Sample records for bone surgical simulation

  1. Good experiences with interactive temporal bone surgical simulator

    DEFF Research Database (Denmark)

    Andersen, Steven A W; Mikkelsen, Peter Trier; Noe, Karsten Ostergaard;


    The Visible Ear Simulator (VES) is a freeware temporal bone surgical simulator utilizing a high-fidelity haptic and graphical voxel model compiled from segmented digital images of fresh frozen sections. A haptic device provides the 3-dimensional handling and drilling with force-feedback in real...

  2. 3D Surgical Simulation (United States)

    Cevidanes, Lucia; Tucker, Scott; Styner, Martin; Kim, Hyungmin; Chapuis, Jonas; Reyes, Mauricio; Proffit, William; Turvey, Timothy; Jaskolka, Michael


    This paper discusses the development of methods for computer-aided jaw surgery. Computer-aided jaw surgery allows us to incorporate the high level of precision necessary for transferring virtual plans into the operating room. We also present a complete computer-aided surgery (CAS) system developed in close collaboration with surgeons. Surgery planning and simulation include construction of 3D surface models from Cone-beam CT (CBCT), dynamic cephalometry, semi-automatic mirroring, interactive cutting of bone and bony segment repositioning. A virtual setup can be used to manufacture positioning splints for intra-operative guidance. The system provides further intra-operative assistance with the help of a computer display showing jaw positions and 3D positioning guides updated in real-time during the surgical procedure. The CAS system aids in dealing with complex cases with benefits for the patient, with surgical practice, and for orthodontic finishing. Advanced software tools for diagnosis and treatment planning allow preparation of detailed operative plans, osteotomy repositioning, bone reconstructions, surgical resident training and assessing the difficulties of the surgical procedures prior to the surgery. CAS has the potential to make the elaboration of the surgical plan a more flexible process, increase the level of detail and accuracy of the plan, yield higher operative precision and control, and enhance documentation of cases. Supported by NIDCR DE017727, and DE018962 PMID:20816308

  3. Simulation-based surgical education. (United States)

    Evgeniou, Evgenios; Loizou, Peter


    The reduction in time for training at the workplace has created a challenge for the traditional apprenticeship model of training. Simulation offers the opportunity for repeated practice in a safe and controlled environment, focusing on trainees and tailored to their needs. Recent technological advances have led to the development of various simulators, which have already been introduced in surgical training. The complexity and fidelity of the available simulators vary, therefore depending on our recourses we should select the appropriate simulator for the task or skill we want to teach. Educational theory informs us about the importance of context in professional learning. Simulation should therefore recreate the clinical environment and its complexity. Contemporary approaches to simulation have introduced novel ideas for teaching teamwork, communication skills and professionalism. In order for simulation-based training to be successful, simulators have to be validated appropriately and integrated in a training curriculum. Within a surgical curriculum, trainees should have protected time for simulation-based training, under appropriate supervision. Simulation-based surgical education should allow the appropriate practice of technical skills without ignoring the clinical context and must strike an adequate balance between the simulation environment and simulators.

  4. Smoking and Bone Healing - A Risky Surgical Combination (United States)

    ... Risky Surgical Combination A A A | Print | Share Smoking and Bone Healing – A Risky Surgical Combination Imagine ... saying that they'd prefer patients to quit smoking. There hasn't been a great deal of ...

  5. Surgical treatment and outcomes of temporal bone chondroblastoma. (United States)

    Moon, In Seok; Kim, Jin; Lee, Ho-Ki; Lee, Won-Sang


    Chondroblastoma is an uncommon primary benign bone tumor that usually arises in the epiphyses of the long bones. Temporal bone chondroblastoma is a rare primary bone tumor that affects the floor of the middle cranial fossa and temporomandibular joint (TMJ). The biological nature of temporal bone chondroblastoma is occasionally aggressive because of local invasion and is known to have a high recurrence after curettage. Therefore, complete resection is recommended. However, the literature provides little information regarding long-term surgical outcomes and complications after surgical resection. The authors have retrospectively analyzed four cases of temporal bone chondroblastoma that had been completely excised by a single surgeon with an eventual long-term follow-up. A single surgeon operated on four patients, two males and two females, with a mean age of 34 years, at the Department of Otorhinolaryngology, Severance Hospital. In all cases, the tumor involved the middle cranial fossa dura and the mandibular fossa with variable degree of infiltration. All patients have had no tumor recurrence to date (mean follow-up period of 5 years). Complete surgical resection of the temporal bone chondroblastoma is the gold standard for treatment. Precise preoperative image evaluation of tumor extension and proper management of the dura mater and temporomandibular joint (TMJ) are the major important features in complete surgical removal that minimize complications in temporal bone chondroblastoma treatment.

  6. The Surgical Treatment of Pelvic Bone Metastases

    Directory of Open Access Journals (Sweden)

    Daniel A. Müller


    Full Text Available Pelvic bone metastases are a growing concern in the field of orthopedic surgery. Patients with pelvic metastasis are individually different with different needs of treatment in order to attain the best possible quality of life despite the advanced stage of disease. A holistic collaboration among the oncologist, radiation therapist, and orthopedic surgeon is mandatory. Special attention has to be directed to osteolytic lesions in the periacetabular region as they can provoke pathological fractures and subsequent functional impairment. Different reconstruction techniques for the pelvis are available; the choice depends on the patient’s prognosis, size of the bone defect, and response of the tumor to adjuvant treatment. If all the conservative treatments are exhausted and the patient is not eligible for surgery, one of the various percutaneous ablation procedures can be considered. We propose a pelvic analogue to the treatment algorithm in long bone metastasis and a scoring system in pelvic metastasis. This algorithm aims to simplify the teamwork and to avoid under- or overtreatment of pelvic bone metastases.

  7. Surgical Simulator Design and Development

    NARCIS (Netherlands)

    Dankelman, J.


    With the introduction of minimally invasive surgery (MIS), it became necessary to develop training methods to learn skills outside the operating room. Several training simulators have become commercially available, but fundamental research into the requirements for effective and efficient training i

  8. Bone and bone marrow function of reconstructed chest wall after surgical correction of pectus excavatum

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    Watanabe, Yoh; Magara, Tatsuo; Kobayashi, Hiroaki; Ichihashi, Takumi; Hikishima, Hiroshi (Kanazawa Univ. (Japan). School of Medicine)


    Bone and bone marrow functions of the reconstructed chest wall after surgical correction of the funnel chest deformities were evaluated by scanning method. In our series, three kinds of operative procedures were employed; strut method for adult cases, sternal turnover method with and without muscle pedicle for infant cases. Bone function was scanned by sup(99m)Tc-methylene-diphosphonate and bone marrow function was evaluated by sup(99m)Tc-sulfur-colloid. For the cases undergone each surgical procedure, bone and bone marrow scan were done at short term after surgery (within 30 days), at intermediate stage (one month to 12 months), and at long term stage (beyond one year). The results were as follows: By the evaluation at the long term stage of the cases undergoing strut method, bone as well as bone marrow scan visualized normal view of the reconstructed sternum. Regarding the cases undergone sternal turnover method without muscle pedicle, or free graft implantation of the plastron, the bone scan at the long term follow-up stage showed abnormal finding, i.e. hypo-, or defect-visualization of the inverted sternum, in 11.5% of the cases. Furthermore, bone marrow scan showed abnormality in 33.3% of the cases. On the other hand, the cases undergone sternal turnover method with muscle pedicle, in which blood supply to the plastron were preserved by the connection from superior epigastric artery to internal mammary artery, showed no abnormality as far as at the long term follow-up study neither in bone scan nor bone marrow scan. However, in the evaluation at short term after surgery, 50% of the cases undergoing bone scan showed abnormality. In addition, in this stage 85.7% of the bone marrow scan showed abnormal finding. These abnormality, however, normalized within 6 months for bone scan and 12 months for bone marrow scan, in contrast to the results of the cases undergone sternal turnover without pedicle.

  9. Virtual reality simulation in endovascular surgical training.

    LENUS (Irish Health Repository)

    Tsang, J S


    Shortened trainingtimes duetothe European Working Time Directive (EWTD) and increased public scrutiny of surgical competency have led to a move away from the traditional apprenticeship model of training. Virtual reality (VR) simulation is a fascinating innovation allowing surgeons to develop without the need to practice on real patients and it may be a solution to achieve competency within a shortened training period.

  10. A novel surgical procedure for bridging of massive bone defects

    Directory of Open Access Journals (Sweden)

    Springfield Dempsey S


    Full Text Available Abstract Background Bony defects arising from tumor resection or debridement after infection, non-union or trauma present a challenging problem to orthopedic surgeons, as well as patients due to compliance issues. Current treatment options are time intensive, require more than one operation and are associated with high rate of complications. For this reason, we developed a new surgical procedure to bridge a massive long bone defect. Methods To bridge the gap, an in situ periosteal sleeve is elevated circumferentially off of healthy diaphyseal bone adjacent to the bone defect. Then, the adjacent bone is osteotomized and the transport segment is moved along an intramedullary nail, out of the periosteal sleeve and into the original diaphyseal defect, where it is docked. Vascularity is maintained through retention of the soft tissue attachments to the in situ periosteal sleeve. In addition, periosteal osteogenesis can be augmented through utilization of cancellous bone graft or in situ cortical bone adherent to the periosteal sleeve. Results The proposed procedure is novel in that it exploits the osteogenic potential of the periosteum by replacing the defect arising from resection of tissue out of a pathological area with a defect in a healthy area of tissue, through transport of the adjacent bone segment. Furthermore, the proposed procedure has several advantages over the current standard of care including ease of implementation, rapid patient mobilization, and no need for specialized implants (intramedullary nails are standard inventory for surgical oncology and trauma departments or costly orthobiologics. Conclusions The proposed procedure offers a viable and potentially preferable alternative to the current standard treatment modalities, particularly in areas of the world where few surgeons are trained for procedures such as distraction osteogenesis (e.g. the Ilizarov procedure as well as areas of the world where surgeons have little access to

  11. Is bone scintigraphy necessary in the initial surgical staging of chondrosarcoma of bone?

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    Douis, Hassan; James, Steven L.; Davies, Mark A. [Royal Orthopaedic Hospital, Department of Radiology, Birmingham (United Kingdom); Grimer, Robert J. [Royal Orthopaedic Hospital, Department of Orthopaedic Oncology, Birmingham (United Kingdom)


    To assess the value of whole-body bone scintigraphy in the initial surgical staging of chondrosarcoma of bone. A retrospective review was conducted of the bone scintigraphy reports of a large series of patients with peripheral or central chondrosarcoma of bone treated in a specialist orthopaedic oncology unit over a 13-year period. Abnormal findings were correlated against other imaging, histological grade and the impact on surgical staging. A total of 195 chondrosarcomas were identified in 188 patients. In 120 (63.8%) patients the reports of bone scintigraphy noted increased activity at the site of one or more chondrosarcomas. In one patient the tumour was outside the field-of-view of the scan, and in the remaining 67 (35.6%) cases, there was increased activity at the site of the chondrosarcoma and further abnormal activity in other areas of the skeleton. Causes of these additional areas of activity included degenerative joint disease, Paget's disease and in one case a previously undiagnosed melanoma metastasis. No cases of skeletal metastases from the chondrosarcoma were found in this series. Multifocal chondrosarcomas were identified in three cases. In two it was considered that all the tumours would have been adequately revealed on the initial MR imaging staging studies. In only the third multifocal case was an unsuspected, further presumed low-grade, central chondrosarcoma identified in the opposite asymptomatic femur. Although this case revealed an unexpected finding the impact on surgical staging was limited as it was decided to employ a watch-and-wait policy for this tumour. There is little role for the routine use of whole-body bone scintigraphy in the initial surgical staging in patients with chondrosarcoma of bone irrespective of the histological grade. (orig.)

  12. Surgical simulation and evaluation in anterior cruciate ligament reconstruction with image-free navigation

    Institute of Scientific and Technical Information of China (English)

    Wang Tianmiao; Hu Yan; Liu Wenyong; Sun Lei; Wang Junchen; Feng Hua; Hu Lei


    A surgical simulation and evaluation method in the anterior cruciate ligament (ACL) reconstruction with image-free navigation was presented. Firstly, video tracking module, bone surface reconstruction module and virtual simulation module of this system were discussed. Secondly, the coordinate relations of several surgery objects (including surgical instrument, anatomical, camera and screen) in the surgical environment, the tracking based on MicronTracker with two cameras and the bone surface real-time reconstruction based on the Delaunay algorithm were introduced in detail. Finally, experiments of anisometry measurement and virtual simulation on two plastics were carried out to verify the validity of the proposed method. The anisometry value of reconstructed ACL was 8.970039mm. The effectiveness of ACL reconstruction has been proved by preliminary evaluation trials.

  13. Modelling and simulation of acrylic bone cement injection and curing within the framework of vertebroplasty

    CERN Document Server

    Landgraf, Ralf; Kolmeder, Sebastian; Lion, Alexander; Lebsack, Helena; Kober, Cornelia


    The minimal invasive procedure of vertebroplasty is a surgical technique to treat compression fractures of vertebral bodies. During the treatment liquid bone cement gets injected into the affected vertebral body and therein cures to a solid. In order to investigate the treatment and the impact of injected bone cement on the vertebra, an integrated modelling and simulation framework has been developed. The framework includes (i) the generation of computer models based on microCT images of human cancellous bone, (ii) CFD simulations of bone cement injection into the trabecular structure of a vertebral body as well as (iii) non-linear FEM simulations of the bone cement curing. Thereby, microstructural models of trabecular bone structures are employed. Furthermore, a detailed description of the material behaviour of acrylic bone cements is provided. More precisely, a non-linear fluid flow model is chosen for the representation of the bone cement behaviour during injection and a non-linear viscoelastic material mo...


    Directory of Open Access Journals (Sweden)

    S. V. Kostritsky


    Full Text Available The data of 35 kidney cancer patients with metastases in long bones, who had been operated, were retrospectively analyzed. The role of surgery in patients with long bones metastases of kidney cancer was assessed and application of surgical treatment was ascertained to yield satisfactory results in improving the quality of life and duration of life in patients with solitary bone metastases.


    Directory of Open Access Journals (Sweden)

    S. V. Kostritsky


    Full Text Available The data of 35 kidney cancer patients with metastases in long bones, who had been operated, were retrospectively analyzed. The role of surgery in patients with long bones metastases of kidney cancer was assessed and application of surgical treatment was ascertained to yield satisfactory results in improving the quality of life and duration of life in patients with solitary bone metastases.

  16. Three-dimensional virtual reality surgical planning and simulation workbench for orthognathic surgery. (United States)

    Xia, J; Samman, N; Yeung, R W; Shen, S G; Wang, D; Ip, H H; Tideman, H


    A new integrated computer system, the 3-dimensional (3D) virtual reality surgical planning and simulation workbench for orthognathic surgery (VRSP), is presented. Five major functions are implemented in this system: post-processing and reconstruction of computed tomographic (CT) data, transformation of 3D unique coordinate system geometry, generation of 3D color facial soft tissue models, virtual surgical planning and simulation, and presurgical prediction of soft tissue changes. The basic mensuration functions, such as linear and spatial measurements, are also included. The surgical planning and simulation are based on 3D CT reconstructions, whereas soft tissue prediction is based on an individualized, texture-mapped, color facial soft tissue model. The surgeon "enters" the virtual operatory with virtual reality equipment, "holds" a virtual scalpel, and "operates" on a virtual patient to accomplish actual surgical planning, simulation of the surgical procedure, and prediction of soft tissue changes before surgery. As a final result, a quantitative osteotomy-simulated bone model and predicted color facial model with photorealistic quality can be visualized from any arbitrary viewing point in a personal computer system. This system can be installed in any hospital for daily use.

  17. Aneurysmal bone cyst of the mandible managed by conservative surgical therapy with preoperative embolization

    Energy Technology Data Exchange (ETDEWEB)

    An, Seo Young [School of Dentistry, Kyungpook National University, Daegu (Korea, Republic of)


    A 9-year-old girl visited our hospital, complaining of a rapid-growing and rigid swelling on the left posterior mandibular area. Panoramic radiograph showed a moderately defined multilocular honeycomb appearance involving the left mandibular body. CT scan revealed an expansile, multilocular osteolytic lesion and multiple fluid levels within cystic spaces. Bone scan demonstrated increased radiotracer uptake and angiography showed a highly vascularized lesion. The lesion was suspected as aneurysmal bone cyst (ABC) and preoperative embolization was performed, which minimize the extent of operation and the surgical complication. The lesion was treated by surgical curettage and lateral decortication with repositioning. No additional treatment such as a surgical reconstruction or bone graft was needed. Early diagnosis of ABC is very important and appropriate treatment should be performed considering several factors such as age, surgical complication, and possibility of recurrence.

  18. Haptic Feedback for the GPU-based Surgical Simulator

    DEFF Research Database (Denmark)

    Sørensen, Thomas Sangild; Mosegaard, Jesper


    The GPU has proven to be a powerful processor to compute spring-mass based surgical simulations. It has not previously been shown however, how to effectively implement haptic interaction with a simulation running entirely on the GPU. This paper describes a method to calculate haptic feedback...... with limited performance cost. It allows easy balancing of the GPU workload between calculations of simulation, visualisation, and the haptic feedback....

  19. GPU Accelerated Surgical Simulators for Complex Morhpology

    DEFF Research Database (Denmark)

    Mosegaard, Jesper; Sørensen, Thomas Sangild


    a springmass system in order to simulate a complex organ such as the heart. Computations are accelerated by taking advantage of modern graphics processing units (GPUs). Two GPU implementations are presented. They vary in their generality of spring connections and in the speedup factor they achieve...

  20. [Animal experimentation, computer simulation and surgical research]. (United States)

    Carpentier, Alain


    We live in a digital world In medicine, computers are providing new tools for data collection, imaging, and treatment. During research and development of complex technologies and devices such as artificial hearts, computer simulation can provide more reliable information than experimentation on large animals. In these specific settings, animal experimentation should serve more to validate computer models of complex devices than to demonstrate their reliability.

  1. MR imaging findings of painful type II accessory navicular bone: correlation with surgical and pathologic studies

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    Choi, Yun Sun; Lee, Kyung Tai; Kim, Eun Kyung [Eulji Hospital, Eulji University School of Medicine, Daejeon (Korea, Republic of); Kang, Heung Sik [Seoul National University Bundang Hospital, Seoul (Korea, Republic of)


    To evaluate the MR imaging findings of painful type II accessory navicular bone and to correlate these with the surgical and pathologic findings. The MR images of 17 patients with medial foot pain and surgically proven type II accessory navicular abnormalities were reviewed. The changes of signal intensity in the accessory navicular, synchondrosis and adjacent soft tissue, the presence of synchondrosis widening, and posterior tibial tendon (PTT) pathology on the T1-weighted and fat-suppressed T2-weighted images were analyzed. The MR imaging findings were compared with the surgical and pathologic findings. The fat-suppressed T2-weighted images showed high signal intensity in the accessory navicular bones and synchondroses in all patients, and in the soft tissue in 11 (64.7%) of the 17 patients, as well as synchondrosis widening in 3 (17.6%) of the 17 patients. The MR images showed tendon pathology in 12 (75%) of the 16 patients with PTT dysfunction at surgery. The pathologic findings of 16 surgical specimens included areas of osteonecrosis with granulomatous inflammation, fibrosis and destruction of the cartilage cap. The MR imaging findings of painful type II accessory navicular bone are a persistent edema pattern in the accessory navicular bone and within the synchondrosis, indicating osteonecrosis, inflammation and destruction of the cartilage cap. Posterior tibial tendon dysfunction was clinically evident in most patients.

  2. Influence of surgical technique, implant shape and diameter on the primary stability in cancellous bone. (United States)

    Bilhan, H; Geckili, O; Mumcu, E; Bozdag, E; Sünbüloğlu, E; Kutay, O


    Achievement of primary stability during surgical placement of dental implants is one of the most important factors for successful osseointegration depending on various anatomical, surgical and implant-related factors. Resonance frequency analysis (RFA) has been shown as a non-invasive and objective technique for measuring the stability of implants. The aim of this study was to evaluate the effect of some surgical and implant-related factors in enhancing primary stability and to estimate a correlation between RFA and insertion torque (IT) in proximal regions of cow ribs representing cancellous bone. Fifteen implant beds were prepared in the most proximal region of six fresh cow ribs. Ninety implants with three different shapes and two different diameters were placed with two different surgical techniques, and the primary stability was compared using RFA and IT. Significantly higher RFA and IT values were achieved when under-dimensioned drilling was used as the surgical method (Pconical Astra Tech implants showed the highest IT values (Pconical implants with a wide diameter to be placed with the modified surgical technique proposed appear to be useful in enhancing the primary stability in cancellous bone.

  3. The surgical ensemble: choreography as a simulation and training tool. (United States)

    Satava, Richard M; Hunter, Anne Marie


    Team training and interprofessional training have recently emerged as critical new simulations that enhance performance by coordinating communication, leadership, professional, and, to a certain extent, technical skills. In describing these new training tools, the term choreography has been loosely used, but no critical appraisal of the role of the science of choreography has been applied to a surgical procedure. By analogy, the surgical team, including anesthetists, surgeons, nurses, and technicians, constitutes a complete ensemble, whose physical actions and interactions constitute the "performance of surgery." There are very specific "elements" (tools) that are basic to choreography, such as space, timing, rhythm, energy, cues, transitions, and especially rehearsal. This review explores whether such a metaphor is appropriate and the possibility of applying the science of choreography to the surgical team in the operating theater.

  4. Repair process of surgical defects filled with autogenous bone grafts in tibiae of diabetic rats

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    Jônatas Caldeira Esteves


    Full Text Available From a biological standpoint, the best material for reconstruction of bone defects is the autogenous bone graft. However, as tissue healing is affected under diabetic conditions, major changes might take place in the revascularization, incorporation, replacement and remodeling phases of the grafted area. The purpose of this study was to assess the bone healing process in surgical wounds prepared in tibiae of diabetic rats and filled with autogenous bone. Forty male rats (Rattus norvegicus albinus, Wistar were randomly assigned to receive an endovenous injection (penile vein of either citrate buffer solution (Group 1 - control; n=20 or streptozotocin dissolved in citrate buffer solution (35 mg/kg to induce diabetes (Group 2 - diabetic; n=20. After determination of glycemia, the animals were anesthetized and the anterolateral regions of the tibiae of both limbs were shaved, antisepsis was performed and longitudinal incisions were made in each limb. The tibiae were exposed and two 2mm-diameter surgical cavities were prepared: one in the right limb, filled with particulate autogenous bone and the other in the left limb, filled with blood clot. The animals were euthanized at 10 and 30 postoperative days. The anatomic pieces were obtained, submitted to laboratory processing and sections were stained by hematoxylin and eosin and Masson's Trichrome for histomorphologic and histometric analyses. In both groups, the wounds filled with autogenous bone graft showed better results than those filled with blood clot. The control group showed higher new bone formation in wounds filled with autogenous bone graft at 30 days than the diabetic group, but without statistical significance. It may be concluded that, in general, the new bone formation occurred with autogenous graft was quantitatively similar between control and diabetic groups and qualitatively better in the control group.

  5. Particulate bioglass in the regeneration of alveolar bone in dogs: clinical, surgical and radiographic evaluations

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    Alexandre Couto Tsiomis


    Full Text Available Bone loss, either by trauma or other diseases, generates an increasing need for substitutes of this tissue. This study evaluated Bioglass as a bone substitute in the regeneration of the alveolar bone in mandibles of dogs by clinical, surgical and radiological analysis. Twenty-eight adult dogs were randomly separated into two equal groups. In each animal, a bone defect was created on the vestibular surface of the alveolar bone between the roots of the fourth right premolar tooth. In the treated group, the defect was immediately filled with bioglass, while in the control, it remained unfilled. Clinical evaluations were performed daily for a week, as well as x-rays immediately after surgery and at 8, 14, 21, 42, 60, 90 and 120 days post-operative. Most animals in both groups showed no signs of inflammation and wound healing was similar. Radiographic examination revealed a gradual increase of radiopacity in the region of the defect in the control group. In the treated group, initial radiopacity was higher than that of adjacent bone, decreasing until 21 days after surgery. Then it gradually increased until 120 days after surgery, when the defect became undetectable. The results showed that Bioglass integrates into bone tissue, is biocompatible and reduced the period for complete bone regeneration.

  6. Preoperative surgical planning and simulation of complex cranial base tumors in virtual reality

    Institute of Scientific and Technical Information of China (English)

    YI Zhi-qiang; LI Liang; MO Da-peng; ZHANG Jia-yong; ZHANG Yang; BAO Sheng-de


    @@ The extremely complex anatomic relationships among bone,tumor,blood vessels and cranial nerves remains a big challenge for cranial base tumor surgery.Therefore.a good understanding of the patient specific anatomy and a preoperative planning are helpful and crocial for the neurosurgeons.Three dimensional (3-D) visualization of various imaging techniques have been widely explored to enhance the comprehension of volumetric data for surgical planning.1 We used the Destroscope Virtual Reality (VR) System (Singapore,Volume Interaction Pte Ltd,software:RadioDexterTM 1.0) to optimize preoperative plan in the complex cranial base tumors.This system uses patient-specific,coregistered,fused radiology data sets that may be viewed stereoscopically and can be manipulated in a virtual reality environment.This article describes our experience with the Destroscope VR system in preoperative surgical planning and simulation for 5 patients with complex cranial base tumors and evaluates the clinical usefulness of this system.

  7. Late surgical results of reattachment to bone in repair of chronic lateral epicondylitis. (United States)

    Pruzansky, Mark E; Gantsoudes, George D; Watters, Nathan


    All cases of lateral epicondylitis surgically treated in Dr. Pruzansky's office practice between October 1986 and December 2005 yielded 24 elbows for this study. Patients were treated with surgical débridement and direct repair to bone through bone tunnels (18 elbows), repair with suture anchors (3 elbows), or augmentation with autologous tendon graft and reattachment to bone via suture anchors (3 elbows). This series represents the earliest reattachment cases to be reported, and with the longest follow-up. Mean follow-up (both telephone and office interviews) was 64.7 months. All patients reported satisfaction and graded their outcomes as good or excellent. Mean time to full painless preinjury level of use of the elbow was 4.3 months for patients who underwent simple repair and 2.75 months for patients repaired with a graft. Surgical reattachment of the débrided extensor tendon of origin of the elbow to bone, either directly or with autologous tendon graft, provided pain relief and return to preinjury level of function in a predictable manner. Both primary repair and tendon graft procedures can be used in primary and salvage surgeries in tennis elbow cases in which conservative treatment fails.

  8. Adaptive scapula bone remodeling computational simulation: Relevance to regenerative medicine

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    Sharma, Gulshan B., E-mail: [Emory University, Department of Radiology and Imaging Sciences, Spine and Orthopaedic Center, Atlanta, Georgia 30329 (United States); University of Pittsburgh, Swanson School of Engineering, Department of Bioengineering, Pittsburgh, Pennsylvania 15213 (United States); University of Calgary, Schulich School of Engineering, Department of Mechanical and Manufacturing Engineering, Calgary, Alberta T2N 1N4 (Canada); Robertson, Douglas D., E-mail: [Emory University, Department of Radiology and Imaging Sciences, Spine and Orthopaedic Center, Atlanta, Georgia 30329 (United States); University of Pittsburgh, Swanson School of Engineering, Department of Bioengineering, Pittsburgh, Pennsylvania 15213 (United States)


    Shoulder arthroplasty success has been attributed to many factors including, bone quality, soft tissue balancing, surgeon experience, and implant design. Improved long-term success is primarily limited by glenoid implant loosening. Prosthesis design examines materials and shape and determines whether the design should withstand a lifetime of use. Finite element (FE) analyses have been extensively used to study stresses and strains produced in implants and bone. However, these static analyses only measure a moment in time and not the adaptive response to the altered environment produced by the therapeutic intervention. Computational analyses that integrate remodeling rules predict how bone will respond over time. Recent work has shown that subject-specific two- and three dimensional adaptive bone remodeling models are feasible and valid. Feasibility and validation were achieved computationally, simulating bone remodeling using an intact human scapula, initially resetting the scapular bone material properties to be uniform, numerically simulating sequential loading, and comparing the bone remodeling simulation results to the actual scapula’s material properties. Three-dimensional scapula FE bone model was created using volumetric computed tomography images. Muscle and joint load and boundary conditions were applied based on values reported in the literature. Internal bone remodeling was based on element strain-energy density. Initially, all bone elements were assigned a homogeneous density. All loads were applied for 10 iterations. After every iteration, each bone element’s remodeling stimulus was compared to its corresponding reference stimulus and its material properties modified. The simulation achieved convergence. At the end of the simulation the predicted and actual specimen bone apparent density were plotted and compared. Location of high and low predicted bone density was comparable to the actual specimen. High predicted bone density was greater than

  9. Simulation based planning of surgical interventions in pediatric cardiology (United States)

    Marsden, Alison L.


    Hemodynamics plays an essential role in the progression and treatment of cardiovascular disease. However, while medical imaging provides increasingly detailed anatomical information, clinicians often have limited access to hemodynamic data that may be crucial to patient risk assessment and treatment planning. Computational simulations can now provide detailed hemodynamic data to augment clinical knowledge in both adult and pediatric applications. There is a particular need for simulation tools in pediatric cardiology, due to the wide variation in anatomy and physiology in congenital heart disease patients, necessitating individualized treatment plans. Despite great strides in medical imaging, enabling extraction of flow information from magnetic resonance and ultrasound imaging, simulations offer predictive capabilities that imaging alone cannot provide. Patient specific simulations can be used for in silico testing of new surgical designs, treatment planning, device testing, and patient risk stratification. Furthermore, simulations can be performed at no direct risk to the patient. In this paper, we outline the current state of the art in methods for cardiovascular blood flow simulation and virtual surgery. We then step through pressing challenges in the field, including multiscale modeling, boundary condition selection, optimization, and uncertainty quantification. Finally, we summarize simulation results of two representative examples from pediatric cardiology: single ventricle physiology, and coronary aneurysms caused by Kawasaki disease. These examples illustrate the potential impact of computational modeling tools in the clinical setting.

  10. Bone mineral density, Bone mineral contents, MMP-8 and MMP-9 levels in Human Mandible and alveolar bone: Simulated microgravity (United States)

    Rai, Balwant; Kaur, Jasdeep; Catalina, Maria

    Exposure to microgravity has been associated with several physiological changes in astronauts and cosmonauts, including an osteoporosis-like loss of bone mass. It has been reported that head-down tilt bed-rest studies mimic many of the observations seen in flights. There is no study on the correlation on effects of mandibular bone and alveolar bone loss in both sex in simulating microgravity. This study was designed to determine the Bone mineral density and GCF MMP-8 MMP-9 in normal healthy subject of both sexes in simulated microgravity condition of -6 head-down-tilt (HDT) bed rest. The subjects of this investigation were 10 male and 10 female volunteers participated in three weeks 6 HDT bed-rest exposure. The Bone density and bone mineral contents were measured by dual energy X-ray absorptiometry before and in simulated microgravity. The GCF MMP-8 MMP-8 were measured by Enzyme-linked immunosorbent assays (Human Quantikine MMP-8,-9 ELISA kit). The bone mineral density and bone mineral contents levels were significantly decreased in simulated microgravity condition in both genders, although insignificantly loss was higher in females as compared to males. MMP-8 MMP-9 levels were significantly increased in simulated microgravity as compared to normal condition although insignificantly higher in females as compared to males. Further study is required on large samples size including all factors effecting in simulated microgravity and microgravity. Keys words-Simulated microgravity condition, head-down-tilt, Bone loss, MMP-8, MMP-9, Bone density, Bone mineral contents.

  11. Mid- and long-term clinical results of surgical therapy in unicameral bone cysts

    Directory of Open Access Journals (Sweden)

    Hagmann Sébastien


    Full Text Available Abstract Background Unicameral (or simple bone cysts (UBC are benign tumours most often located in long bones of children and adolescents. Pathological fractures are common, and due to high recurrence rates, these lesions remain a challenge to treat. Numerous surgical procedures have been proposed, but there is no general consensus of the ideal treatment. The aim of this investigation therefore was to study the long-term outcome after surgical treatment in UBC. Methods A retrospective analysis of 46 patients surgically treated for UBC was performed for short and mid-term outcome. Clinical and radiological outcome parameters were studied according to a modified Neer classification system. Long-term clinical information was retrieved via a questionnaire at a minimum follow-up of 10 years after surgery. Results Forty-six patients (17 female, 29 male with a mean age of 10.0 ± 4.8 years and with histopathologically confirmed diagnosis of UBC were included. Pathological fractures were observed in 21 cases (46%. All patients underwent surgery for UBC (35 patients underwent curettage and bone grafting as a primary therapy, 4 curettage alone, 3 received corticoid instillation and 4 decompression by cannulated screws. Overall recurrence rate after the first surgical treatment was 39% (18/46, second (17.4% of all patients and third recurrence (4.3% were frequently observed and were addressed by revision surgery. Recurrence was significantly higher in young and in male patients as well as in active cysts. After a mean of 52 months, 40 out of 46 cysts were considered healed. Prognosis was significantly better when recurrence was observed later than 30 months after therapy. After a mean follow-up of 15.5 ± 6.2 years, 40 patients acknowledged clinically excellent results, while five reported mild and casual pain. Only one patient reported a mild limitation of range of motion. Conclusions Our results suggest satisfactory overall long-term outcome for the

  12. Temporomandibular joint disc repositioning using bone anchors: an immediate post surgical evaluation by Magnetic Resonance Imaging

    Directory of Open Access Journals (Sweden)

    Haddad Majd S


    Full Text Available Abstract Background Open joint procedures using bone anchors have shown clinical and radiograph good success, but post surgical disc position has not been documented with MRI imaging. We have designed a modified technique of using two bone anchors and 2 sutures to reposition the articular discs. This MRI study evaluates the post surgical success of this technique to reposition and stabilize the TMJ articular discs. Methods Consecutive 81 patients with unilateral TMJ internal derangement (ID (81 TMJs were treated between December 1, 2003, and December 1, 2006, at the Department of Oral and Maxillofacial Surgery, Ninth Peoples Hospital, Shanghai, Jiao Tong University School of Medicine. All patients were subjected to magnetic resonance imaging before and one to seven days post surgery to determine disc position using the modified bone anchor technique. Results Postoperative MRIs (one to seven days confirm that 77 of 81 joints were identified as excellent results and one joint was considered good for an overall effective rate of 96.3% (78 of 81 joints. Only 3.7% (3 of 81 of the joints were designated as poor results requiring a second open surgery. Conclusions This procedure has provided successful repositioning of the articular discs in unilateral TMJ ID at one to seven days post surgery.

  13. Bone Reduction to Facilitate Immediate Implant Placement and Loading Using CAD/CAM Surgical Guides for Patients With Terminal Dentition. (United States)

    Alzoubi, Fawaz; Massoomi, Nima; Nattestad, Anders


    The aim of this study is to present a method, using 3 computer-aided design/computer-aided manufacturing (CAD/CAM) surgical guides, to accurately obtain the desired bone reduction followed by immediate implant placements and loading for patients diagnosed with terminal dentition. Patients who had bone reduction, implants placed, and immediate loading using Anatomage Invivo 5 CAD/CAM surgical guides between the period 2013 and 2015 were evaluated retrospectively. Patients diagnosed with terminal dentition and treated using the "3-guide technique" were identified. Pre- and postsurgical images were superimposed to evaluate deviations of the bone reduction and deviations at the crest, apex, and angle of implants placed. Twenty-six implants placed in 5 patients were included in this study. The overall deviation means measured for bone reduction was 1.98 mm. The overall deviation means measured for implant placement at the crest, apex, and angle were 1.43 mm, 1.90 mm, and 4.14°, respectively. The CAD/CAM surgical guide fabrication is an emerging tool that may facilitate the surgical process and aid in safe and predictable execution of bone reduction and immediate implant placement. Using 3 CAD/CAM surgical guides, a method is presented to obtain the desired bone reduction followed by immediate implant placement and loading for patients diagnosed with terminal dentition. This method may improve guide stability for patients with terminal dentition undergoing complete implant-supported treatment by taking advantage of the teeth to be extracted.

  14. Three Dimensional Finite Element Analysis of Stress Distribution and Displacement of the Maxilla Following Surgically Assisted Rapid Maxillary Expansion with Tooth- and Bone-Borne Devices

    Directory of Open Access Journals (Sweden)

    Mohsen Dalband


    Full Text Available Objectives: The aim of this study was to investigate the displacement and stress distri- bution during surgically assisted rapid maxillary expansion under different surgical conditions with tooth- and bone-borne devices.Materials and Methods: Three-dimensional (3D finite element model of a maxilla was constructed and an expansion force of 100 N was applied to the left and right molars and premolars with tooth-borne devices and the left and right of mid-palatal sutures at the first molar level with bone-borne devices. Five CAD models were simulated as fol- lows and surgical procedures were used:  G1: control group (without surgery; G2: Le Fort I osteotomy; G3: Le Fort I osteotomy and para-median osteotomy; G4: Le Fort I osteotomy and pterygomaxillary separation; and G5: Le Fort I osteotomy, para-median osteotomy, and pterygomaxillary separation.Results: Maxillary displacement showed a gradual increase from group 1 to group 5 in all three planes of space, indicating that Le Fort I osteotomy combined with para-me- dian osteotomy and pterygomaxillary separation produced the greatest displacement of the maxilla with both bone- and tooth-borne devices. Surgical relief and bone-borne devices resulted in significantly reduced stress on anchored teeth.Conclusion: Combination of Le Fort I and para-median osteotomy with pterygomaxil-lary separation seems to be an effective procedure for increasing maxillary expansion, and excessive stress side effects are lowered around the anchored teeth with the use of bone-borne devices.

  15. Evaluation of haptic interfaces for simulation of drill vibration in virtual temporal bone surgery. (United States)

    Ghasemloonia, Ahmad; Baxandall, Shalese; Zareinia, Kourosh; Lui, Justin T; Dort, Joseph C; Sutherland, Garnette R; Chan, Sonny


    Surgical training is evolving from an observership model towards a new paradigm that includes virtual-reality (VR) simulation. In otolaryngology, temporal bone dissection has become intimately linked with VR simulation as the complexity of anatomy demands a high level of surgeon aptitude and confidence. While an adequate 3D visualization of the surgical site is available in current simulators, the force feedback rendered during haptic interaction does not convey vibrations. This lack of vibration rendering limits the simulation fidelity of a surgical drill such as that used in temporal bone dissection. In order to develop an immersive simulation platform capable of haptic force and vibration feedback, the efficacy of hand controllers for rendering vibration in different drilling circumstances needs to be investigated. In this study, the vibration rendering ability of four different haptic hand controllers were analyzed and compared to find the best commercial haptic hand controller. A test-rig was developed to record vibrations encountered during temporal bone dissection and a software was written to render the recorded signals without adding hardware to the system. An accelerometer mounted on the end-effector of each device recorded the rendered vibration signals. The newly recorded vibration signal was compared with the input signal in both time and frequency domains by coherence and cross correlation analyses to quantitatively measure the fidelity of these devices in terms of rendering vibrotactile drilling feedback in different drilling conditions. This method can be used to assess the vibration rendering ability in VR simulation systems and selection of ideal haptic devices.

  16. The behavior of adaptive bone-remodeling simulation models

    NARCIS (Netherlands)

    H.H. Weinans (Harrie); R. Huiskes (Rik); H.J. Grootenboer


    textabstractThe process of adaptive bone remodeling can be described mathematically and simulated in a computer model, integrated with the finite element method. In the model discussed here, cortical and trabecular bone are described as continuous materials with variable density. The remodeling rule

  17. Simulation-based planning of surgical interventions in pediatric cardiology (United States)

    Marsden, Alison


    Hemodynamics plays an essential role in the progression and treatment of cardiovascular disease. This is particularly true in pediatric cardiology, due to the wide variation in anatomy observed in congenital heart disease patients. While medical imaging provides increasingly detailed anatomical information, clinicians currently have limited knowledge of important fluid mechanical parameters. Treatment decisions are therefore often made using anatomical information alone, despite the known links between fluid mechanics and disease progression. Patient-specific simulations now offer the means to provide this missing information, and, more importantly, to perform in-silico testing of new surgical designs at no risk to the patient. In this talk, we will outline the current state of the art in methods for cardiovascular blood flow simulation and virtual surgery. We will then present new methodology for coupling optimization with simulation and uncertainty quantification to customize treatments for individual patients. Finally, we will present examples in pediatric cardiology that illustrate the potential impact of these tools in the clinical setting.

  18. Simulating Bone Loss in Microgravity Using Mathematical Formulations of Bone Remodeling (United States)

    Pennline, James A.


    Most mathematical models of bone remodeling are used to simulate a specific bone disease, by disrupting the steady state or balance in the normal remodeling process, and to simulate a therapeutic strategy. In this work, the ability of a mathematical model of bone remodeling to simulate bone loss as a function of time under the conditions of microgravity is investigated. The model is formed by combining a previously developed set of biochemical, cellular dynamics, and mechanical stimulus equations in the literature with two newly proposed equations; one governing the rate of change of the area of cortical bone tissue in a cross section of a cylindrical section of bone and one governing the rate of change of calcium in the bone fluid. The mechanical stimulus comes from a simple model of stress due to a compressive force on a cylindrical section of bone which can be reduced to zero to mimic the effects of skeletal unloading in microgravity. The complete set of equations formed is a system of first order ordinary differential equations. The results of selected simulations are displayed and discussed. Limitations and deficiencies of the model are also discussed as well as suggestions for further research.

  19. Realistic tool-tissue interaction models for surgical simulation and planning

    NARCIS (Netherlands)

    Misra, Sarthak


    Surgical simulators present a safe and potentially effective method for surgical training, and can also be used in pre- and intra-operative surgical planning. Realistic modeling of medical interventions involving tool-tissue interactions has been considered to be a key requirement in the development

  20. Clinical Outcomes of Surgical Treatments for Primary Malignant Bone Tumors Arising in the Acetabulum

    Directory of Open Access Journals (Sweden)

    Tomohiro Fujiwara


    Full Text Available The functional and oncologic results of eighteen patients with primary malignant periacetabular tumors were reviewed to determine the impact of surgical treatment. The reconstruction procedures were endoprosthesis (11, hip transposition (4, iliofemoral arthrodesis (2, and frozen bone autograft (1. After a mean follow-up of 62 months, 13 patients were alive and 5 had died of their disease; the 5-year overall survival rate was 67.2%. The corresponding mean MSTS scores of patients with endoprosthesis (11 and other reconstructions (7 were 42% and 55% (49%, 68%, and 50%, respectively. Overall, postoperative complications including deep infection or dislocation markedly worsened the functional outcome. Iliofemoral arthrodesis provided better function than the other procedures, whereas endoprosthetic reconstruction demonstrated poor functional outcome except for patients who were reconstructed with the adequate soft tissue coverage. Avoiding postoperative complications is highly important for achieving better function, suggesting that surgical procedures with adequate soft tissue coverage or without the massive use of nonbiological materials are preferable. Appropriate selection of the reconstructive procedures for individual patients, considering the amount of remaining bone and soft tissues, would lead to better clinical outcomes.

  1. Physics-Based Haptic Simulation of Bone Machining. (United States)

    Arbabtafti, M; Moghaddam, M; Nahvi, A; Mahvash, M; Richardson, B; Shirinzadeh, B


    We present a physics-based training simulator for bone machining. Based on experimental studies, the energy required to remove a unit volume of bone is a constant for every particular bone material. We use this physical principle to obtain the forces required to remove bone material with a milling tool rotating at high speed. The rotating blades of the tool are modeled as a set of small cutting elements. The force of interaction between a cutting element and bone is calculated from the energy required to remove a bone chip with an estimated thickness and known material stiffness. The total force acting on the cutter at a particular instant is obtained by integrating the differential forces over all cutting elements engaged. A voxel representation is used to represent the virtual bone and removed chips for calculating forces of machining. We use voxels that carry bone material properties to represent the volumetric haptic body and to apply underlying physical changes during machining. Experimental results of machining samples of a real bone confirm the force model. A real-time haptic implementation of the method in a dental training simulator is described.

  2. Successful surgical management of osteonecrosis of the jaw due to RANK-ligand inhibitor treatment using fluorescence guided bone resection. (United States)

    Otto, Sven; Baumann, Sebastian; Ehrenfeld, Michael; Pautke, Christoph


    Osteonecrosis of the jaw has recently been described in patients receiving subcutaneous administration of RANKL-inhibitors (denosumab). However, due to promising study results, more patients will receive denosumab in order to avoid skeletal complications due to metastatic bone disease and osteoporosis. Therefore, this has the potential to become a comparable challenge to the bisphosphonate induced jaw necrosis in the area of Oral and Maxillofacial Surgery. Indeed, so far no convincing surgical technique has been described to overcome the non-healing mucosal lesions with exposed bone due to RANKL-inhibitor therapy. In this technical note, we report two successful cases of surgical treatment of jaw-bone necrosis under RANKL-inhibitor treatment using fluorescence guided bone resection. In conclusion, the technique is suggested as treatment option for this entity of osteonecrosis of the jaw.

  3. Adjacent tooth trauma in complicated mandibular third molar surgery: Risk degree classification and digital surgical simulation (United States)

    Ye, Zhou-Xi; Yang, Chi; Ge, Jing


    Analysis of adjacent tooth resistance is essential in wisdom teeth extraction to prevent adjacent tooth trauma, however it lacks adequate attention nowadays. This study aims at suggesting special extraction methods based on adjacent tooth resistance analysis for prevention of adjacent tooth damage. In this study, 136 complicated mandibular third molars extracted using piezosurgery were reviewed and classified based on the adjacent teeth resistances shown in orthopantomogram (OPG) during their mesio-distal rotations: degree I refers to teeth with no adjacent teeth resistance; degree II refers to teeth with resistance released after mesial-half crown sectioning; degree III refers to teeth which still had resistance after mesial-half crown sectioning. With the use of surgical simulations using cone beam computerized tomography (CBCT) reconstruction, all teeth in degree I were designed to rotate mesio-distally; 86.36%(38/44) teeth in degree II were designed to rotate mesio-distally after mesio-half crown sectioning; 69.09%(36/55) teeth in degree III were designed to rotate bucco-lingually. All teeth were extracted successfully, and only one adjacent tooth was subluxated due to the incomplete bone removal. Our study suggested that in order to prevent adjacent teeth trauma, complete bone removal is of importance, and impacted teeth with higher adjacent teeth trauma risks should consider bucco-lingual rotations. PMID:27974819

  4. A Computational Model for Simulating Spaceflight Induced Bone Remodeling (United States)

    Pennline, James A.; Mulugeta, Lealem


    An overview of an initial development of a model of bone loss due to skeletal unloading in weight bearing sites is presented. The skeletal site chosen for the initial application of the model is the femoral neck region because hip fractures can be debilitating to the overall performance health of astronauts. The paper begins with the motivation for developing such a model of the time course of change in bone in order to understand the mechanism of bone demineralization experienced by astronauts in microgravity, to quantify the health risk, and to establish countermeasures. Following this, a general description of a mathematical formulation of the process of bone remodeling is discussed. Equations governing the rate of change of mineralized bone volume fraction and active osteoclast and osteoblast are illustrated. Some of the physiology of bone remodeling, the theory of how imbalance in remodeling can cause bone loss, and how the model attempts to capture this is discussed. The results of a preliminary validation analysis that was carried out are presented. The analysis compares a set of simulation results against bone loss data from control subjects who participated in two different bed rest studies. Finally, the paper concludes with outlining the current limitations and caveats of the model, and planned future work to enhance the state of the model.

  5. Long-term stability of surgical bone regenerative procedures of peri-implantitis lesions in a prospective case-control study over three years



    Abstract Objectives: To evaluate the extent of bone fill over three years following surgical treatment of peri-implantitis with bone grafting with or without a membrane. Material & Methods: In a non-submerged wound healing mode, 15 subjects with 27 implants were treated with a bone substitute (Algipore?) alone, and 17 subjects with 29 implants were treated with the bone substitute and a resorbable membrane (Osseoquest?). Implants with radiographic bone loss ?1.8 mm following the...

  6. The tent pole splint: a bone-supported stereolithographic surgical splint for the soft tissue matrix expansion graft procedure. (United States)

    Cillo, Joseph E; Theodotou, Nicholas; Samuels, Marc; Krajekian, Joseph


    This report details the use of computer-aided planning and intraoperative stereolithographic direct-bone-contact surgical splints for the accurate extraoral placement of dental implants in the soft tissue matrix expansion (tent pole) graft of the severely resorbed mandible.

  7. Surgical repair of central slip avulsion injuries with Mitek bone anchor--retrospective analysis of a case series.

    LENUS (Irish Health Repository)

    Chan, Jeffrey C Y


    The purpose of this study is to describe our technique of central slip repair using the Mitek bone anchor and to evaluate the treatment outcome. Eight digits in eight patients were reconstructed using the bone anchor: three little fingers, two middle fingers, two index fingers and one ring finger. There were two immediate and six delayed repairs (range from one day to eight months). Four patients had pre-operative intensive splinting and physiotherapy to restore passive extension of the proximal interphalangeal joint prior to central slip reconstruction. All patients have made good progress since surgery. No patient requires a second procedure and none of the bone anchors have dislodged or loosened. We conclude that the Mitek bone anchor is a reliable technique to achieve soft tissue to bone fixation in central slip avulsion injuries. We recommend that this technique be considered as a treatment option for patients requiring surgical repair.

  8. Mastering surgical skills through simulation-based learning: Practice makes one perfect

    Directory of Open Access Journals (Sweden)

    Niti Khunger


    Full Text Available Simulation-based learning in surgery is a learning model where an environment similar to real life surgical situation is created for the trainee to learn various surgical skills. It can be used to train a new operator as well to assess his skills. This methodology helps in repetitive practice of surgical skills on nonliving things so that the operator can be near-perfect when operating on a live patient. Various models are available for learning different dermatosurgery skills.

  9. Does Simulated Spaceflight Modify Epigenetic Status During Bone Remodeling? (United States)

    Thomas, Nicholas J.; Stevick, Rebecca J.; Tran, Luan H.; Nalavadi, Mohit O.; Almeida, Eduardo A.C.; Globus, Ruth K.; Alwood, Joshua S.


    Little is known about the effects of spaceflight conditions on epigenetics. The term epigenetics describes changes to the genome that can affect expression of a gene without changes to the sequence of DNA. Epigenetic processes are thought to underlie cellular differentiation, where transcription of specific genes occurs in response to key stimuli, and may be heritable - passing from one cell to its daughter cell. We hypothesize that the mechanical environment during spaceflight, namely microgravity-induced weightlessness or exercise regulate gene expression in the osteoblast-lineage cells both to control bone formation by osteoblasts and bone resorption by osteoclasts, which continually shapes bone structure throughout life. Similarly we intend to evaluate how radiation regulates these same bone cell activity and differentiation related genes. We further hypothesize that the regulation in bone cell gene expression is at least partially controlled through epigenetic mechanisms of methylation or small non-coding RNA (microRNAs). We have acquired preliminary data suggesting that global genome methylation is modified in response to axial compression of the tibia - a model of exercise. We intend to pursue these hypotheses wherein we will evaluate changes in gene expression and, congruently, changes in epigenetic state in bones from mice subjected to the aforementioned conditions: hindlimb unloading to simulate weightlessness, axial compression of the tibia, or radiation exposure in order to gain insight into the role of epigenetics in spaceflight-induced bone loss.

  10. Microsoft Kinect based head tracking for Life Size Collaborative Surgical Simulation Environments (LS-CollaSSLE). (United States)

    Dargar, Saurabh; Nunno, Austin; Sankaranarayanan, Ganesh; De, Suvranu


    Virtual surgical skills trainers are proving to be very useful for the medical training community. With efforts to increase patient safety and surgeon expertise, the need for surgical skills trainers that provide training in an operating room (OR) like condition is now more pressing. To allow for virtual surgery simulators to be instructed in an OR-like setting we have created a large display based immersive surgical simulation environment. Using the Microsoft Kinect we have created a real-time simulation environment that tracks the test user and appropriately adjust the perspective of the virtual OR for an immersive virtual experience.

  11. Notes From the Field: Secondary Task Precision for Cognitive Load Estimation During Virtual Reality Surgical Simulation Training. (United States)

    Rasmussen, Sebastian R; Konge, Lars; Mikkelsen, Peter T; Sørensen, Mads S; Andersen, Steven A W


    Cognitive load (CL) theory suggests that working memory can be overloaded in complex learning tasks such as surgical technical skills training, which can impair learning. Valid and feasible methods for estimating the CL in specific learning contexts are necessary before the efficacy of CL-lowering instructional interventions can be established. This study aims to explore secondary task precision for the estimation of CL in virtual reality (VR) surgical simulation and also investigate the effects of CL-modifying factors such as simulator-integrated tutoring and repeated practice. Twenty-four participants were randomized for visual assistance by a simulator-integrated tutor function during the first 5 of 12 repeated mastoidectomy procedures on a VR temporal bone simulator. Secondary task precision was found to be significantly lower during simulation compared with nonsimulation baseline, p precision. This finding suggests that even though considerable changes in CL are reflected in secondary task precision, it lacks sensitivity. In contrast, secondary task reaction time could be more sensitive, but requires substantial postprocessing of data. Therefore, future studies on the effect of CL modifying interventions should weigh the pros and cons of the various secondary task measurements.

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

    Energy Technology Data Exchange (ETDEWEB)

    Marques, Alexandre Perez; Perrella, Andreia; Arita, Emiko Saito; Pereira, Marlene Fenyo Soeiro de Matos; Cavalcanti, Marcelo de Gusmao Paraiso, E-mail: [Universidade de Sao Paulo (USP), SP (Brazil). Faculdade de Odontologia. Dept. de Estomatologia


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

  13. Fast garment simulation with aid of hybrid bones

    Institute of Scientific and Technical Information of China (English)

    吴博; 陈寅; 徐凯; 程志全; 熊岳山


    A data-driven method was proposed to realistically animate garments on human poses in reduced space. Firstly, a gradient based method was extended to generate motion sequences and garments were simulated on the sequences as our training data. Based on the examples, the proposed method can fast output realistic garments on new poses. Our framework can be mainly divided into offline phase and online phase. During the offline phase, based on linear blend skinning (LBS), rigid bones and flex bones were estimated for human bodies and garments, respectively. Then, rigid bone weight maps on garment vertices were learned from examples. In the online phase, new human poses were treated as input to estimate rigid bone transformations. Then, both rigid bones and flex bones were used to drive garments to fit the new poses. Finally, a novel formulation was also proposed to efficiently deal with garment-body penetration. Experiments manifest that our method is fast and accurate. The intersection artifacts are fast removed and final garment results are quite realistic.

  14. Surgical treatment of zygomatic bone fracture using two points fixation versus three point fixation-a randomised prospective clinical trial



    Abstract Background The zygoma plays an important role in the facial contour for both cosmetic and functional reasons; therefore zygomatic bone injuries should be properly diagnosed and adequately treated. Comparison of various surgical approaches and their complications can only be done objectively using outcome measurements which in turn require protocol management and long-term follow up. The preference for open reduction and internal fixation of zygomatic fractures at three points has con...

  15. Artificial Gravity as a Bone Loss Countermeasure in Simulated Weightlessness (United States)

    Smith, S. M.; Zwart, S. R.; Crawford, G. E.; Gillman, P. L.; LeBlanc, A.; Shackelford, L. C.; Heer, M. A.


    The impact of microgravity on the human body is a significant concern for space travelers. We report here initial results from a pilot study designed to explore the utility of artificial gravity (AG) as a countermeasure to the effects of microgravity, specifically to bone loss. After an initial phase of adaptation and testing, 15 male subjects underwent 21 days of 6 head-down bed rest to simulate the deconditioning associated with space flight. Eight of the subjects underwent 1 h of centrifugation (AG, 1 gz at the heart, 2.5 gz at the feet) each day for 21 days, while 7 of the subjects served as untreated controls (CN). Blood and urine were collected before, during, and after bed rest for bone marker determinations. At this point, preliminary data are available on the first 8 subjects (6 AG, and 2 CN). Comparing the last week of bed rest to before bed rest, urinary excretion of the bone resorption marker n-telopeptide increased 95 plus or minus 59% (mean plus or minus SD) in CN but only 32 plus or minus 26% in the AG group. Similar results were found for another resorption marker, helical peptide (increased 57 plus or minus 0% and 35 plus or minus 13% in CN and AG respectively). Bone-specific alkaline phosphatase, a bone formation marker, did not change during bed rest. At this point, sample analyses are continuing, including calcium tracer kinetic studies. These initial data demonstrate the potential effectiveness of short-radius, intermittent AG as a countermeasure to the bone deconditioning that occurs during bed rest.

  16. Importance of bone scintigraphy in children from a surgical and orthopedic point of view

    Energy Technology Data Exchange (ETDEWEB)

    Martinez, A.D.; Carro, G.A.

    Sixty children with Legg-Perthes disease (19), bone tumor (27), osteogenesis imperfecta (7), osteomyelitis (5) and transient synovitis (2) were studied using sup(99m)Tc labeled diphosphonate. A number of benign or malign bone diseases of children need early detection in order to institute the best form - the fine form - of treatment. We recommend the bone scintigraphy in the initial screening of children with signs and symptoms of bone pathology.

  17. Topology modification for surgical simulation using precomputed finite element models based on linear elasticity. (United States)

    Lee, Bryan; Popescu, Dan C; Ourselin, Sébastien


    Surgical simulators provide another tool for training and practising surgical procedures, usually restricted to the use of cadavers. Our surgical simulator utilises Finite Element (FE) models based on linear elasticity. It is driven by displacements, as opposed to forces, allowing for realistic simulation of both deformation and haptic response at real-time rates. To achieve demanding computational requirements, the stiffness matrix K, which encompasses the geometrical and physical properties of the object, is precomputed, along with K⁻¹. Common to many surgical procedures is the requirement of cutting tissue. Introducing topology modifications, such as cutting, into these precomputed schemes does however come as a challenge, as the precomputed data needs to be modified, to reflect the new topology. In particular, recomputing K⁻¹ is too costly to be performed during the simulation. Our topology modification method is based upon updating K⁻¹ rather than entirely recomputing the matrix. By integrating condensation, we improve efficiency to allow for interaction with larger models. We can further enhance this by redistributing computational load to improve the system's real-time response. We exemplify our techniques with results from our surgical simulation system.

  18. Bone mineral content reduction in youth with surgical form of Schistosomiasis mansoni: factors involved in the pathogenesis

    Directory of Open Access Journals (Sweden)

    Brandt Carlos Teixeira


    Full Text Available Thirty two children and adolescents from 14 to 20 years of age, suffering from hepatosplenic schistosomiasis mansoni and bleeding esophageal varicose veins, were evaluated for bone mineral density (BMD, before undergoing medical and surgical treatment. The surgical protocol was splenectomy, autoimplantation of spleen tissue into a pouch of the major omentum and ligature of the left gastric vein. Follow up of these patients? ranges from one to ten years with a mean of five years. The BMD was measured at the lumbar spine (L2 - L4 through the dual energy absorptionmetry X-ray (DEXA, using a LUNAR DPX-L densitometer. The degree of Symmers´ fibrosis was assessed by semiautomatic hystomorphometry. In eleven patients, the serum magnesium was measured before an intravenous overload of this ion and subsequently after eight and twenty four hours. Urine was collected 24 hours before and 24 hours after the magnesium overload. Deficiency of magnesium was considered when the uptake of this ion was greater than 40%. There was a significant trend of association between the status of bone mineral content and the Symmers´ fibrosis degree (c² = 6.606 R = 0.01017. There was also a moderate agreement between the greater fibrosis densities ( > the mean percentage and bone mineral deficits. Although the normal bone mineral content was more found among the patients with better hepatic functional reserve, the results did not reach statistical significance. There was a marked magnesium retention (>95% in one patient who had severe osteoporosis and a slight depletion (<5% in another patient, who presented no bone mineral deficit. It was concluded that the patients included in this series, showed an important BMD deficit, specially among the females which has had a significant improvement after medical and surgical treatment. Bone mineral deficit was associated with the degree of Symmers´ fibrosis. Magnesium depletion was present in two out of eleven patients. It is

  19. Foot bone kinematics as measured in a cadaveric robotic gait simulator. (United States)

    Whittaker, Eric C; Aubin, Patrick M; Ledoux, William R


    The bony motion of the foot during the stance phase of gait is useful to further our understanding of joint function, disease etiology, injury prevention and surgical intervention. In this study, we used a 10-segment in vitro foot model with anatomical coordinate systems and a robotic gait simulator (RGS) to measure the kinematics of the tibia, talus, calcaneus, cuboid, navicular, medial cuneiform, first metatarsal, hallux, third metatarsal, and fifth metatarsal from six cadaveric feet. The RGS accurately reproduced in vivo vertical ground reaction force (5.9% body weight RMS error) and tibia to ground kinematics. The kinematic data from the foot model generally agree with invasive in vivo descriptions of bony motion and provides the most realistic description of bony motion currently available for an in vitro model. These data help to clarify the function of several joints that are difficult to study in vivo; for example, the combined range of motion of the talonavicular, naviculocuneiform, metatarsocuneiform joints provided more sagittal plane mobility (27.4°) than the talotibial joint alone (23.2°). Additionally, the anatomical coordinate systems made it easier to meaningfully determine bone-to-bone motion, describing uniplanar motion as rotation about a single axis rather than about three. The data provided in this study allow for many kinematic interpretations to be made about dynamic foot bone motion, and the methodology presents a means to explore many invasive foot biomechanics questions under near-physiologic conditions.

  20. Stiffness matrix representation of hyper-elasticity for surgical simulation and navigation. (United States)

    Nishiyama, Shuhei; Kuroda, Yoshihiro; Takemura, Haruo


    Nowadays, physics-based simulation plays an important role in industries and clinical fields thanks to the outstanding progress of computer technologies and numerical simulation. One of the demands for the applied technology of physics-based simulation, is the surgical simulation of organ tissue not only for surgical training but also for intra-operative navigation. Although linear Finite Element Method (FEM) is capable of real-time simulation, the conventional FEM analysis does not satisfy the accuracy of non-linear response and interactivity at the same time. The aim of this study is to establish the surgical simulation and navigation to consider hyper-elasticity (HE), which represents the organ's non-linear response material better than the conventional linear material. In this paper, we propose a novel method to decompose the stress-strain relationship of HE, and construct the stiffness matrix for real-time and interactive simulation by extending the linear FEM, which is capable of efficient simulation. The experimental results showed that the proposed method is able to simulate non-linear FEM deformation accurately almost equivalent to the existing non-linear FEM analysis by shorter calculation time. In addition, the deformation with the kidney model was demonstrated.

  1. Computer-simulated bone architecture in a simple bone-remodeling model based on a reaction-diffusion system. (United States)

    Tezuka, Ken-ichi; Wada, Yoshitaka; Takahashi, Akiyuki; Kikuchi, Masanori


    Bone is a complex system with functions including those of adaptation and repair. To understand how bone cells can create a structure adapted to the mechanical environment, we propose a simple bone remodeling model based on a reaction-diffusion system influenced by mechanical stress. Two-dimensional bone models were created and subjected to mechanical loads. The conventional finite element method (FEM) was used to calculate stress distribution. A stress-reactive reaction-diffusion model was constructed and used to simulate bone remodeling under mechanical loads. When an external mechanical stress was applied, stimulated bone formation and subsequent activation of bone resorption produced an efficient adaptation of the internal shape of the model bone to a given stress, and demonstrated major structures of trabecular bone seen in the human femoral neck. The degree of adaptation could be controlled by modulating the diffusion constants of hypothetical local factors. We also tried to demonstrate the deformation of bone structure during osteoporosis by the modulation of a parameter affecting the balance between formation and resorption. This simple model gives us an insight into how bone cells can create an architecture adapted to environmental stress, and will serve as a useful tool to understand both physiological and pathological states of bone based on structural information.

  2. 3D tracking of surgical instruments using a single camera for laparoscopic surgery simulation. (United States)

    Shin, Sangkyun; Kim, Youngjun; Kwak, Hyunsoo; Lee, Deukhee; Park, Sehyung


    Most laparoscopic surgery simulation systems are expensive and complex. To overcome these problems, this study presents a novel three-dimensional tracking method for laparoscopic surgical instruments that uses only a single camera and fiducial markers. The proposed method does not require any mechanical parts to measure the three-dimensional positions/orientations of surgical instruments and the opening angle of graspers. We implemented simple and cost-effective hardware using the proposed method and successfully combined it with virtual simulation software for laparoscopic surgery.

  3. Surgical simulation: where have we come from? Where are we now? Where are we going? (United States)

    Munro, Malcolm G


    It is now clear to most stakeholders that acquisition of surgical psychomotor skills is best achieved outside of the clinical operating room, in the context of a simulated environment. Endoscopic simulation can be accomplished using simple "box" simulators or video trainers, and virtual reality simulation is now possible using microprocessor-controlled systems. Structured surgical training performed outside of the operating room environment is relatively new to health care, a circumstance different from the process of pilot training, in which simulation has been a mainstay for more than 75 years and in which virtual reality simulation is now the norm. Those charged with surgical education are faced with a dilemma as, while attempting to understand the basic goals of simulation, they are simultaneously faced with choice between relatively inexpensive video trainers and the often prohibitively expensive virtual reality systems. This article explores the history of simulation, reports the results of a modified systematic review of currently available systems and performance, and identifies the gaps in current research and development. It is apparent that available video trainers provide the opportunity for skill development that at present is not surpassed by virtual reality systems. In the future, there will likely be an increasing role for virtual reality; however, challenges remain that include determination of the appropriate metrics and system design, and the fiscal resources necessary for the required hardware and related software development.

  4. [Objective surgery -- advanced robotic devices and simulators used for surgical skill assessment]. (United States)

    Suhánszki, Norbert; Haidegger, Tamás


    Robotic assistance became a leading trend in minimally invasive surgery, which is based on the global success of laparoscopic surgery. Manual laparoscopy requires advanced skills and capabilities, which is acquired through tedious learning procedure, while da Vinci type surgical systems offer intuitive control and advanced ergonomics. Nevertheless, in either case, the key issue is to be able to assess objectively the surgeons' skills and capabilities. Robotic devices offer radically new way to collect data during surgical procedures, opening the space for new ways of skill parameterization. This may be revolutionary in MIS training, given the new and objective surgical curriculum and examination methods. The article reviews currently developed skill assessment techniques for robotic surgery and simulators, thoroughly inspecting their validation procedure and utility. In the coming years, these methods will become the mainstream of Western surgical education.

  5. Bed capacity and surgical waiting lists: a simulation analysis

    Directory of Open Access Journals (Sweden)

    Manel Antelo


    Full Text Available Waiting time for elective surgery is a key problem in the current medical world. This paper aims to reproduce, by a Monte Carlo simulation model, the relationship between hospital capacity, inpatient activity, and surgery waiting list size in teaching hospitals. Inpatient activity is simulated by fitting a Normal distribution to real inpatient activity data, and the effect of the number of beds on inpatient activity is modelled with a linear regression model. Analysis is performed with data of the University Multi-Hospital Complex of Santiago de Compostela (Santiago de Compostela, Spain, by considering two scenarios regarding the elastiticity of demand with bed increase. If demand does not grow with an increase on bed capacity, small changes lead to drastic reductions in the waiting lists. However, if demand grows as bed capacity does, adding additional capacity merely makes waiting lists worse.

  6. New simulation model for bone formation markers in osteoporosis patients treated with once-weekly teriparatide

    Institute of Scientific and Technical Information of China (English)

    Sakae Tanaka; Taiji Adachi; Tatsuhiko Kuroda; Toshitaka Nakamura; Masataka Shiraki; Toshitsugu Sugimoto; Yasuhiro Takeuchi; Mitsuru Saito; John P Bilezikian


    Daily 20-mg and once-weekly 56.5-mg teriparatide (parathyroid hormone 1–34) treatment regimens increase bone mineral density (BMD) and prevent fractures, but changes in bone turnover markers differ between the two regimens. The aim of the present study was to explain changes in bone turnover markers using once-weekly teriparatide with a simulation model. Temporary increases in bone formation markers and subsequent decreases were observed during once-weekly teriparatide treatment for 72 weeks. These observations support the hypothesis that repeated weekly teriparatide administration stimulates bone remodeling, replacing old bone with new bone and leading to a reduction in the active remodeling surface. A simulation model was developed based on the iterative remodeling cycle that occurs on residual old bone. An increase in bone formation and a subsequent decrease were observed in the preliminary simulation. For each fitted time point, the predicted value was compared to the absolute values of the bone formation and resorption markers and lumbar BMD. The simulation model strongly matched actual changes in bone turnover markers and BMD. This simulation model indicates increased bone formation marker levels in the early stage and a subsequent decrease. It is therefore concluded that remodeling-based bone formation persisted during the entire treatment period with once-weekly teriparatide.

  7. Effect of biphasic calcium phosphate nanocomposite on healing of surgically created alveolar bone defects in beagle dogs (United States)

    Wang, Lanlei; Guan, Aizhong; Shi, Han; Chen, Yangxi; Liao, Yunmao


    The aim of the present study was to investigate the effect of porous biphasic calcium phosphate nanocomposite (nanoBCP) scaffolds bioceramic. Alveolar bone defects were surgically created bilaterally at the buccal aspects of the upper second premolar in fourteen beagle dogs. After root conditioning with ethylenediaminetetraacetate (EDTA), nanoBCP was randomly filled in the defects and nothing was put into the contralaterals as controls. Dogs were killed at the 12th weeks. Histological observations were processed through a light microscopy. The results revealed that a great amount of functional periodontal fissures formed in the defects in the nanoBCP groups while minimal bone took shape in the controls. In this study, nanoBCP has proved to work well as a biocompatible and osteoconductive scaffold material to promote periodontal regeneration effectively.

  8. Preserving the socket dimensions with bone grafting in single sites: an esthetic surgical approach when planning delayed implant placement. (United States)

    Irinakis, Tassos; Tabesh, Moe


    Recent advancements in barrier membranes, bone grafting substitutes, and surgical techniques have led to a predictable arsenal of treatment methods for clinicians who practice implant dentistry. The contemporary clinician is supplied with proven knowledge, substantiated materials, and instrument inventory that allows implant placement in cases that used to be reserved for the specialist in the past because of their complexity. Nowadays, postextraction alveolar ridge maintenance can be a predictable procedure and can certainly aid the clinician in preventing ridge collapse, thereby allowing for implant placement in a position that satisfies esthetics and function. Extraction socket maintenance for future implant therapy does not rule out immediate implant placement but rather provides an additional option when treatment planning implant patients. This article will focus on the concept of extraction socket preservation using regenerative materials. It will describe a technique suggested by the authors to resist bone resorption and soft tissue shrinkage following tooth extraction.

  9. Implementation of simulation in surgical practice: minimally invasive surgery has taken the lead: the Dutch experience. (United States)

    Schreuder, Henk W R; Oei, Guid; Maas, Mario; Borleffs, Jan C C; Schijven, Marlies P


    Minimal invasive techniques are rapidly becoming standard surgical techniques for many surgical procedures. To develop the skills necessary to apply these techniques, box trainers and/or inanimate models may be used, but these trainers lack the possibility of inherent objective classification of results. In the past decade, virtual reality (VR) trainers were introduced for training minimal invasive techniques. Minimally invasive surgery (MIS) is, by nature, very suitable for this type of training. The specific psychomotor skills and eye-hand coordination needed for MIS can be mastered largely using VR simulation techniques. It is also possible to transfer skills learned on a simulator to real operations, resulting in error reduction and shortening of procedural operating time. The authors aim to enlighten the process of gaining acceptance in the Netherlands for novel training techniques. The Dutch Societies of Surgery, Obstetrics and Gynecology, and Urology each developed individual training curricula for MIS using simulation techniques, to be implemented in daily practice. The ultimate goal is to improve patient safety. The authors outline the opinions of actors involved, such as different simulators, surgical trainees, surgeons, surgical societies, hospital boards, government, and the public. The actual implementation of nationwide training curricula for MIS is, however, a challenging step.

  10. Computer-assisted three-dimensional surgical planning and simulation: 3D virtual osteotomy. (United States)

    Xia, J; Ip, H H; Samman, N; Wang, D; Kot, C S; Yeung, R W; Tideman, H


    A computer-assisted three-dimensional virtual osteotomy system for orthognathic surgery (CAVOS) is presented. The virtual reality workbench is used for surgical planning. The surgeon immerses in a virtual reality environment with stereo eyewear, holds a virtual "scalpel" (3D Mouse) and operates on a "real" patient (3D visualization) to obtain pre-surgical prediction (3D bony segment movements). Virtual surgery on a computer-generated 3D head model is simulated and can be visualized from any arbitrary viewing point in a personal computer system.

  11. Large-scale microstructural simulation of load-adaptive bone remodeling in whole human vertebrae

    NARCIS (Netherlands)

    Badilatti, Sandro D.; Christen, Patrik; Levchuk, Alina; Hazrati Marangalou, Javad; Rietbergen, van Bert; Parkinson, Ian; Müller, Ralph


    Identification of individuals at risk of bone fractures remains challenging despite recent advances in bone strength assessment. In particular, the future degradation of the microstructure and load adaptation has been disregarded. Bone remodeling simulations have so far been restricted to small-volu

  12. The effects of simulated hypogravity on murine bone marrow cells (United States)

    Lawless, Desales


    Mouse bone marrow cells grown in complete medium at unit gravity were compared with a similar population cultured in conditions that mimic some aspects of microgravity. After the cells adjusted to the conditions that simulated microgravity, they proliferated as fetal or oncogenic populations; their numbers doubled in twelve hour periods. Differentiated subpopulations were depleted from the heterogeneous mixture with time and the undifferentiated hematopoietic stem cells increased in numbers. The cells in the control groups in unit gravity and those in the bioreactors in conditions of microgravity were monitored under a number of parameters. Each were phenotyped as to cell surface antigens using a panel of monoclonal antibodies and flow cytometry. Other parameters compared included: pH, glucose uptake, oxygen consumption and carbon-dioxide production. Nuclear DNA was monitored by flow cytometry. Functional responses were studied by mitogenic stimulation by various lectins. The importance of these findings should have relevance to the space program. Cells should behave predictably in zero gravity; specific populations can be eliminated from diverse populations and other populations isolated. The availability of stem cell populations will enhance both bone marrow and gene transplant programs. Stem cells will permit developmental biologists study the paths of hematopoiesis.

  13. Computational simulation of bone fracture healing under inverse dynamisation. (United States)

    Wilson, Cameron J; Schütz, Michael A; Epari, Devakara R


    Adaptive finite element models have allowed researchers to test hypothetical relationships between the local mechanical environment and the healing of bone fractures. However, their predictive power has not yet been demonstrated by testing hypotheses ahead of experimental testing. In this study, an established mechano-biological scheme was used in an iterative finite element simulation of sheep tibial osteotomy healing under a hypothetical fixation regime, "inverse dynamisation". Tissue distributions, interfragmentary movement and stiffness across the fracture site were compared between stiff and flexible fixation conditions and scenarios in which fixation stiffness was increased at a discrete time-point. The modelling work was conducted blind to the experimental study to be published subsequently. The simulations predicted the fastest and most direct healing under constant stiff fixation, and the slowest healing under flexible fixation. Although low fixation stiffness promoted more callus formation prior to bridging, this conferred little additional stiffness to the fracture in the first 5 weeks. Thus, while switching to stiffer fixation facilitated rapid subsequent bridging of the fracture, no advantage of inverse dynamisation could be demonstrated. In vivo data remains necessary to conclusively test this treatment protocol and this will, in turn, provide an evaluation of the model's performance. The publication of both hypotheses and their computational simulation, prior to experimental testing, offers an appealing means to test the predictive power of mechano-biological models.

  14. Evaluation of opening pattern and bone neoformation at median palatal suture area in patients submitted to surgically assisted rapid maxillary expansion (SARME through cone beam computed tomography

    Directory of Open Access Journals (Sweden)

    Daniel Gomes SALGUEIRO


    Full Text Available AbstractSurgically assisted rapid maxillary expansion (SARME is the treatment of choice to adult patients even with severe transversal maxillary discrepancies. However, the adequate retention period to achieve the bone remodeling, thus assuring treatment stability, is controversial.Objective To evaluate the opening pattern and bone neoformation process at the midpalatal suture in patients submitted to surgically assisted (SARME through cone beam computed tomography (CBCT.Material and Methods Fourteen patients were submitted to SARME through subtotal Le Fort I osteotomy. Both the opening pattern and the mean bone density at midpalatal suture area to evaluate bone formation were assessed pre- and post-operatively (15, 60 and 180 days through CBCT.Results Type I opening pattern (from anterior to posterior nasal spine occurred in 12 subjects while type II opening pattern (from anterior nasal spine to transverse palatine suture occurred in 2 individuals. The 180-day postoperative mean (PO 180 of bone density value was 49.9% of the preoperative mean (Pre value.Conclusions The opening pattern of midpalatal suture is more related to patients’ age (23.9 years in type I and 33.5 years in type II and surgical technique. It was not possible to observe complete bone formation at midpalatal suture area at the ending of the retention period studied (180 days.

  15. Simulation of Surgical Cutting in Deformable Bodies using a Game Engine

    DEFF Research Database (Denmark)

    Jørgensen, Martin Kibsgaard; Kronborg Thomsen, Kasper; Kraus, Martin


    Simulators as a training tool for surgeons are becoming more important with the increase of minimally invasive surgery and a wish to limit training on animals, especially in the field of robotic surgery. Accessibility to surgery simulators is currently limited and the ability to cut is restricted...... are implemented using a spring mass model combined with a volumetric tetrahedral mesh. The cutting algorithm is semi-progressive and allows for arbitrary cuts in the deformable objects. The prototype was evaluated by a chief surgeon with expertise in robot surgery and experience with commercial simulators....... The low-cost prototype presents a step towards robotic surgery simulators that are able to simulate complete surgical procedures.)...

  16. Validation study of a computer-based open surgical trainer: SimPraxis® simulation platform

    Directory of Open Access Journals (Sweden)

    Tran LN


    Full Text Available Linh N Tran,1 Priyanka Gupta,2 Lauren H Poniatowski,2 Shaheen Alanee,3 Marc A Dall’Era,4 Robert M Sweet21Department of Internal Medicine, Loma Linda University, Loma Linda, CA, 2Department of Urology, University of Minnesota, Minneapolis, MN, 3Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, 4Department of Urology, University of California, Davis, CA, USABackground: Technological advances have dramatically changed medical education, particularly in the era of work-hour restrictions, which increasingly highlights a need for novel methods to teach surgical skills. The purpose of this study was to evaluate the validity of a novel, computer-based, interactive, cognitive simulator for training surgeons to perform pelvic lymph node dissection (PLND.Methods: Eight prostate cancer experts evaluated the content of the simulator. Contextual aspects of the simulator were rated on a five-point Likert scale. The experts and nine first-year residents completed a simulated PLND. Time and deviations were logged, and the results were compared between experts and novices using the Mann–Whitney test.Results: Before training, 88% of the experts felt that a validated simulator would be useful for PLND training. After testing, 100% of the experts felt that it would be more useful than standard video training. Eighty-eight percent stated that they would like to see the simulator in the curriculum of residency programs and 56% thought it would be useful for accreditation purposes. The experts felt that the simulator aided in overall understanding, training indications, concepts and steps of the procedure, training how to use an assistant, and enhanced the knowledge of anatomy. Median performance times taken by experts and interns to complete a PLND procedure on the simulator were 12.62 and 23.97 minutes, respectively. Median deviation from the incorporated procedure pathway for experts was 24.5 and was 89 for novices

  17. Bone loss during simulated weightlessness - Is it glucocorticoid mediated? (United States)

    Bikle, D. D.; Halloran, B. P.; Cone, C. M.; Morey-Holton, E.


    Elevating the hindquarters of a rat by the tail unweights the hind limbs but maintains normal weight-bearing by the forelimbs. This maneuver leads to a decrease in bone mass and calcium content in the unweighted bones (e.g., tibia and L1 vertebra), but not in the normally weighted bones (e.g., humerus and mandible). Potentially, the stress of the maneuver, mediated by increased glucocorticoid production and secretion, could explain the decreased bone formation, rather than the skeletal unweighting per se. To test this possibility, the effects of adrenalectomy on the response of bone to the unweighting of the hind limbs of normal rats were evaluated.

  18. A framework-based approach to designing simulation-augmented surgical education and training programs. (United States)

    Cristancho, Sayra M; Moussa, Fuad; Dubrowski, Adam


    The goal of simulation-based medical education and training is to help trainees acquire and refine the technical and cognitive skills necessary to perform clinical procedures. When designers incorporate simulation into programs, their efforts should be in line with training needs, rather than technology. Designers of simulation-augmented surgical training programs, however, face particular problems related to identifying a framework that guides the curricular design activity to fulfill the particular requirements of such training programs. These problems include the lack of (1) an objective identification of training needs, (2) a systematic design methodology to match training objectives with simulation resources, (3) structured assessments of performance, and (4) a research-centered view to evaluate and validate systematically the educational effectiveness of the program. In this report, we present a process called "Aim - FineTune - FollowThrough" to enable the connection of the identified problems to solutions, using frameworks from psychology, motor learning, education and experimental design.

  19. Surgical treatment of zygomatic bone fracture using two points fixation versus three point fixation-a randomised prospective clinical trial

    Directory of Open Access Journals (Sweden)

    Rana Majeed


    Full Text Available Abstract Background The zygoma plays an important role in the facial contour for both cosmetic and functional reasons; therefore zygomatic bone injuries should be properly diagnosed and adequately treated. Comparison of various surgical approaches and their complications can only be done objectively using outcome measurements which in turn require protocol management and long-term follow up. The preference for open reduction and internal fixation of zygomatic fractures at three points has continued to grow in response to observations of inadequate results from two point and one point fixation techniques. The objectives of this study were to compare the efficacy of zygomatic bone after treatment with ORIF using 2 point fixation and ORIF using 3 point fixation and compare the outcome of two procedures. Methods 100 patients were randomly divided equally into two groups. In group A, 50 patients were treated by ORIF using two point fixation by miniplates and in group B, 50 patients were treated by ORIF using three point fixation by miniplates. They were evaluated for their complications during and after surgery with their advantages and disadvantages and the difference between the two groups was observed. Results A total of 100 fractures were sustained. We found that postoperative complication like decreased malar height and vertical dystopia was more common in those patients who were treated by two point fixation than those who were treated with three point fixation. Conclusions Based on this study open reduction and internal fixation using three point fixation by miniplates is the best available method for the treatment zygomatic bone fractures.

  20. Effect of surgical drill guide and irrigans temperature on thermal bone changes during drilling implant sites - thermographic analysis on bovine ribs

    Directory of Open Access Journals (Sweden)

    Marković Aleksa


    Full Text Available Background/Aim. During drilling implant sites, mechanical energy is converted into thermal one resulting in transient rise in temperature of surrounding bone. The temperature of 47°C exeeding one minute impairs osseointegration, compromises mechanical properties of the local bone and could cause early implant failure. This in vitro study aimed to assess the effect of surgical drill guide and temperature of irrigans on thermal changes of the local bone during drilling implant sites, and to test the influence of irrigans temperature on the temperature of surgical drill guide. Methods. A total of 48 specimens obtained from bovine ribs were randomly allocated to four experimental conditions according to the 2 x 2 factorial design: drill guide (with or without and saline (at 25°C or 5°C. Real-time infrared thermography was used as a method for temperature measurement. The primary outcome was bone temperature change during drilling implant sites measured at 3 osteotomy depths, whereas the second one was change in the temperature of the drill guide. Data were analyzed by Brunner and Langer nonparametric analysis and Wilcoxon test. Results. The effect of drill guide on the changes of bone temperature was significant at the entrance of osteotomy, whereas the effect of saline temperature was significant at all osteotomy levels (p 0.05. Guided surgery and irrigation with saline at 25°C were associated with the highest bone temperature increase. Increase in drill guide temperature was significantly higher when saline at 25°C was used (p < 0.001. Conclusion. Guided implant site preparation generates higher temperature of the local bone than conventional drilling, not exceeding the threshold for thermal bone necrosis. Although saline at room temperature provides sufficient heat control during drilling, cooled saline is more effective regardless the use of surgical drill guide.

  1. Simulation of carbon dioxide insufflation via a diffuser in an open surgical wound model. (United States)

    Cater, John E; van der Linden, Jan


    Flow within a model surgical opening during insufflation with heated carbon dioxide was studied using computational fluid dynamics. A volume of fluid method was used to simulate the mixture of ambient air and carbon dioxide gas. The negative buoyancy of the carbon dioxide caused it to fill the wound and form a protective layer on the internal surfaces for a range of flow rates, temperatures, and angles of patient inclination. It was observed that the flow remained attached to the surface of the model due to the action of the Coanda effect. A flow rate of 10 L/min was sufficient to maintain a warm carbon dioxide barrier for a moderately sized surgical incision for all likely angles of inclination.

  2. Mixed reality orthognathic surgical simulation by entity model manipulation and 3D-image display (United States)

    Shimonagayoshi, Tatsunari; Aoki, Yoshimitsu; Fushima, Kenji; Kobayashi, Masaru


    In orthognathic surgery, the framing of 3D-surgical planning that considers the balance between the front and back positions and the symmetry of the jawbone, as well as the dental occlusion of teeth, is essential. In this study, a support system for orthodontic surgery to visualize the changes in the mandible and the occlusal condition and to determine the optimum position in mandibular osteotomy has been developed. By integrating the operating portion of a tooth model that is to determine the optimum occlusal position by manipulating the entity tooth model and the 3D-CT skeletal images (3D image display portion) that are simultaneously displayed in real-time, the determination of the mandibular position and posture in which the improvement of skeletal morphology and occlusal condition is considered, is possible. The realistic operation of the entity model and the virtual 3D image display enabled the construction of a surgical simulation system that involves augmented reality.

  3. Does computer-aided surgical simulation improve efficiency in bimaxillary orthognathic surgery? (United States)

    Schwartz, H C


    The purpose of this study was to compare the efficiency of bimaxillary orthognathic surgery using computer-aided surgical simulation (CASS), with cases planned using traditional methods. Total doctor time was used to measure efficiency. While costs vary widely in different localities and in different health schemes, time is a valuable and limited resource everywhere. For this reason, total doctor time is a more useful measure of efficiency than is cost. Even though we use CASS primarily for planning more complex cases at the present time, this study showed an average saving of 60min for each case. In the context of a department that performs 200 bimaxillary cases each year, this would represent a saving of 25 days of doctor time, if applied to every case. It is concluded that CASS offers great potential for improving efficiency when used in the planning of bimaxillary orthognathic surgery. It saves significant doctor time that can be applied to additional surgical work.


    Directory of Open Access Journals (Sweden)

    Arun Kumar


    Full Text Available BACKGROUND Among the various methods of treating the long bone fractures in children less than 5yrs (POP cast and adolescents 16yrs (IMN, flexible intramedullary nail has gained importance because of its stability, not violating the physis and less complications and early rehabilitation. Irrespective of mode of treatment, goal shall be to achieve union at fracture site, control length and alignment, minimize the morbidity and complications for patient and their family. MATERIALS AND METHODS A prospective study was conducted on children of both sexes, between the age group of 5-15yrs with diaphyseal fractures of long bones, meeting the inclusion and exclusion criteria during the study period at RRMCH (September 2012 to September 2014. Totally, 30 cases were evaluated clinically and radiologically and followed up at 3, 6, 12, 24 weeks after surgery. Final outcome was assessed using Flynn’s criteria for Tens Scoring System. RESULTS Results of entire, 30 patients were followed up for an average of 6 months, was excellent in 19(63% cases and satisfactory in 11(37% cases and no poor outcome. CONCLUSION Based on this study and result, we found that intramedullary elastic nailing technique is an ideal method for treatment of pediatric femoral and tibial diaphyseal fractures.

  5. Implantable microelectromechanical sensors for diagnostic monitoring and post-surgical prediction of bone fracture healing. (United States)

    McGilvray, Kirk C; Unal, Emre; Troyer, Kevin L; Santoni, Brandon G; Palmer, Ross H; Easley, Jeremiah T; Demir, Hilmi Volkan; Puttlitz, Christian M


    The relationship between modern clinical diagnostic data, such as from radiographs or computed tomography, and the temporal biomechanical integrity of bone fracture healing has not been well-established. A diagnostic tool that could quantitatively describe the biomechanical stability of the fracture site in order to predict the course of healing would represent a paradigm shift in the way fracture healing is evaluated. This paper describes the development and evaluation of a wireless, biocompatible, implantable, microelectromechanical system (bioMEMS) sensor, and its implementation in a large animal (ovine) model, that utilized both normal and delayed healing variants. The in vivo data indicated that the bioMEMS sensor was capable of detecting statistically significant differences (p-value bioMEMS sensor can be used as a diagnostic tool for detecting the in vivo course of fracture healing in the acute post-treatment period.

  6. Surgical workflow analysis with Gaussian mixture multivariate autoregressive (GMMAR) models: a simulation study. (United States)

    Loukas, Constantinos; Georgiou, Evangelos


    There is currently great interest in analyzing the workflow of minimally invasive operations performed in a physical or simulation setting, with the aim of extracting important information that can be used for skills improvement, optimization of intraoperative processes, and comparison of different interventional strategies. The first step in achieving this goal is to segment the operation into its key interventional phases, which is currently approached by modeling a multivariate signal that describes the temporal usage of a predefined set of tools. Although this technique has shown promising results, it is challenged by the manual extraction of the tool usage sequence and the inability to simultaneously evaluate the surgeon's skills. In this paper we describe an alternative methodology for surgical phase segmentation and performance analysis based on Gaussian mixture multivariate autoregressive (GMMAR) models of the hand kinematics. Unlike previous work in this area, our technique employs signals from orientation sensors, attached to the endoscopic instruments of a virtual reality simulator, without considering which tools are employed at each time-step of the operation. First, based on pre-segmented hand motion signals, a training set of regression coefficients is created for each surgical phase using multivariate autoregressive (MAR) models. Then, a signal from a new operation is processed with GMMAR, wherein each phase is modeled by a Gaussian component of regression coefficients. These coefficients are compared to those of the training set. The operation is segmented according to the prior probabilities of the surgical phases estimated via GMMAR. The method also allows for the study of motor behavior and hand motion synchronization demonstrated in each phase, a quality that can be incorporated into modern laparoscopic simulators for skills assessment.

  7. Osteocyte-viability-based simulations of trabecular bone loss and recovery in disuse and reloading

    NARCIS (Netherlands)

    Wang, H.; Ji, B.; Liu, X.S.; van Oers, R.F.M.; Guo, X.E.; Huang, Y.; Hwang, K.C.


    Osteocyte apoptosis is known to trigger targeted bone resorption. In the present study, we developed an osteocyte-viability-based trabecular bone remodeling (OVBR) model. This novel remodeling model, combined with recent advanced simulation methods and analysis techniques, such as the element-by-ele

  8. Long-term prediction of three-dimensional bone architecture in simulations of pre-, peri- and post-menopausal microstructural bone remodeling. (United States)

    Müller, Ralph


    The mechanical behavior of trabecular bone depends on the internal bone structure. It is generally accepted now that the trabecular bone structure is a result of a load adaptive bone remodeling. The mathematical laws that relate bone remodeling to the local state of stress and strain, however, are still under investigation. The aim of this project was to investigate if changes in the trabecular architecture as observed with age-related bone loss and osteoporosis can be predicted from a computer model that simulates bone resorption after hormone depletion based on realistic models of trabecular microstructure using micro-computed tomography (muCT). A compact desktop muCT providing a nominal isotropic resolution of 14 mum was used to measure two groups of seven trabecular bone specimens from pre-menopausal and post-menopausal women respectively. A novel algorithm was developed to simulate age-related bone loss for the specimens in the first group. The algorithm, also referred to as simulated bone atrophy (SIBA), describes a truly three-dimensional approach and is based directly on cellular bone remodeling with an underlying realistic time frame. Bone resorption is controlled by osteoclastic penetration depth and bone formation is governed by the efficiency level of the osteoblasts. The simulation itself describes an iterative process with a cellular remodeling cycle of 197 days. Activation frequency is controllable and can be adjusted for the different phases of pre-, peri- and post-menopause. For our simulations, osteoblastic and osteoclastic activities were in balance until the onset of menopause, set to be at the age of 50 years. In that period, the structure remained almost constant. After the onset of menopause an imbalance in the cell activities was modeled resulting in a net bone loss. The doubling of the activation frequency in the peri-menopausal phase caused a pronounced loss. Using advanced animation tools and quantitative bone morphometry, the changes in

  9. Newly forming bone graft: a novel surgical approach to the treatment of denuded roots

    Directory of Open Access Journals (Sweden)

    Adriana Campos Passanezi Sant'Ana


    Full Text Available Many techniques have been proposed for root coverage. However, none of them presents predictable results in deep and wide recessions. OBJECTIVES: The aim of this case series report is to describe an alternative technique for root coverage at sites showing deep recessions and attachment loss >4 mm at buccal sites. MATERIAL AND METHODS: Four patients presenting deep recession defects at buccal sites (>4 mm were treated by the newly forming bone graft technique, which consists in the creation of an alveolar socket at edentulous ridge and transferring of granulation tissue present in this socket to the recession defect after 21 days. Clinical periodontal parameters, including recession depth (RD, probing depth (PD, clinical attachment level (CAL, bleeding on probing (BOP, plaque index (PI and keratinized gingiva width (KGW were evaluated by a single examiner immediately before surgery and at 1, 3, 6 and 9 months postoperatively. RESULTS: All cases showed reduction in RD and PD, along with CAL gain, although no increase in KGW could be observed. These findings suggest that the technique could favor periodontal regeneration along with root coverage, especially in areas showing deep recessions and attachment loss.

  10. Teaching surgical skills in obstetrics using a cesarean section simulator – bringing simulation to life

    Directory of Open Access Journals (Sweden)

    Venkata Sujatha Vellanki


    Full Text Available Venkata Sujatha Vellanki1, Sarath Babu Gillellamudi21Department of Obstetrics and Gynaecology 2Department of General Surgery Kamineni Institute of Medical Sciences, Sreepuram, Narketpally, Nalgonda, Andhra Pradesh, IndiaPurpose: Cesarean section is the most common surgery performed in obstetrics. Incorporating a simulation model into training provides a safe, low-stress environment in which students can gain skills and receive feedback. The purpose of this study was to determine the effectiveness of obstetrics simulator training for medical students doing their internship.Methods: Twenty-five students posted in the Department of Obstetrics and Gynecology received a formal lecture on cesarean section and demonstration of the procedure on a mannequin in the first week of their internship, The study group (n = 12 practiced their skills on an obstetrics simulator under the direct supervision of a faculty member. The control group received no simulator-based training (n = 13 or further instruction. All students were asked to complete a prevalidated questionnaire to assess their level of confidence in performing the procedure after the educational session.Results: Compared with their peers in the study, students in the simulator group were significantly more likely to define the steps of cesarean section (91% vs 61.5%, and were comfortable in assisting cesarean section (100% vs 46.15% as they were able to identify the layers of abdomen opened during cesarean section. All 12 students reported this as an excellent experience.Conclusion: We were able to construct an inexpensive cesarean section trainer that facilitates instruction in cesarean section technique in a low-stress environment.Keywords: simulation, obstetrics, medical students

  11. Multiscale approach for bone remodeling simulation based on finite element and neural network computation

    CERN Document Server

    Hambli, Ridha


    The aim of this paper is to develop a multiscale hierarchical hybrid model based on finite element analysis and neural network computation to link mesoscopic scale (trabecular network level) and macroscopic (whole bone level) to simulate bone remodelling process. Because whole bone simulation considering the 3D trabecular level is time consuming, the finite element calculation is performed at macroscopic level and a trained neural network are employed as numerical devices for substituting the finite element code needed for the mesoscale prediction. The bone mechanical properties are updated at macroscopic scale depending on the morphological organization at the mesoscopic computed by the trained neural network. The digital image-based modeling technique using m-CT and voxel finite element mesh is used to capture 2 mm3 Representative Volume Elements at mesoscale level in a femur head. The input data for the artificial neural network are a set of bone material parameters, boundary conditions and the applied str...

  12. An evidence-based laparoscopic simulation curriculum shortens the clinical learning curve and reduces surgical adverse events

    Directory of Open Access Journals (Sweden)

    De Win G


    Full Text Available Gunter De Win,1,2 Siska Van Bruwaene,3,4 Jyotsna Kulkarni,5 Ben Van Calster,6 Rajesh Aggarwal,7,8 Christopher Allen,9 Ann Lissens,4 Dirk De Ridder,3 Marc Miserez4,10 1Department of Urology, Antwerp University Hospital, 2Faculty of Health Sciences, University of Antwerp, Antwerp, 3Department of Urology, University Hospitals of KU Leuven, 4Centre for Surgical Technologies, KU Leuven, Leuven, Belgium; 5Kulkarni Endo Surgery Institute, Pune, India; 6Department of Development and Regeneration, KU Leuven, Leuven, Belgium; 7Department of Surgery, Faculty of Medicine, 8Steinberg Centre for Simulation and Interactive Learning, Faculty of Medicine, McGill University, Montreal, QC, Canada; 9School of Arts and Sciences, University of Pennsylvania, Philadelphia, PA, USA; 10Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium Background: Surgical simulation is becoming increasingly important in surgical education. However, the method of simulation to be incorporated into a surgical curriculum is unclear. We compared the effectiveness of a proficiency-based preclinical simulation training in laparoscopy with conventional surgical training and conventional surgical training interspersed with standard simulation sessions.Materials and methods: In this prospective single-blinded trial, 30 final-year medical students were randomized into three groups, which differed in the way they were exposed to laparoscopic simulation training. The control group received only clinical training during residency, whereas the interval group received clinical training in combination with simulation training. The Center for Surgical Technologies Preclinical Training Program (CST PTP group received a proficiency-based preclinical simulation course during the final year of medical school but was not exposed to any extra simulation training during surgical residency. After 6 months of surgical residency, the influence on the learning curve while performing

  13. Changes in Mechanical Properties of Rat Bones under Simulated Effects of Microgravity and Radiation† (United States)

    Walker, Azida H.; Perkins, Otis; Mehta, Rahul; Ali, Nawab; Dobretsov, Maxim; Chowdhury, Parimal

    The aim of this study was to determine the changes in elasticity and lattice structure in leg bone of rats which were: 1) under Hind-Limb Suspension (HLS) by tail for 2 weeks and 2) exposed to a total radiation of 10 Grays in 10 days. The animals were sacrificed at the end of 2 weeks and the leg bones were surgically removed, cleaned and fixed with a buffered solution. The mechanical strength of the bone (elastic modulus) was determined from measurement of bending of a bone when under an applied force. Two methodologies were used: i) a 3-point bending technique and ii) classical bending where bending is accomplished keeping one end fixed. Three point bending method used a captive actuator controlled by a programmable IDEA drive. This allowed incremental steps of 0.047 mm for which the force is measured. The data is used to calculate the stress and the strain. In the second method a mirror attached to the free end of the bone allowed a reflected laser beam spot to be tracked. This provided the displacement measurement as stress levels changed. Analysis of stress vs. strain graph together with solution of Euler-Bernoulli equation for a cantilever beam allowed determination of the elastic modulus of the leg bone for (i) control samples, (ii) HLS samples and (iii) HLS samples with radiation effects. To ascertain changes in the bone lattice structure, the bones were cross-sectioned and imaged with a 20 keV beam of electrons in a Scanning Electron Microscope (SEM). A backscattered detector and a secondary electron detector in the SEM provided the images from well-defined parts of the leg bones. Elemental compositions in combination with mechanical properties (elastic modulus and lattice structure) changes indicated weakening of the bones under space-like conditions of microgravity and radiation.

  14. Surgical Treatment of Malar Bone Fracture by a Modified Preauricular Temporal Approach (Al-Kayat-Brameley method) : Report of 2 cases



    Although there have been various reports on improving visibility and safety in the surgical approach to the malar bone, post-operative problems such as sensory loss over the distribution of the auriculotemporal region and undersirable cosmetic results are not uncommon. In 1979, Al-Kayat and Brameley reported on a modified preauricular approach to the malar arch and temporomandibular joint. Since 1990, we have applied this method to malar arch fractures and the result revealed that the method ...

  15. Protocol for concomitant temporomandibular joint custom-fitted total joint reconstruction and orthognathic surgery using computer-assisted surgical simulation. (United States)

    Movahed, Reza; Wolford, Larry M


    Combined orthognathic and total joint reconstruction cases can be predictably performed in 1 stage. Use of virtual surgical planning can eliminate a significant time requirement in preparation of concomitant orthognathic and temporomandibular joint (TMJ) prostheses cases. The concomitant TMJ and orthognathic surgery-computer-assisted surgical simulation technique increases the accuracy of combined cases. In order to have flexibility in positioning of the total joint prosthesis, recontouring of the lateral aspect of the rami is advantageous.

  16. Bone (United States)

    Helmberger, Thomas K.; Hoffmann, Ralf-Thorsten

    The typical clinical signs in bone tumours are pain, destruction and destabilization, immobilization, neurologic deficits, and finally functional impairment. Primary malignant bone tumours are a rare entity, accounting for about 0.2% of all malignancies. Also benign primary bone tumours are in total rare and mostly asymptomatic. The most common symptomatic benign bone tumour is osteoid osteoma with an incidence of 1:2000.

  17. Stimulatory effect of low-level GaAlAs laser (808 nm) on bone defect created surgically in rabbit femur (United States)

    Li, Qiushi; Zhou, Yanmin; Qu, Zhou; Zhang, Tianfu


    Recently, low-level laser therapy (LLLT) has been reported to have a photobiomodulation effect on bio-tissues. Our aim was to evaluate the effect of low level GaAlAs laser on bone regeneration around bone defect sites created surgically in rabbit femur. Thirty rabbits were randomly divided into an experimental and a control groups. A GaAlAs semiconductor diode laser was applied in the experimental group( λ = 808nm, P =75mW, (symbol) =0.4mm,t=5min, ρE=28J/cm2)immediately after surgery once a day for 3 consecutive days with no irradiation in the control group. Rabbits were sacrificed on the 7th, 14th, 21th days after surgery (DAS) and femur samples were prepared for bone histomorphometry analysis. The results showed that the bone volume, the osteoid volume, osteoblast surface and the mineral apposition rate in the laser group were higher statistically (P<0.05) than those indices in the control group at different periods. These data revealed that LLLT can enhance bone regeneration. LLLT seems to have a clinical application in promoting bone healing around implant in the future.

  18. Addressing gaps in surgical skills training by means of low-cost simulation at Muhimbili University in Tanzania

    Directory of Open Access Journals (Sweden)

    Taché Stephanie


    Full Text Available Abstract Background Providing basic surgical and emergency care in rural settings is essential, particularly in Tanzania, where the mortality burden addressable by emergency and surgical interventions has been estimated at 40%. However, the shortages of teaching faculty and insufficient learning resources have hampered the traditionally intensive surgical training apprenticeships. The Muhimbili University of Health and Allied Sciences consequently has experienced suboptimal preparation for graduates practising surgery in the field and a drop in medical graduates willing to become surgeons. To address the decline in circumstances, the first step was to enhance technical skills in general surgery and emergency procedures for senior medical students by designing and implementing a surgical skills practicum using locally developed simulation models. Methods A two-day training course in nine different emergency procedures and surgical skills based on the Canadian Network for International Surgery curriculum was developed. Simulation models for the surgical skills were created with locally available materials. The curriculum was pilot-tested with a cohort of 60 senior medical students who had completed their surgery rotation at Muhimbili University. Two measures were used to evaluate surgical skill performance: Objective Structured Clinical Examinations and surveys of self-perceived performance administered pre- and post-training. Results Thirty-six students participated in the study. Prior to the training, no student was able to correctly perform a surgical hand tie, only one student was able to correctly perform adult intubation and three students were able to correctly scrub, gown and glove. Performance improved after training, demonstrated by Objective Structured Clinical Examination scores that rose from 6/30 to 15/30. Students perceived great benefit from practical skills training. The cost of the training using low-tech simulation was four

  19. A multiscale analytical approach for bone remodeling simulations: linking scales from collagen to trabeculae. (United States)

    Colloca, Michele; Blanchard, Romane; Hellmich, Christian; Ito, Keita; van Rietbergen, Bert


    Bone is a dynamic and hierarchical porous material whose spatial and temporal mechanical properties can vary considerably due to differences in its microstructure and due to remodeling. Hence, a multiscale analytical approach, which combines bone structural information at multiple scales to the remodeling cellular activities, could form an efficient, accurate and beneficial framework for the prognosis of changes in bone properties due to, e.g., bone diseases. In this study, an analytical formulation of bone remodeling integrated with multiscale micromechanical models is proposed to investigate the effects of structural changes at the nanometer level (collagen scale) on those at higher levels (tissue scale). Specific goals of this study are to derive a mechanical stimulus sensed by the osteocytes using a multiscale framework, to test the accuracy of the multiscale model for the prediction of bone density, and to demonstrate its multiscale capabilities by predicting changes in bone density due to changes occurring at the molecular level. At each different level, the bone composition was modeled as a two-phase material which made it possible to: (1) find a closed-form solution for the energy-based mechanical stimulus sensed by the osteocytes and (2) describe the anisotropic elastic properties at higher levels as a function of the stiffness of the elementary components (collagen, hydroxyapatite and water) at lower levels. The accuracy of the proposed multiscale model of bone remodeling was tested first by comparing the analytical bone volume fraction predictions to those obtained from the corresponding μFE-based computational model. Differences between analytical and numerical predictions were less than 1% while the computational time was drastically reduced, namely by a factor of 1 million. In a further analysis, the effects of changes in collagen and hydroxyapatite volume fractions on the bone remodeling process were simulated, and it was found that such changes

  20. Developing an International Combined Applied Surgical Science and Wet Lab Simulation Course as an Undergraduate Teaching Model

    Directory of Open Access Journals (Sweden)

    Michail Sideris


    Full Text Available Background. Essential Skills in the Management of Surgical Cases (ESMSC is an international, animal model-based course. It combines interactive lectures with basic ex vivo stations and more advanced wet lab modules, that is, in vivo dissections and Heart Transplant Surgery on a swine model. Materials and Methods. Forty-nine medical students (male, N=27, female N=22, and mean age = 23.7 years from King’s College London (KCL and Greek Medical Schools attended the course. Participants were assessed with Direct Observation of Procedural Skills (DOPS, as well as Multiple Choice Questions (MCQs. Paired t-test associations were used to evaluate whether there was statistically significant improvement in their performance. Aim. To evaluate the effectiveness of a combined applied surgical science and wet lab simulation course as a teaching model for surgical skills at the undergraduate level. Results. The mean MCQ score was improved by 2.33/32 (P<0.005. Surgical skills competences, as defined by DOPS scores, were improved in a statically significant manner (P<0.005 for all paired t-test correlations. Conclusions. ESMSC seems to be an effective teaching model, which improves the understanding of the surgical approach and the basic surgical skills. In vivo models could be used potentially as a step further in the Undergraduate Surgical Education.

  1. The evolution of simulation techniques for dynamic bone tissue engineering in bioreactors. (United States)

    Vetsch, Jolanda Rita; Müller, Ralph; Hofmann, Sandra


    Bone tissue engineering aims to overcome the drawbacks of current bone regeneration techniques in orthopaedics. Bioreactors are widely used in the field of bone tissue engineering, as they help support efficient nutrition of cultured cells with the possible combination of applying mechanical stimuli. Beneficial influencing parameters of in vitro cultures are difficult to find and are mostly determined by trial and error, which is associated with significant time and money spent. Mathematical simulations can support the finding of optimal parameters. Simulations have evolved over the last 20 years from simple analytical models to complex and detailed computational models. They allow researchers to simulate the mechanical as well as the biological environment experienced by cells seeded on scaffolds in a bioreactor. Based on the simulation results, it is possible to give recommendations about specific parameters for bone bioreactor cultures, such as scaffold geometries, scaffold mechanical properties, the level of applied mechanical loading or nutrient concentrations. This article reviews the evolution in simulating various aspects of dynamic bone culture in bioreactors and reveals future research directions.

  2. Human maxillary sinus floor elevation as a model for bone regeneration enabling the application of one-step surgical procedures

    NARCIS (Netherlands)

    Farre-Guasch, E.; Prins, H.J.; Overman, J.R.; ten Bruggenkate, C.M.; Schulten, E.A.J.M.; Helder, M.N.; Klein-Nulend, J.


    Bone loss in the oral and maxillofacial region caused by trauma, tumors, congenital disorders, or degenerative diseases is a health care problem worldwide. To restore (reconstruct) these bone defects, human or animal bone grafts or alloplastic (synthetic) materials have been used. However, several d

  3. Protocol for concomitant temporomandibular joint custom-fitted total joint reconstruction and orthognathic surgery utilizing computer-assisted surgical simulation. (United States)

    Movahed, Reza; Teschke, Marcus; Wolford, Larry M


    Clinicians who address temporomandibular joint (TMJ) pathology and dentofacial deformities surgically can perform the surgery in 1 stage or 2 separate stages. The 2-stage approach requires the patient to undergo 2 separate operations and anesthesia, significantly prolonging the overall treatment. However, performing concomitant TMJ and orthognathic surgery (CTOS) in these cases requires careful treatment planning and surgical proficiency in the 2 surgical areas. This article presents a new treatment protocol for the application of computer-assisted surgical simulation in CTOS cases requiring reconstruction with patient-fitted total joint prostheses. The traditional and new CTOS protocols are described and compared. The new CTOS protocol helps decrease the preoperative workup time and increase the accuracy of model surgery.

  4. Mineralization behavior and interface properties of BG-PVA/bone composite implants in simulated body fluid

    Energy Technology Data Exchange (ETDEWEB)

    Ma Yanxuan; Zheng Yudong; Huang Xiaoshan; Xi Tingfei; Han Dongfei [School of Materials Science and Engineering, Beijing University of Science and Technology, Beijing 100083 (China); Lin Xiaodan [College of Materials Science and Engineering, South China University of Technology, Guangzhou 510640 (China); Song Wenhui, E-mail:, E-mail: [Wolfson Center for Materials Processing, School of Engineering and Design, Brunel University, West London, UB8 3PH (United Kingdom)


    Due to the non-bioactivity and poor conjunction performance of present cartilage prostheses, the main work here is to develop the bioactive glass-polyvinyl alcohol hydrogel articular cartilage/bone (BG-PVA/bone) composite implants. The essential criterion for a biomaterial to bond with living bone is well-matched mechanical properties as well as biocompatibility and bioactivity. In vitro studies on the formation of a surface layer of carbonate hydroxyl apatite (HCA) and the corresponding variation of the properties of biomaterials are imperative for their clinical application. In this paper, the mineralization behavior and variation of the interface properties of BG-PVA/bone composites were studied in vitro by using simulated body fluid (SBF). The mineralization and HCA layer formed on the interface between the BG-PVA hydrogel and bone in SBF could provide the composites with bioactivity and firmer combination. The compression property, shear strength and interface morphology of BG-PVA/bone composite implants varying with the immersion time in SBF were characterized. Also, the influence laws of the immersion time, content of BG in the composites and aperture of bones to the mineralization behavior and interface properties were investigated. The good mineralization behavior and enhanced conjunction performance of BG-PVA/bone composites demonstrated that this kind of composite implant might be more appropriate cartilage replacements.

  5. Scanning electron microscope studies of bone samples: Influence of simulated microgravity (United States)

    Mehta, Rahul; Chowdhury, Parimal; Ali, Nawab


    A scanning electron microscope (SEM) with backscatter and secondary electron emission detectors plus a Si(Li) detector for photon yield measurements was used to study bone samples from skull and leg of mice and rats. These animals were either suspended by their tail to induce simulated microgravity, characterized as hind-limb suspension (HLS) or not suspended (control). Analyses of the SEM images and energy dispersive spectrometer (EDS) spectra using Si(Li) detector indicate variation in the lattice structures, and in intensities of the characteristics X-rays, produced from the exposed bone surface due to its interaction with the electron beam. Using Flame software, the X-ray spectra were analyzed and normalized ratios of the elements determined. The elemental analysis indicated a variation in the density of calcium, potassium, and oxygen near the knee joints and near the sutures in the skull bones. The comparison of simulated microgravity subjected samples of the rat skull bones with that of the control samples revealed that in the suture region there was a large increase in the ratio of calcium, and to some degree for phosphorus, suggesting simulated microgravity affects distribution of these elements. Elemental composition for control samples with depth (within the cross section of the leg bones) revealed decrease of oxygen and increase of calcium in the first millimeter of the bone depth after which the relative percentage of elements stayed constant.

  6. Simulated weightlessness and synbiotic diet effects on rat bone mechanical strength (United States)

    Sarper, Hüseyin; Blanton, Cynthia; DePalma, Jude; Melnykov, Igor V.; Gabaldón, Annette M.


    This paper reports results on exposure to simulated weightlessness that leads to a rapid decrease in bone mineral density known as spaceflight osteopenia by evaluating the effectiveness of dietary supplementation with synbiotics to counteract the effects of skeletal unloading. Forty adult male rats were studied under four different conditions in a 2 × 2 factorial design with main effects of diet (synbiotic and control) and weight condition (unloaded and control). Hindlimb unloading was performed at all times for 14 days followed by 14 days of recovery (reambulation). The synbiotic diet contained probiotic strains Lactobacillus acidophilus and Lactococcus lactis lactis and prebiotic fructooligosaccharide. This paper also reports on the development of a desktop three-point bending device to measure the mechanical strength of bones from rats subjected to simulated weightlessness. The importance of quantifying bone resistance to breakage is critical when examining the effectiveness of interventions against osteopenia resulting from skeletal unloading, such as astronauts experience, disuse or disease. Mechanical strength indices provide information beyond measures of bone density and microarchitecture that enhance the overall assessment of a treatment's potency. In this study we used a newly constructed three-point bending device to measure the mechanical strength of femur and tibia bones from hindlimb-unloaded rats fed an experimental synbiotic diet enriched with probiotics and fermentable fiber. Two calculated outputs for each sample were Young's modulus of elasticity and fracture stress. Bone major elements (calcium, magnesium, and phosphorous) were quantified using ICP-MS analysis. Hindlimb unloading was associated with a significant loss of strength in the femur, and with significant reductions in major bone elements. The synbiotic diet did not protect against these unloading effects. Tibia strength and major elements were not reduced by hindlimb unloading, as was

  7. Applicability of Finite-Difference Time-Domain Method to Simulation of Wave Propagation in Cancellous Bone (United States)

    Nagatani, Yoshiki; Imaizumi, Hirotaka; Fukuda, Takashi; Matsukawa, Mami; Watanabe, Yoshiaki; Otani, Takahiko


    In cancellous bone, longitudinal waves often separate into fast and slow waves depending on the alignment of bone trabeculae. This interesting phenomenon becomes an effective tool for the diagnosis of osteoporosis because wave propagation behavior depends on the bone structure. We have, therefore, simulated wave propagation in such a complex medium by the finite-difference time-domain (FDTD) method, using a three-dimensional X-ray computer tomography (CT) model of an actual cancellous bone. In this simulation, experimentally observed acoustic constants of the cortical bone were adopted. As a result, the generation of fast and slow waves was confirmed. The speed of fast waves and the amplitude of slow waves showed good correlations with the bone volume fraction. The simulated results were also compared with the experimental results obtained from the identical cancellous bone.

  8. Effect of simulated weightlessness and chronic 1,25-dihydroxyvitamin D administration on bone metabolism (United States)

    Halloran, B. P.; Bikle, D. D.; Globus, R. K.; Levens, M. J.; Wronski, T. J.; Morey-Holton, E.


    Weightlessness, as experienced during space flight, and simulated weightlessness induce osteopenia. Using the suspended rat model to simulate weightlessness, a reduction in total tibia Ca and bone formation rate at the tibiofibular junction as well as an inhibition of Ca-45 and H-3-proline uptake by bone within 5-7 days of skeletal unloading was observed. Between days 7 and 15 of unloading, uptake of Ca-45 and H-3-proline, and bone formation rate return to normal, although total bone Ca remains abnormally low. To examine the relationship between these characteristic changes in bone metabolism induced by skeletal unloading and vitamin D metabolism, the serum concentrations of 25-hydroxyvitamin D (25-OH-D), 24, 25-dihydroxyvitamin D (24,25(OH)2D) and 1,25-dihydroxyvitamin D (1,25(OH)2D) at various times after skeletal unloading were measured. The effect of chronic infusion of 1,25(OH)2D3 on the bone changes associated with unloading was also determined.

  9. Computer-Aided Simulation of Mastoidectomy

    Institute of Scientific and Technical Information of China (English)

    CHEN He-xin; MA Zhi-chao; Wang Zhang-feng; GUO Jie-bo; WEN Wei-ping; XU Geng


    Objective To establish a three-dimensional model of the temporal bone using CT scan images for study of temporal bone structures and simulation of mastoidectomy procedures. Methods CT scan images from 6 individuals (12 temporal bones) were used to reconstruct the Fallopian canal, internal auditory canal, cochlea, semicircular canals, sigmoid sinus, posterior fossa floor and jugular bulb on a computer platform. Their anatomical relations within the temporal bone were restored in the computed model. The same model was used to simulate mastoidectomy procedures. Results The reconstructed computer model provided accurate and clear three-dimensional images of temporal bone structures. Simulation of mastoidectomy using these images provided procedural experiences closely mimicking the real surgical procedure. Conclusion Computeraided three dimensional reconstruction of temporal bone structures using CT scan images is a useful tool in surgical simulation and can aid surgical procedure planning.

  10. 3D-printed soft-tissue physical models of renal malignancies for individualized surgical simulation: a feasibility study. (United States)

    Maddox, Michael M; Feibus, Allison; Liu, James; Wang, Julie; Thomas, Raju; Silberstein, Jonathan L


    To construct patient-specific physical three-dimensional (3D) models of renal units with materials that approximates the properties of renal tissue to allow pre-operative and robotic training surgical simulation, 3D physical kidney models were created (3DSystems, Rock Hill, SC) using computerized tomography to segment structures of interest (parenchyma, vasculature, collection system, and tumor). Images were converted to a 3D surface mesh file for fabrication using a multi-jet 3D printer. A novel construction technique was employed to approximate normal renal tissue texture, printers selectively deposited photopolymer material forming the outer shell of the kidney, and subsequently, an agarose gel solution was injected into the inner cavity recreating the spongier renal parenchyma. We constructed seven models of renal units with suspected malignancies. Partial nephrectomy and renorrhaphy were performed on each of the replicas. Subsequently all patients successfully underwent robotic partial nephrectomy. Average tumor diameter was 4.4 cm, warm ischemia time was 25 min, RENAL nephrometry score was 7.4, and surgical margins were negative. A comparison was made between the seven cases and the Tulane Urology prospectively maintained robotic partial nephrectomy database. Patients with surgical models had larger tumors, higher nephrometry score, longer warm ischemic time, fewer positive surgical margins, shorter hospitalization, and fewer post-operative complications; however, the only significant finding was lower estimated blood loss (186 cc vs 236; p = 0.01). In this feasibility study, pre-operative resectable physical 3D models can be constructed and used as patient-specific surgical simulation tools; further study will need to demonstrate if this results in improvement of surgical outcomes and robotic simulation education.

  11. Comparison between cone-beam and multislice computed tomography for identification of simulated bone lesions

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    Gaia, Bruno Felipe [University of Sao Paulo (USP), SP (Brazil). Dental School. Stomatology Dept.; Sales, Marcelo Augusto Oliveira de [University of Paraiba (UFPB), Joao Pessoa, PB (Brazil). Dental School. Dept. of Radiology; Perrella, Andreia; Fenyo-Pereira, Marlene; Cavalcanti, Marcelo Gusmao Paraiso, E-mail: mgpcaval@usp.b [University of Sao Paulo (USP), SP (Brazil). Dental School. Dept. of Radiology


    There are many studies that compare the accuracy of multislice (MSCT) and cone beam (CBCT) computed tomography for evaluations in the maxillofacial region. However, further studies comparing both acquisition techniques for the evaluation of simulated mandibular bone lesions are needed. The aim of this study was to compare the accuracy of MSCT and CBCT in the diagnosis of simulated mandibular bone lesions by means of cross sectional images and axial/MPR slices. Lesions with different dimensions, shape and locularity were produced in 15 dry mandibles. The images were obtained following the cross sectional and axial/MPR (Multiplanar Reconstruction) imaging protocols and were interpreted independently. CBCT and MSCT showed similar results in depicting the percentage of cortical bone involvement, with great sensitivity and specificity (p < 0.005). There were no significant intra- or inter-examiner differences between axial/MPR images and cross sectional images with regard to sensitivity and specificity. CBCT showed results similar to those of MSCT for the identification of the number of simulated bone lesions. Cross sectional slices and axial/MPR images presented high accuracy, proving useful for bone lesion diagnosis. (author)

  12. Evaluation of bone remodeling around single dental implants of different lengths: a mechanobiological numerical simulation and validation using clinical data. (United States)

    Sotto-Maior, Bruno Salles; Mercuri, Emílio Graciliano Ferreira; Senna, Plinio Mendes; Assis, Neuza Maria Souza Picorelli; Francischone, Carlos Eduardo; Del Bel Cury, Altair Antoninha


    Algorithmic models have been proposed to explain adaptive behavior of bone to loading; however, these models have not been applied to explain the biomechanics of short dental implants. Purpose of present study was to simulate bone remodeling around single implants of different lengths using mechanoregulatory tissue differentiation model derived from the Stanford theory, using finite elements analysis (FEA) and to validate the theoretical prediction with the clinical findings of crestal bone loss. Loading cycles were applied on 7-, 10-, or 13-mm-long dental implants to simulate daily mastication and bone remodeling was assessed by changes in the strain energy density of bone after a 3, 6, and 12 months of function. Moreover, clinical findings of marginal bone loss in 45 patients rehabilitated with same implant designs used in the simulation (n = 15) were computed to validate the theoretical results. FEA analysis showed that although the bone density values reduced over time in the cortical bone for all groups, bone remodeling was independent of implant length. Clinical data showed a similar pattern of bone resorption compared with the data generated from mathematical analyses, independent of implant length. The results of this study showed that the mechanoregulatory tissue model could be employed in monitoring the morphological changes in bone that is subjected to biomechanical loads. In addition, the implant length did not influence the bone remodeling around single dental implants during the first year of loading.

  13. A glass-reinforced hydroxyapatite and surgical-grade calcium sulfate for bone regeneration: In vivo biological behavior in a sheep model. (United States)

    Cortez, Paulo Pegado; Silva, Marta Alves; Santos, Marta; Armada-da-Silva, Paulo; Afonso, Amrico; Lopes, Maria A; Santos, Jose Domingos; Maurício, Ana Colette


    A glass-reinforced hydroxyapatite (HA) composite (Bonelike®) was developed for bone grafting. This biomaterial is composed of a modified HA matrix with α- and β-tricalcium phosphate secondary phases, resulting in higher solubility than single HA type of materials. Several in vitro and in vivo studies demonstrated that Bonelike® has a highly bioactive behavior, which was also confirmed by employing granular forms of this biomaterial in orthopedics and dental applications. However, a fast consolidation vehicle was needed to promote the fixation of Bonelike® granules if applied in larger defects or in unstable sites. Surgical-grade calcium sulfate (CS), which is widely recognized as a well-tolerated and inexpensive bone graft material, was the chosen vehicle to improve the handling characteristics of Bonelike® as it can be used in the form of a powder that is mixed with a liquid to form a paste that sets in situ. After application in non-critical monocortical defects in sheep, histological, and scanning electron microscopy evaluations demonstrated that Bonelike® associated to CS functioned as a very satisfactory scaffold for bone regeneration as it achieved synchronization of the ingrowing bone with biomaterial resorption and subsequent preservation of the bone graft initial volume. Therefore, our results indicate that CS is an effective vehicle for Bonelike® granules as it facilitates their application and does not interfere with their proven highly osteoconductive properties. In the opposite way, the incorporation of Bonelike® improves the bone regeneration capabilities of CS.

  14. Adaptive space warping to enhance passive haptics in an arthroscopy surgical simulator. (United States)

    Spillmann, Jonas; Tuchschmid, Stefan; Harders, Matthias


    Passive haptics, also known as tactile augmentation, denotes the use of a physical counterpart to a virtual environment to provide tactile feedback. Employing passive haptics can result in more realistic touch sensations than those from active force feedback, especially for rigid contacts. However, changes in the virtual environment would necessitate modifications of the physical counterparts. In recent work space warping has been proposed as one solution to overcome this limitation. In this technique virtual space is distorted such that a variety of virtual models can be mapped onto one single physical object. In this paper, we propose as an extension adaptive space warping; we show how this technique can be employed in a mixed-reality surgical training simulator in order to map different virtual patients onto one physical anatomical model. We developed methods to warp different organ geometries onto one physical mock-up, to handle different mechanical behaviors of the virtual patients, and to allow interactive modifications of the virtual structures, while the physical counterparts remain unchanged. Various practical examples underline the wide applicability of our approach. To the best of our knowledge this is the first practical usage of such a technique in the specific context of interactive medical training.

  15. The Mozart effect on task performance in a laparoscopic surgical simulator. (United States)

    Wiseman, Michael C


    The Mozart Effect is a phenomenon whereby certain pieces of music induce temporary enhancement in "spatial temporal reasoning." To determine whether the Mozart Effect can improve surgical performance, 55 male volunteers (mean age = 20.6 years, range = 16-27), novice to surgery, were timed as they completed an activity course on a laparoscopic simulator. Subjects were then randomized for exposure to 1 of 2 musical pieces by Mozart (n = 21) and Dream Theater (n = 19), after which they repeated the course. Following a 15-minute exposure to a nonmusical piece, subjects were exposed to one of the pieces and performed the activity course a third time. An additional group (n = 15) that was not corandomized performed the tasks without any exposure to music. The percent improvements in completion time between 3 successive trials were calculated for each subject and group means compared. In 2 of the tasks, subjects exposed to the Dream Theater piece achieved approximately 30% more improvement (26.7 ± 8.3%) than those exposed to the Mozart piece (20.2 ± 7.8%, P = .021) or to no music (20.4 ± 9.1%, P = .049). Distinct patterns of covariance between baseline performance and subsequent improvement were observed for the different musical conditions and tasks. The data confirm the existence of a Mozart Effect and demonstrate for the first time its practical applicability. Prior exposure to certain pieces may enhance performance in practical skills requiring spatial temporal reasoning.

  16. The Influence of Oblique Angle Forced Exercise in Surgically Destabilized Stifle Joints Is Synergistic with Bone, but Antagonistic with Cartilage in an Ovine Model of Osteoarthritis. (United States)

    Hill, Rachel J; Mason, Holly M; Yeip, Gavin; Merchant, Samer S; Olsen, Aaron L; Stott, Rusty D; Van Wettere, Arnaud J; Bressel, Eadric; Mason, Jeffrey B


    Large animal models of osteoarthritis are a necessary testing ground for FDA approval of human medicine applications. Sheep models have advantages over other available large animals, but development and progression of osteoarthritis in sheep is exceedingly slow, which handicaps progress in development of potential treatments. We combined oblique angle forced exercise to increase stress on the stifle, with surgical destabilization to hasten the development of osteoarthritis in ewes. Methods for early detection of clinical signs included radiography, urine, and serum biomarker assays and gait analysis and ex vivo we used microcomputed tomography and macroscopic joint analysis. Our model was able to produce clinically detectable signs of osteoarthritis in a relatively short period (14 weeks). Changes in bone were highly correlated between microcomputed tomography and radiographic analysis and changes in cartilage correlated well between urinary glycosaminoglycan levels and serum aggrecanase analyses. Exercise improved the negative effects of destabilization in bone but exacerbated the negative effects of destabilization in cartilage. These observations suggest that we may need to consider treatments for bone and cartilage separately. These results represent an improved large animal model of osteoarthritis with rapid onset of disease and superior detection of bone and soft tissue changes.

  17. [Pre-surgical simulation of microvascular decompression for hemifacial spasm using 3D-models]. (United States)

    Mashiko, Toshihiro; Yang, Qiang; Kaneko, Naoki; Konno, Takehiko; Yamaguchi, Takashi; Watanabe, Eiju


    We have been performing pre-surgical simulations using custom-built patient-specific 3D-models. Here we report the advantageous use of 3D-models for simulating microvascular decompression(MVD)for hemifacial spasms. Seven cases of MVD surgery were performed. Two types of 3D-printers were used to fabricate the 3D-models:one using plaster as the modeling material(Z Printer®450, 3D systems, Rock Hill, SC, USA)and the other using acrylonitrile butadiene styrene(ABS)(UP! Plus 3D printer®, Beijing Tiertime Technology, Beijing). We tested three types of models. Type 1 was a plaster model of the brainstem, cerebellum, facial nerve, and the artery compressing the root exit zone of the facial nerve. Part of the cerebellum was digitally trimmed off to observe "the compressing point" from the same angle as that used during actual surgery. Type 2 was a modified Type 1 in which part of the skull was opened digitally to mimic a craniectomy. Type 3 was a combined model in which the cerebellum and the artery of the Type 2 model were replaced by a soft retractable cerebellum and an elastic artery. The cerebellum was made from polyurethane and cast from a plaster prototype. To fabricate elastic arteries, liquid silicone was painted onto the surface of an ABS artery and the inner ABS model was dissolved away using solvent. In all cases, the 3D-models were very useful. Although each type has advantages, the Type-3 model was judged extremely useful for training junior surgeons in microsurgical approaches.

  18. Surgical treatment of multifocal giant cell tumor of carpal bones with preservation of wrist function: case report. (United States)

    Tarng, Yih-Wen; Yang, Shan-Wei; Hsu, Chien-Jen


    We report a rare case of multifocal giant cell tumor of bone involving the trapezium, trapezoid, capitate, and scaphoid with soft tissue extension. Following intralesional resection, an autogenous corticocancellous iliac crest bone graft was used to fill the resultant defect and preserve carpal height and radiocarpal motion. Successful union with no recurrence was noted at 1-year follow-up.

  19. Bone characteristics of 16 wk-old turkeys subjected to different dietary regimens and simulated stress (United States)

    The effects of a yeast extract (YE) feed supplement and/or vitamin D3 (VD) on the bone properties of 16 wk-old turkeys, transiently subjected to a simulated stress using dexamethasone (Dex), were determined. The turkeys were fed diets with or without YE and/or VD during 6, 11, and 15 wk post hatch, ...

  20. Implementation of simulation in surgical practice: Minimally invasive surgery has taken the lead: The Dutch experience

    NARCIS (Netherlands)

    H.W.R. Schreuder; G. Oei; M. Maas; J.C.C. Borleffs; M.P. Schijven


    Minimal invasive techniques are rapidly becoming standard surgical techniques for many surgical procedures. To develop the skills necessary to apply these techniques, box trainers and/or inanimate models may be used, but these trainers lack the possibility of inherent objective classification of res

  1. Implementation of simulation in surgical practice : Minimally invasive surgery has taken the lead: The Dutch experience

    NARCIS (Netherlands)

    Schreuder, Henk W. R.; Oei, Guid; Maas, Mario; Borleffs, Jan C. C.; Schijven, Marlies P.


    Minimal invasive techniques are rapidly becoming standard surgical techniques for many surgical procedures. To develop the skills necessary to apply these techniques, box trainers and/or inanimate models may be used, but these trainers lack the possibility of inherent objective classification of res

  2. Algorithm for planning a double-jaw orthognathic surgery using a computer-aided surgical simulation (CASS) protocol. Part 1: planning sequence. (United States)

    Xia, J J; Gateno, J; Teichgraeber, J F; Yuan, P; Chen, K-C; Li, J; Zhang, X; Tang, Z; Alfi, D M


    The success of craniomaxillofacial (CMF) surgery depends not only on the surgical techniques, but also on an accurate surgical plan. The adoption of computer-aided surgical simulation (CASS) has created a paradigm shift in surgical planning. However, planning an orthognathic operation using CASS differs fundamentally from planning using traditional methods. With this in mind, the Surgical Planning Laboratory of Houston Methodist Research Institute has developed a CASS protocol designed specifically for orthognathic surgery. The purpose of this article is to present an algorithm using virtual tools for planning a double-jaw orthognathic operation. This paper will serve as an operation manual for surgeons wanting to incorporate CASS into their clinical practice.

  3. Battle of the bots: a comparison of the standard da Vinci and the da Vinci Surgical Skills Simulator in surgical skills acquisition. (United States)

    Brown, Kevin; Mosley, Natalie; Tierney, James


    Virtual reality simulators are increasingly used to gain robotic surgical skills. This study compared use of the da Vinci Surgical Skills Simulator (dVSSS) to the standard da Vinci (SdV) robot for skills acquisition in a prospective randomized study. Residents from urology, gynecology, and general surgery programs performed three virtual reality tasks (thread the ring, ring rail, and tubes) on the dvSSS. Participants were then randomized to one of the two study groups (dVSSS and SdV). Each participant then practiced on either the dVSSS or the SdV (depending on randomization) for 30 min per week over a 4-week time period. The dVSSS arm was not permitted to practice ring rail (due to no similar practice scenario available for the SdV group). Following 4 weeks of practice, participants performed the same three virtual reality tasks and the results were recorded and compared to baseline. Overall and percent improvement were recorded for all participants from pre-test to post-test. Two-way ANOVA analyses were used to compare the dVSSS and SdV groups and three tasks. Initially, 30 participants were identified and enrolled in the study. Randomization resulted in 15 participants in each arm. During the course of the study, four participants were unable to complete all tasks and practice sessions and were, therefore, excluded. This resulted in a total of 26 participants (15 in the dVSSS group and 11 in the SdV group) who completed the study. Overall total improvement score was found to be 23.23 and 23.48 for the SdV and dVSSS groups, respectively (p = 0.9245). The percent improvement was 60 and 47 % for the SdV and dVSSS groups respectively, which was a statistically significant difference between the two groups and three tasks. Practicing on the standard da Vinci is comparable to practicing on the da Vinci simulator for acquiring robotic surgical skills. In spite of several potential advantages, the dVSSS arm performed no better than the SdV arm in the final

  4. Development of a novel method for surgical implant design optimization through noninvasive assessment of local bone properties. (United States)

    Schiuma, D; Brianza, S; Tami, A E


    A method was developed to improve the design of locking implants by finding the optimal paths for the anchoring elements, based on a high resolution pQCT assessment of local bone mineral density (BMD) distribution and bone micro-architecture (BMA). The method consists of three steps: (1) partial fixation of the implant to the bone and creation of a reference system, (2) implant removal and pQCT scan of the bone, and (3) determination of BMD and BMA of all implant-anchoring locations along the actual and alternative directions. Using a PHILOS plate, the method uncertainty was tested on an artificial humerus bone model. A cadaveric humerus was used to quantify how the uncertainty of the method affects the assessment of bone parameters. BMD and BMA were determined along four possible alternative screw paths as possible criteria for implant optimization. The method is biased by a 0.87 ± 0.12 mm systematic uncertainty and by a 0.44 ± 0.09 mm random uncertainty in locating the virtual screw position. This study shows that this method can be used to find alternative directions for the anchoring elements, which may possess better bone properties. This modification will thus produce an optimized implant design.

  5. Is suppression of bone formation during simulated weightlessness related to glucocorticoid levels (United States)

    Morey-Holton, E. R.; Bomalaski, M. D.; Enayati-Gordon, E.; Gonsalves, M. R.; Wronski, T. J.


    To investigate the hypothesis that suppression of bone formation in the suspended rat model was the result of increased levels of corticosterone, experiments were performed on young, growing, male rats exposed either to 4 C or suspended for two weeks. Rats suspended on the model system, designed to simulate certain aspects of spaceflight, gained weight at a rate at least equal to control animals but still showed a significant suppression of bone formation within 7 days. Cold-exposed rats gained less weight than their corresponding control group and did not demonstrate any suppression of bone formation. These findings suggest: (1) tail suspension is less stressful than previously used harness systems; (2) suspension in young, rapidly growing rats causes a significant suppression of cortical bone formation; (3) cold exposure does not alter bone formation rate in rats of a similar age and strain to those suspended in this study; and (4) suppression of bone formation provoked by unloading the rear limbs is not due solely to sustained stimulation of the pituitary-adrenal system.

  6. A multiscale modelling of bone ultrastructure elastic proprieties using finite elements simulation and neural network method. (United States)

    Barkaoui, Abdelwahed; Tlili, Brahim; Vercher-Martínez, Ana; Hambli, Ridha


    Bone is a living material with a complex hierarchical structure which entails exceptional mechanical properties, including high fracture toughness, specific stiffness and strength. Bone tissue is essentially composed by two phases distributed in approximately 30-70%: an organic phase (mainly type I collagen and cells) and an inorganic phase (hydroxyapatite-HA-and water). The nanostructure of bone can be represented throughout three scale levels where different repetitive structural units or building blocks are found: at the first level, collagen molecules are arranged in a pentameric structure where mineral crystals grow in specific sites. This primary bone structure constitutes the mineralized collagen microfibril. A structural organization of inter-digitating microfibrils forms the mineralized collagen fibril which represents the second scale level. The third scale level corresponds to the mineralized collagen fibre which is composed by the binding of fibrils. The hierarchical nature of the bone tissue is largely responsible of their significant mechanical properties; consequently, this is a current outstanding research topic. Scarce works in literature correlates the elastic properties in the three scale levels at the bone nanoscale. The main goal of this work is to estimate the elastic properties of the bone tissue in a multiscale approach including a sensitivity analysis of the elastic behaviour at each length scale. This proposal is achieved by means of a novel hybrid multiscale modelling that involves neural network (NN) computations and finite elements method (FEM) analysis. The elastic properties are estimated using a neural network simulation that previously has been trained with the database results of the finite element models. In the results of this work, parametric analysis and averaged elastic constants for each length scale are provided. Likewise, the influence of the elastic constants of the tissue constituents is also depicted. Results highlight

  7. A new surgical management for oro-antral communication: the resorbable guided tissue regeneration membrane--bone substitute sandwich technique. (United States)

    Ogunsalu, C


    This paper describes a new technique for the closure of oro-antral fistula/communication, in which both hard tissue (bone) and soft tissue closure is achieved. The sandwich technique utilizes a suitable bone grafting material sandwiched between two sheaths of Biogide (a resorbable membrane) for the hard tissue closure of oro-antral communication post traumatic exodontia. The bone grafting material utilized for this case was Bio-oss. The result obtained was excellent with regeneration of sufficient bony tissue to allow placement of an endosseous implant. This sandwich technique is a simple and excellent technique for the closure of oro-antral communication, especially when subsequent placement of endosseous implant is considered without the need of donor site surgery for bone grafting. The otorhinolaryngologists and oral and maxillofacial surgeons should find this technique very useful in the closure of oro-antral fistulae.

  8. Computer-assisted three-dimensional surgical planing and simulation. 3D soft tissue planning and prediction. (United States)

    Xia, J; Samman, N; Yeung, R W; Wang, D; Shen, S G; Ip, H H; Tideman, H


    The purpose of this paper is to report a new technique for three-dimensional facial soft-tissue-change prediction after simulated orthognathic surgical planning. A scheme for soft tissue deformation, "Computer-assisted three-dimensional virtual reality soft tissue planning and prediction for orthognathic surgery (CASP)", is presented. The surgical planning was based on three-dimensional reconstructed CT visualization. Soft tissue changes were predicted by two newly devised algorithms: Surface Normal-based Model Deformation Algorithm and Ray Projection-based Model Deformation Algorithm. A three-dimensional color facial texture-mapping technique was also used for generating the color photo-realistic facial model. As a final result, a predicted and simulated patient's color facial model can be visualized from arbitrary viewing points.

  9. The impact of critical event checklists on medical management and teamwork during simulated crises in a surgical daycare facility. (United States)

    Everett, T C; Morgan, P J; Brydges, R; Kurrek, M; Tregunno, D; Cunningham, L; Chan, A; Forde, D; Tarshis, J


    Although the incidence of major adverse events in surgical daycare centres is low, these critical events may not be managed optimally due to the absence of resources that exist in larger hospitals. We aimed to study the impact of operating theatre critical event checklists on medical management and teamwork during whole-team operating theatre crisis simulations staged in a surgical daycare facility. We studied 56 simulation encounters (without and with a checklist available) divided between an initial session and then a retention session several months later. Medical management and teamwork were quantified via percentage adherence to key processes and the Team Emergency Assessment Measure, respectively. In the initial session, medical management was not improved by the presence of a checklist (56% without checklist vs. 62% with checklist; p = 0.50). In the retention session, teams performed significantly worse without the checklists (36% without checklist vs. 60% with checklist; p = 0.04). We did not observe a change in non-technical skills in the presence of a checklist in either the initial or retention sessions (68% without checklist vs. 69% with checklist (p = 0.94) and 69% without checklist vs. 65% with checklist (p = 0.36), respectively). Critical events checklists do not improve medical management or teamwork during simulated operating theatre crises in an ambulatory surgical daycare setting.

  10. Simulation-based cutaneous surgical-skill training on a chicken-skin bench model in a medical undergraduate program

    Directory of Open Access Journals (Sweden)

    Rafael Denadai


    Full Text Available Background: Because of ethical and medico-legal aspects involved in the training of cutaneous surgical skills on living patients, human cadavers and living animals, it is necessary the search for alternative and effective forms of training simulation. Aims: To propose and describe an alternative methodology for teaching and learning the principles of cutaneous surgery in a medical undergraduate program by using a chicken-skin bench model. Materials and Methods: One instructor for every four students, teaching materials on cutaneous surgical skills, chicken trunks, wings, or thighs, a rigid platform support, needled threads, needle holders, surgical blades with scalpel handles, rat-tooth tweezers, scissors, and marking pens were necessary for training simulation. Results: A proposal for simulation-based training on incision, suture, biopsy, and on reconstruction techniques using a chicken-skin bench model distributed in several sessions and with increasing levels of difficultywas structured. Both feedback and objective evaluations always directed to individual students were also outlined. Conclusion: The teaching of a methodology for the principles of cutaneous surgery using a chicken-skin bench model versatile, portable, easy to assemble, and inexpensive is an alternative and complementary option to the armamentarium of methods based on other bench models described.

  11. Aesthetic Surgical Approach for Bone Dehiscence Treatment by Means of Single Implant and Interdental Tissue Regeneration: A Case Report with Five Years of Follow-Up

    Directory of Open Access Journals (Sweden)

    Giorgio Lombardo


    Full Text Available The replacement of single anterior teeth by means of endosseous implants implies the achievement of success in restoring both aesthetic and function. However, the presence of wide endoperiodontal lesions can lead to horizontal hard and soft tissues defects after tooth extraction, making it impossible to correctly place an implant in the compromised alveolar socket. Vertical augmentation procedures have been proposed to solve these clinical situations, but the amount of new regenerated bone is still not predictable. Furthermore, bone augmentation can be complicated by the presence of adjacent teeth, especially if they bring with them periodontal defects. Therefore, it is used to restore periodontal health of adjacent teeth before making any augmentation procedures and to wait a certain healing period before placing an implant in vertically augmented sites, otherwise risking to obtain a nonsatisfactory aesthetic result. All of these procedures, however, lead to an expansion of treatment time which should affect patient compliance. For this reason, this case report suggests a surgical technique to perform vertical bone augmentation at a single gap left by a central upper incisor while placing an implant and simultaneously to regenerate the periodontal attachment of an adjacent lateral incisor, without compromising the aesthetic result.

  12. Simulation for CCSDS Advanced Orbiting System (AOS) with BONeS Designer

    Institute of Scientific and Technical Information of China (English)

    马永奎; 张中兆; 张乃通


    This paper describes the modeling and simulation of the protocol of CCSDS advanced orbiting systems (AOS). The network features modeled in the implementation of CCSDS AOS are to multiplex different kinds of sources into virtual channel data units (VCDUs) in the data processing module. The emphasis of this work is placed on the algorithm for commutating VCDUs into physical channels in the form of continuous data stream. The objectives of modeling CCSDS AOS protocol are to analyze the performance of this protocol when it is used to process various data.

  13. Surgical treatment of giant cell tumors of long bone combined with inserted microwave antennas induced hyperthermia%插入式微波天线阵列诱导高温治疗长骨骨巨细胞瘤

    Institute of Scientific and Technical Information of China (English)

    周勇; 范清宇; 马保安; 张明华; 沈万安


    AIM:To evaluate the surgical treatment methods of giant cell tumors (GCT) of long bone in conjunction with inserted microwave antennas induced hyperthermia.METHODS:46 patients, included the surgical procedures,the oncology results,the functions of the limbs and the complications were analyzed.RESULTS:Follow up 3.5 to 9 years (mean 5.5 years).All patients were evaluated according to oncological and orthopaedic criteria.Two tumors were recurred.Orthopaedic function were perfect in 44 patients and were fair in 2.Infection was found in 2 patients.CONCLUSION:The surgical procedure to treat the giant cell tumors of long bone by inserted microwave antennas induced hyperthermia is a definitive surgical method which is safe and confident.

  14. Radioactive bone cement for the treatment of spinal metastases: a dosimetric analysis of simulated clinical scenarios (United States)

    Kaneko, T. S.; Sehgal, V.; Skinner, H. B.; Al-Ghazi, M. S. A. L.; Ramsinghani, N. S.; Marquez Miranda, M.; Keyak, J. H.


    Vertebral metastases are a common manifestation of many cancers, potentially leading to vertebral collapse and neurological complications. Conventional treatment often involves percutaneous vertebroplasty/kyphoplasty followed by external beam radiation therapy. As a more convenient alternative, we have introduced radioactive bone cement, i.e. bone cement incorporating a radionuclide. In this study, we used a previously developed Monte Carlo radiation transport modeling method to evaluate dose distributions from phosphorus-32 radioactive cement in simulated clinical scenarios. Isodose curves were generally concentric about the surface of bone cement injected into cadaveric vertebrae, indicating that dose distributions are relatively predictable, thus facilitating treatment planning (cement formulation and dosimetry method are patent pending). Model results indicated that a therapeutic dose could be delivered to tumor/bone within ∼4 mm of the cement surface while maintaining a safe dose to radiosensitive tissue beyond this distance. This therapeutic range should be sufficient to treat target volumes within the vertebral body when tumor ablation or other techniques are used to create a cavity into which the radioactive cement can be injected. With further development, treating spinal metastases with radioactive bone cement may become a clinically useful and convenient alternative to the conventional two-step approach of percutaneous strength restoration followed by radiotherapy.

  15. Simulated surgical workshops enhance medical school students’ preparation for clinical rotation

    Directory of Open Access Journals (Sweden)

    Patricia Johnson


    Full Text Available BackgroundA major focus of the medical school curriculum is to ensure medical students are well prepared prior to entering clinical rotations, which includes the compulsory surgical rotation.AimsThe objective of this research was to design and formally evaluate a set of real-life surgical workshops aimed at better preparing medical students for their clinical rotation in surgery. These workshops would be incorporated into the pre-clinical medical school curriculum.MethodDedicated surgical workshops were introduced into the preclinical component of the Bachelor of Medicine/Bachelor of Surgery (MBBS program at our University in 2009. These workshops encompassed training in the clinical skills needed in the perioperative and wider hospital setting. A survey comprising of eight to nine ranked questions (utilising a five-point Likert Scale as well as three short answer questions was administered to the medical students after they completed their compulsory surgical clinical rotation.ResultsThe overall response rate to the survey evaluating the surgical workshops was 79% (123/155. The mean of the ranked questions ranged from 4.05 to 4.89 which indicated that the students found the workshops useful. When evaluating the short answer questions (via topic coding, additional information was provided that supported and explained the survey findings and also included suggestions for improvements.ConclusionThe findings of the medical student survey demonstrated the value of incorporating dedicated preparatory surgical workshops in the medical school pre-clinical curriculum. However, further research is warranted to determine if this inclusion translated into improved student performance during the clinical surgical rotation.

  16. The MAVID heart holder: a demonstration device to anchor cadaver hearts for surgical simulation and practical education. (United States)

    Mavroudis, Constantine; Idriss, Rachid; Klaus, Kristen E


    Performing open heart surgery involves learning challenging techniques and a need for realistic training models to achieve and maintain a high level of surgical skills. The MAVID heart holder is an organ holder primarily designed to hold the heart in its anatomic position for the purpose of surgical simulation and education, thereby closing the gap between surgical performance in the laboratory and in the operating room. The device is simple to use, can be adjusted to organ size, and has the necessary instrumentation to be used with any solid organ. The MAVID heart holder also provides a platform for presentation and assists in advancing the research sphere. The advantage over other existing models is that the MAVID heart holder uses real tissue and does not distort the organ at the attachment sites. Further, it offers superior stability as well as the ability to manipulate the organ during presentation and dissection. Training with the MAVID heart holder has the potential to shorten training time to acquire surgical skills and proficiency before performing these techniques in the operating room and in so doing enhance patient safety.

  17. Evaluation of diabetic foot osteomyelitis using probe to bone test and magnetic resonance imaging and their impact on surgical intervention

    Directory of Open Access Journals (Sweden)

    Fatma Zaiton


    Conclusion: PTB test is a simple, minimally invasive, low cost test and can be done at outpatient clinic. Its sensitivity and specificity are good when compared to those of MRI, but when we need to diagnose associated soft tissue infection and planning the surgical management MRI was the image of choice.

  18. Computer assisted preoperative planning of bone fracture reduction: Simulation techniques and new trends. (United States)

    Jiménez-Delgado, Juan J; Paulano-Godino, Félix; PulidoRam-Ramírez, Rubén; Jiménez-Pérez, J Roberto


    The development of support systems for surgery significantly increases the likelihood of obtaining satisfactory results. In the case of fracture reduction interventions these systems enable surgery planning, training, monitoring and assessment. They allow improvement of fracture stabilization, a minimizing of health risks and a reduction of surgery time. Planning a bone fracture reduction by means of a computer assisted simulation involves several semiautomatic or automatic steps. The simulation deals with the correct position of osseous fragments and fixation devices for a fracture reduction. Currently, to the best of our knowledge there is no computer assisted methods to plan an entire fracture reduction process. This paper presents an overall scheme of the computer based process for planning a bone fracture reduction, as described above, and details its main steps, the most common proposed techniques and their main shortcomings. In addition, challenges and new trends of this research field are depicted and analyzed.

  19. Planning the Surgical Correction of Spinal Deformities: Toward the Identification of the Biomechanical Principles by Means of Numerical Simulation (United States)

    Galbusera, Fabio; Bassani, Tito; La Barbera, Luigi; Ottardi, Claudia; Schlager, Benedikt; Brayda-Bruno, Marco; Villa, Tomaso; Wilke, Hans-Joachim


    In decades of technical developments after the first surgical corrections of spinal deformities, the set of devices, techniques, and tools available to the surgeons has widened dramatically. Nevertheless, the rate of complications due to mechanical failure of the fixation or the instrumentation remains rather high. Indeed, basic and clinical research about the principles of deformity correction and the optimal surgical strategies (i.e., the choice of the fusion length, the most appropriate instrumentation, and the degree of tolerable correction) did not progress as much as the implantable devices and the surgical techniques. In this work, a software approach for the biomechanical simulation of the correction of patient-specific spinal deformities aimed to the identification of its biomechanical principles is presented. The method is based on three-dimensional reconstructions of the spinal anatomy obtained from biplanar radiographic images. A user-friendly graphical user interface allows for the planning of the desired deformity correction and to simulate the implantation of pedicle screws. Robust meshing of the instrumented spine is provided by using consolidated computational geometry and meshing libraries. Based on a finite element simulation, the program is able to predict the loads and stresses acting in the instrumentation as well as those in the biological tissues. A simple test case (reduction of a low-grade spondylolisthesis at L3–L4) was simulated as a proof of concept, and showed plausible results. Despite the numerous limitations of this approach which will be addressed in future implementations, the preliminary outcome is promising and encourages a wide effort toward its refinement. PMID:26579518

  20. The Use of Laparoscopy Simulation to Explore Gender Differences in Resident Surgical Confidence (United States)

    White, Eliza E.; Goodman, Linnea R.; Mohr, Catherine; Dutta, Sanjeev; Zanotti, Kristine M.


    Background. The objective of this study was to determine whether female surgical residents underestimate their surgical abilities relative to males on a standardized test of laparoscopic skill. Methods. Twenty-six male and female general surgery residents and 25 female obstetrics and gynecology residents at two academic centers were asked to predict their score prior to undergoing the Fundamentals of Laparoscopic Surgery standardized skills exam. Actual and predicted score as well as delta values (predicted score minus actual score) were compared between residents. Multivariate linear regression was used to determine variables associated with predicted score, actual score, and delta scores. Results. There was no difference in actual score based on residency or gender. Predicted scores, however, were significantly lower in female versus male general surgery residents (25.8 ± 13.3 versus 56.0 ± 16.0; p < 0.01) and in female obstetrics and gynecology residents versus male general surgery residents (mean difference 20.9, 95% CI 11.6–34.8; p < 0.01). Male residents more accurately predicted their scores while female residents significantly underestimated their scores. Conclusion. Gender differences in estimating surgical ability exist that do not reflect actual differences in performance. This finding needs to be considered when structuring mentorship in surgical training programs. PMID:28203253

  1. The Use of Laparoscopy Simulation to Explore Gender Differences in Resident Surgical Confidence

    Directory of Open Access Journals (Sweden)

    Rebecca L. Flyckt


    Full Text Available Background. The objective of this study was to determine whether female surgical residents underestimate their surgical abilities relative to males on a standardized test of laparoscopic skill. Methods. Twenty-six male and female general surgery residents and 25 female obstetrics and gynecology residents at two academic centers were asked to predict their score prior to undergoing the Fundamentals of Laparoscopic Surgery standardized skills exam. Actual and predicted score as well as delta values (predicted score minus actual score were compared between residents. Multivariate linear regression was used to determine variables associated with predicted score, actual score, and delta scores. Results. There was no difference in actual score based on residency or gender. Predicted scores, however, were significantly lower in female versus male general surgery residents (25.8 ± 13.3 versus 56.0 ± 16.0; p<0.01 and in female obstetrics and gynecology residents versus male general surgery residents (mean difference 20.9, 95% CI 11.6–34.8; p<0.01. Male residents more accurately predicted their scores while female residents significantly underestimated their scores. Conclusion. Gender differences in estimating surgical ability exist that do not reflect actual differences in performance. This finding needs to be considered when structuring mentorship in surgical training programs.

  2. Diagnosis and surgical treatment of defects in the wall of the orbit of children and adults using demineralized bone allografts. (United States)

    Ryabov, Alexey; Lekishvili, Mikhail


    Accuracy of diagnosis defines the quality of treatment in patients with traumatic damage to eyelet walls. In this area, complex functional and anatomical breaches are typical and require full characterization of pathological changes in bone and soft tissue structures. A new plastic material with a high degree level of demineralization called "Perfoost" can be used to treat defects in the bones of the face of children and adults. In the present study, 79 patients with fractured eyelet walls were treated between 1999 and 2006 by grafting the defect wall with demineralized bone allografts. Grafts were applied from 2 days to 18 months after trauma. Magnetic resonance computer CT was used to check the realignment of allografts every 6 months after the reconstructive operation. The post-operative period of the observation was from 6 months to 7 years after the operation. Good or satisfactory results were obtained for 97.47 % of patients.

  3. Does mechanical stimulation really protect the architecture of trabecular bone? A simulation study. (United States)

    Maurer, Manfred M; Weinkamer, Richard; Müller, Ralph; Ruffoni, Davide


    Although it is beyond doubt that mechanical stimulation is crucial to maintain bone mass, its role in preserving bone architecture is much less clear. Commonly, it is assumed that mechanics helps to conserve the trabecular network since an "accidental" thinning of a trabecula due to a resorption event would result in a local increase of load, thereby activating bone deposition there. However, considering that the thin trabecula is part of a network, it is not evident that load concentration happens locally on the weakened trabecula. The aim of this work was to clarify whether mechanical load has a protective role for preserving the trabecular network during remodeling. Trabecular bone is made dynamic by a remodeling algorithm, which results in a thickening/thinning of trabeculae with high/low strain energy density. Our simulations show that larger deviations from a regular cubic lattice result in a greater loss of trabeculae. Around lost trabeculae, the remaining trabeculae are on average thinner. More generally, thin trabeculae are more likely to have thin trabeculae in their neighborhood. The plausible consideration that a thin trabecula concentrates a higher amount of strain energy within itself is therefore only true when considering a single isolated trabecula. Mechano-regulated remodeling within a network-like architecture leads to local concentrations of thin trabeculae.

  4. An Evaluation of the Diagnostic Accuracy of the Grade of Preoperative Biopsy Compared to Surgical Excision in Chondrosarcoma of the Long Bones

    Directory of Open Access Journals (Sweden)

    Robert Jennings


    Full Text Available Chondrosarcoma is the second most common primary malignant bone tumour. Distinguishing between grades is not necessarily straightforward and may alter the disease management. We evaluated the correlation between histological grading of the preoperative image-guided needle biopsy and the resection specimen of 78 consecutive cases of chondrosarcoma of the femur, humerus, and tibia. In 11 instances, there was a discrepancy in histological grade between the biopsy and surgical specimen. Therefore, there was an 85.9% (67/78 accuracy rate for pre-operative histological grading of chondrosarcoma, based on needle biopsy. However, the accuracy of the diagnostic biopsy to distinguish low-grade from high-grade chondrosarcoma was 93.6% (73/78. We conclude that accurate image-guided biopsy is a very useful adjunct in determining histological grade of chondrosarcoma and the subsequent treatment plan. At present, a multidisciplinary approach, comprising experienced orthopaedic surgeons, radiologists, and pathologists, offers the most reliable means of accurately diagnosing and grading of chondrosarcoma of long bones.

  5. Transverse and Oblique Long Bone Fracture Evaluation by Low Order Ultrasonic Guided Waves: A Simulation Study

    Directory of Open Access Journals (Sweden)

    Ying Li


    Full Text Available Ultrasonic guided waves have recently been used in fracture evaluation and fracture healing monitoring. An axial transmission technique has been used to quantify the impact of the gap breakage width and fracture angle on the amplitudes of low order guided wave modes S0 and A0 under a 100 kHz narrowband excitation. In our two dimensional finite-difference time-domain (2D-FDTD simulation, the long bones are modeled as three layers with a soft tissue overlay and marrow underlay. The simulations of the transversely and obliquely fractured long bones show that the amplitudes of both S0 and A0 decrease as the gap breakage widens. Fixing the crack width, the increase of the fracture angle relative to the cross section perpendicular to the long axis enhances the amplitude of A0, while the amplitude of S0 shows a nonmonotonic trend with the decrease of the fracture angle. The amplitude ratio between the S0 and A0 modes is used to quantitatively evaluate the fracture width and angles. The study suggests that the low order guided wave modes S0 and A0 have potentials for transverse and oblique bone fracture evaluation and fracture healing monitoring.

  6. Large eddy simulation of the pharyngeal airflow associated with obstructive sleep apnea syndrome at pre and post-surgical treatment. (United States)

    Mihaescu, Mihai; Mylavarapu, Goutham; Gutmark, Ephraim J; Powell, Nelson B


    Obstructive Sleep Apnea Syndrome (OSAS) is the most common sleep-disordered breathing medical condition and a potentially life-threatening affliction. Not all the surgical or non-surgical OSAS therapies are successful for each patient, also in part because the primary factors involved in the etiology of this disorder are not completely understood. Thus, there is a need for improving both diagnostic and treatment modalities associated with OSAS. A verified and validated (in terms of mean velocity and pressure fields) Large Eddy Simulation approach is used to characterize the abnormal pharyngeal airflow associated with severe OSAS and its interaction with the airway wall in a subject who underwent surgical treatment. The analysis of the unsteady flow at pre- and post-treatment is used to illustrate the airflow dynamics in the airway associated with OSAS and to reveal as well, the changes in the flow variables after the treatment. At pre-treatment, large airflow velocity and wall shear stress values were found at the obstruction site in all cases. Downstream of obstruction, flow separation generated flow recirculation regions and enhanced the turbulence production in the jet-like shear layers. The interaction between the generated vortical structures and the pharyngeal airway wall induced large fluctuations in the pressure forces acting on the pharyngeal wall. After the surgery, the flow field instabilities vanished and both airway resistance and wall shear stress values were significantly reduced.

  7. Surgical rehearsal platform: potential uses in microsurgery. (United States)

    Bambakidis, Nicholas C; Selman, Warren R; Sloan, Andrew E


    Surgical training has remained remarkably similar in many respects since the early days of halstedian training. Neurosurgery is a demanding field that requires extensive cognitive, perceptive, and technical training. Surgical simulation is a promising approach to facilitate acquiring proficiency in neurosurgical procedures. Simulation can permit mentoring trainees in a "safe" environment. By incorporating images that depict specific abnormalities in actual patients, simulation can provide realistic rehearsal for any given case for both novice and experienced surgeons in much the same way that data acquired from drones can be used to allow pilots to rehearse mission-critical maneuvers in a simulator before taking flight. Most neurosurgical simulators to date have focused on endovascular procedures, spinal procedures, temporal bone dissection, and stereotactic procedures. The use of simulator technology for microsurgery is in its infancy. This article describes a novel simulator technology developed by Surgical Theater LLC ( called the Selman Surgical Rehearsal Platform. The platform shows promise for use in intracranial microvascular procedures, which require experience that is becoming increasingly limited for trainees who have to become proficient in more procedures in much less time than ever before.

  8. Stereolithography in oral implantology: a comparison of surgical guides. (United States)

    Sammartino, Gilberto; Della Valle, Antonio; Marenzi, Gaetano; Gerbino, Salvatore; Martorelli, Massimo; di Lauro, Alessandro Espedito; di Lauro, Francesco


    This article presents the use of stereolithography in oral implantology. Stereolithography is a new technology that can produce physical models by selectively solidifying an ultraviolet-sensitive liquid resin using a laser beam, reproducing the true maxillary and mandibular anatomic dimensions. With these models, it is possible to fabricate surgical guides that can place the implants in vivo in the same places and same directions as those in the planned computer simulation. A 70-year-old woman, in good health, with severe mandibular bone atrophy was rehabilitated with an over-denture supported by 2 Branemark implants. Two different surgical planning methods were considered: 1) the construction of a surgical guide evaluating clinical aspects, and 2) the surgical guide produced by stereolithographic study. The accuracy of surgical planning can reduce the problems related to bone density and dimensions. Furthermore, the stereolithographic study assured the clinicians of a superior location of fixtures in bone. Surgical planning based on stereolithographic technique is a safe procedure and has many advantages. This technologic advance has biologic and therapeutic benefits because it simplifies anatomic surgical management for improved implant placement.

  9. Effectiveness, usability, and acceptability of haptic-enabled virtual reality and mannequin modality simulators for surgical cricothyroidotomy. (United States)

    Proctor, Michael D; Campbell-Wynn, Lillian


    This research assesses the effectiveness, usability, and acceptability of mannequin and haptic-enabled virtual reality (VR) modality simulators by Army medics in a surgical cricothyroidotomy procedure. Research methods investigate through experimentation surgical task performance, technology acceptance, user recommendation, comparative analysis, and select cognitive task load results. Results indicate that the HapMed mannequin and CricSim VR simulators proved effective by meeting training task performance evaluation requirements. Both systems meet 95% user technology acceptance and 85% user recommendation levels. In conclusion, at those levels, either system may complement, reduce, or replace the use of some alternative training methods such as animals or cadavers. To raise recommendation rates, future research needs to reduce barriers to blending visualization with mannequin modalities and make further refinements within the modalities. One research pathway identified blends a mannequin with stereoscopic visualization and motion parallax, providing correlated, partially transparent visual layers of anatomy and of various medical procedures in virtual overlay with the mannequin. Future research also needs to clarify acceptable degrees of freedom levels by task for haptics VR in light of real-world degrees of freedom requirements. Finally, artificial skin may need research to achieve better replication of human skin on mannequins.

  10. Effects of Zoledronate and Mechanical Loading during Simulated Weightlessness on Bone Structure and Mechanical Properties (United States)

    Scott, R. T.; Nalavadi, M. O.; Shirazi-Fard, Y.; Castillo, A. B.; Alwood, J. S.


    Space flight modulates bone remodeling to favor bone resorption. Current countermeasures include an anti-resorptive drug class, bisphosphonates (BP), and high-force loading regimens. Does the combination of anti-resorptives and high-force exercise during weightlessness have negative effects on the mechanical and structural properties of bone? In this study, we implemented an integrated model to mimic mechanical strain of exercise via cyclical loading (CL) in mice treated with the BP Zoledronate (ZOL) combined with hindlimb unloading (HU). Our working hypothesis is that CL combined with ZOL in the HU model induces additive structural and mechanical changes. Thirty-two C57BL6 mice (male,16 weeks old, n8group) were exposed to 3 weeks of either HU or normal ambulation (NA). Cohorts of mice received one subcutaneous injection of ZOL (45gkg), or saline vehicle, prior to experiment. The right tibia was axially loaded in vivo, 60xday to 9N in compression, repeated 3xweek during HU. During the application of compression, secant stiffness (SEC), a linear estimate of slope of the force displacement curve from rest (0.5N) to max load (9.0N), was calculated for each cycle once per week. Ex vivo CT was conducted on all subjects. For ex vivo mechanical properties, non-CL left femurs underwent 3-point bending. In the proximal tibial metaphysis, HU decreased, CL increased, and ZOL increased the cancellous bone volume to total volume ratio by -26, +21, and +33, respectively. Similar trends held for trabecular thickness and number. Ex vivo left femur mechanical properties revealed HU decreased stiffness (-37),and ZOL mitigated the HU stiffness losses (+78). Data on the ex vivo Ultimate Force followed similar trends. After 3 weeks, HU decreased in vivo SEC (-16). The combination of CL+HU appeared additive in bone structure and mechanical properties. However, when HU + CL + ZOL were combined, ZOL had no additional effect (p0.05) on in vivo SEC. Structural data followed this trend with

  11. The Relationship of Endoscopic Proficiency to Educational Expense for Virtual Reality Simulator Training Amongst Surgical Trainees. (United States)

    Raque, Jessica; Goble, Adam; Jones, Veronica M; Waldman, Lindsey E; Sutton, Erica


    With the introduction of Fundamentals of Endoscopic Surgery, training methods in flexible endoscopy are being augmented with simulation-based curricula. The investment for virtual reality simulators warrants further research into its training advantage. Trainees were randomized into bedside or simulator training groups (BED vs SIM). SIM participated in a proficiency-based virtual reality curriculum. Trainees' endoscopic skills were rated using the Global Assessment of Gastrointestinal Endoscopic Skills (GAGES) in the patient care setting. The number of cases to reach 90 per cent of the maximum GAGES score and calculated costs of training were compared. Nineteen residents participated in the study. There was no difference in the average number of cases required to achieve 90 per cent of the maximum GAGES score for esophagogastroduodenoscopy, 13 (SIM) versus11 (BED) (P = 0.63), or colonoscopy 21 (SIM) versus 4 (BED) (P = 0.34). The average per case cost of training for esophagogastroduodenoscopy was $35.98 (SIM) versus $39.71 (BED) (P = 0.50), not including the depreciation costs associated with the simulator ($715.00 per resident over six years). Use of a simulator appeared to increase the cost of training without accelerating the learning curve or decreasing faculty time spent in instruction. The importance of simulation in endoscopy training will be predicated on more cost-effective simulators.

  12. Preserving plantar flexion strength after surgical treatment for contracture of the triceps surae: a computer simulation study. (United States)

    Delp, S L; Statler, K; Carroll, N C


    Contractures of the triceps surae commonly are treated by surgical lengthening of the gastrocnemius aponeurosis or the Achilles tendon. Although these procedures generally relieve contractures, patients sometimes are left with dramatically decreased plantar flexion strength (i.e., decreased capacity to generate plantar flexion moment). The purpose of this study was to examine the trade-off between restoring range of motion and maintaining plantar flexion strength after surgical treatment for contracture of the triceps surae. A computer model representing the normal moment-generating characteristics of the triceps surae was altered to represent two conditions: isolated contracture of the gastrocnemius and contracture of both the gastrocnemius and the soleus. The effects of lengthening the gastrocnemius aponeurosis and the Achilles tendon were simulated for each condition. The simulations showed that nearly normal moment-generating characteristics could be restored when isolated gastrocnemius contracture was treated with lengthening of the gastrocnemius aponeurosis. However, when isolated gastrocnemius contracture was treated with lengthening of the Achilles tendon, the moment-generating capacity of the plantar flexors decreased greatly. This suggests that lengthening of the Achilles tendon should be avoided in persons with isolated gastrocnemius contracture. Our simulations also suggest that neither lengthening of the gastrocnemius aponeurosis nor lengthening of the Achilles tendon by itself is an effective treatment for combined contracture of the gastrocnemius and soleus. Lengthening the gastrocnemius aponeurosis did not decrease the excessive passive moment developed by the contracted soleus. Lengthening the Achilles tendon restored the normal passive range of motion but substantially decreased the active force-generating capacity of the muscles.(ABSTRACT TRUNCATED AT 250 WORDS)

  13. Basic Endovascular Skills Trainer: A surgical simulator for the training of novice practitioners of endovascular procedures. (United States)

    Sinceri, S; Carbone, M; Marconi, M; Moglia, A; Ferrari, M; Ferrari, V


    In recent years the clinical interest for structured training in endovascular procedures has increased. Such procedures respect the physical integrity of the patient and at the same time ensure good therapeutic results. This study describes the development and testing of the B.E.S.T. (Basic Endovascular Skills Trainer) simulator. The B.E.S.T is an innovative physical endovascular simulator to learn basic skills of endovascular surgery. The simulator was tested by 25 clinicians with different levels of experience: novices, intermediates, and experts. All clinicians agree on affirming the importance of training in endovascular surgery; in particular they consider the B.E.S.T a valid simulator to learn specific basic skills of vascular surgery.

  14. VR-simulation cataract surgery in non-experienced trainees: evolution of surgical skill (United States)

    Söderberg, Per; Erngrund, Markus; Skarman, Eva; Nordh, Leif; Laurell, Carl-Gustaf


    Conclusion: The current data imply that the performance index as defined herein is a valid measure of the performance of a trainee using the virtual reality phacoemulsification simulator. Further, the performance index increase linearly with measurement cycles for less than five measurement cycles. To fully use the learning potential of the simulator more than four measurement cycles are required. Materials and methods: Altogether, 10 trainees were introduced to the simulator by an instructor and then performed a training program including four measurement cycles with three iterated measurements of the simulation at the end of each cycle. The simulation characteristics was standardized and defined in 14 parameters. The simulation was measured separately for the sculpting phase in 21 variables, and for the evacuation phase in 22 variables. A performance index based on all measured variables was estimated for the sculpting phase and the evacuation phase, respectively, for each measurement and the three measurements for each cycle were averaged. Finally, the performance as a function of measurement cycle was estimated for each trainee with regression, assuming a straight line. The estimated intercept and inclination coefficients, respectively, were finally averaged for all trainees. Results: The performance increased linearly with the number of measurement cycles both for the sculpting and for the evacuation phase.

  15. Three-dimensional computer-assisted surgical simulation and intraoperative navigation in orthognathic surgery: a literature review. (United States)

    Lin, Hsiu-Hsia; Lo, Lun-Jou


    By incorporating three-dimensional (3D) imaging and computer-aided design and manufacturing techniques, 3D computer-assisted technology has been applied widely to provide accurate guidance for assessment and treatment planning in clinical practice. This technology has recently been used in orthognathic surgery to improve surgical planning and outcome. The modality will gradually become popular. This study reviewed the literature concerning the use of computer-assisted techniques in orthognathic surgery including surgical planning, simulation, intraoperative translation of the virtual surgery, and postoperative evaluation. A Medline, PubMed, ProQuest, and ScienceDirect search was performed to find relevant articles with regard to 3D computer-assisted orthognathic surgery in the past 10 years. A total of 460 articles were revealed, out of which 174 were publications addressed the topic of this study. The purpose of this article is to present an overview of the state-of-art methods for 3D computer-assisted technology in orthognathic surgery. From the review we can conclude that the use of computer-assisted technique in orthognathic surgery provides the benefit of optimal functional and aesthetic results, patient satisfaction, precise translation of the treatment plan, and facilitating intraoperative manipulation.

  16. Bone cutting. (United States)

    Giraud, J Y; Villemin, S; Darmana, R; Cahuzac, J P; Autefage, A; Morucci, J P


    Bone cutting has always been a problem for surgeons because bone is a hard living material, and many osteotomes are still very crude tools. Technical improvement of these surgical tools has first been their motorization. Studies of the bone cutting process have indicated better features for conventional tools. Several non-conventional osteotomes, particularly ultrasonic osteotomes are described. Some studies on the possible use of lasers for bone cutting are also reported. Use of a pressurised water jet is also briefly examined. Despite their advantages, non-conventional tools still require improvement if they are to be used by surgeons.

  17. Contemporary virtual reality laparoscopy simulators: quicksand or solid grounds for assessing surgical trainees?

    NARCIS (Netherlands)

    A.S. Thijssen; M.P. Schijven


    BACKGROUND: A demand for safe, efficient laparoscopic training tools has prompted the introduction of virtual reality (VR) laparoscopic simulators, which might be used for performance assessment. The purpose of this review is to determine the value of VR metrics in laparoscopic skills assessment. DA

  18. Abortion - surgical (United States)

    Suction curettage; Surgical abortion; Elective abortion - surgical; Therapeutic abortion - surgical ... Surgical abortion involves dilating the opening to the uterus (cervix) and placing a small suction tube into the uterus. ...

  19. Reduction of Biomechanical Models for Subject Specific Real-Time Simulation of Surgical Trocar Insertion


    Channa Naik, Ravi Kumar


    Trocar insertion is the first step in Laparoscopy, Thoracoscopy and most other micro surgery procedures. It is a difficult procedure to learn and practice because procedure is carried out almost entirely without any visual feedback of the organs underlying the tissues being punctured. A majority of injuries is attributed to excessive use of force by surgeons. Practicing on cadavers and synthetic tissues may not accurately simulate the process. So there is a need for haptic based computer simu...

  20. Modeling and simulation of physical performance of a external unilateral mechatronic orthopaedic fixator - bone system. (United States)

    Lesniewska, A; Choromanski, W; Deszczynski, J; Dobrzynski, G


    Restricted element study of the fracture healing by external fixation device was investigated. The analyses were performed under an axial and variable loaded boundary conditions. The effect of different fracture size and different distance between bone and the external fixator device on the stress distribution was investigated. The results show that stresses in the external fixator device are highest at the beginning of the fracture healing process, and are gradually decreasing with the time of the treatment. The analyses were carried out using the commercial package CATIA P3 V5R11. This allowed to build a three-dimensional model more similar to the geometrical architecture of the long bone as well as of the external fixator. Three-dimensional restricted element model also allowed a collection of more realistic results. However, the accuracy of the results depends not only on the quality of the model geometry but also on the material properties assigned to the model components. It also depends on the accuracy in the simulation of the finite element model and the optimized mesh generation.

  1. High-Speed Burring with and without the Use of Surgical Adjuvants in the Intralesional Management of Giant Cell Tumor of Bone: A Systematic Review and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    H. Algawahmed


    Full Text Available Local control rates for Giant Cell Tumor of Bone (GCT have been reported in a large number of retrospective series. However, there remains a lack of consensus with respect to the need for a surgical adjuvant when intralesional curettage is performed. We have systematically reviewed the literature and identified six studies in which two groups from the same patient cohort were treated with intralesional curettage and high-speed burring with or without a chemical or thermal adjuvant. Studies were evaluated for quality and pooled data was analyzed using the fixed effects model. Data from 387 patients did not indicate improved local control with the use of surgical adjuvants. Given the available data, we conclude that surgical adjuvants are not required when meticulous tumor removal is performed.

  2. High-Speed Burring with and without the Use of Surgical Adjuvants in the Intralesional Management of Giant Cell Tumor of Bone: A Systematic Review and Meta-Analysis. (United States)

    Algawahmed, H; Turcotte, Robert; Farrokhyar, F; Ghert, M


    Local control rates for Giant Cell Tumor of Bone (GCT) have been reported in a large number of retrospective series. However, there remains a lack of consensus with respect to the need for a surgical adjuvant when intralesional curettage is performed. We have systematically reviewed the literature and identified six studies in which two groups from the same patient cohort were treated with intralesional curettage and high-speed burring with or without a chemical or thermal adjuvant. Studies were evaluated for quality and pooled data was analyzed using the fixed effects model. Data from 387 patients did not indicate improved local control with the use of surgical adjuvants. Given the available data, we conclude that surgical adjuvants are not required when meticulous tumor removal is performed.

  3. Combining Latin Hypercube Designs and Discrete Event Simulation in a Study of a Surgical Unit

    DEFF Research Database (Denmark)

    Dehlendorff, Christian; Andersen, Klaus Kaae; Kulahci, Murat

    Summary form given only:In this article experiments on a discrete event simulation model for an orthopedic surgery are considered. The model is developed as part of a larger project in co-operation with Copenhagen University Hospital in Gentofte. Experiments on the model are performed by using...... Latin hypercube designs. The parameter set consists of system settings such as use of preparation room for sedation and the number of operating rooms, as well as management decisions such as staffing, size of the recovery room and the number of simultaneously active operating rooms. Sensitivity analysis...

  4. The role of simulation in the development of endovascular surgical skills. (United States)

    Nesbitt, Craig Iain; Birdi, Nikhil; Mafeld, Sebastian; Stansby, Gerrard


    Endovascular trainees in the National Health Service still largely rely on the apprentice-apprenticeship model from the late 19th century. As the scope for endovascular therapy increases, due to the rapid innovation, evolution and refinement of technology, so too do patients' therapeutic options. This climate has also opened the door for more novel training adjuncts, to address the gaps that exist in our current endovascular training curriculum. The aim of this paper is to present a succinct overview of endovascular simulation, synthesizing the trials and research behind this rapidly evolving training as well as highlighting areas where further research is required. The authors searched MEDLINE and EMBASE for relevant manuscripts on all aspects of endovascular simulation training. A comprehensive Google search was also undertaken to look for any relevant information on endovascular training courses available and any unpublished work that had been presented at relevant scientific meetings. Papers were categorized into the four models: synthetic, animal, virtual reality and human cadaver, and separate searches for evidence of skill transfer were also undertaken. Authors of novel research projects were contacted for further details of unpublished work and permission granted to report such findings in this manuscript.

  5. A numerical simulation of the effect of using porous superelastic Nitinol and stiff Titanium fixation hardware on the bone remodeling (United States)

    Raad, Bahram; Shayesteh Moghaddam, Narges; Elahinia, Mohammad


    The aim of this article is to investigate the effect of two different fixation hardware materials on bone remodeling after a mandibular reconstruction surgery and to restore the mandible's function, healthy appearance, mastication, swallowing, breathing, and speech. The hypothesis is that using fixation hardware with stiffness close to that of the surrounding bone will result in a more successful healing process in the mandible bone. The finite element model includes the material properties and forces of the cancellous bone, cortical bone, ligaments, muscles, and teeth. The reconstruction surgery is modeled by including the fixation hardware and the grafted bone. In the sectioned mandible, to best mimic the geometry of the mandible, two single barrel grafts are placed at the top of each other to form a double barrel graft set. Two different materials were used as the mandibular fixation parts, stiff Ti-6Al-4V, and porous superelastic Nickel-Titanium (NiTi) alloys. A comparison of these two alloys demonstrates that using porous NiTi alloy as the fixation part results in a faster healing pace. Furthermore, the density distribution in the mandibular bone after the healing process is more similar to the normal mandible density distribution. The simulations results indicate that the porous superelastic NiTi fixation hardware transfers and distributes the existing forces on the mandible bone more favorably. The probability of stress shielding and/or stress concentration decrease. This type of fixation hardware, therefore, is more appropriate for mandible bone reconstruction surgery. These predictions are in agreement with the clinical observations.

  6. Clinical evaluation of regenerative potential of type I collagen membrane along with xenogenic bone graft in the treatment of periodontal intrabony defects assessed with surgical re-entry and radiographic linear and densitometric analysis

    Directory of Open Access Journals (Sweden)

    Sowmya N


    Full Text Available Background and Objectives: The primary goal of periodontal therapy is to restore the tooth supporting tissues lost due to periodontal disease. The aim of the present study was to compare the efficacy of combination of type I collagen (GTR membrane and xenogenic bone graft with open flap debridement (OFD in treatment of periodontal intrabony defects. Materials and Methods: Twenty paired intrabony defects were surgically treated using split mouth design. The defects were randomly assigned to treatment with OFD + collagen membrane + bone graft (Test or OFD alone (Control. The clinical efficacy of two treatment modalities was evaluated at 9 month postoperatively by clinical, radiographical, and intrasurgical (re-entry parameters. The measurements included probing pocket depth (PD, clinical attachment level (CAL, gingival recession (GR, bone fill (BF, bone density (BD and intra bony component (INTRA. Results: The mean reduction in PD at 0-9 month was 3.3±0.82 mm and CAL gain of 3.40±1.51 mm occurred in the collagen membrane + bone graft (Test group; corresponding values for OFD (Control were 2.20±0.63 mm and 1.90±0.57 mm. Similar pattern of improvement was observed when radiographical and intra-surgical (re-entry post operative evaluation was made. All improvement in different parameters was statistically significant (P< 0.01. Interpretation and Conclusion: Treatment with a combination of collagen membrane and bone graft led to a significantly more favorable clinical outcome in intrabony defects as compared to OFD alone.

  7. Evaluation of Veterinary Student Surgical Skills Preparation for Ovariohysterectomy Using Simulators: A Pilot Study. (United States)

    Read, Emma K; Vallevand, Andrea; Farrell, Robin M


    This paper describes the development and evaluation of training intended to enhance students' performance on their first live-animal ovariohysterectomy (OVH). Cognitive task analysis informed a seven-page lab manual, 30-minute video, and 46-item OVH checklist (categorized into nine surgery components and three phases of surgery). We compared two spay simulator models (higher-fidelity silicone versus lower-fidelity cloth and foam). Third-year veterinary students were randomly assigned to a training intervention: lab manual and video only; lab manual, video, and $675 silicone-based model; lab manual, video, and $64 cloth and foam model. We then assessed transfer of training to a live-animal OVH. Chi-square analyses determined statistically significant differences between the interventions on four of nine surgery components, all three phases of surgery, and overall score. Odds ratio analyses indicated that training with a spay model improved the odds of attaining an excellent or good rating on 25 of 46 checklist items, six of nine surgery components, all three phases of surgery, and the overall score. Odds ratio analyses comparing the spay models indicated an advantage for the $675 silicon-based model on only 6 of 46 checklist items, three of nine surgery components, and one phase of surgery. Training with a spay model improved performance when compared to training with a manual and video only. Results suggested that training with a lower-fidelity/cost model might be as effective when compared to a higher-fidelity/cost model. Further research is required to investigate simulator fidelity and costs on transfer of training to the operational environment.

  8. Electrical Bioimpedance-Controlled Surgical Instrumentation. (United States)

    Brendle, Christian; Rein, Benjamin; Niesche, Annegret; Korff, Alexander; Radermacher, Klaus; Misgeld, Berno; Leonhardt, Steffen


    A bioimpedance-controlled concept for bone cement milling during revision total hip replacement is presented. Normally, the surgeon manually removes bone cement using a hammer and chisel. However, this procedure is relatively rough and unintended harm may occur to tissue at any time. The proposed bioimpedance-controlled surgical instrumentation improves this process because, for example, most risks associated with bone cement removal are avoided. The electrical bioimpedance measurements enable online process-control by using the milling head as both a cutting tool and measurement electrode at the same time. Furthermore, a novel integrated surgical milling tool is introduced, which allows acquisition of electrical bioimpedance data for online control; these data are used as a process variable. Process identification is based on finite element method simulation and on experimental studies with a rapid control prototyping system. The control loop design includes the identified process model, the characterization of noise as being normally distributed and the filtering, which is necessary for sufficient accuracy ( ±0.5 mm). Also, in a comparative study, noise suppression is investigated in silico with a moving average filter and a Kalman filter. Finally, performance analysis shows that the bioimpedance-controlled surgical instrumentation may also performs effectively at a higher feed rate (e.g., 5 mm/s).

  9. Simulation of mechanical behavior and optimization of simulated injection molding process for PLA based antibacterial composite and nanocomposite bone screws using central composite design. (United States)

    Heidari, Behzad Shiroud; Oliaei, Erfan; Shayesteh, Hadi; Davachi, Seyed Mohammad; Hejazi, Iman; Seyfi, Javad; Bahrami, Mozhgan; Rashedi, Hamid


    In this study, injection molding of three poly lactic acid (PLA) based bone screws was simulated and optimized through minimizing the shrinkage and warpage of the bone screws. The optimization was carried out by investigating the process factors such as coolant temperature, mold temperature, melt temperature, packing time, injection time, and packing pressure. A response surface methodology (RSM), based on the central composite design (CCD), was used to determine the effects of the process factors on the PLA based bone screws. Upon applying the method of maximizing the desirability function, optimization of the factors gave the lowest warpage and shrinkage for nanocomposite PLA bone screw (PLA9). Moreover, PLA9 has the greatest desirability among the selected materials for bone screw injection molding. Meanwhile, a finite element analysis (FE analysis) was also performed to determine the force values and concentration points which cause yielding of the screws under certain conditions. The Von-Mises stress distribution showed that PLA9 screw is more resistant against the highest loads as compared to the other ones. Finally, according to the results of injection molding simulations, the design of experiments (DOE) and structural analysis, PLA9 screw is recommended as the best candidate for the production of biomedical materials among all the three types of screws.

  10. Numerical simulation on the adaptation of forms in trabecular bone to mechanical disuse and basic multi-cellular unit activation threshold at menopause (United States)

    Gong, He; Fan, Yubo; Zhang, Ming


    The objective of this paper is to identify the effects of mechanical disuse and basic multi-cellular unit (BMU) activation threshold on the form of trabecular bone during menopause. A bone adaptation model with mechanical- biological factors at BMU level was integrated with finite element analysis to simulate the changes of trabecular bone structure during menopause. Mechanical disuse and changes in the BMU activation threshold were applied to the model for the period from 4 years before to 4 years after menopause. The changes in bone volume fraction, trabecular thickness and fractal dimension of the trabecular structures were used to quantify the changes of trabecular bone in three different cases associated with mechanical disuse and BMU activation threshold. It was found that the changes in the simulated bone volume fraction were highly correlated and consistent with clinical data, and that the trabecular thickness reduced significantly during menopause and was highly linearly correlated with the bone volume fraction, and that the change trend of fractal dimension of the simulated trabecular structure was in correspondence with clinical observations. The numerical simulation in this paper may help to better understand the relationship between the bone morphology and the mechanical, as well as biological environment; and can provide a quantitative computational model and methodology for the numerical simulation of the bone structural morphological changes caused by the mechanical environment, and/or the biological environment.

  11. Numerical simulation on the adaptation of forms in trabecular bone to mechanical disuse and basic multi-cellular unit activation threshold at menopause

    Institute of Scientific and Technical Information of China (English)

    He Gong; Yubo Fan; Ming Zhang


    The objective of this paper is to identify the effects of mechanical disuse and basic multi-cellular unit (BMU) activation threshold on the form of trabecular bone during menopause. A bone adaptation model with mechanical-biological factors at BMU level was integrated with finite element analysis to simulate the changes of trabecular bone structure during menopause. Mechanical disuse and changes in the BMU activation threshold were applied to the model for the period from 4 years before to 4 years after menopause.The changes in bone volume fraction, trabecular thickness and fractal dimension of the trabecular structures were used to quantify the changes of trabecular bone in three different cases associated with mechanical disuse and BMU activation threshold. It was found that the changes in the simulated bone volume fraction were highly correlated and consistent with clinical data, and that the trabecular thickness reduced signi-ficantly during menopause and was highly linearly correlated with the bone volume fraction, and that the change trend of fractal dimension of the simulated trabecular structure was in correspondence with clinical observations. The numerical simulation in this paper may help to better understand the relationship between the bone morphology and the mecha- nical, as well as biological environment; and can provide a quantitative computational model and methodology for the numerical simulation of the bone structural morphological changes caused by the mechanical environment, and/or the biological environment.

  12. Influences of traditional Chinese medicine intervention on the bone growth and metabolism of rats with simulated weightlessness

    Institute of Scientific and Technical Information of China (English)

    Jun Zhu


    Objective:To probe into the influences ofChinese herbal compound on the growth and metabolism of weight-bearing bones of tail-suspended rats.Methods:Twenty-four maleSD rats were randomly divided into blank control group(eight), tail-suspended control group(eight) and Chinese medicine treatment group(eight) according to their weights.No treatment was done for the blank control group.Double distilled water lavage was performed daily for the tail-suspended control group.On the basis of the tail-suspended rat model, the rats were givenChinese herbal compound lavage every day inChinese medicine treatment group.This compound includes mulberry,Poria cocos and barbary wolfberry,etc.The test cycle was four weeks.The rats were killed after the experiment.The right femoral bone was taken out for the physical measurements, and the left femoral bone was for the three-point bending test.The influences ofChinese herbal compound on femoral bone growth and biomechanical properties of simulated weightlessness rats were observed.Results:(1)After simulated weightlessness(tail-suspension), compared with the blank control group, all the physiological indexes of rat femoral bone decreased in tail-suspended group andChinese medicine treatment group(P<0.05).The strength and rigidity of rat femoral bone decreased in tail-suspended group(P<0.01).The maximum load and rigidity coefficient also decreased with the increasing toughness coefficient in the control group(P<0.01). (2)After the countermeasure ofChinese herbal compound, each biomechanical indexes showed the tendency of increasing inChinese medicine treatment group, and theses indexes were close to those of the blank control group(P<0.05), which indicated that the bone loss caused by simulated weightlessness was improved.Conclusions:Chinese herbal compound for tonifying kidney could effectively prevent the bone loss and have some enhancements on the bone biomechanical properties.

  13. Simulation of fracture of the bone implant with the porous structure (United States)

    Korobenkov, M. V.; Kulkov, S. N.


    Different approaches to bone defects reconstruction with the use of ceramic materials have been developed recently. Ceramics are identical with bone matrix, provide biomedical compatibility with bone tissue and possess high strength. But with an overall high strength ceramic implants destruct in dynamic mode. The paper presents a study of the effect of the porosity gradient on the destruction of the bone implants under dynamic loading. It is shown that the fracture behavior of the bone implants is changed with increasing levels of the gradient of porosity.

  14. Osteoblastomatosis of bone. A benign, multifocal osteoblastic lesion, distinct from osteoid osteoma and osteoblastoma, radiologically simulating a vascular tumor

    Energy Technology Data Exchange (ETDEWEB)

    Kyriakos, Michael [Washington University School of Medicine, Division of Surgical Pathology, Campus Box 8118, St. Louis, MO (United States); El-Khoury, Georges Y. [University of Iowa, Department of Radiology, Roy J. and Lucille A. Carver School of Medicine, Iowa City, IA (United States); McDonald, Douglas J. [Washington University School of Medicine, Department of Orthopaedic Surgery, St. Louis, MO (United States); Buckwalter, Joseph A. [University of Iowa, Department of Orthopaedics, Roy J. and Lucille A. Carver School of Medicine, Iowa City, IA (United States); Sundaram, Murali [Cleveland Clinic Foundation, Department of Radiology, Cleveland, OH (United States); DeYoung, Barry [University of Iowa, Department of Pathology, School of Medicine, Iowa City, IA (United States); O' Brien, Michael P. [University of Wisconsin Hospital, Department of Radiology, Madison, WI (United States)


    Two adult patients are described with multifocal osteolytic lesions radiologically simulating a vascular tumor. One patient had multiple bones involved. Histologically, the individual lesions had the features of the nidus of osteoid osteoma/osteoblastoma. A review of the English language medical literature yielded only one other reported case with similar features. The process is designated as osteoblastomatosis to indicate its bone-forming character, prominent osteoblast proliferation, and multiplicity. The cases are distinguished from multifocal/multicentric osteoid osteoma and osteoblastoma, and from benign and malignant vascular tumors. (orig.)

  15. Surgical Assisting (United States)

    ... Insert and remove Foley urinary bladder catheter Place pneumatic tourniquet Confirm procedure with surgeon Drape patient within ... Technology and Surgical Assisting (NBSTSA) offers the CertifiedSurgical First Assistant (CSFA) credential, and the National Surgical Assistant ...

  16. Bone-like apatite formation on HA/316L stainless steel composite surface in simulated body fluid

    Institute of Scientific and Technical Information of China (English)

    FAN Xin; CHEN Jian; ZOU Jian-peng; WAN Qian; ZHOU Zhong-cheng; RUAN Jian-ming


    HA/316L stainless steel(316L SS) biocomposites were prepared by hot-pressing technique. The formation of bone-like apatite on the biocomposite surfaces in simulated body fluid(SBF) was analyzed by digital pH meter, plasma emission spectrometer, scanning electron microscope(SEM) and energy dispersive X-ray energy spectrometer(EDX). The results indicate that the pH value in SBF varies slightly during the immersion. It is a dynamic process of dissolution-precipitation for the formation of apatite on the surface. With prolonging immersion time, Ca and P ion concentrations increase gradually, and then approach equilibrium. The bone-like apatite layer forms on the composites surface, which possesses benign bioactivity and favorable biocompatibility and achieves osseointegration, and can provide firm fixation between HA60/316L SS composite implants and human body bone.

  17. [The effect of a simulated inflammation procedure in simulated body fluid on bone-like apatite formation on porous HA/beta-TCP bioceramics]. (United States)

    Ji, Jingou; Ran, Junguo; Gou, Li; Wang, Fangfu; Sun, Luwei


    The formation of bone-like apatite on porous HA/beta-TCP bioceramics in dynamic simulated body fluid (SBF) undergoing a simulated inflammation procedure (pH = 6.5) was investigated in order to study the mechanism of osteoinduction and build a new method to choose biomaterials with better bioactivity. The results showed that the surface of porous HA/beta-TCP bioceramics which underwent a simulated inflammation procedure in dynamic SBF was more smooth. The light acidity in the simulated inflammation procedure would dissolve the fine grains and the parts possessing smaller curvature radius on the surface of porous HA/beta-TCP bioceramics, which would reduce the bioceramics solubility. Followed in normal SBF (pH = 7.4), the amount of bone-like apatite formed on the porous HA/beta-TCP bioceramics was less than that of porous HA/beta-TCP bioceramics incubation in normal SBF all along. The results also showed that the amount of bone-like apatite formed on the porous HA/beta-TCP bioceramics sintered by a microwave plasma was more than that of porous HA/beta-TCP bioceramics sintered by a conventional furnace.

  18. 手部骨巨细胞瘤的诊断和手术治疗%Diagnosis and surgical treatment of giant cell tumor in hand bone

    Institute of Scientific and Technical Information of China (English)

    郭阳; 李淳; 田光磊; 姜保国; 赵俊会; 田文; 陈山林; 王海华


    Objective: To review the experience with clinical and imaging characteristics of giant cell tumor (GCT) of the hand as well as the surgical outcomes. Methods; Between 2000 and 2010,16 cases of GCT of the hand were admitted to our department. There were 10 male and 6 female patients with a mean age of 41.3 years ( age range; 24 to 65 years) with Campanacci' s grade I ( n = 0) , Grade H (n = 12) , and Grade HI ( n = 4) . Eight cases occurred in metacarpal bone and 8 cases in phalanx. All patients had the symptoms of pain, swelling and restricted range of motion in the affected joint. The average time from the onset of the symptom to the first visit of the patients was 12 months( range; 5 to 15 months). Radiographic changes showed osteolytic lesions occupying at least half of the diaphyseal region in most of the cases. Four grade IH patients underwent tumor resection and bone graft or serial amputation, while 12 Grade H patients extensive curettage and bone graft. Results; Twelve the patients' clinical and radiographic diagnosis at admission was endochondroma, while post-operative histopathology reported all the lesions as GCT. Twelve patients were followed up for a mean of 58. 8 months ( range; 24 to 140 months). Immediate relief of pain was observed post-operatively in all patients. No complications, such as infection or joint stiffness, were observed in any patient. The average healing time of bone graft was 3. 3 months ( range; 3 to 5 months). Ten grade II patients were followed up for at least 2 years and 3 of them had local recurrence 8 to 16 months after first resection. En bloc resection was then performed, and no second reccurence was reported. Two grade II patients were followed up for at least 2 years and none of them had local recurrence. No malignancy, multiple center lesion or lung metastasis was reported. Active range of motion in the patients without joint arthrodesis was maintained during the follow-up period. Conclusion; GCTs of the hand are

  19. 肩胛带骨肿瘤的外科治疗结果及评价%Surgical treatment of bone tumors of the shoulder girdle

    Institute of Scientific and Technical Information of China (English)

    郭卫; 杨毅; 姬涛


    Objective To evaluate the surgical procedures and both oncological and functional outcome in patients with bone tumors of the shoulder girdle.Methods Seventy-one patients including 61.pts with malignant tumor and 10 pts with giant cell tumors of the shoulder girdle treated in our department from July 1998 to July 2006 were studied retrospectively.According to the location,there were 15 pts with scapula tumor and 56 pts with proximal humeral tumor.Forty-two male pts and 29 female pts were included in this study with an average age of 36.5 years old ranging from 62 years old.Surgical procedures:forequarter amputation in 10 pts;Scapulectomy in 3 pts;Scapulectomy and artificial scapular replacement in 3pts;partial scapulectomy and proximal humerus resection with prosthetic reconstruction in 8 pts;proximal humerus resection and prosthesis replacement in 47 pts.Results Due to adequate soft tissue was preserved,the mean functional score was 28 for the pts with giant cell tumor according to MSTS functional scoring system,compared with the functional score 23 for the pts with malignant tumor because the deltoid muscle insertion was resected in the latter group.Among the thirty-seven patients with osteosarcoma,local recurrence occurred in four cases(10.8%),lung metastasis in five and bone metastasis in two.The seven patients died of disease.One patient iagnosed of malignancy in giant cell tumor died after distal metastasis.thtee patients with Ewing sarcoma died of the disease.No recurrence Wag observed in both five humeral chondrosarcoma and five scapular chondrosarcoma.Conclusion Tumot resection and proximal humeral prostbesis replacement is the optimal method for the sarcoma of shoulder girdle in term of preservation of elbow and hand function.Preservation of abductor insertion is necessary for good abduction function.The metastatic rate of proximal humeral osteosarcoma was lower than that of lower extremities.also the prognosis of oncological outcome

  20. 88例骨科手术切口感染手术护理要点分析%The nursing essentials for surgical wound infection after bone surgery in 88 patients

    Institute of Scientific and Technical Information of China (English)

    郭汉卿; 谢婉萍


    目的 探讨并分析骨科手术后切口的感染情况.方法 2008年3月至2011年3月于我院因骨科就诊并行手术的1884例中发生了感染88例,对其切口类型、患者情况进行问卷调查分类总结,同时,将伤口的感染部分送检区分感染细菌种类.结果 Ⅲ类切口的感染率最高,为2.49%;感染发生在手术的5~8天之间,为61.36%;感染的病原菌以G-杆菌为主,占77.27%.结论 改善手术切口的感染需要提高患者自身的健康卫生知识、加强医护人员对患者的关心及重视和提高院方的控制感染的管理.%Objective To investigate and analyze the occurrence of surgical wound incision after bone surgery.Methods 88 patients who had developed surgical wound infection after bone surgery during the period of March 2008 to March 201 1 were surveyed by questionnaires for types of incision and patient conditions.The infected parts of surgical wound was tested for identifying types of related bacteria.Results Type Ⅲ incision had the highest infection rate of 2.49%.61.36% of the wound infection eccurred 5 to 8 days after bone surgery.G- bacillus was the main pathogenic bacteria,accounting for 77.27%.Conclusions Control of surgical wound infection after bone surgery needs an increase in self knowledge of health,enhancement of patient care from medical staff,and strengthened management of infection control.

  1. Automated simulation of areal bone mineral density assessment in the distal radius from high-resolution peripheral quantitative computed tomography


    Burghardt, A. J.; Kazakia, G. J.; Link, T.M.; Majumdar, S


    Summary An automated image processing method is presented for simulating areal bone mineral density measures using high-resolution peripheral quantitative computed tomography (HR-pQCT) in the ultra-distal radius. The accuracy of the method is validated against clinical dual X-ray absorptiometry (DXA). This technique represents a useful reference to gauge the utility of novel 3D quantification methods applied to HR-pQCT in multi-center clinical studies and potentially negates the need for sepa...

  2. The release of gentamicin from acrylic bone cements in a simulated prosthesis-related interfacial gap

    NARCIS (Netherlands)

    Hendriks, JGE; Neut, D; van Horn, [No Value; van der Mei, HC; Busscher, HJ


    Gentamicin is added to polymethylmethacrylate bone cements in orthopedics as a measure against infection in total joint arthroplasties. Numerous studies have been published on gentamicin release from bone cements, but none have been able to estimate the local concentrations in the prosthesis-related

  3. A massive chondroblastoma in the proximal humerus simulating malignant bone tumors. (United States)

    Tonogai, Ichiro; Takahashi, Mitsuhiko; Manabe, Hiroaki; Nishisho, Toshihiko; Iwamoto, Seiji; Takao, Shoichiro; Kagawa, Seiko; Kudo, Eiji; Yasui, Natsuo


    Chondroblastoma is a mostly benign bone neoplasm that typically affects the second decade of life and exhibits a lytic lesion in the epiphysis of long bones. We report an extreme case of massive, destructive chondroblastoma of the proximal humerus in a 9-year-old girl. It was difficult to differentiate using imaging information the lesion from malignant bone tumors such as osteosarcoma. Histopathological examination from biopsy proved chondroblastoma. The tumor was resected after preoperative transcatheter embolization. Reconstructive procedure for the proximal humerus was not performed due to the local destruction. The present case demonstrates clinical and radiological differentiations of the massive chondroblastoma from the other lesions and histopathological understandings for this lesion.

  4. Young's modulus and SEM analysis of leg bones exposed to simulated microgravity by hind limb suspension (HLS)

    Energy Technology Data Exchange (ETDEWEB)

    Patel, Niravkumar D.; Mehta, Rahul [Department of Physics and Astronomy, University of Central Arkansas, 201 Donaghey Avenue, Lewis Science Center 171, Conway, AR 72035 (United States); Ali, Nawab [Department of Applied Science, University of Arkansas at Little Rock, 2801 S. University Avenue, Little Rock, AR 72204 (United States); Soulsby, Michael; Chowdhury, Parimal [Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR 72205 (United States)


    The aim of this study was to determine composition of the leg bone tissue of rats that were exposed to simulated microgravity by Hind-Limb Suspension (HLS) by tail for one week. The leg bones were cross sectioned, cleaned of soft tissues, dried and sputter coated, and then placed horizontally on the stage of a Scanning Electron Microscope (SEM) for analysis. Interaction of a 17.5 keV electron beam, incident from the vertical direction on the sample, generated images using two detectors. X-rays emitted from the sample during electron bombardment were measured with an Energy Dispersive Spectroscopy (EDS) feature of SEM using a liquid-nitrogen cooled Si(Li) detector with a resolution of 144 eV at 5.9 keV ({sub 25}Mn K{sub {alpha}} x-ray). K{sub {alpha}}- x-rays from carbon, oxygen, phosphorus and calcium formed the major peaks in the spectrum. Relative percentages of these elements were determined using a software that could also correct for ZAF factors namely Z(atomic number), A(X-ray absorption) and F(characteristic fluorescence). The x-rays from the control groups and from the experimental (HLS) groups were analyzed on well-defined parts (femur, tibia and knee) of the leg bone. The SEM analysis shows that there are definite changes in the hydroxyl or phosphate group of the main component of the bone structure, hydroxyapatite [Ca{sub 10}(PO{sub 4}){sub 6}(OH){sub 2}], due to hind limb suspension. In a separate experiment, entire leg bones (both from HLS and control rats) were subjected to mechanical stress by mean of a variable force. The stress vs. strain graph was fitted with linear and polynomial function, and the parameters reflecting the mechanical strength of the bone, under increasing stress, were calculated. From the slope of the linear part of the graph the Young's modulus for HLS bones were calculated and found to be 2.49 times smaller than those for control bones.

  5. Young's modulus and SEM analysis of leg bones exposed to simulated microgravity by hind limb suspension (HLS) (United States)

    Patel, Niravkumar D.; Mehta, Rahul; Ali, Nawab; Soulsby, Michael; Chowdhury, Parimal


    The aim of this study was to determine composition of the leg bone tissue of rats that were exposed to simulated microgravity by Hind-Limb Suspension (HLS) by tail for one week. The leg bones were cross sectioned, cleaned of soft tissues, dried and sputter coated, and then placed horizontally on the stage of a Scanning Electron Microscope (SEM) for analysis. Interaction of a 17.5 keV electron beam, incident from the vertical direction on the sample, generated images using two detectors. X-rays emitted from the sample during electron bombardment were measured with an Energy Dispersive Spectroscopy (EDS) feature of SEM using a liquid-nitrogen cooled Si(Li) detector with a resolution of 144 eV at 5.9 keV (25Mn Kα x-ray). Kα- x-rays from carbon, oxygen, phosphorus and calcium formed the major peaks in the spectrum. Relative percentages of these elements were determined using a software that could also correct for ZAF factors namely Z(atomic number), A(X-ray absorption) and F(characteristic fluorescence). The x-rays from the control groups and from the experimental (HLS) groups were analyzed on well-defined parts (femur, tibia and knee) of the leg bone. The SEM analysis shows that there are definite changes in the hydroxyl or phosphate group of the main component of the bone structure, hydroxyapatite [Ca10(PO4)6(OH)2], due to hind limb suspension. In a separate experiment, entire leg bones (both from HLS and control rats) were subjected to mechanical stress by mean of a variable force. The stress vs. strain graph was fitted with linear and polynomial function, and the parameters reflecting the mechanical strength of the bone, under increasing stress, were calculated. From the slope of the linear part of the graph the Young's modulus for HLS bones were calculated and found to be 2.49 times smaller than those for control bones.

  6. Surgical treatment for desmoplastic fibroma of bone%骨韧带样纤维瘤外科手术疗效分析

    Institute of Scientific and Technical Information of China (English)

    张嘉锴; 庞清江


    目的:探讨骨韧带样纤维瘤外科手术治疗效果。方法:自2000年6月至2010年6月,手术治疗15例骨韧带样纤维瘤患者,男4例,女11例;年龄18~64岁,平均39岁。部位分别是股骨上段4例、股骨下段3例、胫骨下段2例、肱骨上段1例、肱骨下段1例、肩胛骨1例、耻骨支1例、髂骨1例、胸骨柄1例。15例中1例行单纯病灶内刮除,14例按手术方式分两组,广泛切除组(7例),扩大刮除加灭活组(7例)。观察术后复发情况,采用Enneking功能评分对术后恢复情况进行评定。结果:15例患者均获随访,时间18~132个月,平均56个月。未发现转移。复发2例,1例为单纯病灶内刮除,1例为广泛切除组,复发率13.3%(2/15)。根据Enneking功能评估标准,广泛切除组术后(21.6±3.8)分,扩大刮除加灭活(28.3±1.3)分。广泛切除组优2例,良5例;扩大刮除加灭活组优7例。结论:扩大刮除加灭活手术较广泛切除组功能恢复更好,在重建较为困难的特殊部位建议优先考虑。%Objective:To discuss clinical effects of surgical treatment for desmoplastic fibroma of bone. Methods:Be-tween June 2000 and June 2010,15 cases of desmoplastic fibroma were treated by surgical operation including 4 males and 7 females with an average age of 39 years old (ranged from 18 to 64 years old). The site of tumor was proximal femur in 4 cases, distal femur in 3,distal tibia in 2,proximal humerus in 1,distal humerus in 1,scapula in 1,pelvic in 2,manubrium of sternum in 1. The simple intralesional curettage was performed in 1 case. The other 14 cases were divided into two groups ,7 cases had an aggressive curettage with inactivation and the last 7 cases had a wide resection. Recurrence condition were observed after operation. The function was valuated in two groups after the operation according to Enneking's standard. Results:The mean duration of follow up

  7. Dynamic virtual simulation of the occurrence and severity of edge loading in hip replacements associated with variation in the rotational and translational surgical position. (United States)

    Leng, Joanna; Al-Hajjar, Mazen; Wilcox, Ruth; Jones, Alison; Barton, David; Fisher, John


    Variation in the surgical positioning of total hip replacement can result in edge loading of the femoral head on the rim of the acetabular cup. Previous work has reported the effect of edge loading on the wear of hip replacement bearings with a fixed level of dynamic biomechanical hip separation. Variations in both rotational and translational surgical positioning of the hip joint replacement combine to influence both the biomechanics and the tribology including the severity of edge loading, the amount of dynamic separation, the force acting on the rim of the cup and the resultant wear and torque acting on the cup. In this study, a virtual model of a hip joint simulator has been developed to predict the effect of variations in some surgical positioning (inclination and medial-lateral offset) on the level of dynamic separation and the contact force of the head acting on the rim as a measure of severity of edge loading. The level of dynamic separation and force acting on the rim increased with increased translational mismatch between the centres of the femoral head and the acetabular cup from 0 to 4 mm and with increased cup inclination angle from 45° to 65°. The virtual model closely replicated the dynamics of the experimental hip simulator previously reported, which showed similar dynamic biomechanical trends, with the highest level of separation being found with a mismatch of 4 mm between the centres of the femoral head and acetabular cup and 65° cup inclination angle.

  8. The salutary effect of dietary calcium on bone mass in a rat model of simulated weightlessness (United States)

    Bikle, D. D.; Globus, R.; Halloran, B. P.; Morey-Holton, E.


    Whether supplementation of dietary calcium reduces the differences in bone mass of unweighed limbs and normally weighted limbs, and whether parathyroid hormone (PTH) and 1,25-dihydroxyvitamin D (1,25(OH)2D) respond differently to dietary calcium in unweighted animals in comparison with pair-fed controls was studied. The hind limbs of rats were unweighted by a tail suspension method and diets containing 0.1% to 2.4% calcium. After 2 weeks serum calcium, phosphorus, PTH and 1,25(OH)2D intestinal calcium transport were determined and bone mass, ash weight, and calcium in the tibia, L-1 vertebra, and humerus were measured. No significant differences in body weights were observed among the various groups. Suspended rats maintained constant levels of serum calcium and phosphate over the wide range of dietary calcium. Serum PTH and 1,25(OH)2D and intestinal calcium transport fell as dietary calcium was increased. Bone calcium in the tibia and vertebra from suspended rats remained less than that from pair-fed control. It is suggested that although no striking difference between suspended and control animals was observed in response to dieteary calcium, increasing dietary calcium may reduce the negative impact of unloading on the calcium content of the unweighted bones. The salutary effect of high dietary calcium appears to be due to inhibition of bone resorption rather than to stimulation of bone formation.

  9. Numerical simulation of fluid field and in vitro three-dimensional fabrication of tissue-engineered bones in a rotating bioreactor and in vivo implantation for repairing segmental bone defects. (United States)

    Song, Kedong; Wang, Hai; Zhang, Bowen; Lim, Mayasari; Liu, Yingchao; Liu, Tianqing


    In this paper, two-dimensional flow field simulation was conducted to determine shear stresses and velocity profiles for bone tissue engineering in a rotating wall vessel bioreactor (RWVB). In addition, in vitro three-dimensional fabrication of tissue-engineered bones was carried out in optimized bioreactor conditions, and in vivo implantation using fabricated bones was performed for segmental bone defects of Zelanian rabbits. The distribution of dynamic pressure, total pressure, shear stress, and velocity within the culture chamber was calculated for different scaffold locations. According to the simulation results, the dynamic pressure, velocity, and shear stress around the surface of cell-scaffold construction periodically changed at different locations of the RWVB, which could result in periodical stress stimulation for fabricated tissue constructs. However, overall shear stresses were relatively low, and the fluid velocities were uniform in the bioreactor. Our in vitro experiments showed that the number of cells cultured in the RWVB was five times higher than those cultured in a T-flask. The tissue-engineered bones grew very well in the RWVB. This study demonstrates that stress stimulation in an RWVB can be beneficial for cell/bio-derived bone constructs fabricated in an RWVB, with an application for repairing segmental bone defects.

  10. The Maxillary Sinus Membrane Elevation Procedure: Augmentation of Bone around Dental Implants without Grafts—A Review of a Surgical Technique

    Directory of Open Access Journals (Sweden)

    Christopher Riben


    Full Text Available Background. Long-term edentulism may in many cases result in resorption of the alveolar process. The sinus lift procedure aims to create increased bone volume in the maxillary sinus in order to enable installation of dental implants in the region. The method is over 30 years old, and initially autogenous bone grafts were used and later also different bone substitutes. Since 1997, a limited number of studies have explored the possibility of a graftless procedure where the void under the sinus membrane is filled with a blood clot that enables bone formation. Aim. To describe the evolution of the sinus-lift technique and to review the literature related to the technique with a focus on long-term studies related to the graft-less technique. Methods. The electronic database PubMed was searched, and a systematic review was conducted regarding relevant articles. Results. A relatively few long-term studies using the described technique were found. However, the technique was described as reliable considering the outcome of the existing studies. Conclusion. All investigated studies show high implant survival rates for the graftless technique. The technique is considered to be cost-effective, less time-consuming, and related to lower morbidity since no bone harvesting is needed.

  11. A Massive Chondroblastoma in the Proximal Humerus Simulating Malignant Bone Tumors

    Directory of Open Access Journals (Sweden)

    Ichiro Tonogai


    Full Text Available Chondroblastoma is a mostly benign bone neoplasm that typically affects the second decade of life and exhibits a lytic lesion in the epiphysis of long bones. We report an extreme case of massive, destructive chondroblastoma of the proximal humerus in a 9-year-old girl. It was difficult to differentiate using imaging information the lesion from malignant bone tumors such as osteosarcoma. Histopathological examination from biopsy proved chondroblastoma. The tumor was resected after preoperative transcatheter embolization. Reconstructive procedure for the proximal humerus was not performed due to the local destruction. The present case demonstrates clinical and radiological differentiations of the massive chondroblastoma from the other lesions and histopathological understandings for this lesion.

  12. Treatment of endodontic perforations using guided tissue regeneration and demineralized freeze-dried bone allograft: two case reports with 2-4 year post-surgical evaluations. (United States)

    Zenobio, Elton Golçalves; Shibli, Jamil Awad


    Clinicians often have difficulty with the diagnosis and treatment of root perforation. This paper reports two patients with root perforation treated with periodontal surgery associated with guided tissue regeneration (GTR) and demineralized freeze-dried bone allograft (DFDBA). This combined treatment resulted in minimal probing depths, minimal attachment loss, and radiographic evidence of bone gain after follow-up evaluations that ranged from 2 to 4 years. These case reports show a correct diagnosis and removal of etiologic factors can restore both periodontal and endodontic health.

  13. Rapid attachment of adipose stromal cells on resorbable polymeric scaffolds facilitates the one-step surgical procedure for cartilage and bone tissue engineering purposes

    NARCIS (Netherlands)

    W.J. Jurgens; R.J. Kroeze; R.A. Bank; M.J.P.F. Ritt; M.N. Helder


    The stromal vascular fraction (SVF) of adipose tissue provides an abundant source of mesenchymal stem cells. For clinical application, it would be beneficial to establish treatments in which SVF is obtained, seeded onto a scaffold, and returned into the patient within a single surgical procedure. In

  14. Rapid Attachment of Adipose Stromal Cells on Resorbable Polymeric Scaffolds Facilitates the One-Step Surgical Procedure for Cartilage and Bone Tissue Engineering Purposes

    NARCIS (Netherlands)

    Jurgens, Wouter J.; Kroeze, Robert Jan; Bank, Ruud A.; Ritt, Marco J. P. F.; Helder, Marco N.


    The stromal vascular fraction (SVF) of adipose tissue provides an abundant source of mesenchymal stem cells. For clinical application, it would be beneficial to establish treatments in which SVF is obtained, seeded onto a scaffold, and returned into the patient within a single surgical procedure. In

  15. Detection of Simulated Periodontal Bone Defects Using Digital Images. An in vitro Study

    Directory of Open Access Journals (Sweden)

    Rafael Scaf de Molon


    Materials and Methods: The samples comprised 24 hemi-mandibles from pigs, which were allocated into 3 groups; G1 (before acid application, G2 (after acid application and G3 (without bone defect and acid treatment. Periodontal bone defects were created with round burs between the second and third pre-molar. The radiographs were taken using the Visualix eHD sensor. The central ray was perpendicular to the sensor and to the hemi-mandible at a 40 cm focal-spot to sensor distance (settings 70 kVp, 10 mA and 15 impulses. After the defects were created in groups G1 and G2, they were treated with 100% perchloric acid for 48 hours. Images were zoomed to the level of 125% and interpreted by three examiners. Sensitivity and specificity were computed for the detection of periodontal bone defects with acid application and created using only round burs. The examiner's radiographic interpretation produced a diagnosis based on a five-point confidence scale. If the interpretation received the scores 1 or 2, it was concluded that no bone defect was present, whereas the scores 3, 4, or 5 were considered to reflect evidence of a bone defect. Results: There was no difference between groups G1 (Sen -95%CI=0.9167; Spec -95%CI=0.9167 and G2 (Sen -95%CI=0.8333; Spec -95%CI=0.9167. Conclusions: There is no difference in the detection of periodontal bone defects created using round burs and defects created using round burs followed by acid treatment. [Arch Clin Exp Surg 2014; 3(4.000: 220-225

  16. Individual-specific multi-scale finite element simulation of cortical bone of human proximal femur

    Energy Technology Data Exchange (ETDEWEB)

    Ascenzi, Maria-Grazia, E-mail: [UCLA/Orthopaedic Hospital, Department of Orthopaedic Surgery, Rehabilitation Bldg, Room 22-69, 1000 Veteran Avenue, University of California, Los Angeles, CA 90095 (United States); Kawas, Neal P., E-mail: [UCLA/Orthopaedic Hospital, Department of Orthopaedic Surgery, Rehabilitation Bldg, Room 22-69, 1000 Veteran Avenue, University of California, Los Angeles, CA 90095 (United States); Lutz, Andre, E-mail: [Institute of Biomechanics and Numerical Mechanics, Leibniz University Hannover, 30167 Hannover (Germany); Kardas, Dieter, E-mail: [ContiTech Vibration Control, Jaedekamp 30 None, 30419 Hannover (Germany); Nackenhorst, Udo, E-mail: [Institute of Biomechanics and Numerical Mechanics, Leibniz University Hannover, 30167 Hannover (Germany); Keyak, Joyce H., E-mail: [Department of Radiological Sciences, Medical Sciences I, Bldg 811, Room B140, University of California, Irvine, CA 92697-5000 (United States)


    We present an innovative method to perform multi-scale finite element analyses of the cortical component of the femur using the individual’s (1) computed tomography scan; and (2) a bone specimen obtained in conjunction with orthopedic surgery. The method enables study of micro-structural characteristics regulating strains and stresses under physiological loading conditions. The analysis of the micro-structural scenarios that cause variation of strain and stress is the first step in understanding the elevated strains and stresses in bone tissue, which are indicative of higher likelihood of micro-crack formation in bone, implicated in consequent remodeling or macroscopic bone fracture. Evidence that micro-structure varies with clinical history and contributes in significant, but poorly understood, ways to bone function, motivates the method’s development, as does need for software tools to investigate relationships between macroscopic loading and micro-structure. Three applications – varying region of interest, bone mineral density, and orientation of collagen type I, illustrate the method. We show, in comparison between physiological loading and simple compression of a patient’s femur, that strains computed at the multi-scale model’s micro-level: (i) differ; and (ii) depend on local collagen-apatite orientation and degree of calcification. Our findings confirm the strain concentration role of osteocyte lacunae, important for mechano-transduction. We hypothesize occurrence of micro-crack formation, leading either to remodeling or macroscopic fracture, when the computed strains exceed the elastic range observed in micro-structural testing.

  17. Simulation of the mechanical behavior of a HIP implant. Implant fixed to bone by cementation under arbitrary load

    Energy Technology Data Exchange (ETDEWEB)

    Oldani, C R [Materials Department - FCEFyN - Universidad Nacional de Cordoba, Av.Velez Sarsfield 1611 (5016) Cordoba (Argentina); Dominguez, A A [INTI Cordoba, Av. Velez Sarsfield 1561 (5016) Cordoba (Argentina)


    In a previous work a finite elements model was constructed to simulate a fatigue assay according to the norm IRAM 9422-3. Three materials were studied, two of them are the most used in this type of implant (Stainless steel 3161 and alloy T16A14V) and the third was a new developed titanium alloy (Ti35Nb7Zr5Ta). Static loads were applied to the model according to the highest requirements of the norm and the stress - strain distribution were determined. In this study a simplified analysis of the material's fatigue was done according to the previous work. The best behavior of the titanium alloys vs. the stainless steel was evident. With the objective of studying the behavior of both: the implant and the femur bone, new finite elements models were realized, in which the presence of the bone was considered. Inside the bone, the femoral component of the implant was placed in a similar way of a cemented prosthesis in a total hip arthroplasty. The advantage of the titanium implant related to the stainless steel one, was very clear.

  18. 髂骨块状骨植骨术修复恒牙列牙槽突裂的短期临床观察%Alveolar bulk bone grafting:A new surgical approach for alveolar cleft

    Institute of Scientific and Technical Information of China (English)

    唐燕驰; 杜一飞; 李盛; 袁华; 江宏兵; 万林忠


    目的:探讨牙槽突裂髂骨块状骨植骨术的临床可行性和可靠性。方法回顾分析15例行“牙槽突裂髂骨块状骨植骨术”的恒牙列牙槽突裂患者,随访6个月以上,收集临床资料,并进行影像学分析。结果所有患者均能定期复诊,术后13例患者创口愈合良好,2例因创口裂开导致植骨失败。影像学资料显示术后6个月植骨区间隙消失,骨桥形成,且植骨区无明显吸收。已有2例患者完成正畸及种植治疗。术后3个月所有患者均可正常行走,无明显行动障碍。结论牙槽突裂髂骨块状骨植骨术短期临床效果满意,移植骨吸收少,长期效果还需进一步研究。%Objective To investigate the feasibility and reliability of alveolar bulk bone grafting in clinical practice. Methods 15 cases of alveolar cleft treated with alveolar bulk bone grafting were analyzed retrospectively, and were followed up for over 6 months. Clinical materials were collected to carry out the radiological analysis. Results The clinical over 6-month follow⁃up of 15 cases was finished. 13 patients showed satisfactory recovery of wounds. 2 cases failed due to the dehiscence. The radiological materials showed that after 6 months the bone graft clearances disappeared, bone bridge formed and bone graft area had no obvious absorption.2 patients fin⁃ished the orthodontic treatment and dental implantation. All the patients could walk normally after 3 months and had no obvious action barriers. Conclusions Alveolar bulk bone grafting, a new surgical approach for alveolar cleft, has satisfactory short⁃term clinical effects, and the long⁃term clinical effects need more further studies.

  19. Conseqüências no crescimento de maxila e mandíbula de defeito ósseo cirúrgico no ramo da mandíbula de ratos Consequences on the growth of maxilla and mandible of surgical bone defect on mandibular ramus of rats

    Directory of Open Access Journals (Sweden)

    Lucimar Rodrigues


    Full Text Available OBJETIVO: Analisar as conseqüências no crescimento de maxila e mandíbula de defeito ósseo cirúrgico simulando fratura no ramo da mandíbula. MÉTODOS: Foram utilizados 25 ratos Wistar com um mês de idade. Sob anestesia geral e por meio de incisão submandibular. Foi realizada osteotomia vertical no ramo da mandíbula do lado direito com emprego de motor cirúrgico. Após período de dois meses os animais foram sacrificados, os tecidos moles retirados e as hemimandíbulas desarticuladas. Foram realizadas incidências radiográficas axiais para o crânio e laterais para as hemimandíbulas. A seguir, por intermédio de um sistema de computador foram obtidas medidas lineares da maxila e das hemimandíbulas. Foi empregado o teste "t" de Student para verificação da significância da diferença entre os lados experimental e controle. RESULTADOS: A diferença foi significante para a altura do ramo (p=0,010 e comprimento da mandíbula referente ao côndilo (p=0,015 e ao ângulo (pPURPOSE: To analyse the consequences on the growth of maxilla and mandible of a surgical bone defect that simulates a mandibular ramus fracture. METHODS: A group of 25 one-month-old Wistar rats were used in this study. Under general anesthesia, and through a submandibular incision, a vertical osteotomy on the right side of the mandibular ramus was made using a surgical drill. The animals were sacrificed after two months, soft tissues removed, and the mandible disarticulated. The skull was submitted to axial radiograph and the hemimandibles to a lateral radiograph. With these, cephalometric mensurations were made through a computer system, and the obtained values submitted to Student's t-test. RESULTS: The height of the mandibular ramus presented significant difference (p=0,010 as well as the length of mandible, both to the condyle (P=0,015 and the angle (p=0,001. There was no significant difference to the mensurations of the maxilla. CONCLUSION: The consequences of the

  20. Simulation of multi-stage nonlinear bone remodeling induced by fixed partial dentures of different configurations: a comparative clinical and numerical study. (United States)

    Liao, Zhipeng; Yoda, Nobuhiro; Chen, Junning; Zheng, Keke; Sasaki, Keiichi; Swain, Michael V; Li, Qing


    This paper aimed to develop a clinically validated bone remodeling algorithm by integrating bone's dynamic properties in a multi-stage fashion based on a four-year clinical follow-up of implant treatment. The configurational effects of fixed partial dentures (FPDs) were explored using a multi-stage remodeling rule. Three-dimensional real-time occlusal loads during maximum voluntary clenching were measured with a piezoelectric force transducer and were incorporated into a computerized tomography-based finite element mandibular model. Virtual X-ray images were generated based on simulation and statistically correlated with clinical data using linear regressions. The strain energy density-driven remodeling parameters were regulated over the time frame considered. A linear single-stage bone remodeling algorithm, with a single set of constant remodeling parameters, was found to poorly fit with clinical data through linear regression (low [Formula: see text] and R), whereas a time-dependent multi-stage algorithm better simulated the remodeling process (high [Formula: see text] and R) against the clinical results. The three-implant-supported and distally cantilevered FPDs presented noticeable and continuous bone apposition, mainly adjacent to the cervical and apical regions. The bridged and mesially cantilevered FPDs showed bone resorption or no visible bone formation in some areas. Time-dependent variation of bone remodeling parameters is recommended to better correlate remodeling simulation with clinical follow-up. The position of FPD pontics plays a critical role in mechanobiological functionality and bone remodeling. Caution should be exercised when selecting the cantilever FPD due to the risk of overloading bone resorption.

  1. A Three-Dimensional Finite Element Study on the Biomechanical Simulation of Various Structured Dental Implants and Their Surrounding Bone Tissues


    Zhang, Gong; Yuan, Hai; Chen, Xianshuai; Wang, Weijun; Chen, Jianyu; Liang, Jimin; Zhang, Peng


    Background/Purpose. This three-dimensional finite element study observed the stress distribution characteristics of 12 types of dental implants and their surrounding bone tissues with various structured abutments, implant threads, and healing methods under different amounts of concentrated loading. Materials and Methods. A three-dimensional geometrical model of a dental implant and its surrounding bone tissue was created; the model simulated a screw applied with a preload of 200 N or a torque...

  2. Radioisotopic evaluation of bone repair after experimental surgical trauma Avaliação radiofarmacológica do reparo ósseo após trauma cirúrgico padronizado

    Directory of Open Access Journals (Sweden)

    Ana Cristina Breithaupt-Faloppa


    Full Text Available BACKGROUND: Scientific approach of the bone reaction after surgical procedures provides valuable information on methods and techniques. The purpose of this study was to follow this process using a radioisotope marker of bone remodelling. MATERIAL AND METHODS: Two bone cavities were created (one for every tibia in adult Wistar male rats using a 0.5 mm spherical burr; left tibial cavities were filled with bovine freeze-dried bone; the right ones were left unfilled for control. Scintigrams were done with sodium methylene diphosphonate (MDP labelled with radioactive pertechnetate (99mTcO4- to evaluate the inflammatory response and the local osteoblastic activity. The evolution of bone repair was additionally evaluated by light microscopy. RESULTS: Our results have shown that the highest bone activity was recorded between the 7th and the 14th day after surgery. The morphological analysis confirmed the results obtained with radioisotope analysis and did not reveal significant differences regarding the evolution of bone repair between the filled and the unfilled defects. CONCLUSION: We confirmed that 99mTc -MDP is a valuable tool to study bone repair, as it was able to show subtle alterations of bone activity even in lesions as small as those created herein (0.5 mm wide, 0.5 mm deep.Este trabalho objetivou estudar a evolução temporal do processo de reparo ósseo em tíbia de rato, após trauma cirúrgico padronizado. A incorporação do radiofármaco 99mTc-MDP na região afetada foi tomada como medida indireta da intensidade de reação tecidual; foi feito também acompanhamento histológico do processo de reparo. Foram realizadas cirurgias nas duas tíbias de 72 animais divididos em 2 grupos, sendo sacrificados em diferentes dias pós-operatórios (1, 3, 7, 14, 21 e 28 dias p.o.. As cavidades criadas nas tíbias esquerdas foram preenchidas com osso liofilizado bovino, e as direitas serviram como controle (não preenchidas. Grupos paralelos de

  3. Micro-finite element simulation of trabecular-bone post-yield behaviour--effects of material model, element size and type. (United States)

    Verhulp, E; Van Rietbergen, B; Muller, R; Huiskes, R


    Micro-finite element (micro-FE) analysis became a standard tool for the evaluation of trabecular bone mechanical properties. The accuracy of micro-FE models for linear analyses is well established. However, the accuracy of recently developed nonlinear micro-FE models for simulations of trabecular bone failure is not known. In this study, a trabecular bone specimen was compressed beyond the apparent yield point. The experiment was simulated using different micro-FE meshes with different element sizes and types, and material models based on cortical bone. The results from the simulations were compared with experimental results to study the effects of the different element and material models. It was found that a decrease in element size from 80 to 40 mum had little effect on predicted post-yield behaviour. Element type and material model had significant effects. Nevertheless, none of the established material models for cortical bone were able to predict the typical descent in the load-displacement curve seen during compression of trabecular bone.

  4. The Impact of Simulated and Real Microgravity on Bone Cells and Mesenchymal Stem Cells

    Directory of Open Access Journals (Sweden)

    Claudia Ulbrich


    machine (RPM, the 2D-clinostat, or the NASA-developed rotating wall vessel bioreactor (RWV to create tissue from bone, tumor, and mesenchymal stem cells. To understand the development of 3D structures, in vitro experiments using s-µg devices can provide valuable information about modulations in signal-transduction, cell adhesion, or extracellular matrix induced by altered gravity conditions. These systems also facilitate the analysis of the impact of growth factors, hormones, or drugs on these tissue-like constructs. Progress has been made in bone tissue engineering using the RWV, and multicellular tumor spheroids (MCTS, formed in both r- and s-µg, have been reported and were analyzed in depth. Currently, these MCTS are available for drug testing and proteomic investigations. This review provides an overview of the influence of µg on the aforementioned cells and an outlook for future perspectives in tissue engineering.

  5. Pathological fracture in non-ossifying fibroma with histological features simulating aneurysmal bone cyst

    Energy Technology Data Exchange (ETDEWEB)

    Hoeffel, C.; Mainard, L.; Hoeffel, J.C. [Dept. of Radiology, Hopital Jeanne d`Arc, Toul (France); Panuel, M. [Dept. of Radiology, Hopital Nord, Marseille (France); Plenat, F. [Dept. of Pathology, Hopital de Brabois Adultes, Vandoeuvre (France)


    A 12-year-old-girl presented with a fracture of an osteolytic lesion of the distal radius. A 7-year-old girl presented with a fracture of an osteolytic lesion of the femoral shaft. In both cases it was a non-ossifying fibroma with fracture misdiagnosed at pathology as aneurysmal bone cyst. Fractures through non-ossifying fibromas may alter the histological pattern of the initial lesion in two ways: firstly, by the presence of blood pigments due to the fracture, and secondly, by formation of new bone. Radiological-pathological correlation is essential to avoid histological errors after pathological fracture in a non-ossifying fibroma. (orig.) With 4 figs., 6 refs.

  6. Surgical treatment of the osteoporotic spine with bone cement-injectable cannulated pedicle screw fixation: technical description and preliminary application in 43 patients

    Directory of Open Access Journals (Sweden)

    Fei Dai


    Full Text Available OBJECTIVES: To describe a new approach for the application of polymethylmethacrylate augmentation of bone cement-injectable cannulated pedicle screws. METHODS: Between June 2010 and February 2013, 43 patients with degenerative spinal disease and osteoporosis (T-score <-2.5 underwent lumbar fusion using cement-injectable cannulated pedicle screws. Clinical outcomes were evaluated using a Visual Analog Scale and the Oswestry Disability Index. Patients were given radiographic follow-up examinations after 3, 6, and 12 months and once per year thereafter. RESULTS: All patients were followed for a mean of 15.7±5.6 months (range, 6 to 35 months. The Visual Analog Scale and Oswestry Disability Index scores showed a significant reduction in back pain (p = 0.018 and an improvement in lower extremity function (p = 0.025 in patients who underwent lumbar fusion using the novel screw. Intraoperative cement leakage occurred in four patients, but no neurological complications were observed. Radiological observation indicated no loosening or pulling out of the novel screw, and bone fusion was excellent. CONCLUSIONS: The described polymethylmethacrylate augmentation technique using bone cement-injectable cannulated pedicle screws can reduce pain and improve spinal dysfunction in osteoporotic patients undergoing osteoporotic spine surgery.

  7. Difference in the Surgical Outcome of Unilateral Cleft Lip and Palate Patients with and without Pre-Alveolar Bone Graft Orthodontic Treatment (United States)

    Chang, Chun-Shin; Wallace, Christopher Glenn; Hsiao, Yen-Chang; Chiu, Yu-Ting; Pai, Betty Chien-Jung; Chen, I.-Ju; Liao, Yu-Fang; Liou, Eric Jen-Wein; Chen, Philip Kuo-Ting; Chen, Jyh-Ping; Noordhoff, M. Samuel


    Presurgical orthodontic treatment before secondary alveolar bone grafting (SABG) is widely performed for cleft lip/palate patients. However, no randomized controlled trial has been published comparing SABG outcomes in patients with, and without, presurgical orthodontic treatment. This randomized, prospective, single-blinded trial was conducted between January 2012 and April 2015 to compare ABG volumes 6 months postoperatively between patients with and without presurgical orthodontic treatment. Twenty-four patients were enrolled and randomized and 22 patients completed follow-up. Patients who had presurgical orthodontics before SABG had significantly improved inclination (p < 0.001) and rotation (p < 0.001) of the central incisor adjacent to the defect, significantly improved ABG fill volume (0.81 ± 0.26 cm3 at 6 months compared to 0.59 ± 0.22 cm3 p < 0.05) and less residual alveolar bone defect (0.31 ± 0.08 cm3 at 6 months compared to s 0.55 ± 0.14 cm3 p < 0.001) compared to patients who did not have presurgical orthodontic treatment. In conclusion, orthodontic treatment combined with SABG results in superior bone volume when compared with conventional SABG alone.

  8. Micro-scale finite element modeling of ultrasound propagation in aluminum trabecular bone-mimicking phantoms: A comparison between numerical simulation and experimental results. (United States)

    Vafaeian, B; Le, L H; Tran, T N H T; El-Rich, M; El-Bialy, T; Adeeb, S


    The present study investigated the accuracy of micro-scale finite element modeling for simulating broadband ultrasound propagation in water-saturated trabecular bone-mimicking phantoms. To this end, five commercially manufactured aluminum foam samples as trabecular bone-mimicking phantoms were utilized for ultrasonic immersion through-transmission experiments. Based on micro-computed tomography images of the same physical samples, three-dimensional high-resolution computational samples were generated to be implemented in the micro-scale finite element models. The finite element models employed the standard Galerkin finite element method (FEM) in time domain to simulate the ultrasonic experiments. The numerical simulations did not include energy dissipative mechanisms of ultrasonic attenuation; however, they expectedly simulated reflection, refraction, scattering, and wave mode conversion. The accuracy of the finite element simulations were evaluated by comparing the simulated ultrasonic attenuation and velocity with the experimental data. The maximum and the average relative errors between the experimental and simulated attenuation coefficients in the frequency range of 0.6-1.4 MHz were 17% and 6% respectively. Moreover, the simulations closely predicted the time-of-flight based velocities and the phase velocities of ultrasound with maximum relative errors of 20 m/s and 11 m/s respectively. The results of this study strongly suggest that micro-scale finite element modeling can effectively simulate broadband ultrasound propagation in water-saturated trabecular bone-mimicking structures.

  9. Surgical selection of traumatic tibia tubular bone defect of different clinical cla ssification%不同临床分型创伤性胫骨管状骨缺损的手术选择分析

    Institute of Scientific and Technical Information of China (English)



    Objective:To study the surgical selection of traumatic tibia tubular bone defect of different clinical classification.Mte h-ods:85 cases of patients with traumatic tibia tubular bone defect and admitted into the hospital during May 2012 to August 2014 were se-lected as the research objects.According to the length of the tibia tubular bone defect, they were divided into three clinical classification groups:39 cases of type I (4-6cm), 25 cases of type II (6-9cm)and 21 cases of type III ( >9cm)., monosegment osteotomy tele-port, double-segment osteotomy transport and ipsilateral vascularized fibula grafts in Ilizarov technique combined with Ilizarov external fixator fixation surgical therapy were performed respectively in the three groups.The bone healing time, the time with external fixation and the degree indexes of limb function recovery after operation in the three groups of different clinical classification were observed.The cura-tive effect of surgical treatment of different clinical classification was analyzed.Results:The three groups of different clinical classification achieved significant efficacy.The time of type I bone healing was the longest which was 9.4 months while of type III was 5.6 months which was the shortest.The fixation time of Ilizarov external fixator in type II was the shortest which was 10.5months while in type III was the longest which was 181. months.After operation, the function recovery of the diseased limbs in the three groups reached the normal levels. Because the three groups of different clinical classification were different in the pathogenetic condition, the number of cases,the choice of surgical operation, they can not be statistically compared.Conclus ion:The curative effect of hree kinds of surgical treatment for treating traumatic tibia tubular bone defect of different clinical classification was significant, which was of significant clinical value.%目的:研究不同临床分型创伤性胫骨管状骨缺损的手术选择

  10. Petrous Bone Cholesteatoma (United States)

    Sanna, Mario; Zini, Carlo; Gamoletti, Roberto; Frau, Niccolò; Taibah, Abdel Kader; Russo, Alessandra; Pasanisi, Enrico


    Petrous bone cholesteatoma is a rare pathologic entity and may be a difficult surgical challenge because of potential involvement of the facial nerve, carotid artery, dura mater, otic capsule, and risk of cerebrospinal fluid leak. The objective of this article is to present a personal classification of petrous bone cholesteatomas, a survey of recent surgical attitudes, and our present surgical strategy based on our experience with 54 operations between 1978 and 1990. Radical petromastoid exenteration with marsupialization and the middle cranial fossa approach were used only for small pure infra- or supralabyrinthine cholesteatomas, respectively. The enlarged transcochlear approach with closure of the external auditory canal was used for infralabyrinthine, infralabyrinthine-apical, and massive petrous bone cholesteatomas. Five cases with petrous bone cholesteatomas in different locations are described in detail to present the signs and symptoms together with the management. ImagesFigure 10Figure 11Figure 12Figure 13Figure 14Figure 15Figure 16Figure 17Figure 18 PMID:17170912

  11. 3D Rapid Prototyping for Otolaryngology-Head and Neck Surgery: Applications in Image-Guidance, Surgical Simulation and Patient-Specific Modeling.

    Directory of Open Access Journals (Sweden)

    Harley H L Chan

    Full Text Available The aim of this study was to demonstrate the role of advanced fabrication technology across a broad spectrum of head and neck surgical procedures, including applications in endoscopic sinus surgery, skull base surgery, and maxillofacial reconstruction. The initial case studies demonstrated three applications of rapid prototyping technology are in head and neck surgery: i a mono-material paranasal sinus phantom for endoscopy training ii a multi-material skull base simulator and iii 3D patient-specific mandible templates. Digital processing of these phantoms is based on real patient or cadaveric 3D images such as CT or MRI data. Three endoscopic sinus surgeons examined the realism of the endoscopist training phantom. One experienced endoscopic skull base surgeon conducted advanced sinus procedures on the high-fidelity multi-material skull base simulator. Ten patients participated in a prospective clinical study examining patient-specific modeling for mandibular reconstructive surgery. Qualitative feedback to assess the realism of the endoscopy training phantom and high-fidelity multi-material phantom was acquired. Conformance comparisons using assessments from the blinded reconstructive surgeons measured the geometric performance between intra-operative and pre-operative reconstruction mandible plates. Both the endoscopy training phantom and the high-fidelity multi-material phantom received positive feedback on the realistic structure of the phantom models. Results suggested further improvement on the soft tissue structure of the phantom models is necessary. In the patient-specific mandible template study, the pre-operative plates were judged by two blinded surgeons as providing optimal conformance in 7 out of 10 cases. No statistical differences were found in plate fabrication time and conformance, with pre-operative plating providing the advantage of reducing time spent in the operation room. The applicability of common model design and

  12. Bone tumor (United States)

    Tumor - bone; Bone cancer; Primary bone tumor; Secondary bone tumor; Bone tumor - benign ... The cause of bone tumors is unknown. They often occur in areas of the bone that grow rapidly. Possible causes include: Genetic defects ...

  13. A Three-Dimensional Finite Element Study on the Biomechanical Simulation of Various Structured Dental Implants and Their Surrounding Bone Tissues. (United States)

    Zhang, Gong; Yuan, Hai; Chen, Xianshuai; Wang, Weijun; Chen, Jianyu; Liang, Jimin; Zhang, Peng


    Background/Purpose. This three-dimensional finite element study observed the stress distribution characteristics of 12 types of dental implants and their surrounding bone tissues with various structured abutments, implant threads, and healing methods under different amounts of concentrated loading. Materials and Methods. A three-dimensional geometrical model of a dental implant and its surrounding bone tissue was created; the model simulated a screw applied with a preload of 200 N or a torque of 0.2 N·m and a prosthetic crown applied with a vertical or an inclined force of 100 N. The Von Mises stress was evaluated on the 12 types of dental implants and their surrounding bone tissues. Results. Under the same loading force, the stress influence on the implant threads was not significant; however, the stress influence on the cancellous bone was obvious. The stress applied to the abutment, cortical bone, and cancellous bone by the inclined force applied to the crown was larger than the stress applied by the vertical force to the crown, and the abutment stress of the nonsubmerged healing implant system was higher than that of the submerged healing implant system. Conclusion. A dental implant system characterised by a straight abutment, rectangle tooth, and nonsubmerged healing may provide minimum value for the implant-bone interface.

  14. A Three-Dimensional Finite Element Study on the Biomechanical Simulation of Various Structured Dental Implants and Their Surrounding Bone Tissues

    Directory of Open Access Journals (Sweden)

    Gong Zhang


    Full Text Available Background/Purpose. This three-dimensional finite element study observed the stress distribution characteristics of 12 types of dental implants and their surrounding bone tissues with various structured abutments, implant threads, and healing methods under different amounts of concentrated loading. Materials and Methods. A three-dimensional geometrical model of a dental implant and its surrounding bone tissue was created; the model simulated a screw applied with a preload of 200 N or a torque of 0.2 N·m and a prosthetic crown applied with a vertical or an inclined force of 100 N. The Von Mises stress was evaluated on the 12 types of dental implants and their surrounding bone tissues. Results. Under the same loading force, the stress influence on the implant threads was not significant; however, the stress influence on the cancellous bone was obvious. The stress applied to the abutment, cortical bone, and cancellous bone by the inclined force applied to the crown was larger than the stress applied by the vertical force to the crown, and the abutment stress of the nonsubmerged healing implant system was higher than that of the submerged healing implant system. Conclusion. A dental implant system characterised by a straight abutment, rectangle tooth, and nonsubmerged healing may provide minimum value for the implant-bone interface.

  15. [Surgical dilemmas. Sinus floor elevation]. (United States)

    ten Bruggenkate, C M; Schulten, E A J M; Zijderveld, S A


    Limited alveolar bone height prevents the placement of dental implants. Sinus floor elevation is an internal augmentation of the maxillary sinus that allows implants to be placed. The principle of this surgical procedure is the preparation of a 'top hinge door', that is raised together with the Schneiderian membrane in the cranial direction. The space which created under this lid is filled with a bone transplant. Autogenous bone is the standard transplant material, despite the fact that a second surgery site is necessary. Under certain circumstances bone substitutes can be used, with a longer healing phase. If sufficient alveolar bone height is available to secure implant stability, simultaneous implantation and sinus floor elevation are possible. Considering the significant anatomical variation in the region of the maxillary sinus, a sound knowledge of the anatomy is of great importance.

  16. The effect of implementing cognitive load theory-based design principles in virtual reality simulation training of surgical skills: a randomized controlled trial

    DEFF Research Database (Denmark)

    Andersen, Steven Arild Wuyts; Mikkelsen, Peter Trier; Konge, Lars;


    completion exercise (intervention). Participants then completed two post-training virtual procedures for assessment and comparison. Cognitive load during the post-training procedures was estimated by reaction time testing on an integrated secondary task. Final-product analysis by two blinded expert raters...... was used to assess the virtual mastoidectomy performances. Results Participants in the intervention group had a significantly increased cognitive load during the post-training procedures compared with the control group (52 vs. 41 %, p = 0.02). This was also reflected in the final-product performance....... Increased cognitive load when part tasks needed to be integrated in the post-training procedures could be a possible explanation for this. Other instructional designs and methods are needed to lower the cognitive load and improve the performance in virtual reality surgical simulation training of novices....

  17. Surgical Management of Fractures and Tendons. (United States)

    Pentecost, Rebecca; Niehaus, Andrew J; Anderson, David E


    Long bone fractures and disorders of tendons and ligaments represent a significant proportion of surgical orthopedic cases presented to ruminant veterinarians. The presentation of these patients, their diagnostic work-up, surgical treatment, and expected outcome will be discussed. The outcome of these cases depends largely on the presenting problem; however, accurate diagnosis and prompt surgical intervention can greatly improve the outcome of many of these cases.

  18. Immunolocalization of markers for bone formation during guided bone regeneration in osteopenic rats

    Directory of Open Access Journals (Sweden)

    Tábata de Mello TERA


    Full Text Available Objective The aim of this paper was to evaluate the repair of onlay autogenous bone grafts covered or not covered by an expanded polytetrafluoroethylene (e-PTFE membrane using immunohistochemistry in rats with induced estrogen deficiency. Material and Methods Eighty female rats were randomly divided into two groups: ovariectomized (OVX and with a simulation of the surgical procedure (SHAM. Each of these groups was again divided into groups with either placement of an autogenous bone graft alone (BG or an autogenous bone graft associated with an e-PTFE membrane (BGM. Animals were euthanized on days 0, 7, 21, 45, and 60. The specimens were subjected to immunohistochemistry for bone sialoprotein (BSP, osteonectin (ONC, and osteocalcin (OCC. Results All groups (OVX+BG, OVX+BMG, SHAM+BG, and SHAM+BMG showed greater bone formation, observed between 7 and 21 days, when BSP and ONC staining were more intense. At the 45-day, the bone graft showed direct bonding to the recipient bed in all specimens. The ONC and OCC showed more expressed in granulation tissue, in the membrane groups, independently of estrogen deficiency. Conclusions The expression of bone forming markers was not negatively influenced by estrogen deficiency. However, the markers could be influenced by the presence of the e-PTFE membrane.

  19. Olecranon bone graft: revisited. (United States)

    Mersa, Berkan; Ozcelik, Ismail Bulent; Kabakas, Fatih; Sacak, Bulent; Aydin, Atakan


    Autogenous bone grafts are frequently in use in the field of reconstructive upper extremity surgery. Cancellous bone grafts are applied to traumatic osseous defects, nonunions, defects after the resection of benign bone tumors, arthrodesis, and osteotomy procedures. Cancellous bone grafts do not only have benefits such as rapid revascularization, but they also have mechanical advantages. Despite the proximity to the primary surgical field, cancellous olecranon grafts have not gained the popularity they deserve in the field of reconstructive hand surgery. In this study, the properties, advantages, and technical details of harvesting cancellous olecranon grafts are discussed.

  20. Rehabilitation of a dentate mandible requiring a full arch rehabilitation. Immediate loading of a fixed complete denture on 8 implants placed with a bone-supported surgical computer-planned guide: a case report. (United States)

    Amorfini, Leonardo; Storelli, Stefano; Romeo, Eugenio


    The use of technologies that merge computerized tomography X-ray imaging and 3-dimensional (3D) planning software allow the surgeon to digitally elaborate on the computer the position, length, and diameter of every implant to be placed. Following this approach, the placement is guided in a 3D digital model, and the implants are placed in the final position avoiding eventual anatomic structures. In this case report, the patient's remaining mandibular teeth were extracted, and the patient received 8 implants with the help of a computer surgical guide. The case was planned using SimPlant and a bone-supported guide. Because of the high precision of the planning, it was possible to realize a provisional rehabilitation before the actual surgery. The planning allows placement of parallel implants to optimize the prosthetic procedure and outcome. An immediate provisional implant was fixed with a flow composite on the temporary abutments and then refined in the dental laboratory. The patient received the provisional rehabilitation the same day of the surgery. After 6 weeks of healing, the final impression was taken and the prosthesis was finalized with a computer-aided design/computer-aided manufacturing titanium full-arch screwed framework with composite veneering. A 6-month follow-up showed good integration of the prostheses and success of all 8 implants. The use of surgical computer-guided planning changes the surgeon's approach: whereas before the use of conventional guides permitted a certain degree of offset from what was planned, the use of computer guides allows the implant to be inserted in a far more precise way. It is obvious that careful planning is the key factor to avoid implant misplacement.

  1. IERAPSI project: simulation of a canal wall-up mastoidectomy. (United States)

    Neri, E; Sellari Franceschini, S; Berrettini, S; Caramella, D; Bartolozzi, C


    Among the various EU research projects concerning the medical application of virtual reality, the project Ist-1999-12175, called IERAPSI (Integrated Environment for the Rehearsal and Planning of Surgical Interventions), specifically addressed the creation of a virtual and interactive surgical field for the temporal bone using three-dimensional images derived from CT data. We report on the experience obtained in the IERAPSI project in simulating a canal wall-up mastoidectomy. A surgeon with extensive experience in surgery of the petrous bone performed the mastoidectomy. The operative field included the mastoid, with its substantial differences in density between the cortex and the pneumatized bone, together with soft tissue structures, both on the border and inside the bone. The simulation is better in the first part of the operation than in the second part, suffering from a lack of haptic feedback from soft tissue and the surgical tool in deeper contexts, and under-representation of the variability inherent in pneumatized bone. This said, the excellent representation of dust production and removal, 3D simulation through color, and very good visual and haptic feedback in the early stage of the procedure are impressive. IERAPSI represents a potential surgical planning theater for the training of students and young surgeons, but is also expected to aid expert surgeons in the preoperative planning of difficult cases.

  2. Bone cysts: unicameral and aneurysmal bone cyst. (United States)

    Mascard, E; Gomez-Brouchet, A; Lambot, K


    Simple and aneurysmal bone cysts are benign lytic bone lesions, usually encountered in children and adolescents. Simple bone cyst is a cystic, fluid-filled lesion, which may be unicameral (UBC) or partially separated. UBC can involve all bones, but usually the long bone metaphysis and otherwise primarily the proximal humerus and proximal femur. The classic aneurysmal bone cyst (ABC) is an expansive and hemorrhagic tumor, usually showing characteristic translocation. About 30% of ABCs are secondary, without translocation; they occur in reaction to another, usually benign, bone lesion. ABCs are metaphyseal, excentric, bulging, fluid-filled and multicameral, and may develop in all bones of the skeleton. On MRI, the fluid level is evocative. It is mandatory to distinguish ABC from UBC, as prognosis and treatment are different. UBCs resolve spontaneously between adolescence and adulthood; the main concern is the risk of pathologic fracture. Treatment in non-threatening forms consists in intracystic injection of methylprednisolone. When there is a risk of fracture, especially of the femoral neck, surgery with curettage, filling with bone substitute or graft and osteosynthesis may be required. ABCs are potentially more aggressive, with a risk of bone destruction. Diagnosis must systematically be confirmed by biopsy, identifying soft-tissue parts, as telangiectatic sarcoma can mimic ABC. Intra-lesional sclerotherapy with alcohol is an effective treatment. In spinal ABC and in aggressive lesions with a risk of fracture, surgical treatment should be preferred, possibly after preoperative embolization. The risk of malignant transformation is very low, except in case of radiation therapy.

  3. The impact of simulated and real microgravity on bone cells and mesenchymal stem cells

    NARCIS (Netherlands)

    C. Ulbrich; M. Wehland; J. Pietsch; G. Aleshcheva; P. Wise; J. van Loon; N. Magnusson; M. Infanger; J. Grosse; C. Eilles; A. Sudaresan; D. Grimm


    How microgravity affects the biology of human cells and the formation of 3D cell cultures in real and simulated microgravity (r- and s- ) is currently a hot topic in biomedicine. In r- and s- , various cell types were found to form 3D structures. This review will focus on the current knowledge of ti

  4. Medium-Term Function of a 3D Printed TCP/HA Structure as a New Osteoconductive Scaffold for Vertical Bone Augmentation: A Simulation by BMP-2 Activation

    Directory of Open Access Journals (Sweden)

    Mira Moussa


    Full Text Available Introduction: A 3D-printed construct made of orthogonally layered strands of tricalcium phosphate (TCP and hydroxyapatite has recently become available. The material provides excellent osteoconductivity. We simulated a medium-term experiment in a sheep calvarial model by priming the blocks with BMP-2. Vertical bone growth/maturation and material resorption were evaluated. Materials and methods: Titanium hemispherical caps were filled with either bare- or BMP-2 primed constructs and placed onto the calvaria of adult sheep (n = 8. Histomorphometry was performed after 8 and 16 weeks. Results: After 8 weeks, relative to bare constructs, BMP-2 stimulation led to a two-fold increase in bone volume (Bare: 22% ± 2.1%; BMP-2 primed: 50% ± 3% and a 3-fold decrease in substitute volume (Bare: 47% ± 5%; BMP-2 primed: 18% ± 2%. These rates were still observed at 16 weeks. The new bone grew and matured to a haversian-like structure while the substitute material resorbed via cell- and chemical-mediation. Conclusion: By priming the 3D construct with BMP-2, bone metabolism was physiologically accelerated, that is, enhancing vertical bone growth and maturation as well as material bioresorption. The scaffolding function of the block was maintained, leaving time for the bone to grow and mature to a haversian-like structure. In parallel, the material resorbed via cell-mediated and chemical processes. These promising results must be confirmed in clinical tests.

  5. Space simulations of thermal fields generated in bone tissue for application to nanophotohyperthermia and nanophotothermolysis (United States)

    Letfullin, Renat R.; Rice, Colin E. W.; George, Thomas F.


    The use of nanoparticles in medical applications has been gaining momentum as antibody-conjugated nanoparticles are becoming more and more feasible as a means of targeted delivery of various therapies. Irradiating nanoparticles with light of strongly-absorbed wavelengths allows them to act as heat generation sites. Two therapies utilize these nanoparticle heat sources to kill the target cells: nanophotohyperthermia, which heats the particles just enough to disrupt cell function and trigger cell death; and nanophotothermolysis, which heats the particles to such extremes as to destroy the cell membrane. The use of optical wavelengths in the range of 750-1100 nm has been to capitalize on the "optical transparency window" of biotissues between the absorption peaks of hemoglobin in the visible end and water in the near-IR. However, further research has shown that a plasmon resonance can greatly affect the absorption characteristics of nanoparticles at the plasmon resonant frequency, allowing for increased absorption characteristics at desirable wavelengths. Thus, other transparency windows may find use in a similar manner, such as nanoparticle heating by RF waves. This paper presents the modeling of 3D thermal fields around nanoparticle absorbers in bone tissue for various frequencies. A comparison of the heating effectiveness across multiple wavelengths is discussed for application to nanophotothermolysis and nanophotohyperthermia treatments in or near biological hard tissue.

  6. Bone graft substitutes and bone morphogenetic proteins for osteoporotic fractures: What is the evidence?

    NARCIS (Netherlands)

    E.M.M. van Lieshout (Esther); V. Alt (Volker)


    textabstractDespite improvements in implants and surgical techniques, osteoporotic fractures remain challenging to treat. Among other major risk factors, decreased expression of morphogenetic proteins has been identified for impaired fracture healing in osteoporosis. Bone grafts or bone graft substi

  7. A study of murine bone marrow cells cultured in bioreactors which create an environment which simulated microgravity (United States)

    Lawless, Brother Desales


    Previous research indicated that mouse bone marrow cells could be grown in conditions of simulated microgravity. This environment was created in rotating bioreactor vessels. On three attempts mouse cells were grown successfully in the vessels. The cells reached a stage where the concentrations were doubling daily. Phenotypic analysis using a panel of monoclonal antibodies indicated that the cell were hematopoietic pluripotent stem cells. One unsuccessful attempt was made to reestablish the immune system in immunocompromised mice using these cells. Since last summer, several unsuccessful attempts were made to duplicate these results. It was determined by electron microscopy that the cells successfully grown in 1989 contained virus particles. It was suggested that these virally parasitized cells had been immortalized. The work of this summer is a continuation of efforts to grow mouse bone marrow in these vessels. A number of variations of the protocol were introduced. Certified pathogen free mice were used in the repeat experiments. In some attempts the medium of last summer was used; in others Dexture Culture Medium containing Iscove's Medium supplemented with 20 percent horse serum and 10-6 M hydrocortisone. Efforts this summer were directed solely to repeating the work of last summer. Plans were made for investigations if stem cells were isolated. Immortalization of the undifferentiated stem cell would be attempted by transfection with an oncogenic vector. Selective differentiation would be induced in the stem cell line by growing it with known growth factors and immune response modulators. Interest is in identifying any surface antigens unique to stem cells that would help in their characterization. Another goal was to search for markers on stem cells that would distinguish them from stem cells committed to a particular lineage. If the undifferentiated hematopoietic stem cell was obtained, the pathways that would terminally convert it to myeloid, lyphoid

  8. Evolution of surgical skills training

    Institute of Scientific and Technical Information of China (English)

    Kurt E Roberts; Robert L Bell; Andrew J Duffy


    Surgical training is changing: one hundred years of tradition is being challenged by legal and ethical concerns for patient safety, work hours restrictions, the cost of operating room time, and complications. Surgical simulation and skills training offers an opportunity to teach and practice advanced skills outside of the operating room environment before attempting them on living patients.Simulation training can be as straight forward as using real instruments and video equipment to manipulate simulated "tissue" in a box trainer. More advanced,virtual reality simulators are now available and ready for widespread use. Early systems have demonstrated their effectiveness and discriminative ability. Newer systems enable the development of comprehensive curricula and full procedural simulations.The Accreditation Council of Graduate Medical Education's (ACGME) has mandated the development of novel methods of training and evaluation. Surgical organizations are calling for methods to ensure the maintenance of skills, advance surgical training, and to credential surgeons as technically competent.Simulators in their current form have been demonstrated to improve the operating room performance of surgical residents. Development of standardized training curricula remains an urgent and important agenda, particularly for minimal invasive surgery.An innovative and progressive approach, borrowing experiences from the field of aviation, can provide the foundation for the next century of surgical training,ensuring the quality of the product. As the technology develops, the way we practice will continue to evolve, to the benefit of physicians and patients.

  9. Surgical bleeding in microgravity (United States)

    Campbell, M. R.; Billica, R. D.; Johnston, S. L. 3rd


    A surgical procedure performed during space flight would occur in a unique microgravity environment. Several experiments performed during weightlessness in parabolic flight were reviewed to ascertain the behavior of surgical bleeding in microgravity. Simulations of bleeding using dyed fluid and citrated bovine blood, as well as actual arterial and venous bleeding in rabbits, were examined. The high surface tension property of blood promotes the formation of large fluid domes, which have a tendency to adhere to the wound. The use of sponges and suction will be adequate to prevent cabin atmosphere contamination with all bleeding, with the exception of temporary arterial droplet streams. The control of the bleeding with standard surgical techniques should not be difficult.

  10. Stereo morphology of temporal bone and ear

    Institute of Scientific and Technical Information of China (English)

    戴朴; 刘阳; 姜泗长; 方耀云; 王今; 杨伟炎


    Background The temporal bone has the most complicated anatomic feature among the whole human body, which always challenges otolaryngologists. This study was to study three-dimensional (3D) morphology of the temporal bone and the ear by means of a computer image processing technique, for the purpose of providing a 3D image to help in pathological, diagnostic and surgical procedures. Methods Forty sets of temporal bone celloidin serial sections with reference points were prepared and the contours of selected structures and reference points were entered into a graphics programme. The technique of computer-aided 3D reconstruction was applied to obtain 3D images and parameters of the temporal bones and the ears. Stereo views of the ossicles (n=5), the facial nerves (n=11), the posterior tympanic sinuses (n=11), the posterior ampullary nerves (n=4), the endolymphatic ducts and sacs (n=5), and the bony and membranous labyrinth (n=1) were reconstructed. Results Three-dimensional images, including the cochlea, the ossicles, the nerves, the tendons and the endolymphatic fluid system in the temporal bone, were obtained. Stereo picture pairs and 3D parameters of spatial dimensions, angle and volume for these reconstructed structures were calculated. The arrangement of the ossicles, spatial relationship of the bony and membranous labyrinth, the whole course of the facial nerves, the endolymphatic sac and posterior tympanic cavity were clearly observable. Stereo picture pairs made the spatial relationships among the above-mentioned structures much clearer. The operation of the posterior ampullary nerve transection was designed and simulated on the graphic computer based on 3D anatomic investigations. Conclusion The technique of computer-aided 3D reconstruction provides a new tool to observe the morphology of the temporal bone and thus may allow design and study of new surgical approaches.

  11. Computer-assisted preoperative simulation for positioning of plate fixation in Lefort I osteotomy: A case report. (United States)

    Suenaga, Hideyuki; Taniguchi, Asako; Yonenaga, Kazumichi; Hoshi, Kazuto; Takato, Tsuyoshi


    Computed tomography images are used for three-dimensional planning in orthognathic surgery. This facilitates the actual surgery by simulating the surgical scenario. We performed a computer-assisted virtual orthognathic surgical procedure using optically scanned three-dimensional (3D) data and real computed tomography data on a personal computer. It helped maxillary bone movement and positioning and the titanium plate temporary fixation and positioning. This simulated the surgical procedure, which made the procedure easy, and we could perform precise actual surgery and could forecast the postsurgery outcome. This simulation method promises great potential in orthognathic surgery to help surgeons plan and perform operative procedures more precisely.

  12. A Digital Model to Simulate Effects of Bone Architecture Variations on Texture at Spatial Resolutions of CT, HR-pQCT, and μCT Scanners

    Directory of Open Access Journals (Sweden)

    T. Lowitz


    Full Text Available The quantification of changes in the trabecular bone structure induced by musculoskeletal diseases like osteoarthritis, osteoporosis, rheumatoid arthritis, and others by means of a texture analysis is a valuable tool which is expected to improve the diagnosis and monitoring of a disease. The reaction of texture parameters on different alterations in the architecture of the fine trabecular network and inherent imaging factors such as spatial resolution or image noise has to be understood in detail to ensure an accurate and reliable determination of the current bone state. Therefore, a digital model for the quantitative analysis of cancellous bone structures was developed. Five parameters were used for texture analysis: entropy, global and local inhomogeneity, local anisotropy, and variogram slope. Various generic structural changes of cancellous bone were simulated for different spatial resolutions. Additionally, the dependence of the texture parameters on tissue mineralization and noise was investigated. The present work explains changes in texture parameter outcomes based on structural changes originating from structure modifications and reveals that a texture analysis could provide useful information for a trabecular bone analysis even at resolutions below the dimensions of single trabeculae.

  13. Decomposition of two-component ultrasound pulses in cancellous bone using modified least squares prony method--phantom experiment and simulation. (United States)

    Wear, Keith A


    Porous media such as cancellous bone often support the simultaneous propagation of two compressional waves. When small bone samples are interrogated in through-transmission with broadband sources, these two waves often overlap in time. The modified least-squares Prony's (MLSP) method was tested for decomposing a 500 kHz-center-frequency signal containing two overlapping components: one passing through a polycarbonate plate (to produce the "fast" wave) and another passing through a cancellous-bone-mimicking phantom (to produce the "slow" wave). The MLSP method yielded estimates of attenuation slopes accurate to within 7% (polycarbonate plate) and 2% (cancellous bone phantom). The MLSP method yielded estimates of phase velocities accurate to within 1.5% (both media). The MLSP method was also tested on simulated data generated using attenuation slopes and phase velocities corresponding to bovine cancellous bone. Throughout broad ranges of signal-to-noise ratio (SNR), the MLSP method yielded estimates of attenuation slope that were accurate to within 1.0% and estimates of phase velocity that were accurate to within 4.3% (fast wave) and 1.3% (slow wave).

  14. Curative effect of bone transport for infectious large segmental bone defect after surgical treatment for tibial fracture%骨搬移术治疗胫骨骨折术后感染性大段骨缺损的疗效分析

    Institute of Scientific and Technical Information of China (English)

    郝光亮; 张贵春; 曹学成


    背景:胫骨骨折术后感染性大段骨缺损的发生率高,治疗困难,效果不理想。目前,骨缺损修复方法包括皮瓣覆盖+自体骨移植术、异体骨或异种骨移植、带血供腓骨移植、骨延长和骨搬移术。  目的:探讨骨搬移术治疗胫骨骨折术后感染性大段骨缺损的疗效。  方法:选取2010年9月至2014年9月收治的胫骨骨折术后感染性大段骨缺损患者40例,男24例,女16例;年龄18~64岁,平均(42.8±12.1)岁。将患者随机分成两组各20例,一组采用Orthofix单臂外固定延长架截骨延长,另一组采用Ilizarov环形外固定延长架截骨延长,术后随访对比两组患者的手术时间、手术出血量、HHS膝关节功能评分、Baird-Jackson踝关节功能评分。  结果:Orthofix单臂外固定延长架的手术时间较短、手术出血量较少,与Ilizarov环形外固定延长架比较均有统计学差异(P<0.05)。两组患者的术后HHS膝关节功能评分、Baird-Jackson踝关节功能评分均较术前有明显提高(P<0.01)。  结论:骨搬移术治疗胫骨骨折术后感染性大段骨缺损的疗效佳,可较好地改善患者的膝关节和踝关节功能。其中Or-thofix单臂外固定延长架能减少手术创伤,安全性较高,但骨搬运过程中容易发生延长骨成角和偏移;Ilizarov环形外固定延长架的术中应用置入较多钢针,移动时可造成部分皮瓣坏死和血管损伤,应避免在皮瓣覆盖创面的胫骨大段骨缺损患者中使用。%Background:There are high incidences of infectious large segmental bone defect after surgical treatment for tibial fracture, and it is very difficult to be cured. At present, there are a few of methods for repairing bone defect, such as skin flap cover-age plus autogenous bone transplantation, allograft bone or xenogeneic bone transplantation, vascularized fibular graft, bone lengthening and bone

  15. Bone Biopsy (United States)

    ... News Physician Resources Professions Site Index A-Z Bone Biopsy Bone biopsy uses a needle and imaging ... the limitations of Bone Biopsy? What is a Bone Biopsy? A bone biopsy is an image-guided ...

  16. Pterion: An anatomical variation and surgical landmark

    Directory of Open Access Journals (Sweden)

    Prashant E Natekar


    Full Text Available Introduction : The frontal and the parietal bones superiorly and the greater wing of the sphenoid and the squamous temporal inferiorly of one side meet at an H-shaped sutural junction termed the pterion. This is an important anatomical and anthropological landmark as it overlies both the anterior branch of middle meningeal artery and the lateral fissure of the cerebral hemisphere. The knowledge of sutural joints between frontal, parietal, sphenoid and temporal bones at pterion is clinically, radiologically and surgically important during surgical interventions involving burr hole surgeries. Materials and Methods : Study performed on 150 dry temporal bones. The pterion, and its sutural articulations with frontal, parietal, sphenoid and temporal bones and also anatomical variations, if any, were studied. Results : Four types of pterion, i.e. sphenoparietal, frontotemporal, stellate and epipteric, were observed. Conclusions : The knowledge of the variations of pterion and its surgical anatomy, in Indian population are important for surgeons operating in the fieldThe present study will also contribute additional information of skull bone fractures in infancy and early childhood, which may be associated with large intersutural bones giving false appearance of fracture radiologically and also during surgical interventions involving burr hole surgeries, as their extensions may lead to continuation of fracture lines.

  17. The effect of fasting on surgical performance

    DEFF Research Database (Denmark)

    Schefte, David Fenger; Rosenstock, Steffen Jais


    BACKGROUND: It is unknown whether fasting has any impact on surgical performance. This simulator-based study investigates whether fasting affects surgical performance. METHODS: Twelve healthy medical students [seven women, mean age 26.5 years (range 23-34)] with no prior experience with surgical...... simulators underwent a short course introduction to the LapSim(®) simulator. After having reached a predefined level, the participants performed five simulated salpingectomies on the LapSim(®) simulator 5-30 days after the initial introduction. The procedures took place at 9 a.m. and 2 p.m. after fasting...... in the longitudinal axis with the left hand. CONCLUSION: The simulator-based study suggests that 17 h of fasting does not deteriorate surgical performance. Further studies on the effect of fasting on surgical performance are needed....

  18. Mesenchymal Stem Cells as a Potent Cell Source for Bone Regeneration


    Elham Zomorodian; Mohamadreza Baghaban Eslaminejad


    While small bone defects heal spontaneously, large bone defects need surgical intervention for bone transplantation. Autologous bone grafts are the best and safest strategy for bone repair. An alternative method is to use allogenic bone graft. Both methods have limitations, particularly when bone defects are of a critical size. In these cases, bone constructs created by tissue engineering technologies are of utmost importance. Cells are one main component in the manufacture of bone construct...

  19. Effect of heat generation from bone cement on bone tissue in total knee arthroplasty; Jinko kansetsu okikaeji no one cement no hatsunetsu ga seitai soshiki ni oyobosu eikyo ni kansuru kenkyu

    Energy Technology Data Exchange (ETDEWEB)

    Matsuda, M.; Uchida, T. [Kobe University, Kobe (Japan); Iwatsubo, T. [Kobe University, Kobe (Japan). Faculty of Engineering; Kurosawa, M.; Hashimoto, Y. [Kobe University, Kobe (Japan). Faculty of Medicine; Fukushima, H.


    Bone cement is often applied to fix the components in a surgical operation, such as TKA (total knee arthroplasty). In this paper, we consider the effect of heat generation from bone cement on bone tissue in TKA by using numerical simulation. First, we applied an axisymmetric model of tibia to finite element method and analyzed heat generation of bone cement. To confirm the results of analysis by experiment, we measured the temperature determined by 6 points i.e., 2 points each in component-cement interface, cement and bone-cement interface. As a result, the temperature determined by analysis agrees with that determined by experiment. Next, we proposed the evaluation formula of the bone necrosis. We constructed a bone necrosis map from the simulation. From the map, we found that the bone necrosis region was about 2 mm from the bone-cement interface. In addition, the bone necrosis is severe at the base of the tibial component. 7 refs., 15 figs., 3 tabs.

  20. Bone Densitometry (Bone Density Scan) (United States)

    ... News Physician Resources Professions Site Index A-Z Bone Densitometry (DEXA) Bone densitometry, also called dual-energy ... limitations of DEXA Bone Densitometry? What is a Bone Density Scan (DEXA)? Bone density scanning, also called ...

  1. Endotoxins in surgical instruments of hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Vania Regina Goveia


    Full Text Available Abstract OBJECTIVE To investigate endotoxins in sterilized surgical instruments used in hip arthroplasties. METHOD A descriptive exploratory study conducted in a public teaching hospital. Six types of surgical instruments were selected, namely: acetabulum rasp, femoral rasp, femoral head remover, chisel box, flexible bone reamer and femoral head test. The selection was based on the analysis of the difficulty in removing bone and blood residues during cleaning. The sample was made up of 60 surgical instruments, which were tested for endotoxins in three different stages. The EndosafeTM Gel-Clot LAL (Limulus Amebocyte Lysate method was used. RESULT There was consistent gel formation with positive analysis in eight instruments, corresponding to 13.3%, being four femoral rasps and four bone reamers. CONCLUSION Endotoxins in quantity ≥0.125 UE/mL were detected in 13.3% of the instruments tested.

  2. Application of surgical simulation system to the teaching of orthognathic surgery%手术虚拟系统在正颌外科教学中的应用

    Institute of Scientific and Technical Information of China (English)

    于洪波; 代杰文; 于德栋; 沈国芳


    Orthognathic surgical procedure is relatively complex and poses high requirements for accuracy and minimal invasion .However , the means of surgical teaching and training is limited .Because of its special advantages , virtual reality ( VR ) technology plays an important role in the teaching of orthognathic surgery .This paper describes the value and significance of surgical simulation and operation training.Based on the application of surgical simulation in orthognathic surgery , the paper illustrates the role, advantages and application prospects of VR technology to orthognathic surgery teaching .%治疗牙颌面畸形的正颌手术操作相对复杂,对精度及微创的要求较高。而其手术教学及操作培训的手段有限。虚拟现实技术以其独有的优势,在正颌外科教学中具有重要意义。该文介绍了手术虚拟及操作培训的价值及意义,并结合虚拟现实技术在正颌外科的应用实例,阐述了其在正颌外科教学中的作用、优势及其应用前景。

  3. Towards Safe Robotic Surgical Systems

    DEFF Research Database (Denmark)

    Sloth, Christoffer; Wisniewski, Rafael


    A proof of safety is paramount for an autonomous robotic surgical system to ensure that it does not cause trauma to patients. However, a proof of safety is rarely constructed, as surgical systems are too complex to be dealt with by most formal verification methods. In this paper, we design...... a controller for motion compensation in beating-heart surgery, and prove that it is safe, i.e., the surgical tool is kept within an allowable distance and orientation of the heart. We solve the problem by simultaneously finding a control law and a barrier function. The motion compensation system is simulated...

  4. The surgical treatment of chronic recurrent hematogenous osteomyelitis in children

    Directory of Open Access Journals (Sweden)

    Sukhrob Zayniev


    Full Text Available The results of surgical treatment of 178 patients with chronic recurrent osteomyelitis of the tube bones have been analyzed. It has been proposed the tactic of surgical treatment consisting of the tear of tissues for a distance of the diaphysis of the affected bone, cautious periosteum exfoliation from the bone, longitudinal osteotomy, sequestrnecrectomy with full restoration structure of intramedullary canal along the whole length, lavage and ultrasound cavitation with antiseptic solution. The performed surgical tactic secured the most radical sanation of the osteomyelitic focus and improved the treatment results of this severe pathology.

  5. Surgical therapy strategy of soft tissue sarcomas with juxta-articular bone involvement%侵犯关节周围骨组织的软组织肉瘤外科治疗策略

    Institute of Scientific and Technical Information of China (English)

    燕太强; 梁伟民; 郭卫; 杨荣利; 董森; 周文灏


    Objective To explore the surgical treating methods of extremity soft tissue sarcomas with juxta-articular bone involvement, and to analyze the postoperative complications, limb function and survival status of the patients. Methods 30 patients of soft tissue sarcomas with local juxta-articular bone involvement were adopted in our center from May 2004 to October 2011, whose clinical data were retrospectively analyzed. There were 14 males and 16 females, with a mean age of 51 years old (range; 17-75 years). There were 12 cases of malignant fibrous histiocytoma (MFH), 8 cases of liposarcoma, 4 cases of primitive neuroectodermal tumors (PNET), and 2 cases of synovial sarcoma, alveolar soft part sarcoma and malignant peripheral nerve sheath tumors (MPNST) respectively. Among them, 10 patients had tumors in the proximal femur, 9 in the distal femur, 8 in the proximal humerus, 2 in the proximal tibia and 1 in the total femur. Bone defect reconstruction using tumor prostheses was performed on all the patients after the wide excision of tumors and bone tissues involved. The periodic reviews of limb function, X-ray images, pulmonary CT scans and so on were carried out postoperatively. All patients were followed up regularly, including the occurrence of postoperative complications, recovery condition of limb function, oncology and survival status and so on. Results The mean follow-up period was 25 months (range; 3-84 months). 1 patient had temporary peroneal nerve palsy. 3 patients had poor wound healing, and then underwent debridement, 1 of whom underwent amputation due to deep infection. Implant fractures leading to additional revisions occurred in 2 cases. 4 patients had local tumor recurrence, and the recurrence rate was 13.3%, 1 of whom underwent amputation. 15 patients had lung metastases, and 11 patients died of disseminated metastases, including 3 patients with bone and lymph node metastases. In the latest follow-up, 14 patients survived tumor free, and 5 were alive

  6. Tophi - surgical treatment. (United States)

    Słowińska, Iwona; Słowiński, Radosław; Rutkowska-Sak, Lidia


    Gout is an inflammatory joint disease associated with deposition of monosodium urate crystals in the bones forming the joints, in periarticular tissues and in other organs. The disease is one of the most frequent causes of disability. This paper presents the case of a 57-year-old male patient treated for generalised gout. A "clinical mask" suggesting another disease was the cause of making the correct diagnosis only six years after the occurrence of the first manifestations. The patient, with high values of inflammatory markers, severe pain and advanced joint destruction, was given an aggressive anti-inflammatory treatment. The unsatisfactory effect of the conservative treatment forced the authors to perform surgical resection of the gouty nodules in the hands. After several operations the function of the hand joints operated on, appearance of the hands and the quality of the patient's life improved significantly.

  7. Tophi – surgical treatment (United States)

    Słowińska, Iwona; Słowiński, Radosław


    Gout is an inflammatory joint disease associated with deposition of monosodium urate crystals in the bones forming the joints, in periarticular tissues and in other organs. The disease is one of the most frequent causes of disability. This paper presents the case of a 57-year-old male patient treated for generalised gout. A “clinical mask” suggesting another disease was the cause of making the correct diagnosis only six years after the occurrence of the first manifestations. The patient, with high values of inflammatory markers, severe pain and advanced joint destruction, was given an aggressive anti-inflammatory treatment. The unsatisfactory effect of the conservative treatment forced the authors to perform surgical resection of the gouty nodules in the hands. After several operations the function of the hand joints operated on, appearance of the hands and the quality of the patient’s life improved significantly. PMID:27994273

  8. Experimental investigations and finite element simulation of cutting heat in vibrational and conventional drilling of cortical bone. (United States)

    Wang, Yu; Cao, Meng; Zhao, Xiangrui; Zhu, Gang; McClean, Colin; Zhao, Yuanyuan; Fan, Yubo


    Heat generated during bone drilling could cause irreversible thermal damage, which can lead to bone necrosis or even osteomyelitis. In this study, vibrational drilling was applied to fresh bovine bones to investigate the cutting heat in comparison with conventional drilling through experimental investigation and finite element analysis (FEA). The influence of vibrational frequency and amplitude on cutting heat generation and conduction were studied. The experimental results showed that, compared with the conventional drilling, vibrational drilling could significantly reduce the cutting temperature in drilling of cortical bone (P<0.05): the cutting temperature tended to decrease with increasing vibrational frequency and amplitude. The FEA results also showed that the vibrational amplitude holds a significant effect on the cutting heat conduction.

  9. Bone within a bone

    Energy Technology Data Exchange (ETDEWEB)

    Williams, H.J.; Davies, A.M. E-mail:; Chapman, S


    The 'bone within a bone' appearance is a well-recognized radiological term with a variety of causes. It is important to recognize this appearance and also to be aware of the differential diagnosis. A number of common conditions infrequently cause this appearance. Other causes are rare and some remain primarily of historical interest, as they are no longer encountered in clinical practice. In this review we illustrate some of the conditions that can give the bone within a bone appearance and discuss the physiological and pathological aetiology of each where known.

  10. Inducible models of bone loss. (United States)

    Doucette, Casey R; Rosen, Clifford J


    Bone is an essential organ that not only confers structural stability to the organism, but also serves as a reservoir for hematopoietic elements and is thought to affect systemic homeostasis through the release of endocrine factors as well as calcium. The loss of bone mass due to an uncoupling of bone formation and bone resorption leads to increased fragility that can result in devastating fractures. Further understanding of the effects of environmental stimuli on the development of bone disease in humans is needed, and they can be studied using animal models. Here, we present established and novel methods for the induction of bone loss in mice, including manipulation of diet and environment, administration of drugs, irradiation, and surgically induced hormone deficiency. All of these models are directly related to human cases, and thus, can be used to investigate the causes of bone loss resulting from these interventions.

  11. Mastoidectomy: anatomical parameters x surgical difficulty

    Directory of Open Access Journals (Sweden)

    Pereira Júnior, Anastácio Rodrigues


    Full Text Available Introduction: The lowered temporal meninges and/ or anterior sigmoid sinus are contiditions that can determine surgical difficulties in performing mastoidectomy. Objective: To correlate in the tomography the extent of the prolapse of the sigmoid sinus and of temporal meninges with the surgical difficulty in the mastoidectomy. Method: The tomographic measurements of prolapse sigmoid and of temporal meninges were correlated with the presence or non-presence of the surgical difficulty observed during the mastoidectomy procedure in patients with ostomatoiditis chronic (n=30. Form of study: Contemporary cohort transverse. Results: In 10 patients were observed surgical difficulty distributed as: due to prolapse of the sigmoid sinus (n = 2 or temporal meninges prolapse (n = 7 or both (n = 1. In patients in which the surgical difficulty was due to sigmoid sinus prolapse, the tomography distance of the anterior border of the sigmoid sinus to posterior wall of external auditory canal was lower than 9 mm. In patients in which surgical difficulty was due to temporal meninges prolapse, the tomographic distance to the upper plane of the petrous bone was 7 mm. Conclusion: The computerized tomography distance between the temporal meninges and the upper plane of the petrous bone 7 mm and the distance of the anterior border of the sigmoid sinus to posterior wall of external auditory canal was lower than 9 mm are predictive to the surgical difficulties to perform mastoidectomy.

  12. Pseudoanaplastic tumors of bone

    Energy Technology Data Exchange (ETDEWEB)

    Bahk, Won-Jong [Uijongbu St. Mary Hospital, The Catholic University of Korea, Department of Orthopaedic Surgery, Gyunggido, 480-821 (Korea); Mirra, Joseph M. [Orthopaedic Hospital, Orthopedic Oncology, Los Angeles, California (United States)


    To discuss the concept of pseudoanaplastic tumors of bone, which pathologically show hyperchromatism and marked pleomorphism with quite enlarged, pleomorphic nuclei, but with no to extremely rare, typical mitoses, and to propose guidelines for their diagnosis. From a database of 4,262 bone tumors covering from 1971 to 2001, 15 cases of pseudoanaplastic bone tumors (0.35% of total) were retrieved for clinical, radiographic and pathologic review. Postoperative follow-up after surgical treatment was at least 3 years and a maximum of 7 years. There were eight male and seven female patients. Their ages ranged from 10 to 64 years with average of 29.7 years. Pathologic diagnoses of pseudoanaplastic variants of benign bone tumors included: osteoblastoma (4 cases), giant cell tumor (4 cases), chondromyxoid fibroma (3 cases), fibrous dysplasia (2 cases), fibrous cortical defect (1 case) and aneurysmal bone cyst (1 case). Radiography of all cases showed features of a benign bone lesion. Six cases, one case each of osteoblastoma, fibrous dysplasia, aneurysmal bone cyst, chondromyxoid fibroma, giant cell tumor and osteoblastoma, were initially misdiagnosed as osteosarcoma. The remaining cases were referred for a second opinion to rule out sarcoma. Despite the presence of significant cytologic aberrations, none of our cases showed malignant behavior following simple curettage or removal of bony lesions. Our observation justifies the concept of pseudoanaplasia in some benign bone tumors as in benign soft tissue tumors, especially in their late evolutionary stage when bizarre cytologic alterations strongly mimic a sarcoma. (orig.)

  13. 肱骨近段锁定板结合植骨治疗肱骨外科颈Ⅱ、Ⅲ型骨折疗效观察%Clinical Observation of Locking Proximal Humerus Plate Combining Bone Graft in Treating Humerus Surgical Neck Fracture (NearⅡ,Ⅲ)

    Institute of Scientific and Technical Information of China (English)

    李家德; 陈榆; 钟永祥; 林晓; 辛伟光; 付新美; 吴永辉; 黄杨; 颜灵松


    Objective To evaluate the clinical results of open reduction and internal fixation combining bone graft in the treatment of humerus surgical neck fracture (NeerⅡ, Ⅲ). Methods Twenty-one cases of humerus surgical neck fractures (Neer Ⅱ: 5 cases; Neer Ⅲ: 16 cases) were treated by locking proximal humerus plate combining bone grafting. Results All patients were followed for more than 6 months on average, all of the fractures were healed and got satisfactory results of shoulder functional recovery. The results were excellent and good in 18 cases, the good rate was 85.7%. Conclusion Locking proximal humerus plate fracture fragments combining bone graft is conductive to the fracture healing and shoulder functional recovery. It is an effective method in the treatment of humerus surgical neck fracture (Near Ⅱ, Ⅲ ).%目的 评价切开复位内固定加植骨治疗肱骨外科颈Ⅱ、Ⅲ型骨折的疗效.方法 采用肱骨近段锁定板结合植骨治疗肱骨外科颈骨折21例,根据Neer分型,Ⅱ型5例,Ⅲ型16例;其中二部分骨折5例,三部分骨折10例,四部分骨折6例.结果 所有病例均随访6个月以上,骨折全部愈合,肩关节功能恢复满意,优良率85.7%.结论 肱骨近段锁定板结合植骨有利于骨折断端愈合、肩关节功能的恢复,是治疗肱骨外科颈Ⅱ、Ⅲ型骨折的有效方法.

  14. 四肢骨转移癌126例手术疗效分析%Clinical results in surgical treatment of bone metastases in limbs: 126 cases report

    Institute of Scientific and Technical Information of China (English)

    吴宗明; 唐献忠; 杨庆诚


    目的 回顾性分析手术治疗四肢骨转移癌126例的临床疗效.方法 2007年1月至2012年12月,我院收治四肢转移性肿瘤患者126例,男69例,女57例,年龄41~92 (平均65.8) 岁.其中肿瘤假体人工关节置换42例,单纯人工关节置换14例,骨水泥加带锁髓内钉内固定38例,骨水泥加钢板固定19例,瘤段灭活加钢板内固定4例,肢体短缩加钢板固定3例,外固定支架固定6例.对患者术前及术后1个月采用视觉模拟评分法 (visual analogue scale,VAS) 评分法进行疼痛评分;术前及术后3个月的生活质量 (quality of life,QOL) 采用SF-36评分系统进行评估;术后肢体功能按照美国肌肉骨骼肿瘤学会评分系统标准 (American musculo-skeletal tumor society system,MSTS) 于术后3个月进行评价.结果手术均顺利进行,无手术相关死亡病例,11例出现术后并发症,包括急性呼吸窘迫综合征1例、应激性溃疡 1例、轻度脑梗塞2例、深静脉血栓 3 例、急性肾功能衰竭1例、伤口感染 1例、髋关节脱位2例,给予相应治疗后均好转.126例均获3~60(平均32) 个月随访.术后生存期3~12个月45例,13~24个月32例,25~36个月26例,另有23例存活超过3年.术后疼痛明显改善,VAS 评分由术前的 (6.85±3.11) 分下降至术后1个月的 (1.26±0.81) 分 (t=9.978,P<0.001 ).术后生活质量明显改善,术前QOL评分平均为 (38.30±13.05) 分提高至术后3个月的(65.78±10.65)分 (t=-18.550,P<0.001 ).在肢体功能方面,术后 MSTS 评分范围 17~30分,平均为 (23.32±3.03) 分 (t=-1.450,P=0.016).结论 手术治疗四肢骨转移癌可以有效缓解疼痛、提高患者生存质量、改善肢体功能.%Objective To retrospectively analyze the clinical results in surgical treatment of bone metastases in limbs in 126 cases.Methods The data of 126 patients with bone metastases in limbs who were admitted from January 2007 to December 2012 were retrospectively analyzed

  15. Surgical disaster in temporomandibular joint: Case report

    Directory of Open Access Journals (Sweden)

    Guilherme Machado De Carvalho


    Conclusion: Since there is no corrective treatment for this type of injuries, the craniomaxillofacial surgeon and other professionals who carry out interventions of this nature need perfect knowledge of the anatomy of the temporal bone and lateral skull base, taking into account the risk of surgical disasters like the one here reported.

  16. CT pre-operative planning of a new semi-implantable bone conduction hearing device

    Energy Technology Data Exchange (ETDEWEB)

    Law, Eric K.C.; Bhatia, Kunwar S.S. [Prince of Wales Hospital, The Chinese University of Hong Kong, Department of Imaging and Interventional Radiology, Hong Kong, SAR (China); Tsang, Willis S.S.; Tong, Michael C.F. [Prince of Wales Hospital, The Chinese University of Hong Kong, Department of Otorhinolaryngology, Head and Neck Surgery, Hong Kong, SAR (China); Shi, Lin [The Chinese University of Hong Kong, Department of Medicine and Therapeutics, Hong Kong, SAR (China); The Chinese University of Hong Kong, Chow Yuk Ho Technology Center for Innovative Medicine, Hong Kong, SAR (China)


    Accommodating a novel semi-implantable bone conduction hearing device within the temporal bone presents challenges for surgical planning. This study describes the utility of CT in pre-operative assessment of such an implant. Retrospective review of pre-operative CT, clinical and surgical records of 16 adults considered for device implantation. Radiological suitability was assessed on CT using 3D simulation software. Antero-posterior (AP) dimensions of the mastoid bone and minimum skull thickness were measured. CT planning results were correlated with operative records. Eight and five candidates were suitable for device placement in the transmastoid and retrosigmoid positions, respectively, and three were radiologically unsuitable. The mean AP diameter of the mastoid cavity was 14.6 mm for the transmastoid group and 4.6 mm for the retrosigmoid group (p < 0.05). Contracted mastoid and/or prior surgery were predisposing factors for unsuitability. Four transmastoid and five retrosigmoid positions required sigmoid sinus/dural depression and/or use of lifts due to insufficient bone capacity. A high proportion of patients being considered have contracted or operated mastoids, which reduces the feasibility of the transmastoid approach. This finding combined with the complex temporal bone geometry illustrates the importance of careful CT evaluation using 3D software for precise device simulation. (orig.)

  17. Simulated bone remodeling around two types of osseointegrated implants for direct fixation of upper-leg prostheses

    NARCIS (Netherlands)

    Tomaszewski, P.K.; Verdonschot, N.; Bulstra, S.K.; Rietman, J.S.; Verkerke, G.J.


    Direct attachment of an upper leg prosthesis to the skeletal system by a percutaneous implant is an alternative solution to the traditional socket fixation. In this study, we investigated long-term periprosthetic bone changes around two types of fixation implants using two different initial conditio

  18. Measurements of simulated periodontal bone defects in inverted digital image and film-based radiograph: an in vitro study

    Energy Technology Data Exchange (ETDEWEB)

    Molon, Rafael Scaf; Morais Camillo, Juliana Aparecida Najarro Dearo; Ferreira, Mauricio Goncalves; Loffredo, Leonor Castro Monteiro; Scaf, Gulnara [Araraquara Dental School, Universidade Estadual Paulista, Sao Paulo (Brazil); Sakakura, Celso Eduardo [Barretos Dental School, Barretos Educational Fundation, Sao Paulo (Brazil)


    This study was performed to compare the inverted digital images and film-based images of dry pig mandibles to measure the periodontal bone defect depth. Forty 2-wall bone defects were made in the proximal region of the premolar in the dry pig mandibles. The digital and conventional radiographs were taken using a Schick sensor and Kodak F-speed intraoral film. Image manipulation (inversion) was performed using Adobe Photoshop 7.0 software. Four trained examiners made all of the radiographic measurements in millimeters a total of three times from the cementoenamel junction to the most apical extension of the bone loss with both types of images: inverted digital and film. The measurements were also made in dry mandibles using a periodontal probe and digital caliper. The Student's t-test was used to compare the depth measurements obtained from the two types of images and direct visual measurement in the dry mandibles. A significance level of 0.05 for a 95% confidence interval was used for each comparison. There was a significant difference between depth measurements in the inverted digital images and direct visual measurements (p>|t|=0.0039), with means of 6.29 mm (IC{sub 95%}:6.04-6.54) and 6.79 mm (IC{sub 95%}:6.45-7.11), respectively. There was a non-significant difference between the film-based radiographs and direct visual measurements (p>|t|=0.4950), with means of 6.64 mm(IC{sub 95%}:6.40-6.89) and 6.79 mm(IC{sub 95%}:6.45-7.11), respectively. The periodontal bone defect measurements in the inverted digital images were inferior to film-based radiographs, underestimating the amount of bone loss.

  19. Surgical tools and medical devices

    CERN Document Server

    Jackson, Mark


    This new edition presents information and knowledge on the field of biomedical devices and surgical tools. The authors look at the interactions between nanotechnology, nanomaterials, design, modeling, and tools for surgical and dental applications, as well as how nanostructured surfaces can be created for the purposes of improving cell adhesion between medical devices and the human body. Each original chapter is revised in this second edition and describes developments in coatings for heart valves, stents, hip and knee joints, cardiovascular devices, orthodontic applications, and regenerative materials such as bone substitutes. There are also 8 new chapters that address: Microvascular anastomoses Inhaler devices used for pulmonary delivery of medical aerosols Surface modification of interference screws Biomechanics of the mandible (a detailed case study) Safety and medical devices The synthesis of nanostructured material Delivery of anticancer molecules using carbon nanotubes Nano and micro coatings for medic...

  20. [Encounter of cancer cells with bone. Therapy for bone metastasis from lung cancer]. (United States)

    Sugiura, Hideshi


    Bone metastasis from lung cancer requires a thorough examination of bones, including axial bones (e.g., spine, pelvis, and proximal femur) . Most patients have multiple bone metastases by the time they are initially diagnosed. In such patients, radiation therapy is often the first choice of treatment. Surgical treatment is indicated for pathological fracture and impending fracture associated with cortical bone invasion in long bone metastasis. Spinal metastasis requires accurate imaging to evaluate the extent of bone metastasis ; surgical treatment is indicated when the spinal cord is compressed. Given reports that bisphosphonates decrease the incidence of pathological fractures, prescribing bisphosphonates at an early stage is likely to be an effective therapeutic strategy for bone metastasis.

  1. Perfluorodecalin and bone regeneration

    Directory of Open Access Journals (Sweden)

    F Tamimi


    Full Text Available Perfluorodecalin (PFD is a chemically and biologically inert biomaterial and, as many perfluorocarbons, is also hydrophobic, radiopaque and has a high solute capacity for gases such as oxygen. In this article we have demonstrated, both in vitro and in vivo, that PFD may significantly enhance bone regeneration. Firstly, the potential benefit of PFD was demonstrated by prolonging the survival of bone marrow cells cultured in anaerobic conditions. These findings translated in vivo, where PFD incorporated into bone-marrow-loaded 3D-printed scaffolds substantially improved their capacity to regenerate bone. Secondly, in addition to biological applications, we have also shown that PFD improves the radiopacity of bone regeneration biomaterials, a key feature required for the visualisation of biomaterials during and after surgical implantation. Finally, we have shown how the extreme hydrophobicity of PFD enables the fabrication of highly cohesive self-setting injectable biomaterials for bone regeneration. In conclusion, perfluorocarbons would appear to be highly beneficial additives to a number of regenerative biomaterials, especially those for bone regeneration.

  2. 根形骨块onlay移植治疗上颌前牙种植术所需的牙槽骨骨量不足%Restoration of anterior maxillar bone deficiency by simulated root-type bone graft onlay for dental implan-tation

    Institute of Scientific and Technical Information of China (English)

    张健; 杨晶; 朱甄慧; 王庆福; 王文慧


    目的:研究根形骨块移植治疗上颌骨前部骨量不足的效果.方法:通过对7例患者前牙区的26个牙位进行根形植骨术,重建牙槽骨的形态后植入种植体,术后随访时间平均10个月.结果:重建的牙槽骨唇侧丰满,骨面根形逼真,种植体无松动,无脱落,唇侧牙龈无退缩.结论:根形植骨术是治疗上颌多颗前牙缺失伴水平向骨量不足的有效手段.%Objective: To study the effects of simulated root- type bone graft onlay in the restoration of anterior maxilla bone deficiency for dental implantation. Methods: Restoration of anterior maxilla alveolar bone deficience was performed in 7 patients with 26 missing teeth by root-type bone graft,followed by dental implantation. 10 month follow-up was conducted. Results: A significant increase in the alveolar bone dimensions was achieved,labial alveolar bone presented root type. No implant was loosening or dropping,and there was no labial gingival recession. Conclusion: Root- type bone graft is effective in the restoration of anterior maxillar bone deficiency for dental implantation.

  3. Biomechanical analysis of the effects of implant diameter and bone quality in short implants placed in the atrophic posterior maxilla. (United States)

    Chang, Shih-Hao; Lin, Chun-Li; Hsue, Shue-Sang; Lin, Yang-Sung; Huang, Shiang-Rung


    Short dental implant (SDI) placement has been proposed as an alternative to reduce the surgical risks related to the advanced grafting procedures. The aim of this study was to simulate the biomechanical behaviors and influences of SDI diameters under various conditions of bone quality by using a validated finite element (FE) model for simulation. The CT image and CAD system were combined to construct the FE models with 6 mm length SDIs for 6, 7 and 8 mm diameters under three types of bone qualities, from normal to osteoporotic. The simulated results showed that implant diameter did not influence the von Mises strains of bone under the vertical load. The bone strains increased about 58.58% in the bone of least density under lateral load. Lateral loads induced high bone strain and implant stress than vertical loads. The bone strains of 7 mm- and 8 mm-diameter short implants were not different, and both were about 52% and 66% compared to those of 6 mm-wide short implant under lateral loads. The von Mises stress of the SDIs and their compartments were all less than the yield stress of the material under vertical and lateral loads. SDIs with diameter of 7 mm or above may have better mechanical transmission in the same length at feasible condition. Attaining a proper occlusal scheme design or selective occlusal adjustments to reduce the lateral occlusal force upon the SDIs is recommended.

  4. Bone Markers (United States)

    ... markers may be seen in conditions such as: Osteoporosis Paget disease Cancer that has spread to the bone (metastatic bone disease) Hyperparathyroidism Hyperthyroidism Osteomalacia in adults and rickets in children—lack of bone mineralization, ...

  5. Bone scan (United States)

    ... legs, or spine fractures) Diagnose a bone infection (osteomyelitis) Diagnose or determine the cause of bone pain, ... 2015:chap 43. Read More Broken bone Metabolism Osteomyelitis Review Date 12/10/2015 Updated by: Jatin ...

  6. Bone Cancer (United States)

    Cancer that starts in a bone is uncommon. Cancer that has spread to the bone from another ... more common. There are three types of bone cancer: Osteosarcoma - occurs most often between ages 10 and ...

  7. Bone Diseases (United States)

    Your bones help you move, give you shape and support your body. They are living tissues that rebuild constantly ... childhood and your teens, your body adds new bone faster than it removes old bone. After about ...

  8. Osteoradionecrosois of the temporal bone

    Energy Technology Data Exchange (ETDEWEB)

    Thornley, G.D.; Gullane, P.J.; Ruby, R.R.; Heeneman, H.


    Six cases of osteoradionecrosis of the temporal bone are described. Persistent symptoms of otitis externa refractory to local treatment measures should alert the physician to the possibility of underlying osteoradionecrosis. Treatment of superficial parotidectomy and partial temporal bone resection with preservation of the facial nerve is indicated if local aggressive conservative measures fail to control the disease. Benign mixed tumors of the parotid gland should be treated surgically with avoidance of radiotherapy.

  9. Micro-surgical endodontics. (United States)

    Eliyas, S; Vere, J; Ali, Z; Harris, I


    Non-surgical endodontic retreatment is the treatment of choice for endodontically treated teeth with recurrent or residual disease in the majority of cases. In some cases, surgical endodontic treatment is indicated. Successful micro-surgical endodontic treatment depends on the accuracy of diagnosis, appropriate case selection, the quality of the surgical skills, and the application of the most appropriate haemostatic agents and biomaterials. This article describes the armamentarium and technical procedures involved in performing micro-surgical endodontics to a high standard.

  10. Surgical innovation as sui generis surgical research. (United States)

    Lotz, Mianna


    Successful innovative 'leaps' in surgical technique have the potential to contribute exponentially to surgical advancement, and thereby to improved health outcomes for patients. Such innovative leaps often occur relatively spontaneously, without substantial forethought, planning, or preparation. This feature of surgical innovation raises special challenges for ensuring sufficient evaluation and regulatory oversight of new interventions that have not been the subject of controlled investigatory exploration and review. It is this feature in particular that makes early-stage surgical innovation especially resistant to classification as 'research', with all of the attendant methodological and ethical obligations--of planning, regulation, monitoring, reporting, and publication--associated with such a classification. This paper proposes conceptual and ethical grounds for a restricted definition according to which innovation in surgical technique is classified as a form of sui generis surgical 'research', where the explicit goal of adopting such a definition is to bring about needed improvements in knowledge transfer and thereby benefit current and future patients.

  11. Real-time in situ three-dimensional integral videography and surgical navigation using augmented reality: a pilot study. (United States)

    Suenaga, Hideyuki; Hoang Tran, Huy; Liao, Hongen; Masamune, Ken; Dohi, Takeyoshi; Hoshi, Kazuto; Mori, Yoshiyuki; Takato, Tsuyoshi


    To evaluate the feasibility and accuracy of a three-dimensional augmented reality system incorporating integral videography for imaging oral and maxillofacial regions, based on preoperative computed tomography data. Three-dimensional surface models of the jawbones, based on the computed tomography data, were used to create the integral videography images of a subject's maxillofacial area. The three-dimensional augmented reality system (integral videography display, computed tomography, a position tracker and a computer) was used to generate a three-dimensional overlay that was projected on the surgical site via a half-silvered mirror. Thereafter, a feasibility study was performed on a volunteer. The accuracy of this system was verified on a solid model while simulating bone resection. Positional registration was attained by identifying and tracking the patient/surgical instrument's position. Thus, integral videography images of jawbones, teeth and the surgical tool were superimposed in the correct position. Stereoscopic images viewed from various angles were accurately displayed. Change in the viewing angle did not negatively affect the surgeon's ability to simultaneously observe the three-dimensional images and the patient, without special glasses. The difference in three-dimensional position of each measuring point on the solid model and augmented reality navigation was almost negligible (augmented reality system was highly accurate and effective for surgical navigation and for overlaying a three-dimensional computed tomography image on a patient's surgical area, enabling the surgeon to understand the positional relationship between the preoperative image and the actual surgical site, with the naked eye.

  12. Effects of simulated weightlessness on the kinase activity of MEK1 induced by bone morphogenetic protein-2 in rat osteosarcoma cells (United States)

    Zhang, S.; Wang, B.; Cao, X. S.; Yang, Z.

    Objective The mRNA expression of alpha 1 chain of type I collagen COL-I alpha 1 in rat osteosarcoma ROS17 2 8 cells induced by bone morphogenetic protein-2 BMP-2 was reduced under simulated microgravity The protein kinase MEK1 of MAPK signal pathway plays an important role in the expression of COL-I alpha 1 mRNA The purpose of this study is to investigate the effects of simulated weightlessness on the activity of MEK1 induced by BMP-2 in ROS17 2 8 cells Methods ROS17 2 8 cells were cultured in 1G control and rotating clinostat simulated weightlessness for 24 h 48 h and 72 h BMP-2 500 ng ml was added into the medium 1 h before the culture ended There was a control group in which ROS17 2 8 cells were cultured in 1G condition without BMP-2 Then the total protein of cells was extracted and the expression of phosphated-ERK1 2 p-ERK1 2 protein was detected by means of Western Blotting to show the kinase activity of MEK1 Results There were no significant differences in the expression of total ERK1 2 among all groups The expression of p-ERK1 2 was unconspicuous in the control group without BMP-2 but increased significantly when BMP-2 was added P 0 01 The level of p-ERK1 2 in simulated weightlessness group was much more lower than that in 1G group in every time point P 0 01 The expression of p-ERK1 2 gradually decreased along with the time of weightlessness simulation P 0 01 Conclusions The kinase activity of MEK1 induced by BMP-2 in rat osteosarcoma cells was reduced under simulated weightlessness

  13. 3D bone mineral density distribution and shape reconstruction of the proximal femur from a single simulated DXA image: an in vitro study (United States)

    Whitmarsh, Tristan; Humbert, Ludovic; De Craene, Mathieu; del Río Barquero, Luis M.; Fritscher, Karl; Schubert, Rainer; Eckstein, Felix; Link, Thomas; Frangi, Alejandro F.


    Area Bone Mineral Density (aBMD) measured by Dual-energy X-ray Absorptiometry (DXA) is an established criterion in the evaluation of hip fracture risk. The evaluation from these planar images, however, is limited to 2D while it has been shown that proper 3D assessment of both the shape and the Bone Mineral Density (BMD) distribution improves the fracture risk estimation. In this work we present a method to reconstruct both the 3D bone shape and 3D BMD distribution of the proximal femur from a single DXA image. A statistical model of shape and a separate statistical model of the BMD distribution were automatically constructed from a set of Quantitative Computed Tomography (QCT) scans. The reconstruction method incorporates a fully automatic intensity based 3D-2D registration process, maximizing the similarity between the DXA and a digitally reconstructed radiograph of the combined model. For the construction of the models, an in vitro dataset of QCT scans of 60 anatomical specimens was used. To evaluate the reconstruction accuracy, experiments were performed on simulated DXA images from the QCT scans of 30 anatomical specimens. Comparisons between the reconstructions and the same subject QCT scans showed a mean shape accuracy of 1.2mm, and a mean density error of 81mg/cm3. The results show that this method is capable of accurately reconstructing both the 3D shape and 3D BMD distribution of the proximal femur from DXA images used in clinical routine, potentially improving the diagnosis of osteoporosis and fracture risk assessments at a low radiation dose and low cost.

  14. Automated 3D-2D registration of X-ray microcomputed tomography with histological sections for dental implants in bone using chamfer matching and simulated annealing. (United States)

    Becker, Kathrin; Stauber, Martin; Schwarz, Frank; Beißbarth, Tim


    We propose a novel 3D-2D registration approach for micro-computed tomography (μCT) and histology (HI), constructed for dental implant biopsies, that finds the position and normal vector of the oblique slice from μCT that corresponds to HI. During image pre-processing, the implants and the bone tissue are segmented using a combination of thresholding, morphological filters and component labeling. After this, chamfer matching is employed to register the implant edges and fine registration of the bone tissues is achieved using simulated annealing. The method was tested on n=10 biopsies, obtained at 20 weeks after non-submerged healing in the canine mandible. The specimens were scanned with μCT 100 and processed for hard tissue sectioning. After registration, we assessed the agreement of bone to implant contact (BIC) using automated and manual measurements. Statistical analysis was conducted to test the agreement of the BIC measurements in the registered samples. Registration was successful for all specimens and agreement of the respective binary images was high (median: 0.90, 1.-3. Qu.: 0.89-0.91). Direct comparison of BIC yielded that automated (median 0.82, 1.-3. Qu.: 0.75-0.85) and manual (median 0.61, 1.-3. Qu.: 0.52-0.67) measures from μCT were significant positively correlated with HI (median 0.65, 1.-3. Qu.: 0.59-0.72) between μCT and HI groups (manual: R(2)=0.87, automated: R(2)=0.75, p<0.001). The results show that this method yields promising results and that μCT may become a valid alternative to assess osseointegration in three dimensions.

  15. Evaluation of Qualitative Changes in Simulated Periodontal Ligament and Alveolar Bone Using a Noncontact Electromagnetic Vibration Device with a Laser Displacement Sensor. (United States)

    Kobayashi, Hiroshi; Hayashi, Makoto; Yamaoka, Masaru; Yasukawa, Takuya; Ibi, Haruna; Ogiso, Bunnai


    Evaluating periodontal tissue condition is an important diagnostic parameter in periodontal disease. Noncontact electromagnetic vibration device (NEVD) was previously developed to monitor this condition using mechanical parameters. However, this system requires accelerometer on the target tooth. This study assessed application of laser displacement sensor (LDS) to NEVD without accelerometer using experimental tooth models. Tooth models consisted of cylindrical rod, a tissue conditioner, and polyurethane or polyurethane foam to simulate tooth, periodontal ligament, and alveolar bone, respectively. Tissue conditioner was prepared by mixing various volumes of liquid with powder. Mechanical parameters (resonant frequency, elastic modulus, and coefficient of viscosity) were assessed using NEVD with the following methods: Group A, measurement with accelerometer; Group B, measurement with LDS in the presence of accelerometer; and Group C, measurement with LDS in the absence of accelerometer. Mechanical parameters significantly decreased with increasing liquid volume. Significant differences were also observed between the polyurethane and polyurethane foam models. Meanwhile, no statistically significant differences were observed between Groups A and B; however, most mechanical parameters in Group C were significantly larger and more distinguishable than those of Groups A and B. LDS could measure mechanical parameters more accurately and clearly distinguished the different periodontal ligament and alveolar bone conditions.

  16. Porous surface modified bioactive bone cement for enhanced bone bonding.

    Directory of Open Access Journals (Sweden)

    Qiang He

    Full Text Available BACKGROUND: Polymethylmethacrylate bone cement cannot provide an adhesive chemical bonding to form a stable cement-bone interface. Bioactive bone cements show bone bonding ability, but their clinical application is limited because bone resorption is observed after implantation. Porous polymethylmethacrylate can be achieved with the addition of carboxymethylcellulose, alginate and gelatin microparticles to promote bone ingrowth, but the mechanical properties are too low to be used in orthopedic applications. Bone ingrowth into cement could decrease the possibility of bone resorption and promote the formation of a stable interface. However, scarce literature is reported on bioactive bone cements that allow bone ingrowth. In this paper, we reported a porous surface modified bioactive bone cement with desired mechanical properties, which could allow for bone ingrowth. MATERIALS AND METHODS: The porous surface modified bioactive bone cement was evaluated to determine its handling characteristics, mechanical properties and behavior in a simulated body fluid. The in vitro cellular responses of the samples were also investigated in terms of cell attachment, proliferation, and osteoblastic differentiation. Furthermore, bone ingrowth was examined in a rabbit femoral condyle defect model by using micro-CT imaging and histological analysis. The strength of the implant-bone interface was also investigated by push-out tests. RESULTS: The modified bone cement with a low content of bioactive fillers resulted in proper handling characteristics and adequate mechanical properties, but slightly affected its bioactivity. Moreover, the degree of attachment, proliferation and osteogenic differentiation of preosteoblast cells was also increased. The results of the push-out test revealed that higher interfacial bonding strength was achieved with the modified bone cement because of the formation of the apatite layer and the osseointegration after implantation in the bony

  17. 术前正畸联合可吸收胶原生物膜用于牙槽突裂植骨修复30例分析%Analysis of 30 patients with pre-surgical orthodontics and application of absorbable collagen bio-membrane on alveolar clefe bone grafting

    Institute of Scientific and Technical Information of China (English)

    李志强; 黄诺蓓; 艾伟健; 刘曙光


    目的 探讨术前正畸联合术中应用可吸收胶原生物膜对单侧牙槽突裂植骨效果的影响.方法 选择牙弓狭窄、上颌前牙舌倾或扭转、牙槽突裂隙不规则、难以进行牙槽突裂檀骨术的单侧完全性牙槽突裂患者30例,年龄9 ~13岁,先进行植骨前正畸治疗,再应用髂骨松质骨加可吸收胶原生物膜覆盖行植骨修复,术后定期拍X线片检查,观察植骨效果.牙槽骨高度评价标准采用Bergland标准进行,术后观察期为1~3年.结果 30例患者术后成骨情况Ⅰ型11例,Ⅱ型17例,植骨成功率达93.3%.结论 对于上颌牙弓狭窄、牙槽突裂隙不规则、牙颌畸形严重的牙槽突裂患者,建议先行植骨前正畸治疗,植骨术中联合应用可吸收胶原生物膜可有效提高植骨成功率.%Objective To discuss the effect of bone grafting in patients with unilateral alveolar cleft,treated by presurgical orthodontics and secondary alveolar bone grafting surgery with absorbable collagen bio-membrane,in order to improve the success rate of graft.Methods Thirty complete unilateral alveolar cleft patients,aged 9-13 years,with collapsed upper arch or severe malpositioned upper incisors were selected.The patients received pre-surgical orthodontics before secondary alveolar bone grafting used ilium and absorbable bio-membrane.The observation period was 1-3 years and X-ray was taken regularly.Bergland criteria were used to evaluate the alveolar bone height.Results Pre-surgical orthodontics expanded the collapsed upper arch to benefit the secondary alveolar bone grafting with absorbable collagen bio-membrane,and the success rate of graft was improved to 93.3%.Conclusion It is worth popularizing that patients with collapsed upper arch or severe mal-positioned upper incisors should receive pre-surgical orthodontics and then secondary alveolar bone graft surgery with absorbable collagen bio-membrane.

  18. Clinical Analysis on Locking Plate Combining Bone Grafting in Treating with Fracture of Surgical Neck of Humerus%锁定钢板联合植骨治疗老年性肱骨外科颈骨折临床分析

    Institute of Scientific and Technical Information of China (English)

    张坤和; 黄黎; 王理德


    Objective To explore clinical efficacy of locking plate combining bone grafting in treating the senile with fracture of surgical neck of humerus and to provide references for future clinical treatment. Methods 180 patients with fracture of surgical neck of humerus admitted by this Hospital were selected as research subjects, who were divided into the research group and the control group on different treatment methods with 90 cases in each group. The patients in the research group underwent locking plate combining bone grafting treatment, and patients in the control group underwent locking plate treatment. Results The comparison and difference between intra-operative duration and postoperative healing time of patients in two groups were statistically significant (P <0.05).Conclusions The locking plate combining bone grafting in treating the senile with fracture of surgical neck of humerus delivers remarkable clinical efficacy, and patients are greatly recovered.%目的:探究钢板联合植骨治疗老年肱骨外科颈骨折的临床效果,为后期临床治疗提供参考。方法选取我院收入的肱骨骨折患者180例为研究对象,根据治疗方式的不同分为研究组与对照组各90例。研究组行锁定钢板联合植骨治疗,对照组行锁定钢板治疗。结果两组患者在手术及术后愈合时间比较,差异具有统计学意义(P<0.05)。结论锁定钢板联合植骨治疗老年性肱骨外科颈骨折的临床效果显著,患者恢复好。

  19. 骨髓腔注射骨髓间充质干细胞防治模拟失重大鼠的骨质疏松%Preventive and therapeutic effects of intra-bone marrow cavity injection of bone mesenchymal stem cells on osteoporosis in rats subjected to simulated weightlessness

    Institute of Scientific and Technical Information of China (English)

    吴礼凤; 孙平; 麦燕兴; 刘海明; 徐艳花; 杨锐; 黄震


    背景:模拟失重条件下自身骨髓间充质干细胞的增殖受到抑制,并且向成骨细胞分化的能力减弱,造成骨量减少与骨微结构的破坏,最终导致骨质疏松.目的:观察同种异体骨髓间充质干细胞骨髓腔注射对模拟失重大鼠胫骨骨密度和骨组织微结构的影响.方法:将雄性SD大鼠随机分为自由活动对照组、尾吊模拟失重组、细胞治疗组(尾吊模拟失重同时给予双侧胫骨骨髓腔注射成骨诱导的同种异体BMSCs细胞).结果与结论:与自由活动对照组相比,尾吊模拟失重组胫骨骨密度、骨小梁面积百分比、骨小梁数量和厚度均显著降低(P < 0.01),骨小梁分离度显著增加(P < 0.01).与尾吊模拟失重组相比,细胞治疗组中胫骨骨密度、骨小梁面积百分比、骨小梁数量和厚度均显著增加(P < 0.01),骨小梁分离度显著降低(P < 0.01).说明骨髓腔注射能够增加模拟失重大鼠骨密度,改善骨超微结构,减缓骨量丢失,有效防治骨质疏松.%BACKGROUND: Simulated weightlessness can inhibit the proliferation of bone marrow mesenchymal stem cells and their differentiation towards osteoblasts, which leads to osteoporosis characterized by low bone mass and microarchitectural deterioration of bone tissue.OBJECTIVE: To study the effects of intra-bone marrow cavity injection of allogeneic bone mesenchymal stem cells (BMSCs) on the bone mineral density and microarchitecture of the tibias in rats subjected to simulated weightlessness.METHODS: Male SD rats were randomly divided into three groups: normal control group, tail-suspended simulated weightlessness group, and treatment group. The bilateral tibias were subjected to intra-bone marrow cavity injection of allogeneic BMSCs while giving the tail-suspended simulated weightlessness.RESULTS AND CONCLUSION: Compared with the normal control group, the bone mineral density, percentage of trabecular area, trabecular number and trabecular thickness

  20. Measuring temperature rise during orthopaedic surgical procedures. (United States)

    Manoogian, Sarah; Lee, Adam K; Widmaier, James C


    A reliable means for measuring temperatures generated during surgical procedures is needed to recommend best practices for inserting fixation devices and minimizing the risk of osteonecrosis. Twenty four screw tests for three surgical procedures were conducted using the four thermocouples in the bone and one thermocouple in the screw. The maximum temperature rise recorded from the thermocouple in the screw (92.7±8.9°C, 158.7±20.9°C, 204.4±35.2°C) was consistently higher than the average temperature rise recorded in the bone (31.8±9.3°C, 44.9±12.4°C, 77.3±12.7°C). The same overall trend between the temperatures that resulted from three screw insertion procedures was recorded with significant statistical analyses using either the thermocouple in the screw or the average of several in-bone thermocouples. Placing a single thermocouple in the bone was determined to have limitations in accurately comparing temperatures from different external fixation screw insertion procedures. Using the preferred measurement techniques, a standard screw with a predrilled hole was found to have the lowest maximum temperatures for the shortest duration compared to the other two insertion procedures. Future studies evaluating bone temperature increase need to use reliable temperature measurements for recommending best practices to surgeons.

  1. Simulations

    CERN Document Server

    Ngada, N M


    The complexity and cost of building and running high-power electrical systems make the use of simulations unavoidable. The simulations available today provide great understanding about how systems really operate. This paper helps the reader to gain an insight into simulation in the field of power converters for particle accelerators. Starting with the definition and basic principles of simulation, two simulation types, as well as their leading tools, are presented: analog and numerical simulations. Some practical applications of each simulation type are also considered. The final conclusion then summarizes the main important items to keep in mind before opting for a simulation tool or before performing a simulation.

  2. Bone Densitometry (Bone Density Scan) (United States)

    ... of DXA Bone Densitometry? What is a Bone Density Scan (DXA)? Bone density scanning, also called dual-energy x-ray absorptiometry ( ... is today's established standard for measuring bone mineral density (BMD). An x-ray (radiograph) is a noninvasive ...

  3. Hernia Surgical Mesh Implants (United States)

    ... Prosthetics Hernia Surgical Mesh Implants Hernia Surgical Mesh Implants Share Tweet Linkedin Pin it More sharing options ... majority of tissue used to produce these mesh implants are from a pig (porcine) or cow (bovine) ...

  4. Urogynecologic Surgical Mesh Implants (United States)

    ... Prosthetics Urogynecologic Surgical Mesh Implants Urogynecologic Surgical Mesh Implants Share Tweet Linkedin Pin it More sharing options ... majority of tissue used to produce these mesh implants are from a pig (porcine) or cow (bovine). ...

  5. Abortion - surgical - aftercare (United States)

    ... this page: // Abortion - surgical - aftercare To use the sharing features on ... please enable JavaScript. You have had a surgical abortion. This is a procedure that ends pregnancy by ...

  6. Bone marrow aspiration (United States)

    Iliac crest tap; Sternal tap; Leukemia - bone marrow aspiration; Aplastic anemia - bone marrow aspiration; Myelodysplastic syndrome - bone marrow aspiration; Thrombocytopenia - bone marrow aspiration; Myelofibrosis - bone marrow aspiration

  7. A novel combination of printed 3-dimensional anatomic templates and computer-assisted surgical simulation for virtual preoperative planning in Charcot foot reconstruction. (United States)

    Giovinco, Nicholas A; Dunn, S Patrick; Dowling, Leslie; Smith, Clifford; Trowell, Larry; Ruch, John A; Armstrong, David G


    Charcot foot syndrome (Charcot neuroarthropathy affecting the foot), particularly in its latter stages, may pose a significant technical challenge to the surgeon. Because of the lack of anatomic consistency, preoperative planning with virtual and physical models of the foot could improve the chances of achieving a predictable intraoperative result. In this report, we describe the use of a novel, inexpensive, 3-dimensional template printing technique that can provide, with just a normal printer, multiple "copies" of the foot to be repaired. Although we depict this method as it pertains to repair of the Charcot foot, it could also be used to plan and practice, or revise, 3-dimensional surgical manipulations of other complex foot deformities.

  8. Computerized geometric features of carpal bone for bone age estimation

    Institute of Scientific and Technical Information of China (English)

    Chi-Wen Hsieh; Tai-Lang Jong; Yi-Hong Chou; Chui-Mei Tiu


    Background Bone age development is one of the significant indicators depicting the growth status of children.However, bone age assessment is an heuristic and tedious work for pediatricians. We developed a computerized bone age estimation system based on the analysis of geometric features of carpal bones.Methods The geometric features of carpals were extracted and analyzed to judge the bone age of children by computerized shape and area description. Four classifiers, linear, nearest neighbor, back-propagation neural network,and radial basis function neural network, were adopted to categorize bone age. Principal component and discriminate analyses were employed to improve assorting accuracy.Results The hand X-ray films of 465 boys and 444 girls served as our database. The features were extracted from carpal bone images, including shape, area, and sequence. The proposed normalization area ratio method was effective in bone age classification by simulation. Besides, features statistics showed similar results between the standard of the Greulich and Pyle atlas and our database.Conclusions The bone area has a higher discriminating power to judge bone age. The ossification sequence of trapezium and trapezoid bones between Taiwanese and the atlas of the GP method is quite different. These results also indicate that carpal bone assessment with classification of neural networks can be correct and practical.

  9. Inca bones at asterion

    Directory of Open Access Journals (Sweden)

    Prashant E Natekar


    Full Text Available Background: Surgical approach towards asterion has to be done with caution as many surgeons are unfamiliar with the anatomical variations. The asterion corresponds to the site of the posterolateral (mastoid fontanelle of the neonatal skull which closes at the end of the first year. Inca bones provide information as markers for various diseases, and can mislead in the diagnosis of fractures. Observation and Results: 150 dry skull bones from the Department of Anatomy at Goa Medical College, India and other neighboring medical colleges by examining the asterion, and its sutural articulations with parietal, temporal and occipital bones and also anatomical variations if any in adults. Discussion: The anatomical landmarks selected must be reliable and above all easy to identify. Bony structures are more suitable than soft tissue or cartilaginous landmarks because of their rigid and reliable location. Presence of these bones provides false impressions of fractures or the fractures may be interpreted for inca bones especially in the region of asterion either radiologically or clinically which may lead to complications during burr hole surgeries.

  10. Surgical and Prosthetic Rehabilitation of Combination Syndrome

    Directory of Open Access Journals (Sweden)

    Paolo Carlino


    Full Text Available The aim of this report is to analyze the clinical symptoms, ethologic factors, and prosthetic rehabilitation in a case of Combination Syndrome (CS. The treatment of CS can be conventional or surgical, with or without the bone reconstruction of maxilla. The correct prosthetic treatment helps this kind of patients to restore the physiologic occlusion plane to allow a correct masticatory and aesthetic function. Management of this kind of patients can be a challenge for a dental practitioner.

  11. Surgical history of ancient China: Part 2. (United States)

    Fu, Louis


    In this second part of ancient Chinese surgical history, the practice of bone setting in China began around 3000 years ago. Throughout this period, significant progress was made, some highlights of which are cited. These methods, comparable with Western orthopaedic technique, are still being practised today. In conclusion, the possible reasons for the lack of advancement in operative surgery are discussed, within context of the cultural, social and religious background of ancient China.

  12. Computer-Assisted Technique for Surgical Tooth Extraction. (United States)

    Hamza, Hosamuddin


    Introduction. Surgical tooth extraction is a common procedure in dentistry. However, numerous extraction cases show a high level of difficulty in practice. This difficulty is usually related to inadequate visualization, improper instrumentation, or other factors related to the targeted tooth (e.g., ankyloses or presence of bony undercut). Methods. In this work, the author presents a new technique for surgical tooth extraction based on 3D imaging, computer planning, and a new concept of computer-assisted manufacturing. Results. The outcome of this work is a surgical guide made by 3D printing of plastics and CNC of metals (hybrid outcome). In addition, the conventional surgical cutting tools (surgical burs) are modified with a number of stoppers adjusted to avoid any excessive drilling that could harm bone or other vital structures. Conclusion. The present outcome could provide a minimally invasive technique to overcome the routine complications facing dental surgeons in surgical extraction procedures.

  13. Surgical endodontic management of infected lateral canals of maxillary incisors (United States)


    This case report presents surgical endodontic management outcomes of maxillary incisors that were infected via the lateral canals. Two cases are presented in which endodontically-treated maxillary central incisors had sustained lateral canal infections. A surgical endodontic treatment was performed on both teeth. Flap elevation revealed vertical bone destruction along the root surface and infected lateral canals, and microscopy revealed that the lateral canals were the origin of the lesions. After the infected lateral canals were surgically managed, both teeth were asymptomatic and labial fistulas were resolved. There were no clinical or radiographic signs of surgical endodontic management failure at follow-up visits. This case report highlights the clinical significance and surgical endodontic management of infected lateral canal of maxillary incisor. It is important to be aware of root canal anatomy variability in maxillary incisors. Maxillary central incisors infected via the lateral canal can be successfully managed by surgical endodontic treatment. PMID:25671217

  14. Computer-Assisted Technique for Surgical Tooth Extraction

    Directory of Open Access Journals (Sweden)

    Hosamuddin Hamza


    Full Text Available Introduction. Surgical tooth extraction is a common procedure in dentistry. However, numerous extraction cases show a high level of difficulty in practice. This difficulty is usually related to inadequate visualization, improper instrumentation, or other factors related to the targeted tooth (e.g., ankyloses or presence of bony undercut. Methods. In this work, the author presents a new technique for surgical tooth extraction based on 3D imaging, computer planning, and a new concept of computer-assisted manufacturing. Results. The outcome of this work is a surgical guide made by 3D printing of plastics and CNC of metals (hybrid outcome. In addition, the conventional surgical cutting tools (surgical burs are modified with a number of stoppers adjusted to avoid any excessive drilling that could harm bone or other vital structures. Conclusion. The present outcome could provide a minimally invasive technique to overcome the routine complications facing dental surgeons in surgical extraction procedures.

  15. Haptic Modeling and Rendering Based on Neurofuzzy Rules for Surgical Cutting Simulation%手术切割模拟中基于模糊规则的触觉建模及绘制

    Institute of Scientific and Technical Information of China (English)

    宋卫国; 原魁; 付玉锦


    This paper combines image processing with 3D magnetic tracking method to develop a scalpel for haptic simulation in surgical cutting. First, a cutting parameter acquisition setup is presented and the performance is validated from soft tissue cutting. Then, based on the acquired input-output data pairs, a method for fuzzy system modeling is presented, that is, after partitioning each input space equally and giving the premises and the total number of fuzzy rules, the consequent parameters and the fuzzy membership functions (MF) of the input variables are learned and optimized via a neurofuzzy modeling technique. Finally, a haptic scalpel implemented with the established cutting model is described. Preliminary results show the feasibility of the haptic display system for real-time interaction.

  16. Virtual Temporal Bone Anatomy

    Institute of Scientific and Technical Information of China (English)


    Background The Visible Human Project(VHP) initiated by the U.S. National Library of Medicine has drawn much attention and interests from around the world. The Visible Chinese Human (VCH) project has started in China. The current study aims at acquiring a feasible virtual methodology for reconstructing the temporal bone of the Chinese population, which may provide an accurate 3-D model of important temporal bone structures that can be used in teaching and patient care for medical scientists and clinicians. Methods A series of sectional images of the temporal bone were generated from section slices of a female cadaver head. On each sectional image, SOIs (structures of interest) were segmented by carefully defining their contours and filling their areas with certain gray scale values. The processed volume data were then inducted into the 3D Slicer software(developed by the Surgical Planning Lab at Brigham and Women's Hospital and the MIT AI Lab) for resegmentation and generation of a set of tagged images of the SOIs. 3D surface models of SOIs were then reconstructed from these images. Results The temporal bone and structures in the temporal bone, including the tympanic cavity, mastoid cells, sigmoid sinus and internal carotid artery, were successfully reconstructed. The orientation of and spatial relationship among these structures were easily visualized in the reconstructed surface models. Conclusion The 3D Slicer software can be used for 3-dimensional visualization of anatomic structures in the temporal bone, which will greatly facilitate the advance of knowledge and techniques critical for studying and treating disorders involving the temporal bone.

  17. Surgical Lasers In Gynecology (United States)

    Schellhas, Helmut F.; Barnes, Alfonso E.


    Multipurpose surgical CO2 lasers marketed in the USA have been developed to be applicable to a variety of surgical procedures in many surgical fields. They are all suited for endoscopic surgical procedures and can be fitted to all standard surgical microscopes. They all can adjust the focal length of the laser beam to the different standard focal lengths of the surgical microscope which for instance in laryngoscopy is 400 mm and in colposcopy 300 mm. One laser instrument can even change the spot size in a given focal distance which is very advantageous for some microsurgical procedures (Merrimack Laboratories 820). All multipurpose surgical CO2 laser systems provide a multi-articulated surgical arm for free-hand surgery. The surgical arms are cumbersome to use but they are adapted to the surgeons needs with ingenuity. The practicality of the multi-articulated surgical arms depends mostly on the distance of the handpiece from the surgical console which now is also overbridged by the laser tube in most surgical laser system. The spot size of the beam is variable in most handpieces by interchangeable lenses which modify the focal distance of the beam and the power density. Another common feature in all systems is a coaxial He-Ne pilot light which provides a red spot which unfortunately becomes invisible in a bleeding surgical field. Most surgical laser systems have a spacial mode of TEM 00 which is essential for incisional surgery. The continuous mode of beam delivery is used for incisional surgery and also for most endoscopic procedures.

  18. Surgical Vision: Google Glass and Surgery. (United States)

    Chang, Johnny Yau Cheung; Tsui, Lok Yee; Yeung, Keith Siu Kay; Yip, Stefanie Wai Ying; Leung, Gilberto Ka Kit


    Google Glass is, in essence, a smartphone in the form of a pair of spectacles. It has a display system, a bone conduction "speaker," video camera, and connectivity via WiFi or Bluetooth technologies. It can also be controlled by voice command. Seizing Google Glass' capabilities as windows of opportunity, surgeons have been the first group of doctors trying to incorporate the technology into their daily practices. Experiences from different groups have demonstrated Google Glass' potential in improving perioperative care, intraoperative communication and documentation, surgical outcome as well as surgical training. On the other hand, the device has technical limitations, notably suboptimal image qualities and a short battery life. Its operational functions also bring forth concerns on the protection of patient privacy. Nonetheless, the technological advances that this device embodies hold promises in surgical innovations. Further studies are required, and surgeons should explore, investigate, and embrace similar technologies with keen and informed anticipation.

  19. Surgical dislocation of the hip in patients with femoroacetabular impingement: Surgical techniques and our experience

    Directory of Open Access Journals (Sweden)

    Mladenović Marko


    Full Text Available Background/Aim. Arthrosis of the hip is the most common cause of a hip joint disorders. The aim of this study was to present our experience in the application of a safe surgical dislocation of the hip in patients with minor morphological changes in the hip joint, which, through the mechanism of femoroacetabular impingement, cause damage to the acetabular labrum and adjacent cartilage as an early sign of the hip arthrosis. Methods. We have operated 51 patients with different morphological bone changes in the hip area and resultant soft tissue damage of the acetabular labrum and its adjacent cartilage. Surgical technique that we applied in this group of patients, was adapted to our needs and capabilities and it was minimaly modified compared to the original procedure. Results. The surgical technique presented in this paper, proved to be a good method of treatment of bone and soft tissue pathomorphological changes of the hip in patients with femoroacetabular impingement. We had no cases with avascular necrosis of the femoral head, and two patients had nonunion of the greater trochanter, 9 patients developed paraarticular ossification, without subjective symptoms, while 3 patients suffered from postoperative pain in the groin during more energetic physical activities. Conclusion. Utilization of our partly modified surgical technique of controlled and safe dislocation of the hip can solve all the bone and soft tissue problems in patients with femoroacetibular impingement to stop already developed osteoarthritis of the hip or to prevent mild form of it.

  20. Enhancing predicted efficacy of tumor treating fields therapy of glioblastoma using targeted surgical craniectomy: A computer modeling study

    DEFF Research Database (Denmark)

    Korshoej, Anders Rosendal; Saturnino, Guilherme Bicalho; Rasmussen, Line Kirkegaard


    Objective: The present work proposes a new clinical approach to TTFields therapy of glioblastoma. The approach combines targeted surgical skull removal (craniectomy) with TTFields therapy to enhance the induced electrical field in the underlying tumor tissue. Using computer simulations, we explore...... clinical scenarios. Results: For the superficial tumor, removal of a standard craniotomy bone flap increased the electrical field strength by 60-70% in the tumor. The percentage of tissue in expected growth arrest or regression was increased from negligible values to 30-50%. The observed effects were...

  1. 耳周复合带蒂软组织瓣在鼻咽癌放疗后颞骨骨坏死手术治疗中的应用%The application of local composite vascularized fascia flaps in the surgical treatment of diffused osteoradionecrosis of temporal bone in cases with nasopharyngeal carcinoma after radiotherapy

    Institute of Scientific and Technical Information of China (English)

    许耀东; 区永康; 郑亿庆; 陈穗俊; 吴树浓; 何晓峥; 纪树芳; 郭晓娟


    Objective To investigate the value of the local composite vascularized fascia flaps in the surgical treatment of osteoradionecresis(ORN)of temporal bone in cases with nasopharyngeal carcinoma(NPC)after radiotheraphy.Methods Eight NPC patients with ORN of temporal bone accepted radical mastoidectomy and obliteration with local composite veuscularized fascia flaps including palva flap,temporalis fascia flap and skin flap of external acoustic meatus.Results Five ears(62.5%)achieved dry ear.Two ears(25%)still had infection and granulation tissue in the operating cavities,but the symptoms relieved and the esrs were without re-sequestration.One ear(12.5%)needed regular cleaning for the operating cavity because of neciosis of the fascia flaps and re-sequestration.Conclusion The surgical treatment for diffused ORN of temporal bone is difficult.Obliteration with local composite vascularized fascia flaps is an effective method in order to get dry ear and prevent from re-sequestration after radical mastoidectomy.%目的 探讨耳周复合带蒂软组织瓣乳突术腔转移填塞在NPC放疗后颞骨放射性骨坏死手术治疗中的应用价值.方法 对8例NPC放疗后颞骨放射性骨坏死的患者行乳突根治术,同期采用耳后Palva辨、带蒂颞肌筋膜瓣及外耳道皮瓣复合转移乳突术腔填塞.结果 5耳(62.5%)获得干耳.无死骨再形成;2耳(25%)症状改善,术腔仍有感染及局限肉芽组织生长,无死骨再形成;1耳(12.5%)术腔填塞筋膜局部坏死及局灶游离死骨形成,定期换药.结论 NPC放疗后颞骨骨坏死治疗困难,应用耳周复合带蒂软组织瓣转移术腔填塞术是乳突根治术后获得干耳、预防死骨再形成等术腔问题的有效技术方法.

  2. Preoperative Guidance Optimization of Surgical Robot Based on Simulation%基于仿真的外科手术机器人术前引导优化

    Institute of Scientific and Technical Information of China (English)

    闫志远; 杜志江; 吴冬梅


    A method to complete the setup of the surgical robot is presented, which can guarantee the dexterity, acces-sibility, visibility. And a virtual reality system is established to assist the surgeon to pose the robot before operation. The incision placement and the arm position are obtained by particle swarm optimization algorithm. The method not only can effectively complete setup optimization of the robot in an operation space, but also can reflect the internal difference of the operation space by dividing the operation space and assigning the subspaces with weights. Global isotropy index and cooperation ability are put forward, and their weighted average based on space division are used as objective functions to reflect the single-arm and three-arm cooperation performances of the robot respectively. Hence, the method can intuitively guide surgeons to complete the complex preoperative arrangement, taking into account the performance of the surgical robot and the internal difference of the operation space. Experiments show that compared with the method without weights, the dexterity of the three arms are all better, and cooperation capability index of the three arms increases by 25%∼30%, and it can give priority to important regions of the operation space.%给出一种保证术中较高灵巧度、可达性和可视化指标的手术机器人布置方法,建立一个能够辅助医生完成手术机器人术前布置的虚拟现实系统。基于粒子群优化算法提出了引导手术切口布置和机器人摆位的方法,该方法不仅能够有效完成针对某一手术空间的摆位优化,还通过手术空间划分并赋予权值的方法来反映手术空间内部差异,在空间分割的基础上提出加权平均的全域各向同性和多臂协同性两个目标函数,分别反映机器人系统的单臂性能和三臂协作能力。该方法可以在兼顾手术机器人性能和手术空间内部差异的前提下直观地引导医生完

  3. Biomechanical Role of Bone Anisotropy Estimated on Clinical CT Scans by Image Registration. (United States)

    Taghizadeh, Elham; Reyes, Mauricio; Zysset, Philippe; Latypova, Adeliya; Terrier, Alexandre; Büchler, Philippe


    Image-based modeling is a popular approach to perform patient-specific biomechanical simulations. Accurate modeling is critical for orthopedic application to evaluate implant design and surgical planning. It has been shown that bone strength can be estimated from the bone mineral density (BMD) and trabecular bone architecture. However, these findings cannot be directly and fully transferred to patient-specific modeling since only BMD can be derived from clinical CT. Therefore, the objective of this study was to propose a method to predict the trabecular bone structure using a µCT atlas and an image registration technique. The approach has been evaluated on femurs and patellae under physiological loading. The displacement and ultimate force for femurs loaded in stance position were predicted with an error of 2.5% and 3.7%, respectively, while predictions obtained with an isotropic material resulted in errors of 7.3% and 6.9%. Similar results were obtained for the patella, where the strain predicted using the registration approach resulted in an improved mean squared error compared to the isotropic model. We conclude that the registration of anisotropic information from of a single template bone enables more accurate patient-specific simulations from clinical image datasets than isotropic model.

  4. Computational biomechanics of bone's responses to dental prostheses - osseointegration, remodeling and resorption (United States)

    Li, Wei; Rungsiyakull, Chaiy; Field, Clarice; Lin, Daniel; Zhang, Leo; Li, Qing; Swain, Michael


    Clinical and experimental studies showed that human bone has the ability to remodel itself to better adapt to its biomechanical environment by changing both its material properties and geometry. As a consequence of the rapid development and extensive applications of major dental restorations such as implantation and fixed partial denture (FPD), the effect of bone remodeling on the success of a dental restorative surgery is becoming critical for prosthetic design and pre-surgical assessment. This paper aims to provide a computational biomechanics framework to address dental bone's responses as a result of dental restoration. It explored three important issues of resorption, apposition and osseointegration in terms of remodeling simulation. The published remodeling data in long bones were regulated to drive the computational remodeling prediction for the dental bones by correlating the results to clinical data. It is anticipated that the study will provide a more predictive model of dental bone response and help develop a new design methodology for patient-specific dental prosthetic restoration.

  5. Virtual reality simulation training of mastoidectomy - studies on novice performance. (United States)

    Andersen, Steven Arild Wuyts


    Virtual reality (VR) simulation-based training is increasingly used in surgical technical skills training including in temporal bone surgery. The potential of VR simulation in enabling high-quality surgical training is great and VR simulation allows high-stakes and complex procedures such as mastoidectomy to be trained repeatedly, independent of patients and surgical tutors, outside traditional learning environments such as the OR or the temporal bone lab, and with fewer of the constraints of traditional training. This thesis aims to increase the evidence-base of VR simulation training of mastoidectomy and, by studying the final-product performances of novices, investigates the transfer of skills to the current gold-standard training modality of cadaveric dissection, the effect of different practice conditions and simulator-integrated tutoring on performance and retention of skills, and the role of directed, self-regulated learning. Technical skills in mastoidectomy were transferable from the VR simulation environment to cadaveric dissection with significant improvement in performance after directed, self-regulated training in the VR temporal bone simulator. Distributed practice led to a better learning outcome and more consolidated skills than massed practice and also resulted in a more consistent performance after three months of non-practice. Simulator-integrated tutoring accelerated the initial learning curve but also caused over-reliance on tutoring, which resulted in a drop in performance when the simulator-integrated tutor-function was discontinued. The learning curves were highly individual but often plateaued early and at an inadequate level, which related to issues concerning both the procedure and the VR simulator, over-reliance on the tutor function and poor self-assessment skills. Future simulator-integrated automated assessment could potentially resolve some of these issues and provide trainees with both feedback during the procedure and immediate

  6. Manual of Surgical Instruments

    Directory of Open Access Journals (Sweden)

    Olga Lidia Sánchez Sarría


    Full Text Available Surgical instruments are the group of tools used in surgical procedures. They are very expensive and sophisticated. Consequently, a standardized and meticulous care is essential; they should go through the decontamination, cleaning and sterilization process. These instruments are designed in order to provide surgeons with tools that help them to perform a basic surgical procedure; there are multiple variations and the design depends on their function. This paper aims at showing all surgical instruments that can be used in an operating room during surgery and are not generally included in the medical literature.


    Directory of Open Access Journals (Sweden)

    V. I. Zavarukhin


    Full Text Available The purpose - to study the morphofunctional changes of upper extremities in patients with brachymetacarpia. Material and methods. The results of the examination and surgical treatment by distraction osteosynthesis of six patients (10 hands, shortening of the 18-metacarpal bones with brachymetacarpia are presented. Results. All patients noted dissatisfaction with the cosmetic state of hands and tiredness during physical activities with the hand. IV ray was shortened in 50%, V ray - in 33% of cases and III ray - in 17%. Limitation of active flexion was noted in all patients, an average flexion was 58.9 ± 7,1°. After treatment flexion increased an average on 20.5 ° (22.7%. Complications were obtained in two patients on three hands. Conclusions. Brachymetacarpia is a rare disease, the etiology of which is still unknown and requires further study. In all cases of brachymetacarpia there is a restriction of active flexion of the MCP joint of the affected ray and the indications for treatment are caused not only by a cosmetic defect, but also functional impairment. Surgical treatment of brachymetacarpia by distraction osteosynthesis gives predictably good results. Complications during the treatment of brachymetacarpia are rare and mostly related to the appearance of contractures, in order to prevent which in the postoperative period should be used preventive conservative therapy.

  8. Computer-Assisted Orthognathic Surgery for Patients with Cleft Lip/Palate: From Traditional Planning to Three-Dimensional Surgical Simulation.

    Directory of Open Access Journals (Sweden)

    Daniel Lonic

    Full Text Available Although conventional two-dimensional (2D methods for orthognathic surgery planning are still popular, the use of three-dimensional (3D simulation is steadily increasing. In facial asymmetry cases such as in cleft lip/palate patients, the additional information can dramatically improve planning accuracy and outcome. The purpose of this study is to investigate which parameters are changed most frequently in transferring a traditional 2D plan to 3D simulation, and what planning parameters can be better adjusted by this method.This prospective study enrolled 30 consecutive patients with cleft lip and/or cleft palate (mean age 18.6±2.9 years, range 15 to 32 years. All patients received two-jaw single-splint orthognathic surgery. 2D orthodontic surgery plans were transferred into a 3D setting. Severe bony collisions in the ramus area after 2D plan transfer were noted. The position of the maxillo-mandibular complex was evaluated and eventually adjusted. Position changes of roll, midline, pitch, yaw, genioplasty and their frequency within the patient group were recorded as an alternation of the initial 2D plan. Patients were divided in groups of no change from the original 2D plan and changes in one, two, three and four of the aforementioned parameters as well as subgroups of unilateral, bilateral cleft lip/palate and isolated cleft palate cases. Postoperative OQLQ scores were obtained for 20 patients who finished orthodontic treatment.83.3% of 2D plans were modified, mostly concerning yaw (63.3% and midline (36.7% adjustments. Yaw adjustments had the highest mean values in total and in all subgroups. Severe bony collisions as a result of 2D planning were seen in 46.7% of patients. Possible asymmetry was regularly foreseen and corrected in the 3D simulation.Based on our findings, 3D simulation renders important information for accurate planning in complex cleft lip/palate cases involving facial asymmetry that is regularly missed in conventional 2D

  9. Disc degeneration: current surgical options

    Directory of Open Access Journals (Sweden)

    C Schizas


    Full Text Available Chronic low back pain attributed to lumbar disc degeneration poses a serious challenge to physicians. Surgery may be indicated in selected cases following failure of appropriate conservative treatment. For decades, the only surgical option has been spinal fusion, but its results have been inconsistent. Some prospective trials show superiority over usual conservative measures while others fail to demonstrate its advantages. In an effort to improve results of fusion and to decrease the incidence of adjacent segment degeneration, total disc replacement techniques have been introduced and studied extensively. Short-term results have shown superiority over some fusion techniques. Mid-term results however tend to show that this approach yields results equivalent to those of spinal fusion. Nucleus replacement has gained some popularity initially, but evidence on its efficacy is scarce. Dynamic stabilisation, a technique involving less rigid implants than in spinal fusion and performed without the need for bone grafting, represents another surgical option. Evidence again is lacking on its superiority over other surgical strategies and conservative measures. Insertion of interspinous devices posteriorly, aiming at redistributing loads and relieving pain, has been used as an adjunct to disc removal surgery for disc herniation. To date however, there is no clear evidence on their efficacy. Minimally invasive intradiscal thermocoagulation techniques have also been tried, but evidence of their effectiveness is questioned. Surgery using novel biological solutions may be the future of discogenic pain treatment. Collaboration between clinicians and basic scientists in this multidisciplinary field will undoubtedly shape the future of treating symptomatic disc degeneration.

  10. Surgical ethics and the challenge of surgical innovation. (United States)

    Angelos, Peter


    Surgical ethics as a specific discipline is relatively new to many. Surgical ethics focuses on the ethical issues that are particularly important to the care of surgical patients. Informed consent for surgical procedures, the level of responsibility that surgeons feel for their patients' outcomes, and the management of surgical innovation are specific issues that are important in surgical ethics and are different from other areas of medicine. The future of surgical progress is dependent on surgical innovation, yet the nature of surgical innovation raises specific concerns that challenge the professionalism of surgeons. These concerns will be considered in the following pages.

  11. 数字化三维手术模拟在正颌外科专科医师培训中的应用%Application of digital three-dimensional surgical simulation system in specialist training of orthognathic surgery

    Institute of Scientific and Technical Information of China (English)

    沈末伦; 王旭东


    牙颌面畸形患者面部形态异常和咬合功能障碍常较严重,需要采用正颌—正畸联合治疗的方法进行矫正。治疗牙颌面畸形的正颌手术术野狭小、操作复杂、风险较大,其手术教学和操作培训手段有限,限制了此类技术的推广应用。文章介绍了将数字化三维手术设计与模拟系统应用于正颌外科专科医师培训,可取得良好的手术教学效果。实践表明,通过手术虚拟操作,可使受训医师加深对牙颌面畸形和正颌外科手术的理解。%Patients with dento-maxillofacial deformities often suffer relatively severe facial anomalies and occlusal dysfunction, which need to be corrected with combined orthodontic and orthognathic treatment.Orthognathic surgery is very complicated with narrow operative field and relatively high risk.The means of orthognathic surgery teaching and operation training are limited,which restricts the promotion of orthognathic surgical technology.In this study,a digital three-dimensional surgical design and simulation system was applied to specialist training of orthognathic surgery with satisfactory results.Practice proves that through virtual operation training,the trained surgeons obtained a deeper understanding of dento-maxillofacial deformities and orthognathic surgery.

  12. Characterization of aerosols produced by surgical procedures

    Energy Technology Data Exchange (ETDEWEB)

    Yeh, H.C.; Muggenburg, B.A.; Lundgren, D.L.; Guilmette, R.A.; Snipes, M.B.; Jones, R.K. [Inhalation Toxicology Research Institute, Albuquerque, NM (United States); Turner, R.S. [Lovelace Health Systems, Albuquerque, NM (United States)


    In many surgeries, especially orthopedic procedures, power tools such as saws and drills are used. These tools may produce aerosolized blood and other biological material from bone and soft tissues. Surgical lasers and electrocautery tools can also produce aerosols when tissues are vaporized and condensed. Studies have been reported in the literature concerning production of aerosols during surgery, and some of these aerosols may contain infectious material. Garden et al. (1988) reported the presence of papilloma virus DNA in the fumes produced from laser surgery, but the infectivity of the aerosol was not assessed. Moon and Nininger (1989) measured the size distribution and production rate of emissions from laser surgery and found that particles were generally less than 0.5 {mu}m diameter. More recently there has been concern expressed over the production of aerosolized blood during surgical procedures that require power tools. In an in vitro study, the production of an aerosol containing the human immunodeficiency virus (HIV) was reported when power tools were used to cut tissues with blood infected with HIV. Another study measured the size distribution of blood aerosols produced by surgical power tools and found blood-containing particles in a number of size ranges. Health care workers are anxious and concerned about whether surgically produced aerosols are inspirable and can contain viable pathogens such as HIV. Other pathogens such as hepatitis B virus (HBV) are also of concern. The Occupational Safety and Health funded a project at the National Institute for Inhalation Toxicology Research Institute to assess the extent of aerosolization of blood and other tissues during surgical procedures. This document reports details of the experimental and sampling approach, methods, analyses, and results on potential production of blood-associated aerosols from surgical procedures in the laboratory and in the hospital surgical suite.

  13. Application and surgical techniques of structural allograft in treatment of patients with serious bone defects%膝关节翻修术中结构性异体植骨的应用及手术技巧

    Institute of Scientific and Technical Information of China (English)

    刘璞; 蔡谞; 吴厦


    目的:比较膝关节翻修术中是否使用结构性异体骨移植的临床效果,并探讨植骨手术技巧及相关问题。方法回顾性分析2010年7月-2013年6月我院收治的34例膝关节置换术后由于各种原因在我院骨科行膝关节翻修术的病例,平均年龄64.6(51~76)岁,平均随访28.5(14~46)个月。根据术中是否使用结构性异体骨移植分为治疗组和对照组。治疗组使用结构性异体植骨处理骨缺损;对照组使用颗粒打压植骨和骨水泥填充等常规方法处理。通过KSS评分评估患者症状改善和关节功能恢复情况,通过X线检查评估术后假体在位情况和植骨愈合情况。结果两组各有1例失访,其他患者假体在位良好。治疗组X线片提示植骨均愈合。两组患者随访时的KSS评分较术前均有显著提高。治疗组术前的骨缺损情况较对照组严重,KSS评分低于对照组(38.19±18.71 vs 52.39±9.79)(t=2.891,P=0.008),但随访时两组KSS临床评分(85.19±10.23 vs 90.39±5.71)(t=1.859,P=0.072)、疼痛评分(45.00±5.16 vs 43.33±5.69)(t=0.859,P=0.377)、功能评分(63.13±19.12 vs 72.78±16.74)(t=1.557,P=0.130)差异均无统计学意义。结论使用结构性异体骨移植修复膝关节翻修中的大块骨缺损可取得较好效果,与其他骨缺损的处理方法相比,临床效果无明显差异。%Objective To compare the effectiveness of whether or not using structural allograft in treatment of patients with serious bone defects in revision total knee arthroplasty (RTKA). Methods Thirty-four patients who underwent RTKA in our department from July 2010 to June 2013 were selected with an average age of 64.6 years (range 51-76) and follow-up period of 28.5 month (range 14-46). They were divided into treatment group and control group according to the usage of allograft or not. Patients in treatment group underwent structural allograft during the operation. In control group, morselized

  14. Surgical medical record

    DEFF Research Database (Denmark)

    Bulow, S.


    A medical record is presented on the basis of selected linguistic pearls collected over the years from surgical case records Udgivelsesdato: 2008/12/15......A medical record is presented on the basis of selected linguistic pearls collected over the years from surgical case records Udgivelsesdato: 2008/12/15...

  15. Recognizing surgical patterns

    NARCIS (Netherlands)

    Bouarfa, L.


    In the Netherlands, each year over 1700 patients die from preventable surgical errors. Numerous initiatives to improve surgical practice have had some impact, but problems persist. Despite the introduction of checklists and protocols, patient safety in surgery remains a continuing challenge. This is

  16. 闭合式开窗术联合正畸牵引治疗骨埋伏阻生前牙32例临床分析%Clinical analysis of cosed-eruption surgical technique combined with orthodontic traction in the treatment of bone impacted anterior teeth of 32 cases

    Institute of Scientific and Technical Information of China (English)

    孟元元; 韩立显


    目的:探讨闭合式开窗术联合正畸牵引治疗骨埋伏阻生前牙的治疗效果。方法:收治骨埋伏前牙患者32例35颗,先行正畸开拓埋伏牙萌出间隙,后行手术开窗,术中充分暴露埋伏牙黏接牙面,黏接正畸牵引附件,待伤口愈合开始埋伏牙牵引助萌。结果:32例患者中,导萌术后有2例2颗埋伏前牙在术后2个月内自行萌出,有3例患者因出国、转学等原因停止治疗。27例共28颗埋伏前牙中成功23颗(82.14%),有效3颗(10.71%),失败1颗(3.57%)。经闭合式开窗术联合正畸牵引治疗28颗埋伏牙全部萌出至正常咬牙合位置,牙龈形态满意,牙髓活力正常,未见邻牙牙根吸收及损伤。结论:使用闭合式开窗术联合正畸牵引治疗埋伏阻生前牙可取得良好的临床治疗效果。%Objective:To explore the clinical effect of cosed-eruption surgical technique combined with orthodontic traction in the treatment of bone impacted anterior teeth.Methods:32 patients with bone impacted anterior teeth of 35 teeth were selected.The patients first were given orthodontic pioneering impacted tooth adorable out the gap,and then were given fenestration operation. Impacted tooth bonding tooth surface was fully exposed in the operation.It was adhesive with orthodontic traction accessories.After wound healing,traction of teeth was impacted to help germination.Results:In 32 patients,after guided eruption operation,2 cases of 2 impacted anterior teeth were eruption in 2 months after operation,3 patients discontinued treatment due to go abroad,transfer and other reasons.A total of 27 patients with 28 impacted anterior teeth,23 teeth(82.14%) were successful;3 teeth(10.71%) were effective;1 tooth(3.57%) was failed.After cosed-eruption surgical technique combined with orthodontic traction treatment,the 28 impacted teeth were erupted to the normal position;gingival morphology was satisfied;dental pulp vitality was normal

  17. Accuracy of a newly developed cone-beam computerized tomography-aided surgical guidance system for dental implant placement: an ex vivo study. (United States)

    Murat, Sema; Kamburoğlu, Kivanç; Özen, Tuncer


    The aim of the present study was to measure the accuracy of the cone-beam computerized tomography (CBCT)- aided StentCad Beyond surgical guidance system and to compare bone-supported and tooth/bone-supported guidance by using this system in dental implant placement ex vivo. Five cadaver mandibles were scanned using an Iluma CBCT scanner. After scanning, DICOM slices were transferred to the StentCad Beyond implant simulation software, which was used for preoperative implant planning. Using the StentCad Beyond guidance system, 9 implant drills were inserted using a bone-supported guidance system and 11 using a tooth/bone-supported guidance system. Mandibles were scanned again and these data were transferred to the StentCad Beyond software. Pre- and postoperative information was superimposed using the Rhinoceros version 4 software program, and deviations between planned and actual drill positions were calculated for each implant. In addition, differences between bone-supported and tooth/bone-supported guidance systems were analyzed by t-test, with a significance level of P .05); however, statistically significant differences between groups were found in mean horizontal coronal deviation (P = .016) and mean horizontal apical deviation (P = .047). The StentCad Beyond system was found to be a reliable guide for placing implants ex vivo.


    Directory of Open Access Journals (Sweden)

    A. V. Zaletina


    Full Text Available Objective: to develop the surgical treatment of patients with congenital metacarpal synostosis. Material and methods. 65 operations were performed in 58 children. with congenital metacarpal synostosis. Surgical intervention was determined by the localization of congenital metacarpal synostosis and the presence of concomitant deformities. Results. Excellent and good results were observed in 69,4% (33 hands cases, satisfactory - in 30,6% (15 hands, unsatisfactory results were not obtained. At the same time excellent results were obtained in patients with less severe variants of metacarpal synostosis, good treatment results were observed in children with more severe associated abnormalities, as well as in cases where the correction is not performed metacarpal shortening. Overall, the results were significantly (p <0,05 better after application of advanced methods, including correction of all components of the strain. Satisfactory results were found out in patients with severe comorbidity, a total fusion of the metacarpal bones and fingers, the total PPS. Conclusions. Surgical treatment options for all congenital metacarpal synostosis should be individualized and be concluded in the performance of bone and plastic surgery to remove metacarpal synostosis and related deformities.

  19. Bone marrow edema syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Korompilias, Anastasios V.; Lykissas, Marios G.; Beris, Alexandros E. [University of Ioannina, Department of Orthopaedic Surgery, School of Medicine, Ioannina (Greece); Karantanas, Apostolos H. [University of Crete School of Medicine, Department of Radiology, Heraklion (Greece)


    Bone marrow edema syndrome (BMES) refers to transient clinical conditions with unknown pathogenic mechanism, such as transient osteoporosis of the hip (TOH), regional migratory osteoporosis (RMO), and reflex sympathetic dystrophy (RSD). BMES is primarily characterized by bone marrow edema (BME) pattern. The disease mainly affects the hip, the knee, and the ankle of middle-aged males. Many hypotheses have been proposed to explain the pathogenesis of the disease. Unfortunately, the etiology of BMES remains obscure. The hallmark that separates BMES from other conditions presented with BME pattern is its self-limited nature. Laboratory tests usually do not contribute to the diagnosis. Histological examination of the lesion is unnecessary. Plain radiographs may reveal regional osseous demineralization. Magnetic resonance imaging is mainly used for the early diagnosis and monitoring the progression of the disease. Early differentiation from other aggressive conditions with long-term sequelae is essential in order to avoid unnecessary treatment. Clinical entities, such as TOH, RMO, and RSD are spontaneously resolving, and surgical treatment is not needed. On the other hand, early differential diagnosis and surgical treatment in case of osteonecrosis is of crucial importance. (orig.)

  20. Three-dimensional finite element simulation of surgical correction for Lenke 2 type adolescent idiopathic scoliosis%Lenke2型特发性脊柱侧凸三维矫形手术的有限元模拟

    Institute of Scientific and Technical Information of China (English)

    刘祥胜; 吴冰; 魏显招; 吴大江; 杨宗德; 易红蕾; 王传锋; 董有海; 李明


    Objective To simulate different anterior and posterior correction strategies using finite element model of Lenke 2 type adolescent idiopathic scoliosis(AlS), in an effort to seek the optimal surgical protocol. Methods The finite element model of Lenke 2 type AIS was established and used to simulate five surgical strategies. The effectiveness and shoulder balance parameters were compared among different surgical approaches. Results The coronary proximal thoracic(PT) Cobb angle and corrective rates of the five surgical strategies were 21. 5(44. 8%), 26.5(32. 1%), 28. 1(27.9%), 34. 1(12.5%), and 32(17. 9%). The corrective rates for the main thoracic curves were not significantly different among the five strategies, and the physiological sagittal configuration was maintained. Postoperative radiographic shoulder balance parameters were increased for all five surgical protocols. Except for strategy A(posterior fusion from T2 to T11 ), other four strategy achieved the following outcomes! coracoid height difference>9 mm, elavical angle>2. 5° and clavicular tilt angle difference>4. 5° . Conclusion Simulation of posterior correction and fusion to T2 including both thoracic curve can achieve excellent three-dimensional shoulder imbalance slight to moderate degrees.%目的 利用建立的Lenke 2型青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)三维有限元模型,分别仿真模拟前路、后路手术矫形操作,探讨其最佳手术方案.方法 建立Lenke 2型AIS的有限元模型,分别模拟前路和后路共5种不同的矫形方案,比较不同手术方案的矫形效果和双肩平衡参数的变化.结果 5种不同矫形方案有限元模拟术后的上胸弯冠状面Cobb角和矫形率分别为:21.5(44.8%)、26.5(32.1%)、28.1(27.9%)、34.1(12.5%)、32(17.9%),各矫形方案的主胸弯矫正率无明显差别.胸椎矢状面生理后凸得以维持.5种矫形方案术后各双肩平衡影像学参数较术前有所升高,除方

  1. Bioresorbable and nonresorbable polymers for bone tissue engineering. (United States)

    Girones Molera, Jordi; Mendez, José Alberto; San Roman, Julio


    In recent years, bone tissue engineering has emerged as one of the main research areas in the field of regenerative biomedicine. Frequency and relevance age-related diseases, such as healing and regeneration of bone tissues, are rising due to increasing life expectancy. Even though bone tissue has excellent self-regeneration ability, when bone defects exceed a critical size, impaired bone formation can occur and surgical intervention becomes mandatory. Bone tissue engineering represents an alternative approach to conventional bone transplants. The main aim of tissue engineering is to repair, regenerate or reconstruct damaged or degenerative tissue. This review presents an overview on the main materials, techniques and strategies in the field of bone tissue engineering. Whilst presenting some reviews recently published that deepen on each of the sections of the paper, this review article aims to present some of the most relevant advances, both in terms of new materials and strategies, currently being developed for bone repair and regeneration.

  2. 锁定加压接骨板内固定结合自体髂骨植骨治疗肱骨干骨折术后骨不连%Locking compression plates and autologous bone graft for the humeral shaft nonunion after surgical failure

    Institute of Scientific and Technical Information of China (English)

    王军强; 赵春鹏; 龚晓峰; 张健; 李宁; 王满宜


    Objective To evaluate the efficacy of secondary revision with locking compression plates (LCP) and autologous bone graft for nonunion of humeral shaft fracture after surgical failure. Methods Included in this study were 26 patients with nonunion of humeral shaft fracture after various surgical treatments who had received secondary revision with LCP and autologous iliac graft in our department between March 2006 and June 2008 and had been fully followed.They were 19 men and 7 women,with an average age of 46.7 years (range,19 to 63 years).There were 17 cases of hypertrophic nonunion,7 cases of atrophic nonunion and 2 cases of pseudarthrosis.The mean interval between the primary operative treatment and the secondary revision was 9.3 months (from 9.1 to 9.6 months). All nonunions were managed with removal of previous implants,open reduction and internal fixation with LCP,supplemented by cancellous bone graft.Functional recovery was evaluated by Mayo Elbow Performance Index and the modified scale of Constant and Murley. Results The average follow-up was 25.6 months (range,25 to 33 months).The secondary revision led to postoperative bone union in 25 patients after a mean time of 5.2 months (range,4 to 9 months).Only one patient suffered nonunion caused by wound infection before he eventually obtained bone union after anti-infective therapy for 5 months.Temporary palsy of the radial ncrve occurred in 2 cases.The mean functional scores for the shoulder (Constant) and the elbow (Mayo) were 79.1 ±0.1 and 85.7 ±0.8,respectively.Conclusions In revision of the nonunion of humeral shaft fracture after surgical failure,LCP and autologous bone graft can greatly increase the rate of union and reduce complications to ensure good functional recovery of the upper extremity.We believe the key to the procedure lies in complete resection of the nonunion ends and fibrous tissue,cortex-to-cortex apposition with stalwart compression across the entire site and wide use of autologous bone


    Directory of Open Access Journals (Sweden)

    Sergio Alexander Salinas


    Full Text Available Este artículo presenta el modelado matemático y estructural, la simulación por computador y el control por par calculado del robot para cirugía laparoscópica ‘LapBot’, que ha sido desarrollado en el Grupo de Investigación de Automática Industrial de la Universidad del Cauca, Colombia. Inicialmente se muestra un resumen de los principales robots utilizados como asistentes para cirugías de laparoscopia en el mundo, y de cómo tratan ellos el problema del paso por la incisión practicada en la cavidad abdominal. Con base en lo anterior se describen los requerimientos que deben cumplir los robots de este tipo y a partir de éstos se diseña el robot LapBot. Se muestra el modelo cinemático y dinámico del robot LapBot, así como el modelo de la restricción espacial que representa el punto de incisión abdominal. Se implementa una estrategia de control basada en el modelo del robot (control por par calculado. Diversas trayectorias en un plano y en un espacio de tres dimensiones son utilizadas para validar tanto el modelo como el controlador.This paper presents the mathematical and structural model, simulation and computed torque control of the LapBot robot, developed by the Group of Investigation of Industrial Automatics, of the University of Cauca, Colombia. First, a summary of the principal surgery assistant robots of the world is presented, and how they solve the problem of passing through the incision into the abdominal cavity. Based on this, the conditions that must be fulfilled by the robots of this type is exposed, and from these conditions the LapBot robot is designed. Its kinematics and dynamics model is shown, as well as the mathematical spatial restriction that incision represents. A control strategy based on the model (computed torque control is implemented. Several trajectories defined in a plane and in a three dimensions space are used to validate the model and the control.

  4. Surgical and Technical Modalities for Hearing Restoration in Ear Malformations. (United States)

    Dazert, Stefan; Thomas, Jan Peter; Volkenstein, Stefan


    Malformations of the external and middle ear often go along with an aesthetic and functional handicap. Independent of additional aesthetic procedures, a successful functional hearing restoration leads to a tremendous gain in quality of life for affected patients. The introduction of implantable hearing systems (bone conduction and middle ear devices) offers new therapeutic options in this field. We focus on functional rehabilitation of patients with malformations, either by surgical reconstruction or the use of different implantable hearing devices, depending on the disease itself and the severity of malformation as well as hearing impairment. Patients with an open ear canal and minor malformations are good candidates for surgical hearing restoration of middle ear structures with passive titanium or autologous implants. In cases with complete fibrous or bony atresia of the ear canal, the most promising functional outcome and gain in quality of life can be expected with an active middle ear implant or a bone conduction device combined with a surgical aesthetic rehabilitation in a single or multi-step procedure. Although the surgical procedure for bone conduction devices is straightforward and safe, more sophisticated operations for active middle ear implants (e.g., Vibrant Soundbridge, MED-EL, Innsbruck, Austria) provide an improved speech discrimination in noise and the ability of sound localization compared with bone conduction devices where the stimulation reaches both cochleae.

  5. [Unilateral surgically assisted rapid maxillary expansion using a transpalatal distractor].

    NARCIS (Netherlands)

    Roelofs, J.; Breuning, K.H.; Spijker, A. van 't; Borstlap, W.A.; Berge, S.J.; Kuijpers-Jagtman, A.M.


    A 46-year-old woman was referred for orthodontic surgery consultation because ofa retrognathic maxilla, unilateral cross bite and functional, aesthetic and speech problems. The maxilla was widened unilaterally by unilateral surgically assisted rapid maxillary expansion with a bone-borne transpalatal

  6. Multiscale Surgical Telerobots

    Energy Technology Data Exchange (ETDEWEB)

    Miles, R R; Seward, K P; Benett, W J; Tendick, F; Bentley, L; Stephan, P L


    A project was undertaken to improve robotic surgical tools for telerobotic minimally invasive surgery. The major objectives were to reduce the size of the tools to permit new surgical procedures in confined spaces such as the heart and to improve control of surgical tools by locating positional sensors and actuators at the end effector rather than external to the patient as is currently the state of the technology. A new compact end-effector with wrist-like flexibility was designed. Positional sensors based on MEMS microfabrication techniques were designed.

  7. Chondroblastoma of the navicular bone. (United States)

    Li, Xiao Na; Peng, Zhi Gang; Zhao, Jing Pin; Zhang, Ze Kun


    This is a case report of a 24-year-old man who presented with increased pain and firm swelling of the right foot after a minor twisting injury. Radiography, computed tomography (CT) and magnetic resonance imaging (MRI) findings showed ancillary information that was helpful for surgical treatment. The final diagnosis was confirmed as chondroblastoma of the navicular bone based on the pathology report. The navicularbone is a very rare site in the foot, where we should pay attention to chondroblastoma.

  8. Simulation

    DEFF Research Database (Denmark)

    Gould, Derek A; Chalmers, Nicholas; Johnson, Sheena J;


    Recognition of the many limitations of traditional apprenticeship training is driving new approaches to learning medical procedural skills. Among simulation technologies and methods available today, computer-based systems are topical and bring the benefits of automated, repeatable, and reliable...... performance assessments. Human factors research is central to simulator model development that is relevant to real-world imaging-guided interventional tasks and to the credentialing programs in which it would be used....

  9. Technetium bone scanning as an aid in the diagnosis of atypical acute osteomyelitis in children

    Energy Technology Data Exchange (ETDEWEB)

    Letts, R.M.; Afifi, A.; Sutherland, J.B.


    Technetium bone scanning is a simple, safe and accurate method for the diagnosis of acute osteomyelitis in children whose presenting clinical findings are atypical of bone infection. Bone scanning was effective in the localization of the exact site of osteomyelitis, thus facilitating needle aspiration as well as subsequent surgical decompression. Technetium bone scanning is a diagnostic technique for determining bone infection in children who are unable to communicate adequately or in those whose signs have been modified by previous inadequate antibacterial therapy.

  10. Surgical Critical Care Initiative (United States)

    Federal Laboratory Consortium — The Surgical Critical Care Initiative (SC2i) is a USU research program established in October 2013 to develop, translate, and validate biology-driven critical care....

  11. Guide to Surgical Specialists (United States)

    ... have expertise in the following areas of responsibility: neonatal surgery (specialized knowledge in the surgical repair of ... and non-operative management of certain types of pain. Common conditions managed by neurologic surgeons include disorders ...

  12. Ambulatory Surgical Measures - National (United States)

    U.S. Department of Health & Human Services — The Ambulatory Surgical Center Quality Reporting (ASCQR) Program seeks to make care safer and more efficient through quality reporting. ASCs eligible for this...

  13. Ambulatory Surgical Measures - Facility (United States)

    U.S. Department of Health & Human Services — The Ambulatory Surgical Center Quality Reporting (ASCQR) Program seeks to make care safer and more efficient through quality reporting. ASCs eligible for this...

  14. Surgical Management of Significant Maxillary Anterior Vertical Ridge Defects. (United States)

    Urban, Istvan A; Monje, Alberto; Nevins, Myron; Nevins, Marc L; Lozada, Jamie L; Wang, Hom-Lay


    Severe vertical ridge deficiency in the anterior maxilla represents one of the most challenging scenarios in bone regeneration. Under ideal circumstances, guided bone regeneration in combination with soft tissue management has shown predictable esthetic and functional outcomes. Success largely relies on primary wound closure during and after the surgical procedure. Surgical sites present different challenges that need to be considered when designing the flap. The goal of this article is to propose a classification of flap designs that considers vestibular depth and scar formation around the periosteum when performing vertical ridge augmentation in the atrophic anterior maxilla. The four clinical conditions proposed under this classification are (1) shallow vestibule with healthy periosteum, (2) deep vestibule with healthy periosteum, (3) shallow vestibule with scarred periosteum, and (4) deep vestibule with scarred periosteum. The classification will allow clinicians to achieve tension-free closure and more predictable vertical bone gain.

  15. Surgical-prosthetic treatment of large mandibular cysts

    Directory of Open Access Journals (Sweden)

    Džambas Ljubiša D.


    Full Text Available This paper presents a combined surgical-prosthetic procedure of reconstructing mandibular bone defect in a 53 year old patient, following enucleation of a mandibular cyst (Cystectomy Partsch II. After a thorough diagnostic evaluation, a surgical procedure was planned with the particular attention to the nature of the disease, patient’s condition, size and extension of the cyst, tissue loss, and the possibilities of prosthetic management of a mandibular bone defect with partial postresection dental prosthesis. It is of great importance to point to the significance of teamwork of a maxillofacial surgeon and a specialist in prosthodontics. This kind of cooperation provided very effective and less risky soft tissue, as well as bone tissue regeneration (osteogenesis. The patient’s recovery was fast, and he could return to his daily activities and work without significant changes regarding quality of life after surgery and prosthetic treatment.

  16. Surgical treatment of odontogenic keratocyst by enucleation

    Directory of Open Access Journals (Sweden)

    Mamta Singh


    Full Text Available Although odontogenic keratocysts (OKCs are benign, they are often locally destructive and tend to recur after conservative surgical treatment. They must therefore be distinguished from other cysts of the jaw. Keratocysts possess outpouchings and microscopic daughter cysts from which recurrences may arise. Histologic examination is essential for diagnosis since the appearances on roentgenograms and at operation usually do not reveal the true nature of the lesion. Since many non-dental surgeons and pathologists are unaware of OKCs, a case is presented in which surgical treatment was by original conservative method. Decompression causes a reduction in the cyst volume with new bone formation so that the structures impinged upon (e.g., teeth, nerves are completely free.

  17. Bone x-ray (United States)

    ... or broken bone Bone tumors Degenerative bone conditions Osteomyelitis (inflammation of the bone caused by an infection) ... Multiple myeloma Osgood-Schlatter disease Osteogenesis imperfecta Osteomalacia Osteomyelitis Paget disease of the bone Rickets X-ray ...

  18. Time Simulation of Bone Adaptation

    DEFF Research Database (Denmark)

    Bagge, Mette


    . The remodeling algorithm is derived directly from theoptimization recurrence formula, and in a time increment the materialdistribution changes towards the optimal structure for the present load case.The speed of remodeling is taken from clinical data.Numerical examples of respectively increasing and reducing...

  19. Real-time in situ three-dimensional integral videography and surgical navigation using augmented reality:a pilot study

    Institute of Scientific and Technical Information of China (English)

    Hideyuki Suenaga; Huy Hoang Tran; Hongen Liao; Ken Masamune; Takeyoshi Dohi; Kazuto Hoshi; Yoshiyuki Mori; Tsuyoshi Takato


    To evaluate the feasibility and accuracy of a three-dimensional augmented reality system incorporating integral videography for imaging oral and maxillofacial regions, based on preoperative computed tomography data. Three-dimensional surface models of the jawbones, based on the computed tomography data, were used to create the integral videography images of a subject’s maxillofacial area. The three-dimensional augmented reality system (integral videography display, computed tomography, a position tracker and a computer) was used to generate a three-dimensional overlay that was projected on the surgical site via a half-silvered mirror. Thereafter, a feasibility study was performed on a volunteer. The accuracy of this system was verified on a solid model while simulating bone resection. Positional registration was attained by identifying and tracking the patient/surgical instrument’s position. Thus, integral videography images of jawbones, teeth and the surgical tool were superimposed in the correct position. Stereoscopic images viewed from various angles were accurately displayed. Change in the viewing angle did not negatively affect the surgeon’s ability to simultaneously observe the three-dimensional images and the patient, without special glasses. The difference in three-dimensional position of each measuring point on the solid model and augmented reality navigation was almost negligible (,1 mm);this indicates that the system was highly accurate. This augmented reality system was highly accurate and effective for surgical navigation and for overlaying a three-dimensional computed tomography image on a patient’s surgical area, enabling the surgeon to understand the positional relationship between the preoperative image and the actual surgical site, with the naked eye.

  20. Simulation

    CERN Document Server

    Ross, Sheldon


    Ross's Simulation, Fourth Edition introduces aspiring and practicing actuaries, engineers, computer scientists and others to the practical aspects of constructing computerized simulation studies to analyze and interpret real phenomena. Readers learn to apply results of these analyses to problems in a wide variety of fields to obtain effective, accurate solutions and make predictions about future outcomes. This text explains how a computer can be used to generate random numbers, and how to use these random numbers to generate the behavior of a stochastic model over time. It presents the statist

  1. Bone grafting in four-corner mid-carpal fusion. (United States)

    McBride, T J; Jewell, D P A; Deshmukh, S C


    Four-corner fusion is an accepted surgical treatment for established SLAC and SNAC wrist. We describe a technique of bone grafting to be used in conjunction with any of the standard fusion techniques. A step by step, illustrated approach allows the easy placement of an autograft which is in contact with all surfaces of the bones involved in the fusion.

  2. Novel Surgical Approaches to the Orbit. (United States)

    Campbell, Ashley A; Grob, Seanna R; Yoon, Michael K


    Determining safe surgical access to the orbit can be difficult given the complex anatomy and delicacy of the orbital structures. When considering biopsy or removal of an orbital tumor or repair of orbital fractures, careful planning is required to determine the ideal approach. Traditionally, this has at times necessitated invasive procedures with large incisions and extensive bone removal. The purpose of this review was to present newly techniques and devices in orbital surgery that have been reported over the past decade, with aims to provide better exposure and/or minimally invasive approaches and to improve morbidity and/or mortality.

  3. Nonviral gene transfer strategies to promote bone regeneration. (United States)

    Im, Gun-Il


    Despite the inherent ability of bone to regenerate itself, there are a number of clinical situations in which complete bone regeneration fails to occur. In view of shortcomings of conventional treatment, gene therapy may have a place in cases of critical-size bone loss that cannot be properly treated with current medical or surgical treatment. The purpose of this review is to provide an overview of gene therapy in general, nonviral techniques of gene transfer including physical and chemical methods, RNA-based therapy, therapeutic genes to be transferred for bone regeneration, route of application including ex vivo application, and direct gene therapy approaches to regenerate bone.

  4. 利用仿真手术模型探索腹腔镜胃癌手术动态导航的初步经验%Exploring surgical navigation in laparoscopic gastrectomy by using simulation model

    Institute of Scientific and Technical Information of China (English)

    陈韬; 师为礼; 祁小龙; 胡彦锋; 刘浩; 余江; 蒋振刚; 李国新


    Laparoscopic technique is now widely used in gastrointestinal surgery, but the limitation of its “tubular vision” pose disadvantages. Benefits from the realization of dynamic navigation which can match the preoperative dimensional reconstruction model and the surgical scene in real time, the computer-aided surgery(CAS) can supplement the insufficiency of laparoscopic view. Focusing on pancreas, the key organ in the laparoscopic gastrectomy for cancer cancer,the initial experience of dynamic navigation in such surgery using a virtual surgical model is shared. The method is as follows: First, the virtual model of pancreas and peripheral blood vessels was reconstructed with the Mimics17.0 based on the abdominal computed tomography data of the patients with gastric cancer; and the location information of the virtual marker was captured with the tracking software. Second, the three dimensional (3D) construction image displayed in SLT file, was read in ZEditTM3.21 and was printed by Spectrum ZTM510 printer. Then, the 3D model was fixed in a laparoscopic simulation training device to achieve the simulation operation. The location information of the laparoscopic training device , lens and laparoscopic instrument was recorded with tracking software. Besides, the coordinate information of simulation operation was also achieved. Third, we conducted a match between the virtual and simulation operation. Our study show that scenes splitting is conducive to the tracking and matching of the surgical navigation in laparoscopic surgery for gastric cancer.%腹腔镜技术目前在胃肠外科应用广泛,但其管状视野的局限性为手术造成了不便。计算机辅助技术通过动态导航,实现手术场景和术前重建的三维模型在术中的实时匹配,从而达到实时跟踪的效果,有望弥补腹腔镜技术视野上的局限性。本研究以腹腔镜胃癌手术中最关键的解剖器官———胰腺作为实验对象,介绍笔者团队利

  5. A novel osteogenesis technique: The expansible guided bone regeneration


    Osama Zakaria; Marwa Madi; Shohei Kasugai


    Guided bone regeneration is a unique osteogenesis technique that requires a barrier membrane under periosteum to create space for bone regeneration. However, creating sizeable spaces is clinically not commonly feasible. A titanium plate and a thin silicone membrane were surgically layered on each calvaria of eight rabbits. Then, the periphery of the silicone membrane was fixed by a plastic ring to the underlying bone u...

  6. Bone pain

    DEFF Research Database (Denmark)

    Frost, Charlotte Ørsted; Hansen, Rikke Rie; Heegaard, Anne-Marie


    Skeletal conditions are common causes of chronic pain and there is an unmet medical need for improved treatment options. Bone pain is currently managed with disease modifying agents and/or analgesics depending on the condition. Disease modifying agents affect the underlying pathophysiology...... of the disease and reduce as a secondary effect bone pain. Antiresorptive and anabolic agents, such as bisphosphonates and intermittent parathyroid hormone (1-34), respectively, have proven effective as pain relieving agents. Cathepsin K inhibitors and anti-sclerostin antibodies hold, due to their disease...... modifying effects, promise of a pain relieving effect. NSAIDs and opioids are widely employed in the treatment of bone pain. However, recent preclinical findings demonstrating a unique neuronal innervation of bone tissue and sprouting of sensory nerve fibers open for new treatment possibilities....

  7. Bone graft (United States)

    ... around the area. The bone graft can be held in place with pins, plates, or screws. Why ... Orthopaedic Surgery, San Francosco, CA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the ...

  8. [Evaluation of reparative regeneration of the jaw bone by microfocus roentgenography in an experiment]. (United States)

    Vasil'ev, A Iu; Bulanova, I M; Mal'ginov, N N; Tarasenko, I V; Tarasenko, S V; Kiseleva, E V; Drobyshev, A Iu; Volozhin, A I


    In experiment on 16 grown-up chinchilla rabbits the dynamic of reparative regeneration was evaluated by digital microfocal rontgenography in the terms of 1, 2 and 4 months. Bone defect of the 8capital CHE, Cyrillic8 mm size in the region of mandible angle was caused by surgical laser Smart 2940 D+ on the right side and by physiodespenser Surgec XT on the left side. Surgical laser use let to reduce intact mother bone traumatisation and to improve remote results of bone tissue regeneration. After bone defect creation bone tissue regeneration was put into effect by all 3 callus types - endosteal, periosteal and intermediary.

  9. Bone SPECT/CT detection of a sequestrum in chronic-infected nonunion of the tibia

    DEFF Research Database (Denmark)

    Madsen, Jan L


    Abstract: Sequestra are dead pieces of bone most often seen in long bones affected with prior or current infection. In addition to antibiotic therapy, chronic osteomyelitis with sequestration requires surgical debridement for cure. The author presents a case of tibial fracture associated with chr......Abstract: Sequestra are dead pieces of bone most often seen in long bones affected with prior or current infection. In addition to antibiotic therapy, chronic osteomyelitis with sequestration requires surgical debridement for cure. The author presents a case of tibial fracture associated...... with chronic osteomyelitis, nonunion, and the presence of a sequestrum that was detected by bone SPECT/CT.  ...

  10. Anxiety in veterinary surgical students

    DEFF Research Database (Denmark)

    Langebæk, Rikke; Eika, Berit; Jensen, Asger Lundorff


    The surgical educational environment is potentially stressful and this can negatively affect students' learning. The aim of this study was to investigate whether veterinary students' level of anxiety is higher in a surgical course than in a non-surgical course and if pre-surgical training...... in a Surgical Skills Lab (SSL) has an anxiety reducing effect. Investigations were carried out as a comparative study and a parallel group study. Potential participants were fourth-year veterinary students who attended a surgical course (Basic Surgical Skills) and a non-surgical course (Clinical Examination...... and 28 students from 2010). Our results show that anxiety levels in veterinary students are significantly higher in a surgical course than in a non-surgical course (p...

  11. Bone defect animal models for testing efficacy of bone substitute biomaterials

    Directory of Open Access Journals (Sweden)

    Ye Li


    Full Text Available Large bone defects are serious complications that are most commonly caused by extensive trauma, tumour, infection, or congenital musculoskeletal disorders. If nonunion occurs, implantation for repairing bone defects with biomaterials developed as a defect filler, which can promote bone regeneration, is essential. In order to evaluate biomaterials to be developed as bone substitutes for bone defect repair, it is essential to establish clinically relevant in vitro and in vivo testing models for investigating their biocompatibility, mechanical properties, degradation, and interactional with culture medium or host tissues. The results of the in vitro experiment contribute significantly to the evaluation of direct cell response to the substitute biomaterial, and the in vivo tests constitute a step midway between in vitro tests and human clinical trials. Therefore, it is essential to develop or adopt a suitable in vivo bone defect animal model for testing bone substitutes for defect repair. This review aimed at introducing and discussing the most available and commonly used bone defect animal models for testing specific substitute biomaterials. Additionally, we reviewed surgical protocols for establishing relevant preclinical bone defect models with various animal species and the evaluation methodologies of the bone regeneration process after the implantation of bone substitute biomaterials. This review provides an important reference for preclinical studies in translational orthopaedics.

  12. [Bovine heterologous bone graft in orbital surgery]. (United States)

    Morax, S; Hurbli, T; Smida, R


    Lubboc (T650) is a bovine heterologous bone implant obtained by specific preparation of trabecular of bone. In vitro and in vivo biocompatibility studies have revealed the absence of any cytotoxicity or systemic toxicity. Lubboc has many fields of application, including all bone graft surgical indications. We report our first results concerning the use of this product in orbital surgery either as a filling or contention material or as an apposition material. On all 20 operated patients we did not encounter any intolerance, inflammation or infection. The follow-up is still too short to appreciate the long term integration of this material which has the advantage of being a substitute for autologous bone, avoiding bone graft harvesting.

  13. In-Vivo Electrical Impedance Measurement in Mastoid Bone. (United States)

    Wyss Balmer, Thomas; Ansó, Juan; Muntane, Enric; Gavaghan, Kate; Weber, Stefan; Stahel, Andreas; Büchler, Philippe


    Nerve monitoring is a safety mechanism to detect the proximity between surgical instruments and important nerves during surgical bone preparation. In temporal bone, this technique is highly specific and sensitive at distances below 0.1 mm, but remains unreliable for distances above this threshold. A deeper understanding of the patient-specific bone electric properties is required to improve this range of detection. A sheep animal model has been used to characterize bone properties in vivo. Impedance measurements have been performed at low frequencies (drilled into the sheep mastoid bone. An electric circuit composed of a resistor and a Fricke constant phase element was able to accurately describe the experimental measurements. Bone resistivity was shown to be linearly dependent on the inter-electrode distance and the local bone density. Based on this model, the amount of bone material between the electrodes could be predicted with an error of 0.7 mm. Our results indicate that bone could be described as an ideal resistor while the electrochemical processes at the electrode-tissue interface are characterized by a constant phase element. These results should help increasing the safety of surgical drilling procedures by better predicting the distance to critical nerve structures.

  14. The advantage of the three dimensional computed tomographic (3 D-CT for ensuring accurate bone incision in sagittal split ramus osteotomy

    Directory of Open Access Journals (Sweden)

    Coen Pramono D


    Full Text Available Functional and aesthetic dysgnathia surgery requires accurate pre-surgical planning, including the surgical technique to be used related with the difference of anatomical structures amongst individuals. Programs that simulate the surgery become increasingly important. This can be mediated by using a surgical model, conventional x-rays as panoramic, cephalometric projections and another sophisticated method such as a three dimensional computed tomography (3 D-CT. A patient who had undergone double jaw surgeries with difficult anatomical landmarks was presented. In this case the mandible foramens were seen highly relatively related to the sigmoid notches. Therefore, ensuring the bone incisions in sagittal split was presumed to be difficult. A 3D-CT was made and considered to be very helpful in supporting the pre-operative diagnostic.

  15. [Orthognathic surgery: corrective bone operations]. (United States)

    Reuther, J


    The article reviews the history of orthognathic surgery from the middle of the last century up to the present. Initially, mandibular osteotomies were only performed in cases of severe malformations. But during the last century a precise and standardized procedure for correction of the mandible was established. Multiple modifications allowed control of small fragments, functionally stable osteosynthesis, and finally a precise positioning of the condyle. In 1955 Obwegeser and Trauner introduced the sagittal split osteotomy by an intraoral approach. It was the final breakthrough for orthognathic surgery as a standard treatment for corrections of the mandible. Surgery of the maxilla dates back to the nineteenth century. B. von Langenbeck from Berlin is said to have performed the first Le Fort I osteotomy in 1859. After minor changes, Wassmund corrected a posttraumatic malocclusion by a Le Fort I osteotomy in 1927. But it was Axhausen who risked the total mobilization of the maxilla in 1934. By additional modifications and further refinements, Obwegeser paved the way for this approach to become a standard procedure in maxillofacial surgery. Tessier mobilized the whole midface by a Le Fort III osteotomy and showed new perspectives in the correction of severe malformations of the facial bones, creating the basis of modern craniofacial surgery. While the last 150 years were distinguished by the creation and standardization of surgical methods, the present focus lies on precise treatment planning and the consideration of functional aspects of the whole stomatognathic system. To date, 3D visualization by CT scans, stereolithographic models, and computer-aided treatment planning and simulation allow surgery of complex cases and accurate predictions of soft tissue changes.

  16. Three-dimensional visualization system as an aid for facial surgical planning (United States)

    Barre, Sebastien; Fernandez-Maloigne, Christine; Paume, Patricia; Subrenat, Gilles


    We present an aid for facial deformities treatment. We designed a system for surgical planning and prediction of human facial aspect after maxillo-facial surgery. We study the 3D reconstruction process of the tissues involved in the simulation, starting from CT acquisitions. 3D iso-surfaces meshes of soft tissues and bone structures are built. A sparse set of still photographs is used to reconstruct a 360 degree(s) texture of the facial surface and increase its visual realism. Reconstructed objects are inserted into an object-oriented, portable and scriptable visualization software allowing the practitioner to manipulate and visualize them interactively. Several LODs (Level-Of- Details) techniques are used to ensure usability. Bone structures are separated and moved by means of cut planes matching orthognatic surgery procedures. We simulate soft tissue deformations by creating a physically-based springs model between both tissues. The new static state of the facial model is computed by minimizing the energy of the springs system to achieve equilibrium. This process is optimized by transferring informations like participation hints at vertex-level between a warped generic model and the facial mesh.

  17. Osteobiology: newest bone organ topics and the platelet-rich plasma treatment.

    Directory of Open Access Journals (Sweden)

    Ananias García Cardona


    Full Text Available The bone is a dynamic tissue taht provides mechanical support, physical protection, storage site for minerals, and enables genesis movement. The bone biology (osteobiology is regulated by the balance betqeen osteoblastic formation and osteoclatic resorption. the skeletal bone homeostasis is influenced by components of the bone marrow organ, neuroendocrine system and hemato-inmmune system. The purpose of this review is to describe the biodynamic of the bone organ, and actual terapeutics with platelet-rich plasma in guide bone regeneration, a co-surgical method employed to increase the quantity and quality of the bone.

  18. Surgical management of presbyopia

    Directory of Open Access Journals (Sweden)

    Torricelli AA


    Full Text Available André AM Torricelli, Jackson B Junior, Marcony R Santhiago, Samir J BecharaDivision of Ophthalmology, University of São Paulo Medical School, São Paulo, BrazilAbstract: Presbyopia, the gradual loss of accommodation that becomes clinically significant during the fifth decade of life, is a physiologic inevitability. Different technologies are being pursued to achieve surgical correction of this disability; however, a number of limitations have prevented widespread acceptance of surgical presbyopia correction, such as optical and visual distortion, induced corneal ectasia, haze, anisometropy with monovision, regression of effect, decline in uncorrected distance vision, and the inherent risks with invasive techniques, limiting the development of an ideal solution. The correction of the presbyopia and the restoration of accommodation are considered the final frontier of refractive surgery. The purpose of this paper is to provide an update about current procedures available for presbyopia correction, their advantages, and disadvantages.Keywords: presbyopia, surgical correction, treatment

  19. Low Bone Density (United States)

    ... Information › Bone Density Exam/Testing › Low Bone Density Low Bone Density Low bone density is when your ... compared to people with normal bone density. Detecting Low Bone Density A bone density test will determine ...

  20. Surgical virtual reality - highlights in developing a high performance surgical haptic device. (United States)

    Custură-Crăciun, D; Cochior, D; Constantinoiu, S; Neagu, C


    Just like simulators are a standard in aviation and aerospace sciences, we expect for surgical simulators to soon become a standard in medical applications. These will correctly instruct future doctors in surgical techniques without there being a need for hands on patient instruction. Using virtual reality by digitally transposing surgical procedures changes surgery in are volutionary manner by offering possibilities for implementing new, much more efficient, learning methods, by allowing the practice of new surgical techniques and by improving surgeon abilities and skills. Perfecting haptic devices has opened the door to a series of opportunities in the fields of research,industry, nuclear science and medicine. Concepts purely theoretical at first, such as telerobotics, telepresence or telerepresentation,have become a practical reality as calculus techniques, telecommunications and haptic devices evolved,virtual reality taking a new leap. In the field of surgery barrier sand controversies still remain, regarding implementation and generalization of surgical virtual simulators. These obstacles remain connected to the high costs of this yet fully sufficiently developed technology, especially in the domain of haptic devices.

  1. Remoción de terceros molares mandibulares con asistencia endoscópica: Nota técnica de un nuevo procedimiento quirúrgico para prevenir lesiones del NAI y formación de defectos óseos Removal of mandibular third molars with endoscopic approach: Technical note of a new surgical procedure to avoid IAN damage and bone defect formation

    Directory of Open Access Journals (Sweden)

    R Fuentes


    , preserving the buccal and lingual walls through direct and magnified visualization of the surgical site, adaptable to the patient’s movements during the surgery. In this report, we present a new and minimally invasive procedure through endoscopic assistance for bone conservation in the removal of third molars at risk of inferior alveolar nerve injury.

  2. 前外侧和外侧联合入路的股骨颈肿瘤刮除植骨及内固定术%Surgical technique of combined anterior-lateral and lateral approach in the management of bone tumor of femoral neck

    Institute of Scientific and Technical Information of China (English)

    伦登兴; 胡永成; 黄洪超; 夏群; 苗军; 于金虎


    Objective To explore surgical procedure of combined anterior-lateral and lateral approach for the treatment of bone tumors of femoral neck. Methods Forty patients with bone tumors of femoral neck treated in Tianjin Hospital were included from July 2005 to August 2009. Of the patients, 12 who were treated with curettage and bone graft through combined anterior-lateral and lateral incision were analyzed in this study. There were 7 males and 5 females with an average age of 34 years ranging from 17 to 68 years. 4 patients were diagnosed as chondroblastoma, 2 giant cell tumor, 3 fibrous dysplasia, and 3 single bone cysts. 7 patients suffered from pathologic fractures, and 5 had presented thin cortical bone because of tumor involvement. There were 1 tumor located in H1 zone, 4 in H2 zone and 7 in H1,2 zone according to ISOLS femoral neck classification. All patients were treated by curettage and bone graft via anterior-lateral approach, 10 cases underwent internal fixation with anatomical plate, and 2 cases with canulated screws with lateral approach. Results The follow-up time ranged from 10 to 68 months with an average of 35 months.Pain disappeared in all patients, and there were not recurrence of tumor, pathologic fractures and avascular necrosis. One case had complained of lateral femoral skin numbness which may be caused by injures of femoral lateral nerves. One case had difficulties in the valgus of hip joint. The mean MSTS score was 29.2 points ranging from 27 to 30 points. Conclusion Anterior approaches of "SP" incision is helpful to thorough curettage which decrease the risk of recurrence due to good visualization and intemal fixation is easy to perform via lateral approaches. The result suggested that combined anterior-lateral "SP" and lateral incision is liable option in treatment of bone tumors of femoral neck.%目的 探讨前外侧和外侧联合入路肿瘤刮除植骨重建治疗股骨颈骨肿瘤的疗效.方法 2005年7月至2009年8月采用前外侧

  3. Bone marrow transplant (United States)

    Transplant - bone marrow; Stem cell transplant; Hematopoietic stem cell transplant; Reduced intensity nonmyeloablative transplant; Mini transplant; Allogenic bone marrow transplant; Autologous bone marrow transplant; Umbilical ...

  4. Diagnostic problems and surgical treatment of histiocytosis X

    Directory of Open Access Journals (Sweden)

    Alkhalil M


    Full Text Available A 16-year-old boy, with swelling and pain in the left submandibular region was treated at the Clinic for Maxillofacial Surgery. The x-ray examination showed destructive bone lesion of the mandibulae left side and oval lesions on the left hand bone and ribs. A biopsy showed characteristics of the Hand-Schueller-Christian disease. A surgical treatment consisted of a complete excision of the mandible lesion and reconstruction defect using a rib autologous transplant. After 3 years, osteolysis and extensive process of resorption of the autologous rib bone transplant occurred. Chemotherapy and radiotherapy stopped spreading of the disease for 4 years. However, progression with involvement of the cervical spine with limited motions, pain, and lesions of C5 and C7 appeared. An autologous bone transplant in the reconstruction of the postresection defects in this disease is not recommended.

  5. Mesenchymal Stem Cells as a Potent Cell Source for Bone Regeneration

    Directory of Open Access Journals (Sweden)

    Elham Zomorodian


    Full Text Available While small bone defects heal spontaneously, large bone defects need surgical intervention for bone transplantation. Autologous bone grafts are the best and safest strategy for bone repair. An alternative method is to use allogenic bone graft. Both methods have limitations, particularly when bone defects are of a critical size. In these cases, bone constructs created by tissue engineering technologies are of utmost importance. Cells are one main component in the manufacture of bone construct. A few cell types, including embryonic stem cells (ESCs, adult osteoblast, and adult stem cells, can be used for this purpose. Mesenchymal stem cells (MSCs, as adult stem cells, possess characteristics that make them good candidate for bone repair. This paper discusses different aspects of MSCs that render them an appropriate cell type for clinical use to promote bone regeneration.

  6. [Optimizing surgical hand disinfection]. (United States)

    Kampf, G; Kramer, A; Rotter, M; Widmer, A


    For more than 110 years hands of surgeons have been treated before a surgical procedure in order to reduce the bacterial density. The kind and duration of treatment, however, has changed significantly over time. Recent scientific evidence suggests a few changes with the aim to optimize both the efficacy and the dermal tolerance. Aim of this article is the presentation and discussion of new insights in surgical hand disinfection. A hand wash should be performed before the first disinfection of a day, ideally at least 10 min before the beginning of the disinfection as it has been shown that a 1 min hand wash significantly increases skin hydration for up to 10 min. The application time may be as short as 1.5 min depending on the type of hand rub. Hands and forearms should be kept wet with the hand rub for the recommended application time in any case. A specific rub-in procedure according to EN 12791 has been found to be suitable in order to avoid untreated skin areas. The alcohol-based hand rub should have a proven excellent dermal tolerance in order to ensure appropriate compliance. Considering these elements in clinical practice can have a significant impact to optimize the high quality of surgical hand disinfection for prevention of surgical site infections.

  7. Surgical infections with Mycoplasma

    DEFF Research Database (Denmark)

    Levi-Mazloum, Niels Donald; Prag, Jørgen Brorson; Jensen, J S;


    Mycoplasma hominis and Ureaplasma urealyticum are common inhabitants of the human genital tract. Evidence for an aetiological role in pyelonephritis, pelvic inflammatory disease, post-abortion and post-partum fever has been presented. There are sporadic reports of Mycoplasma causing serious extra...... extragenital infection such as septicemia, septic arthritis, neonatal meningitis and encephalitis. We review 38 cases of surgical infections with Mycoplasma....

  8. [da Vinci surgical system]. (United States)

    Watanabe, Gou; Ishikawa, Norihiro


    The da Vinci surgical system was developed by Intuitive Surgical Inc. in the United States as an endoscopic surgical device to assist remote control surgeries. In 1998, the Da Vinci system was first used for cardiothoracic procedures. Currently a combination of robot-assisted internal thoracic artery harvest together with coronary artery bypass grafting (CABG) through a mini-incision (ThoraCAB) or totally endoscopic procedures including anastomoses under robotic assistance (TECAB) are being conducted for the treatment of coronary artery diseases. With the recent advances in catheter interventions, hybrid procedures combining catheter intervention with ThoraCAB or TECAB are anticipated in the future.On the other hand, with the decrease in number of coronary artery bypass surgeries, the share of valvular surgeries is expected to increase in the future. Among them, mitral valvuloplasty for mitral regurgitation is anticipated to be conducted mainly by low-invasive procedures, represented by minimally invasive cardiac surgery( MICS) and robot-assisted surgery. Apart from the intrinsic good surgical view, robotic-assisted systems offer additional advantages of the availability of an amplified view and the easy to observe the mitral valve in the physiological position. Thus, robotic surgical surgeries that make complicated procedures easier are expected to accomplish further developments in the future. Furthermore, while the number of surgeries for atrial septal defects has decreased dramatically following the widespread use of Amplatzer septal occluder, robotic surgery may become a good indication for cases in which the Amplatzer device is not indicated. In Japan, clinical trial of the da Vinci robotic system for heart surgeries has been completed. Statutory approval of the da Vinci system for mitral regurgitation and atrial septal defects is anticipated in the next few years.

  9. Bone mineral content and bone metabolism in young adults with severe periodontitis

    DEFF Research Database (Denmark)

    Wowern von, N.; Westergaard, J.; Kollerup, G.


    Bone loss, bone markers, bone metabolism, bone mineral content, osteoporosis, severe periodontitis......Bone loss, bone markers, bone metabolism, bone mineral content, osteoporosis, severe periodontitis...

  10. [Bone transplant]. (United States)

    San Julián, M; Valentí, A


    We describe the methodology of the Bone and Soft Tissue Bank, from extraction and storage until use. Since the year 1986, with the creation of the Bone Bank in the University Clinic of Navarra, more than 3,000 grafts have been used for very different types of surgery. Bone grafts can be classified into cortical and spongy; the former are principally used in surgery to save tumour patients, in large post-traumatic reconstructions and in replacement surgery where there are massive bone defects and a structural support is required. The spongy grafts are the most used due to their numerous indications; they are especially useful in filling cavities that require a significant quantity of graft when the autograft is insufficient, or as a complement. They are also of special help in treating fractures when there is bone loss and in the treatment of delays in consolidation and pseudoarthrosis in little vascularized and atrophic zones. They are also used in prosthetic surgery against the presence of cavity type defects. Allografts of soft tissues are specially recognised in multiple ligament injuries that require reconstructions. Nowadays, the most utilised are those employed in surgery of the anterior cruciate ligament although they can be used for filling any ligament or tendon defect. The principal difficulties of the cortical allografts are in the consolidation of the ends with the bone itself and in tumour surgery, given that these are patients immunodepressed by the treatment, the incidence of infection is increased with respect to spongy grafts and soft tissues, which is irrelevant. In short, the increasingly widespread use of allografts is an essential therapeutic weapon in orthopaedic surgery and traumatology. It must be used by expert hands.

  11. Good result after surgical treatment of Pellegrini-Stieda syndrome. (United States)

    Theivendran, Kanthan; Lever, Caroline J; Hart, William J


    Ossification of the femoral attachment of the medial collateral ligament (MCL) of the knee with associated pain and restricted movements is rare and is characteristic of the Pellegrini-Stieda (PS) syndrome. Although in mild cases conservative treatment is often successful, patients with more significant bone formation and persistent symptoms require surgical excision. We describe a case of PS syndrome with a description of the surgical technique consisting of excision of the bony lesion and reconstruction of the MCL by using the adductor magnus tendon.

  12. Successful surgical excision of primary right atrial angiosarcoma

    Directory of Open Access Journals (Sweden)

    van der Horst Iwan CC


    Full Text Available Abstract Primary cardiac angiosarcoma is a rare and aggressive tumor with a high incidence of metastatic spread (up to 89% at the time of diagnosis, which restricts the indication for surgical resection to a small number of patients. We report the case of a 50-year old Caucasian woman with non-metastatic primary right atrial angiosarcoma, who underwent successful surgical excision of the tumor (with curative intent and reconstruction of the right atrium with a porcine pericardial patch. However, after a symptom-free survival of five months the patient presented with bone and liver metastases without evidence of local tumor recurrence.

  13. Bone biopsy (image) (United States)

    A bone biopsy is performed by making a small incision into the skin. A biopsy needle retrieves a sample of bone and it ... examination. The most common reasons for bone lesion biopsy are to distinguish between benign and malignant bone ...

  14. Bone lesion biopsy (United States)

    Bone biopsy; Biopsy - bone ... needle is gently pushed and twisted into the bone. Once the sample is obtained, the needle is ... sample is sent to a lab for examination. Bone biopsy may also be done under general anesthesia ...

  15. Facts about Broken Bones (United States)

    ... Room? What Happens in the Operating Room? Broken Bones KidsHealth > For Kids > Broken Bones Print A A ... sticking through the skin . What Happens When a Bone Breaks? It hurts to break a bone! It's ...

  16. Calcium and bones (United States)

    Bone strength and calcium ... calcium (as well as phosphorus) to make healthy bones. Bones are the main storage site of calcium in ... your body does not absorb enough calcium, your bones can get weak or will not grow properly. ...

  17. Broken Bones (For Parents) (United States)

    ... Feeding Your 1- to 2-Year-Old Broken Bones KidsHealth > For Parents > Broken Bones Print A A ... bone fragments in place. When Will a Broken Bone Heal? Fractures heal at different rates, depending upon ...

  18. [Pathological proximal femur fracture: consider also primary bone tumour]. (United States)

    van de Sande, Michiel A J; van Rijswijk, Carla S P; Dijkstra, P D Sander; Taminiau, Antonie M H


    Two male and one female patient, aged 64, 70 and 51 respectively, were surgically treated for pathological fracture of the proximal femur without preoperative biopsy. In contrast to their benign radiological diagnosis, all three patients were finally diagnosed as having a malignant primary bone tumour. The proximal femur is the primary location of pathological fractures in the appendicular skeleton. Metastases to bone are the most common cause of a destructive lesion of the skeleton in an adult. Although rare, a primary bone tumour must be included in differential diagnosis of a pathological fracture. A systematic diagnostic strategy is critical to avoid complications that make curative treatment impossible. A solitary bone lesion seen on radiography should never be assumed to be a bone metastasis. Without further diagnostic research, surgical treatment for a pathological fracture should never be commenced before a definitive diagnosis is made.

  19. Bone grafting simultaneous to implant placement. Presentation of a case. (United States)

    Peñarrocha-Diago, Miguel; Gómez-Adrián, Maria Dolores; García-Mira, Berta; Ivorra-Sais, Mariola


    Bone defects at mandibular alveolar crest level complicate the placement of dental implants in the ideal location. Surgical reconstruction using autologous bone grafts allows implant fixation in an esthetic and functional manner. We describe a patient with large mandibular bone loss secondary to periodontal inflammatory processes. Reconstruction of the mandibular alveolar process was carried out using onlay block bone grafts harvested from the mandible. The grafts were stabilized by positioning the dental implants through them--a procedure that moreover afforded good primary implant fixation. After two years of follow-up the clinical and radiological outcome is good. In the lower jaw, where bone regeneration is complicated, we were able to achieve good results in this patient--minimizing the corresponding waiting time by grafting and placing the implants in the same surgical step.


    Directory of Open Access Journals (Sweden)

    Angad eMalhotra


    Full Text Available Appropriate, well characterized bone defect animal models remain essential for preclinical research. This pilot study demonstrates a relevant animal model for cancellous bone defect healing. Three different defect diameters (8, 11, 14mm of fixed depth (25mm were compared in both skeletally immature (18 month old and aged sheep (5 year old. In each animal, four defects were surgically created and placed in the cancellous bone of the medial distal femoral and proximal tibial epiphyses bilaterally. Animals were euthanized at four weeks post-operatively to assess early healing and any biological response. Defect sites were graded radiographically, and new bone formation quantified using µCT and histomorphometry. Fibrous tissue was found within the central region in most of the defects, with woven bone normally forming near the periphery of the defect. Bone volume fraction (BV/TV significantly decreased with an increasing defect diameter. Actual bone volume (BV, however, increased with defect diameter. Bone ingrowth was lower for all defect diameters in the aged group. This pilot study proposes that the surgical creation of 11mm diameter defects in the proximal tibial and distal femoral epiphyses of aged sheep is a suitable large animal model to study early healing of cancellous bone defects. The refined model allows for the placement of four separate bone defects per animal, and encourages a reduction in animal numbers required for preclinical research.

  1. Bone densitometry

    DEFF Research Database (Denmark)

    Ravn, Pernille; Alexandersen, P; Møllgaard, A


    The bisphosphonates have been introduced as alternatives to hormone replacement therapy (HRT) for the treatment and prevention of postmenopausal osteoporosis. The expected increasing application in at clinical practice demands cost-effective and easily handled methods to monitor the effect on bone...

  2. In Vivo Osteoinductive Effect and In Vitro Isolation and Cultivation Bone Marrow Mesenchymal Stem Cells


    Redžić, Amira; Smajilagić, Amer; Aljičević, Mufida; Berberović, Ljubomir


    Bone marrow contains cell type termed Mesenchymal Stem Cells (MSC), first recognized in bone marrow by a German pathologist, Julius Cohnheim in 1867. That MSCs have potential to differentiate in vitro in to the various cells lines as osteoblast, chondroblast, myoblast and adipoblast cells lines. Aims of our study were to show in vivo capacity of bone marrow MSC to produce bone in surgically created non critical size mandible defects New Zeeland Rabbits, and then in second part of study to iso...

  3. Spacecraft surgical scrub system (United States)

    Abbate, M.


    Ease of handling and control in zero gravity and minimizing the quantity of water required were prime considerations. The program tasks include the selection of biocidal agent from among the variety used for surgical scrub, formulation of a dispensing system, test, and delivery of flight dispensers. The choice of an iodophore was based on effectiveness on single applications, general familiarity among surgeons, and previous qualification for space use. The delivery system was a choice between the squeeze foamer system and impregnated polyurethane foam pads. The impregnated foam pad was recommended because it is a simpler system since the squeeze foamer requires some applicator to effectively clean the skin surfaces, whereas the form pad is the applicator and agent combined. Testing demonstrated that both systems are effective for use as surgical scrubs.

  4. Vitiligo- A surgical approach

    Directory of Open Access Journals (Sweden)

    Deepti Ghia


    Full Text Available Aims and objective- To describe the spectrum of surgical modalities for stable vitiligo patients Methods- Patients having stable vitiligo since past 2 years with no improvement with medical line of treatment were enrolled for surgery after informed consent. Depending upon the size and location of vitiligo patch different modalities were performed. Suction blister, mini-punch grafting, split thickness skin grafting, trypsinised melanocyte-keratinocyte transfer and non-trypsinised melanocyte- keratinocyte transfer (Jodhpur technique and follicular grafting technique have been described photographically which have been performed at a tertiary care hospital. Conclusion- Vitiligo is often difficult to treat, stable patches resistant to medical line of management do respond to surgical treatment; however it is very important to choose the modality of surgery according location of the patch, size of the lesion and available resources.

  5. The temporal response of bone to unloading (United States)

    Globus, R. K.; Bikle, D. D.; Morey-Holton, E.


    Rats were suspended by their tails with the forelimbs bearing the weight load to simulate the weightlessness of space flight. Growth in bone mass ceased by 1 week in the hindlimbs and lumbar vertebrae in growing rats, while growth in the forelimbs and cervical vertebrae remained unaffected. The effects of selective skeletal unloading on bone formation during 2 weeks of suspension was investigated using radio iostope incorporation (with Ca-45 and H-3 proline) and histomorphometry (with tetracycline labeling). The results of these studies were confirmed by histomorphometric measurements of bone formation using triple tetracycline labeling. This model of simulated weightlessness results in an initial inhibition of bone formation in the unloaded bones. This temporary cessation of bone formation is followed in the accretion of bone mass, which then resumes at a normal rate by 14 days, despite continued skeletal unloading. This cycle of inhibition and resumption of bone formation has profound implication for understanding bone dynamics durng space flight, immobilization, or bed rest and offers an opportunity to study the hormonal and mechanical factors that regulate bone formation.

  6. Hepatic surgical anatomy. (United States)

    Skandalakis, John E; Skandalakis, Lee J; Skandalakis, Panajiotis N; Mirilas, Petros


    The liver, the largest organ in the body, has been misunderstood at nearly all levels of organization, and there is a tendency to ignore details that do not fit the preconception. A complete presentation of the surgical anatomy of the liver includes the study of hepatic surfaces, margins, and fissures; the various classifications of lobes and segments; and the vasculature and lymphatics. A brief overview of the intrahepatic biliary tract is also presented.

  7. Surgical navigation with QR codes

    Directory of Open Access Journals (Sweden)

    Katanacho Manuel


    Full Text Available The presented work is an alternative to established measurement systems in surgical navigation. The system is based on camera based tracking of QR code markers. The application uses a single video camera, integrated in a surgical lamp, that captures the QR markers attached to surgical instruments and to the patient.

  8. Guideline implementation: Surgical attire. (United States)

    Cowperthwaite, Liz; Holm, Rebecca L


    Surgical attire helps protect patients from microorganisms that may be shed from the hair and skin of perioperative personnel. The updated AORN "Guideline for surgical attire" provides guidance on scrub attire, shoes, head coverings, and masks worn in the semirestricted and restricted areas of the perioperative setting, as well as how to handle personal items (eg, jewelry, backpacks, cell phones) that may be taken into the perioperative suite. This article focuses on key points of the guideline to help perioperative personnel adhere to facility policies and regulatory requirements for attire. The key points address the potential benefits of wearing scrub attire made of antimicrobial fabric, covering the arms when in the restricted area of the surgical suite, removing or confining jewelry when wearing scrub attire, disinfecting personal items that will be taken into the perioperative suite, and sending reusable attire to a health care-accredited laundry facility after use. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.

  9. Louis Pasteur surgical revolution. (United States)

    Toledo-Pereyra, Luis H


    Louis Pasteur (1822-1895) is considered the most notable medical scientist of his time and perhaps one of the most distinguished of all times in the history of medicine. From Dole in France to Paris, from a student of crystals to "living ferments," and from chemistry to biology and medicine, Pasteur changed the world for the benefit of humanity. The genius of Pasteur dealt with the most pressing issues of his time, basing the germ theory on the effects that microorganisms had on fermentation and putrefaction of organic matter, which gave birth to the science of bacteriology. Many other difficult problems in medicine and biology were tackled by Pasteur, culminating in the spectacular results seen with the treatment of rabies. Surgery was no exception to the scientific conquests of Pasteur. The transformation of the surgical world arose from the antiseptic concepts of Lister that were based on the germ theory of the disease, which had been derived from the germ theory of fermentation and putrefaction discovered by Pasteur. The acceptance of these principles represented the surgical revolution brought on by the science of Pasteur, a revolution that is now accepted in our daily care of surgical patients.

  10. Autologous bone graft versus demineralized bone matrix in internal fixation of ununited long bones

    Directory of Open Access Journals (Sweden)

    Rubenbauer Bianka


    Full Text Available Abstract Background Non-unions are severe complications in orthopaedic trauma care and occur in 10% of all fractures. The golden standard for the treatment of ununited fractures includes open reduction and internal fixation (ORIF as well as augmentation with autologous-bone-grafting. However, there is morbidity associated with the bone-graft donor site and some patients offer limited quantity or quality of autologous-bone graft material. Since allogene bone-grafts are introduced on the market, this comparative study aims to evaluate healing characteristics of ununited bones treated with ORIF combined with either iliac-crest-autologous-bone-grafting (ICABG or demineralized-bone-matrix (DBM. Methods and results From 2000 to 2006 out of sixty-two consecutive patients with non-unions presenting at our Level I Trauma Center, twenty patients had ununited diaphyseal fractures of long bones and were treated by ORIF combined either by ICABG- (n = 10 or DBM-augmentation (n = 10. At the time of index-operation, patients of the DBM-group had a higher level of comorbidity (ASA-value: p = 0.014. Mean duration of follow-up was 56.6 months (ICABG-group and 41.2 months (DBM-group. All patients were clinically and radiographically assessed and adverse effects related to bone grafting were documented. The results showed that two non-unions augmented with ICABG failed osseous healing (20% whereas all non-unions grafted by DBM showed successful consolidation during the first year after the index operation (p = 0.146. No early complications were documented in both groups but two patients of the ICABG-group suffered long-term problems at the donor site (20% (p = 0.146. Pain intensity were comparable in both groups (p = 0.326. However, patients treated with DBM were more satisfied with the surgical procedure (p = 0.031. Conclusion With the use of DBM, the costs for augmentation of the non-union-site are more expensive compared to ICABG (calculated difference: 160

  11. Bone remodeling as a spatial evolutionary game. (United States)

    Ryser, Marc D; Murgas, Kevin A


    Bone remodeling is a complex process involving cell-cell interactions, biochemical signaling and mechanical stimuli. Early models of the biological aspects of remodeling were non-spatial and focused on the local dynamics at a fixed location in the bone. Several spatial extensions of these models have been proposed, but they generally suffer from two limitations: first, they are not amenable to analysis and are computationally expensive, and second, they neglect the role played by bone-embedded osteocytes. To address these issues, we developed a novel model of spatial remodeling based on the principles of evolutionary game theory. The analytically tractable framework describes the spatial interactions between zones of bone resorption, bone formation and quiescent bone, and explicitly accounts for regulation of remodeling by bone-embedded, mechanotransducing osteocytes. Using tools from the theory of interacting particle systems we systematically classified the different dynamic regimes of the spatial model and identified regions of parameter space that allow for global coexistence of resorption, formation and quiescence, as observed in physiological remodeling. In coexistence scenarios, three-dimensional simulations revealed the emergence of sponge-like bone clusters. Comparison between spatial and non-spatial dynamics revealed substantial differences and suggested a stabilizing role of space. Our findings emphasize the importance of accounting for spatial structure and bone-embedded osteocytes when modeling the process of bone remodeling. Thanks to the lattice-based framework, the proposed model can easily be coupled to a mechanical model of bone loading.

  12. Marked increase in bone formation markers after cinacalcet treatment by mechanisms distinct from hungry bone syndrome in a haemodialysis patient (United States)

    Goto, Shunsuke; Fujii, Hideki; Matsui, Yutaka; Fukagawa, Masafumi


    A 59-year-old female who was on dialysis due to diabetic nephropathy was referred to our hospital for severe hyperparathyroidism refractory to intravenous vitamin D receptor activator treatment. With subsequent cinacalcet hydrochloride treatment, parathyroid hormone (PTH) levels were only slightly suppressed. However, progressive increases were observed in serum alkaline phosphatase (ALP) and bone-specific alkaline phosphatase (BAP) levels with mild hypocalcaemia. A bone biopsy, obtained immediately before surgical parathyroidectomy after 3 months of cinacalcet treatment, revealed no disappearance of osteoclasts. These data suggest that cinacalcet hydrochloride treatment may induce a marked promotion of bone formation by mechanisms distinct from hungry bone syndrome that usually develops after parathyroidectomy. PMID:25949410

  13. The Variation of CRP and the TNF-α in the Vupratentorial Hypertensive Cerebral Hemorrhage after Surgical Treated with Small Bone and the Relationship to the Patient's Condition and Prognostic%幕上高血压脑出血小骨窗开颅术后C反应蛋白及TNF-α的变化及对转归影响的临床分析

    Institute of Scientific and Technical Information of China (English)

    廖鑫; 王佳唐; 罗东; 何俊; 吴昌松; 梁敬心


    Objective: To investigate the role and the rules of Tumor necrosis factor alpha and C-reactive protein of patients after surgical treated with small bone with supratentorial hypertensive cerebral hemorrhage and relation with the GCS. Methods: 38 cases diagnosed supratentorial hypertensive intracerebral hemorrhage were given surgery underwent eraniotomy with small bone window after a clear indication. The levels of CRP and TNF-αwere detected before and at 1 day, 7 days and 14 days after surgical treatment, and the Glasgow coma score (GCS) also determination. We also have 30 cases as control of the CRP and TNF-α. Results: Preoperative serum CRP and TNF-α levels were significantly higher than the control group. Postoperative CRP and TKF-α levels continued to rise,but decreased after 7 days of surgical treatment. The levels of CRP and TNF-α are closely associated with the GCS score. Conclusions: CRP and TNF-α levels may reflect patient's condition and prognostic with hypertensive intracerebral hemorrhage.%目的:探索幕上高血压脑出血术前及小骨窗开颅术后C反应蛋白(CRP)及肿瘤坏死因子α(TNF-α)的变化与病情的关系及对患者临床预后的预测价值.方法:38例诊断为幕上高血压脑出血的患者,在明确手术指征后行小骨窗开颅术,于术前,术后第1天,第7天,第14天监测患者的CRP及TNF-α的水平;并同时测定格拉斯哥昏迷评分(GSS).另设30例作为正常对照病例,一次性抽取静脉血进行CRP及TNF-α进行检测.结果:①术前脑出血患者血中CRP与TNF-α的水平显著高于正常对照组;②术后CRP与TNF-α的水平仍继续上升,术后第7天显著下降;③CRP及TNF-α的水平与GCCS评分密切相关.结论:CRP与TNF-α的水平可反映脑出血患者的病情,对病情转归有预测意义.

  14. Surgical management of temporomandibular joint ankylosis in ankylosing spondylitis. (United States)

    Felstead, Andrew M; Revington, Peter J


    Relatively few patients develop such severe degenerative temporomandibular joint (TMJ) disease that they require total joint replacement. Current indications include those conditions involving condylar bone loss such as degenerative (osteoarthritis) or inflammatory joint disease (ankylosing spondylitis, rheumatoid, and psoriatic). Ankylosis of the temporomandibular joint (TMJ) secondary to ankylosing spondylitis remains an under investigated entity. We aim to provide an overview of treatment objectives, surgical procedures, and our experience with total TMJ replacement for this condition.

  15. Surgical Management of Temporomandibular Joint Ankylosis in Ankylosing Spondylitis

    Directory of Open Access Journals (Sweden)

    Andrew M. Felstead


    Full Text Available Relatively few patients develop such severe degenerative temporomandibular joint (TMJ disease that they require total joint replacement. Current indications include those conditions involving condylar bone loss such as degenerative (osteoarthritis or inflammatory joint disease (ankylosing spondylitis, rheumatoid, and psoriatic. Ankylosis of the temporomandibular joint (TMJ secondary to ankylosing spondylitis remains an under investigated entity. We aim to provide an overview of treatment objectives, surgical procedures, and our experience with total TMJ replacement for this condition.

  16. Three different surgical techniques of crown lengthening: A comparative study

    Directory of Open Access Journals (Sweden)

    Ramya Nethravathy


    Full Text Available Introduction: A short clinical crown may lead to poor retention form thereby leading to improper tooth preparation. Surgical crown lengthening procedure is done to increase the clinical crown length without violating the biologic width. Several techniques have been proposed for clinical crown lengthening which includes gingivectomy, apically displaced flap with or without resective osseous surgery, and surgical extrusion using periotome. Objective: The aim of this paper is to compare clinically the three different surgical techniques of crown lengthening procedures. Materials and Methods: Fifteen patients who reported to the department of Periodontology, were included in the study. Patients were randomly divided into three groups, which include patients who underwent gingivectomy (Group A, apically repositioned flap (Group B and surgical extrusion using periotome (Group C. Clinical measurements such as clinical crown length, gingival zenith, interdental papilla height were taken at baseline and at 3 rd month post-operatively. Results: Clinical and radiographic evaluation at 3 rd month suggest that surgical extrusion technique offers several advantages over the other conventional surgical techniques such as preservation of the interproximal papilla, gingival margin position and no marginal bone loss. Conclusions: This technique can be used to successfully treat a grossly damaged crown structure as a result of tooth fracture, dental caries and iatrogenic factors especially in the anterior region, where esthetics is of great concern.

  17. Chondroblastoma of the sphenoid bone

    Directory of Open Access Journals (Sweden)

    Patrocíni, Tomas Gomes


    Full Text Available Introduction: Chondroblastoma is an uncommon cartilaginous benign neoplasm, highly destructive, which specifically appears in the epiphysis of long bones in young patients. Its occurrence is extremely rare in the cranial base, normally occurring in the temporal bone. Objective: To describe a rare case in a patient presenting with a sphenoid bone chondroblastoma that invaded the middle cranial cavity, submitted to a successful surgical resection, without recurrence after 2 years. Case Report: W.J.S, 37 years old, male, forwarded to the otorhinolaryngology service with persistent and strong otalgia for 3 months. He had normal otoscopy and without visible tumorations. The computerized tomography confirmed tumor mass in the left infra-temporal cavity, invading the middle cranial cavity. The biopsy suggested giant cells tumor. After wide resection by frontal approach via orbitozygomatic osteotomy. During the surgery, we confirmed tomographic statements and didn't find temporal bone involvement. The histopathological exam confirmed chondroblastoma. After 18 months after the surgery, he doesn't present with complaints, without motor, sensitive deficits or of cranial nerves and without recurrence tomographic signals. Conclusion: The importance of differential diagnosis of chondroblastoma is remarkable in the cranial base lesions and its therapeutic approach, whose objective must always be the major possible resection with the maximum function conservation.

  18. Exploring challenges and solutions in the preparation of surgical patients

    DEFF Research Database (Denmark)

    Møller, Thea Palsgaard; Münter, Kristine Husum; Østergaard, Doris;


    INTRODUCTION: Handover of surgical patients from ward to operating room is a sensible point for information and communication failures. Guidelines were developed for preparation of surgical patients. Our aim was to explore if patients are sufficiently prepared for surgery according to local......, workshops including table simulations involving the various professions and specialties were held. RESULTS: In total, 314 surgical procedures were performed of which 196 were eligible for analysis. Emergency procedures showed the poorest results with non-completed tasks comprising 58% of electronic patient...... documentation. Furthermore, challenges and suggestions for solutions were identified. CONCLUSIONS: Completion of mandatory tasks for surgical patient preparation was poor. Workshops with table simulations actively involved the stakeholders from various professions and specialties in describing the patient...

  19. [Intraoperative crisis and surgical Apgar score]. (United States)

    Oshiro, Masakatsu; Sugahara, Kazuhiro


    Intraoperative crisis is an inevitable event to anesthesiologists. The crisis requires effective and coordinated management once it happened but it is difficult to manage the crises properly under extreme stressful situation. Recently, it is reported that the use of surgical crisis checklists is associated with significant improvement in the management of operating-room crises in a high-fidelity simulation study. Careful preoperative evaluation, proper intraoperative management and using intraoperative crisis checklists will be needed for safer perioperative care in the future. Postoperative complication is a serious public health problem. It reduces the quality of life of patients and raises medical cost. Careful management of surgical patients is required according to their postoperative condition for preventing postoperative complications. A 10-point surgical Apgar score, calculated from intraoperative estimated blood loss, lowest mean arterial pressure, and lowest heart rate, is a simple and available scoring system for predicting postoperative complications. It undoubtedly predicts higher than average risk of postoperative complications and death within 30 days of surgery. Surgical Apgar score is a bridge between proper intraoperative and postoperative care. Anesthesiologists should make effort to reduce the postoperative complication and this score is a tool for it.

  20. Surgical technique of alcohol-inactivated autograft replantation with articulation preservation in management of malignant bone tumor around knee%保留关节的瘤段切除酒精灭活再植术在膝关节周围恶性骨肿瘤治疗中的应用

    Institute of Scientific and Technical Information of China (English)

    许宋锋; 于秀淳; 徐明; 刘晓平; 宋若先; 付志厚


    Objective To evaluate the clinical outcome of alcohol-inactivated autograft replantation with articulation preservation in management of malignant bone tumor around knee, and explain the surgical technique. Methods Seven patients were treated with alcohol-inactivated autograft replantation with articulation preservation from January 2010 to November 2011, including six males and one female, with the median age of 21 years (16 to 23 years). Five neoplasms were located in left distal femur, one in right distal femur, and one in left proximal fibula involving tibia. According to Enneking tumor staging, six patients were identified as stage ⅡB,one as stage Ⅲ. Six patients were diagnosed as osteosarcoma and one as non-Hodgkin' s lymphoma. The postoperative results were evaluated by MSTS limb function score system and ISOLS composite graft evaluation method. Combining the operation process, surgical technique and perioperative key points were explained. Results All seven patients achieved primary healing. With the mean follow-up time of 17 months (8 to 24 months), there was no infection, recurrence, loosening or limb length inequality. The mean ISOLS graft score was 31 (87% ) (range 30 -34). The mean MSTS function score was 25 (84%) (range 22-25 ). Conclusions These results suggest that alcohol-inactivated autograft replantation with articulation preservation could improve the short-term limb function, avoiding complications of prosthesis. With strict indications, good surgical technique and perioperative managements, fine clinical outcome could be achieved. It is relatively economic- applicable for patients and could be an option among surgical treatments. The clinical outcomes in long-term still need to be investigated.%目的 探讨保留关节的酒精灭活骨再植术在膝关节周围恶性骨肿瘤治疗中的应用,并阐述其手术技术要点.方法 2010年1月至2011年5月采用保留关节的瘤段切除酒精灭活再植术治疗

  1. Diverticulitis: selective surgical management. (United States)

    Rugtiv, G M


    The surgical treatment of complications of diverticulitis remains most challenging. A review of twenty years' experience with one hundred fifteen cases is presented with one proved anastomotic leak and no deaths. Interval primary resection with anastomosis for chronic recurrent disease including colovesical fistula and mesocolic abscess was proved sate with low morbidity. The three-stage procedure for perforated diverticulitis with spreading peritonitis or pericolic abscess was associated with a high rate of complications and morbidity. An aggressive approach with resection without anastomosis in two stages is indicated.

  2. Closed hip and long bone fractures The regimen effectiveness of antibiotic prophylaxis in surgical fixation%闭合性髋部骨折或长骨骨折围手术期抗生素预防性应用的疗效分析

    Institute of Scientific and Technical Information of China (English)

    Dan C Norvell; 王簕; 杨云峰


    对22项随机对照研究进行Meta分析,以评价在闭合性髋部骨折或长骨骨折的围手术期中,静脉预防性抗生素应用的疗效.与未应用静脉抗生素组相比,术前静脉应用抗生素(术前单剂量抗生素应用或术前联合术后多次应用)可以明显降低术后深部感染、浅表感染、泌尿道感染的发生率.当应用短效抗生素预防术中感染时,多次剂量应用可以明显降低感染的发生率.但是,当应用长效抗生素预防感染时,单剂量应用组与多剂量应用其他短效抗生素组效果相当.在比较抗生素多剂量给药疗法间或不同给药方式间(口服或静脉给药)对预防感染的疗效时发现,不论采取何种方法 ,预防感染的效果均无明显差异.%A metaanalysis of 22 randomized controlled trials found evidence to support parenteral antibiotic prophylaxis regimens for patients undergoing surgical fixation of closed hip and long bone fractures. Preoperative parenteral antibiotic doses (single or combined with multiple postoperative doses) resulted in decreased risk of deep, superficial, and urinary tract infections compared with no antibiotic. Single doses of short acting agents may be less effective than multiple doses of the same agent in decreasing the risk of any of the infections evaluated. By contrast, there was no significant difference in infection risk between a single dose of a long acting agent and multiple doses of other agents with shorter half lives. No significant differences were found when multiple dose regimens were compared or when administration routes (oral versus parenteral) were compared.

  3. [Aspects of development of surgical service of modem Navy]. (United States)

    Kabanov, M Iu; Gaĭdash, A A; Rukhliada, N V; Solov'ev, I A; Titov, R V; Utochkin, A P; Smirnov, S I; Smolin, N V; Tiurin, M V


    The article is devoted to the aspects of a current state of surgical service in the Navy, prospects of development of professianl training for navy surgeons, formation of modern training comlex, united electronic library, containig the issues about combat surgical trauma, software technologies, realizing of the application methodology during the process of training and practical activity for the development of the training system for surgeons of Navy and improvement of effectiveness. Formation of normative technical documents, regulating activity of navy surgians is also among the expectations. The authors also touched on the issues of development of modern technologies in bone grafting with the help of domestic implants based on the osteoinductive nanostructured nonorganic matrices (titanium) with defined structure and composition. Department of navy and hospital surgery participate in this debelopment. Due to increased amount of oncologic patients, it was decided to establish the Cancer Center of the Ministry of Defense based on department of navy and hospital surgery of the Kirov Military Medical Academy. It makes possible to perform the following procedures: canser surgery; surgical repair; plastic repair of major vessels, bone and soft tissue grafting, removal of residual cancer cells with the help of loco-regional methods of hyperthermic intracavitary and intravascular chemoperfusion; diagnostics and treatment of recurrent tumors (surgical and radiation treatment, systemic chemotherapy, loco-regional chemoembolization. Each of the given methods help to develop and improve the innovation technologies.

  4. A virtual reality interface for pre-planning of surgical operations based on a customized model of the patient (United States)

    Witkowski, Marcin; Lenar, Janusz; Sitnik, Robert; Verdonschot, Nico


    We present a human-computer interface that enables the operator to plan a surgical procedure on the musculoskeletal (MS) model of the patient's lower limbs, send the modified model to the bio-mechanical analysis module, and export the scenario parameters to the surgical navigation system. The interface provides the operator with tools for: importing customized MS model of the patient, cutting bones and manipulating/removal of bony fragments, repositioning muscle insertion points, muscle removal and placing implants. After planning the operator exports the modified MS model for bio-mechanical analysis of the functional outcome. If the simulation result is satisfactory the exported scenario data may be directly used during the actual surgery. The advantages of the developed interface are the possibility of installing it in various hardware configurations and coherent operation regardless of the devices used. The hardware configurations proposed to be used with the interface are: (a) a standard computer keyboard and mouse, and a 2-D display, (b) a touch screen as a single device for both input and output, or (c) a 3-D display and a haptic device for natural manipulation of 3-D objects. The interface may be utilized in two main fields. Experienced surgeons may use it to simulate their intervention plans and prepare input data for a surgical navigation system while student or novice surgeons can use it for simulating results of their hypothetical procedure. The interface has been developed in the TLEMsafe project ( funded by the European Commission FP7 program.

  5. Evaluation of trabecular bone patterns on dental radiographic images: influence of cortical bone (United States)

    Amouriq, Yves; Evenou, Pierre; Arlicot, Aurore; Normand, Nicolas; Layrolle, Pierre; Weiss, Pierre; Guédon, Jean-Pierre


    For some authors trabecular bone is highly visible in intraoral radiographs. For other authors, the observed intrabony trabecular pattern is a representation of only the endosteal surface of cortical bone, not of intermedullary striae. The purpose of this preliminary study was to investigate the true anatomical structures that are visible in routine dental radiographs and classically denoted trabecular bone. This is a major point for bone texture analysis on radiographs. Computed radiography (CR) images of dog mandible section in molar region were compared with simulations calculated from high-resolution micro-CT volumes. Calculated simulations were obtained using the Mojette Transform. By digitally editing the CT volume, the simulations were separated into trabecular and cortical components into a region of interest. Different images were compared and correlated, some bone micro-architecture parameters calculated. A high correlation was found between computed radiographs and calculated simulations from micro-CT. The Mojette transform was successful to obtain high quality images. Cortical bone did not contribute to change in a major way simulated images. These first results imply that intrabony trabecular pattern observed on radiographs can not only be a representation of the cortical bone endosteal surface and that trabecular bone is highly visible in intraoral radiographs.

  6. Lumbopelvic fixation: a surgical alternative for lumbar stability

    Directory of Open Access Journals (Sweden)

    Gabriel Virgilio Ortiz García


    Full Text Available OBJECTIVE: Lumbopelvic fixation is a valid surgical option to achieving great stability in cases where it is particularly demanded, such as in patients with poor quality bone, degenerative scoliosis, and revision surgeries with modern materials and techniques. It enables simple integration of the iliopelvic systems with the rest of the spinal structure, maintaining hemorrhagia at acceptable levels, as well as surgery time. METHODS: We analyzed a case series of 15 patients of our center, who required major construction and/or presented poor quality bone. RESULTS: A total of 15 patients was studied, of which 12 (80% were women and three (20%, men. Nine (60% of these were revision surgeries, maintaining a surgery time of 5 hours (±1 h, with average blood loss of 1380 ml (±178 ml. All the patients received six to eight transpedicular screws, including iliac screws, and in all cases, a bone graft was inserted. CONCLUSION: Lumbopelvic fixation in patients with characteristics associated with osteopenia and osteoporosis, and in major instrumentations, particularly revision surgeries, three-dimensional correction is achieved, constructing a strong, stable pelvic base that is very useful, in patients with fragile surgical anatomy, for changes of implant or extensive decompression, provided the arthrodesis technique is adequate and with the insertion of a sufficient bone graft, and obviously, taking care to maintain the sagittal balance.

  7. [A rapid prototype fabrication method of dental splint based on 3D simulation and technology]. (United States)

    Lin, Yanping; Chen, Xiaojun; Zhang, Shilei; Wang, Chengtao


    The conventional design and fabrication of the dental splint (in orthognathic surgery) is based on the preoperative planning and model surgery so this process is of low precision and efficiency. In order to solve the problems and be up to the trend of computer-assisted surgery, we have developed a novel method to design and fabricate the dental splint--computer-generated dental splint, which is based on three-dimensional model simulation and rapid prototype technology. After the surgical planning and simulation of 3D model, we can modify the model to be superior in chewing action (functional) and overall facial appearance (aesthetic). Then, through the Boolean operation of the dental splint blank and the maxillofacial bone model the model of dental splint is formed. At last, the dental splint model is fabricated through rapid prototype machine and applied in clinic. The result indicates that, with the use of this method, the surgical precision and efficiency are improved.


    Directory of Open Access Journals (Sweden)



    Full Text Available INTRODUCTION Sarcomas are quite rare with only 15,000 new cases per year in the United States. Sarcomas therefore represent about one percent of the 1.5 million new cancer diagnoses in that country each year. Sarcoma can be defined as cancer whose cells originate from the cells of mesenchymal origin. The bones, cartilages, muscles are a few examples to be mentioned. This is in contrast to a malignant tumour originating from epithelial cells, which are termed carcinoma. AIMS AND OBJECTIVES 1. To clinically analyze the sarcomas. 2. To analyze the surgical outcome of this disease. The survival of the patient depends on the extent of metastasis and the primary identification. The study forms a base for further studies. So atleast it could be diagnosed earlier and treated to the full extent.

  9. Connecting mechanics and bone cell activities in the bone remodeling process: an integrated finite element modeling. (United States)

    Hambli, Ridha


    Bone adaptation occurs as a response to external loadings and involves bone resorption by osteoclasts followed by the formation of new bone by osteoblasts. It is directly triggered by the transduction phase by osteocytes embedded within the bone matrix. The bone remodeling process is governed by the interactions between osteoblasts and osteoclasts through the expression of several autocrine and paracrine factors that control bone cell populations and their relative rate of differentiation and proliferation. A review of the literature shows that despite the progress in bone remodeling simulation using the finite element (FE) method, there is still a lack of predictive models that explicitly consider the interaction between osteoblasts and osteoclasts combined with the mechanical response of bone. The current study attempts to develop an FE model to describe the bone remodeling process, taking into consideration the activities of osteoclasts and osteoblasts. The mechanical behavior of bone is described by taking into account the bone material fatigue damage accumulation and mineralization. A coupled strain-damage stimulus function is proposed, which controls the level of autocrine and paracrine factors. The cellular behavior is based on Komarova et al.'s (2003) dynamic law, which describes the autocrine and paracrine interactions between osteoblasts and osteoclasts and computes cell population dynamics and changes in bone mass at a discrete site of bone remodeling. Therefore, when an external mechanical stress is applied, bone formation and resorption is governed by cells dynamic rather than adaptive elasticity approaches. The proposed FE model has been implemented in the FE code Abaqus (UMAT routine). An example of human proximal femur is investigated using the model developed. The model was able to predict final human proximal femur adaptation similar to the patterns observed in a human proximal femur. The results obtained reveal complex spatio-temporal bone

  10. Dating of cremated bones

    NARCIS (Netherlands)

    Lanting, JN; Aerts-Bijma, AT; van der Plicht, J; Boaretto, E.; Carmi, I.


    When dating unburnt bone, bone collagen, the organic fraction of the bone, is used. Collagen does not survive the heat of the cremation pyre, so dating of cremated bone has been considered impossible. Structural carbonate in the mineral fraction of the bone, however, survives the cremation process.

  11. Surgical treatment of extensive complex odontoma in the mandible by corticotomy. A case report. (United States)

    Nogueira, A S; Gonçales, E S; Gonçales, A G B; Thiegui-Neto, V; Nogueira, C B P; Nogueira, A; Medeiros, R


    Odontomas represent the most prevalent odontogenic tumors in the jaw. The treatment of choice is surgical removal, usually performed by conventional techniques involving ostectomies to expose the tumor. In this paper, the authors describe, through the report of a case of complex odontoma located in the mandibular angle, a more conservative surgical technique called corticotomy, in which the bone removed for access to the tumor (buccal cortical) is repositioned and fixed by titanium plates of 1.5 mm.

  12. Multiple verification in computational modeling of bone pathologies

    CERN Document Server

    Liò, Pietro; Paoletti, Nicola; 10.4204/EPTCS.67.8


    We introduce a model checking approach to diagnose the emerging of bone pathologies. The implementation of a new model of bone remodeling in PRISM has led to an interesting characterization of osteoporosis as a defective bone remodeling dynamics with respect to other bone pathologies. Our approach allows to derive three types of model checking-based diagnostic estimators. The first diagnostic measure focuses on the level of bone mineral density, which is currently used in medical practice. In addition, we have introduced a novel diagnostic estimator which uses the full patient clinical record, here simulated using the modeling framework. This estimator detects rapid (months) negative changes in bone mineral density. Independently of the actual bone mineral density, when the decrease occurs rapidly it is important to alarm the patient and monitor him/her more closely to detect insurgence of other bone co-morbidities. A third estimator takes into account the variance of the bone density, which could address the...

  13. Surgical scar revision: An overview

    Directory of Open Access Journals (Sweden)

    Shilpa Garg


    Full Text Available Scar formation is an inevitable consequence of wound healing from either a traumatic or a surgical intervention. The aesthetic appearance of a scar is the most important criteria to judge the surgical outcome. An understanding of the anatomy and wound healing along with experience, meticulous planning and technique can reduce complications and improve the surgical outcome. Scar revision does not erase a scar but helps to make it less noticeable and more acceptable. Both surgical and non-surgical techniques, used either alone or in combination can be used for revising a scar. In planning a scar revision surgeon should decide on when to act and the type of technique to use for scar revision to get an aesthetically pleasing outcome. This review article provides overview of methods applied for facial scar revision. This predominantly covers surgical methods.

  14. Optimizing esthetics for implant restorations in the anterior maxilla: anatomic and surgical considerations. (United States)

    Buser, Daniel; Martin, William; Belser, Urs C


    The placement of dental implants in the anterior maxilla is a challenge for clinicians because of patients' exacting esthetic demands and difficult pre-existing anatomy. This article presents anatomic and surgical considerations for these demanding indications for implant therapy. First, potential causes of esthetic implant failures are reviewed, discussing anatomic factors such as horizontal or vertical bone deficiencies and iatrogenic factors such as improper implant selection or the malpositioning of dental implants for an esthetic implant restoration. Furthermore, aspects of preoperative analysis are described in various clinical situations, followed by recommendations for the surgical procedures in single-tooth gaps and in extended edentulous spaces with multiple missing teeth. An ideal implant position in all 3 dimensions is required. These mesiodistal, apicocoronal, and orofacial dimensions are well described, defining "comfort" and "danger" zones for proper implant position in the anterior maxilla. During surgery, the emphasis is on proper implant selection to avoid oversized implants, careful and low-trauma soft tissue handling, and implant placement in a proper position using either a periodontal probe or a prefabricated surgical guide. If missing, the facial bone wall is augmented using a proper surgical technique, such as guided bone regeneration with barrier membranes and appropriate bone grafts and/or bone substitutes. Finally, precise wound closure using a submerged or a semi-submerged healing modality is recommended. Following a healing period of between 6 and 12 weeks, a reopening procedure is recommended with a punch technique to initiate the restorative phase of therapy.

  15. Bone repair: Effects of physical exercise and LPS systemic exposition. (United States)

    Nogueira, Jonatas E; Branco, Luiz G S; Issa, João Paulo M


    Bone repair can be facilitated by grafting, biochemical and physical stimulation. Conversely, it may be delayed lipopolysaccharide (LPS). Physical exercise exerts beneficial effects on the bone, but its effect on bone repair is not known. We investigated the effect of exercise on the LPS action on bone healing through bone densitometry, quantitative histological analysis for bone formation rate and immunohistochemical markers in sedentary and exercised animals. Rats ran on the treadmill for four weeks. After training the rats were submitted to a surgical procedure (bone defect in the right tibia) and 24h after the surgery LPS was administered at a dose of 100μg/kg i.p., whereas the control rats received a saline injection (1ml/kg, i.p.). Right tibias were obtained for analysis after 10days during which rats were not submitted to physical training. Physical exercise had a positive effect on bone repair, increasing bone mineral density, bone mineral content, bone formation rate, type I collagen and osteocalcin expression. These parameters were not affected by systemic administration of LPS. Our data indicate that physical exercise has an important osteogenic effect, which is maintained during acute systemic inflammation induced by exposure to a single dose of LPS.

  16. Role of cranial and spinal virtual and augmented reality simulation using immersive touch modules in neurosurgical training. (United States)

    Alaraj, Ali; Charbel, Fady T; Birk, Daniel; Tobin, Matthew; Tobin, Mathew; Luciano, Cristian; Banerjee, Pat P; Rizzi, Silvio; Sorenson, Jeff; Foley, Kevin; Slavin, Konstantin; Roitberg, Ben


    Recent studies have shown that mental script-based rehearsal and simulation-based training improve the transfer of surgical skills in various medical disciplines. Despite significant advances in technology and intraoperative techniques over the last several decades, surgical skills training on neurosurgical operations still carries significant risk of serious morbidity or mortality. Potentially avoidable technical errors are well recognized as contributing to poor surgical outcome. Surgical education is undergoing overwhelming change, as a result of the reduction of work hours and current trends focusing on patient safety and linking reimbursement with clinical outcomes. Thus, there is a need for adjunctive means for neurosurgical training, which is a recent advancement in simulation technology. ImmersiveTouch is an augmented reality system that integrates a haptic device and a high-resolution stereoscopic display. This simulation platform uses multiple sensory modalities, re-creating many of the environmental cues experienced during an actual procedure. Modules available include ventriculostomy, bone drilling, percutaneous trigeminal rhizotomy, and simulated spinal modules such as pedicle screw placement, vertebroplasty, and lumbar puncture. We present our experience with the development of such augmented reality neurosurgical modules and the feedback from neurosurgical residents.

  17. Neuronavigation. Principles. Surgical technique. (United States)

    Ivanov, Marcel; Ciurea, Alexandru Vlad


    Neuronavigation and stereotaxy are techniques designed to help neurosurgeons precisely localize different intracerebral pathological processes by using a set of preoperative images (CT, MRI, fMRI, PET, SPECT etc.). The development of computer assisted surgery was possible only after a significant technological progress, especially in the area of informatics and imagistics. The main indications of neuronavigation are represented by the targeting of small and deep intracerebral lesions and choosing the best way to treat them, in order to preserve the neurological function. Stereotaxis also allows lesioning or stimulation of basal ganglia for the treatment of movement disorders. These techniques can bring an important amount of confort both to the patient and to the neurosurgeon. Neuronavigation was introduced in Romania around 2003, in four neurosurgical centers. We present our five-years experience in neuronavigation and describe the main principles and surgical techniques.

  18. Smoking and Bone Health (United States)

    ... supported by your browser. Home Bone Basics Lifestyle Smoking and Bone Health Publication available in: PDF (85 ... late to adopt new habits for healthy bones. Smoking and Osteoporosis Cigarette smoking was first identified as ...

  19. Pure waterjet drilling of articular bone


    Biskup, Christian; Dunnen, Steven den; Kraaij, Gert; Kerkhoffs, Gino M. M. J.; Tuijthof, Gabrielle J. M.


    The clinical application of waterjet technology for machining tough human tissues, such as articular bone, has advantages, as it produces clean sharp cuts without tissue heating. Additionally, water supply is possible via flexible tubing, which enables minimally invasive surgical access. This pilot study investigates whether drilling bony tissue with pure waterjets is feasible. Water pressures between 20 and 120 MPa with an orifice of 0.6 mm were used to create waterjets to drill blind boring...

  20. Diaphyseal chondroblastoma in a long bone: first report

    Energy Technology Data Exchange (ETDEWEB)

    Azorin, D.; Gonzalez-Mediero, I.; Colmenero, I.; Prada, I. de [Hospital Infantil Universitario Nino Jesus, Service of Anatomic Pathology, Madrid (Spain); Lopez-Barea, F. [Hospital Universitario La Paz, Department of Anatomic Pathology, Madrid (Spain)


    Chondroblastoma is a rare benign bone tumor typically located in the epiphysis. We describe the first case of chondroblastoma arising in the diaphysis of a long bone. The patient was a 13-year-old girl who presented with pain over her right thigh. Radiographs showed a lytic lesion in the diaphysis of her right femur. A core biopsy and a subsequent surgical resection were performed. (orig.)

  1. Human Bone Matrix Changes During Deep Saturation Dives (United States)


    agreement notwithstanding, much remains unknown about its pathogenesis, prevention, and treatment . DON is currently disqualifying for U.S. Navy divers...recourse for symptomatic treatment is surgical joint replacement.7 The principal mechanism of bone injury is generally accepted to be bubble formation...urine concentrations of Ntx have been demonstrated in bone diseases such as osteoporosis, primary hyperthyroidism , and Paget’s disease. Also

  2. Brodie's abscess of the cuboid bone: a case report. (United States)

    Bagatur, A Erdem; Zorer, Gazi


    The case of a patient with Brodie's abscess of the cuboid bone and who presented with a painful and swollen right foot is described. The patient was treated successfully by surgical evacuation of the abscess and with antibiotics. To the authors' knowledge, Brodie's abscess of the cuboid bone has not been reported previously. The clinical presentation and diagnostic difficulties which may be encountered are discussed.

  3. Biology and augmentation of tendon-bone insertion repair

    Directory of Open Access Journals (Sweden)

    Lui PPY


    Full Text Available Abstract Surgical reattachment of tendon and bone such as in rotator cuff repair, patellar-patella tendon repair and anterior cruciate ligament (ACL reconstruction often fails due to the failure of regeneration of the specialized tissue ("enthesis" which connects tendon to bone. Tendon-to-bone healing taking place between inhomogenous tissues is a slow process compared to healing within homogenous tissue, such as tendon to tendon or bone to bone healing. Therefore special attention must be paid to augment tendon to bone insertion (TBI healing. Apart from surgical fixation, biological and biophysical interventions have been studied aiming at regeneration of TBI healing complex, especially the regeneration of interpositioned fibrocartilage and new bone at the healing junction. This paper described the biology and the factors influencing TBI healing using patella-patellar tendon (PPT healing and tendon graft to bone tunnel healing in ACL reconstruction as examples. Recent development in the improvement of TBI healing and directions for future studies were also reviewed and discussed.

  4. An intramembranous ossification model for the in silico analysis of bone tissue formation in tooth extraction sites. (United States)

    Corredor-Gómez, Jennifer Paola; Rueda-Ramírez, Andrés Mauricio; Gamboa-Márquez, Miguel Alejandro; Torres-Rodríguez, Carolina; Cortés-Rodríguez, Carlos Julio


    The accurate modeling of biological processes allows us to predict the spatiotemporal behavior of living tissues by computer-aided (in silico) testing, a useful tool for the development of medical strategies, avoiding the expenses and potential ethical implications of in vivo experimentation. A model for bone healing in mouth would be useful for selecting proper surgical techniques in dental procedures. In this paper, the formulation and implementation of a model for Intramembranous Ossification is presented aiming to describe the complex process of bone tissue formation in tooth extraction sites. The model consists in a mathematical description of the mechanisms in which different types of cells interact, synthesize and degrade extracellular matrices under the influence of biochemical factors. Special attention is given to angiogenesis, oxygen-dependent effects and growth factor-induced apoptosis of fibroblasts. Furthermore, considering the depth-dependent vascularization of mandibular bone and its influence on bone healing, a functional description of the cell distribution on the severed periodontal ligament (PDL) is proposed. The developed model was implemented using the finite element method (FEM) and successfully validated by simulating an animal in vivo experiment on dogs reported in the literature. A good fit between model outcome and experimental data was obtained with a mean absolute error of 3.04%. The mathematical framework presented here may represent an important tool for the design of future in vitro and in vivo tests, as well as a precedent for future in silico studies on osseointegration and mechanobiology.

  5. Histological evaluation of the influence of magnetic field application in autogenous bone grafts in rats

    Directory of Open Access Journals (Sweden)

    Ponzoni Deise


    Full Text Available Abstract Background Bone grafts are widely used in oral and maxillofacial reconstruction. The influence of electromagnetic fields and magnets on the endogenous stimulation of target tissues has been investigated. This work aimed to assess the quality of bone healing in surgical cavities filled with autogenous bone grafts, under the influence of a permanent magnetic field produced by in vivo buried devices. Methods Metal devices consisting of commercially pure martensitic stainless steel washers and titanium screws were employed. Thirty male Wistar rats were divided into 3 experimental and 3 control groups. A surgical bone cavity was produced on the right femur, and a bone graft was collected and placed in each hole. Two metallic washers, magnetized in the experimental group but not in the control group, were attached on the borders of the cavity. Results The animals were sacrificed on postoperative days 15, 45 and 60. The histological analysis of control and experimental samples showed adequate integration of the bone grafts, with intense bone neoformation. On days 45 and 60, a continued influence of the magnetic field on the surgical cavity and on the bone graft was observed in samples from the experimental group. Conclusion The results showed intense bone neoformation in the experimental group as compared to control animals. The intense extra-cortical bone neoformation observed suggests that the osteoconductor condition of the graft may be more susceptible to stimulation, when submitted to a magnetic field.

  6. Surgical treatment of acquired tracheocele. (United States)

    Porubsky, Edward A; Gourin, Christine G


    Acquired tracheoceles are rare clinical entities that can cause a variety of chronic and recurrent aerodigestive tract symptoms. The management of acquired tracheoceles is primarily conservative, but surgical intervention may be indicated for patients with refractory symptoms. We present a case of acquired tracheocele and describe a method of successful surgical management.

  7. Surgical innovations in canine gonadectomy

    NARCIS (Netherlands)

    Van Goethem, Bart


    In this thesis some recent technological developments in human surgery are evaluated for their potential use in veterinary medicine by introducing them as surgical innovations for canine gonadectomy. Barbed sutures achieve wound apposition without surgical knot tying and thus avoid knot-associated n

  8. Acquiring minimally invasive surgical skills

    NARCIS (Netherlands)

    Hiemstra, Ellen


    Many topics in surgical skills education have been implemented without a solid scientific basis. For that reason we have tried to find this scientific basis. We have focused on training and evaluation of minimally invasive surgical skills in a training setting and in practice in the operating room.

  9. Bone wax as a cause of a foreign body granuloma in a cranial defect: a case report. (United States)

    Wolvius, E B; van der Wal, K G H


    Bone wax was used to stop bleeding of the diploic vessels after harvesting cranial bone for reconstruction of an orbital floor defect. After five months a fistula in the overlying skin of the donor site appeared and was eventually surgically explored. Remnants of bone wax and surrounding inflammatory tissue were removed and the fistula was excised. Histological examination revealed a foreign body granuloma. The use of bone wax and possible alternative local haemostatic agents and their complications are discussed.

  10. Bone development

    DEFF Research Database (Denmark)

    Tatara, M.R.; Tygesen, Malin Plumhoff; Sawa-Wojtanowicz, B.


    The objective of this study was to determine the long-term effect of alpha-ketoglutarate (AKG) administration during early neonatal life on skeletal development and function, with emphasis on bone exposed to regular stress and used to serve for systemic changes monitoring, the rib. Shropshire ram...... lambs were randomly assigned to two weight-matched groups at birth. During the first 14 days of life AKG was administered orally to the experimental group (n=12) at the dosage of 0.1 g/kg body weight per day, while the control group (n=11) received an equal dose of the vehicle. Lambs were slaughtered...... has a long-term effect on skeletal development when given early in neonatal life, and that changes in rib properties serve to improve chest mechanics and functioning in young animals. Moreover, neonatal administration of AKG may be considered as an effective factor enhancing proper development...

  11. Exercise Countermeasures for Bone Loss During Space Flight: A Method for the Study of Ground Reaction Forces and their Implications for Bone Strain (United States)

    Peterman, M.; McCrory, J. L.; Sharkey, N. A.; Piazza, S.; Cavanagh, P. R.


    Effective countermeasures to prevent loss of bone mineral during long duration space flight remain elusive. Despite an exercise program on MIR flights, the data from LeBlanc et al. (1996) indicated that there was still a mean rate of loss of bone mineral density in the proximal femur of 1.58% per month (n=18, flight duration 4 - 14.4 months). The specific mechanisms regulating bone mass are not known, but most investigators agree that bone maintenance is largely dependent upon mechanical demand and the resultant local bone strains. A plausible hypothesis is that bone loss during space flight, such as that reported by LeBlanc et al. (1996), may result from failure to effectively load the skeleton in order to generate localized bone strains of sufficient magnitude to prevent disuse osteoporosis. A variety of methods have been proposed to simulate locomotor exercise in reduced gravity. In such simulations, and in an actual microgravity environment, a gravity replacement load (GRL) must always be added to return the exercising subject to the support surface and the resulting skeletal load is critically dependent upon the magnitude of the GRL. To our knowledge, GRLs during orbital flight have only been measured once (on STS 81) and it is likely that most or all prior treadmill exercise in space has used GRLs that were less than one body weight. McCrory (1997) has shown that subjects walking and running in simulated zero-G can tolerate GRLs of 1 if an appropriate harness is used. Several investigators have attempted to measure in vivo strains and forces in the bones of humans, but have faced ethical and technical limitations. The anteromedial aspect of the tibial midshaft has been a common site for the placement of strain gauges; one reason to measure strains in the anterior tibia is that this region is surgically accessible. Aamodt et al. (1997) were able to measure strains on the lateral surface of the proximal femur only because their experimental subjects were

  12. An adaptation model for trabecular bone at different mechanical levels

    Directory of Open Access Journals (Sweden)

    Lv Linwei


    Full Text Available Abstract Background Bone has the ability to adapt to mechanical usage or other biophysical stimuli in terms of its mass and architecture, indicating that a certain mechanism exists for monitoring mechanical usage and controlling the bone's adaptation behaviors. There are four zones describing different bone adaptation behaviors: the disuse, adaptation, overload, and pathologic overload zones. In different zones, the changes of bone mass, as calculated by the difference between the amount of bone formed and what is resorbed, should be different. Methods An adaptation model for the trabecular bone at different mechanical levels was presented in this study based on a number of experimental observations and numerical algorithms in the literature. In the proposed model, the amount of bone formation and the probability of bone remodeling activation were proposed in accordance with the mechanical levels. Seven numerical simulation cases under different mechanical conditions were analyzed as examples by incorporating the adaptation model presented in this paper with the finite element method. Results The proposed bone adaptation model describes the well-known bone adaptation behaviors in different zones. The bone mass and architecture of the bone tissue within the adaptation zone almost remained unchanged. Although the probability of osteoclastic activation is enhanced in the overload zone, the potential of osteoblasts to form bones compensate for the osteoclastic resorption, eventually strengthening the bones. In the disuse zone, the disuse-mode remodeling removes bone tissue in disuse zone. Conclusions The study seeks to provide better understanding of the relationships between bone morphology and the mechanical, as well as biological environments. Furthermore, this paper provides a computational model and methodology for the numerical simulation of changes of bone structural morphology that are caused by changes of mechanical and biological

  13. 蒙特卡罗方法计算外照射所致红骨髓剂量方法的研究%Monte Carlo simulation methods of determining red bone marrow dose from external radiation

    Institute of Scientific and Technical Information of China (English)

    高佚名; 刘海宽; 顾乃谷; 吴锦海; 黄卫琴; 王凤仙; 王力; 苏旭


    Objective To provide evidence for a more reasonable method of determining red bone marrow dose by analyzing and comparing existing simulation methods.Methods By utilizing Monte Carlo simulation software MCNPX,the absorbed doses of red hone marrow of Rensselaer Polytechnic Institute (RPI)adult female voxel phantom were calculated throush 4 different methods:direct energy deposition.dose response function(DRF),King-Spiers factor method and mass-energy absorption coefficient (MEAC).The radiation sources were defined as infinite plate.sources with the energy ranging from 20 keV to 10 MeV.and 23 sources with different energies were simulated in total.The source was placed right next to the front of the RPI model to achieve a homogeneous anteroposterior radiation scenario.The results of different simulated photon energy sources through different methods were compared.Results When the photon energy was lower than 100 key,the direct energy deposition method gave the highest result while the MEAC and King-Spiers factor methods showed more reasonable results.When the photon energy was higher than 150 keV taking into account of the higher absorption ability of red bone marrow at highcr photon energy,the result of the King-Spiers factor method was larger than those of other methods.Conclusions The King-Spiers factor method might be the most reasonable method to estimate the red bone marrow dose from external radiation.%目的 对现有的红骨髓剂量模拟计算方法进行比较和分析.为确定更为合理的计算方法提供依据.方法 借助MCNPX蒙特卡罗模拟软件,模拟了能量20 keV~10 MeV的γ光子源,对Rensselaer理工学院(RPI)体素人体模型进行前后(AP)全身均匀照射,分别采用直接能量沉积法、剂量响应函数法(DRF)、King-Spiers因子法和质能吸收系数法(MEAC),进行红骨髓剂量的模拟计算.结果 在入射γ光子能量低于100 keV时,直接能量沉积法的结果最大,而质能吸收系数法和King

  14. A review of surgical repair methods and patient outcomes for gluteal tendon tears. (United States)

    Ebert, Jay R; Bucher, Thomas A; Ball, Simon V; Janes, Gregory C


    Advanced hip imaging and surgical findings have demonstrated that a common cause of greater trochanteric pain syndrome (GTPS) is gluteal tendon tears. Conservative measures are initially employed to treat GTPS and manage gluteal tears, though patients frequently undergo multiple courses of non-operative treatment with only temporary pain relief. Therefore, a number of surgical treatment options for recalcitrant GTPS associated with gluteal tears have been reported. These have included open trans-osseous or bone anchored suture techniques, endoscopic methods and the use of tendon augmentation for repair reinforcement. This review describes the anatomy, pathophysiology and clinical presentation of gluteal tendon tears. Surgical techniques and patient reported outcomes are presented. This review demonstrates that surgical repair can result in improved patient outcomes, irrespective of tear aetiology, and suggests that the patient with "trochanteric bursitis" should be carefully assessed as newer surgical techniques show promise for a condition that historically has been managed conservatively.

  15. Silver Nanoparticles in Alveolar Bone Surgery Devices

    Directory of Open Access Journals (Sweden)

    Stefano Sivolella


    Full Text Available Silver (Ag ions have well-known antimicrobial properties and have been applied as nanostrategies in many medical and surgical fields, including dentistry. The use of silver nanoparticles (Ag NPs may be an option for reducing bacterial adhesion to dental implant surfaces and preventing biofilm formation, containing the risk of peri-implant infections. Modifying the structure or surface of bone grafts and membranes with Ag NPs may also prevent the risk of contamination and infection that are common when alveolar bone augmentation techniques are used. On the other hand, Ag NPs have revealed some toxic effects on cells in vitro and in vivo in animal studies. In this setting, the aim of the present paper is to summarize the principle behind Ag NP-based devices and their clinical applications in alveolar bone and dental implant surgery.

  16. Impact of Orthodontic Decompensation on Bone Insertion

    Directory of Open Access Journals (Sweden)

    Fabio Pinto Guedes


    Full Text Available There has always been concern in determining the relationship between orthodontic tooth movement and the consequent biological costs to the periodontium and tooth root. The possibility of evaluating the tooth and bone morphology by CBCT allows more accurate analysis of qualitative and quantitative aspects of these processes. This paper presents a case report of a 20-year-old male patient with Class III malocclusion and hyperdivergent facial pattern, who was surgically treated. A significant amount of labial movement of mandibular incisors was performed during orthodontic treatment before surgery. CBCT was used for evaluation of buccal and lingual bone plates before and after tooth decompensation. The changes in the bone insertion level of maxillary and mandibular incisors in the present case encourage a reflection on the treatment protocol in individuals with dentoskeletal discrepancies.

  17. Surgical infection in art. (United States)

    Meakins, J L


    The earliest images of medicine and surgery in Western art are from the late Middle Ages. Although often attractive, at that time they were illustrative and mirrored the text on how to diagnose or treat a specific condition. These drawings in medieval manuscripts represent management of abscesses, perianal infection and fistulas, amputation, and wound dressings. With the Renaissance, art in all its forms flourished, and surgeons were represented at work draining carbuncles, infected bursae, and mastoiditis; managing ulcers, scrofula, and skin infections; and performing amputations. Specific diagnosis can be made, such as streptococcal infection in the discarded leg of the miraculous transplantation performed by Saints Cosmas and Damian and in the works of Rembrandt van Rijn and Frederic Bazille. Evocations of cytokine activity are evident in works by Albrecht Dürer, Edvard Munch, and James Tissot. The iconography of society's view of a surgeon is apparent and often not complimentary. The surgeon's art is a visual art. Astute observation leads to early diagnosis and better results in surgical infection and the septic state. Learning to see what we look at enhances our appreciation of the world around us but, quite specifically, makes us better clinicians.


    Directory of Open Access Journals (Sweden)

    Тимур Фаизович Зубаиров


    Full Text Available The purpose. To examine the results of the treatment of children with aneurysmal cyst of the clavicle. Material and methods. The results of examination and treatment of patients aged 16 and 17 years with a diagnosis of aneurysmal cyst of the clavicle. All patients underwent surgical treatment with the ABC stage delimitation. We used a surgical technique, which consists in open removement of the abnormal tissue with replacement of the bone defect with bone-plastic material or autogenous bone from the iliac crest. Conclusions. The method of treatment of aneurysmal bone cyst of the clavicle must be individualized depending on the location, aggressiveness and extent of the lesion. The use bone-plastic material or autogenous bone from the iliac crest restore the structural integrity of a compromised clavicle gives good results in the observation period of up to 2 years.

  19. 模拟体液中生物大分子对类骨磷灰石矿化的影响%Effect of Biomolecules on the Formation of Bone-Like Apatite in Simulated Body Fluid

    Institute of Scientific and Technical Information of China (English)

    邓迟; 王秀红; 卢晓英; 鲍益富; 袁宇; 翁杰


    To explore the effect of biomolecules on the mineralization of hydroxyapatite surface , the macro-molecule of bovine serum albumin ( BSA) and chondroitin sulfate ( CS) were respectively plunged in simulation body fluid ( SBF) to form the mineralizing mediums. Then the films of hydroxyappatite ( HA) were immersed in SBF double concentrated ( 2SBF) modified with BSA and CS for 3 days and we observed the mineralization of bone-like apatite in SBF. The results showed that Na + and CO32- substituted bone-like apatite ( Ca3.78 Na0.02 ) ( Cas.22 Na0. 48 ) ( PO4 ) 4.5 ( CO3 )1.5 ( OH ) were formed on the surface of HA film after soaked in modified 2SBF. The presence of BSA in 2SBF solution promoted the growth of bone-like apatite crystal,which tended to prefer orientation of crystals along (300) plane. However, CS strongly restrained the growth of HA crystal. When BSA and CS were mixed and co-existed in 2SBF solution , BSA advanced mineral crystal growth , while CS inhibited the growth.%为考察体内生物大分子对羟基磷灰石(hydroxyapatite,HA)基底表面矿化物形成的影响,将牛血清白蛋白(bovine serum albumin,BSA)和硫酸软骨素(chondroitin sulfate,CS)大分子分别浸入模拟体液(SBF)中制备成2种矿化介质,再将HA浸入上述矿化介质中3d观察类骨磷灰石形成过程.结果 发现HA基底表面均沉积有Na+和CO2-3取代的类骨磷灰石(Ca3.78Na0.02)(Ca5.22Na0.48)(CO3)1.5(OH).BSA在2SBF中的存在促进了类骨磷灰石晶体在基材表面沉积,有利于其沿(300)晶面择优取向生长.CS对类骨磷灰石晶体的生长呈阻碍作用,获得的晶粒尺寸较小.模拟体液中BSA和CS大分子对类骨磷灰石晶体生长和形貌等均有一定的作用.

  20. In vitro experiment of the modular orthopedic plate based on Nitinol, used for human radius bone fractures. (United States)

    Tarniţă, Daniela; Tarniţă, D N; Hacman, L; Copiluş, C; Berceanu, C


    Shape memory alloys (SMAs) and in particular Ni-Ti alloys are commonly used in bioengineering applications as they join important qualities as resistance to corrosion, biocompatibility, fatigue resistance, MR compatibility, kink resistance with two unique thermo-mechanical behaviors: the shape memory effect and the pseudoelastic effect. They allow Ni-Ti devices to undergo large mechanically induced deformations and then to recover the original shape by thermal loading or simply by mechanical unloading. Diaphyseal fractures of the radius and ulna present specific problems not encountered in the treatment of fractures of the shafts of other long bones. The adaptive modular implants based on smart materials represent a superior solution in the osteosynthesis of the fractured bones over the conventional implants known so far. To realize the model of the implant module we used SolidWorks software. The small sizes of the modules enable the surgeon to make small incisions, using surgical techniques minimally invasive, having the following advantages: reduction of soft tissues destruction; eliminating intra-operator infections; reduction of blood losses; the reduction of infection risk; the reduction of the healing time. Numerical simulations of the virtual modular implant are realized using Visual Nastran software. The stress diagrams, the displacements diagram and the strain diagram are obtained. An in vitro experiment is made, simulating the osteosynthesis of a transverse diaphyseal fracture of human radius bone. The kinematical parameters diagrams of the staple are obtained, using SIMI Motion video capture system. The experimental diagram force-displacement is obtained.

  1. An investigation of the neutron flux in bone-fluorine phantoms comparing accelerator based in vivo neutron activation analysis and FLUKA simulation data

    Energy Technology Data Exchange (ETDEWEB)

    Mostafaei, F.; McNeill, F.E.; Chettle, D.R.; Matysiak, W.; Bhatia, C.; Prestwich, W.V.


    We have tested the Monte Carlo code FLUKA for its ability to assist in the development of a better system for the in vivo measurement of fluorine. We used it to create a neutron flux map of the inside of the in vivo neutron activation analysis irradiation cavity at the McMaster Accelerator Laboratory. The cavity is used in a system that has been developed for assessment of fluorine levels in the human hand. This study was undertaken to (i) assess the FLUKA code, (ii) find the optimal hand position inside the cavity and assess the effects on precision of a hand being in a non-optimal position and (iii) to determine the best location for our γ-ray detection system within the accelerator beam hall. Simulation estimates were performed using FLUKA. Experimental measurements of the neutron flux were performed using Mn wires. The activation of the wires was measured inside (1) an empty bottle, (2) a bottle containing water, (3) a bottle covered with cadmium and (4) a dry powder-based fluorine phantom. FLUKA was used to simulate the irradiation cavity, and used to estimate the neutron flux in different positions both inside, and external to, the cavity. The experimental results were found to be consistent with the Monte Carlo simulated neutron flux. Both experiment and simulation showed that there is an optimal position in the cavity, but that the effect on the thermal flux of a hand being in a non-optimal position is less than 20%, which will result in a less than 10% effect on the measurement precision. FLUKA appears to be a code that can be useful for modeling of this type of experimental system.

  2. Bone grafting: An overview

    Directory of Open Access Journals (Sweden)

    D. O. Joshi


    Full Text Available Bone grafting is the process by which bone is transferred from a source (donor to site (recipient. Due to trauma from accidents by speedy vehicles, falling down from height or gunshot injury particularly in human being, acquired or developmental diseases like rickets, congenital defects like abnormal bone development, wearing out because of age and overuse; lead to bone loss and to replace the loss we need the bone grafting. Osteogenesis, osteoinduction, osteoconduction, mechanical supports are the four basic mechanisms of bone graft. Bone graft can be harvested from the iliac crest, proximal tibia, proximal humerus, proximal femur, ribs and sternum. An ideal bone graft material is biologically inert, source of osteogenic, act as a mechanical support, readily available, easily adaptable in terms of size, shape, length and replaced by the host bone. Except blood, bone is grafted with greater frequency. Bone graft indicated for variety of orthopedic abnormalities, comminuted fractures, delayed unions, non-unions, arthrodesis and osteomyelitis. Bone graft can be harvested from the iliac crest, proximal tibia, proximal humerus, proximal femur, ribs and sternum. By adopting different procedure of graft preservation its antigenicity can be minimized. The concept of bone banking for obtaining bone grafts and implants is very useful for clinical application. Absolute stability require for successful incorporation. Ideal bone graft must possess osteogenic, osteoinductive and osteocon-ductive properties. Cancellous bone graft is superior to cortical bone graft. Usually autologous cancellous bone graft are used as fresh grafts where as allografts are employed as an alloimplant. None of the available type of bone grafts possesses all these properties therefore, a single type of graft cannot be recomm-ended for all types of orthopedic abnormalities. Bone grafts and implants can be selected as per clinical problems, the equipments available and preference of

  3. Bone mass and bone quality are altered by hypoactivity in the chicken.

    Directory of Open Access Journals (Sweden)

    Eric Aguado

    Full Text Available Disuse induces a rapid bone loss in adults; sedentarity is now recognized as a risk factor for osteoporosis. Hypoactivity or confinement also decrease bone mass in adults but their effects are largely unknown and only few animal models have been described. We have used 10 chickens of the rapidly growing strain 857K bred in a large enclosure (FREE group; 10 others were confined in small cages with little space to move around (HYPO group. They were sacrificed at 53 days and femurs and tibias were evaluated by texture analysis, dual energy X-ray densitometry, microcomputed tomography (microCT and histomorphometry. Hypoactivity had no effect on the length and diameter of the bones. Bone mineral density (BMD, microCT (trabecular bone volume and trabecular microarchitecture and texture analysis were always found significantly reduced in the animals of the HYPO group. BMD was reduced at both femur and tibia diaphysises; BMD of the metaphysis was significantly reduced in the femur but not in the tibia. An increase in osteoid volume and surfaces was noted in the HYPO group. However, there was no alteration of the mineral phase as the osteoid thickness did not differ from control animals. Bone loss was much more pronounced at the lower femur metaphysis than at the upper metaphysis of the tibia. At the tibia, only microarchitectural changes of trabecular bone could be evidenced. The confined chicken represents a new method for the study of hypodynamia since these animals do not have surgical lesions.

  4. 低骨密度对Lenke Ⅰ型青少年特发性脊柱侧凸患者手术疗效的影响%The influence of lower bone mineral density on surgical outcomes in Lenke Ⅰ type adolescent idio pathic scoliosis

    Institute of Scientific and Technical Information of China (English)

    林小龙; 邱勇; 刘臻; 郭倞; 吕峰; 张兴; 周松; 孙旭


    Objectives: To determine the role of preoperative lower bone mineral densily(BMD) in surgical outcomes of patients with Lenke I type adolescent idiopathic scoliosis(AIS). Methods: Thirty-seven female patients with Lenke I type AIS who underwent posterior correction and fusion with pedical screw instrumentation between June 2007 and August 2008 were included in this study. The mean age of AIS patients was 14.3±1.3 years (rang from 11 to 17 years), and the mean Cobb angle was 48.9°±6.7°(rang from 40° to 66°). BMD was assessed in every patient before surgery by dual energy X-ray absorptiometry (DEXA). All patients were divided into 2 groups according to the Z-score of their femur neck BMD: nonosteopenic patients(Z>-1.0) and osteopenic patients (Z≤-1.0). The radiography parameters including Cobb angle, thoracic kyphosis (TK), lumbar lordosis(LL) and apical vertebral translation(AVT) were measured preoperatively and immediatly postop-eratively (3 months postoperation) as well as at the latest follow-up. C7 plumb line to center sacral vertical line(C7-CSVL) was used to evaluate the coronal balance while sagittal vertical axis(SVA) was measured to assess the sagittal balance. All the parameters between two groups were compared. Results: IS patients were included in nonosteopenic group and 22 patients in osteopenic group, respectively. The mean age, Kisser sign, age, Risser sign, instrumented level, implant density and follow-up time were similar(P>0.05). No difference with respect to the Cobb angle, AVT, C7-CSVL was observed between two groups preoperatively (P>0.05). There was no difference in the mean Cobb angle, correction loss, correction loss rate, AVT, C7-CSVL or the change of C7-CSVL immediatly postoperatively and at latest follow-up (P>0.05). In addition, there was no difference in terms of the mean TK, LL, SVA or the change of SVA between these two groups preoperatively and immediatly postoperatively as well as at the latest follow-up (P>0

  5. Orchestration of bone remodeling

    NARCIS (Netherlands)

    Moester, Martiene Johanna Catharina


    In healthy individuals, a balance exists between bone formation and resorption. Disruption of this balance can lead to higher or lower bone mass, and disease such as osteoporosis. Treatment for osteoporosis generally inhibits bone resorption, but does not rebuild bone to a healthy strength. More kno

  6. Bone grafts in dentistry

    Directory of Open Access Journals (Sweden)

    Prasanna Kumar


    Full Text Available Bone grafts are used as a filler and scaffold to facilitate bone formation and promote wound healing. These grafts are bioresorbable and have no antigen-antibody reaction. These bone grafts act as a mineral reservoir which induces new bone formation.

  7. Bone Marrow Diseases (United States)

    Bone marrow is the spongy tissue inside some of your bones, such as your hip and thigh bones. It contains stem cells. The stem cells can ... the platelets that help with blood clotting. With bone marrow disease, there are problems with the stem ...

  8. Histomorphometric evaluation of bone regeneration using autogenous bone and beta-tricalcium phosphate in diabetic rabbits

    Directory of Open Access Journals (Sweden)

    Živadinović Milka


    Full Text Available Background/Aim. The mechanism of impaired bone healing in diabetes mellitus includes different tissue and cellular level activities due to micro- and macrovascular changes. As a chronic metabolic disease with vascular complications, diabetes affects a process of bone regeneration as well. The therapeutic approach in bone regeneration is based on the use of osteoinductive autogenous grafts as well as osteoconductive synthetic material, like a β-tricalcium phosphate. The aim of the study was to determine the quality and quantity of new bone formation after the use of autogenous bone and β-tricalcium phosphate in the model of calvarial critical-sized defect in rabbits with induced diabetes mellitus type I. Methods. The study included eight 4-month-old Chincilla rabbits with alloxan-induced diabetes mellitus type I. In all animals, there were surgically created two calvarial bilateral defects (diameter 12 mm, which were grafted with autogenous bone and β-tricalcium phosphate (n = 4 or served as unfilled controls (n = 4. After 4 weeks of healing, animals were sacrificed and calvarial bone blocks were taken for histologic and histomorphometric analysis. Beside descriptive histologic evaluation, the percentage of new bone formation, connective tissue and residual graft were calculated. All parameters were statistically evaluated by Friedman Test and post hock Wilcoxon Singed Ranks Test with a significance of p < 0.05. Results. Histology revealed active new bone formation peripherally with centrally located connective tissue, newly formed woven bone and well incorporated residual grafts in all treated defects. Control samples showed no bone bridging of defects. There was a significantly more new bone in autogeonous graft (53% compared with β-tricalcium phosphate (30%, (p < 0.030 and control (7%, (p < 0.000 groups. A significant difference was also recorded between β-tricalcium phosphate and control groups (p < 0.008. Conclusion. In the present

  9. Modelagem e análise de um novo centro cirúrgico para um hospital em crescimento: uma abordagem baseada em simulação Modeling and analysis of a new surgical center for a growing hospital: a simulation-based approach

    Directory of Open Access Journals (Sweden)

    Élcio Douglas Joaquim


    Full Text Available Uma instituição hospitalar precisa de constante aperfeiçoamento para ser eficiente no seu principal negócio: o bem-estar do ser humano. Este artigo descreve um projeto realizado no Hospital Universitário da PUCPR, cujo principal objetivo é avaliar alterações no Centro Cirúrgico com o intuito de se preparar melhor para o aumento de demanda esperado para os próximos anos. Foram simulados e analisados quatro novos cenários, os quais incluíram restruturação de atividades de atendimento e ampliação do número de salas cirúrgicas. Os modelos de simulação mostraram que em geral as alterações sugeridas trarão benefícios ao centro e que o melhor cenário deverá ter duas novas salas de cirurgia e uma restruturação das atividades internas do centro. Isto reduzirá o tempo de espera do paciente por sala cirúrgica e também a própria taxa de ocupação das salas, além de atender bem à comunidade até 2010/2011.A hospital institution needs frequent improvement to be efficient at its core business: the care of the human being. This paper describes a project conducted at PUCPR's University Hospital, which main objective is to evaluate changes to the Surgical Center aiming at being better prepared for the demand increase expected for the coming years. Four new scenarios were simulated and analyzed, which included restructuring of internal activities and the increase on the number of surgical rooms. The simulation models showed that the suggested changes will benefit the center and that the best scenario should have two new surgical rooms along with the restructuring of the internal activities flow. This will reduce the patient waiting time for surgical room and the rooms' utilization, besides providing a good service to the community until 2010/2011.

  10. Surgical landmarks of the ureter in the cadaveric female pelvis. (United States)

    Barksdale, P A; Brody, S P; Garely, A D; Elkins, T E; Nolan, T E; Gasser, R F


    Our purpose was to delineate the course of the ureter in the female pelvis in relationship to several important surgical landmarks. Ten female cadavers with undissected pelves were used. The ureter was identified at the pelvic brim and traced inferiorly to the bladder. Sets of measurements (+/- 0.1 cm) that help define the location of the ureter were obtained at the three landmarks; the ischial spine, the obturator canal and the insertion of the arcus tendineus on the pubic bone. The mean distances from the ureter to the pelvic floor were ischial spine, 3.2 +/- 0.1 cm; obturator canal, 3.2 +/- 0.1 cm; and the insertion of the arcus tendineus on the pubic bone, 1.6 +/- 0.1 cm. The mean distances from the arcus tendineus to the pelvic floor were ischial spine, 1.9 +/- 0.1 cm; obturator canal, 2.8 +/- 0.1 cm; and the insertion of the arcus tendineus on the pubic bone, 3.2 +/- 0.1 cm. This study defines the relationship of the ureter to the pelvic floor through measurements taken at three landmarks. The data should be useful to pelvic surgeons and are important for the development of future surgical techniques.

  11. Bone Health and Osteoporosis. (United States)

    Lupsa, Beatrice C; Insogna, Karl


    Osteoporosis is characterized by low bone mass and microarchitectural deterioration of bone tissue leading to decreased bone strength and an increased risk of low-energy fractures. Central dual-energy X-ray absorptiometry measurements are the gold standard for determining bone mineral density. Bone loss is an inevitable consequence of the decrease in estrogen levels during and following menopause, but additional risk factors for bone loss can also contribute to osteoporosis in older women. A well-balanced diet, exercise, and smoking cessation are key to maintaining bone health as women age. Pharmacologic agents should be recommended in patients at high risk for fracture.

  12. Aneurysmal bone cyst of the mandibular condyle with condylar neck fracture

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jeong Hoon [Department of Biomedical Engineering, College of Medicine and Healthcare Industry Research Institute, Kyung Hee University, Seoul (Korea, Republic of); Yu, Jae Jung; Kang, Ju Han; Kim, Gyu Tae; Choi, Yong Suk; Hwang, Eui Hwan [Department of Oral and Maxillofacial Radiology, School of Dentistry and Institute of Oral Biology, Kyung Hee University, Seoul (Korea, Republic of)


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


    Directory of Open Access Journals (Sweden)



    Full Text Available Osteopetrosis, a generalized developmental bone disease due to genetic disturbances, characterized by failure of bone re sorption and continuous bone formation making the bone hard, dense and brittle. Bones of intramembranous ossification and enchondrial ossification are affected genetically and symmetrically. During the process of disease the excess bone formation obliterates the cranial foramina and presses the optic, auditory and facial nerves resulting in defective vision, impaired hearing and facial paralysis. The bone formation in osteopetrosis affects bone marrow function leading to severe anemia and deficient of blood cells. The bone devoid of blood supply due to compression of blood vessels by excess formation of bone are prone to osteomyelitic changes with suppuration and pathological fracture if exposed to infection. Though the condition is chronic progressive, it produces changes leading to fatal condition, it should be studied thoroughly by everyone and hence this article presents a classical case of osteopetrosis with detailed description and discussion for the benefit of readers

  14. Screw-bone finite element models for screw pullout simulation%螺钉-骨抗拔出力试验有限元模型的建立与验证

    Institute of Scientific and Technical Information of China (English)

    严亚波; 裴国献; 桑宏勋; 马真胜; 雷伟


    Objective To establish screw-bone finite element (FE) models for screw pullout simulation.Methods A pedicle screw model with a diameter of 6.5 mm,a model of screw-low density porous foam and a model of screw-high density porous foam were established and validated against the published data.Next,a screw-bone model was established and imported into the ANSYS software for FE simulation to study the dynamic bone responses during screw pullout according to the criteria set by American Association for Testing Materials (ASTM).A velocity loading of 0.01 mm/s with a maximum displacement of 2.7 mm was applied on the screw.For validation,the screw-foam models with 2 different densities were used for comparison of the pullout forces with the experimental data published.Results In validation,the predicted pullout forces were 2028.8 N in the high density foam model and 607.0 N in the low density foam model,respectively.They were in good agreement with the data of Hashemi et al.(2132.5 ± 119.3 N and 688.2 ±91.4 N,respectively).The load-displacement curves in the FE models were similar to the published (1.8 mm versus 1.5mm).In the simulation of screw pullout,the areas around the crew changed in volume in the process of pullout.Conclusion The dynamic screw-bone FE model established and validated by the present study can be used in simulation of pullout of pedicle screws to study mechanical bone responses to the pullout.%目的 建立螺钉-骨抗拔出力试验的动态有限元模型,模拟螺钉的拔出过程. 方法 基于螺钉的国标尺寸,建立直径为6.5 mm的椎弓根螺钉模型,并建立对应骨组织的高密度和低密度多孔泡沫三维模型进行验证,最后建立螺钉-骨模型研究螺钉拔出过程中骨骼的动态响应.在Ansys中对三维模型进行网格划分,并按照美国材料试验协会(ASTM)标准对螺钉进行拔出力加载分析.拔出方向为轴向拔出,拔出速度为0.01 mm/s.建立模型后,对模型进行加载计算并与

  15. Digitally Designed Surgical Guides for Placing Extraoral Implants in the Mastoid Area

    NARCIS (Netherlands)

    van der Meer, W. Joerd; Vissink, Arjan; Raghoebar, Gerry M.; Visser, Anita


    Purpose: When planning implant therapy, knowledge of the bone volume in the implant area is needed to plan and place implants in the most appropriate locations from the prosthetic and surgical perspectives. Commercial software for digital planning of implants in the craniofacial region is not yet av

  16. Chemotherapy effectiveness and mortality prediction in surgically treated osteosarcoma dogs : A validation study

    NARCIS (Netherlands)

    Schmidt, A. F.; Nielen, M.; Withrow, S. J.; Selmic, L. E.; Burton, J. H.; Klungel, O. H.; Groenwold, R. H H; Kirpensteijn, J.


    Canine osteosarcoma is the most common bone cancer, and an important cause of mortality and morbidity, in large purebred dogs. Previously we constructed two multivariable models to predict a dog's 5-month or 1-year mortality risk after surgical treatment for osteosarcoma. According to the 5-month mo

  17. Radiology trainer. Surgical ambulance. 2. rev. and enl. ed.; Roentgen-Trainer. Chirurgische Ambulanz

    Energy Technology Data Exchange (ETDEWEB)

    Ackermann, Ole [Wedau-Kliniken Duisburg (Germany). Klinik fuer Unfallchirurgie; Ruchholtz, Steffen [Universitaetsklinikum Giessen und Marburg GmbH, Marburg (Germany). Klinik fuer Unfall-, Hand- und Wiederherstellungschirurgie; Siemann, Holger [LVR Klinikum Essen (Germany); Barkhausen, Joerg [Universitaetsklinikum Schleswig-Holstein, Luebeck (Germany). Klinik fuer Radiologie und Nuklearmedizin


    The radiology trainer for surgical ambulance includes informative X-ray imaging examples for the following issues: zygoma, nasal bone, spinal cord, clavicle, shoulder, upper arms, elbow, forearms, wrist, hand, phalanx, thorax, sternum, pelvis, abdomen, hips, femur, knee, lower leg, ankle, feet.

  18. Retained surgical sponge: An enigma

    Directory of Open Access Journals (Sweden)

    Gurjit Singh


    Full Text Available Retained surgical sponge in the body following a surgery is called "gossypiboma". A 27-year-old female who had undergone lower segment cesarean section 4 months earlier was admitted with complaints of pain abdomen with a palpable mass in left iliac fossa. X-ray, ultrasonography, and CT scan findings were suggestive of retained surgical sponge. Surgical sponge was removed following laparotomy. Surgeons must be aware of the risk factors that lead to gossypiboma, and measures should be taken to prevent it. Besides increasing morbidity and possible mortality, it may result in libel suit for compensation.

  19. Surgical treatment of pediatric rhinosinusitis. (United States)

    Isaacson, G


    Pediatric rhinosinusitis is a common sequela of upper respiratory infections in children. It is usually a self-limited disease, sometimes requiring antibiotic therapy. Surgery may be indicated in children who suffer complication of acute rhinosinusitis, severe recurrent acute rhinosinusitis, rhinosinusitis in cystic fibrosis with or without polyposis, chronic rhinosinusitis refractory to maximal medical management, allergic fungal sinusitis, and paranasal sinus mucoceles. Surgical options include, adenoidectomy, sinus puncture and lavage, open surgical approaches, endoscopic sinus surgery, balloon sinuplasty, and turbinectomy or turbinate reduction. This paper reviews the anatomy and physiology of rhinosinusitis in children and current knowledge of the indications and best methods of surgical treatment.

  20. Surgical Skills Beyond Scientific Management (United States)

    Whitfield, Nicholas


    During the Great War, the French surgeon Alexis Carrel, in collaboration with the English chemist Henry Dakin, devised an antiseptic treatment for infected wounds. This paper focuses on Carrel’s attempt to standardise knowledge of infected wounds and their treatment, and looks closely at the vision of surgical skill he espoused and its difference from those associated with the doctrines of scientific management. Examining contemporary claims that the Carrel–Dakin method increased rather than diminished demands on surgical work, this paper further shows how debates about antiseptic wound treatment opened up a critical space for considering the nature of skill as a vital dynamic in surgical innovation and practice. PMID:26090737

  1. Surgical education through video broadcasting. (United States)

    Nagengast, Eric S; Ramos, Margarita S; Sarma, Hiteswar; Deshpande, Gaurav; Hatcher, Kristin; Magee, William P; Campbell, Alex


    Surgical training is facing new obstacles. As advancements in medicine are made, surgeons are expected to know more and to be able to perform more procedures. In the western world, increasing restrictions on residency work hours are adding a new hurdle to surgical training. In low-resource settings, a low attending-to-resident ratio results in limited operative experience for residents. Advances in telemedicine may offer new methods for surgical training. In this article, the authors share their unique experience using live video broadcasting of surgery for educational purposes at a comprehensive cleft care center in Guwahati, India.

  2. Infrared Thermal Imaging During Ultrasonic Aspiration of Bone (United States)

    Cotter, D. J.; Woodworth, G.; Gupta, S. V.; Manandhar, P.; Schwartz, T. H.

    Ultrasonic surgical aspirator tips target removal of bone in approaches to tumors or aneurysms. Low profile angled tips provide increased visualization and safety in many high risk surgical situations that commonly were approached using a high speed rotary drill. Utilization of the ultrasonic aspirator for bone removal raised questions about relative amount of local and transmitted heat energy. In the sphenoid wing of a cadaver section, ultrasonic bone aspiration yielded lower thermal rise in precision bone removal than rotary mechanical drills, with maximum temperature of 31 °C versus 69 °C for fluted and 79 °C for diamond drill bits. Mean ultrasonic fragmentation power was about 8 Watts. Statistical studies using tenacious porcine cranium yielded mean power levels of about 4.5 Watts to 11 Watts and mean temperature of less than 41.1 °C. Excessively loading the tip yielded momentary higher power; however, mean thermal rise was less than 8 °C with bone removal starting at near body temperature of about 37 °C. Precision bone removal and thermal management were possible with conditions tested for ultrasonic bone aspiration.

  3. Multiscale Modeling of Bone (United States)


    DISEASE Both age and disease can affect the structure of bone, the effects of which are often similar. The most common bone disease is osteoporosis ... Osteoporosis is a disease that results in reduced bone mass and density. This reduction of bone mass and density has a greater impact on trabecular...Bone loss in females is linked to a decrease in estrogen ; the decrease of estrogen associated with menopause increases osteoclast activity [89]. This

  4. Evidence-based surgical wound care on surgical wound infection. (United States)

    Reilly, Jaqueline


    Surgical wound infection is an important outcome indicator in the postoperative period. A 3-year prospective cohort epidemiological study of 2202 surgical patients from seven surgical wards across two hospitals was carried out using gold standard surveillance methodology. This involved following patients up as inpatients and postdischarge surveillance to 30 days by an independent observer. The results led to the development of a mathematical model for risk of clean, elective surgical wound infection. Risk of surgical wound infection was increased by smoking, higher body mass index, presence of malignancy, haematoma formation, increasing numbers of people in theatre, adherent dressing usage, and higher times to suture removal (P<0.05). The results show that this type of surveillance is an effective way of collecting accurate data on wound infection rates. It was noted that patient care practices affected the surgical wound infection rate and the surveillance was used to facilitate the adoption of evidence-based practice, through recommendations for clean surgery, to reduce the risk from extrinsic risk factors for wound infection. As a result of the implementation of this evidence-based practice there was a significant reduction (P<0.05) in the clean wound infection rate.

  5. Pharmacokinetics of gentamicin eluted from a regenerating bone graft substitute

    DEFF Research Database (Denmark)

    Stravinskas, M; Horstmann, P; Ferguson, J;


    in patients treated surgically for chronic corticomedullary osteomyelitis. RESULTS: The release pattern in vitro was comparable with the obtained release in the patient studies. No recurrence was detected in the osteomyelitis group at latest follow-up (minimum 1.5 years). CONCLUSIONS: This new biphasic bone...

  6. Bone-Cement: The new medical quick fix

    Directory of Open Access Journals (Sweden)

    Dinesh Bhatia


    Full Text Available Bone Cement is being widely used in vertebroplasty, a minimally invasive surgical procedure to treat spinal frac-tures and collapsed vertebrae. It is being labeled as a concrete success in medical field. It is being used to treat fractures due to osteoporosis, menopause, steroids, hyperthyroidism and chronic obstructive pulmonary diseases. In this technique a needle with bone cement (PMMA, polymethylmethacrylate is injected into the collapsed verte-bra after administering local anesthesia to patient. It solidifies within few minutes and provides support to damaged bone resulting in relief to the patient. It also prevents the movement between different parts of the broken bone. Hence it requires a short hospital stay for the patient and the procedure can be performed with much ease and at significant lower costs. Patient can resume normal activity within a day or so. Bone cement is now being referred to as the quick medical fix material for early repair of fractures.

  7. Essential Tremor (ET): Surgical Options (United States)

    ... t respond to propranolol, primidone, or other common ET medications and whose tremor has become debilitating, there ... treatments were first introduced. Current surgical options for ET include Deep Brain Stimulation (DBS) , Focused Ultrasound , and ...

  8. Surgical trainees and trauma emergencies. (United States)

    Wybaillie, E; Broos, P L O


    An accident and emergency (A&E) training has been suggested as an essential part of the basic surgical training. The A&E curriculum should be divided into three sections: a critical curriculum, a core curriculum and a comprehensive curriculum. For instance, the critical curriculum contains topics that provide the opportunity to translate the ABCDE principles of trauma management into practice. Furthermore, a post in the A&E department provides the surgical trainee with significant exposure to the management of the polytrauma patient and to the management of other acute general surgical, urological and orthopaedic conditions. By presenting better educational programs and by reducing the non-medical tasks a trainee has to deal with, the education of surgical trainees during A&E attachment can be improved.

  9. Surgical treatment of cranial neuralgias. (United States)

    Franzini, Angelo; Ferroli, Paolo; Messina, Giuseppe; Broggi, Giovanni


    The most common types of cranial neuralgias amenable to surgical therapeutic options are trigeminal neuralgia and glossopharyngeal neuralgia, the former having an approximate incidence of 5/100000 cases per year and the latter of 0.05/100000 cases per year. Surgical therapy of these pathological conditions encompasses several strategies, going from ablative procedures to neurovascular decompression, to radiosurgery. The choice of the most appropriate surgical option (which must be taken into account when all conservative treatments have proven to be unsuccessful) has to take into account many factors, the most important ones being neuroradiological evidence of a neurovascular conflict, severity of symptoms, the age and clinical history of the patient, and the patient's overall medical condition. In this chapter we report our experience with the treatment of trigeminal and glossopharyngeal neuralgia, describing the surgical procedures performed and reviewing the most recent aspects on this subject in the past literature.

  10. Stress Distribution on Short Implants at Maxillary Posterior Alveolar Bone Model With Different Bone-to-Implant Contact Ratio: Finite Element Analysis. (United States)

    Yazicioglu, Duygu; Bayram, Burak; Oguz, Yener; Cinar, Duygu; Uckan, Sina


    The aim of this study was to evaluate the stress distribution of the short dental implants and bone-to-implant contact ratios in the posterior maxilla using 3-dimensional (3D) finite element models. Two different 3D maxillary posterior bone segments were modeled. Group 1 was composed of a bone segment consisting of cortical bone and type IV cancellous bone with 100% bone-to-implant contact. Group 2 was composed of a bone segment consisting of cortical bone and type IV cancellous bone including spherical bone design and homogenous tubular hollow spaced structures with 30% spherical porosities and 70% bone-to-implant contact ratio. Four-millimeter-diameter and 5-mm-height dental implants were assumed to be osseointegrated and placed at the center of the segments. Lateral occlusal bite force (300 N) was applied at a 25° inclination to the implants long axis. The maximum von Mises stresses in cortical and cancellous bones and implant-abutment complex were calculated. The von Mises stress values on the implants and the cancellous bone around the implants of the 70% bone-to-implant contact group were almost 3 times higher compared with the values of the 100% bone-to-implant contact group. For clinical reality, use of the 70% model for finite element analysis simulation of the posterior maxilla region better represents real alveolar bone and the increased stress and strain distributions evaluated on the cortical and cancellous bone around the dental implants.

  11. Numerical analysis of an osseointegrated prosthesis fixation with reduced bone failure risk and periprosthetic bone loss. (United States)

    Tomaszewski, P K; van Diest, M; Bulstra, S K; Verdonschot, N; Verkerke, G J


    Currently available implants for direct attachment of prosthesis to the skeletal system after transfemoral amputation (OPRA system, Integrum AB, Sweden and ISP Endo/Exo prosthesis, ESKA Implants AG, Germany) show many advantages over the conventional socket fixation. However, restraining biomechanical issues such as considerable bone loss around the stem and peri-prosthetic bone fractures are present. To overcome these limiting issues a new concept of the direct intramedullary fixation was developed. We hypothesize that the new design will reduce the peri-prosthetic bone failure risk and adverse bone remodeling by restoring the natural load transfer in the femur. Generic CT-based finite element models of an intact femur and amputated bones implanted with 3 analyzed implants were created and loaded with a normal walking and a forward fall load. The strain adaptive bone remodeling theory was used to predict long-term bone changes around the implants and the periprosthetic bone failure risk was evaluated by the von Mises stress criterion. The results show that the new design provides close to physiological distribution of stresses in the bone and lower bone failure risk for the normal walking as compared to the OPRA and the ISP implants. The bone remodeling simulations did not reveal any overall bone loss around the new design, as opposed to the OPRA and the ISP implants, which induce considerable bone loss in the distal end of the femur. This positive outcome shows that the presented concept has a potential to considerably improve safety of the rehabilitation with the direct fixation implants.

  12. Intermittent exotropia: Surgical treatment strategies

    Directory of Open Access Journals (Sweden)

    Jai Aditya Kelkar


    Full Text Available Surgical management of intermittent exotropias (IXTs is ambiguous, with techniques of management varying widely between institutions. This review aims to examine available literature on the surgical management of IXT. A literature search was performed using PubMed, Web of Knowledge, LILACS, and the University of Liverpool Orthoptic Journals and Conference Transactions Database. All English-language papers published between 1958 and the present day were considered.

  13. Innovation in pediatric surgical education. (United States)

    Clifton, Matthew S; Wulkan, Mark L


    Pediatric surgical training in the United States remained basically unchanged from the model developed by Ladd and Gross in the 1930s until recently. Standardized curriculum and novel evaluation methods are now being implemented. Pediatric Surgical education is currently undergoing a transition to competency-based evaluation and promotion. Unfortunately, there is little data on the efficacy of these changes. This presents an opportunity for further study of how we conduct training, and how we evaluate and promote our trainees.

  14. Aesthetic Surgical Crown Lengthening Procedure (United States)

    de Oliveira, Pablo Santos; Chiarelli, Fabio; Rodrigues, José A.; Shibli, Jamil A.; Zizzari, Vincenzo Luca; Piattelli, Adriano; Iezzi, Giovanna; Perrotti, Vittoria


    The aim of this case report was to describe the surgical sequence of crown lengthening to apically reposition the dentogingival complex, in addition to an esthetic restorative procedure. Many different causes can be responsible for short clinical crown. In these cases, the correct execution of a restorative or prosthetic rehabilitation requires an increasing of the crown length. According to the 2003 American Academy of Periodontology (Practice Profile Survey), crown lengthening is the most habitual surgical periodontal treatment. PMID:26609452

  15. Aesthetic Surgical Crown Lengthening Procedure

    Directory of Open Access Journals (Sweden)

    Pablo Santos de Oliveira


    Full Text Available The aim of this case report was to describe the surgical sequence of crown lengthening to apically reposition the dentogingival complex, in addition to an esthetic restorative procedure. Many different causes can be responsible for short clinical crown. In these cases, the correct execution of a restorative or prosthetic rehabilitation requires an increasing of the crown length. According to the 2003 American Academy of Periodontology (Practice Profile Survey, crown lengthening is the most habitual surgical periodontal treatment.

  16. Surgical Treatment of Facial Paralysis


    Mehta, Ritvik P.


    The management of facial paralysis is one of the most complex areas of reconstructive surgery. Given the wide variety of functional and cosmetic deficits in the facial paralysis patient, the reconstructive surgeon requires a thorough understanding of the surgical techniques available to treat this condition. This review article will focus on surgical management of facial paralysis and the treatment options available for acute facial paralysis (2 yr). For acute facial paralysis, the main surgi...

  17. Aesthetic Surgical Crown Lengthening Procedure. (United States)

    de Oliveira, Pablo Santos; Chiarelli, Fabio; Rodrigues, José A; Shibli, Jamil A; Zizzari, Vincenzo Luca; Piattelli, Adriano; Iezzi, Giovanna; Perrotti, Vittoria


    The aim of this case report was to describe the surgical sequence of crown lengthening to apically reposition the dentogingival complex, in addition to an esthetic restorative procedure. Many different causes can be responsible for short clinical crown. In these cases, the correct execution of a restorative or prosthetic rehabilitation requires an increasing of the crown length. According to the 2003 American Academy of Periodontology (Practice Profile Survey), crown lengthening is the most habitual surgical periodontal treatment.

  18. [Atraumatic bone expansion: Interest of piezo-surgery, conicals expanders and immediate implantation combination]. (United States)

    Iraqui, O; Lakhssassi, N; Berrada, S; Merzouk, N


    The durability of dental implants depends on the presence of a 1mm coating bone sheath all around the fixture. Therefore, bone resorption represents a challenge for the practitioner. Bone expansion is a surgical technique that allows the management of horizontal bone atrophy. Cortical bone splitting allows for an enlargement of the residual crest by displacement of the vestibular bone flap. The immediate placement of implants secures the widening and allows for a 97% survival rate. However, bone expansion is hard to undertake in sites with high bone density. Furthermore, the use of traditional instruments increases patient's stress and the risk for an interruptive fracture during bone displacement. Non-traumatic bone expansion is one solution to this problem. The combination of piezo-surgery and conical expanders allows for a secured displacement of the selected bone flap as well as an immediate implant placement, avoiding the risk of slipping, overheating, or fracture, all within an undeniable operative comfort. Non-traumatic bone expansion is a reliable, reproducible, conservative, and economical in time and cost procedure. We describe our atraumatic bone expension and immediate implant placement technique in high bone density sites and illustrate it by a clinical case.

  19. Giant aneurysmal bone cyst of the mandible with unusual presentation. (United States)

    Capote-Moreno, Ana; Acero, Julio; García-Recuero, Ignacio; Ruiz, Julián; Serrano, Rosario; de Paz, Víctor


    Aneurysmal bone cysts are rare benign lesions of bone tissue, infrequent in craneofacial skeleton with regard to other structures like long bones or the spine. They are composed of sinusoidal and vascular spaces blood-filled and surrounded by fibrous tissue septa. We present a case of a 29-year-old Caucasian male with a big swelling in the left mandible associated to pain and rapid growth. He referred previous extraction of the left inferior third molar. On the X-ray study, an expansive multilocular and high vascularized bony lesion within the mandibular angle was observed. It produced expansion and destruction of lingual and buccal cortex. An incisional biopsy was performed showing a fibrous tissue with blood-filled spaces lesion suggestive of an aneurysmal bone cyst. After selective embolization of the tumour, surgical resection was done with curettage and immediate reconstruction of the defect with an anterior iliac crest graft. Aneurysmal bone cysts are non-neoplastic but locally aggressive tumours with occasional rapid growth that may be differentiated from other multilocular process like ameloblastoma, ossifying fibroma, epithelial cyst, giant cell granuloma and sarcomas. Treatment of choice consists on conservative surgical excision of the mass with curettage or enucleation. When resection creates a big defect, primary surgical reconstruction is recommended.

  20. Anatomy-based registration of CT-scan and intraoperative X-ray images for guiding a surgical robot. (United States)

    Guéziec, A; Kazanzides, P; Williamson, B; Taylor, R H


    We describe new methods for rigid registration of a preoperative computed tomography (CT)-scan image to a set of intraoperative X-ray fluoroscopic images, for guiding a surgical robot to its trajectory planned from CT. Our goal is to perform the registration, i.e., compute a rotation and translation of one data set with respect to the other to within a prescribed accuracy, based upon bony anatomy only, without external fiducial markers. With respect to previous approaches, the following aspects are new: 1) we correct the geometric distortion in fluoroscopic images and calibrate them directly with respect to the robot by affixing to it a new calibration device designed as a radiolucent rod with embedded metallic markers, and by moving the device along two planes, while radiographs are being acquired at regular intervals; 2) the registration uses an algorithm for computing the best transformation between a set of lines in three space, the (intraoperative) X-ray paths, and a set of points on the surface of the bone (imaged preoperatively), in a statistically robust fashion, using the Cayley parameterization of a rotation; and 3) to find corresponding sets of points to the X-ray paths on the surfaces, our new approach consists of extracting the surface apparent contours for a given viewpoint, as a set of closed three-dimensional nonplanar curves, before registering the apparent contours to X-ray paths. Aside from algorithms, there are a number of major technical difficulties associated with engineering a clinically viable system using anatomy and image-based registration. To detect and solve them, we have so far conducted two experiments with the surgical robot in an operating room (OR), using CT and fluoroscopic image data of a cadaver bone, and attempting to faithfully simulate clinical conditions. Such experiments indicate that intraoperative X-ray-based registration is a promising alternative to marker-based registration for clinical use with our proposed method.

  1. 模拟失重对大鼠承重骨骨髓基质细胞数量及体外成骨能力的影响%Effects of simulated weightlessness on bone marrow stromal cell count and osteogentic capacity of weight bearing bone in rats

    Institute of Scientific and Technical Information of China (English)

    付崇建; 郁冰冰; 杨连甲; 曹新生; 张立藩


    of simulated weightlessness on bone marrow stromal cell count and osteogentic capacity of weight bearing bone in rats so as to reveal the mechanism of bone loss.DESIGN : Randomized pairing and controlled study.SETTING: College of Aerospace Medicine and Department of Pathology of Stomatology College, the Fourth Military Medical University of Chinese PLA.MATERIALS: A total of 20 adult healthy male SD rats were selected in this study. At the beginning of experiment, rats based on their body mass were randomly divided into control group and suspension group with 10 in each group. Alkaline phosphatase kit was provided by Beijing Zhongsheng Bioengineering High-technological Company.METHODS: The experiment was carried out in the Department of Pathology, Collage of Stomatology, the Fourth Military Medical University of Chinese PLA from November 1999 to July 2000. Rats were randomly divided into tail suspension group and control group with 10 in each group. Rats in the tail suspension group were given tail suspension for 28 days. Their heads maintained 30° low position, and their hindlimbs freely suspended and were not given weight loading. While, rats in the control group were fed normally. At the end of experiment, bone marrow stromal cells were obtained from femur for primary and transferring cultures.MAIN OUTCOME MEASURES: Cell counting and methylthianolyldiphenyl-tetrazolium bromide (MTT) assay were used to draw growth curve of cells in primary and transferring cultures and to measure activity of alkaline phosphatase and forming quantity of mineralized nodules in vitro.RESULTS : ① Activity of alkaline phosphatase: Activity of alkaline phosphatase of cells in the primary and transferring cultures in the suspension group was lower than that in the control group, and there was significant difference between them (P<0.05). ② Forming quantity of mineralized nodules: Forming quantity of mineralized nodules in the suspension group was less than that in the control group

  2. Femoral lengthening during hip resurfacing arthroplasty: a new surgical procedure. (United States)

    Vasseur, L; Ayoub, B; Mesnil, P; Pasquier, G; Migaud, H; Girard, J


    Correction of leg length discrepancy during hip arthroplasty is a technical challenge. Although resurfacing proposed to young subjects presents a number of advantages (stability, bone stock, etc.), it does not correct leg length discrepancy. We propose an original femoral lengthening technique concomitant to resurfacing performed through the same approach, consisting in a Z-shaped subtrochanteric osteotomy. Resurfacing was performed first and the femoral and acetabular reaming material was used for autografting. The series comprised five cases followed for a mean 42.2 months (range, 33-64 months). The mean surgical time was 100 min (range, 76-124 min). Weightbearing was authorized in all cases at the 8th week. The mean lengthening was 32 mm (range, 25-40 mm). Healing was observed in all cases. This surgical technique, reserved for very young subjects who accept an 8-week postoperative period without weightbearing, can be proposed in cases with substantial preoperative leg length discrepancy.

  3. Surgical Management of Compound Odontoma Associated with Unerupted Tooth. (United States)

    Pacifici, Andrea; Carbone, Daniele; Marini, Roberta; Pacifici, Luciano


    Odontomas represent the most common type of odontogenic benign jaws tumors among patients younger than 20 years of age. These tumors are composed of enamel, dentine, cementum, and pulp tissue. According to the World Health Organization classification, two distinct types of odontomas are acknowledged: complex and compound odontoma. In complex odontomas, all dental tissues are formed, but appeared without an organized structure. In compound odontomas, all dental tissues are arranged in numerous tooth-like structures known as denticles. Compound odontomas are often associated with impacted adjacent permanent teeth and their surgical removal represents the best therapeutic option. A case of a 20-year-old male patient with a compound odontoma-associated of impacted maxillary canine is presented. A minimally invasive surgical technique is adopted to remove the least amount of bone tissue as far as possible.

  4. Surgical Management of Compound Odontoma Associated with Unerupted Tooth

    Directory of Open Access Journals (Sweden)

    Andrea Pacifici


    Full Text Available Odontomas represent the most common type of odontogenic benign jaws tumors among patients younger than 20 years of age. These tumors are composed of enamel, dentine, cementum, and pulp tissue. According to the World Health Organization classification, two distinct types of odontomas are acknowledged: complex and compound odontoma. In complex odontomas, all dental tissues are formed, but appeared without an organized structure. In compound odontomas, all dental tissues are arranged in numerous tooth-like structures known as denticles. Compound odontomas are often associated with impacted adjacent permanent teeth and their surgical removal represents the best therapeutic option. A case of a 20-year-old male patient with a compound odontoma-associated of impacted maxillary canine is presented. A minimally invasive surgical technique is adopted to remove the least amount of bone tissue as far as possible.

  5. Surgical treatment of osteochondritis dissecans of the talus

    DEFF Research Database (Denmark)

    Zwingmann, Jörn; Südkamp, Norbert P; Schmal, Hagen


    PURPOSE: Osteochondritis dissecans (OCD) is an aseptic bone necrosis and represents pathology of high clinical relevance, which is frequently located on the talus. Various treatment strategies including non-surgical and surgical approaches have been described. An evidence-based treatment algorithm...... inclusion criteria (minimum follow-up 12 months, patient evaluation by standardized scoring systems, etc.), a total of 54 studies with clinical follow-up of 1,105 patients was included. Methodology of these studies was systematically analyzed by the means of the Coleman Methodology Score. Outcome......,105 patients was 47 months (SD ± 17) with a mean age of 29 (SD ± 5.6) years. The proportion of excellent and good treatment results was stage-independent in total 75 %. According to the criteria of the score applied for patient's evaluation in the individual study, the overall percentage of "good...

  6. Modification of the technique of osteotomy for surgical maxillary expansion

    Directory of Open Access Journals (Sweden)

    João Luis Carlini


    Full Text Available Surgically assisted maxillary expansion is a technique used to correct transverse maxillary deficiency, which is a dentofacial anomaly related to the decrease of the upper arch over the lower arch. It is applied to patients in their late teens and adults due to skeletal maturity, causing obliteration of the intermaxillary suture, which requires orthodontic procedure, associated with surgery. The purpose of this study is to report the clinical case of a patient admitted for surgical maxillary expansion through the modified technique and point out the possible advantages, such as aesthetics maintenence, long-term stability, faster return to orthodontic treatment, and improved bone healing. However, there are some contraindications when the patient presents severe crowding, roots of the canine and lateral incisor are converging and in patients who will undergo to protraction with facial mask.

  7. Surgical Revision after Sacroiliac Joint Fixation or Fusion (United States)

    Holt, Timothy


    Background Minimally invasive sacroiliac joint (SIJ) fusion has been shown to be safe and effective for the treatment of SIJ dysfunction. Multiple devices are available to perform SIJ fixation or fusion. Surgical revision rates after these procedures have not been directly compared. Methods We retrospectively identified all patients in our practice who underwent SIJ fixation or fusion between 2003 and 2015. Using both chart review and focused contact with individual patients, we determined the likelihood of surgical revision. Revision rates were compared using Kaplan-Meier survival analysis. Results Thirty-eight patients underwent SIJ fixation with screws and 274 patients underwent SIJ fusion using triangular titanium implants. Four-year cumulative revision rates were 30.8% for fixation and 5.7% for fusion. Conclusions In our study, SIJ fixation with screws had a much higher revision rate compared to SIJ fusion with triangular titanium implants designed for bone adherence.

  8. Bacterial migration through punctured surgical gloves under real surgical conditions

    Directory of Open Access Journals (Sweden)

    Heidecke Claus-Dieter


    Full Text Available Abstract Background The aim of this study was to confirm recent results from a previous study focussing on the development of a method to measure the bacterial translocation through puncture holes in surgical gloves under real surgical conditions. Methods An established method was applied to detect bacterial migration from the operating site through the punctured glove. Biogel™ double-gloving surgical gloves were used during visceral surgeries over a 6-month period. A modified Gaschen-bag method was used to retrieve organisms from the inner glove, and thus-obtained bacteria were compared with micro-organisms detected by an intra-operative swab. Results In 20 consecutive procedures, 194 gloves (98 outer gloves, 96 inner gloves were examined. The rate of micro-perforations of the outer surgical glove was 10% with a median wearing time of 100 minutes (range: 20-175 minutes. Perforations occurred in 81% on the non-dominant hand, with the index finger most frequently (25% punctured. In six cases, bacterial migration could be demonstrated microbiologically. In 5% (5/98 of outer gloves and in 1% (1/96 of the inner gloves, bacterial migration through micro-perforations was observed. For gloves with detected micro-perforations (n = 10 outer layers, the calculated migration was 50% (n = 5. The minimum wearing time was 62 minutes, with a calculated median wearing time of 71 minutes. Conclusions This study confirms previous results that bacterial migration through unnoticed micro-perforations in surgical gloves does occur under real practical surgical conditions. Undetected perforation of surgical gloves occurs frequently. Bacterial migration from the patient through micro-perforations on the hand of surgeons was confirmed, limiting the protective barrier function of gloves if worn over longer periods.

  9. Conservative Surgical Treatment of Infected Ulceration of the First Metatarsophalangeal Joint With Osteomyelitis in Diabetic Patients. (United States)

    Dalla Paola, Luca; Carone, Anna; Morisi, Claudio; Cardillo, Sara; Pattavina, Marco


    Ulceration of the plantar aspect of the first metatarsophalangeal joint is a common localization in the diabetic foot. Conservative treatment of this lesion is a challenging problem, performed through the soft tissues and osseous debridement. The present study included a cohort of 28 patients affected by diabetes mellitus and a first ray lesion penetrating the bone. After surgical debridement with removal of the infected bone, we positioned antibiotic-loaded bone cement and stabilized the treated area with an external fixator. All patients with critical limb ischemia had their vascular disease treated before the procedure. The mean follow-up was 12.2 ± 6.9 months. Four patients developed a relapse of the ulceration after the procedure. In the postoperative period, 1 patient (3.57%) developed dehiscence of the surgical site and underwent a second procedure. In the follow-up period, 2 patients (7.14%) experienced bone cement dislocation. In 1 of these patients, a new ulceration was observed dorsally to the surgical site. The approach was surgical revision with bone cement replacement and stabilization with a new external fixator. In the other patient, given the absence of ulcerations, the cement was removed, and arthrodesis with internal stabilization using 2 cannulated screws was performed. One patient (3.57%), who had developed a relapse of ulceration after recurrent critical ischemia, underwent a percutaneous revascularization procedure and transmetatarsal amputation. During the follow-up period, no ulceration recurrences, transfer ulcerations, shoe fit problems, or gait abnormalities were detected in the other 24 patients. Our study presents the results of a technique requiring a 1-stage surgical approach to a relatively common problem, which is often difficult to solve.

  10. A projective surgical navigation system for cancer resection (United States)

    Gan, Qi; Shao, Pengfei; Wang, Dong; Ye, Jian; Zhang, Zeshu; Wang, Xinrui; Xu, Ronald


    Near infrared (NIR) fluorescence imaging technique can provide precise and real-time information about tumor location during a cancer resection surgery. However, many intraoperative fluorescence imaging systems are based on wearable devices or stand-alone displays, leading to distraction of the surgeons and suboptimal outcome. To overcome these limitations, we design a projective fluorescence imaging system for surgical navigation. The system consists of a LED excitation light source, a monochromatic CCD camera, a host computer, a mini projector and a CMOS camera. A software program is written by C++ to call OpenCV functions for calibrating and correcting fluorescence images captured by the CCD camera upon excitation illumination of the LED source. The images are projected back to the surgical field by the mini projector. Imaging performance of this projective navigation system is characterized in a tumor simulating phantom. Image-guided surgical resection is demonstrated in an ex-vivo chicken tissue model. In all the experiments, the projected images by the projector match well with the locations of fluorescence emission. Our experimental results indicate that the proposed projective navigation system can be a powerful tool for pre-operative surgical planning, intraoperative surgical guidance, and postoperative assessment of surgical outcome. We have integrated the optoelectronic elements into a compact and miniaturized system in preparation for further clinical validation.

  11. Regulation of Bone Metabolism. (United States)

    Shahi, Maryam; Peymani, Amir; Sahmani, Mehdi


    Bone is formed through the processes of endochondral and intramembranous ossification. In endochondral ossification primary mesenchymal cells differentiate to chondrocytes and then are progressively substituted by bone, while in intramembranous ossification mesenchymal stem cells (MSCs) differentiate directly into osteoblasts to form bone. The steps of osteogenic proliferation, differentiation, and bone homeostasis are controlled by various markers and signaling pathways. Bone needs to be remodeled to maintain integrity with osteoblasts, which are bone-forming cells, and osteoclasts, which are bone-degrading cells.In this review we considered the major factors and signaling pathways in bone formation; these include fibroblast growth factors (FGFs), bone morphogenetic proteins (BMPs), wingless-type (Wnt) genes, runt-related transcription factor 2 (RUNX2) and osteoblast-specific transcription factor (osterix or OSX).

  12. Regulation of Bone Metabolism (United States)

    Shahi, Maryam; Peymani, Amir; Sahmani, Mehdi


    Bone is formed through the processes of endochondral and intramembranous ossification. In endochondral ossification primary mesenchymal cells differentiate to chondrocytes and then are progressively substituted by bone, while in intramembranous ossification mesenchymal stem cells (MSCs) differentiate directly into osteoblasts to form bone. The steps of osteogenic proliferation, differentiation, and bone homeostasis are controlled by various markers and signaling pathways. Bone needs to be remodeled to maintain integrity with osteoblasts, which are bone-forming cells, and osteoclasts, which are bone-degrading cells.In this review we considered the major factors and signaling pathways in bone formation; these include fibroblast growth factors (FGFs), bone morphogenetic proteins (BMPs), wingless-type (Wnt) genes, runt-related transcription factor 2 (RUNX2) and osteoblast-specific transcription factor (osterix or OSX). PMID:28367467

  13. [Motor nerves of the face. Surgical and radiologic anatomy of facial paralysis and their surgical repair]. (United States)

    Vacher, C; Cyna-Gorse, F


    Motor innervation of the face depends on the facial nerve for the mobility of the face, on the mandibular nerve, third branch of the trigeminal nerve, which gives the motor innervation of the masticator muscles, and the hypoglossal nerve for the tongue. In case of facial paralysis, the most common palliative surgical techniques are the lengthening temporalis myoplasty (the temporal is innervated by the mandibular nerve) and the hypoglossal-facial anastomosis. The aim of this work is to describe the surgical anatomy of these three nerves and the radiologic anatomy of the facial nerve inside the temporal bone. Then the facial nerve penetrates inside the parotid gland giving a plexus. Four branches of the facial nerve leave the parotid gland: they are called temporal, zygomatic, buccal and marginal which give innervation to the cutaneous muscles of the face. Mandibular nerve gives three branches to the temporal muscles: the anterior, intermediate and posterior deep temporal nerves which penetrate inside the deep aspect of the temporal muscle in front of the infratemporal line. The hypoglossal nerve is only the motor nerve to the tongue. The ansa cervicalis, which is coming from the superficial cervical plexus and joins the hypoglossal nerve in the submandibular area is giving the motor innervation to subhyoid muscles and to the geniohyoid muscle.

  14. Compacted cancellous bone has a spring-back effect

    DEFF Research Database (Denmark)

    Kold, S; Bechtold, JE; Ding, Ming;


    A new surgical technique, compaction, has been shown to improve implant fixation. It has been speculated that the enhanced implant fixation with compaction could be due to a spring-back effect of compacted bone. However, such an effect has yet to be shown. Therefore we investigated in a canine...... model whether implant cavities prepared with compaction had spring back. Before killing the animals, we used one of two surgical techniques to make implant cavities of identical dimensions in both lateral femoral condyles of 7 dogs. One side had the implant cavity prepared with compaction, the other....... Thus we found a spring-back effect of compacted bone, which may be important for increasing implant fixation by reducing initial gaps between the implant and bone....

  15. Guided bone regeneration for fenestration defects in dental implants. (United States)

    Yeh, Hwey-Chin; Hsu, Kuang-Wei


    Guided bone regeneration has been applied in implant dentistry for increasing the width and height of the alveolar ridge in areas with insufficient bone. Various materials and techniques have been used for this purpose. It refers to a surgical procedure by which utilizing a mechanical barrier to create a secluded space around the defect to permit bone regeneration without the competition of other tissues. This report presents a case with buccal fenestrations on maxillary implant sites observed during a surgical procedure. An allograft and a non-resorbable membrane were concomitantly used to increase the width of the alveolar ridge. Hard tissue regeneration was evident clinically. The implants were restored for functioning and followed for 2 years. Factors affecting outcomes are also discussed. Membrane stability and the space-making effect remain the keys to success.

  16. Surgical approaches for minimally invasive plate osteosynthesis in dogs. (United States)

    Pozzi, A; Lewis, D


    Fracture stabilisation techniques continue to evolve and to provide approaches which minimise the iatrogenic trauma associated with surgery. Minimally invasive plate osteosynthesis (MIPO) is a recently described method of biological internal fixation performed by introducing a bone plate via small insertional incisions that are made remote to the fracture site. The plate is slid adjacent to the bone in an epiperiosteal tunnel connecting the two insertional incisions. Screws are placed in the plate through the insertional incisions or via additional stab incisions made over the holes in the plate. In this paper we describe the surgical approaches used to perform MIPO in humeral, radial, femoral and tibial fractures in dogs. We found that these approaches allowed safe insertion of the plate without grossly damaging neuro-vascular structures. Further studies are needed to evaluate the clinical outcome of MIPO in dogs.

  17. Preoperative embolization of primary bone tumors: A case control study (United States)

    Jha, Roushan; Sharma, Raju; Rastogi, Shishir; Khan, Shah Alam; Jayaswal, Arvind; Gamanagatti, Shivanand


    AIM: To study the safety and effectiveness of preoperative embolization of primary bone tumors in relation to intraoperative blood loss, intraoperative blood transfusion volume and surgical time. METHODS: Thirty-three patients underwent preoperative embolization of primary tumors of extremities, hip or vertebrae before resection and stabilization. The primary osseous tumors included giant cell tumors, aneurysmal bone cyst, osteoblastoma, chondroblastoma and chondrosarcoma. Twenty-six patients were included for the statistical analysis (embolization group) as they were operated within 0-48 h within preoperative embolization. A control group (non-embolization group, n = 28) with bone tumor having similar histological diagnosis and operated without embolization was retrieved from hospital record for statistical comparison. RESULTS: The mean intraoperative blood loss was 1300 mL (250-2900 mL), the mean intraoperative blood transfusion was 700 mL (0-1400 mL) and the mean surgical time was 221 ± 76.7 min for embolization group (group I, n = 26). Non-embolization group (group II, n = 28), the mean intraoperative blood loss was 1800 mL (800-6000 mL), the mean intraoperative blood transfusion was 1400 mL (700-8400 mL) and the mean surgical time was 250 ± 69.7 min. On comparison, statistically significant (P < 0.001) difference was found between embolisation group and non-embolisation group for the amount of blood loss and requirement of blood transfusion. There was no statistical difference between the two groups for the surgical time. No patients developed any angiography or embolization related complications. CONCLUSION: Preoperative embolization of bone tumors is a safe and effective adjunct to the surgical management of primary bone tumors that leads to reduction in intraoperative blood loss and blood transfusion volume. PMID:27158424

  18. Outcome of surgical treatment of type IV capitellum frac-

    Directory of Open Access Journals (Sweden)

    Singh Ajay Pal


    Full Text Available 【Abstract】 Objective: Fractures of the capitellum and trochlea constitute less than 1% of all elbow fractures and a shear fracture involving the capitellum and extending medially into most of the trochlea is rarely reported. Type IV capitellum fracture is still controversial in regard to its ra-diographic appearance, surgical approach and osteosynthesis. We report 10 cases of type IV capitellum fracture with a view to elucidating its clinical features and treatment outcome. Methods: We treated 10 patients of type IV capitellum fracture with a mean age of 32 years. A uniform surgical approach and postoperative rehabilitation were followed. Results: Nine patients presented to us after a mean of 4 days of injury and one patient was nonunion after 6 months of injury who had been treated conservatively by a bone setter. Double arc sign was absent in 6 cases. Intraopera-tively 6 capitellotrochlear fragments were devoid of soft Chin J Traumatol 2012;15(4:201-205 DOI: 10.3760/cma.j.issn.1008-1275.2012.04.002 Punjab Civil Medical Services-I Mukerian, Punjab, In-dia (Singh AP Department of Orthopaedics, UCMS & GTB Hospital, Delhi, India (Dhammi IK and Garg V Swami Premanand Hospital, Mukerian, Punjab, India (Singh AP *Corresponding author: Tel: 98-72069734, Email: C oronal shear fractures of distal end of humeral articular surface involve the capitellum and trochlea. These fractures are difficult to assess accurately on plain radiographs and the limited amount of subchondral bone available for stable internal fixation makes the operative treatment equally difficult. 1 Joint stiffness, instability and osteoarthrosis are complications resulting from treatment failures. 2 The major classification systems are proposed by Bryan and Dubberley et al. 3,4 Type IV fracture is a fracture involving the capitellum and extends to more than lateral half of the trochlea. 1 We report an analysis of ten cases of type IV capi-tissue attachments. By

  19. Surgical versus non-surgical treatment of congenital hyperinsulinism. (United States)

    Mazor-Aronovitch, Kineret; Landau, Heddy; Gillis, David


    Congenital hyperinsulinism is a functional disorder of insulin secretion. In its diffuse severe form, it is traditionally treated with over 95% pancreatectomy. However, even after this procedure normoglycemia is not always achieved. Non-surgical therapy with frequent or continuous feeding, medication and close monitoring is another alternative. In this review we compare the two approaches to this condition focusing on early complications, diabetes, neurological outcome and home management issues. Early complications of pancreatectomy include mechanical, metabolic and infectious complications. Non-surgical interventions can be complicated by unwarranted effects of medications and of invasive procedures. Diabetes occurs with both approaches but much less frequently and years later with non-surgical treatment. Regarding neurodevelopmental outcome, most data come from heterogeneous groups. Nevertheless, it appears that outcome is not adversely affected by avoiding surgery. Home management is far more difficult for the non-surgical form. When the non-surgical approach is successful in achieving normoglycemia and parents are highly motivated, this mode of therapy should be considered.

  20. Effects of implant drilling parameters for pilot and twist drills on temperature rise in bone analog and alveolar bones. (United States)

    Chen, Yung-Chuan; Hsiao, Chih-Kun; Ciou, Ji-Sih; Tsai, Yi-Jung; Tu, Yuan-Kun


    This study concerns the effects of different drilling parameters of pilot drills and twist drills on the temperature rise of alveolar bones during dental implant procedures. The drilling parameters studied here include the feed rate and rotation speed of the drill. The bone temperature distribution was analyzed through experiments and numerical simulations of the drilling process. In this study, a three dimensional (3D) elasto-plastic dynamic finite element model (DFEM) was proposed to investigate the effects of drilling parameters on the bone temperature rise. In addition, the FE model is validated with drilling experiments on artificial human bones and porcine alveolar bones. The results indicate that 3D DFEM can effectively simulate the bone temperature rise during the drilling process. During the drilling process with pilot drills or twist drills, the maximum bone temperature occurred in the region of the cancellous bones close to the cortical bones. The feed rate was one of the important factors affecting the time when the maximum bone temperature occurred. Our results also demonstrate that the elevation of bone temperature was reduced as the feed rate increased and the drill speed decreased, which also effectively reduced the risk region of osteonecrosis. These findings can serve as a reference for dentists in choosing drilling parameters for dental implant surgeries.