarchical stereo matching with hardware-efficient bilateral filtering. Hardware-efficient bilateral filtering is different from the exact bilateral filter. The purpose of the method is to design an edge-preserving filter that can be efficiently parallelized on hardware. The proposed hierarchical bilateral filtering based disparity estimation is essentially a coarse-to-fine use of stereo matching with bilateral filtering. It works as follows: firstly, the hierarchical image pyramid are constructed; the multi-scale algorithm then starts by applying a local stereo matching to the downsampled images at the coarsest level of the hierarchy. After the local stereo matching, the estimated disparity map is refined with the bilateral filtering. And then the refined disparity map will be adaptively upsampled to the next finer level. The upsampled disparity map used as a prior of the corresponding local stereo matching at the next level, and filtered and so on. The method we propose is essentially a combination of hierarchical stereo matching and hardware-efficient bilateral filtering. As a result, visual comparison using real-world stereoscopic video clips shows that the method gives better results than one of state-of-art methods in terms of robustness and computation time.

  6. Hansen′s disease with bilateral tarsal disorganisation

    OpenAIRE

    Nair Pradeep; Vijayadharan M; Yogirajan K; Suprakasan S; Rajasree P

    1999-01-01

    A 37-year old male patient with Hansen′s disease midborderline spectrum, presented with bilateral pedal edema. X-ray examination of the feet showed disorganisation and disintegration of the tarsal bones. Bilateral tarsal disorganisation which can develop in Hansen′s disease is usually not recognised by the clinician.

  7. Ultrasound Diagnosis of Bilateral Quadriceps Tendon Rupture After Statin Use

    Science.gov (United States)

    Nesselroade, Ryan D.; Nickels, Leslie Connor

    2010-01-01

    Simultaneous bilateral quadriceps tendon rupture is a rare injury. We report the case of bilateral quadriceps tendon rupture sustained with minimal force while refereeing a football game. The injury was suspected to be associated with statin use as the patient had no other identifiable risk factors. The diagnosis was confirmed using bedside ultrasound. PMID:21079697

  8. Tibial plato leveling osteotomy / Osteotomia de nivelamento do plato da tíbia

    Directory of Open Access Journals (Sweden)

    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

  9. Rare cause of paraparesis: bilateral obturator neuropathy after hysterosalpingectomy.

    Science.gov (United States)

    López-Blanco, Roberto; Mejía-Jiménez, Inmaculada; de Fuenmayor-Fernández de la Hoz, Carlos Pablo; Ruiz-Morales, Juan

    2015-01-01

    Bilateral obturator nerve injury during pelvic surgery is an infrequent cause of lower limb paraparesis. We report the case of a 45-year-old woman with a large uterine leiomyoma who underwent simple total hysterectomy and bilateral salpingectomy. At 24 h after the surgery, the patient noticed loss of muscle strength when adducting both legs. She had no problem with other movements and no sensory or sphincter abnormalities. Neurological examination confirmed that there was loss of strength only in the adductor muscles, with preserved sensory function and reflexes, suggesting bilateral obturator nerve involvement. Pelvic MRI showed a small postsurgical haematoma in the Douglas recess, but far from the obturator nerves. 2 weeks later, electromyography showed positive sharp waves and low motor unit recruitment in the adductor magnus muscles, confirming acute, bilateral obturator nerve neuropathy. The few cases of bilateral obturator neuropathy that have been reported were mostly related to abdominopelvic interventions. PMID:26689250

  10. Bilateral Clavicle Fractures: A Report of Three Cases.

    Science.gov (United States)

    Lakhotia, Devendra; Khatri, Kavin; Sharma, Vijay; Farooque, Kamran; Sharma, Swati

    2016-06-01

    Bilateral clavicle fractures are uncommonly reported in the literature with the incidence being less than 0.5% of all the clavicle fractures. Bilateral clavicle fractures are caused either by high-energy transfer of compression forces across both shoulder girdles or by a direct trauma to one clavicle followed by that to the other clavicle. These fractures could be missed due to their association with more severe chest injuries or a more symptomatically displaced fracture on one side or due to inadequate chest radiographs. We report three cases of traumatic bilateral clavicle fractures with three modes of injuries in different age groups. All the fractures were treated conservatively with good functional outcomes without any sequelae. Bilateral clavicle fractures should be actively sought by every trauma team with proper clinical examination and chest radiographs including both shoulder joints in high-energy trauma cases or with bilateral shoulder compression injuries. PMID:27504365

  11. MRI features of bilateral parotid haemangiomas of infancy

    Energy Technology Data Exchange (ETDEWEB)

    Andronikou, Savvas; Jadwat, Saaleeha [Institute of Child Health, University of Cape Town, Klipfontein Road, Rondebosch, 7700, Cape Town (South Africa); McHugh, Kieran; Linward, Jane [Department of Radiology, Great Ormond Street Hospital for Children, London, WC1N 3JH (United Kingdom)

    2003-04-01

    The aim of this article is to report the MRI features of bilateral parotid haemangiomas of infancy and highlight the diagnostic and prognostic value of MRI especially with regard to those lesions that may cause respiratory compromise. Retrospective review of MRI scans in six infants with bilateral parotid haemangiomas. The bilateral haemangiomas were symmetrical in all but one patient. On T1-weighted images the masses were isointense to muscle and on T2 they were hyperintense with numerous small vessels giving a septated appearance. There was vivid enhancement with gadolinium in all cases. In three patients, deep bilateral extensions were demonstrated involving the parapharyngeal spaces resulting in respiratory compromise which required tracheostomy. Bilateral parotid haemangiomas are rare, but when present may have deep extensions, which can result in respiratory compromise requiring tracheostomy. (orig.)

  12. Bilateral periventricular nodular heterotopia with megalencephaly: a case report.

    Science.gov (United States)

    Abe, Yu; Kobayashi, Satoru; Wakusawa, Keisuke; Tanaka, Soichiro; Inui, Takehiko; Yamamoto, Toshiyuki; Kunishima, Shinji; Haginoya, Kazuhiro

    2014-06-01

    Bilateral periventricular nodular heterotopia is a neuronal migration disorder characterized by gray matter cellular rests in the periventricular regions. Megalencephaly has not been reported in children with bilateral periventricular nodular heterotopia. No other disorder with a similar phenotype has been reported. Here we report the case of a 5-year-old Japanese boy with bilateral periventricular nodular heterotopia and megalencephaly. Relative macrocephaly was evident at birth, and bilateral periventricular nodular heterotopia and megalencephaly were noted on magnetic resonance imaging (MRI). However, no hydrocephalus or indication of cerebral cortical dysplasia was seen. A mild intellectual disability was present, but the patient had no history of seizures. Genetic analysis revealed no mutation on the capillary sequences for FLNA, and no pathogenic abnormalities were evident on array comparative genomic hybridization. This case could represent a new disease entity: bilateral periventricular nodular heterotopia with megalencephaly. PMID:23439715

  13. Bilateral Tubal Gestation Associated with Schistosomiasis in an African Woman

    Directory of Open Access Journals (Sweden)

    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.

  14. Relationship between static anterior laxity using the KT-1000 and dynamic tibial rotation during motion in patients with anatomical anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Sato, Koji; Maeda, Akira; Takano, Yoshio; Matsuse, Hiroo; Ida, Hirofumi; Shiba, Naoto

    2013-01-01

    The anterior cruciate ligament (ACL) plays an important role in controlling knee joint stability, not only by limiting tibial anterior translation but also by controlling knee axial rotation. The aim of ACL reconstruction is to reduce excessive anterior joint laxity, hoping to restore normal tibiofemoral kinematics including knee axial rotation. The purpose of this study was to investigate the relationship between static anterior instability and tibial rotation during several activities in an anterior cruciate ligament reconstructed knee. Seven patients with unilateral ACL injury performed plain walking, running, landing and side step cutting tasks after ACL reconstruction with a mean follow-up of 14 months. The kinematic data for the 4 motions was measured using a motion analysis system and the point cluster technique. The evaluation period was defined to be from the first contact to removal of the tested leg from the ground. Maximum tibial internal rotation during tasks was calculated using the point cluster technique (PCT). Passive anterior tibial translation was measured using a KT-1000 arthrometer. Regression analysis was used to determine the correlation of the maximum internal rotation with the side-to-side difference of static anterior tibial translation measured using a KT-1000 arthrometer. During side step cutting maneuvers, maximum tibial internal rotation significantly showed negative correlation with static anterior tibial translation (pknee rotation kinematics. The normal anterior tibial translation obtained by ACL reconstruction is thought to be the key factor in successful restoration of normal knee kinematics. PMID:23925154

  15. Arthrofibrosis of the knee following a fracture of the tibial plateau.

    Science.gov (United States)

    Haller, J M; Holt, D C; McFadden, M L; Higgins, T F; Kubiak, E N

    2015-01-01

    The aim of this study was to report the incidence of arthrofibrosis of the knee and identify risk factors for its development following a fracture of the tibial plateau. We carried out a retrospective review of 186 patients (114 male, 72 female) with a fracture of the tibial plateau who underwent open reduction and internal fixation. Their mean age was 46.4 years (19 to 83) and the mean follow-up was16.0 months (6 to 80). A total of 27 patients (14.5%) developed arthrofibrosis requiring a further intervention. Using multivariate regression analysis, the use of a provisional external fixator (odds ratio (OR) 4.63, 95% confidence interval (CI) 1.26 to 17.7, p = 0.021) was significantly associated with the development of arthrofibrosis. Similarly, the use of a continuous passive movement (CPM) machine was associated with significantly less development of arthrofibrosis (OR = 0.32, 95% CI 0.11 to 0.83, p = 0.024). The effect of time in an external fixator was found to be significant, with each extra day of external fixation increasing the odds of requiring manipulation under anaesthesia (MUA) or quadricepsplasty by 10% (OR = 1.10, p = 0.030). High-energy fracture, surgical approach, infection and use of tobacco were not associated with the development of arthrofibrosis. Patients with a successful MUA had significantly less time to MUA (mean 2.9 months; sd 1.25) than those with an unsuccessful MUA (mean 4.86 months; sd 2.61, p = 0.014). For those with limited movement, therefore, performing an MUA within three months of the injury may result in a better range of movement. Based our results, CPM following operative fixation for a fracture of the tibial plateau may reduce the risk of the development of arthrofibrosis, particularly in patients who also undergo prolonged provisional external fixation. PMID:25568423

  16. Extracorporeal shockwave therapy (ESWT) ameliorates healing of tibial fracture non-union unresponsive to conventional therapy.

    Science.gov (United States)

    Haffner, Nicolas; Antonic, Vlado; Smolen, Daniel; Slezak, Paul; Schaden, Wolfgang; Mittermayr, Rainer; Stojadinovic, Alexander

    2016-07-01

    Tibial non-unions are common cause of demanding revision surgeries and are associated with a significant impact on patients' quality of life and health care costs. Extracorporeal shockwave therapy (ESWT) has been shown to improve osseous healing in vitro and in vivo. The main objective of present study was to evaluate the efficacy of ESWT in healing of tibial non-unions unresponsive to previous surgical and non-surgical measures. A retrospective multivariant analysis of a prospective open, single-centre, clinical trial of tibia non-union was conducted. 56 patients with 58 eligible fractures who met the FDA criteria were included. All patients received 3000-4000 impulses of electrohydraulic shockwaves at an energy flux density of 0.4mJ/mm(2) (-6dB). On average patients underwent 1.9 times (±1.3SD) surgical interventions prior to ESWT displaying the rather negatively selected cohort and its limited therapy responsiveness. In 88.5% of patients receiving ESWT complete bone healing was observed after six months irrespective of underlying pathology. The multivariant analysis showed that time of application is important for therapy success. Patients achieving healing received ESWT earlier: mean number of days between last surgical intervention and ESWT (healed - 355.1 days±167.4SD vs. not healed - 836.7 days±383.0SD; ptherapies. The procedure is well tolerated, time-saving, lacking side effects, with potential to significantly decrease health care costs. Thus, in our view, ESWT should be considered the treatment of first choice in established tibial non-unions. PMID:27158008

  17. ANTERIOR KNEE PAIN IN TRANSTENDINOUS AND PARATENDINOUS APPROACHES OF TIBIAL INTERLOCKING NAIL: A COMPARATIVE STUDY

    Directory of Open Access Journals (Sweden)

    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

  18. 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.

  19. Treatment of tibial diaphysis fractures with reamed and locked intramedullary nailing

    Directory of Open Access Journals (Sweden)

    Yahya Coşar

    2011-06-01

    Full Text Available The aim of this study was to evaluate the results of reamed and locked intramedullary nailing for tibial diaphysis fractures.Materials and methods: The study included 38 patients (26 males, 12 females who were treated with reamed and locked intramedullary nailing for tibial diaphysis fractures. Fractures were classified according to Gustilo-Anderson classification and functional results were assessed using the Johner-Wrush criteria.Results: The mean age was 36 years (range 18-61. There were 21 AO/ASIF type A, 16 type B, and 1 type C fractures. Twenty-four fracture were closed (63.1% and 14 (36.9% were open fractures. According to the Gustilo-Anderson classification, 9 were grade I, 4 patients grade II, and one grade IIIA open fractures. Intramedullary nailing was performed following open reduction in 18 patients, and closed reduction in 20. The mean time to surgery was 9.4 days and the mean follow-up was 29 months. Union was achieved in all patients within a mean of 17.6 weeks. Anterior knee pain developed in 18 patients and infection developed in three patients. Angular deformity less than 10º was developed 12 patients (31.6%. There were screw breakacge and synostosis in four and two patients respectively. According to the Johner-Wrush criteria, functional results were very good in 23 patients (60.5%, good in 12 patients (31.6% and fair in 3 (7.9% patients.Conclusion: Treatment of tibial diaphysis fractures with reamed and locked intramedullary nailing gives satisfactory results. It should be considered as first choice in the treatment of these fractures. J Clin Exp Invest 2011;2(2:168-74

  20. 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.

  1. Open tibial shaft fractures. Treatment with intramedullary nailing after provisional stabilization with non penetrating external fixator

    Directory of Open Access Journals (Sweden)

    Jose Octavio Soares Hungri

    2013-12-01

    Full Text Available Objective: To evaluate the incidence of union, nonunion, deep infection and factors influencing the time of bone healing in the treatment of open tibial shaft fractures Gustilo and Anderson types I and II initially treated with a non penetrating external fixator (Pinless(r followed by an unreamed intramedullary locked nail (UTN(r. Methods: It is a prospective study of 39 open tibial shaft fractures. According to the AO classification, 16 patients (41.0% were type A, 17 (43.6% were type B and six (15.4% were type C. According to the Gustilo and Anderson classification, 14 patients (35.9% were type I and 25 (64.1% were type II. For the definitive stabilization of the fracture were used an unreamed intramedulary locked nail (UTN(r. Results: Bone healing was achieved in 97.4% of the cases, with a mean time of 21.2 weeks, ranging from 12 to 104 weeks. Deep infection was seen in 2.6% patients and malunion were seen in 5.1%. Only the presence of complications were statistically significant to the time of bone healing, with a risk of faster healing in patients without complications of 4.29 times (CI 95%: 1.25 -14.71 comparing to patients with complications. Conclusion: The treatment of open tibial shaft fractures with unreamed intramedullary locked nail allows high rates of bone healing, low rates of nonunion and deep infection, and only the presence of complications is statistically significant to the time of bone healing.

  2. 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.

  3. Biomechanical analysis of the anterior displacement of Tibial tuberosity (Maquet operation: A computer model study

    Directory of Open Access Journals (Sweden)

    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

  4. Fixação das fraturas do platô tibial com placas pela via de acesso posterior - relato preliminar de 12 casos Tibial plateau fractures fixation using posterior approaches - preliminary results of 12 cases

    OpenAIRE

    André Wajnsztejn; Eduardo Fiorentino Alves de Araújo; Marcos Roberto Mellega; Luiz Fernando Cocco; Wesley Max Ramos; Daniel Balbachevsky; Hélio Jorge Alvachian Fernandes; Fernando Baldy dos Reis

    2011-01-01

    OBJETIVO: Apresentar os resultados preliminares com técnicas de abordagem posterior para fraturas do platô tibial, com traço de cisalhamento no plano sagital. MÉTODOS: Doze pacientes com fraturas do platô tibial tratados cirurgicamente através de um acesso posterior direto foram incluídos no estudo. Foram revisados os prontuários, as radiografias e tomografias dos pacientes bem como as avaliações clínicas. Todos os casos foram acompanhados até o momento da consolidação óssea, definido como aq...

  5. Fascicular Involvement of the Posterior Tibial Nerve as a Result of Perineural Ganglion Cyst at the Posterior Tibial Nerve in the Calf: A Case Report and Review of Literature.

    Science.gov (United States)

    Patel, Chilvana; Vishnubhakat, Surya Murthy; Narayan, Raj

    2015-12-01

    We report a 19-year-old woman with a 6-month history of nontraumatic left foot numbness associated with intermittent weakness. Nerve conduction studies and electromyography localized the lesion to the posterior tibial nerve, below the innervation to the soleus and medial gastrocnemius muscles. MRI of the left leg revealed a multiloculated cystic collection near the proximal tibiofibular joint. Surgical excision and pathology confirmed the diagnosis of a ganglion cyst, in an atypical location distal to the popliteal fossa. We believe this is the first reported case of fascicular posterior tibial nerve involvement by a ganglion cyst in the calf. PMID:26583496

  6. 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.

  7. A Fluoroscopy-Free Technique for Percutaneous Screw Positioning During Arthroscopic Treatment of Depression Tibial Plateau Fractures.

    Science.gov (United States)

    Thaunat, Mathieu; Camelo Barbosa, Nuno; Tuteja, Sanesh; Jan, Nicolas; Fayard, Jean Marie; Sonnery-Cottet, Bertrand

    2016-06-01

    This article aims to describe a simple and reliable technique that helps in positioning the cannulated percutaneous screws during fixation of depression-type tibial plateau fractures. After fracture reduction under arthroscopic control, an outside-in anterior cruciate ligament femoral guide is introduced through the tibial cortical metaphyseal window and positioned under endoscopic control just underneath the elevated fragment. When proper height is achieved, a guide pin is drilled from lateral to medial through the sleeve, 1 to 2 cm distal to the articular surface of the depressed fragment. The cannulated screw can then be introduced under endoscopic control, without fluoroscopic assistance, just under the previously elevated joint surface. This technique ensures optimal placement of the cannulated screw in the middle of the bony tunnel to obtain optimal subchondral bone support during fixation of the depressed tibial plateau fracture. PMID:27656370

  8. Mycotic aneurysm of the posterior tibial artery – a rare complication of bacterial endocarditis: a case report

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    Patel S

    2008-11-01

    Full Text Available Abstract Introduction Distal arterial embolisation and subsequent aneurysm formation are rare occurrences and most are secondary to trauma. We have found no case reports that describe posterior tibial aneurysm formation secondary to bacterial endocarditis. Case presentation We report the case of a 47-year-old Caucasian man who, 2 years after an episode of subacute bacterial endocarditis, presented with signs and symptoms consistent with posterior tibial aneurysm formation. Conclusion Posterior tibial aneurysm formation is a rare occurrence, most commonly occurring after trauma and, although other causes have been described, to our knowledge, endocarditis has not been implicated before, and as such should therefore be borne in mind when dealing with cases where no obvious aetiology is evident.

  9. 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

  10. Anterior Tibial Artery Pseudoaneurysm following Ankle Arthroscopy in a Hemophiliac Patient.

    Science.gov (United States)

    Chamseddin, Khalil H; Kirkwood, Melissa L

    2016-07-01

    Arthroscopy of the foot and ankle is a common orthopedic procedure with low complication rates. Arterial injuries from these procedures are an even more rare subset of the complications. Hemophilia A is a genetic disorder of aberrant coagulation, which leads to increased risk of bleeding even after minor trauma. We present the second case of anterior tibial artery pseudoaneurysm formation secondary to ankle arthroscopy in a hemophiliac patient and suggest that these individuals are at higher risk for developing complications associated with arterial injury. Furthermore, potential risk factors include port placement, anatomic variation of the vessels, and nature of the arthroscopic procedure. We recommend steps to prevent complications in hemophiliac patients. PMID:27174350

  11. MR imaging appearance of insufficiency fractures of the medial tibial plateau

    International Nuclear Information System (INIS)

    This paper reports on the etiology of a painful syndrome of the medial tibial plateau (MTP) in elderly patients. Findings include acute pain of the medial aspect of the knee, normal plain radiographs, and increased uptake of the MTP on bone scans. It has been related to osteonecrosis in most cases and, more rarely, to an insufficiency fracture. To our knowledge, no MR studies of patients with this syndrome have been previously reported. Five patients presenting with this syndrome (age > 59 years) were studied with MR imaging. In all five cases, initial plain radiographs were normal and increased uptake of the MTP was found on bone scans

  12. Tibial avulsion fracture of the posterior root of the medial meniscus in children

    DEFF Research Database (Denmark)

    Iversen, Jonas Vestergård; Krogsgaard, Michael Rindom

    2012-01-01

    Few reports have described avulsion fractures of the posterior root of the medial meniscus in skeletally immature patients. This lesion should not be overlooked as it damages the load absorptive (distributive) function of the meniscus, increasing the risk of cartilage degeneration. Two cases of...... displaced avulsion fractures of the posterior root of the medial meniscus in children are presented along with a concise report of the literature regarding avulsion fractures of the posterior root of the medial meniscus. Both avulsions were reattached arthroscopically by trans-tibial pull-out sutures with a...

  13. 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.

  14. Iatrogenic posterior tibial nerve division during a combined anterior ankle arthroscopy with an additional posterolateral portal

    Science.gov (United States)

    Abdul-Jabar, Hani B; Bhamra, Jagmeet; Quick, Tom J; Fox, Michael

    2016-01-01

    Ankle arthroscopy is an important diagnostic and therapeutic technique in the management of ankle disorders. Nowadays ankle arthroscopy provides good to excellent results (up to 90%) in the treatment of certain intra-articular disorders. Due to the superficial location of ankle joint and the abundance of overlying neurovascular structures, complications reported in ankle arthroscopy are greater than those reported in other joints. We present the first reported case of a complete division of the posterior tibial nerve during an anterior ankle arthroscopy combined with an additional posterolateral portal. This was due to a poorly controlled use of the arthroscopic instruments. PMID:27197613

  15. The management of tibial fracture non-union using the Taylor Spatial Frame.

    Science.gov (United States)

    Khunda, A; Al-Maiyah, M; Eardley, W G P; Montgomery, R

    2016-12-01

    We reviewed 40 complex tibial non-unions treated with Taylor Spatial Frames. 39 healed successfully. Using the ASAMI scoring, we obtained 33 excellent, 5 good, 1 fair and 1 poor bone results. The functional results were excellent in 29 patients, good in 8, fair in two and poor in one. Mean patient satisfaction score was 95%. All but one patient would have the same treatment again. 28 of the 36 patients in work when injured, returned to work at the time of their final review. Four patients had an adverse event requiring significant intervention. Average treatment cost was approximately £26,000/patient. PMID:27453643

  16. Posterior Tibial Labrum Injury in a Professional Soccer Player: A Case Report.

    Science.gov (United States)

    Batista, Jorge Pablo; del Vecchio, Jorge Javier; Maestu, Rodrigo

    2016-01-01

    Ankle ligament injuries are one of the most frequent lesions identified in professional soccer players. In most cases, the ligaments involved are the anterior talofibular ligament and the calcaneal fibular ligament. In the present report, we describe a professional soccer player who sustained an ankle sprain that did not respond to initial therapy. The findings from radiographic and magnetic resonance images were inconclusive. Ultimately, rupture of the posterior, transverse ligament with avulsion of the tibial labrum was identified as the cause of his ongoing ankle pain. Confirmation of the pathologic findings and successful treatment were performed arthroscopically. PMID:25459088

  17. Comparative gait initiation kinematics between simulated unilateral and bilateral ankle hypomobility: Does bilateral constraint improve speed performance?

    Science.gov (United States)

    Delafontaine, A; Honeine, J-L; Do, M-C; Gagey, O; Chong, R K

    2015-08-31

    Improvement of motor performance in unilateral upper limb motor disability has been shown when utilizing inter-limb coupling strategies during physical rehabilitation. This suggests that 'default' bilateral central motor commands are facilitated. Here, we tested whether this bilateral motor control principle may be generalized to the lower limbs during gait initiation, which involves alternate bilateral actions. Disability was simulated by strapping to produce ankle hypomobility. Healthy adult subjects initiated gait at a self-paced speed with no ankle constraint (control), or with the stance, swing or bilateral ankles strapped. The duration of the anticipatory postural adjustments lengthened and the center of mass instantaneous progression velocity at foot-off decreased when the ankle was strapped. During the step execution phase, progression velocity at foot-contact was higher when both ankles were strapped compared to unilateral strapping of the stance ankle. These findings suggest that bilateral central motor commands are favored during walking tasks. Indeed, unilateral constraint of the stance ankle should compel the central nervous system to adapt specific commands to the constraint and normal sides whereas the 'default' bilateral motor commands would be utilized when both ankles are strapped leading to better kinematics performance. Bilateral in-phase upper limb coordination and bilateral alternating lower limb locomotor movements may share similar control mechanisms. PMID:26197055

  18. 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.

  19. Osteotomía tibial valguizante osteosíntesis con tornillos canulados : estudio biomecánico experimental /

    OpenAIRE

    Serra Porta, Teresa

    2003-01-01

    Consultable des del TDX Títol obtingut de la portada digitalitzada La osteosíntesis aplicada a las osteotomías tibiales valguizantes aporta estabilidad primaria y disminuye la pérdida de corrección el primer año postoperatorio. Por otra parte, hace posible la movilización precoz de la rodilla después de la cirugía. No hemos hallado referencias en la literatura de tornillos canulados para la estabilización primaria de la osteotomía tibial valguizante (OTV). OBJETIVO Desarrollamos un estu...

  20. 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