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Sample records for closed wedge osteotomy

  1. Vertebral Osteotomies in Ankylosing Spondylitis-Comparison of Outcomes Following Closing Wedge Osteotomy versus Opening Wedge Osteotomy: A Systematic Review.

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    Ravinsky, Robert A; Ouellet, Jean-Albert; Brodt, Erika D; Dettori, Joseph R

    2013-04-01

    Study Design Systematic review. Study Rationale To seek out and assess the best quality evidence available comparing opening wedge osteotomy (OWO) and closing wedge osteotomy (CWO) in patients with ankylosing spondylitis to determine whether their results differ with regard to several different subjective and objective outcome measures. Objective The aim of this study is to determine whether there is a difference in subjective and objective outcomes when comparing CWO and OWO in patients with ankylosing spondylitis suffering from clinically significant thoracolumbar kyphosis with respect to quality-of-life assessments, complication risks, and the amount of correction of the spine achieved at follow-up. Methods A systematic review was undertaken of articles published up to July 2012. Electronic databases and reference lists of key articles were searched to identify studies comparing effectiveness and safety outcomes between adult patients with ankylosing spondylitis who received closing wedge versus opening wedge osteotomies. Studies that included pediatric patients, polysegmental osteotomies, or revision procedures were excluded. Two independent reviewers assessed the strength of evidence using the GRADE criteria and disagreements were resolved by consensus. Results From a total of 67 possible citations, 4 retrospective cohorts (class of evidence III) met our inclusion criteria and form the basis for this report. No differences in Oswestry Disability Index, visual analog scale for pain, Scoliosis Research Society (SRS)-24 score, SRS-22 score, and patient satisfaction were reported between the closing and opening wedge groups across two studies. Regarding radiological outcomes following closing versus opening osteotomies, mean change in sagittal vertical axis ranged from 8.9 to 10.8 cm and 8.0 to 10.9 cm, respectively, across three studies; mean change in lumbar lordosis ranged from 36 to 47 degrees and 19 to 41 degrees across four studies; and mean change

  2. Lateral closed wedge osteotomy for cubitus varus deformity

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    Srivastava Amit

    2008-01-01

    Full Text Available Background: Lateral closed wedge (LCW osteotomy is a commonly accepted method for the correction of the cubitus varus deformity. The fixation of osteotomy is required to prevent loss of correction achieved. The fixation of the osteotomy by the two screw and figure of eight wire is not stable enough to maintain the correction achieved during surgery. In this prospective study we supplemented the fixation by Kirschner′s (K- wires for stable fixation and evaluated the results. Materials and Methods: Twenty-one cases of the cubitus varus deformity following supracondylar fractures of the humerus were operated by LCW osteotomy during February 2001 to June 2006. The mean age of the patients at the time of corrective surgery was 8.5 years (range 6.6-14 years. The osteotomy was fixed by two screws with figure of eight tension band wire between them and the fixation was supplemented by passing two to three K-wires from the lateral condyle engaging the proximal medial cortex through the osteotomy site. Result: The mean follow-up period was 2.5 years (range seven months to 3.4 years. The results were assessed as per Morrey criteria. Eighteen cases showed excellent results and three cases showed good results. Two cases had superficial pin tract infection. Conclusion: The additional fixation by K wires controls rotational forces effectively besides angulation and translation forces and maintains the correction achieved peroperatively.

  3. Opening- and Closing-Wedge Distal Femoral Osteotomy

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    Chahla, Jorge; Mitchell, Justin J.; Liechti, Daniel J.; Moatshe, Gilbert; Menge, Travis J.; Dean, Chase S.; LaPrade, Robert F.

    2016-01-01

    Background: Lateral compartment osteoarthritis of the knee can be a challenging pathology in the younger, active population due to limited treatment options and high patient expectations. Distal femoral osteotomy (DFO) has been reported to be a potential treatment option. Purpose: To perform a systematic review on the survival, outcomes, and complications of DFO for treatment of genu valgum with concomitant lateral compartment osteoarthritis of the knee. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of the literature was performed using the Cochrane Database of Systematic Reviews, the Cochrane Central Registry of Controlled Trials, PubMed, and MEDLINE from 1980 to present. Inclusion criteria were as follows: outcomes of opening- and closing-wedge DFOs performed for treatment of genu valgum with concomitant lateral compartment osteoarthritis of the knee, English language, minimum 2-year follow-up, and human studies. Data abstracted from the selected studies included type of osteotomy (opening vs closing), survival rate, patient-reported and radiographic outcomes, and complications. Results: Fourteen studies met the inclusion criteria and were considered for the review. A total of 9 closing-wedge and 5 opening-wedge DFO studies were included. All were retrospective studies and reported good to excellent patient-reported outcomes after DFO. Survival decreased with increasing time from surgery, with 1 study reporting a 100% survival rate at 6.5 years, compared with 21.5% at 20 years in another study. A low rate of complications was reported throughout the review. Conclusion: Highly heterogeneous literature exists for both opening- and closing-wedge DFOs for the treatment of isolated lateral compartment osteoarthritis with valgus malalignment. A mean survival rate of 80% at 10-year follow-up was reported, supporting that this procedure can be a viable treatment option to delay or reduce the need for joint arthroplasty. A low

  4. Total knee arthroplasty after failed high tibial osteotomy: a systematic review of open versus closed wedge osteotomy.

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    Han, Jae Hwi; Yang, Jae-Hyuk; Bhandare, Nikhl N; Suh, Dong Won; Lee, Jong Seong; Chang, Yong Suk; Yeom, Ji Woong; Nha, Kyung Wook

    2016-08-01

    Medial opening wedge high tibial osteotomy (HTO) has become increasingly popular as an alternative to lateral closing wedge osteotomy for the treatment of medial compartment knee osteoarthritis with varus deformity. The present systematic review was conducted to provide an objective analysis of total knee arthroplasty (TKA) outcomes following previous knee osteotomy (medial opening wedge vs. lateral closing wedge). A literature search of online databases (MEDLINE, EMBASE, Cochrane Library database) was made, in addition to manual search of major orthopaedic journals. The methodological quality of each of the studies was assessed on the Newcastle-Ottawa Scale and Effective Practice and Organization of Care. A total of ten studies were included in the review. There were eight studies with Level IV and two studies with Level III evidence. Eight studies reported clinical and radiologic scores. Comparative studies between TKA following medial opening and lateral closing wedge HTO did not demonstrate statistically significant clinical and radiologic differences. The revision rates were similar. However, more technical issues during TKA surgery after lateral closing wedge HTO were mentioned than the medial open wedge group. The quadriceps snip, tibial tubercle osteotomy, and lateral soft tissue release were more frequently needed in the lateral closing wedge HTO group. In addition, because of loss of proximal tibia bone geometry in the lateral closing wedge HTO group, concerns such as tibia stem impingement in the lateral tibial cortex was noted. The present systematic review suggests that TKA after medial opening and lateral closing wedge HTO showed similar performance. Clinical and radiologic outcome including revision rates did not statistically differ from included studies. However, there are more surgical technical concerns in TKA conversion from lateral closing wedge HTO than from the medial opening wedge HTO group. IV.

  5. A reciprocating ledge technique in closing wedge osteotomy for genu valgum in adolescents.

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    Dhar, Shabir Ahmed; Butt, Mohammed Farooq; Mir, Mohammed Ramzan; Dar, Tahir Ahmed; Sultan, Asif

    2009-12-01

    To describe a technique that preserves anterior and posterior alternate ledges in a closing wedge osteotomy. Five patients aged 14 to 19 years underwent a closing wedge osteotomy for genu valgum in 8 limbs using a reciprocating ledge technique. A unicortical wedge of bone was removed, with the anterior and posterior cortices spared. The anterior cortex at the proximal level and the posterior cortex at the distal level were cut through. With a wobbling action, the osteotomy site was rotated, and the distal fragment externally rotated. Manual force was applied to close the osteotomy site ensuring overlapping of the reciprocal ledges. The distal fragment was translated laterally to prevent club deformity. The osteotomy site was held with one or 2 staples. Stability was tested by flexion and extension of knee. All 8 limbs attained bone union within 12 weeks, and full range of motion within a mean of 13 (range, 12-15) weeks. The mean correction of the tibiofemoral angle was 13 degrees. At a mean follow-up of 12 months, all patients were pain-free and none developed club deformity. Sparing reciprocal ledges in a closing wedge osteotomy for genu valgum may increase stability in the flexion-extension axis, enable early range-of-motion exercises, and facilitate early bone union.

  6. Medial Closing-Wedge Distal Femoral Osteotomy for Genu Valgum With Lateral Compartment Disease.

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    Wylie, James D; Maak, Travis G

    2016-12-01

    Lateral compartment disease combined with valgus alignment can lead to progressive knee joint degeneration. In the symptomatic patient with isolated lateral compartment disease, a varus-producing distal femoral osteotomy can unload the diseased lateral compartment. This osteotomy may be combined with other cartilage or meniscal restorative techniques to optimize knee joint preservation and pain relief. The osteotomy can be performed with a medial closing-wedge or lateral opening-wedge technique. Both techniques have been reported to improve knee-related quality of life in patients with lateral compartment disease. Advantages of the medial closing-wedge technique are direct bone apposition leading to inherent stability of the construct, as well as reliable bony healing, and less hardware irritation. Advantages of the lateral opening-wedge technique are a single bony cut and therefore more of an ability to adjust correction intraoperatively. However, this technique requires bone grafting and has a high rate of hardware irritation or removal. We present a surgical technique for the medial closing-wedge distal femoral osteotomy using an anteromedial-distal femoral locking plate.

  7. Midterm results following medial closed wedge distal femoral osteotomy stabilized with a locking internal fixation device.

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    Forkel, Philipp; Achtnich, Andrea; Metzlaff, Sebastian; Zantop, Thore; Petersen, Wolf

    2015-07-01

    Aim of this study was to evaluate the subjective and radiological outcome and to evaluate the complications of a medial closing wedge osteotomy at the femur for lateral osteoarthritis with genu valgum. Twenty-three patients with grade III to IV cartilage damage and valgus knee alignment were treated with medial closing wedge osteotomy at the distal femur. The osteotomy was stabilized with an internal plate fixator. Age varied between 25 and 55 years (mean 47 years). One patient was lost to final follow-up. After 3.5 years, all Knee Osteoarthritis Outcome Score (KOOS) subitems increased significantly. There was no significant difference in the subgroup analysis of KOOS subitems for patients with and without microfracture or age (>50 vs. <50 years). There were no perioperative complications. One patient had an overcorrection. All, but one osteotomy, showed stable bone healing. There was a loss of correction due to delayed bone healing in one case. Possible explanations for this complication were injury of the lateral cortex or smoking. This case required revision with bone graft and an additional lateral plate. In no case, a conversion to an endoprosthesis was necessary. The femoral medial closing wedge osteotomy is a surgical method for improving symptoms of lateral osteoarthritis in the valgus knee. IV.

  8. [Medial closing wedge osteotomy for correction of genu valgum and torsional malalignment].

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    Petersen, W; Forkel, P

    2013-12-01

    Femoral medial closing wedge osteotomy for the correction of valgus malalignment to unload the cartilage in the lateral compartment and/or correction of symptomatic torsional malalignment. Lateral unicompartmental osteoarthritis of the knee with genu valgum in young patients. Symptomatic torsional malalignement of > 30° and genu valgum with medial closing osteotomy of the distal femur (6 men and 17 women). After 3.5-years follow-up, the KOOS increased from 48.4 points to 84.9 points. In one case, there was an early loss of correction, with subsequent revision with bone grafting and lateral osteosynthesis. No peri-or postoperative complications such as infection, thrombosis, and embolism occurred. In 5 cases a torsional osteotomy was performed. The torsional osteotomy was performed 4 times due to chronic patellofemoral instability, and once due to a medial tibiofemoral instability. Healing complications were not observed in this population. Recurrent instability was not observed.

  9. Cubitus varus in adults correction with lateral closing wedge osteotomy and fixation with posterior plating

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    S Pandey

    2012-09-01

    Full Text Available To share the result of lateral closing wedge osteotomy and fixation with posterior reconstruction plate in correction of cubitus varus in adults. It is a retrospective case analysis of 8 cases of cubitus varus in adult treated with lateral closing wedge osteotomy through posterior triceps retracting approach. Internal fixation was done with two posterior reconstruction plates. All cases were from 15 to 29 years of age (mean 22.3 with 3 female and 5 male. All had cubitus varus ranging from 15- 28 deg (mean 20.16 deg due to childhood malunited supracondylar fracture of humerus. Indication for operation was cosmetic reason only. Follow up duration was 4-22 months (mean 12.5 months. All the osteotomy united clinically in mean duration of 9 weeks ( range 8-12 weeks with mean carrying angle 8.33 degree in postoperative phase. There was no loss of motion, no loss of fixation, no surgical site infection, nonunion or neurovascular deficit. Lateral closing wedge corrective osteotomy and fixation with posterior reconstruction plate is easy technique with satisfactory result in correction of cubitus varus in adults. Journal of College of Medical Sciences-Nepal,2012,Vol-8,No-2, 49-53 DOI: http://dx.doi.org/10.3126/jcmsn.v8i2.6839

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

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    Tuli S

    2008-01-01

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

  11. Secondary Subacromial Impingement after Valgus Closing-Wedge Osteotomy for Proximal Humerus Varus

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    Hirotaka Sano

    2015-01-01

    Full Text Available A 31-year-old construction worker had been suffering from both the motion pain and the restriction of elevation in his right shoulder due to severe varus deformity of humeral neck, which occurred after proximal humeral fracture. The angle for shoulder flexion and abduction was restricted to 50 and 80 degrees, respectively. Valgus closing-wedge osteotomy followed by the internal fixation using a locking plate was carried out at 12 months after injury. Postoperatively, the head-shaft angle of the humerus improved from 65 to 138 degrees. Active flexion and abduction angles improved from 80 to 135 degrees and from 50 to 135 degrees, respectively. However, the patient complained from a sharp pain with a clicking sound during shoulder abduction even after removal of the locking plate. Since subacromial steroid injection temporarily relieved his shoulder pain, we assumed that the secondary subacromial impingement was provoked after osteotomy. Thus, arthroscopic subacromial decompression was carried out at 27 months after the initial operation, which finally relieved his symptoms. In the valgus closing-wedge osteotomy, surgeons should pay attention to the condition of subacromial space to avoid causing the secondary subacromial impingement.

  12. Accuracy and initial stability of open- and closed-wedge high tibial osteotomy: a cadaveric RSA study.

    NARCIS (Netherlands)

    Gaasbeek, R.D.A.; Welsing, R.T.C.; Verdonschot, N.J.J.; Rijnberg, W.J.; Loon, C.J.M. van; Kampen, A. van

    2005-01-01

    We analyzed the difference in angle-correction accuracy and initial stability between open-wedge (OWO) and closed-wedge tibial valgus osteotomy (CWO). Five fresh-frozen pairs of human cadaver lower limbs were used; their bone mineral density (BMD) was measured with DEXA and a planned 7 degrees valgu

  13. Modified closing-opening wedge osteotomy for the treatment of sagittal malalignment in thoracolumbar fractures malunion.

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    Bourghli, Anouar; Boissière, Louis; Vital, Jean-Marc; Bourghli, Mohamed Aiman; Almusrea, Khaled; Khoury, Ghassan; Obeid, Ibrahim

    2015-12-01

    Many techniques have been described for the surgical treatment of rigid posttraumatic thoracolumbar kyphosis, but none is well adapted to the modified shape of the wedged vertebra. The study aimed to describe the modified closing-opening wedge osteotomy (MCOWO), a new osteotomy technique that adapts to the triangular shape of the wedged apical vertebra of the deformity. A retrospective assessment of the degree of correction before and after the MCOWO was carried out. Ten patients presenting rigid posttraumatic thoracolumbar kyphosis were enrolled in this study. We used preoperative and postoperative whole spine radiographs to assess the sagittal plane parameters, and computed tomography scan for measurement of the vertebral segment height at the osteotomy level, spinal cord length, aorta length, and fusion rate. Ten patients underwent the MCOWO at T12 or L1. The procedure involves removing the postero-superior triangular corner of the wedged vertebra and transforming it to a shape similar to a trapezoid. The patients' mean age was 36.6±7.5 years, the mean time between the fracture and the surgery was 12.2±5.6 months, and the mean follow-up was 30.6±5 months. In all patients, statistically significant improvement was observed in the sagittal plane after surgery. The thoracolumbar angle improved from 52±6° preoperatively to 7.1±5.7° at the last follow-up. Mean osteotomy angle was 38.1±2.6°, mean spinal cord shortening was 1.2±0.2 cm, and mean aorta lengthening was 2.3±0.4 cm. All the patients showed complete fusion at 2 years, and none required revision surgery. Two patients presented a temporary unilateral weakness that recovered completely within 3 months after the surgery. The MCOWO is an interesting procedure for patients with posttraumatic thoracolumbar kyphosis. The modified osteotomy is adapted to the modified shape of the compressed vertebra. Spinal cord shortening and aorta lengthening were well tolerated in all patients. Copyright © 2015

  14. Comparison of clinical and radiological outcomes between opening-wedge and closing-wedge high tibial osteotomy: A comprehensive meta-analysis

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    Wu, Lingfeng; Lin, Jun; Jin, Zhicheng; Cai, Xiaobin; Gao, Weiyang

    2017-01-01

    High tibial osteotomy (HTO) has been widely used for clinical treatment of osteoarthritis of the medial compartment of the knee, and both opening-wedge and closing-wedge HTO are the most commonly used methods. However, it remains unclear which technique has better clinical and radiological outcomes in practice. To systematically evaluate this issue, we conducted a comprehensive meta-analysis by pooling all available data for the opening-wedge HTO and closing-wedge HTO techniques from the electronic databases including PubMed, Embase, Wed of Science and Cochrane Library. A total of 22 studies encompassing 2582 cases were finally enrolled in the meta-analysis. There was no significant difference regarding surgery time, duration of hospitalization, knee pain VAS, Lysholm score and HSS knee score (clinical outcomes) between the opening-wedge and closing-wedge HTO groups (P > 0.05). However, the opening-wedge HTO group showed wider range of motion than the closing-wedge HTO group (P = 0.003). Moreover, as for Hip-Knee-Ankle angle and mean angle of correction, no significant difference was observed between the opening-wedge and closing-wedge HTO groups (P > 0.05), while the opening-wedge HTO group showed greater posterior tibial slope angle (P < 0.001) and lesser patellar height than the closing-wedge HTO group (P < 0.001). On light of the above analysis, we believe that individualized surgical approach should be introduced based on the clinical characteristics of each patient. PMID:28182736

  15. Comparative evaluation of single-level closing-wedge vertebral osteotomies for the correction of fixed kyphotic deformity of the lumbar spine: a cadaveric study.

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    Li, F; Sagi, H C; Liu, B; Yuan, H A

    2001-11-01

    Anatomic study. To compare spinal osteotomies with respect to obtainable correction and change in anterior height and distance of the spinal column and to describe a modification of the decancellation closing-wedge osteotomy to obtain further correction. Fixed kyphotic deformity of the lumbar spine can cause difficulty with sitting, lying flat, and pain and can pose a risk to adjacent spinal cord and nerves as well as impair respiratory and abdominal function. Various corrective osteotomies have been described. Osteotomies involving decancellation and a closing wedge of the apical vertebra theoretically decrease the risk to anterior vascular structures. Single-level vertebral osteotomies were performed on three groups of fresh-frozen human cadaveric lumbar spines. Group 1 underwent a conventional anterior opening-wedge/posterior closing-wedge osteotomy, Group 2 underwent a conventional decancellation posterior closing-wedge osteotomy, and Group 3 underwent our modified decancellation posterior closing-wedge osteotomy. Sagittal plane angulation as well as anterior height and distance of the spinal column were measured before and after osteotomy. The mean correction was 38 degrees for Group 1, 36 degrees for Group 2, and 49 degrees for Group 3. The mean change in anterior height and distance was 20 and 30 mm, respectively, for Group 1. For Groups 2 and 3 it was only 2-4 mm. The authors recommend single-level posterior decancellation procedures for correction of fixed kyphotic deformities of the thoracolumbar spine to decrease the risk to anterior neurovascular structures. An additional 10-13 degrees of correction can be obtained with the authors' modification.

  16. Progression of medial compartmental osteoarthritis 2-8 years after lateral closing-wedge high tibial osteotomy.

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    Huizinga, M R; Gorter, J; Demmer, A; Bierma-Zeinstra, S M A; Brouwer, R W

    2016-07-07

    The primary purpose of this study is to investigate the progression of medial osteoarthritis (OA) following lateral closing-wedge high tibial osteotomy (HTO). Secondary outcomes included functional and pain scores. This prospective cohort study analysed 298 patients treated with lateral closing-wedge HTO surgery for medial compartmental OA. OA progression was measured by comparing the minimum joint space width (mJSW) and Kellgren-Lawrence (KL) score on radiographs preoperatively and postoperatively. The WOMAC score and NRS score for pain were obtained preoperatively and postoperatively to assess secondary outcomes. Failure was defined as revision surgery; survival was estimated. Mean follow-up was 5.2 ± 1.8 years (range 2-8.5). Mean preoperative mJSW was 3.4 ± 1.6 mm, which changed nonsignificantly (p = 0.51) to 3.4 ± 1.7 mm postoperatively. Mean annual joint space narrowing was 0.02 ± 0.34 mm/year. Progression to 1 KL grade or more was seen in 132 (44 %) patients, and annual risk of KL progression was 8.6 %. No KL progression was seen in 56 % of patients. Mean NRS decreased from 7.3 ± 1.5 to 3.5 ± 2.5 (p < 0.001). WOMAC scores decreased from 48.0 ± 17.2 to 23.6 ± 19.7 (p < 0.001). Failure was seen in 21 patients. Compared to demographic data in the literature, valgus high tibial osteotomy seems to reduce the progression of OA, reduces pain and improves knee function in patients with medial compartment OA and a varus alignment. III.

  17. Comparison of Lateral Closing-Wedge Versus Medial Opening-Wedge High Tibial Osteotomy on Knee Joint Alignment and Kinematics in the ACL-Deficient Knee.

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    Ranawat, Anil S; Nwachukwu, Benedict U; Pearle, Andrew D; Zuiderbaan, Hendrik A; Weeks, Kenneth D; Khamaisy, Saker

    2016-12-01

    Lateral closing-wedge (LCW) and medial opening-wedge (MOW) high tibial osteotomies (HTOs) correct varus knee alignment and stabilize the anterior cruciate ligament (ACL)-deficient knee. Tibiofemoral and patellofemoral alignment and kinematics after HTO are not well quantified. To compare the effect of LCW and MOW HTO on tibiofemoral and patellofemoral alignment in the ACL-deficient knee. Controlled laboratory study. Anterior drawer, Lachman, and pivot-shift tests were performed on cadaveric specimens (N = 16), and anterior tibial translation and tibial rotation were measured for the native and ACL-sectioned knee. The right and left knee of each cadaveric specimen underwent an LCW and MOW HTO, respectively, and stability testing was repeated. All cadavers underwent pre- and postosteotomy computerized tomography with 3-dimensional computer modeling to determine the effect of HTO on posterior tibial slope, as well as tibial and patellofemoral axial plane alignment (tibial axial rotation and patellar axial tilt). Correction to neutral coronal alignment was obtained with both osteotomy techniques; however, larger posterior tibial slope neutralization was achieved with LCW compared with MOW (mean ± SD, 11° ± 3.8° vs 5° ± 5°). LCW demonstrated a greater decrease in anterior tibial translation (P rotation with pivot shift. Relative to MOW, LCW resulted in greater tibial axial rotation and patellar axial tilt (7.7° ± 4° and 5.6° ± 3.9° [LCW], 2.8° ± 2.3° and 2.4° ± 0.9° [MOW], respectively; P rotation and lateral patellar tilt, which may adversely affect the patellofemoral joint. More work is needed to understand the clinical and functional outcome of these biomechanical findings in the ACL-deficient knee. © 2016 The Author(s).

  18. Outcome of Tibial Closing Wedge Osteotomy in 55 Cranial Cruciate Ligament-Deficient Stifles of Small Dogs (<15 kg).

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    Campbell, Kathryn A; Payne, John T; Doornink, Michael T; Haggerty, Jamie

    2016-11-01

    To describe the outcome of cranial closing wedge osteotomy (CWO) of the tibia for treatment of cranial cruciate ligament (CrCL)-deficient stifles in dogs with a body weight of 55 stifles). Medical records (2005-2014), radiographs, and owner questionnaire were used to identify the surgical procedure performed, associated complications and outcome in 45 dogs undergoing CWO in 55 stifles. Data for 55 stifles from 45 dogs were included. Bichon Frise was the most frequent dog breed (n=11). Mean pre- and postoperative tibial plateau angle (TPA) were 36.3° (95% CI 35.1-37.5) and 7.5° (95% CI 6.7-8.2), respectively. Pin and tension bands were placed in 38/55 stifles (69%). The most frequent complication at short-term follow-up (2 weeks) was incisional complications in 8 stifles; all resolved with systemic antibiotic administration alone. Data were available for all stifles at 8 week follow-up with an overall complication occurrence in 16/55 stifles (28%); 1 dog required revision surgery. Tibial osteotomy healing was evident on radiographs at 8 weeks postoperative in 53 stifles (96%), considered complete in 27 stifles, and good in 26 stifles. Follow-up owner questionnaire was available for 36 dogs at a mean of 24 months and 34/36 owners (94%) were satisfied with the procedure and considered their dog had a good quality of life with minimal long-term complications. Dogs with a body weight <15 kg undergoing CWO for treatment of a CrCL-deficient stifle had a good outcome based on clinical status, radiographic evaluation, and owner questionnaire. © Copyright 2016 by The American College of Veterinary Surgeons.

  19. A Combined Closing Wedge Distal Femoral Osteotomy and Medial Reefing Procedure for Recurrent Patellar Dislocation with Genu Valgum.

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    Chang, Chong Bum; Shetty, Gautam M; Lee, Jong Seong; Kim, Young Chan; Kwon, Jae Ho; Nha, Kyung Wook

    2017-07-01

    Recurrent patellar dislocation is often associated with genu valgum. The purpose of this study was to analyze the short-term results of single-incision, closing-wedge distal femoral osteotomy (CWDFO) combined with medial reefing and lateral release for recurrent patellar instability with genu valgum. Combined CWDFO/medial reefing/lateral release was performed on 10 knees. Clinical evaluation was based on pre- and postoperative Knee Society Score (KSS) and Kujala patellofemoral score. Radiographic evaluation was performed with reference to the weight-bearing line (WBL), the femorotibial angle (FTA), and the mechanical lateral distal femoral angles in the knee-standing view. At a mean follow-up of 20±11.7 months (range, 12-42 months), KSS scores improved significantly, from 46.7±5.2 preoperatively to 87±4.4 postoperatively (p<0.001), as did the Kujala score, from 44±8 preoperatively to 86.6±6.8 postoperatively (p<0.001). The WBL decreased significantly, from 76±7% preoperatively to 41±11% postoperatively (p<0.001). The FTA was improved significantly, from 12.7±1.7° preoperatively to 4±4° postoperatively (p<0.001), as was the mLDFA, from 83±4° preoperatively to 91±1.3° postoperatively (p<0.001). Use of single-incision CWDFO combined with medial reefing and lateral release prevents patellar dislocation, corrects deformity, and improves clinical outcomes.

  20. Osteotomy of the knee

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    Proximal tibial osteotomy; Lateral closing wedge osteotomy; High tibial osteotomy; Distal femoral osteotomy ... There are two types of surgery: Tibial osteotomy is surgery done on ... osteotomy is surgery done on the thigh bone above the knee ...

  1. Distal femoral varus osteotomy: problems associated with the lateral open-wedge technique.

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    Jacobi, Matthias; Wahl, Peter; Bouaicha, Samy; Jakob, Roland P; Gautier, Emanuel

    2011-06-01

    Varisation osteotomies on the distal femur are an established treatment method for valgus osteoarthritis of the knee in younger patients. Osteotomy can be done in a lateral open-wedge or medial closed-wedge manner. We retrospectively studied 14 patients treated by the lateral open-wedge technique, fixed with the Tomofix plate, with a mean duration of follow-up of 45 ± 3.4 months. We observed often delayed osteotomy healing after 3, 6 and 12 months, no secondary dislocations, and frequent troublesome irritation due to the plate being on the iliotibial band. However, outcome was satisfactory once the osteotomy healed and the plate was removed. Based on the often slow healing of the osteotomy and frequent irritation due to the plate, this procedure has been abandoned by the authors, and the medial closing-wedge osteotomy adopted as the alternative treatment.

  2. An inexpensive and innovative correction of medial compartmental osteoarthritis knee joint by high tibial lateral closed wedge osteotomy in a rural set up

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    Prasad DV, Arun AA, Tushar Chaudhari, Sagar Jawale, Shakthi Panda, Abhinav Jadhav, Deepak Dathrange

    2014-11-01

    Full Text Available Osteoarthritis of Knee joint with Varus deformity causes considerable disability. Operative treatment aims at shifting the mechanical load bearing axis to the less affected compartment of the knee to relieve the symptoms. Exclusion Criteria: Non-walkers due to generalized arthropathies / medical comorbidities, Flexion deformity > 10 degrees, Range of motion 1cm lateral subluxation in standing A-P X rays of both knees. Methodology: 32 (12 Males and 20 Females cases of Medial compartment osteoarthritis presenting in our OPD between 2008-2012 were treated by HTOand cortical screw and SS wire fixation (TBW Technique. Results: Evaluation of results was done based on knee rating scale by Japanese orthopaedic association. 22 cases were Excellent, 8 cases were good. One case of failure, an iatrogenic intracondylar fracture of Tibia, and another secondary haematoma under the suture line, aspirated and complete healing was achieved. Patients had good range of motion, were able to squat and sit cross legged comfortably. Conclusion: HTO by Closed Medial wedge osteotomy and fixation with cortical screw and SS wire provides a good alternative to unicompartmental knee Arthroplasty and even Total knee Arthroplasty (may be up to 10-15 years in patients with Medial compartmental osteoarthritis. It is a cost effective technique with the use of minimum hardware and early postoperative mobilization in patients who cannot afford Knee Arthroplasty in a Rural set up.

  3. Open wedge metatarsal osteotomy versus crescentic osteotomy to correct severe hallux valgus deformity

    DEFF Research Database (Denmark)

    Wester, Jens Ulrik; Hamborg-Petersen, Ellen; Herold, Niels

    2016-01-01

    BACKGROUND: Different techniques of proximal osteotomies have been introduced to correct severe hallux valgus. The open wedge osteotomy is a newly introduced method for proximal osteotomy. The aim of this prospective randomized study was to compare the radiological and clinical results after...... operation for severe hallux valgus, comparing the open wedge osteotomy to the crescentic osteotomy which is our traditional treatment. METHODS: Forty-five patients with severe hallux valgus (hallux valgus angle >35̊, and intermetatarsal angle >15̊) were included in this study. The treatment was proximal...... open wedge osteotomy and fixation with plate (Hemax), group 1, or operation with proximal crescentic osteotomy and fixation with a 3mm cannulated screw, group 2. The mean age was 52 years (19-71). Forty-one females and four males were included. Clinical and radiological follow-ups were performed 4...

  4. Sagittal osteotomy inclination in medial open-wedge high tibial osteotomy.

    Science.gov (United States)

    Lee, Seung-Yup; Lim, Hong-Chul; Bae, Ji Hoon; Kim, Jae Gyoon; Yun, Se-Hyeok; Yang, Jae-Hyuk; Yoon, Jung-Ro

    2017-03-01

    Unlike postoperative changes in posterior tibial slope after medial open-wedge high tibial osteotomy, sagittal osteotomy inclination has not been examined. It has been recommended that the osteotomy line in the sagittal plane be parallel to the medial posterior tibial slope. The purpose of this study was to determine the frequency of parallel osteotomy in medial open-wedge high tibial osteotomy. To determine the sagittal osteotomy inclination, the angle between the medial joint line and the osteotomy line was measured in the lateral radiograph. A positive angle value indicates that the osteotomy is anteriorly inclined relative to the medial posterior tibial slope. Correlation between the sagittal osteotomy inclination and posterior tibial slope was also evaluated. The mean sagittal osteotomy inclination was 15.1 ± 7.5°. The majority 87.1 % of knees showed an anterior-inclined osteotomy. There was a significantly positive correlation between the postoperative posterior tibial slope and the sagittal osteotomy inclination (r, 0.33; 95 % confidence interval (CI) 0.19-0.46; P osteotomy inclination (r, 0.35; 95 % CI 0.21-0.47; P osteotomy in the sagittal plane relative to the medial joint line was planned, only 12.9 % of cases achieved osteotomy parallel to the medial posterior tibial slope in the sagittal plane. Because of high rate of the anterior-inclined osteotomy and their correlations with posterior tibial slope, surgeons should make all efforts to perform parallel osteotomy relative to medial posterior tibial slope. IV.

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

    Science.gov (United States)

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

    2011-01-01

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

  6. Medial opening wedge distal femoral osteotomy for post-traumatic secondary knee osteoarthritis.

    Science.gov (United States)

    Matsui, Gen; Akiyama, Takenori; Ikemura, Satoshi; Mawatari, Taro

    2014-04-30

    Osteoarthritis of the knee secondary to femoral fracture is difficult to treat. There are some surgical options, such as total knee arthroplasty or correction osteotomy. Opening wedge high tibial osteotomy is an established treatment of gonarthrosis. However, few reports are available on the effectiveness of a medial opening wedge distal femoral osteotomy. We present a case of a medial opening wedge distal femoral osteotomy on gonarthrosis secondary to a malunited femoral fracture with varus deformity and leg length discrepancy. This osteotomy was performed at the deformed femur, with locking plate fixation and autologous bone graft. Six months after the surgery, the osteotomy site was filled with bridging callus. Two years later, the Knee Society Score improved from 45 to 90 points. Medial opening wedge distal femoral osteotomy can be a useful method to treat knee osteoarthritis associated with distal femoral deformity.

  7. Proximal first metatarsal opening wedge osteotomy: geometric analysis on saw bone models.

    Science.gov (United States)

    Kugan, R; Currall, V A; Johal, P; Clark, C I C

    2015-03-01

    For hallux valgus correction, distal first metatarsal osteotomy is generally used for minor to moderate deformities, diaphyseal osteotomy for moderate deformities and basal osteotomy or arthrodesis for severe deformities. With the advent of locking plates, there has been renewed interest in opening wedge basal osteotomy. We undertook this study in order to understand the power and limitations of this osteotomy. Proximal opening wedge osteotomies were performed on saw bone models in four orientations, with three different wedge sizes: (1) perpendicular to the ground (PG); (2) perpendicular to the shaft (PS); (3) perpendicular to shaft with 30° declination (DEC); (4) 30° oblique (OB). Pre- and post-osteotomy measurements were made of axial and plantar translation and inter-metatarsal angle. Plantar translation and intermetatarsal angle correction increased with increasing wedge size. The DEC osteotomy produced the greatest increase in length of metatarsal shaft, while the PS osteotomy gave the least. The most plantar translation was achieved with the DEC osteotomy. Overall, the PS osteotomy gave the largest correction of the intermetatarsal angle. Although there are several published clinical case series of the proximal opening wedge osteotomy, this is the first study to fully evaluate its geometry. Copyright © 2014 Elsevier Ltd. All rights reserved.

  8. First metatarsal proximal opening wedge osteotomy for correction of hallux valgus deformity: comparison of straight versus oblique osteotomy.

    Science.gov (United States)

    Han, Seung Hwan; Park, Eui Hyun; Jo, Joon; Koh, Yong Gon; Lee, Jin Woo; Choi, Woo Jin; Kim, Yong Sang

    2015-05-01

    The aim of this study was to compare clinical and radiographic outcomes of proximal opening wedge osteotomy using a straight versus oblique osteotomy. We retrospectively reviewed 104 consecutive first metatarsal proximal opening wedge osteotomies performed in 95 patients with hallux valgus deformity. Twenty-six feet were treated using straight metatarsal osteotomy (group A), whereas 78 feet were treated using oblique metatarsal osteotomy (group B). The hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle, and distance from the first to the second metatarsal (distance) were measured for radiographic evaluation, whereas the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score was used for clinical evaluation. Significant corrections in the HVA, IMA, and distance from the first to the second metatarsal were obtained in both groups at the last follow-up (posteotomy, an oblique first metatarsal osteotomy yielded better clinical and radiological outcomes.

  9. The use of sternal wedge osteotomy in pectus surgery: when is it necessary?

    Science.gov (United States)

    Kara, Murat; Gundogdu, Ahmet Gokhan; Kadioglu, Salih Zeki; Cayirci, Ertug Can; Taskin, Necati

    2016-09-01

    The Ravitch procedure is a well-established surgical procedure for correction of chest wall deformities. Sternal wedge osteotomy is an important part of this procedure. We studied the incidence of wedge osteotomy with respect to the type of chest wall deformity in patients undergoing surgical correction with the use of a recently developed chest wall stabilization system. A total of 47 patients, 39 (83%) male and 8 (17%) female with a mean age of 14.9 ± 2.1 years, underwent the Ravitch procedure. Twenty-four (51.1%) had pectus carinatum, 19 (40.4%) had pectus excavatum, and 4 (8.5%) had pectus arcuatum. A conventional or oblique sternal wedge osteotomy was performed as indicated, followed by chest wall stabilization using the MedXpert system. Of the 47 patients, 27 (57.4%) had a sternal wedge osteotomy. All cases of pectus arcuatum and redo cases underwent sternal wedge osteotomy. Pectus excavatum cases tended to have a greater incidence of wedge osteotomy compared to pectus carinatum cases (68.4% vs. 41.7%, p = 0.052). Patients with more resected ribs had a greater rate of wedge osteotomy (63.4%) compared to those with fewer resected ribs (16.7%, p = 0.043). A sternal wedge osteotomy is more commonly performed in patients with pectus excavatum compared to those with pectus carinatum. All redo and pectus arcuatum cases need a wedge osteotomy for proper correction. Wedge osteotomy is very likely in more aggressive corrections with more rib resections. © The Author(s) 2016.

  10. Open wedge metatarsal osteotomy versus crescentic osteotomy to correct severe hallux valgus deformity - A prospective comparative study.

    Science.gov (United States)

    Wester, Jens Ulrik; Hamborg-Petersen, Ellen; Herold, Niels; Hansen, Palle Bo; Froekjaer, Johnny

    2016-03-01

    Different techniques of proximal osteotomies have been introduced to correct severe hallux valgus. The open wedge osteotomy is a newly introduced method for proximal osteotomy. The aim of this prospective randomized study was to compare the radiological and clinical results after operation for severe hallux valgus, comparing the open wedge osteotomy to the crescentic osteotomy which is our traditional treatment. Forty-five patients with severe hallux valgus (hallux valgus angle >35̊, and intermetatarsal angle >15̊) were included in this study. The treatment was proximal open wedge osteotomy and fixation with plate (Hemax), group 1, or operation with proximal crescentic osteotomy and fixation with a 3mm cannulated screw, group 2. The mean age was 52 years (19-71). Forty-one females and four males were included. Clinical and radiological follow-ups were performed 4 and 12 months after the operation. In group 1 the hallux valgus angle decreased from 39.0̊ to 24.1̊ after 4 months and 27.9̊ after 12 months. In group 2 the angle decreased from 38.3̊ to 21.4̊ after 4 months and 27.0̊ after 12 months. The intermetatarsal angle in group 1 was 19.0̊ preoperatively, 11.6̊ after 4 months and 12.6̊ after 12 months. In group 2 the mean intermetatarsal angle was 18.9̊ preoperatively, 12.0̊ after 4 months and 12.6̊ after 12 months. The AOFAS score improved from 59.3 to 81.5 in group 1 and from 61.8 to 84.8 in group 2 respectively measured 12 months postoperatively. The relative length of the 1 metatarsal compared to 2 metatarsal bone was 0.88 and 0.87 preoperatively and 0.88 and 0.86 for group 1 and 2 respectively measured after 12 months. Crescentic osteotomy and open wedge osteotomy improve AOFAS score and VAS scores on patients operated with severe hallux valgus. No significant difference was found in the two groups looking at the postoperative improvement of HVA and IMA measured 4 and 12 months postoperatively. The postoperative VAS score and AOFAS score were

  11. Mechanism of bone incorporation of beta-TCP bone substitute in open wedge tibial osteotomy in patients.

    NARCIS (Netherlands)

    Gaasbeek, R.D.A.; Toonen, H.G.; Heerwaarden, R.J. van; Buma, P.

    2005-01-01

    A histological study was performed of bone biopsies from 16 patients (17 biopsies) treated with open wedge high tibial osteotomies for medial knee osteoarthritis. The open wedge osteotomies were filled with a wedge of osteoconductive beta tricalcium phosphate (beta-TCP) ceramic bone replacement. At

  12. Osteotomy configuration of the proximal wedge and analysis of the affecting factors in the medial open-wedge high tibial osteotomy.

    Science.gov (United States)

    Lee, Yong Seuk; Kang, Jong Yeal; Lee, Myung Chul; Elazab, Ashraf; Choi, Uk Hyun; Kang, Seo Goo; Lee, Kyoung Jae; Lee, Sahnghoon

    2017-03-01

    The purposes of this study were (1) to confirm the disparity of the measured thickness at the lateral hinge between anterior-posterior (AP) radiograph and 3D CT image, (2) to evaluate the affecting factors, and (3) to evaluate the differences between uniplanar and biplanar osteotomies. From 2012 to 2014, a prospective comparative study was performed with 30 patients who received uniplanar osteotomy (group I) and 35 patients who received biplanar osteotomy (group II). For measurement of the proximal wedge, postoperative AP radiograph and 3D CT images were used. In the AP radiograph, medial and lateral bony bridge thicknesses were measured. In the 3D CT, the anterior and posterior images parallel to the coronal plane were selected for the evaluation. Coronal osteotomy slope was measured with the anterior image of the 3D CT scan. Sagittal osteotomy slope was measured with the sagittal section of the CT scan. Differences between the lateral bony bridge thicknesses measured in AP radiograph and the posterolateral posterolateral bony bridge thicknesses measured in 3D CT were statistically significant in both groups. Negative correlation was observed in the biplanar osteotomy group. Differences of the sagittal osteotomy slope from the native tibial slope showed negative correlation in the biplanar osteotomy group. Thickness of the posterolateral bony bridge was smaller compared to the observed thickness on the AP radiograph image that is routinely used for the follow-up. The thickness would be getting smaller if osteotomy is performed with an abrupt angle on the coronal plane and reverse slope on the sagittal plane. Therefore, osteotomy with abrupt angle on the coronal plane and reverse slope on the sagittal plane should be avoided for the proper thickness of the posterolateral bony bridge. III.

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

    Directory of Open Access Journals (Sweden)

    Ricardo Hideki Yanasse

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

  14. Open-wedge high tibial osteotomy: incidence of lateral cortex fractures and influence of fixation device on osteotomy healing.

    Science.gov (United States)

    Dexel, Julian; Fritzsche, Hagen; Beyer, Franziska; Harman, Melinda K; Lützner, Jörg

    2017-03-01

    Open-wedge high tibial osteotomy (HTO) is an established treatment for young and middle-aged patients with medial compartment knee osteoarthritis and varus malalignment. Although not intended, a lateral cortex fracture might occur during this procedure. Different fixation devices are available to repair such fractures. This study was performed to evaluate osteotomy healing after fixation with two different locking plates. Sixty-nine medial open-wedge HTO without bone grafting were followed until osteotomy healing. In patients with an intact lateral hinge, no problems were noted with either locking plate. A fracture of the lateral cortex occurred in 21 patients (30.4 %). In ten patients, the fracture was not recognized during surgery but was visible on the radiographs at the 6-week follow-up. Lateral cortex fracture resulted in non-union with the need for surgical treatment in three out of eight (37.5 %) patients using the newly introduced locking plate (Position HTO Maxi Plate), while this did not occur with a well-established locking plate (TomoFix) (0 out of 13, p = 0.023). With regard to other adverse events, no differences between both implants were observed. In cases of lateral cortex fracture, fixation with a smaller locking plate resulted in a relevant number of non-unions. Therefore, it is recommended that bone grafting, another fixation system, or an additional lateral fixation should be used in cases with lateral cortex fracture. III.

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

    OpenAIRE

    Yoo, Moon-Jib; Shin, Yong-Eun

    2016-01-01

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

  16. Hemi-wedge osteotomy in the management of large angular deformities around the knee joint.

    Science.gov (United States)

    El-Alfy, Barakat Sayed

    2016-08-01

    Angular deformity around the knee joint is a common orthopedic problem. Many options are available for the management of such problem with varying degrees of success and failure. The aim of the present study was to assess the results of hemi-wedge osteotomy in the management of big angular deformities about the knee joint. Twenty-eight limbs in 21 patients with large angular deformities around the knee joint were treated by the hemi-wedge osteotomy technique. The ages ranged from 12 to 43 years with an average of 19.8 years. The deformity ranged from 20° to 40° with a mean of 30.39° ± 5.99°. The deformities were genu varum in 12 cases and genu valgum in 9 cases. Seven cases had bilateral deformities. Small wedge was removed from the convex side of the bone and put in the gap created in the other side after correction of the deformity. At the final follow-up, the deformity was corrected in all cases except two. Full range of knee movement was regained in all cases. The complications included superficial wound infection in two cases, overcorrection in one case, pain along the lateral aspect of the knee in one case and recurrence of the deformity in one case. No cases were complicated by nerve injury or vascular injury. Hemi-wedge osteotomy is a good method for treatment of deformities around the knee joint. It can correct large angular deformities without major complications.

  17. Open-wedge osteotomy using an internal plate fixator in patients with medial-compartment gonarthritis and varus malalignment

    DEFF Research Database (Denmark)

    Niemeyer, Philipp; Schmal, Hagen; Hauschild, Oliver

    2010-01-01

    PURPOSE: Our purpose was to evaluate the 3-year clinical results of patients with medial-compartment osteoarthritis of the knee and varus malalignment who underwent open-wedge high tibial osteotomy (HTO) with an internal plate fixator (TomoFix; Synthes, Solothurn, Switzerland). Clinical results...... of patients reported discomfort related to the implant at some point during the follow-up period (40.6%). CONCLUSIONS: Open-wedge osteotomy by use of the TomoFix system leads to reliable 3-year results. Results do not depend on the severity of medial cartilage defects, whereas partial-thickness defects...

  18. Distal femoral opening-wedge osteotomy for lateral compartment osteoarthritis of the knee

    Directory of Open Access Journals (Sweden)

    Dirk HPW Das

    2008-11-01

    Full Text Available Dirk HPW Das1, Thea Sijbesma2, Henk J Hoekstra2, Willem M van Leeuwen21Department of Orthopaedics and Traumatology, Máxima Medisch Centrum Veldhoven, The Netherlands; 2Department of Orthopaedic Surgery, The St Anna Hospital, Geldrop, The NetherlandsAbstract: We retrospectively evaluated 12 patients with lateral gonarthritis after a distal femoral lateral opening osteotomy using a Puddu-plate. Thirteen patients with lateral gonarthritis and genu valgum were operated upon. One patient died during follow-up. We used the Lysholm score and the adapted Hospital for Special Surgery (HSS clinical and functional score. At 34 months follow up, all patients had a functional and clinical evaluation. All patients responded to a questionnaire over the telephone regarding the survival, Lysholm, and functional HSS score at 74 months follow-up. The average age at operation was 52 years. The average correction angle was 11° (16° to 5°. At 34 months follow up, the functional HSS score improved from 58 to 72 points. At 74 months follow up, the Lysholm score improved from 64 to 77 points. The clinical horizon scanning system score improved from 42 points presurgery to 64 postsurgery. Two knees were converted to total knee arthroplasty due to persisting postoperative pain. Lateral supracondylar opening-wedge osteotomy is a satisfying treatment for lateral osteoarthritis of the knee with genu valgum in younger patients.Keywords: lateral gonarthritis, femoral osteotomy, Lysholm score, knee

  19. Posterior wedge osteotomy and debridement for Andersson lesion with severe kyphosis in ankylosing spondylitis.

    Science.gov (United States)

    Liang, Yan; Tang, Xiangyu; Zhao, Yongfei; Wang, Zheng

    2017-03-31

    Andersson lesion is a well-known complication in ankylosing spondylitis. Recently, owing to the worry about the healing of fracture, some scholars advocated additional anterior surgery or other procedures were necessary, which increase the risk of the nerve injury. The purpose of this study is to introduce our experience and to explore the efficacy and feasibility of posterior wedge osteotomy and debridement through Andersson Lesion for surgical treatment of severe kyphosis in ankylosing spondylitis. From January 2012 to January 2014, a retrospective study of 14 Andersson lesion patients with severe kyphosis in ankylosing spondylitis treated with surgery was completed with an at least 2-year follow-up. The debridement procedure, before posterior wedge osteotomy in posterior approach, must scrape all sclerosis bone until healthy cancellous bone appears. Radiographic and clinical results and complications were assessed with an average follow-up of 24 months. The CT scan was obtained preoperatively and at the final follow-up to assess the displacement of the fracture preoperatively, the safety of screw insertion, the healing of the fracture at the final follow-up. The Bridwell interbody fusion grading system was used to assess the healing of the fracture. Local kyphosis was substantially corrected from 51.7 ± 15.6 to 7.1 ± 19.5, with a mean correction of 44°. The global kyphosis (GK) changed from 60.6 ± 28.3 to 20.3 ± 10.3 (P = 0.000). The mean VAS back pain scores decreased from 6.7 ± 0.8 preoperatively to 0.75 ± 0.6 after a 2-year follow-up (P = 0.000). The ODI score improved from 60.56 ± 15.1% preoperatively to 23.46 ± 8.2% after a 2-year follow-up (P = 0.000). The CT scan showed solid fusion at the level of the AL, and no internal fixation loose. All patients achieved grade 1 fusion. No major complication occurred. The posterior wedge osteotomy and debridement through AL can be used to correct the severe

  20. First Metatarsophalangeal Contact Properties Following Proximal Opening Wedge and Scarf Osteotomies for Hallux Valgus Correction: A Biomechanical Study.

    Science.gov (United States)

    Kia, Cameron; Yoshida, Ryu; Cote, Mark; DiVenere, Jessica; Geaney, Lauren E

    2017-04-01

    Proximal opening wedge osteotomy (POWO) is an established procedure for moderate to severe hallux valgus. A common concern of this procedure is that it results in lengthening of the first metatarsal, which could cause increased intra-articular pressure of the first metatarsophalangeal joint (MTP) and may ultimately lead to arthritis because of these altered mechanics. The purpose of this study was to use a cadaveric model to compare intra-articular pressures and articulating contact properties of the MTP joint following either scarf osteotomy or POWO. Fresh-frozen cadaveric below-knee specimens with pre-existing hallux valgus (n = 12) and specimens without hallux valgus (n = 6, control group) were used. The hallux valgus specimens were stratified into 2 groups (n = 6 each): POWO or scarf osteotomy. The groups were matched based on the degree of deformity. Peak intra-articular pressure, force, and area were measured in all normal, preoperative, and postoperative specimens with a simulated weightbearing model. These measurements were made with a pressure transducer placed within the first MTP joint. Postoperatively POWO group had slightly higher contact forces and pressures compared to the scarf group and lower contact forces and pressures than those of the normal group but were not statistically significant ( P > .05). Normal specimens had higher intra-articular force, pressure, and area than postoperative specimens but the difference was not found to be significant. First metatarsal lengthening was found in both the scarf and POWO specimens; however, neither increase was found to be significant ( P > .05). The results from this study show that after operative correction, contact properties of the fist MTP joint among normal, POWO, and scarf osteotomy groups revealed no significant differences. First MTP joints in those with hallux valgus had significantly lower contact force and pressure compared to those without hallux valgus. With little long-term outcomes of

  1. The distal radial decompression osteotomy for ulnar impingement syndrome.

    Science.gov (United States)

    Krimmer, Hermann; Unglaub, Frank; Langer, Martin F; Spies, Christian K

    2016-01-01

    The decompression of the distal radioulnar joint (DRUJ) is performed by ulnar translation of the radial shaft proximal to the sigmoid notch, i.e. detensioning of the distal part of the interosseous membrane (DIOM) while containment of the DRUJ is achieved by closed wedge osteotomy of the radius. The osteotomy shortens the radius which entails detensioning of the triangular fibrocartilage complex (TFCC). Facilitating the modified Henry approach to the distal palmar radius a radial based wedge osteotomy is applied. The proximal osteotomy is proximal to the ulnar head and distal osteotomy is proximal to the sigmoid notch to prevent iatrogenic impingement. Ulnar translation of the radial shaft is performed to loosen the DIOM. The closed wedge osteotomy reduces radial inclination which will foster containment of the DRUJ. Distal radial decompression osteotomy of the DRUJ preserves DRUJ function while relieving painful impingement. Further surgical interventions are not compromised in case of failure.

  2. Lateral closing isosceles triangular osteotomy for the treatment of a post-traumatic cubitus varus deformity in children.

    Science.gov (United States)

    Su, Y; Nan, G

    2016-11-01

    Cubitus varus is the most common late complication of a supracondylar fracture of the humerus in children. Correction can be performed using one of a number of techniques of osteotomy but each has disadvantages. We describe a new technique for correcting post-traumatic cubitus varus using a lateral closing wedge isosceles triangular osteotomy. A lateral closing wedge isosceles triangular osteotomy was performed in 25 patients (15 male and ten female with a mean age of 9.5 years (6 to 12)) between May 2010 and April 2013. All patients had cubitus varus secondary to malunion of a supracondylar fracture, with good function of the elbow and a full range of movement. The osteotomy lines were marked on the bone with an isosceles triangular template made before surgery, after which the osteotomy was performed leaving the medial cortex intact. Fixation was performed using two lateral 2 mm Kirschner (K)-wires and patients were immobilised in an above-elbow plaster. By six to eight weeks callus was present and the wires and cast were removed. Patients were reviewed at four and six weeks, three, six and 12 months and then every two years until skeletal maturity. Clinical and radiographic outcomes were categorised as excellent, good or poor. A total of 23 patients had an excellent and two had a good outcome at a mean final follow-up of 3.4 years (two to four). The mean post-operative carrying angle in the corrected elbow was 11.7° (7° to 18°). One patient fell, displacing the osteotomy, and needed revision of the fixation. No patient had a nerve injury. A lateral isosceles triangular osteotomy and with K-wire fixation is a practical, effective, reliable, safe and simple method of correcting post-traumatic cubitus varus in children. It has inherent stability and excellent cosmesis without prominence of the lateral condyle. Cite this article: Bone Joint J 2016;98-B:1521-5. ©2016 The British Editorial Society of Bone & Joint Surgery.

  3. Comparison of two surgeries in treatment of severe kyphotic deformity caused by ankylosing spondylitis: Transpedicular bivertebrae wedge osteotomy versus one-stage interrupted two-level transpedicular wedge osteotomy.

    Science.gov (United States)

    Zhao, Yongfei; Xu, Hui; Zhang, Yonggang; Wang, Zheng; Zhang, Xuesong; Wang, Yan

    2015-12-01

    To explore a simple and effective surgery for correcting severe kyphotic deformity caused by ankylosing spondylitis (AS). From January 2003 to December 2009, we respectively reviewed 32 patients with severe spinal kyphosis caused by AS with at least 2-year follow-up. Patients were divided into two groups, according to surgical methods: transpedicular bivertebrae wedge osteotomy (Group A) or one-stage interrupted two-level transpedicular wedge osteotomy (Group B). We recorded operating time and blood loss. Variation between pre- and post-operative sagittal imbalance, global spinal alignments (Cobb angle of T1 and L5, TLKA), lumbar lordosis, chin-brow vertical angle, thoracolumbar kyphosis angle in both groups were analyzed. The average operating time was 236 ± 39 min and the average blood loss was 2200 ± 712 ml in Group A, and 252 ± 43 min, 2202 ± 737 ml respectively in Group B. There were no significant differences in operating time and blood loss. Variation between pre- and post-operative sagittal imbalance, global spinal alignments, lumbar lordosis and chin-brow vertical angle (CBVA) were comparable between the two groups. The variation of thoracolumbar kyphosis angle was significantly greater in Group B compared with Group A. SRS-22 scores were similar in the two groups at the 2-year follow-up and significantly improved compared with preoperative. For correcting severe kyphosis in patients with AS, the one-stage interrupted two-level transpedicular wedge osteotomy is a safe and effective technique which can significantly improve the thoracolumbar kyphosis angle. Copyright © 2015 Elsevier B.V. All rights reserved.

  4. Modyfied wedge osteotomy for osteoarthritis of elbow secondary to osteochondritis dissecans in adolecent with multiple epiphyseal dysplasia. A case report.

    Science.gov (United States)

    Yoshida, Takashi; Kim, Wook-Cheol; Oka, Yoshinobu; Nakase, Masashi; Nishida, Atsushi; Wada, Hiroaki; Arai, Yuji; Kubo, Toshikazu

    2017-12-01

    Multiple epiphyseal dysplasia (MED) may be complicated by osteochondritis dissecans (OCD), most commonly reported in the knee, but involvement of the elbow is very rare. Optimal treatment for MED-associated elbow OCD and treatment outcome have not been established. This report describes the case of an adolescent male patient with elbow OCD treated by arthroscopic drilling at a previous clinic. Progression of osteoarthritis and radial head subluxation were observed. Resection of the osteophytes and modified wedge osteotomy of the lateral condyle were then performed, and a favorable result was obtained by decompression and sufficient congruency of the radiohumeral joint.

  5. Medial opening wedge high tibial osteotomy alters knee moments in multiple planes during walking and stair ascent.

    Science.gov (United States)

    Leitch, Kristyn M; Birmingham, Trevor B; Dunning, Cynthia E; Giffin, J Robert

    2015-07-01

    Medial opening wedge high tibial osteotomy is a surgical procedure intended to redistribute loads on the knee in patients with medial compartment knee osteoarthritis (OA). The surgery may affect moments in multiple planes during ambulation, with potential beneficial or detrimental effects on joint loads. The objective of this study was to investigate three-dimensional external knee moments before and after medial opening wedge high tibial osteotomy during level walking and during stair ascent. Fourteen patients with varus alignment and osteoarthritis primarily affecting the medial compartment of the tibiofemoral joint were assessed. Three-dimensional motion analyses during level walking and stair ascent was evaluated using inverse dynamics before, 6 and 12 months after surgery. Mean changes at 12 months suggested decreases in the peak knee adduction, flexion and internal rotation moments, with standardized response means ranging from 0.15 to 2.54. These decreases were observed despite increases in speed. Changes in alignment were associated with changes in the adduction and internal rotation moments, but not the flexion moment. Both pre- and postoperatively, the peak knee adduction moment was significantly lower (p=0.001) during stair ascent than during level walking, while the flexion and internal rotation moments were significantly higher (pplanes of motion during ambulation, suggesting substantial alterations of the loads on the knee during ambulation.

  6. The prevention of a lateral hinge fracture as a complication of a medial opening wedge high tibial osteotomy: a case control study.

    Science.gov (United States)

    Ogawa, H; Matsumoto, K; Akiyama, H

    2017-07-01

    We aimed to investigate factors related to the technique of medial opening wedge high tibial osteotomy which might predispose to the development of a lateral hinge fracture. A total of 71 patients with 82 osteotomies were included in the study. Their mean age was 62.9 years (37 to 80). The classification of the type of osteotomy was based on whether it extended beyond the fibular head. The level of the osteotomy was classified according to the height of its endpoint. At a mean follow-up of 20 months (6 to 52), a total of 15 lateral hinge fractures (18.3%) were identified. A sufficient osteotomy, in which both anterior and posterior tibial cortices were involved with extension into the lateral aspect of the plateau in relation to an anteroposterior line tangential to the medial edge of the fibular head in the CT axial plane, was seen in 48 knees (71.6%) in those without a lateral hinge fracture and in seven (46.7%) in those with a lateral hinge fracture. An osteotomy which ended above the level of the fibular head was seen in nine (13.4%) of the knees without a lateral hinge fracture and seven (46.7%) of the those with a lateral hinge fracture. There was a significant relationship between the absence of a lateral hinge fracture and both a sufficient osteotomy and one whose endpoint was at the level of the fibular head (p = 0.0451 and p = 0.0214, respectively). A sufficient osteotomy involving both the anterior and posterior cortices, whose endpoint is at the level of the fibular head, should be performed when undertaking a medial opening wedge high tibial osteotomy if a lateral hinge fracture is to be avoided as a complication. Cite this article: Bone Joint J 2017;99-B:887-93. ©2017 The British Editorial Society of Bone & Joint Surgery.

  7. Comparison between two angular stable locking plates for medial opening-wedge high tibial osteotomy: Decisive wedge locking plate versus TomoFix™.

    Science.gov (United States)

    Shin, Young-Soo; Kim, Keong-Ho; Sim, Hyun-Bo; Yoon, Jung-Ro

    2016-11-01

    An adequate stable fixation implant should be used for medial opening-wedge high tibial osteotomy (MOWHTO) to promote rapid bone healing without complications. This study compared the radiographic and clinical outcomes as well as plate-specific complications between two angular stable locking plates in patients following MOWHTO. This prospective study involved 97 patients (50 with DWL(®), group I; 47 with TomoFix™, group II) undergoing MOWHTO for primary medial compartment osteoarthritis between 2010 and 2013. Clinical and radiographic evaluations were performed by using the HSS and WOMAC scores, and calculating mechanical femorotibial angle (mFTA), medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), and posterior tibial slope (PTS) on radiographs both preoperatively and after 3 years. A statistically significant difference was observed for the MPTA at the last follow-up between the two groups (P = 0.033). Additionally, the last follow-up MPTA of group I was associated with the osteotomy technique (P = 0.004) and preoperative JLCA (P = 0.034) whereas the last follow-up MPTA of group II was associated with gender (P = 0.001) and BMI (P = 0.008). Furthermore, the results showed that group I had a higher rate of non-union (4%) compared to that in group II (0%). Both locking plates are useful tools in the treatment of medial compartment knee osteoarthritis with varus deformity in young, active patients. However, under special consideration of the complication we found in present study, the TomoFix™ seems to be a better alternative in using the MOWHTO for highly demanding patients. Copyright © 2016 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

  8. Radial head dislocation during proximal radial shaft osteotomy.

    Science.gov (United States)

    Hazel, Antony; Bindra, Randy R

    2014-03-01

    The following case report describes a 48-year-old female patient with a longstanding both-bone forearm malunion, who underwent osteotomies of both the radius and ulna to improve symptoms of pain and lack of rotation at the wrist. The osteotomies were templated preoperatively. During surgery, after performing the planned radial shaft osteotomy, the authors recognized that the radial head was subluxated. The osteotomy was then revised from an opening wedge to a closing wedge with improvement of alignment and rotation. The case report discusses the details of the operation, as well as ways in which to avoid similar shortcomings in the future.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2015-03-15

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

  10. Acetabular Remodeling and Role of Osteotomy After Closed Reduction of Developmental Dysplasia of the Hip.

    Science.gov (United States)

    Shin, Chang Ho; Yoo, Won Joon; Park, Moon Seok; Kim, Jun Ho; Choi, In Ho; Cho, Tae-Joon

    2016-06-01

    The purposes of this study were to evaluate acetabular remodeling after closed reduction of developmental dysplasia of the hip (DDH) and to delineate the role of osteotomy. Eighty-four hips with DDH treated with closed reduction and followed until the patient was 8 years of age or older were included in this study. The mean age at closed reduction was 14.0 months (range, 3 to 30 months) and that at the latest follow-up visit was 12.7 years (range, 8.0 to 24.7 years). Osteotomy was performed in 26 hips (31%) during the follow-up period, at an average age of 2.8 years (range, 2.0 to 5.8 years). The acetabular index (AI) and center-edge angle (CEA) were measured, and osteonecrosis was graded. The treatment outcome was evaluated as satisfactory (Severin grade I or II) or unsatisfactory (III or IV). We retrospectively analyzed the associations among radiographic parameters, performance of osteotomy, grade of osteonecrosis, and final outcome. A satisfactory outcome was observed in 67 (80%) of the 84 hips. An osteotomy was not performed in 30 of 34 hips with an AI of 14° at the age of 3 years, and 28 (93%) of these 30 hips showed a satisfactory outcome. Of the 33 hips with an AI of ≥32° and a CEA of ≤14° at the age of 3 years, the 20 that had undergone an osteotomy showed a higher proportion of satisfactory outcomes than the 13 hips that had not (p = 0.01). Three of the 4 hips that showed an unsatisfactory outcome following an osteotomy had an AI of ≥34° at 1 year post-osteotomy. Grade-II, III, or IV osteonecrosis, according to the Bucholz-Ogden classification, developed in 10 of the 84 hips, and these 10 hips had a higher proportion of unsatisfactory outcomes than did those that developed no or grade-I osteonecrosis (p = 0.004). Hips with DDH showing poor acetabular remodeling after closed reduction may benefit from osteotomy. The AI and CEA at the age of 3 years can serve as one of the guidelines for osteotomy. Continued surveillance for acetabular remodeling

  11. Intraoperative adjustment of alignment under valgus stress reduces outliers in patients undergoing medial opening-wedge high tibial osteotomy.

    Science.gov (United States)

    Kim, Man Soo; Son, Jong Min; Koh, In Jun; Bahk, Ji Hoon; In, Yong

    2017-08-01

    A considerable percentage of outliers with under- or over-correction continue to be reported despite precise preoperative planning and cautious intraoperative correction of lower limb alignment in medial opening-wedge high tibial osteotomy (MOWHTO). The purpose of this study was to determine whether our novel technique for the intraoperative adjustment of alignment under valgus stress reduces the number of outliers in patients undergoing MOWHTO compared to the conventional technique, which corrects alignment according to the cable method only. One hundred seventeen consecutive knees were enrolled in this case-control study. The first 52 knees (51 patients) were corrected in accordance with preoperative plans using the Dugdale method with modification with an intraoperative cable (group 1). In the other 65 knees (60 patients), the angle was corrected using the Dugdale method and limb alignment was adjusted using the intraoperative cable technique by applying valgus stress to the knee joint (group 2). The postoperative weight bearing line ratios and mechanical axis of the lower limb were compared at postoperative one year. Each knee was evaluated according to the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score preoperatively and at postoperative one year. A significant reduction in the number of outliers was seen in group 2 compared to group 1 (group 1 = 48.1%, group 2 = 9.2%, p outliers compared to a technique that corrected alignment using the cable method in patients undergoing MOWHTO. Level III, retrospective comparative study.

  12. Modified Dwyer osteotomy with rotation and reinsertion of autograft bone wedge for residual heel deformity despite previous delayed subtalar joint arthrodesis after calcaneal fracture.

    Science.gov (United States)

    Boffeli, Troy J; Abben, Kyle W

    2014-01-01

    Calcaneal fracture patterns vary widely, and many factors determine the type and timing of the treatment rendered. Severe calcaneus fractures involving joint damage, loss of heel height, and varus deformity of the tuberosity are ideally treated with open reduction and internal fixation to repair the joint surface and re-establish anatomic structure. This is not always possible owing to delayed presentation, soft tissue compromise, unrelated injuries, unstable medical condition, or lack of expertise by the treating physician. We present the case of a patient who had residual forefoot and rearfoot deformity despite undergoing delayed subtalar joint arthrodesis at an outside hospital 10 years before for a calcaneal fracture that was initially treated nonoperatively. At 4 years of follow-up after modified Dwyer calcaneal osteotomy with rotation and reinsertion of the autograft bone wedge and Cotton midfoot osteotomy, the postoperative gait was relatively normal, other than the expected lack of hindfoot mobility. The lateral column pain was resolved. The patient remained highly satisfied with the outcome at long-term follow-up of 48 months, with improved heel alignment, lack of a wide stance gait, a functional medial column, and a relatively normal gait. This case demonstrates the value of periarticular calcaneal osteotomies without the need to revise the subtalar joint arthrodesis for this challenging clinical situation. Copyright © 2014 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  13. ACL injury while jumping rope in a patient with an unintended increase in the tibial slope after an opening wedge high tibial osteotomy.

    Science.gov (United States)

    Jung, Kwang Am; Lee, Su Chan; Hwang, Seung Hyun; Song, Moon Bok

    2009-08-01

    High tibial osteotomy (HTO) is an accepted surgical technique for the treatment of medial compartmental arthrosis of the knee in younger patients. Compared to total knee arthroplasty, HTO may be a good choice in patients who wish to continue with heavy labor and/or impact sports. Based on the rehabilitation protocol after HTO, impact sports, such as running, jumping rope, and full sports activities, are generally permitted 6 months postoperatively. Jumping rope is an excellent form of aerobic exercise, and when done properly, jumping rope can lead to a dramatic improvement in rehabilitation and full sports activities. However, an adequate evaluation should be performed prior to initiating impact sports. We present the case of a ruptured anterior cruciate ligament that occurred in a patient with an unintended increase in the tibial slope after an opening wedge HTO who was jumping rope.

  14. Supramalleolar Osteotomies for Posttraumatic Malalignment of the Distal Tibia.

    Science.gov (United States)

    Krause, Fabian; Veljkovic, Andrea; Schmid, Timo

    2016-03-01

    Supramalleolar osteotomies of the tibia (SMOT) for posttraumatic distal tibial malalignment has shown to reduce pain, improve function and radiographic signs of osteoarthritis, and delay ankle arthrodesis or total joint replacement. The procedure also protects the articular cartilage from further degenerative processes by shifting and redistributing loads in the ankle joint. It is technically demanding and requires extensive preoperative planning. The type of osteotomy (opening vs closing wedge) does not influence the final outcome. However, based on the limited evidence, a grade I treatment recommendation has been given for supramalleolar osteotomies of the tibia to treat mild to moderate ankle arthritis in the presence of distal tibial malalignment.

  15. The use of recombinant human bone morphogenetic protein-2 for the treatment of a delayed union following femoral neck open-wedge osteotomy

    Directory of Open Access Journals (Sweden)

    Axel W.A. Baltzer

    2012-03-01

    Full Text Available Although the clinical potential of bone morphogenetic proteins (BMPs has been known for decades, their use in humans has only been approved for a limited number of orthopaedic conditions. Promising results in animals demonstrate the utility of BMP-2 in regional bone repair without using osteoconductors. To our knowledge, no comparable human case has been described. We report the case of a 50- year-old who suffered a femoral neck fracture. After 9 months of extensive treatment, he was still not pain-free. The following open-wedge osteotomy resulted in a therapy-resistant delayed union. We therefore conducted 4 computer tomography-guided injections of recombinant human (rh BMP-2 into the bone gap. No osteoconductor was employed. Six weeks later, there was a 55-60% defect filling. Followup examination showed a complete union of the bone defect. Our case report shows that in a complicated delayed union rhBMP-2 can be successfully used to induce bone formation without any osteoconductor.

  16. Relaxation of the MCL after an Open-Wedge High Tibial Osteotomy results in decreasing contact pressures of the knee over time.

    Science.gov (United States)

    van Egmond, N; Hannink, G; Janssen, D; Vrancken, A C; Verdonschot, N; van Kampen, A

    2017-03-01

    The objective of this study was to investigate the effect of a medial open-wedge osteotomy (OWO) and the release of the superficial medial collateral ligament (MCL) on the tibiofemoral cartilage pressure, the MCL tension and the valgus laxity of the knee. Seven fresh-frozen, human cadaveric knees were used. Medial and lateral mean contact pressure (CP), peak contact pressure (peakCP), and contact area (CA) were measured using a pressure-sensitive film (I-Scan; Tekscan, Boston, MA). The MCL tension was measured using a custom-made device. These measurements were continuously recorded for 5 min after an OWO of 10°. After the osteotomy, the valgus laxity was measured with a handheld Newtonmeter. For one knee, the measurements were continued for 24 h. At the end, a complete release of the superficial MCL was performed and the measurements were repeated at 10°. There was relaxation of the MCL after the osteotomy; the tension dropped in 5 min with 10.7% (mean difference 20.5 N (95% CI 16.1-24.9)), and in 24 h, the tension decreased by 24.2% (absolute difference 38.8 N) (one knee). After the osteotomy, the mean CP, peakCP and CA increased in the medial compartment (absolute difference 0.17 MPa (95% CI 0.14-0.20), 0.27 MPa (95% CI 0.24-0.30), 132.9mm(2) (95% CI 67.7-198.2), respectively), and decreased in the lateral compartment (absolute difference 0.02 MPa (95% CI 0.03 -0.01), 0.08 MPa (95% CI 0.11 - 0.04), 47.0 mm(2) (95% CI -105.8 to 11.8), respectively). Only after a release of the superficial MCL, the mean CP, peak CP and CA significantly decreased in the medial compartment (absolute difference 0.17, 0.27 MPa, 119.8 mm(2), respectively), and increased in the lateral compartment (absolute difference 0.02, 0.11 MPa, 52.4 mm(2), respectively). After the release of the superficial MCL, a mean increase of 7.9° [mean difference - 0.1° (95% CI -1.9 to 1.6)] of the valgus laxity was found. A release of the superficial MCL helps achieve the goal of

  17. High tibial osteotomy in varus knees: indications and limits

    Science.gov (United States)

    LOIA, MARCO CORGIAT; VANNI, STEFANIA; ROSSO, FEDERICA; BONASIA, DAVIDE EDOARDO; BRUZZONE, MATTEO; DETTONI, FEDERICO; ROSSI, ROBERTO

    2016-01-01

    Opening wedge high tibial osteotomy (OWHTO) is a surgical procedure that aims to correct the weight-bearing axis of the knee, moving the loads laterally from the medial compartment. Conventional indications for OWHTO are medial compartment osteoarthritis and varus malalignment of the knee; recently OWHTO has been used successfully in the treatment of double and triple varus. OWHTO, in contrast to closing wedge high tibial osteotomy, does not require fibular osteotomy or peroneal nerve dissection, or lead to disruption of the proximal tibiofibular joint and bone stock loss. For these reasons, interest in this procedure has grown in recent years. The aim of this study is to review the literature on OWHTO, considering indications and prognostic factors (body mass index, grade of osteoarthritis, instability, range of movement and age), outcomes at mid-term follow-up, and limits of the procedure (slope modifications, patellar height changes and difficulties in conversion to a total knee arthroplasty). PMID:27602350

  18. Asymmetric osteotomy of the spine for coronal imbalance: a technical report.

    Science.gov (United States)

    Thambiraj, Sathya; Boszczyk, Bronek M

    2012-05-01

    Technical report on the surgical technique of asymmetric osteotomy of the spine for coronal imbalance. To describe a successful method of performing asymmetrical pedicle subtraction osteotomy (APSO) through a posterior only approach. Rigid coronal deformity of the spine can be sharply angulated and can create significant coronal imbalance. Surgical correction is the only definitive treatment of restoring the balance as bracing is unhelpful. Corrective surgery can be anterior or posterior. The literature on the methods of surgical correction of rigid coronal deformities of the spine is limited. Unlike osteotomies for sagittal imbalance, blunt dissection of the anterior cortex is necessary in asymmetrical osteotomy to allow resection of the anterior cortex for closure of the wedge. We describe a method by which we performed this in the thoracic and lumbar spine with case examples. After insertion of pedicle screws, laminectomy and unilateral facetectomy of the proposed level of osteotomy is performed. Next, dissection lateral to the pedicle and vertebral body is performed bluntly with mastoids to reach the front of the anterior cortex and confirmed with fluoroscopy. An oblique osteotomy including the lateral and posterior cortex is performed above and below the pedicle under imaging. The osteotomy site is closed through unilateral compression. Satisfactory correction of coronal deformity can be achieved with APSO from an isolated posterior approach. In contrast to sagittal osteotomies, blunt dissection along the anterior cortex is necessary to allow safe resection of anterior cortical bone for closure of the wedge.

  19. Effect of the Osteotomy Length on the Change of the Posterior Tibial Slope With a Simple Distraction of the Posterior Gap in the Uni- and Biplanar Open-Wedge High Tibial Osteotomy.

    Science.gov (United States)

    Lee, Yong Seuk; Kang, Jong Yeal; Lee, Myung Chul; Oh, Won Seok; Elazab, Ashraf; Song, Min Kyu

    2016-02-01

    To (1) determine the length of the osteotomy at the anterior and posterior cortex, (2) compare between uni- and biplanar osteotomy, and (3) evaluate the relationship between the extent of the osteotomy and change of the posterior tibial slope. A prospective comparative study of 24 uniplanar and 30 biplanar osteotomies was performed. To evaluate the length of osteotomy, osteotomy lines of the anterior and posterior cortex were analyzed in the 3-dimensional surface models. For slope measurement, the intramedullary axis of the proximal tibia (slope P), posterior cortical line of the proximal tibia (slope C), and anterior cortical line of the proximal fibula (slope F) were used. An analysis of the changes in the posterior tibial slope was performed independently using a pre- and postoperative lateral plane radiograph. In the uniplanar osteotomy, ratios of the osteotomized length to the total cortical length aligned with the osteotomized plane were larger in the anterior cortex (0.91 in uniplanar v 0.46 in biplanar; P = 0) and posterior cortex (0.97 in uniplanar v 0.79 ratio in biplanar; P = 0). Furthermore, the posterior tibial slope was maintained in both groups and the ratios between the anterior and posterior gap in both groups were 0.57 and 0.63, respectively. The maintenance of the slope was not related to any specific variables. Additionally, these phenomena did not differ between those patients who underwent uni- and those who underwent biplanar osteotomy. Increase in the posterior tibial slope was prevented with appropriate uni- or biplanar osteotomy with a simple distraction at the most posterior gap. However, in the uniplanar osteotomy, the ratio of the osteotomized length to the total cortical length was larger in both the anterior and posterior cortex. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  20. Patellofemoral Osteoarthritis Progression and Alignment Changes after Open-Wedge High Tibial Osteotomy Do Not Affect Clinical Outcomes at Mid-term Follow-up.

    Science.gov (United States)

    Goshima, Kenichi; Sawaguchi, Takeshi; Shigemoto, Kenji; Iwai, Shintaro; Nakanishi, Akira; Ueoka, Ken

    2017-10-01

    To evaluate the clinical and radiological outcomes of open-wedge high tibial osteotomy (OWHTO) with respect to the patellofemoral joint and to assess whether patellofemoral osteoarthritis (OA) progression and alignment changes after OWHTO affect clinical outcomes. Inclusion criteria were consecutive patients who underwent OWHTO from March 2005 to September 2013. Exclusion criteria were loss to follow-up within 2 years and absence of second-look arthroscopy findings at the time of plate removal. The clinical parameters, including anterior knee pain while climbing stairs, Japanese Orthopedic Association score, and Oxford Knee Score, were evaluated. Radiological outcomes, including weight-bearing line ratio, modified Blackburne-Peel ratio, posterior tibial slope, tilting angle, lateral shift ratio, and patellofemoral OA (Kellgren-Lawrence grade), were evaluated preoperatively and at the final follow-up. Cartilage status (International Cartilage Repair Society grade) was evaluated at the initial HTO and at plate removal. Fifty-three patients (60 knees) were included in this study. The mean follow-up was 58.2 ± 22.4 months. Two knees (3%) presented with mild anterior knee pain after OWHTO. The mean Japanese Orthopedic Association score (66.9 ± 11.2 to 91.2 ± 9.7) significantly improved (P < .001), and the mean Oxford Knee Score at the final follow-up was 42.0 ± 5.3. The mean modified Blackburne-Peel ratio (0.9 ± 0.1 to 0.7 ± 0.1, P < .001) and tilting angle (6.8 ± 3.7 to 5.6 ± 3.4, P = .033) significantly decreased after OWHTO, whereas no significant changes in posterior tibial slope (P = .511) and lateral shift ratio (P = .522) were observed. Radiologically, patellofemoral OA had progressed in 15 knees (27%), and arthroscopically patellofemoral cartilage degeneration had progressed in 27 knees (45%). However, there was no significant correlation between changes in patellofemoral alignment and clinical outcomes. Changes in patellofemoral alignment and

  1. Avaliação radiográfica da osteotomia proximal de abertura gradual da tíbia Radiographic assessment of the opening wedge proximal tibial osteotomy

    Directory of Open Access Journals (Sweden)

    Carlos Francisco Bittencourt Silva

    2010-01-01

    Full Text Available OBJETIVO: Avaliar radiograficamente indivíduos submetidos à osteotomia de abertura gradual da tíbia proximal com o objetivo de analisar a inclinação tibial proximal no plano frontal e no plano sagital e a altura patelar. MÉTODO: Foram incluídos no estudo 22 indivíduos operados no Instituto Nacional de Traumatologia e Ortopedia (INTO para correção do desvio angular em varo da tíbia pela técnica de osteotomia de abertura gradual (OAG com fixador externo monolateral da Orthofix. Foram analisados pacientes submetidos à OAG com término de tratamento entre janeiro de 2000 e dezembro de 2006. A técnica utilizada para a mensuração dos valores foi obtida através de radiografias em AP com carga e perfil com flexão a 30º dos joelhos operados. RESULTADOS: Não houve diferenças entre os valores dos índices de altura patelar e inclinação tibial pré-operatórios e pós-operatórios de significância estatística nos pacientes avaliados. CONCLUSÃO: A osteotomia tibial de abertura gradual representa uma técnica que evita os problemas apresentados pela osteotomia tibial proximal alta, pois ela é realizada sem promover alterações do mecanismo extensor, desequilíbrio ligamentar ou distorções na tíbia proximal.OBJETIVO: To radiographically evaluate patients who underwent opening wedge proximal tibial osteotomy in order to analyze the proximal tibial slope in the frontal plane, sagittal plane, and patellar height. METHOD: The study included 22 patients operated on at the Instituto Nacional de Traumatologia e Ortopedia (INTO for the correction of varus angular tibial deviation using the opening wedge osteotomy (OWO technique with the Orthofix monolateral external fixator. We analyzed patients with OWO having completed treatment between January 2000 and December 2006. Values were measured by using X-rays of the anteroposterior profile with load and lateral profile with 30º flexion of the operated knees. RESULTS: No statistically

  2. Osteotomia alta da tíbia com cunha de abertura medial: relevância biomecânica da cortical oposta Open wedge tibial osteotomy: biomechanical relevance of the opposite cortex for the fixation method

    Directory of Open Access Journals (Sweden)

    Rafael Lara de Freitas

    2010-01-01

    Full Text Available OBJETIVO: Avaliar o impacto da integridade da cortical lateral osteo-tomia alta de tíbia (OAT com cunha de abertura. MÉTODOS: Modelos experimentais artificiais em poliuretano foram fixados com placa DCP® 4,5mm. Cunhas de abertura foram confeccionadas para simular a distração da osteotomia alta da tíbia. Realizadas falhas na cortical lateral para simular fraturas e fixadas com diferentes tipos de parafusos. Ensaios de torção e compressão axial foram realizados. 04 diferentes grupos foram constituídos. RESULTADOS: As medidas de torção registradas no grupo com cortical íntegra foram superiores àquelas obtidas no grupo com cortical rompida (p0,05. As medidas de compressão obtidas no grupo com cortical íntegra foram superiores aos demais grupos (p0,05. CONCLUSÃO: A cortical lateral íntegra agrega estabilidade às osteotomias com cunha de abertura medial. Modelo com cortical íntegra evidenciou superioridade biomecânica em rigidez nos ensaios de torção e compressão. Nos ensaios torcionais, os modelos com falha de continuidade cortical com parafusos de estabilização lateral de compressão ou de posição apresentaram equivalência aos modelos com cortical íntegra.OBJECTIVE: To evaluate the role of lateral tibial cortex integrity in open wedge tibial osteotomy (OWTO. METHODS: Experimental models of polyurethane fibers, simulating tibial models and modified with open wedge osteotomies were fixed with DCP® straight 4.5 mm plates. Four groups were constituted: two with cortical integrity and two with a gap in the lateral tibial cortex. Biomechanical analysis of torsion and axial compression were performed. RESULTS: The measures of twist recorded in the group with cortical integrity were higher than those obtained in the group with noncontinuous cortices (p 0.05. CONCLUSION: Integrity of lateral tibial cortex adds stability to open wedge tibial osteotomies. Models with lateral cortical integrity demonstrated superiority in

  3. Combined intra-articular and varus opening wedge osteotomy for lateral depression and valgus malunion of the proximal part of the tibia. Surgical technique

    NARCIS (Netherlands)

    Kerkhoffs, G.M.M.J.; Rademakers, M.V.; Altena, M.; Marti, R.K.

    2009-01-01

    BACKGROUND: Reconstructive surgical measures for treatment of posttraumatic deformities of the lateral tibial plateau are seldom reported on in the literature. We report the long-term follow-up results of a consecutive series of reconstructive osteotomies performed to treat depression and valgus mal

  4. Osteotomia valgizante de tíbia com placa "calço" de Puddu: apresentação de técnica Valgus tibial osteotomy with "wedge" plate of Puddu: technique presentation

    Directory of Open Access Journals (Sweden)

    João Luiz Ellera Gomes

    2000-09-01

    Full Text Available O objetivo do presente trabalho é apresentar os resultados iniciais, obtidos com a osteotomia valgizante de adição de tíbia, fixada com placa calço descrita por Puddu. Foram operados 29 joelhos em 27 pacientes para correção de geno-varo, sendo que, em apenas um paciente o procedimento bilateral teve objetivo profilático. O seguimento foi de 3 a 28 meses com média de 14 meses. A osteotomia proximal de tíbia foi feita de forma oblíqua iniciando na inserção distal do ligamento colateral medial em direção ao tubérculo de Gerdy. A osteotomia foi aberta e fixada com uma placa calço de Puddu. O espaço aberto da osteotomia foi preenchido por enxerto autólogo de ilíaco. A carga total era dada com 45 dias de pós-operatório. Os resultados obtidos mostraram que entre 4 a 6 meses os pacientes tiveram uma significativa melhora na sintomatologia indutora do procedimento cirúrgico. A avaliação final mostrou 27 resultados satisfatórios e apenas 2 regulares. Como conclusão essa técnica tornou a osteotomia de tíbia um procedimento reprodutível com resultados previsíveis com excelente manutenção no pós-operatorio da correção obtida no trans-operatório.The objective of this paper is to present the initial results obtained with the valgus tibial osteotomy, fixed with the wedge plate described by Puddu. This surgery was performed in 29 knees, in 27 patients, for correction of genu-varum, and as a profilatic measure in only one patient. The follow up time was from 3 to 28 months with average of 14 months. The proximal tibial osteotomy was done in an oblique way with start in the distal insertion of the colateral medial ligament and directed to the Gerby tubercle. The osteotomy was opened and fixed with a wedge plate of Puddu. The space opened by the osteotomy was filled with autologous iliac graft. Total weightbearing was allowed 45 days after surgery. The results show that in 4 to 6 months patients had a significant improvement of

  5. Effects of rotation on measurement of lower limb alignment for knee osteotomy.

    Science.gov (United States)

    Kawakami, Hideo; Sugano, Nobuhiko; Yonenobu, Kazuo; Yoshikawa, Hideki; Ochi, Takahiro; Hattori, Asaki; Suzuki, Naoki

    2004-11-01

    The purposes of this study were to clarify the effects of rotation on two-dimensional measurement of lower limb alignment for knee osteotomy using a three-dimensional method and to determine whether this 3-D simulation method could help with planning of knee osteotomy. We developed computer software to calculate femorotibial angle (FTA) and hip-knee-ankle angle (HKA) and simulate knee osteotomy from a CT-based 3-D bone model of the lower limb. Lower limb rotation on anteroposterior long-standing radiographs was measured by superimposing the 3-D bone models. Changes in alignment with limb rotation were calculated using the software. FTA after virtual closed-wedged osteotomy was measured for a hypothetical case of a rotation error of the osteotomy plane in reattaching the proximal cutting surface to the distal cutting surface. For 31 varus knees in 20 patients with medial compartment arthritis, the mean rotation angle, relative to the epicondylar axis, with variable limb position was 7.4 +/- 3.9 degrees of internal rotation (mean +/- SD), ranging from 8 degrees of external rotation to 14 degrees of internal rotation; the mean changes in FTA and HKA were 3.5 +/- 2.2 degrees (range, 0.4-8.6) and 1.6 +/- 1.3 degrees (range, 0.2-4.9), respectively. The FTA "flexion angle" (lateral view alignment from neutral AP) and the absolute HKA "flexion angle" correlated with the change in FTA and HKA with limb rotation, respectively (FTA, R = 0.999; HKA, R = 0.993). The mean change in FTA after virtual closed-wedged osteotomy was 3.2 degrees for internal and external 10 degrees rotation errors in reattaching the osteotomy plane. Rotation may affect measurement of lower limb alignment for knee osteotomy, and 3-D methods are preferable for surgical planning.

  6. Comparison of osteotomy technique and jig type in completion of distal femoral osteotomies for correction of medial patellar luxation. An in vitro study.

    Science.gov (United States)

    Olimpo, Matteo; Piras, Lisa A; Peirone, Bruno; Fox, Derek B

    2017-01-16

    Femoral osteotomies are frequently completed to correct malalignment associated with patellar luxation. The objectives of this study were to compare the use of: 1) two different types of jig; and 2) different types of osteotomy in the realignment of canine femoral bone models which possessed various iterations of angular deformity. Models of canine femora possessing distal varus, external torsion and a combination of varus and torsion underwent correction utilizing two alignment jigs (Slocum jig and Deformity Reduction Device) and either a closing wedge ostectomy (CWO) or an opening wedge osteotomy (OWO). Post-correctional alignment was evaluated by radiographic assessment and compared between groups. The use of the Slocum jig resulted in frontal plane overcorrection when used with CWO in models of femoral varus, and when used with OWO in models of femoral varus and external torsion when compared to other techniques. The Deformity Reduction Device tended to realign the frontal plane closer to the post-correction target value in all angulation types. The use of both jigs resulted in undercorrection in the transverse plane in models with varus and torsion. Jig selection and osteotomy type may lead to different post-correctional alignment results when performing distal femoral osteotomies. Whereas OWO allows accurate correction when used with either jig to address frontal plane deformities, the Deformity Reduction Device can be utilized with both CWO and OWO to correct torsion-angulation femoral deformities to optimize frontal plane alignment.

  7. Slab-derived halogens and noble gases illuminate closed system processes controlling volatile element transport into the mantle wedge

    Science.gov (United States)

    Kobayashi, Masahiro; Sumino, Hirochika; Nagao, Keisuke; Ishimaru, Satoko; Arai, Shoji; Yoshikawa, Masako; Kawamoto, Tatsuhiko; Kumagai, Yoshitaka; Kobayashi, Tetsuo; Burgess, Ray; Ballentine, Chris J.

    2017-01-01

    Halogen and noble gas systematics are powerful tracers of volatile recycling in subduction zones. We present halogen and noble gas compositions of mantle peridotites containing H2O-rich fluid inclusions collected at volcanic fronts from two contrasting subduction zones (the Avacha volcano of Kamchatka arc and the Pinatubo volcano of Luzon arcs) and orogenic peridotites from a peridotite massif (the Horoman massif, Hokkaido, Japan) which represents an exhumed portion of the mantle wedge. The aims are to determine how volatiles are carried into the mantle wedge and how the subducted fluids modify halogen and noble gas compositions in the mantle. The halogen and noble gas signatures in the H2O-rich fluids are similar to those of marine sedimentary pore fluids and forearc and seafloor serpentinites. This suggests that marine pore fluids in deep-sea sediments are carried by serpentine and supplied to the mantle wedge, preserving their original halogen and noble gas compositions. We suggest that the sedimentary pore fluid-derived water is incorporated into serpentine through hydration in a closed system along faults at the outer rise of the oceanic, preserving Cl/H2O and 36Ar/H2O values of sedimentary pore fluids. Dehydration-hydration process within the oceanic lithospheric mantle maintains the closed system until the final stage of serpentine dehydration. The sedimentary pore fluid-like halogen and noble gas signatures in fluids released at the final stage of serpentine dehydration are preserved due to highly channelized flow, whereas the original Cl/H2O and 36Ar/H2O ratios are fractionated by the higher incompatibility of halogens and noble gases in hydrous minerals.

  8. Closing the wedge: Search strategies for extended Higgs sectors with heavy flavor final states

    Science.gov (United States)

    Gori, Stefania; Kim, Ian-Woo; Shah, Nausheen R.; Zurek, Kathryn M.

    2016-04-01

    We consider search strategies for an extended Higgs sector at the high-luminosity LHC14 utilizing multitop final states. In the framework of a two Higgs doublet model, the purely top final states (t t ¯ , 4 t ) are important channels for heavy Higgs bosons with masses in the wedge above 2 mt and at low values of tan β , while a 2 b 2 t final state is most relevant at moderate values of tan β . We find, in the t t ¯H channel, with H →t t ¯, that both single and three lepton final states can provide statistically significant constraints at low values of tan β for mA as high as ˜750 GeV . When systematics on the t t ¯ background are taken into account, however, the three lepton final state is more powerful, though the precise constraint depends fairly sensitively on lepton fake rates. We also find that neither 2 b 2 t nor t t ¯ final states provide constraints on additional heavy Higgs bosons with couplings to tops smaller than the top Yukawa due to expected systematic uncertainties in the t t ¯ background.

  9. Closing the Wedge: Search Strategies for Extended Higgs Sectors with Heavy Flavor Final States

    CERN Document Server

    Gori, Stefania; Shah, Nausheen R.; Zurek, Kathryn M.

    2016-01-01

    We consider search strategies for an extended Higgs sector at the high-luminosity LHC14 utilizing multi-top final states. In the framework of a Two Higgs Doublet Model, the purely top final states ($t\\bar t, \\, 4t$) are important channels for heavy Higgs bosons with masses in the wedge above $2\\,m_t$ and at low values of $\\tan\\beta$, while a $2 b 2t$ final state is most relevant at moderate values of $\\tan \\beta$. We find, in the $t\\bar t H$ channel, with $H \\rightarrow t \\bar t$, that both single and 3 lepton final states can provide statistically significant constraints at low values of $\\tan \\beta$ for $m_A$ as high as $\\sim 750$ GeV. When systematics on the $t \\bar t$ background are taken into account, however, the 3 lepton final state is more powerful, though the precise constraint depends fairly sensitively on lepton fake rates. We also find that neither $2b2t$ nor $t \\bar t$ final states provide constraints on additional heavy Higgs bosons with couplings to tops smaller than the top Yukawa due to expec...

  10. 第一跖骨双截骨矫正重度(足母)外翻畸形%Double wedge osteotomy of the first metatarsal for correction of severe hallux valgus

    Institute of Scientific and Technical Information of China (English)

    李昕宇; 林顺福; 王剑; 陈宇明; 王正义

    2013-01-01

    Objective To explore the curative effect of the operation of double wedge osteotomy of the first metatarsal for correction of severe hallux valgus.Methods The data of 62 patients (87 feet) with severe hallux valgus caused by enlarged distal metatarsal articular angle (DMAA) who were followed up after receiving the treatment of double wedge osteotomy of the first metatarsal from January 2008 to December 2011 were analyzed retrospectively.There are 9 males (14 feet),and 53 females (73 feet),with an average age of 56 years (range,28-70 years).Preoperative radiographs showed hallux valgus angle (HVA) was 48.6° in average,intermetatarsal angle (IMA) was 19.8° in average,and DMAA was 22.1° in avcragc.Thc opcration plan was made based on the preoperative deformity,and the osteotomy site,the angle,the capacity of osteotomy was all based on preoperative measurement.Compare the changes of HVA,IMA,DMAA before and after operation.The changes were also compared before and after the internal fixation extraction.The curative effect was observation based on American Orthopaedic Foot and Ankle Society (AOFAS) propodium score standard.Results Sixty-two patients (87 feet) were followed up for 10 to 57 months,with an average of 21 months.HVA (14.6°±1.2°),IMA (7.9°±0.7°),DMAA (7.7°±0.9°) were all satisfied 6 months after the operation.Stiff occurred in 2 patients after the operation.Cutaneous nerve injury occurred in 2 patients,and metastatic metatarsalgia occurred in 1 patient.No sever recurrence of deformity,bone nonunion and bone necrosis was found in all the patients.AOFAS score reached 91.8±1.8 one year after the operation,which was 28.4±9.1 preoperatively.Among them,49 feet were rated as excellent,31 as good,and 7 as fair.The excellent and good rate was 92% (80/87).Conclusion The first metatarsal double osteotomy can effectively correct the severe hallux valgus deformity with enlarged DMAA with few complications.It achieves good effect.Patients can bear part of

  11. The efficacy of open-wedge high tibial osteotomy for varus knee%开放胫骨高位楔形截骨术治疗膝关节内翻畸形

    Institute of Scientific and Technical Information of China (English)

    张海宁; 冷萍; 王英振; 吕成昱; 王湘达; 王昌耀

    2010-01-01

    sixteen weeks after operation. No complications such as plate broken or injury of nerve or blood vessel had occurred. The mean correct angle was 9. 5°. No degenerative changes had developed in other compartments of the knee. The mechanical axis of the lower extremities was maintained during the follow-up. The overall satisfactory rate was 83.3%.Statistically significant changes exist in the Lysholm score and varus degree. Conclusion The open-wedge high tibial osteotomy is suitable for the symptomatic genu varum in younger patients with good short-term and mid-term results.

  12. Correction of Hallux Valgus Interphalangeus With an Osteotomy of the Distal End of the Proximal Phalanx (Distal Akin Osteotomy).

    Science.gov (United States)

    Vander Griend, Robert

    2017-02-01

    Operative correction of a symptomatic hallux valgus interphalangeus (HVI) deformity is often achieved with an osteotomy at the proximal end of the proximal phalanx (Akin osteotomy). However, the apex of the typical HVI deformity (center of rotation angle) is at the interphalangeal joint of the hallux. This study was done to evaluate the results of performing a medial closing wedge osteotomy at the distal end of the proximal phalanx. Thirty-three patients (33 feet) underwent an osteotomy at the distal end of the proximal phalanx for correction of HVI. All of the patients had other forefoot deformities which were corrected at the same time. Eight of these were revision procedures of prior forefoot operations. The length of follow-up was determined by the associated procedures with a minimum follow-up of 4 months. The preoperative hallux valgus interphalangeus angle averaged 16 degrees of valgus (range 7-32 degrees) and was corrected to an average of 2 degrees of valgus (range 5 degrees valgus to 5 degrees varus). All of the patients were satisfied with the postoperative appearance and function of the first toe. Because of simultaneous correction of numerous other forefoot problems, it was not possible to specifically isolate or evaluate the effects and benefits of this osteotomy using outcomes measures. There was one intraoperative complication resulting in a fracture extending into the adjacent IP joint. Correction of an HVI deformity can be achieved with an osteotomy at the distal end of the proximal phalanx. This was a safe technique with few complications and with good results in terms of both correction and patient satisfaction. Level IV, retrospective case series.

  13. Calcaneal "Z" osteotomy effect on hindfoot varus after triple arthrodesis in a cadaver model.

    Science.gov (United States)

    Zanolli, Diego H; Glisson, Richard R; Utturkar, Gangadhar M; Eckel, Tobin T; DeOrio, James K

    2014-12-01

    Triple arthrodesis involves subtalar, talonavicular, and calcaneocuboid joint fusion and is performed to relieve pain and correct deformity. Complications include malunion resulting in equinovarus and lateral column overload, which can lead to painful callosities and stress fractures. This study quantified the effectiveness of a closing-wedge calcaneal "Z" osteotomy for correction of the varus condition and reduction of abnormal loading of the lateral border of the foot. Ten fresh-frozen feet were used. Angle meters were attached to the calcaneus and second cuneiform to measure hindfoot and midfoot varus, and pressure sensors were placed under the first and fifth metatarsal heads to document loading of the borders of the foot. Tensile loads were applied to ten extrinsic tendons and the Achilles tendon while an 1187 N axial foot load was applied. Calcaneus and second cuneiform coronal plane angles and medial and lateral plantar pressures were measured initially, after triple fusion-induced varus, and after "Z" osteotomy. The calcaneal "Z" osteotomy had no significant corrective effect, with hindfoot alignment virtually identical before and after the procedure under the described foot loading conditions. Similarly, second cuneiform inclination, representative of midfoot alignment, showed no change from the osteotomy. Medial and lateral peak plantar pressures after calcaneal "Z" osteotomy did not differ from those measured after varus triple fusion. In this cadaver model of varus malunited triple arthrodesis, the closing-wedge calcaneal "Z" osteotomy was ineffective for correction of bone alignment and lateral forefoot overloading under the tested conditions. The results provide additional information on which to base treatment after triple arthrodesis with varus malunion. © The Author(s) 2014.

  14. 腰椎椎弓根楔形截骨术治疗强直性脊柱炎后凸畸形%Transpedicular lumbar wedge resection osteotomy for correction of kyphosis in ankyiosing spondylitis

    Institute of Scientific and Technical Information of China (English)

    范建平; 王传锋; 朱晓东; 陈家瑜; 李超; 陈超; 梁楠; 白玉树; 李明

    2013-01-01

    目的 探讨腰椎椎弓根楔形截骨术治疗强直性脊柱炎后凸畸形的临床疗效.方法 2005年1月至2010年3月,第二军医大学长海医院骨科共收治32例强直性脊柱炎后凸畸形患者,均行一期后路经腰椎椎弓根楔形截骨矫形内固定术.其中27例患者行单节段椎弓根楔形截骨术,5例患者行双节段椎弓根截骨术.术前及术后随访时拍摄脊柱全长X线片,测量影像学参数,并填写中文版脊柱侧凸研究学会22项(SRS-22)量表进行患者的健康生存质量评价.结果 手术时间平均为(260±42) min,术中出血平均(1 360±282) mL,平均随访(31±8)个月(24~76个月),均未出现神经系统并发症及假关节.患者颌眉角、全脊柱后凸角、胸腰段后凸角、腰椎前凸角由术前(65.9±11.6)°、(78.2±15.9)°、(38.9±10.3)°、(14.6±17.3)°分别矫正至术后(11.7±4.7)°、(38.9±10.3)°、(1.3±7.8)°、(26.2±5.6)°;身高和矢状面失平衡距离由术前的(135.4±15.2) cm、(37.2±11.3) cm分别矫正至术后的(166.2±9.6) cm、(12.7±7.7) cm,差异均有统计学意义(P<0.01).SRS-22评分由术前平均(1.8±0.4)改善至术后(4.0±0.6),疗效满意.结论 腰椎椎弓根楔形截骨术治疗强直性脊柱炎后凸畸形安全可靠,可获得满意的临床效果.%Objective To explore the clinical efficacies of transpedicular lumbar wedge resection osteotomy for correction of kyphosis in ankylosing spondylitis. Methods From January 2005 to March 2010,32 patients with ankylosing spondylitis kyphotic deformity received one stage posterior transpedicular wedge osteotomy and internal fixation, with 27 receiving single-level ones and 5 receiving two-level ones. All patients underwent X ray examination of the total spine to obtain radiographic parameters and were asked to accomplish simplified Chinese scoliosis research society-22 (SRS-22) questionnaire to assess quality of health before and after operation. Results The mean operation time

  15. Effects on the Tarsal Tunnel Following Malerba Z-type Osteotomy Compared to Standard Lateralizing Calcaneal Osteotomy.

    Science.gov (United States)

    Cody, Elizabeth A; Greditzer, Harry G; MacMahon, Aoife; Burket, Jayme C; Sofka, Carolyn M; Ellis, Scott J

    2016-09-01

    Tarsal tunnel syndrome is a known complication of lateralizing calcaneal osteotomy. A Malerba Z-type osteotomy may preserve more tarsal tunnel volume (TTV) and decrease risk of neurovascular injury. We investigated 2 effects on the tarsal tunnel of the Malerba osteotomy compared to a standard lateralizing osteotomy using a cadaveric model: (1) the effect on TTV as measured by magnetic resonance imaging (MRI) and (2) the proximity of the osteotomy saw cuts to the tibial nerve. Ten above-knee paired cadaveric specimens underwent MRI of the ankle to obtain a baseline measurement of TTV. One foot in each pair received a standard lateralizing calcaneal osteotomy, with the other foot receiving a Malerba osteotomy. MRIs were performed after each of 3 increasing amounts of lateral displacement, which were accompanied by increasing amounts of wedge resection in the Malerba osteotomy group. TTV was measured on MRI using previously described and validated parameters. Differences in TTV with osteotomy type, displacement, and their interaction were assessed with generalized estimating equations. After all MRIs were completed, each specimen was dissected and the nearest distance of tibial nerve branches to the osteotomy site was measured. Baseline TTV averaged 13 229 ± 2354 mm(3) and did not differ between groups (P = .386). TTV decreased on average by 7% after the first translation, 14% after the second, and 27% after the third (P osteotomies versus those with Malerba osteotomies (P = .578). At least one of the major branches of the tibial nerve crossed the osteotomy site in 5 of 5 specimens that received the Malerba osteotomy versus 2 of 5 that received a standard osteotomy. Regardless of osteotomy type, lateralizing calcaneal osteotomy decreased TTV. In all specimens, the osteotomy was at the level of branches of the tibial nerve. Our results demonstrate that lateralizing calcaneal osteotomies must be performed with care to avoid excessive lateral translation as well as

  16. Effect of a biplanar osteotomy on primary stability following high tibial osteotomy: a biomechanical cadaver study.

    Science.gov (United States)

    Pape, Dietrich; Lorbach, Olaf; Schmitz, Christian; Busch, Lüder C; Van Giffen, Nicolien; Seil, Romain; Kohn, Dieter M

    2010-02-01

    Open-wedge high tibial osteotomy (HTO) is becoming increasingly popular for the treatment of varus gonarthrosis in the active patient. The various implants used in HTO differ with regard to its design, the fixation stability and osteotomy technique. It is assumed that the combination of a plate fixator with a biplanar, v-shaped osteotomy supports bone healing. So far, there are no biomechanical studies that quantify the stabilizing effect of a biplanar versus uniplanar osteotomy. We hypothesized that a significant increase in primary stability of bone-implant constructs is achieved when using a biplanar as opposed to a uniplanar osteotomy. Twenty-four fresh-frozen human tibiae were mounted in a metal cylinder, and open-wedge osteotomy (12 mm wedge size) was performed in a standardized fashion. Proximal and distal tibial segments were marked with tantalum markers of 0.8 mm diameter. Two different plates with locking screws were used for fixation: a short spacer plate (group 1, n = 12) and a plate fixator (group 2, n = 12). In six specimens of each group, a biplanar V-shaped osteotomy with a 110 degrees angulated anterior cut behind the tuberosity parallel to the ventral tibial shaft axis was performed. In the remaining six specimens of each group, a simple uniplanar osteotomy was performed in an oblique fashion. Axial compression of the tibiae was performed using a material testing machine under standardized alignment of the loading axis. Load-controlled cyclical staircase loading tests were performed. The specimens were radiographed simultaneously in two planes together with a biplanar calibration cage in front of a film plane with and without load after each subcycle. Radiostereometry allowed for serial quantification of plastic and elastic micromotion at the osteotomy site reflecting the stability provided by the combination of implant and osteotomy technique. No significant additional stabilizing effect of a biplanar osteotomy in craniocaudal and mediolateral

  17. Consolidação da osteotomia valgizante proximal da tíbia com cunha de abertura fixada com placa "calço" de Anthony® Proximal tibial valgusing open-wedge osteotomy union fixated with Anthony® "support" plate

    Directory of Open Access Journals (Sweden)

    Cristiano Hossri Ribeiro

    2008-01-01

    Full Text Available OBJETIVO: Este estudo tem por finalidade verificar a consolidação da osteotomia valgizante da tíbia com cunha de abertura fixada com placa tipo calço de Anthony® (OVT, no tratamento da osteoartrose medial do joelho varo, a correção da deformidade e a resposta clínica ao tratamento cirúrgico. MÉTODOS: Vinte pacientes (vinte joelhos com osteoartrose do compartimento medial do joelho, com idade média de 48,4 ± 9,9, foram avaliados por um período mínimo de um ano. Os pacientes foram submetidos a avaliação radiográfica da consolidação e do eixo mecânico no pré e pós operatório, além da avaliação dos critérios de LYSHOLM. RESULTADOS: A consolidação da osteotomia ocorreu após 12 semanas em 100% dos casos sem complicações. A avaliação do LYSHOLM no pós operatório apresentou 80% de excelentes e bons resultados. A correção final média do eixo mecânico foi de 3,4 ± 3,3 graus de valgo. CONCLUSÃO: Concluímos que a consolidação da osteotomia supra-tuberositária da tíbia com cunha de abertura fixada com placa calço de Anthony® e com enxertia óssea tricortical ocorre num intervalo de três meses. A cirurgia é eficaz para a correção da deformidade em varo do joelho, e propicia melhora clínica significante para o paciente.OBJECTIVE: This paper aims to check the proximal tibial valgusing open-wedge osteotomy union with Anthony® plate for the treatment of bowleg with medial osteoarthrosis, final correction of the deformity and clinical improvement. METHODS: Twenty patients (twenty knees with medial osteoarthrosis of the knee, with mean age of 48.4 years, were evaluated for one year. The patients were submitted to the Lysholm's score, and also to X-ray studies before and after surgery. RESULTS: The osteotomy union occurred after 12 weeks in all cases without complications. The Lysholm's score was regarded as excellent or good in 80% of the cases. The postoperative mechanical alignment was 3.4 ± 3.3 valgus

  18. V-Y vertebral body osteotomy for the treatment of fixed sagittal plane spinal deformity.

    Science.gov (United States)

    Mehdian, Hossein; Arun, Ranganathan; Aresti, Nick A

    2015-04-01

    Fixed sagittal plane imbalance (FSI) has traditionally been corrected by either opening or closing wedge osteotomies or vertebral column resections. These methods involve multiple vertebrae and have been associated with limited degrees of correction and/or neurovascular compromise. We describe a new V-Y vertebral osteotomy (VYO) that involves a single vertebra, allowing for correction of all three columns in a safer fashion. A prospective assessment of the degree of correction pre- and post-VYO in a tertiary spinal center. Ten consecutive patients presenting with sagittal plane imbalance were enrolled in this study. Outcomes were assessed with pre- (preop) and postoperative (postop) outcome questionnaires (Oswestry Disability Index [ODI] and Scoliosis Research Society-24) and radiography. Ten patients underwent VYO at L3 with varying levels of instrumentation. The procedure involves a V-shaped osteotomy in the sagittal plane, sparing the anterior 50% of the body, the apex of which is then converted to a Y shape, and the osteotomy closed. Patients were followed for a mean of 36 months (24-48 months). The procedure led to significant improvements in sagittal balance, lumbar lordosis, thoracic kyphosis, coronal balance, sacral inclination, and pelvic incidence. The average degree of correction achieved was 44.58°±6.19° (mean±standard deviation). The mean blood loss was 1,287±350 mL and the operative time was 220±24 minutes. The mean preop ODI was 72% (range 58%-85%) and postop ODI averaged 22% (range 10%-30%). The mean preop SRS-24 score was 30.1 and postop was 101. The VYO provides a safe correction of up to 45° at a single osteotomy site in FSI patients. It involves an isolated posterior approach and is recommended for corrections below the region of the conus. Copyright © 2015 Elsevier Inc. All rights reserved.

  19. Periacetabular osteotomy

    DEFF Research Database (Denmark)

    Klit, Jakob; Hartig-Andreasen, Charlotte; Jacobsen, Steffen;

    2014-01-01

    Hip joint survivorship and functional outcome are traditional outcome measures applied after periacetabular osteotomy (PAO). Younger adults however have greater demands and expectations on the function of their hip joints and these demands are not expressed using traditional outcome assessment...... tools. The main purpose of this study was to explore alternative functional and quality of life measure after PAO. A cross sectional survey of preserved hip joints following PAO was performed. Fifty-two patients (68 hips), mean age 41 years (range 24-67), returned a questionnaire examining satisfaction...

  20. Posterior release and spinal wedge osteotomy for congenital thoracolumbar hemivertebra with severe rigid kyphoscoliosis deformity%后路松解楔形截骨矫治先天性胸腰段半椎体并重度僵硬性脊柱侧后凸畸形

    Institute of Scientific and Technical Information of China (English)

    李海江; 李超; 付青松; 周宇; 赵刚; 于海洋

    2011-01-01

    侧后凸畸形安全有效,选择TV作为LIV可以减少融合节段.%Objective:To evaluate the early clinical outcome of posterior release and spinal wedge osteotomy for congenital thoracolumbar hemivertebra with severe rigid kyphoscoliosis deformity and to discuss the selection of fusion and fixation.Method:From April 2007 to March 2010,11 patients suffering from congenital thoracolumbar hemivertebra complicated with severe rigid kyphoscoliosis were reviewed retrospectively.There were 4 males and 7 females with an average age of 17.1 years (range, 14-22 years).All hemivertebrae were single fully segmented,which were sited in Til in 3 cases,T12 in 4 cases,LI in 1 case and L2 in 3 cases.The mean preoperative scoliosis Cobb angle was 94.4°(range,82°-125°).The mean scoliosis flexibility was 24.8% (range, 17.4%-28.9% ).The mean preoperative kyphosis Cobb angle was 101.1° (range,72°-145° ).The mean distance from C7 plumb line to middle sacral line was 2.9cm(range,1.5-5.5cm).All cases underwent posterior release and spinal wedge osteotomy,and the touched vertebrae (TV) (defined as the most cephalad vertebrae touched by central sacrum vertical line) were regarded as the lowest instrumented vertebrae(LTV).l case with tethered spinal cord and diastematomyelia underwent tethered spinal cord release plus the above-mentioned procedure. Result: All the patients underwent the operation successfully.An average of 3.0 thoracic vertebra release was performed.The average surgical time was 7.7 hours (5.5-10.0 hours),and the average blood loss was 3500ml(1000-7000ml).There was no neurological deficit.l patient suffered from left pleura tearing during capitulum costae resection complicated with hemopneumothoraxes who was treated by chest cavity closed drainage alone and recovered completely after 2 weeks. 1 patient suffered from screw perforating back skin, that was resolved by taking out the screw 3 months later.Immediately after operation,the mean scoliosis Cobb angle was 28

  1. The effect of alar cinch sutures and V-Y closure versus simple closing sutures after Le Fort I osteotomies on nasolabial esthetics and dynamics

    NARCIS (Netherlands)

    Muradin, M.S.M.|info:eu-repo/dai/nl/304817775

    2010-01-01

    Surgical reposition of the maxilla by means of a Le Fort I osteotomy is a, widely used, procedure to correct dentofacial deformities. Maxillary intrusion, especially, is known to cause unwanted side effects on the orofacial soft tissues, such as broadening of the alar base, loss of vermilion show of

  2. 跳跃式经椎弓根椎体截骨术矫治强直性脊柱炎重度后凸畸形的疗效%Clinical efficacies of skipping two-level transpedicular wedge osteotomy for correction of severe kyphosis in ankylosing spondylitis

    Institute of Scientific and Technical Information of China (English)

    宋若先; 张永刚; 张雪松; 毛克亚; 郑国权; 王岩

    2012-01-01

    目的 探讨跳跃式经椎弓根双脊椎截骨术矫治强直性脊柱炎重度后凸畸形的临床效果.方法 2003年1月至2009年12月对解放军总医院骨科收治的38例颌眉角或脊柱整体后凸角>70°的强直性脊柱炎重度后凸畸形患者,行后路跳跃式经椎弓根双脊椎截骨矫形内固定术.术前测量脊柱整体后凸角、胸腰段后凸角、腰椎前凸角及颌眉角与躯干矢状位失平衡距离,根据后凸畸形的特点,参考正常脊柱生理曲度与力线特点,分配截骨部位与角度,并在计算机上模拟截骨确认.观察术后各指标改善情况,并评价治疗满意度.结果 手术时间平均309 min,出血量平均2050 ml.脊柱整体后凸角、胸腰段后凸角、腰椎前凸角分别由术前(101.0±21.3)°、(45.2±13.6)°、(-28.2±23.3)°改善至术后(26.0±12.1)°、(2.8±11.6)°、(28.9±13.3)°;颌眉角由术前(79.4±15.9)°矫正到术后(13.6±10.9)°;矢状面失平衡距离由术前(49±13)cm,矫正到术后的(15±7)cm,差异均有统计学意义(均P<0.01).术后患者均能平视、直立行走及仰卧睡眠.平均随访32个月(24 ~78个月),截骨部位愈合良好,全部病例无矫正度丢失及内置物失败,SRS-22评分由术前平均1.8分改善到术后4.2分,疗效满意.结论 跳跃式经椎弓根双脊椎截骨矫形内固定术可有效矫正强直性脊柱炎重度后凸畸形,临床效果满意.%Objective To explore the clinical efficacies of skipping two-level transpedicular wedge osteotomy in the correction of severe kyphotic deformity in ankylosing spondylitis (AS).Methods From January 2003 to December 2009,a total of 38 consecutive patients with AS and severe kyphosis ( chin-brow vertical angle (CBVA) or global thoraco-lumbar kyphosis angle (TLKA) over 70°) undergoing skipping two-level transpedicular wedge osteotomy at the Department of Orthopedics of Chinese PLA General Hospital were reviewed retrospectively.There were 32 males and 6

  3. Rethinking wedges

    Science.gov (United States)

    Davis, Steven J.; Cao, Long; Caldeira, Ken; Hoffert, Martin I.

    2013-03-01

    Abstract Stabilizing CO2 emissions at current levels for fifty years is not consistent with either an atmospheric CO2 concentration below 500 ppm or global temperature increases below 2 °C. Accepting these targets, solving the climate problem requires that emissions peak and decline in the next few decades, and ultimately fall to near zero. Phasing out emissions over 50 years could be achieved by deploying on the order of 19 'wedges', each of which ramps up linearly over a period of 50 years to ultimately avoid 1 GtC y-1 of CO2 emissions. But this level of mitigation will require affordable carbon-free energy systems to be deployed at the scale of tens of terawatts. Any hope for such fundamental and disruptive transformation of the global energy system depends upon coordinated efforts to innovate, plan, and deploy new transportation and energy systems that can provide affordable energy at this scale without emitting CO2 to the atmosphere. 1. Introduction In 2004, Pacala and Socolow published a study in Science arguing that '[h]umanity can solve the carbon and climate problem in the first half of this century simply by scaling up what we already know how to do' [1]. Specifically, they presented 15 options for 'stabilization wedges' that would grow linearly from zero to 1 Gt of carbon emissions avoided per year (GtC y-1 1 Gt = 1012 kg) over 50 years. The solution to the carbon and climate problem, they asserted, was 'to deploy the technologies and/or lifestyle changes necessary to fill all seven wedges of the stabilization triangle'. They claimed this would offset the growth of emissions and put us on a trajectory to stabilize atmospheric CO2 concentration at 500 ppm if emissions decreased sharply in the second half of the 21st century. The wedge concept has proven popular as an analytical tool for considering the potential of different technologies to reduce CO2 emissions. In the years since the paper was published, it has been cited more than 400 times, and

  4. Long-term results and comparison of the three different high tibial osteotomy and fixation techniques in medial compartment arthrosis.

    Science.gov (United States)

    Polat, Gökhan; Balcı, Halil İbrahim; Çakmak, Mehmet Fevzi; Demirel, Mehmet; Şen, Cengiz; Aşık, Mehmet

    2017-03-16

    The purpose of this study is to report and analyze the long-term outcomes of the patients who underwent high tibial osteotomy (HTO) with three different techniques for the treatment of medial compartment arthrosis. A total of 187 patients (195 knees) who underwent HTO between 1990 and 2010 were retrospectively evaluated. Eighty-eight knees, opening-wedge osteotomy with Puddu plate (group A); 51 knees, transverse osteotomy below the tubercle with external fixator (group B); and 29 knees, closing-wedge osteotomy with staple fixation (group C) were included in the study. The patients (mean age 44.9 ± 10.6 years, mean follow-up of 12.4 ± 3.2 years) were called for final controls and survival rates of the knees, and functional evaluations of the patients were performed using Knee Society Score (KSS) and Hospital for Special Surgery (HSS) knee score assessments. In the comparison of the three groups, there were no differences regarding the mean age, preoperative arthrosis levels, or preoperative deformity analyses (n.s.). The main finding of these comparisons showed that the closing-wedge osteotomy has the greatest lateralization effect on mechanical axis deviation (MAD) (p = 0.024), the greatest valgization effect on medial proximal tibial angles (MPTA) (p = 0.026), and the lowest posterior tibial slope (PTS) angles (p = 0.032) in comparison to the other groups. There were no functional differences between the three groups in the long-term assessment of patients with KSS and HSS knee scores. According to the Kaplan-Meier survival analysis, the probability of the survival of the native knee joint after HTO was 93.4% in 5 years and 71.2% in 10 years in our study group. During the follow-up of the 168 knees, revision surgery with total knee replacement was needed in 27 knees (16%). The mean time from HTO to total knee replacement was 8.9 years in these patients. HTO has acceptable long-term clinical and functional results that should not be

  5. Effect of Combined Fibular Osteotomy on the Pressure of the Tibiotalar and Talofibular Joints in Supramalleolar Osteotomy of the Ankle: A Cadaveric Study.

    Science.gov (United States)

    Choi, Gi Won; Lee, Soon Hyuck; Nha, Kyung Wook; Lee, Sung Jae; Kim, Won Hyeon; Uhm, Chang-Sub

    We investigated the effect of combined fibular osteotomy on the pressure of the tibiotalar and talofibular joints in medial opening-wedge supramalleolar osteotomy. Three different tibial osteotomy gaps (6, 8, and 10 mm) were created in 10 cadaveric models, and the pressure in the tibiotalar and talofibular joints was measured under axial load before and after fibular osteotomy. The heel alignment angle and talar translation ratio were evaluated radiographically. An increase in osteotomy gap led to increases in hindfoot valgus (p = .001) and the contact and peak pressures in the talofibular joint (p = .03 and p = .004). In contrast, the contact and peak pressures in the tibiotalar joint were unchanged with an increasing osteotomy gap (p = .52 and p = .76). Fibular osteotomy reduced the contact and peak pressures in the talofibular joint (p osteotomy might be necessary in supramalleolar osteotomy for medial ankle arthritis to minimize the increase in pressure in the talofibular joint, especially when the osteotomy gap is large. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  6. Radial wedge flange clamp

    Science.gov (United States)

    Smith, Karl H.

    2002-01-01

    A radial wedge flange clamp comprising a pair of flanges each comprising a plurality of peripheral flat wedge facets having flat wedge surfaces and opposed and mating flat surfaces attached to or otherwise engaged with two elements to be joined and including a series of generally U-shaped wedge clamps each having flat wedge interior surfaces and engaging one pair of said peripheral flat wedge facets. Each of said generally U-shaped wedge clamps has in its opposing extremities apertures for the tangential insertion of bolts to apply uniform radial force to said wedge clamps when assembled about said wedge segments.

  7. Planejamento pré-operatório e técnica cirúrgica da osteotomia supracondiliana varizante de adição do fêmur para correção do geno valgo e fixação com implante de ângulo fixo Pre-operative planning and surgical technique of the open wedge supracondylar osteotomy for correction of valgus knee and fixation with a fixed-angle implant

    Directory of Open Access Journals (Sweden)

    Cleber Antonio Jansen Paccola

    2010-01-01

    Full Text Available É apresentado o planejamento pré-operatório passo a passo da osteotomia de abertura supracondiliana do fêmur para a correção precisa do eixo de carga do membro inferior usando um implante de ângulo fixo (placa lâmina AO 95º. Também é apresentada a técnica cirúrgica e a utilização de enxerto ósseo do próprio local para o preenchimento da falha.The pre-operative planning is presented in a step by step fashion and the surgical technique of the lateral open wedge supracondylar femoral osteotomy for correction of the valgus knee using a fixed angle implant (95º AO angled blade plate. A surgical method for filling in the defect using an autologous bone graft is also presented.

  8. Newborn exstrophy closure without osteotomy: Is there a role?

    Science.gov (United States)

    Inouye, Brian M; Lue, Kathy; Abdelwahab, Mahmoud; Di Carlo, Heather N; Young, Ezekiel E; Tourchi, Ali; Grewal, Mehnaj; Hesh, Christopher; Sponseller, Paul D; Gearhart, John P

    2016-02-01

    Recent articles document successful classic bladder exstrophy (CBE) closure without osteotomy. Still, many patients require osteotomy if they have a large bladder template and pubic diastasis, or non-malleable pelvis. To understand the indications and outcomes of bladder closure with and without pelvic osteotomy in patients younger than 1 month of age. An institutional database of 1217 exstrophy-epispadias patients was reviewed for CBE patients closed at the authors' institution within the first month of life. Patient demographics, closure history, pubic diastasis distance, bladder capacity, and outcomes were recorded and compared using chi-square tests between osteotomy and non-osteotomy patients. Failure was defined as bladder dehiscence, prolapse, vesicocutaneous fistula, or bladder outlet obstruction requiring reoperation. Bladder capacity >100 mL was deemed sufficient for bladder neck reconstruction (BNR). One hundred CBE patients were included for analysis: 38 closed with osteotomy (26 male, 12 female), and 62 closed without osteotomy (42 male, 20 female). There were four failed closures in the osteotomy group (2 dehiscence, 2 prolapse) and four failed closures in the non-osteotomy group (2 dehiscence, 2 prolapse). This corresponded to statistically equivalent rates of failure between the osteotomy and non-osteotomy groups (10.5% vs. 6.5%, p = 0.466). There was no statistically significant difference between the groups' ability to achieve bladder capacity sufficient for BNR (82% vs. 71%, p = 0.234). A successful primary bladder closure, regardless of the use of osteotomy, has been shown to be the single most important predictor of eventual continence. Because of the complexity of exstrophy manifestations, a multidisciplinary team approach is of the utmost importance. Based on our institutional experience, closure without osteotomy is considered when patients are osteotomy in patients considered suitable for closure by both the pediatric urologist and

  9. A 2-year prospective study of patient-relevant outcomes in patients operated on for knee osteoarthritis with tibial osteotomy

    Directory of Open Access Journals (Sweden)

    Toksvig-Larsen Sören

    2005-04-01

    Full Text Available Abstract Background Tibial osteotomy is a treatment for younger and/or physically active patients suffering from uni-compartmental knee osteoarthritis. The open wedge osteotomy by the hemicallotasis technique includes the use of external fixation. The use of external fixation has several advantages, as early mobilization and the opportunity for optimal correction. However, the hemicallotasis technique has also been described as a cumbersome procedure for the patient. The aim of this study was to prospectively evaluate patient-relevant outcomes during the first 2 post-operative years. Especially the treatment period, during which external fixation was used, was closely monitored. Methods In an uncontrolled study, fifty-eight consecutive patients, 30 men and 28 women (mean age 54 years were operated on by the hemicallotasis technique were evaluated with the patient-relevant outcome measure Knee injury and Osteoarthritis Outcome Score (KOOS preoperatively, during the treatment with external fixation, one week after removal of the external fixation, at 6 months, and at one and two years postoperatively. Results At the 2-year postoperative follow-up, all subscales of the KOOS were improved (p Conclusion Tibial osteotomy by the hemicallotasis technique yields large improvement in self-rated pain, function and quality of life, which persists over two years. Surprisingly, large improvements occurred already during the immediate post-operative period when the external fixation was still used.

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

    Science.gov (United States)

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

    2013-05-01

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

  11. [Reorientation osteotomy of the trapezial saddle].

    Science.gov (United States)

    Kapandji, Adalbert I; Heim, Urs F A

    2002-03-01

    At its early stage, the thumb TM osteo-arthritis is occasionally painful during some activities and there are mainly radiological signs, only visible on specific views and with maximum amplitudes. They are the first metacarpal base imperfect reintegration in the trapezium saddle in ante-position and an increased slope angle of 140 degrees. So, the "slippery saddle" of the trapezium induces a metacarpal base subluxation. The goal of the proposed technique is to correct the orientation of the trapezial saddle. The slope angle must return to its normal value of about 125 degrees, thanks to an opening wedge osteotomy into the trapezium, completed with a bony wedge insertion. Proposed for the first time in 1983, and used only once by Dr. Heim, this technique was "rediscovered" recently and used on five patients in ten years. It is easy to do, the only complication being two post-operative radial nerve sensitive branch neuromas. In six cases on seven, the pain disappeared, even if the osteo-arthritis was evolving for the two former cases. The functional recovery was total and the patients were satisfied in most of the cases. In spite of this short series, this technique is worth being used for the early stage of thumb osteo-arthritis, eventually combined with others techniques like tenotomy of the Abductor pollicis longus accessories or different types of ligamentoplasties. It is, in any case, more logical than the first metacarpal osteotomy.

  12. Patella height changes post high tibial osteotomy

    Directory of Open Access Journals (Sweden)

    Siew Ghim Gooi

    2017-01-01

    Full Text Available Background: Medial opening wedge high tibial osteotomy (HTO is a well-described treatment in early medial compartmental osteoarthritis of the knee. However, two undesirable sequelae may follow –patella baja and changes in the posterior tibial slope (TS. Materials and Methods: We conducted a retrospective study in patients who underwent HTO in our center between September 2009 and February 2017. Preoperative and 6-week postoperative long-leg weight bearing films and lateral knee radiographs were assessed. Pre- and postoperative radiological measurements include the Caton-Deschamps Index (CDI, the mechanical axis deviation (MAD, and the posterior TS. Independant t-test and Pearson correlation test were performed. Results: A total of 106 knees were recruited. The mean age was 48.8 ± 10.8 years. 66 (62.3% and 40 (37.7% knees were from males and females, respectively. The mean pre- and postoperative measurements was (−9.70° ± 3.67° to 0.08° ± 2.80° (−varus; +valgus for the MAD, (7.14° ± 1.78° to 8.72° ± 3.11° for posterior TS, and (0.93° ± 0.084° to 0.82° ± 0.13° for CDI (P ≤ 0.001 for all. The association between patella height change and the level of osteotomy (supra-tubercle vs. infra-tubercle was statistically significant (P < 0.001. A supra-tubercle osteotomy cut significantly lowering patella height (P = 0.011. There was otherwise no statistically significant correlations between patella height changes and the correction angle (P = 0.187 or posterior TS change (P = 0.744. Conclusions: A medial opening wedge HTO above the tibial tubercle was significantly associated with lowering patella height or reducing CDI postoperatively. Based on our results, we would recommend the use of an infra-tubercle osteotomy during the corrective surgery to prevent the complication of patella baja.

  13. Checking the virtual treatment modality Wedge from Siemens; Verificacion de la modalidad de tratamiento virtual WEDGE de SIEMENS

    Energy Technology Data Exchange (ETDEWEB)

    Suero Rodrigo, M. A.; Marques Fraguela, E.

    2011-07-01

    The treatment modality Virtual Wedge (VW) or implemented by Siemens virtual wedge in electron linear accelerators achieved dose distributions are similar but not identical, to those obtained with physical wedges. Among the advantages against the latter is the greater ease of use, wedge factor close to one, and lower peripheral dose. However, these benefits are to be effective requires a through quality control dependence because a larger number of parameters that control the generation of the beam, the dose monitor system and the movement of the jaws of the collimator. We performed a study of the wedge taking into account different configurations that can affect their behavior from the dosimetric point of view.

  14. [Metatarsus primus double osteotomy, a logical and non-disabling surgical technique for treatment of hallux valgus].

    Science.gov (United States)

    Osterwalder, A; Maestretti, G

    1993-09-01

    The procedure known as the Metatarsus Primus Double Osteotomy ("L'ostéotomie métatarsienne bipolaire" of Schnepp-Carret) for the treatment of the hallux valgus is a logical, efficient and non-mutilating procedure. The technique consists in reducing the hallux valgus deformity by a subcapital bone wedge resection of the metatarsus primus. The bone wedge is then pinched into a second proximal osteotomy of the metatarsus primus, correcting the varus deformity in a valgus direction. This procedure is little known and is not even mentioned in the classic orthopedic literature of German and English language.

  15. Double First Metatarsal and Akin Osteotomy for Severe Hallux Valgus.

    Science.gov (United States)

    Al-Nammari, Shafic Said; Christofi, Theodoros; Clark, Callum

    2015-10-01

    The technique of double first metatarsal osteotomies was first developed in response to the high frequency of recurrence noted in the treatment of severe adolescent congruent hallux valgus deformities. The concept behind the use of this technique is that it allows the individual correction of each component of the deformity. We have modified the technique for use in adult hallux valgus where the majority of deformities are incongruent deformities and the distal chevron osteotomy is used primarily for its additional translational properties rather than purely to correct the distal metatarsal articular angle (DMAA). We report on a series of double first metatarsal osteotomies (basal opening wedge and distal chevron osteotomy) with Akin osteotomy in the treatment of moderate to severe adult hallux valgus deformity. All patients presenting to our institution with a hallux valgus deformity and treated with this procedure between 2008 and 2013 with a minimum of 1 year of follow-up were identified. Data were obtained through review of case notes, electronic charts, and digital imaging. A total of 50 feet in 48 patients underwent double first metatarsal osteotomy with Akin osteotomy. Three patients were excluded due to loss to follow-up, leaving 47 feet in 45 patients with a mean follow-up of 45 months (range, 14-60 months). Of these 43 (96%) were female and the mean age was 56 years (range, 35-70 years). The mean preoperative hallux valgus angle (HVA), intermetatarsal angle (IMA), DMAA, sesamoid position, and lateral first metatarsotalar angle were 42 degrees (range, 32-52 degrees), 18 degrees (range, 6-26 degrees), 12 degrees (range, 4-26 degrees), stage 6 (range, 4-7), and 2 degrees of dorsiflexion (range, 20 degrees of dorsiflexion to 4 degrees of plantar flexion), respectively. The mean postoperative HVA, IMA, DMAA, sesamoid position, and lateral first metatarsotalar angle were 7 degrees (range, 2 to 24 degrees), 4 degrees (range, 4-14 degrees), 6 degrees (range, 10

  16. Moberg Osteotomy Shifts Contact Pressure Plantarly in the First Metatarsophalangeal Joint in a Biomechanical Model.

    Science.gov (United States)

    Kim, Paul Hyon-Uk; Chen, Xiang; Hillstrom, Howard; Ellis, Scott J; Baxter, Josh R; Deland, Jonathan T

    2016-01-01

    A proximal phalangeal dorsiflexion osteotomy (Moberg osteotomy) is commonly used to treat hallux rigidus, but the mechanical explanation for its effectiveness is unclear. The purpose of our study was to test the effect of a Moberg osteotomy on first metatarsophalangeal joint contact mechanics. Ten cadaveric first ray specimens were dissected, with the medial band of the plantar aponeurosis preserved at its origin, and placed in a custom testing apparatus. Forefoot loads during mid-stance with the first metatarsal positioned at 10 degrees were simulated using a custom-made loading jig while contact mechanics were acquired with a thin pressure-sensitive sensor. A Moberg osteotomy was performed starting 9 mm distal to the proximal phalanx with excision of a 3-mm wedge of bone and fixated with a 2-mm Kirschner wire. The effect of the Moberg osteotomy was tested by reapplying the forefoot loads and acquiring the joint pressures. The center of pressure, peak pressure, and contact area were calculated. Paired t tests were performed to determine if the Moberg osteotomy affected joint contact mechanics. The Moberg osteotomy shifted the center of contact pressure on the proximal phalanx surface more plantarly (P osteotomy did not affect the peak pressure (P = .62) or the joint contact area (P = .96). There were no differences in peak pressure or first MTPJ contact area, but a plantar shift in the center of pressure occurred after the Moberg osteotomy. The plantar cartilage, which is often spared from arthritic changes, may be preferentially loaded and the potential edge loading following cheilectomy may be avoided with the Moberg osteotomy secondary to the plantar shift of center of pressure. © The Author(s) 2015.

  17. Maquet Osteotomy, Results

    Science.gov (United States)

    Díaz, Jorge Luis; Vega, Marcelo; Matesevach, Ivan

    2017-01-01

    Objectives: The objectives are to assess the results and to discuss the indications for Maquet osteotomy in patients with patellofemoral osteoarthritis. Methods: Retrospective study of a series of 32 patients (4 bilateral, that is to say, 36 knees) operated between March 1999 and October 2013 in " Arthroscopy Private Center ", 12 male and 20 female, average age 59 years with an average postoperative surgery outcomes of 53 months. The technique consists of an arthroscopic procedure to treat joint lesions and a tibial tuberosity osteotomy of 5 cm long, by embedding a 1cm subsequent graft taken from the same metaphysis and fixed with 2 screws. Results: All patients had significant improvement, evaluated with Kujala’s score (54 points preop to 86 points postop) and Guillamon Ferguson’s criteria (27.2 very good and 60.7 good). The complication rate was acceptable. Conclusion: The available technics are surgeries on proximal soft structures, osteotomies of tibial tuberosity and patellofemoral arthroplasty. Maquet osteotomy is an excellent procedure when the patient’s selection is right. Obtaining the graft from the same metaphysis simplified the procedure.

  18. Novel TPLO Alignment Jig/Saw Guide Reproduces Freehand and Ideal Osteotomy Positions.

    Science.gov (United States)

    Mariano, Abigail D; Kowaleski, Michael P; Boudrieau, Randy J

    2016-01-01

    To evaluate the ability of an alignment jig/saw guide to reproduce appropriate osteotomy positions in the tibial plateau leveling osteotomy (TPLO) in the dog. Lateral radiographs of 65 clinical TPLO procedures using an alignment jig and freehand osteotomy performed by experienced TPLO surgeons using a 24 mm radial saw blade between Dec 2005-Dec 2007 and Nov 2013-Nov 2015 were reviewed. The freehand osteotomy position was compared to potential osteotomy positions using the alignment jig/saw guide. The proximal and distal jig pin holes on postoperative radiographs were used to align the jig to the bone; saw guide position was selected to most closely match the osteotomy performed. The guide-to-osteotomy fit was categorized by the distance between the actual osteotomy and proposed saw guide osteotomy at its greatest offset (≤1 mm = excellent; ≤2 mm = good; ≤3 mm = satisfactory; >3 mm = poor). Sixty-four of 65 TPLO osteotomies could be matched satisfactorily by the saw guide. Proximal jig pin placement 3-4 mm from the joint surface and pin location in a craniocaudal plane on the proximal tibia were significantly associated with the guide-to-osteotomy fit (P = 0.021 and P = 0.047, respectively). The alignment jig/saw guide can be used to reproduce appropriate freehand osteotomy position for TPLO. Furthermore, an ideal osteotomy position centered on the tibial intercondylar tubercles also is possible. Accurate placement of the proximal jig pin is a crucial step for correct positioning of the saw guide in either instance.

  19. Digital planning of high tibial osteotomy. Interrater reliability by using two different software.

    Science.gov (United States)

    Schröter, Steffen; Ihle, Christoph; Mueller, Johannes; Lobenhoffer, Philipp; Stöckle, Ulrich; van Heerwaarden, Ronald

    2013-01-01

    The purpose of the study was to determine the interrater reliability as well as the correlation of mediCAD(®) and PreOPlan(®) in deformity analysis and digital planning of osteotomies. Digital radiographs were obtained from 81 patients planned to undergo an open wedge high tibial osteotomy. The JPEG files of the radiographs were imported to landmark-based software. Deformity analysis and planning of correction were performed by 1 experienced and 2 unexperienced observers. Osteotomy planning was aimed at correction to the predefined mechanical tibiofemoral angle of 3° valgus leg alignment. The interrater reliability of measurements was assessed using intraclass correlation coefficients (ICCs) and the confidence interval. The ICC of PreOPlan(®) was from 0.841 (mechanical lateral distal femur angle) to 0.993 (wedge-angle) and from 0.896 (joint line convergence angle) to 0.995 (mechanical tibiofemoral angle) of mediCAD(®). The ICC of height of wedge-base was 0.979 with PreOPlan(®) and 0.969 with mediCAD(®). Comparing PreOPlan(®) and mediCAD(®), the ICC of the height of wedge-base of the observers was 0.966, 0.956 and 0.969, respectively. The results show a high interrater reliability of digital planning software. Experience of the observer had no influence on results. Furthermore, a high interrater reliability and correlation of digital planning specific parameters was found. Surgeons need to master limb geometry measurements and osteotomy planning on digital radiographs as digital planning reports are used for intercolleagual correspondence, teaching purposes and as medicolegal documents. The digital planning software tested agrees with the actual demands and could be recommended for deformity analysis and planning of osteotomies. Diagnostic studies, Level I.

  20. Patellar instability treated with distal femoral osteotomy.

    Science.gov (United States)

    Swarup, Ishaan; Elattar, Osama; Rozbruch, S Robert

    2017-06-01

    Patellar instability can cause significant disability in both pediatric and adult patients, and it is associated with several factors including genu valgum. In this study, we describe the role of a lateral opening wedge distal femoral osteotomy (DFO) combined with lateral retinacular release in addressing genu valgum with associated patellar instability. The rationale for this approach is to medialize the patellar tendon insertion and decrease the Q angle with DFO. A consecutive series of patients were studied, and our outcomes of interest included improvements in radiographic measures and patient outcomes. Radiographic improvement was assessed using patella congruency angle (PCA), mechanical axis deviation (MAD), and lateral distal femoral angle (LDFA). Patient outcomes were assessed using Oxford Knee scores, KOOS-PS scores, VAS pain scores, and Kujala scores. We studied eight patients (10 knees) that underwent a lateral opening wedge DFO for genu valgum and patellar instability. Mean follow-up duration was 27 months. PCA improved from 30.4° lateral preoperatively to 5.7° lateral postoperatively (p=0.016). Similarly, MAD improved from 33.1mm lateral to 6.5mm medial, and LDFA improved from 82.4° to 92.7° after surgery (p=0.002). There were significant improvements in VAS pain and Kujala scores after surgery (pgenu valgum. Copyright © 2017 Elsevier B.V. All rights reserved.

  1. Bernese periacetabular osteotomy for hip dysplasia: Surgical technique and indications.

    Science.gov (United States)

    Kamath, Atul F

    2016-05-18

    For young, active patients with healthy hip cartilage, pelvic osteotomy is a surgical option in to address hip pain and to improve mechanical loading conditions related to dysplasia. Hip dysplasia may lead to arthrosis at an early age due to poor coverage of the femoral head and abnormal loading of the joint articulation. In patients with symptomatic dysplasia and closed triradiate cartilage (generally over age 10), including adolescents and young adults (generally up to around age 40), the Bernese periacetabular osteotomy (PAO) is a durable technique for addressing underlying structural deformity. The PAO involves a modified Smith-Petersen approach. Advantages of the Bernese osteotomy include preservation of the weight-bearing posterior column of the hemi-pelvis, preservation of the acetabular blood supply, maintenance of the hip abductor musculature, and the ability to effect powerful deformity correction about an ideal center of rotation. There is an increasing body of evidence that preservation of the native hip can be improved through pelvic osteotomy. In contrast to hip osteotomy and joint preservation, the role of total hip arthroplasty in young, active patients with correctable hip deformity remains controversial. Moreover, the durability of hip replacement in young patients is inherently limited. Pelvic osteotomy should be considered the preferred method to address correctable structural deformity of the hip in the young, active patient with developmental dysplasia. The Bernese PAO is technically demanding, yet offers reproducible results with good long-term survivorship in carefully selected patients with preserved cartilage and the ability to meet the demands of rehabilitation.

  2. Impacto do posicionamento da placa na osteotomia em cunha de fechamento lateral em cúbito varo Impact of plate positioning on the lateral closing wedge osteotomy for cubitus varus

    Directory of Open Access Journals (Sweden)

    Min Yu

    2011-01-01

    Full Text Available OBJETIVO: O cúbito varo é uma doença muito comum em crianças e adultos, ocasionada por fratura supracondilar. Existem vários procedimentos cirúrgicos e fixações internas para correção do cúbito varo, com diferentes desfechos, embora a fixação interna com placa e parafusos seja o mais comum. Contudo, o impacto do posicionamento da placa sobre a cirurgia raramente foi estudado até agora. MÉTODO: Em nosso estudo, 12 pacientes com cúbito varo foram divididos em dois grupos, operados pelo método de osteotomias em cunha com fechamento lateral e fixações internas com placa e parafusos. Em um grupo, as placas foram colocadas no lado póstero-lateral; no outro, as placas foram colocadas no lado lateral do úmero. RESULTADO: O período de acompanhamento foi 4,5 meses (faixa de 2 a 7 meses. Houve cinco resultados excelentes (83,3% e um bom (16,7% em cada grupo. Em todos os casos, a aparência é muito semelhante ao lado oposto; não há diferenças de amplitude de movimento (AM no cotovelo depois da cirurgia. Um paciente no grupo B teve paralisia nervosa transitória; não houve infecções nem osteomielite. CONCLUSÃO: A posição da placa de fixação interna não tem impacto sobre a osteotomia em cunha de fechamento lateral. Nivel de Evidência II, Prospectivo Comparativo.OBJECTIVE: To study the effects of low intensity ultrasound irradiation applied on the spinal cord, in the regeneration of the rat's sciatic nerve after a controlled crush injury, evaluating the functional results of the sciatic functional index as measured on video recorded images of the foot sole. METHODS: Eighteen rats were submitted to a controlled crush injury of the right sciatic nerve, and divided into two groups according to the treatment: Group 1 (n=9, simulated irradiation; Group 2 (n=9, effective irradiation. Low-intensity ultrasound irradiation was started on the 7th postoperative day and applied daily for 6 weeks. Images of the animals´ foot soles were video recorded on a transparenttreadmill belt at weekly intervals until the 6th week of irradiation, and the corresponding sciatic functional index (SFI was measured usingspecific software. RESULTS: The SFI during the first and last week of treatment was -59.12 and -12.55 in Group 1, -53.31 and -1.32 in Group 2, indicating improvements of 79% and 97%, respectively, but differences between the groups were only significant (p<0.05 during the third week of treatment. CONCLUSION: The authors conclude that low intensity therapeutic ultrasound enhances nerve regeneration, with significance during the 3rd week of treatment. Level of Evidence: Level II, prospective comparative study.

  3. Does proximal tibial osteotomy with a novel osteotomy system obtain coronal plane correction without affecting tibial slope and patellar height?

    Science.gov (United States)

    Blackman, Andrew J; Krych, Aaron J; Engasser, William M; Levy, Bruce A; Stuart, Michael J

    2015-12-01

    To determine changes in tibial slope, patellar height, and coronal plane alignment after medial opening wedge proximal tibial osteotomy (PTO) using a modern osteotomy system. Patients undergoing medial opening wedge PTO for any indication with follow-up until radiographic union were identified. Pre- and post-operative tibial slope (referenced off the anterior tibial cortex, proximal tibial anatomic axis, and posterior tibial cortex), patellar height (Caton-Deschamps, Blackburne-Peel, and Insall-Salvati indices), and coronal plane [mechanical axis and weight-bearing line (WBL) ratio] measurements were taken by two observers and compared. Review of 27 patients demonstrated unchanged tibial slope and slightly decreased patellar height post-operatively (Caton-Deschamps: -0.10 ± 0.09; Blackburne-Peel: -0.11 ± 0.10). Coronal plane measurements showed 6.4° ± 1.8° mean change in mechanical axis. Mean post-operative WBL ratio was significantly lower (51.6 ± 11.5 %) than mean goal WBL ratio (62.2 ± 2.5 %). Preoperative mechanical axis >6° varus and osteoarthritis alone as the surgical indication were risk factors for undercorrection >10 %. Medial opening wedge PTO using a recently developed instrumentation system was found to have no effect on tibial slope. Patellar height was decreased after osteotomy using this system, although clinical significance of these findings is unknown. Coronal plane undercorrection of 10.6 % of the target WBL ratio was seen in the group as a whole, although secondary analysis of these results indicated that patients with medial compartment osteoarthritis and/or preoperative mechanical axis of >6° varus accounted for the majority of the cases of undercorrection. Retrospective case series, Level IV.

  4. A prospective study on the effect of modified alar cinch sutures and V-Y closure versus simple closing sutures on nasolabial changes after Le Fort I intrusion and advancement osteotomies.

    NARCIS (Netherlands)

    Muradin, M.S.; Seubring, K.; Stoelinga, P.J.W.; Bilt, A. van der; Koole, R.; Rosenberg, A.J.

    2011-01-01

    PURPOSE: The purpose of this study was to determine whether a modified alar cinch suture and V-Y closure (mACVY) have a beneficial effect on labial form after Le Fort I intrusion and advancement osteotomies and whether they result in excessive upward nasal tip rotation. Both are possible effects com

  5. A Prospective Study on the Effect of Modified Alar Cinch Sutures and V-Y Closure Versus Simple Closing Sutures on Nasolabial Changes After Le Fort I Intrusion and Advancement Osteotomies

    NARCIS (Netherlands)

    Muradin, Marvick S. M.; Seubring, Karlien; Stoelinga, Paul J. W.; Bilt, Andries Vd; Koole, Ronald; Rosenberg, Antoine J. W. P.

    2011-01-01

    Purpose: The purpose of this study was to determine whether a modified alar cinch suture and V-Y closure (mACVY) have a beneficial effect on labial form after Le Fort I intrusion and advancement osteotomies and whether they result in excessive upward nasal tip rotation. Both are possible effects com

  6. Total hip arthroplasty with femoral subtrochanteric osteotomy after Schanz osteotomy.

    Science.gov (United States)

    Sonohata, Motoki; Kitajima, Masaru; Kawano, Shunsuke; Tanaka, Riki; Mawatari, Masaaki

    2016-07-01

    Schanz osteotomy is one of the options for the management of hip instability caused by congenital or septic arthritis. Following Schanz osteotomy, there is risk of hip pain secondary to hip arthritis. It may be necessary to perform subtrochanteric femoral osteotomy in conjunction with total hip arthroplasty (THA). This study evaluates the outcomes and complications associated with THA. We performed 36 THA after Schanz osteotomy. Patients were divided into three groups: (1) successful Schanz osteotomy, (2) highly dislocated hip with contact between the femoral head and pelvis, and (3) completely dislocated hip without contact between the femur and pelvis. Clinical and radiological evaluations were completed for each group. In all three groups, hip function improved significantly (p osteotomy after Schanz osteotomy. However, this procedure is a technically demanding treatment option, and there were characteristic complications intra and after surgery. Therefore, surgeons should treat hip osteoarthritis after Schanz operation with utmost care, especially completely dislocated hip. Copyright © 2016 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

  7. The fate of fibular osteotomies performed during high tibial osteotomy.

    Science.gov (United States)

    Bicer, Elcil Kaya; Basa, Can Doruk; Gunay, Huseyin; Aydogdu, Semih; Sur, Hakki

    2016-08-01

    High tibial osteotomy (HTO) is an important treatment alternative in isolated single compartment knee osteoarthritis. To achieve adequate mechanical axis corrections in the lower extremity fibula is also osteotomized concomitantly. The aim of this study was to compare the union rates of proximal and diaphyseal fibular osteotomies accompanying high tibial osteotomies. Sixty-seven knees of sixty-three patients who had undergone HTO were retrospectively evaluated. The patients were grouped according to the level of the fibular osteotomy (FO). In group I, the level of FO was proximal, and in group II, it was at the level of junction of middle and distal third of diaphysis. The union rates of FOs at two different levels were compared. The influence of the presence of displacement at the osteotomy site and apposition between bone ends on union was also evaluated. Fifty-nine of sixty-seven FOs (88.06 %) were united. The union rate of proximal FOs was significantly greater than diaphyseal osteotomies (p < 0.0001); 97.9 % of proximal FOs were united, whereas this ratio was 65 % for the diaphyseal FOs. The presence of displacement at the FO and apposition between bone ends significantly influenced the bony union rate (p values 0.035 and <0.0001, respectively). Union rates and nonunion characteristics of FO might differ according to its level, apposition of bone ends, and contact area. The fate of FO might also affect the union of HTO.

  8. Wedges of Anxiety

    DEFF Research Database (Denmark)

    Hellström, Maria; Brandt, Eva

    2005-01-01

    The Heraclitian notion of a reality in constant flux seems to have settled even in the public consciousness. We are, to an ever-increasing extent, on the move; in motion between different places of abode, between domiciles and places of residence, between temporary addresses and provisory settlem...... cones of light, as the cut their way into the unknown, like wedges of anxiety...

  9. Complications of minimally invasive calcaneal osteotomy versus open osteotomy.

    Science.gov (United States)

    Kendal, Adrian R; Khalid, Ali; Ball, Tom; Rogers, Mark; Cooke, Paul; Sharp, Robert

    2015-06-01

    Calcaneal osteotomy is an established technique for correcting hindfoot deformity. Patients traditionally receive an osteotomy through the open lateral approach to the calcaneus. To reduce the rate of wound complications associated with a direct open lateral approach, a minimally invasive surgical (MIS) technique has been adopted. This uses a low-speed, high-torque burr to perform the same osteotomy under radiographic guidance. We hypothesized that the new MIS calcaneal osteotomy would be a safe alternative to open calcaneal osteotomy while obtaining the same displacement. The safety of the new MIS technique was investigated with a case controlled study on all patients who underwent displacement calcaneal osteotomy at the Nuffield Orthopaedic Centre from 2008 to 2014. The primary outcome measure was 30 day postoperative complication rate. Secondary outcome measures included operating time, duration of stay, fusion rates, and calcaneal displacement. Eighty-one patients underwent calcaneal osteotomy as part of their corrective surgery, 50 in the Open approach group and 31 in MIS group. The average age was 47.7 years (range 16-77) for the Open group and 50.1 (range 21-77) in the MIS group. A mean calcaneal displacement of 9.4 mm (SD = 1.16, 8 to 11 mm) and 10.2 mm (SD = 1.06, 8 to 13 mm) was achieved through the MIS and Open approaches, respectively. There were significantly fewer wound complications in the MIS group (6.45%) compared to the Open group (28%, P = .022). The MIS group was associated with significantly lower rate of wound infection (3% versus 20%, P = .044). Three patients in the Open group experienced sural peripheral neuropathy. The average length of stay was 3.8 days following MIS and 4.3 days following open calcaneal osteotomy. Nonunion occurred in only 1 patient in the MIS group and none in the open group. MIS calcaneal osteotomy was found to be a safe technique. It was technically as effective as calcaneal osteotomy performed through an open lateral

  10. Precise and feasible measurements of lateral calcaneal lengthening osteotomies by radiostereometric analysis in cadaver feet

    Science.gov (United States)

    Martinkevich, P.; Rahbek, O.; Møller-Madsen, B.; Søballe, K.; Stilling, M.

    2015-01-01

    Objectives Lengthening osteotomies of the calcaneus in children are in general grafted with bone from the iliac crest. Artificial bone grafts have been introduced, however, their structural and clinical durability has not been documented. Radiostereometric analysis (RSA) is a very accurate and precise method for measurements of rigid body movements including the evaluation of joint implant and fracture stability, however, RSA has not previously been used in clinical studies of calcaneal osteotomies. We assessed the precision of RSA as a measurement tool in a lateral calcaneal lengthening osteotomy (LCLO). Methods LCLO was performed in six fixed adult cadaver feet. Tantalum markers were inserted on each side of the osteotomy and in the cuboideum. Lengthening was done with a plexiglas wedge. A total of 24 radiological double examinations were obtained. Two feet were excluded due to loose and poorly dispersed markers. Precision was assessed as systematic bias and 95% repeatability limits. Results Systematic bias was generally below 0.10 mm for translations. Precision of migration measurements was below 0.2 mm for translations in the osteotomy. Conclusion RSA is a precise tool for the evaluation of stability in LCLO. Cite this article: Bone Joint Res 2015;4:78–83. PMID:25957380

  11. Shock detachment from curved wedges

    Science.gov (United States)

    Mölder, S.

    2017-03-01

    Curved shock theory is used to show that the flow behind attached shocks on doubly curved wedges can have either positive or negative post-shock pressure gradients depending on the freestream Mach number, the wedge angle and the two wedge curvatures. Given enough wedge length, the flow near the leading edge can choke to force the shock to detach from the wedge. This local choking can preempt both the maximum deflection and the sonic criteria for shock detachment. Analytical predictions for detachment by local choking are supported by CFD results.

  12. Shock detachment from curved wedges

    Science.gov (United States)

    Mölder, S.

    2017-09-01

    Curved shock theory is used to show that the flow behind attached shocks on doubly curved wedges can have either positive or negative post-shock pressure gradients depending on the freestream Mach number, the wedge angle and the two wedge curvatures. Given enough wedge length, the flow near the leading edge can choke to force the shock to detach from the wedge. This local choking can preempt both the maximum deflection and the sonic criteria for shock detachment. Analytical predictions for detachment by local choking are supported by CFD results.

  13. Non-linear critical taper model and determination of accretionary wedge strength

    Science.gov (United States)

    Yang, Che-Ming; Dong, Jia-Jyun; Hsieh, Yuan-Lung; Liu, Hsueh-Hua; Liu, Cheng-Lung

    2016-12-01

    The critical taper model has been widely used to evaluate the strength contrast between the wedge and the basal detachment of fold-and-thrust belts and accretionary wedges. However, determination of the strength parameters using the traditional critical taper model, which adopts the Mohr-Coulomb failure criterion, is difficult, if not impossible. In this study, we propose a modified critical taper model that incorporates the non-linear Hoek-Brown failure criterion. The parameters in the proposed critical Hoek-Brown wedge CHBW model can be directly evaluated via field investigations and laboratory tests. Meanwhile, the wedge strength is a function of the wedge thickness, which is oriented from stress non-linearity. The fold-and-thrust belt in western central Taiwan was used as an example to validate the proposed model. The determined wedge strength was 0.86 using a representative wedge thickness of 5.3 km; this was close to the inferred value of 0.6 from the critical taper. Interestingly, a concave topographic relief is predicted as a result of the wedge thickness dependency of the wedge strength, even if the wedge is composed of homogeneous materials and if the strength of the detachment is uniform. This study demonstrates that the influence of wedge strength on the critical taper angle can be quantified by the spatial distribution of strength variables and by the consideration of the wedge thickness dependency of wedge strength.

  14. Humeral head osteotomy in shoulder arthroplasty: a comparison between anterosuperior and inferoanterior resection techniques.

    Science.gov (United States)

    Suter, Thomas; Kolz, Christopher W; Tashjian, Robert Z; Henninger, Heath B; Gerber Popp, Ariane

    2017-02-01

    The best chance that a shoulder arthroplasty will restore motion and muscle balance across the glenohumeral joint is by closely replicating natural articular morphology. Defining the humeral osteotomy plane along clear landmarks at the anatomic neck is critical. We hypothesized that a new osteotomy, based on alternative landmarks on the anatomic neck, would restore 3-dimensional humeral head morphology more reliably than the traditional osteotomy. The anatomic neck was digitized in 30 human cadaver shoulders and compared with its 3-dimensional computed tomography reconstruction. Two different osteotomy techniques were virtually performed: the traditional, following the anterosuperior anatomic neck; and a new technique, defined by the inferoanterior anatomic neck. The length-width difference and orientation (retroversion, inclination) of the resection area were compared between the techniques and with native anatomy. Length-width difference of the anterosuperior resection area was higher than in the inferoanterior osteotomy (6 ± 2 mm vs. 3 ± 1 mm; P osteotomy (32° ± 12°) did not differ from native (P = .057). Inclination differed after the anterosuperior osteotomy (129° ± 5°) and the inferoanterior osteotomy (127° ± 4°) compared with the native head (134° ± 4°; P ≤ .001). The inferoanterior referenced osteotomy generated a more circular resection area, matching the native humeral head retroversion more closely than in the anterosuperior technique. This study suggests that in shoulder arthroplasty, the humeral resection level should be referenced at the inferoanterior rather than the anterosuperior anatomic neck. Further studies should investigate the biomechanical effects of this alternative resection plane. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  15. Biplanar chevron osteotomy.

    Science.gov (United States)

    Nery, Caio; Barroco, Rui; Réssio, Cibele

    2002-09-01

    Results of biplanar chevron osteotomy performed on patients with mild-to-moderate hallux valgus deformity with an increased distal metatarsal articular angle (DMAA) are shown. The study included clinical data of 32 patients (54 feet) who had completed a 2-year follow-up, and radiological data of these 32 and other 29 patients (50 feet) for a total of 61 patients (104 feet, 53 right and 51 left). There were 59 females and two males with ages varying from 11 to 66 years. According to the AOFAS Hallux Rating, the preoperative average score (50) improved to 90 (average score after the surgery). The hallux valgus angle was improved from an average of 25 degrees to 14 degrees, the first intermetatarsal angle from 12 degrees to 8 degrees and the DMAA from 15 degrees to 5 degrees. At the end of treatment, 94% of patients were classified as having grade 0 or 1 sesamoid lateral sub-luxation. Given improvement in angles and 90% of patients satisfied with an average AOFAS postoperative score of 90, the technique seems indicated for treatment of symptomatic hallux valgus deformity with increased DMAA.

  16. Casimir Effect for a Semitransparent Wedge and an Annular Piston

    CERN Document Server

    Milton, Kimball A; Kirsten, Klaus

    2009-01-01

    We consider the Casimir energy due to a massless scalar field in a geometry of an infinite wedge closed by a Dirichlet circular cylinder, where the wedge is formed by $\\delta$-function potentials, so-called semitransparent boundaries. A finite expression for the Casimir energy corresponding to the arc and the presence of both semitransparent potentials is obtained, from which the torque on the sidewalls can be derived. The most interesting part of the calculation is the nontrivial nature of the angular mode functions. Numerical results are obtained which are closely analogous to those recently found for a magnetodielectric wedge, with the same speed of light on both sides of the wedge boundaries. Alternative methods are developed for annular regions with radial semitransparent potentials, based on reduced Green's functions for the angular dependence, which allows calculations using the multiple-scattering formalism. Numerical results corresponding to the torque on the radial plates are likewise computed, whic...

  17. Hallux varus following scarf osteotomy.

    Science.gov (United States)

    Akhtar, Shahid; Malek, Sabur; Hariharan, Kartik

    2016-12-01

    Hallux varus is an uncommon condition and majority of the cases are iatrogenic. It can occur as a result of any type of hallux valgus correction surgery and in our cases scarf osteotomy is not an exception. Treatment of this complication can be challenging and it is important to understand the factors that cause this deformity before embarking on surgical correction. Four cases of hallux varus following Scarf osteotomy (1% of our total Scarf osteotomy cases) and discuss the salient features of these patients. The authors ascertained the factors that caused iatrogenic hallux varus and formulated a classification of the nature of the deformity. The management of iatrogenic hallux varus based on our experience and proposed classification system has also been outlined and discussed. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

  18. Electrodynamic Casimir effect in a medium-filled wedge.

    Science.gov (United States)

    Brevik, Iver; Ellingsen, Simen A; Milton, Kimball A

    2009-04-01

    We re-examine the electrodynamic Casimir effect in a wedge defined by two perfect conductors making dihedral angle alpha=pi/p. This system is analogous to the system defined by a cosmic string. We consider the wedge region as filled with an azimuthally symmetric material, with permittivity and permeability epsilon1, micro1 for distance from the axis ra. The results are closely related to those for a circular-cylindrical geometry, but with noninteger azimuthal quantum number mp. Apart from a zero-mode divergence, which may be removed by choosing periodic boundary conditions on the wedge, and may be made finite if dispersion is included, we obtain finite results for the free energy corresponding to changes in a for the case when the speed of light is the same inside and outside the radius a , and for weak coupling, |epsilon1-epsilon2|cosmic string, situated along the cusp line of the pre-existing wedge.

  19. ELASTIC INTERACTION BETWEEN WEDGE DISCLINATION DIPOLE AND INTERNAL CRACK

    Institute of Scientific and Technical Information of China (English)

    FANG Qi-hong; LIU You-wen

    2006-01-01

    The system of a wedge disclination dipole interacting with an internal crack was investigated. By using the complex variable method, the closed form solutions of complex potentials to this problem were presented. The analytic formulae of the physics variables, such as stress intensity factors at the tips of the crack produced by the wedge disclination dipole and the image force acting on disclination dipole center were obtained.The influence of the orientation, the dipole arm and the location of the disclination dipole on the stress intensity factors was discussed in detail. Furthermore, the equilibrium position of the wedge disclination dipole was also examined. It is shown that the shielding or antishielding effect of the wedge disclination to the stress intensity factors is significant when the disclination dipole moves to the crack tips.

  20. Corrective osteotomy for malunion of the distal radius - The effect of concomitant ulnar shortening osteotomy

    NARCIS (Netherlands)

    Oskam, J; Bongers, KM; Karthaus, AJM; Frima, AJ; Klasen, HJ

    1996-01-01

    Positive ulnar variance due to inadequate correction of radial length is a common disorder after radial corrective osteotomy. To avoid this complication we performed a combination of ulnar-shortening osteotomy and radial corrective osteotomy in 6 of 22 radial corrections. The indication for the comb

  1. Impingement of water droplets on wedges and double-wedge airfoils at supersonic speeds

    Science.gov (United States)

    Serafini, John S

    1954-01-01

    An analytical solution has been obtained for the equations of motion of water droplets impinging on a wedge in a two-dimensional supersonic flow field with a shock wave attached to the wedge. The closed-form solution yields analytical expressions for the equation of the droplet trajectory, the local rate of impingement and the impingement velocity at any point on the wedge surface, and the total rate of impingement. The analytical expressions are utilized to determine the impingement on the forward surfaces of diamond airfoils in supersonic flow fields with attached shock waves. The results presented include the following conditions: droplet diameters from 2 to 100 microns, pressure altitudes from sea level to 30,000 feet, free-stream static temperatures from 420 degrees r, free stream Mach numbers from 1.1 to 2.0, semiapex angles for the wedge from 1.14 degrees to 7.97 degrees, thickness-to-chord ratios for the diamond airfoil from 0.02 to 0.14, chord lengths from 1 to 20 feet, and angles of attack from zero to the inverse tangent of the airfoil thickness-to-chord ratio.

  2. Is McMurray′s osteotomy obsolete?

    Directory of Open Access Journals (Sweden)

    Phaltankar P

    1995-10-01

    Full Text Available A review of the method of performing, advantages, disadvantages of McMurray′s displacement osteotomy with regard to treatment of nonunion of transcervical fracture neck femur with viable femoral head was carried out in this study of ten cases, in view of the abandonment of the procedure in favour of angulation osteotomy. Good results obtained in the series attest to the usefulness of McMurray′s osteotomy in the difficult problem of nonunion of transcervical fracture neck femur in well selected cases with certain advantages over the angulation osteotomy due to the ′Armchair effect′.

  3. Computer assisted SCFE osteotomy planning

    Energy Technology Data Exchange (ETDEWEB)

    Drapikowski, Pawel [Poznan University of Technology, Institute of Control and Information Engineering, Poznan (Poland); Tyrakowski, Marcin; Czubak, Jaroslaw; Czwojdzinski, Adam [Postgraduate Medical Education Center, Department of Orthopaedics, Warsaw (Poland)

    2008-11-15

    Slipped capital femoral epiphysis (SCFE) is a common pediatric orthopedic disorder that requires surgical correction. Preoperative planning of a proximal femoral osteotomy is essential in cases of SCFE. This planning is usually done using 2D radiographs, but 3D data can be acquired with CT and analyzed with 3D visualization software. SCFEanalyzer is a computer program developed for preoperative planning of proximal femoral osteotomy to correct SCFE. Computed tomography scans were performed on human bone specimens: one pelvis and two femoral bones (right and left) and volume data of a patient. The CT data were used to test the abilities of the SCFEanalyzer software, which utilizes 3D virtual models of anatomic structures constructed from CT image data. Separation of anatomical bone structures is done by means of ''cutting'' 3D surface model of the pelvis. The software enables qualitative and quantitative spatial analysis of chosen parameters analogous to those done on the basis of plain radiographs. SCFEanalyzer makes it possible to evaluate the function of the hip joint by calculating the range of motion depending on the shape of bone structures based on oriented bounding box object representation. Pelvic and hip CT scans from a patient with SCFE were subjected to femoral geometry analysis and hip joint function assessment. These were done to plan and simulate osteotomy of the proximal femur. Analogous qualitative and quantitative evaluation after performing the virtual surgery were evaluated to determine the potential treatment effects. The use of computer assistance in preoperative planning enable us to increase objectivity and repeatability, and to compare the results of different types of osteotomy on the proximal femur, and thus to choose the optimal operation in each individual case. (orig.)

  4. Complications of intertrochanteric rotational osteotomy

    Energy Technology Data Exchange (ETDEWEB)

    Braunstein, E.M.; Weissman, B.N.; Sosman, J.L.; Drew, M.

    1983-11-01

    Intertrochanteric anterior rotational osteotomy is a recently developed surgical procedure to treat osteonecrosis of the femoral head. We reviewed the radiographic findings in four cases to acquaint radiologists with the usual appearance of the procedure and to assess surgical complications. In all cases, immediate postoperative radiographs showed rotation of the necrotic portion of the femoral head anteriorly so that it was no longer weight-bearing. Clinical and radiologic follow-up ranged from 12 to 30 months. In this time, three patients developed complications, including nonunion of the osteotomy, further osteonecrosis with collapse of the femoral head, and worsening pain in the absence of progressive radiologic change. Radiology provides an important means of assessing rotational osteotomy, particularly in demonstrating sufficient rotation of the femoral head to assure nonweight-bearing by diseased bone. Also, surgical complications such as nonunion and hardware loosening may be identified. Nevertheless, the patient may deteriorate clinically even in the absence of radiologic demonstration of disease pregression, and the absence of radiographic change does not assure a successful surgical outcome.

  5. Some Historical Treatments should not be Forgotten: A Review of Cast Wedging and A Trick to Normalize Non-Standardized Digital X-rays

    OpenAIRE

    2014-01-01

    Introduction: Cast wedging is a simple and reproducible method of manipulating a sub-optimally reduced fracture producing a correction and a final alignment that is amenable to definitive closed treatment. Multiple successful techniques have been previously described in the literature (opening wedge, closing wedge and combination). Technical Note: We present a simple reproducible method of templating and executing a proper cast wedging technique using digital imaging systems that are not cont...

  6. Structure and Kinematics of the Indo-Burmese Wedge

    Science.gov (United States)

    Maurin, T.; Rangin, C.

    2007-12-01

    The Burma subduction trench and the associated Indo Burmese wedge mark the present eastern boundary of the Indian plate in the northern Bengal area. The initiation, duration and history of the Bengal crust subduction beneath Burma is still debated. The aim of this paper is to provide a structural and kinematic analysis of the Indo- Burmese wedge in order to better constraints the Bengal crust subduction history beneath Burma. On the basis of field observations, seismic reflection data interpretation and well logs data we present a structural analysis of the Outer Indo-Burmese Wedge. We also constrain the onset of this Outer Wedge to be younger than 2Ma, implying a recent and fast westward growth (~10cm/yr) since Late Pliocene in close relationship with the onset of the Shillong plateau. Restoration process of a synthetic cross section through the Outer Wedge allowed us to estimate the amount of EW shortening accommodated in the Outer Wedge to be 5.1mm/yr since 2Ma. These results combined with previous available GPS data from central Myanmar suggest strain partitioning at wedge scale. The core of the wedge is affected by shear deformation and acts as a buttress for a frontal wedge that accommodates a more compressive strain component. Finally we propose that the main characteristic of the Indo-Burmese wedge growth mechanism is the progressive incorporation of the most internal part of the wedge, formerly affected by transpressive thin-skinned tectonics, to the buttress where they are subsequently affected by shear deformation. The crustal structure boarding the newly formed buttress seems to be guided by the subducting crust fabrics. We are in favour of a very recent (Late Miocene) onset of the present Indian crust subduction beneath Burma coeval with the global plate kinematics reorganisation related to the Indian/Australian plate spliting. This subduction postdates the Indo Burmese range onset that must have started in early Miocene. This range first began to

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

    Science.gov (United States)

    Denjean, S; Chatain, F; Tayot, O

    2017-03-02

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

  8. Complications after intraoral vertical ramus osteotomy: relationship to the shape of the osteotomy line.

    Science.gov (United States)

    Kawase-Koga, Y; Mori, Y; Fujii, Y; Kanno, Y; Chikazu, D; Susami, T; Takato, T

    2016-02-01

    Intraoral vertical ramus osteotomy (IVRO) is used widely to correct mandibular prognathism. However, several disadvantages of this procedure have been reported, such as condylar luxation and bony interference at the osteotomy site. The aim of this study was to survey the incidence of complications (condylar luxation and bony interference) based on the shape of the osteotomy line. One hundred and eighty-five rami in 118 patients with jaw deformities, which were treated with IVRO, were examined retrospectively. The shape of the osteotomy line and the postoperative complications were examined on panoramic radiographs. Osteotomy lines were classified into three types: vertical, C-shaped, and oblique. Of the 185 osteotomy sites, 98 were vertical, 37 C-shaped, and 50 oblique. Condylar luxation was found in six rami (3.2%); four had undergone vertical osteotomy and two had undergone C-shaped osteotomy. Bony interference occurred in seven rami (3.8%), all with vertical type osteotomy lines. Most complications occurred in the vertical type cases and no complications were found in oblique type cases. Condylar luxation was found mainly in unilateral IVRO cases and bony interference was found in bilateral IVRO cases. These results suggest that the oblique type of osteotomy line has the advantage of avoiding complications. Copyright © 2015. Published by Elsevier Ltd.

  9. LeFort I Osteotomy.

    Science.gov (United States)

    Buchanan, Edward P; Hyman, Charles H

    2013-08-01

    The LeFort I osteotomy is one of the most commonly used procedures to correct midface deformities. It allows for correction in three dimensions including advancement, retrusion, elongation, and shortening. It is indicated, often in conjunction with mandibular surgery, for class II and III malocclusion, facial asymmetry, obstructive sleep apnea, and maxillary atrophy. Before surgery, proper orthodontics and surgical planning should be undertaken to ensure adequate outcomes. Overall, the surgery is widely used due to its low complication profile and reliable long-term results.

  10. Tratamento da extrofia de bexiga: osteotomia posterior dos ossos ilíacos e fechamento da pelve com cinta de náilon Treatment of bladder exstrophy: posterior osteotomy of iliac bones and closing of the pelvis with a nylon braces

    Directory of Open Access Journals (Sweden)

    Francisco Carlos Salles Nogueira

    2011-01-01

    Full Text Available Objetivo: Avaliou-se o resultado obtido em nove correções cirúrgicas de extrofia de bexiga em pacientes pediátricos. Métodos: Foi utilizada osteotomia posterior dos ossos ilíacos seguida pelo fechamento da pelve com cinta de náilon. Os procedimentos foram realizados em dois tempos cirúrgicos distintos com 48h de intervalo. Resultado: A média de idade foi de 17,6 meses. Cinco pacientes eram do sexo masculino. O seguimento médio foi de 32 meses. Conclusão: Os resultados finais foram animadores, mesmo nos pacientes que apresentaram complicações pós-operatórias como infecções e deiscência.Objective: The authors evaluated the results obtained in nine surgical correction of bladder exstrophy in pediatric patients. Methods: We used posterior osteotomy of pelvic iliac bones followed by closing with a nylon brace. The procedures were performed in two different surgical times with intervals of 48 hours. Results: The mean age was 17.6 months. Five patients were male. The mean follow-up was 32 months. Conclusion: The final results were encouraging even in patients who had postoperative complications such as infection and dehiscence.

  11. Casimir effect at nonzero temperature for wedges and cylinders

    CERN Document Server

    Ellingsen, Simen Å; Milton, Kimball A

    2010-01-01

    We consider the Casimir-Helmholtz free energy at nonzero temperature $T$ for a circular cylinder and perfectly conducting wedge closed by a cylindrical arc, either perfectly conducting or isorefractive. The energy expression at nonzero temperature may be regularized to obtain a finite value, except for a singular corner term in the case of the wedge which is present also at zero temperature. Assuming the medium in the interior of the cylinder or wedge be nondispersive with refractive index $n$, the temperature dependence enters only through the non-dimensional parameter $2\\pi naT$, $a$ being the radius of the cylinder or cylindrical arc. We show explicitly that the known zero temperature result is regained in the limit $aT\\to 0$ and that previously derived high temperature asymptotics for the cylindrical shell are reproduced exactly.

  12. Three-phase bone scintigraphic analysis of radial osteotomy for Kienboeck`s disease

    Energy Technology Data Exchange (ETDEWEB)

    Nakao, Etsuhiro; Nakamura, Ryogo; Imaeda, Toshihiko [Branch Hospital of Nagoya Univ. (Japan); Tsunoda, Kenji; Makino, Naoki

    1996-02-01

    Three-phase bone scintigraphy was performed before and after radial wedge osteotomy on 11 joints. All 11 patients were suffering from Kienboeck`s disease. We analized the relations between the change of those images and the clinical courses. On blood pool images that were performed before radial wedge osteotomy, we observed decreased accumulation in the lunate bone in 4 of 9 patients in Lichtman`s stage II or IIIA. Intensive accumulation in the carpal area that seemed to represent the activity of Kienboeck`s disease were seen in all patients. Delayed image showed accumulation demonstrating osteoarthritic changes. Accumulation in the lunte bone on blood pool images was confirmed in all patients 6 to 12 months after operation. This appeared to suggest the increase of blood flow into the lunate bone. Compared with preoperative blood pool images, accumulation in the carpal area decreased in 8 patients who followed good postoperative course and their clinical symptoms improved relatively quickly. In the other 3 patients no decrease in this accumulation was confirmed by the initial postoperative scintigraphy. The improvement in their symptoms was delayed. The postoperative change of delayed images was visualized less sensitively than that of blood pool images. The decreased accumulation in the carpal area on blood pool images allows prediction of the subsequent clinical course prior to improvement in clinical symptoms. We consider this finding to be useful clinically. (author).

  13. Failure of knee osteotomy in a case of neuropathic arthropathy of the knee.

    Science.gov (United States)

    Traina, Francesco; De Fine, Marcello; Abati, Caterina Novella; Frakulli, Ideal; Toni, Aldo

    2011-06-01

    Neuropathic arthropathy (Charcot's joint) is a degenerative process that affects peripheral or vertebral joints as a consequence of a disturbance in proprioception and pain perception. The knee is one of the most frequently affected joints, but even when the diagnosis is made at an early stage there is no consensus on the best treatment options. An early diagnosis of neurosyphilis was made in a 55-year-old woman presenting a delayed union of an asymptomatic Schatzker type IV fracture of the proximal tibia. A medial opening wedge tibial osteotomy was performed to achieve fracture healing, to correct the medial depression of the articular surface, and possibly to avoid an early arthritis typical of the disease. To our knowledge, a knee osteotomy has never been reported at an early stage of neuropathic arthropathy. Even though the clinical and radiographic evaluation performed at 4 months follow-up showed a good stage of healing of the osteotomy and no typical features of neuropathic joint degeneration, at 8 months follow-up the knee was markedly deranged.

  14. [Femoral varus osteotomy combined with interlocking nailing for treatment of genu valgum].

    Science.gov (United States)

    Wang, Huimin; Tan, Mingsheng; Li, Zirong; Yang, Feng; Liang, Li; Zhang, Guangbo

    2005-03-15

    To assess the effect of medial distal femoral osteotomy combined with interlocking nailing on the treatment of knee osteoarthritis with valgus deformity. From May 1996 to August 2000, 16 patients with knee osteoarthritis accompanied by valgus deformity were treated by medial wedged distal femoral osteotomy combined with interlocking nailing. Full-length radiographs were taken before operation and 8 weeks and 2 years after operation. The parameters, including the femorotibial angle, the tibial angle, the femoral angle, the femoral condyle-tibial plateau angle, and the lateral joint space, were measured by these radiographs. The function of knee was evaluated by the 100-point rating scale standard of knee. The mean postoperative score was significantly improved from 50.4 +/- 15.9 points to 78.5 +/- 12.9 points 2 years after the surgery. The lateral joint space was increased from 2.1 +/- 1.8 mm to 4.7 +/- 1.7 mm and the femoral condyle-tibial angle decreased from 5.6 +/- 2.9 degrees to 1.6 +/- 3.4 degrees. There were complications in 2 cases: 1 case of delayed union and 1 case of superficial wound infection. Medial distal femoral osteotomy combined with interlocking nailing proves to be an effective approach to treat knee osteoarthritis with valgus deformity.

  15. Severe gummy smile with class II malocclusion treated with LeFort I osteotomy combined with horseshoe osteotomy and intraoral vertical ramus osteotomy

    National Research Council Canada - National Science Library

    Shimo, Tsuyoshi; Nishiyama, Akiyoshi; Jinno, Tokiari; Sasaki, Akira

    2013-01-01

    .... The patient had an 11-mm gingival exposure during full smile and a convex profile. A LeFort I osteotomy combined with a horseshoe osteotomy was used for the superior repositioning of the maxilla...

  16. Portal dosimetry in wedged beams

    NARCIS (Netherlands)

    Spreeuw, H.; Rozendaal, R.; Camargo, P.; Mans, A.; Wendling, M.; Olaciregui-Ruiz, I.; Sonke, J.J.; Herk, M. van; Mijnheer, B.

    2015-01-01

    Portal dosimetry using electronic portal imaging devices (EPIDs) is often applied to verify high-energy photon beam treatments. Due to the change in photon energy spectrum, the resulting dose values are, however, not very accurate in the case of wedged beams if the pixel-to-dose conversion for the s

  17. Wedge wetting by electrolyte solutions

    Science.gov (United States)

    Mußotter, Maximilian; Bier, Markus

    2017-09-01

    The wetting of a charged wedgelike wall by an electrolyte solution is investigated by means of classical density functional theory. As in other studies on wedge wetting, this geometry is considered as the most simple deviation from a planar substrate, and it serves as a first step toward more complex confinements of fluids. By focusing on fluids containing ions and surface charges, features of real systems are covered that are not accessible within the vast majority of previous theoretical studies concentrating on simple fluids in contact with uncharged wedges. In particular, the filling transition of charged wedges is necessarily of first order, because wetting transitions of charged substrates are of first order and the barrier in the effective interface potential persists below the wetting transition of a planar wall; hence, critical filling transitions are not expected to occur for ionic systems. The dependence of the critical opening angle on the surface charge, as well as the dependence of the filling height, of the wedge adsorption, and of the line tension on the opening angle and on the surface charge are analyzed in detail.

  18. Application of a 3-dimensional printed navigation template in Bernese periacetabular osteotomies

    Science.gov (United States)

    Zhou, You; Kang, Xiaopeng; Li, Chuan; Xu, Xiaoshan; Li, Rong; Wang, Jun; Li, Wei; Luo, Haotian; Lu, Sheng

    2016-01-01

    Abstract The aim of the present study was to describe the application of 3D printed templates for intraoperative navigation and simulation of periacetabular osteotomies (PAOs) in a cadaveric model. Five cadaveric specimens (10 sides) underwent thin-slice computed tomographic scans of the ala of ilium downwards to the proximal end of femoral shaft. Bernese PAO was performed. Using Mimics v10.1 software (Materialise, Leuven, Belgium), 3D computed tomographic reconstructions were created and the 4 standard PAO bone cuts—ischial, pubic, anterior, and posterior aspects of the ilium—as well as rotation of the dislocated acetabular bone blocks were simulated for each specimen. Using these data, custom 3D printed bone-drilling templates of the pelvis were manufactured, to guide surgical placement of the PAO bone cuts. An angle fix wedge was designed and printed, to help accurately achieve the predetermined rotation angle of the acetabular bone block. Each specimen underwent a conventional PAO. Preoperative, postsimulation, and postoperative lateral center-edge angles, acetabular indices, extrusion indices, and femoral head coverage were measured and compared; P and t values were calculated for above-mentioned measurements while comparing preoperative and postoperative data, and also in postsimulation and postoperative data comparison. All 10 PAO osteotomies were successfully completed using the 3D printed bone-drilling template and angle fix wedge. No osteotomy entered the hip joint and a single posterior column fracture was observed. Comparison of preoperative and postoperative measurements of the 10 sides showed statistically significant changes, whereas no statistically significant differences between postsimulation and postoperative values were noted, demonstrating the accuracy and utility of the 3D printed templates. The application of patient-specific 3D printed bone-drilling and rotation templates in PAO is feasible and may facilitate improved clinical outcomes

  19. Application of a 3-dimensional printed navigation template in Bernese periacetabular osteotomies: A cadaveric study.

    Science.gov (United States)

    Zhou, You; Kang, Xiaopeng; Li, Chuan; Xu, Xiaoshan; Li, Rong; Wang, Jun; Li, Wei; Luo, Haotian; Lu, Sheng

    2016-12-01

    The aim of the present study was to describe the application of 3D printed templates for intraoperative navigation and simulation of periacetabular osteotomies (PAOs) in a cadaveric model.Five cadaveric specimens (10 sides) underwent thin-slice computed tomographic scans of the ala of ilium downwards to the proximal end of femoral shaft. Bernese PAO was performed. Using Mimics v10.1 software (Materialise, Leuven, Belgium), 3D computed tomographic reconstructions were created and the 4 standard PAO bone cuts-ischial, pubic, anterior, and posterior aspects of the ilium-as well as rotation of the dislocated acetabular bone blocks were simulated for each specimen. Using these data, custom 3D printed bone-drilling templates of the pelvis were manufactured, to guide surgical placement of the PAO bone cuts. An angle fix wedge was designed and printed, to help accurately achieve the predetermined rotation angle of the acetabular bone block. Each specimen underwent a conventional PAO. Preoperative, postsimulation, and postoperative lateral center-edge angles, acetabular indices, extrusion indices, and femoral head coverage were measured and compared; P and t values were calculated for above-mentioned measurements while comparing preoperative and postoperative data, and also in postsimulation and postoperative data comparison.All 10 PAO osteotomies were successfully completed using the 3D printed bone-drilling template and angle fix wedge. No osteotomy entered the hip joint and a single posterior column fracture was observed. Comparison of preoperative and postoperative measurements of the 10 sides showed statistically significant changes, whereas no statistically significant differences between postsimulation and postoperative values were noted, demonstrating the accuracy and utility of the 3D printed templates.The application of patient-specific 3D printed bone-drilling and rotation templates in PAO is feasible and may facilitate improved clinical outcomes, through the use

  20. New Technique: A Novel Femoral Derotation Osteotomy for Malrotation following Intramedullary Nailing

    Directory of Open Access Journals (Sweden)

    S. Jagernauth

    2012-01-01

    Full Text Available A 19-year-old female patient sustained a closed spiral midshaft femoral fracture and subsequently underwent femoral intramedullary nail insertion. At followup she complained of difficulty in walking and was found to have a unilateral in-toeing gait. CT imaging revealed 30 degrees of internal rotation at the fracture site, which had healed. A circumferential osteotomy was performed distal to the united fracture site using a Gigli saw with the intramedullary femoral nail in situ. The static distal interlocking screws were removed and the malrotation was corrected. Two further static distal interlocking screws were inserted to secure the intramedullary nail in position. The osteotomy went on to union and her symptoms of pain, walking difficulty, and in-toeing resolved. Our paper is the first to describe a technique for derotation osteotomy following intramedullary malreduction that leaves the intramedullary nail in situ.

  1. Some Historical Treatments should not be Forgotten: A Review of Cast Wedging and A Trick to Normalize Non-Standardized Digital X-rays

    Science.gov (United States)

    Jacobson, Nathan A.; Lee, Christopher L.

    2014-01-01

    Introduction: Cast wedging is a simple and reproducible method of manipulating a sub-optimally reduced fracture producing a correction and a final alignment that is amenable to definitive closed treatment. Multiple successful techniques have been previously described in the literature (opening wedge, closing wedge and combination). Technical Note: We present a simple reproducible method of templating and executing a proper cast wedging technique using digital imaging systems that are not controlled for magnification with an illustrative case. Conclusion: Renewed interest in cast wedging can provide a cost effective treatment with proven clinical outcomes in an ever changing and uncertain reimbursement climate. PMID:27298956

  2. Minimally Invasive Osteotomies of the Calcaneus.

    Science.gov (United States)

    Guyton, Gregory P

    2016-09-01

    Osteotomies of the calcaneus are powerful surgical tools, representing a critical component of the surgical reconstruction of pes planus and pes cavus deformity. Modern minimally invasive calcaneal osteotomies can be performed safely with a burr through a lateral incision. Although greater kerf is generated with the burr, the effect is modest, can be minimized, and is compatible with many fixation techniques. A hinged jig renders the procedure more reproducible and accessible. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Total Hip Arthroplasty after Previous Acetabular Osteotomy: Comparison of Three Types of Acetabular Osteotomy.

    Science.gov (United States)

    Tamaki, Tatsuya; Oinuma, Kazuhiro; Miura, Yoko; Shiratsuchi, Hideaki

    2016-01-01

    To compare surgical results of total hip arthroplasty (THA) following acetabular osteotomy, operative records of 13 hips following Chiari osteotomy (Chiari group), 22 hips following rotational periacetabular osteotomy (RAO; RAO group), 16 hips following shelf acetabuloplasty (Shelf group), and 2475 hips without previous osteotomy (Control group) were retrospectively reviewed. The operative time was significantly longer in the RAO group than in the Control group. Bulk bone augmentation was required more often in the Chiari and RAO groups than in the Control group. An early migration of the acetabular cup occurred in 2 hips in the RAO group. RAO made conversion to THA more complicated than did the Chiari osteotomy or the shelf acetabuloplasty. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Contact process in a wedge

    CERN Document Server

    Cox, J Theodore; Schinazi, Rinaldo B

    2009-01-01

    We prove that the supercritical one-dimensional contact process survives in certain wedge-like space-time regions, and that when it survives it couples with the unrestricted contact process started from its upper invariant measure. As an application we show that a type of weak coexistence is possible in the nearest-neighbor ``grass-bushes-trees'' successional model introduced in Durrett and Swindle (1991).

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

    Directory of Open Access Journals (Sweden)

    Roger Avakian

    2008-01-01

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

  6. Three-dimensional wedge filling in ordered and disordered systems

    Energy Technology Data Exchange (ETDEWEB)

    Greenall, M J [Department of Mathematics, Imperial College London, 180 Queen' s Gate, London SW7 2BZ (United Kingdom); Parry, A O [Department of Mathematics, Imperial College London, 180 Queen' s Gate, London SW7 2BZ (United Kingdom); Romero-Enrique, J M [Department of Mathematics, Imperial College London, 180 Queen' s Gate, London SW7 2BZ (United Kingdom)

    2004-04-21

    . The form of the interfacial height probability distribution function predicted by the transfer matrix approach is shown to be consistent with scaling and thermodynamic requirements for distances close to and far from the wedge bottom respectively.

  7. 高弓马蹄内翻足术后复发与跟骨截骨%The recurring of varus and the lateral shift calcaneal osteotomy in the treatment of cavovarus foot

    Institute of Scientific and Technical Information of China (English)

    徐向阳; 刘津浩; 朱渊; 徐继平

    2009-01-01

    Objective To discuss the recurring of varus in the treatment of cavovarus foot and the relationship between correcting degree of lateral shift calcaneal osteotomy and the recurring rate.Methods Twenty-three patients (31 feet) with cavovarus foot were treated, which included 9 males and 14 females.According to the Coleman block test before the surgery, the manual passive correcting degree after the medial soft tissue release and/or the tendon lengthening and whether the calcaneal osteotomy were done, and the feet were divided into four groups.There were 0° and beyond 5° two levels of passive valgus for further differentiating and statistically analysis.The calcaneal osteotomy included lateralizing sliding osteotomy, posterior osteotomy and closing wedge osteotomy.Results In the effective following-up of 31 feet, hind foot varus recurred in 9 feet.Five varus were below 5° and 4 varus beyond 5°.The value is 4.23°±2.15°.The varus recurred in 3 feet without calcaneal osteotomy, whose Coleman block test before the surgery could correct the foot to neutral position.The varus did not recur in 4 feet without calcaneal osteotomy whose Coleman block test could correct the foot to more than 5° valgus.If the Coleman block test could not correct varus before the surgery, the varus recurred in 2 feet which could be corrected to neutral position after medial soft tissue release, while only one recurred varus in 3 feet which could be corrected to more than 5 valgus after medial soft tissue release.For the 19 feet with calcaneal osteotomy, one varus recurred in 9 feet which Coleman block test could correct the hind foot into neutral position, two varus recurred in 7 feet which Coleman block test could not correct the varus before the surgery but could correct to neutral position after the medial soft tissue release, no one varus recurred in 3 feet which Coleman block test could not correct the varus before the surgery but could correct to more than 5° valgus after the

  8. 足中跗骨联合截骨治疗儿童蚕豆足畸形%Combined midfoot osteotomy for the "Bean-Shaped" foot

    Institute of Scientific and Technical Information of China (English)

    梅海波; 赫荣国; 唐进; 刘昆; 伍江雁; 易银芝

    2009-01-01

    目的 介绍足中跗骨联合截骨(外侧骰骨闭合性楔形截骨和内侧楔状骨开放性楔形截骨)治疗儿童复发性马蹄内翻足之蚕豆足畸形的手术方法,并初步评价其临床疗效.方法 自2004年至今,采用该方法治疗儿童复发性马蹄内翻足之蚕豆足畸形共24例28足,具体操作方法:足中跗骨联合截骨分别在足内、外侧作两个手术切口,Ⅰ期进行骰骨的闭合性楔形截骨(基底位于背外侧)与内侧楔状骨冠状面开放性楔形截骨(截骨点位于其中点).在骰骨截除楔形骨块后,将该楔形骨块嵌入内侧楔状骨截骨间隙内,产生前足外展、中足内旋和骰骨截骨间隙闭合的作用,并使用自制门形钉固定两处截骨.并对随访两年以上的14例16足从临床外观和放射学的角度测量评价该手术的临床疗效.结果 随访超过2年者总计为14例16足,其临床外观和放射学改变均有明显改善,跟骨-第四跖骨角从术前平均-32°改善到术后平均-16°,距骨-第一跖骨角从术前平均-18°改善到术后平均-4°,但有1足发生内侧楔状骨移植骨块移位,导致矫形丢失.结论 足中跗骨联合截骨是治疗儿童复发性马蹄内翻足(或称之为先天性马蹄内翻足治疗后的遗留畸形)之"蚕豆足"畸形的有效方法,其操作简单、安全,疗效肯定,且不需要更多的软组织松解,适用于4岁以上或内侧楔状骨已经良好骨化的患儿.%Objective To describe a new procedure of combined midfoot osteotomy for the "Bean-Shaped" foot in children. Methods The combined midfoot osteotomy included a closing wedge osteotomy of the cuboid and an opening wedge of the medial cuneiform. Through a lateral longitudinal incision over the cuboid, a bony wedge based dorsolaterally was removed from the cuboid and inserted through a medial incision into an osteotomy of the medial cuneiform with its base medially, and then the incisions were closed with two or three small

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

    NARCIS (Netherlands)

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

    2009-01-01

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

  10. Electrodynamic Casimir Effect in a Medium-Filled Wedge II

    CERN Document Server

    Ellingsen, Simen Adnoy; Milton, Kimball A

    2009-01-01

    We consider the Casimir energy in a geometry of an infinite magnetodielectric wedge closed by a circularly cylindrical arc embedded in another magnetodielectric medium, under the condition that the speed of light be the same in both media. An expression for the Casimir energy corresponding to the arc is obtained and it is found that in the limit where the reflectivity of the boundaries tends to unity the finite part of the Casimir energy of a perfectly conducting wedge-shaped sheet closed by a circular cylinder is regained. The energy of the latter geometry possesses divergences due to the presence of sharp corners. We argue how this is a pathology of the assumption of ideal conductor boundaries, and that no analogous term enters in the present geometry.

  11. Tibial Tubercle Osteotomy: Indication and Techniques.

    Science.gov (United States)

    Grawe, Brian; Stein, Beth Shubin

    2015-08-01

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

  12. Supramalleolar Osteotomy With or Without Fibular Osteotomy for Varus Ankle Arthritis.

    Science.gov (United States)

    Hongmou, Zhao; Xiaojun, Liang; Yi, Li; Hongliang, Liu; Junhu, Wang; Cheng, Liu

    2016-09-01

    Supramalleolar osteotomy (SMOT) is an alternative operative procedure for the management of early and midstage varus ankle arthritis. However, whether fibular osteotomy is needed is controversial. The purpose of the current study was to evaluate the functional and radiologic outcomes of pre- and postoperative SMOT, and to compare the outcomes between patients with and without fibular osteotomy. Forty-one Takakura stage 2 and 3 varus ankle osteoarthritis patients treated with SMOT were included. Fourteen males and 27 females with a mean age of 50.7 (range, 32-71) years were followed with a mean of 36.6 (range, 17-61) months. There were 22 cases with fibular osteotomy and 19 without. The American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, Maryland foot score, and Ankle Osteoarthritis Score (AOS) were used for pre- and postoperative functional evaluation. The tibial articular surface angle (TAS), talar tilt (TT), tibiocrural angle (TC), and tibial lateral surface angle (TLS) were evaluated pre- and postoperatively. At the last follow-up, the mean AOFAS score (from 50.8 to 83.1 points) and Maryland score (from 58.3 to 81.6 points) in overall were improved (P osteotomy. However, in the fibular osteotomy group, TT was decreased (P osteotomy may be necessary in cases with large TT and small TC angles. Level III, retrospective comparative study. © The Author(s) 2016.

  13. Geometry and kinematics of extensional structural wedges

    Science.gov (United States)

    Gui, Baoling; He, Dengfa; Zhang, Yongsheng; Sun, Yanpeng; Huang, Jingyi; Zhang, Wenjun

    2017-03-01

    Structural wedges in the compressive environment have been recognized and studied in different locations. However, extension structural wedges are less well-understood. Based on the normal fault-bend folding theory and inclined shear model, this paper quantitatively analyses deformations related to extensional structural wedges and builds a series of geometric models for them. An extensional structural wedge is a fault-block held by two or more normal faults, the action of which would fold its overlying strata. Extensional structural wedges of different shapes will lead to different deformation results for the overlying strata, and this paper illustrates both the triangular and quadrangular wedges and their related deformations. This paper also discusses differences between the extensional structural wedges and the normal fault-bend-folding. By analysing two seismic sections from Langfang-Gu'an Sag, East China, this paper provides two natural examples of the triangular and quadrangular extensional structural wedges, where the models can reasonably explain the overlying distinct highs and lows without obvious faults. The establishment of a geometric model of extensional structural wedges can provide reference and theoretical bases for future quantitative analysis of deformations in the extensional environment.

  14. Wedges, cones, cosmic strings and their vacuum energy

    Science.gov (United States)

    Fulling, S. A.; Trendafilova, C. S.; Truong, P. N.; Wagner, J.

    2012-09-01

    One of J Stuart Dowker’s most significant achievements has been to observe that the theory of diffraction by wedges developed a century ago by Sommerfeld and others provided the key to solving two problems of great interest in general-relativistic quantum field theory during the last quarter of the 20th century: the vacuum energy associated with an infinitely thin, straight cosmic string, and (after an interchange of time with a space coordinate) the apparent vacuum energy of empty space as viewed by an accelerating observer. In a sense the string problem is more elementary than the wedge, since Sommerfeld’s technique was to relate the wedge problem to that of a conical manifold by the method of images. Indeed, Minkowski space, as well as all cone and wedge problems, are related by images to an infinitely sheeted master manifold, which we call Dowker space. We review the research in this area and exhibit in detail the vacuum expectation values of the energy density and pressure of a scalar field in Dowker space and the cone and wedge spaces that result from it. We point out that the (vanishing) vacuum energy of Minkowski space results, from the point of view of Dowker space, from the quantization of angular modes, in precisely the way that the Casimir energy of a toroidal closed universe results from the quantization of Fourier modes; we hope that this understanding dispels any lingering doubts about the reality of cosmological vacuum energy. This article is part of a special issue of Journal of Physics A: Mathematical and Theoretical in honour of Stuart Dowker’s 75th birthday devoted to ‘Applications of zeta functions and other spectral functions in mathematics and physics’.

  15. Distal femoral osteotomy using a novel deformity reduction device.

    Science.gov (United States)

    Panichi, Enrico; Cappellari, Fulvio; Olimpo, Matteo; Piras, Lisa A; Radasch, Robert; Ferretti, Antonio; Peirone, Bruno

    2016-09-20

    Distal femoral osteotomy is a surgical procedure used to correct patellar luxation, secondary to a femoral deformity. A distal femoral osteotomy using the tibial plateau levelling osteotomy-jig to temporarily provide stability of the distal femoral osteotomy, maintaining limb alignment in the frontal and axial planes prior to internal plate fixation of the osteotomy, has been described. This report describes a novel jig named Deformity Reduction Device (DRD). This device was developed with the specific aim of increasing precision and predictability during corrective osteotomy execution in order to be consistent with the preoperative planning. The distal femoral osteotomy DRD-assisted procedure is described in detail, discussing the theoretical and practical principles of the application.

  16. Triple pelvic osteotomy in the treatment of hip dysplasia.

    Science.gov (United States)

    Vukasinović, Zoran; Spasovski, Dusko; Zivković, Zorica; Slavković, Nemanja; Cerović, Sofija

    2009-01-01

    Insufficient femoral head coverage is found in a variety of diseases, with acetabular dysplasia as the most frequent disorder and triple pelvic osteotomy as the most recently introduced surgical treatment. This study analyses pre- and postoperative pathoanatomic characteristics of triple in comparison to Salter and Chiari osteotomies, with a logistic regression analysis of outcome predictor and effect explanator factors in relation to the chosen type of operation. The study involved 136 adolescents treated with Salter and Chiari osteotomies or a triple pelvic osteotomy at the Institute of Orthopaedic Surgery "Banjica" in Belgrade. The patients were between 10-20 years old at the time of operation. We collected and analyzed data from all the patients: illness history, operative parameters, preoperative and postoperative pathoanatomic data. The data was statistically processed using the statistical software SPSS, defining standard descriptive values, and by using the appropriate tests of analytic statistics: t-test for dependent and independent variables, chi2-test, Fisher's exact test, Wilcoxon's test, parameter correlation, one-way ANOVA, multi-factorial ANOVA and logistic regression, according to the type of the analyzed data and the conditions under which the statistical methods were applied. The average CE angle after triple pelvic osteotomy was 43.5 degrees, more improved than after the Salter osteotomy (33.0 degrees) and Chiari osteotomy (31.4 degrees) (F = 16.822; p triple osteotomy than after the other two types of operations, and with a high significance. Preoperative painful discomfort was found to be a valid predictor of indications for the triple osteotomy over both Chiari and Salter osteotomies. The valid explanators of effect for the triple osteotomy are: postoperative joint congruence (compared to the Chiari osteotomy) and increase in joint coverage (compared to Salter osteotomy). Triple pelvic osteotomy is the method of choice in the management of

  17. Simultaneous proximal femoral rotational and distal femoral varus osteotomies for femoral retroversion and genu valgum.

    Science.gov (United States)

    Wagner, Russell; Barcak, Eric A

    2012-04-01

    Whereas excess femoral anteversion and its related symptoms have been described many times, excess femoral retroversion is less well documented. We report the case of a 30-year-old woman who had a history of chronic bilateral hip and knee pain and evidence of excess femoral retroversion, genu valgum, early-onset lateral and patellofemoral compartment osteoarthritis of both knees, and hip arthritis. She experienced symptomatic relief after undergoing staged bilateral simultaneous proximal femoral rotational and distal femoral lateral opening wedge osteotomies. Although this combination of alignment problems is not an infrequent clinical occurrence, we have found no literature on this condition or treatment. The patient provided written informed consent for print and electronic publication of this case report.

  18. Ice Particle Impacts on a Moving Wedge

    Science.gov (United States)

    Vargas, Mario; Struk, Peter M.; Kreeger, Richard E.; Palacios, Jose; Iyer, Kaushik A.; Gold, Robert E.

    2014-01-01

    This work presents the results of an experimental study of ice particle impacts on a moving wedge. The experiment was conducted in the Adverse Environment Rotor Test Stand (AERTS) facility located at Penn State University. The wedge was placed at the tip of a rotating blade. Ice particles shot from a pressure gun intercepted the moving wedge and impacted it at a location along its circular path. The upward velocity of the ice particles varied from 7 to 12 meters per second. Wedge velocities were varied from 0 to 120 meters per second. Wedge angles tested were 0 deg, 30 deg, 45 deg, and 60 deg. High speed imaging combined with backlighting captured the impact allowing observation of the effect of velocity and wedge angle on the impact and the post-impact fragment behavior. It was found that the pressure gun and the rotating wedge could be synchronized to consistently obtain ice particle impacts on the target wedge. It was observed that the number of fragments increase with the normal component of the impact velocity. Particle fragments ejected immediately after impact showed velocities higher than the impact velocity. The results followed the major qualitative features observed by other researchers for hailstone impacts, even though the reduced scale size of the particles used in the present experiment as compared to hailstones was 4:1.

  19. Clinical and radiological outcome after periacetabular osteotomy

    DEFF Research Database (Denmark)

    Dahl, Line B; Dengsø, Kristine; Bang-Christiansen, Karl

    2014-01-01

    PURPOSE: Few papers have described results after periacetabular osteotomy (PAO) and risk factors for conversion to total hip arthroplasty (THA). The aim of the present paper was to analyse clinical and radiographic outcome, survival of the hip joint and risk factors of early conversion to THA in ...

  20. Periacetabulaer osteotomi og hoftedysplasi hos yngre voksne

    DEFF Research Database (Denmark)

    Troelsen, Anders; Søballe, Kjeld

    2009-01-01

    The periacetabular osteotomy is recognized as the surgical treatment of choice in young adults with symptomatic hip dysplasia. The procedure is performed to delay or prevent the development of osteoarthritis. The procedure has the ability to improve function and preserve hip joints in > 80% of ca...

  1. Rod strain after pedicle subtraction osteotomy

    DEFF Research Database (Denmark)

    Gehrchen, Poul Martin; Hallager, Dennis Winge; Dahl, Benny

    2016-01-01

    Pedicle subtraction osteotomy (PSO) can provide major sagittal correction for adult spinal deformity, sometimes achieving correction greater than 308. Surgeons have reported failure rates up to 30% within 2 years, increasing to 46% after 4 to 5 years (SDC Figure 1, http://links.lww.com/BRS/B87). ...

  2. Southwick Osteotomy Stabilised with External Fixator

    Science.gov (United States)

    Grubor, Predrag; Mitkovic, Milorad; Grubor, Milan

    2014-01-01

    ABSTRACT Introduction: Epiphysiolysis of the femoral head is the most common accident occurring towards the end of pre-puberty and puberty growth. Case report: The author describes the experience in the treatment of chronic epiphysiolysis in two patients treated by Southwick osteotomy. The site is accessed by way of a 15-cm long lateral skin incision and the trochanteric region is reached through the layers. The osteotomy angles prepared beforehand on a thin aluminium model are used to mark the Southwick osteotomy site on the anterior and lateral sides at the level of the lesser trochanter. Before performing the trochanteric osteotomy, two Mitković convergent pins type M20 are applied distally and proximally, above the planned osteotomy site. A tenotomy of the iliopsas muscle is performed, and then the previously marked bone triangle is redissected up to three quarters of the width of the femur. The distal part of the femur is rotated inwards, so that the patella is turned towards the ceiling. The osteotomised fragments of the femur are adapted, repositioned and fixated by installing an external fixator on the previously placed pins. Two more pins are placed, one proximally and one distally, with a view to adequately stabilising the femur. The patient was mobile from day two after the surgery. If, after the surgery, the lead surgeon realises that there is a requirement to make a correction of 5, 10 and 15 degrees of the valgus, varus, anteversion or retroversion deformity, the correction shall be performed without surgically opening the patient, using the fixator pins. Conclusion: After performing a Southwick osteotomy it is easier to adapt, reposition and fixate the osteotomised fragments of the femur using a fixator type M20. Adequate stability allows regaining mobility quickly, which in turn is the best prevention of chondrolysis of the hip. It is possible to make post-operative valgus, varus, anteversion and retroversion corrections of 5, 10 and 15 degrees

  3. 前柱张开与闭合对经椎弓根椎体截骨治疗强直性脊柱炎胸腰椎后凸畸形疗效的影响%The effect of anterior column open or close technique in pedicle subtraction osteotomy for the treatment of thoracic/lumbar kyphosis deformity in ankylosing spondylitis patients

    Institute of Scientific and Technical Information of China (English)

    邱勇

    2010-01-01

    @@ 目前治疗强直性脊柱炎(ankylosing spondylitis,AS)胸腰椎后凸畸形的后路截骨矫形术式主要有两种,即多节段经椎间关节截骨术(Smith-Petersen osteotomies,SPOs)和经椎弓根截骨术(pedicle subtraction osteotomy,PSO)[1-2].这两种截骨方法术后近期疗效相近,但SPOs术后后柱截骨面融合较慢,且前柱有所延长,支撑作用不完全,术后易发生矫正丢失.

  4. Tibial condylar valgus osteotomy (TCVO) for osteoarthritis of the knee: 5-year clinical and radiological results.

    Science.gov (United States)

    Chiba, Ko; Yonekura, Akihiko; Miyamoto, Takashi; Osaki, Makoto; Chiba, Goji

    2017-03-01

    Tibial condylar valgus osteotomy (TCVO) is a type of opening-wedge high tibial osteotomy for advanced medial knee osteoarthritis (OA) with subluxated lateral joint. We report the concept, the current surgical technique with a locking plate, and the short-term clinical and radiological results of this procedure. 11 knees with medial OA and a widened lateral joint were treated by TCVO (KL stage III: 6, IV: 5). In this procedure, by the L-shaped osteotomy from the medial side of the proximal tibia to the intercondylar eminence and the valgus correction, lateralization of the mechanical axis and reduction of the subluxated lateral joint are obtained with early postoperative weight-bearing. Before, 6 months, 1, and 5 years after the operation, a visual analog scale (VAS), the Western Ontario and McMaster Universities Arthritis Index (WOMAC), alignment of the lower extremity, and congruency and stability of the femorotibial joint were investigated. The VAS improved from an average of 73 mm to 13 mm, and the total WOMAC score from 52 to 14 before to 5 years after the operation, respectively. The mechanical axis changed from 1 to 60%, and the FTA changed from 186° to 171°. The joint line convergence angle (JLCA) changed from 6° to 1°, and the angle difference of JLCA between varus and valgus stress improved from 8° to 4° after the procedure. Improvements in pain and activities of daily living were observed by TCVO along with valgus correction of the lower extremity and stabilization of the femorotibial joint.

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

    Science.gov (United States)

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

    2016-11-01

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

  6. Spinal pedicle subtraction osteotomy for fixed sagittal imbalance patients.

    Science.gov (United States)

    Hyun, Seung-Jae; Kim, Yongjung J; Rhim, Seung-Chul

    2013-11-16

    In addressing spinal sagittal imbalance through a posterior approach, the surgeon now may choose from among a variety of osteotomy techniques. Posterior column osteotomies such as the facetectomy or Ponte or Smith-Petersen osteotomy provide the least correction, but can be used at multiple levels with minimal blood loss and a lower operative risk. Pedicle subtraction osteotomies provide nearly 3 times the per-level correction of Ponte/Smith-Petersen osteotomies; however, they carry increased technical demands, longer operative time, and greater blood loss and associated significant morbidity, including neurological injury. The literature focusing on pedicle subtraction osteotomy for fixed sagittal imbalance patients is reviewed. The long-term overall outcomes, surgical tips to reduce the complications and suggestions for their proper application are also provided.

  7. Personalized implant for high tibial opening wedge: combination of solid freeform fabrication with combustion synthesis process.

    Science.gov (United States)

    Zhim, Fouad; Ayers, Reed A; Moore, John J; Moufarrège, Richard; Yahia, L'Hocine

    2012-09-01

    In this work a new generation of bioceramic personalized implants were developed. This technique combines the processes of solid freeform fabrication (SFF) and combustion synthesis (CS) to create personalized bioceramic implants with tricalcium phosphate (TCP) and hydroxyapatite (HA). These porous bioceramics will be used to fill the tibial bone gap created by the opening wedge high tibial osteotomy (OWHTO). A freeform fabrication with three-dimensional printing (3DP) technique was used to fabricate a metallic mold with the same shape required to fill the gap in the opening wedge osteotomy. The mold was subsequently used in a CS process to fabricate the personalized ceramic implants with TCP and HA compositions. The mold geometry was designed on commercial 3D CAD software. The final personalized bioceramic implant was produced using a CS process. This technique was chosen because it exploits the exothermic reaction between P₂O₅ and CaO. Also, chemical composition and distribution of pores in the implant could be controlled. To determine the chemical composition, the microstructure, and the mechanical properties of the implant, cylindrical shapes were also fabricated using different fabrication parameters. Chemical composition was performed by X-ray diffraction. Pore size and pore interconnectivity was measured and analyzed using an electronic microscope system. Mechanical properties were determined by a mechanical testing system. The porous TCP and HA obtained have an open porous structure with an average 400 µm channel size. The mechanical behavior shows great stiffness and higher load to failure for both ceramics. Finally, this personalized ceramic implant facilitated the regeneration of new bone in the gap created by OWHTO and provides additional strength to allow accelerated rehabilitation.

  8. Segmental sandwich osteotomy and tunnel technique for three-dimensional reconstruction of the jaw atrophy: a case report.

    Science.gov (United States)

    Santagata, Mario; Sgaramella, Nicola; Ferrieri, Ivo; Corvo, Giovanni; Tartaro, Gianpaolo; D'Amato, Salvatore

    2017-12-01

    A three-dimensionally favourable mandibular bone crest is desirable to be able to successfully implant placement to meet the aesthetic and functional criteria in the implant-prosthetic rehabilitation. Several surgical procedures have been advocated for bone augmentation of the atrophic mandible, and the sandwich osteotomy is one of these techniques. The aim of the present case report was to assess the suitability of segmental mandibular sandwich osteotomy combined with a tunnel technique of soft tissue. Based on our knowledge, nobody described before the sandwich osteotomy with tunnel technique to improve the healing of the wound and meet the dimensional requirements of preimplant bone augmentation in cases of a severely atrophic mandible. A 59-year-old woman with a severely atrophied right mandible was treated with the sandwich osteotomy technique filled with autologous bone graft harvested by a cortical bone collector from the ramus. Clinical examination revealed that the mandible was edentulous bilaterally from the first molar to the second molar region. Radiographically, atrophy of the mandibular alveolar ridge in the same teeth site was observed. We began to treat the right side. A horizontal osteotomy of the edentulous mandibular bone was then made with a piezoelectric device after tunnel technique of the soft tissue. The segmental mandibular sandwich osteotomy (SMSO) was finished by two (mesial and distal) slightly divergent vertical osteotomies. The entire bone fragment was displaced cranially, and the desirable position was obtained. The gap was filled completely with autologous bone chips harvested from the mandibular ramus through a cortical bone collector. No barrier membranes were used to protect the grafts. The vertical incisions were closing with interruptive suturing of the flaps with a resorbable material. In this way, the suture will not fall on the osteotomy line of the jaw; the result will be a better predictability of soft and hard tissue

  9. Severe gummy smile with class II malocclusion treated with LeFort I osteotomy combined with horseshoe osteotomy and intraoral vertical ramus osteotomy.

    Science.gov (United States)

    Shimo, Tsuyoshi; Nishiyama, Akiyoshi; Jinno, Tokiari; Sasaki, Akira

    2013-01-01

    In this article, we report the successful surgical treatment of a patient, 34 years of age, who had a severe gummy smile and a class II malocclusion. The patient had an 11-mm gingival exposure during full smile and a convex profile. A LeFort I osteotomy combined with a horseshoe osteotomy was used for the superior repositioning of the maxilla;then, an intraoral vertical ramus osteotomy (IVRO) and genioplasty were performed for mandibular advancement. The maxilla was acceptably impacted 8mm at the first incisor and 5mm at the first molar. Both the occlusion and facial appearance were significantly improved by this surgical-orthodontic treatment. Our results suggest that the combination of a horseshoe osteotomy with a LeFort I osteotomy is a useful technique for reliable superior repositioning of the maxilla.

  10. The pelvic support osteotomy: indications and preoperative planning

    OpenAIRE

    Pafilas, Dimitrios; Nayagam, Selvadurai

    2008-01-01

    The pelvic support osteotomy is a double level femoral osteotomy with the objective of eliminating a Trendelenburg and short limb gait in young patients with severe hip joint destruction as a consequence of neonatal septic arthritis. The osteotomy has seen several changes and a brief historical overview is provided to set the evolution of the modifications of the procedure in context. We present an analysis of the preoperative assessment that will assist the surgeon to plan out the procedure....

  11. The distribution and depth of ion doses implanted into wedges by plasma immersion ion implantation in drifting and stationary plasmas

    Energy Technology Data Exchange (ETDEWEB)

    Tarrant, R N; Devasahayam, S; McKenzie, D R; Bilek, M M M [School of Physics (A28), University of Sydney, NSW 2006 (Australia)

    2006-08-15

    The distribution of ion dose arising from plasma immersion ion implantation (PIII) of a complex shape in the form of a wedge is measured. Two types of plasma are considered: a drifting titanium plasma derived from a pulsed cathodic arc and a stationary plasma generated by PIII pulses in oxygen or nitrogen gas. The distributions of the implanted material over the surface of the aluminium wedge were studied using secondary ion mass spectroscopy and Rutherford backscattering. The effects of varying the apex angles of the wedge and the plasma density are investigated. We conclude that ion-focusing effects at the apex of the wedge were more important for the drifting plasma than for the stationary plasmas. In a drifting plasma, the ion drift velocity directed towards the apex of the wedge compresses the sheath close to the apex and enhances the concentration of the dose. For the stationary plasma, the dose is more uniform.

  12. Polygonal triple (Kotz) osteotomy (over 10 years experience)

    OpenAIRE

    Sen, Cengiz; Gunes, Taner; Erdem, Mehmet; Ozger, Harzem; Tozun, I. Remzi

    2006-01-01

    We evaluated the results of polygonal triple (Kotz) osteotomy for the treatment of acetabular dysplasia over 10 years. This study included 31 hips of 27 patients who had the Kotz osteotomy for acetabular dysplasia. The mean age was 21.5 years. We performed the original Kotz osteotomy for the first 22 hips (group I), while the modified Kotz osteotomy through an intra-pelvic approach without damage to the abductor muscle was applied for the last 9 hips (group II). Patients were evaluated by cli...

  13. Optical dating of relict sand wedges and composite-wedge pseudomorphs in Flanders, Belgium

    DEFF Research Database (Denmark)

    Buylaert, Jan-Pieter; Ghysels, Günther; Murray, Andrew S.;

    2009-01-01

    We report on quartz Optically Stimulated Luminescence (OSL) dating of the infill of 14 relict sand wedges and composite-wedge pseudomorphs at 5 different sites in Flanders, Belgium. A laboratory dose recovery test indicates that the single-aliquot regenerative-dose (SAR) procedure is suitable...... appear to have been commonplace in Flanders during the Late Pleniglacial (Oxygen Isotope Stage 2; OIS2); more specifically, around the Last Glacial Maximum (LGM, similar to 21 kyr ago) and the transition period between the LGM and the start of the Lateglacial (similar to 15 kyr ago). Optical dating...... at one site has revealed two significantly older wedge levels, the younger inset into the older; the younger wedge has an age of 36 +/- 4 kyr (Middle Pleniglacial; OIS3), the older wedge 129 +/- 11 kyr, which points to formation during the Late Saalian (OIS6). Our OSL ages of the wedges and host...

  14. Water-saturated physical modeling of accretionary wedges

    Science.gov (United States)

    Yamada, Y.; Zhang, M.; Nakajima, H.; Driss, E.

    2005-12-01

    Accretionary wedges have been an important research target from view points of earthquake mechanism at the subduction zone, sediment deformation that is closely coupled with hydrology, and resource exploration such as methane hydrates. The knowledge obtained from the study may also be useful for site selection of geological disposal of hazardous materials including radioactive nuclear wastes, in coastal areas of tectonically unstable island arc systems like Japan. The wedges have been well-investigated with analogue models in particular sandbox experiments that typically use dry granular materials, thus the inter-granular pore space of the sandbox experiments is filled with air. In natural sediments, however, the pore space is filled with formation water and its pressure has special effects on structural development. In order to accurately simulate the in-situ conditions and to examine the effects of water on the deformation process of accretionary wedge, a new apparatus was recently constructed in AIST, Japan, to perform physical analog experiments of accretionary wedges under water-saturated condition. For comparisons, equivalent experiments with dry materials were also conducted. The physical properties of the materials were also measured with tri-axial compression tests to interpret the experimental observations. Preliminary results obtained from this study showed that the fundamental parameters on structural geometry, such as taper angle and fault spacing, can be correlated well in wet and dry experiments. These are also in good agreement with physical properties obtained by the tri-axial compression tests, suggesting that the internal friction coefficient decreases as the overburden pressure increases. In the under water models, buoyancy decreases apparent grain density and overburden pressure thus the internal friction coefficient also decreases. This also agrees with the structural geometry of the experimental results. These results suggest that under

  15. Use of Wedge Absorbers in MICE

    Energy Technology Data Exchange (ETDEWEB)

    Neuffer, D. [Fermi National Accelerator Lab. (FNAL), Batavia, IL (United States); Summers, D. [Univ. of Mississippi, Oxford, MS (United States); Mohayai, T. [Fermi National Accelerator Lab. (FNAL), Batavia, IL (United States); IIT, Chicago, IL (United States); Snopok, P. [Fermi National Accelerator Lab. (FNAL), Batavia, IL (United States); IIT, Chicago, IL (United States); Rogers, C. [Science and Technology Facilities Council (STFC), Oxford (United Kingdom). Rutherford Appleton Lab. (RAL)

    2017-03-01

    Wedge absorbers are needed to obtain longitudinal cooling in ionization cooling. They also can be used to obtain emittance exchanges between longitudinal and transverse phase space. There can be large exchanges in emittance, even with single wedges. In the present note we explore the use of wedge absorbers in the MICE experiment to obtain transverse–longitudinal emittance exchanges within present and future operational conditions. The same wedge can be used to explore “direct” and “reverse” emittance exchange dynamics, where direct indicates a configuration that reduces momentum spread and reverse is a configuration that increases momentum spread. Analytical estimated and ICOOL and G4BeamLine simulations of the exchanges at MICE parameters are presented. Large exchanges can be obtained in both reverse and direct configurations.

  16. Benchmarking numerical models of brittle thrust wedges

    NARCIS (Netherlands)

    Buiter, Susanne J H; Schreurs, Guido; Albertz, Markus; Gerya, Taras V.; Kaus, Boris; Landry, Walter; le Pourhiet, Laetitia; Mishin, Yury; Egholm, David L.; Cooke, Michele; Maillot, Bertrand; Thieulot, Cedric|info:eu-repo/dai/nl/270177493; Crook, Tony; May, Dave; Souloumiac, Pauline; Beaumont, Christopher

    2016-01-01

    We report quantitative results from three brittle thrust wedge experiments, comparing numerical results directly with each other and with corresponding analogue results. We first test whether the participating codes reproduce predictions from analytical critical taper theory. Eleven codes pass the

  17. A specially curved wedge for eliminating wedge angle effect in unsteady shock reflection

    Science.gov (United States)

    Wang, He; Zhai, Zhigang; Luo, Xisheng; Yang, Jiming; Lu, Xiyun

    2017-08-01

    A curved wedge with a specific shape is designed and manufactured to guarantee the wedge angle unvaried during the cylindrically converging shock moving along the wedge. Thus the variation of the wedge angle caused by the wedge will be eliminated in unsteady shock reflection. Different initial wedge angles are considered to observe regular reflection and Mach reflection. When Mach reflection occurs, it is found that direct Mach reflection is persisted over the wedge without wave pattern transitions, which differs from our previous work with varied wedge angles [Zhang et al. "Reflection of cylindrical converging shock wave over a plane wedge," Phys. Fluids 28, 086101 (2016)]. Moreover, the Mach stem is nearly straight when the wedge angle is relatively large, and the trajectory of triple point can be well predicted by three-shock theory. It is believed that the straight Mach stem results from the coupling effect of the converging shock and the convexly curved wedge, which exert opposite effects on the Mach stem curvature. As the wedge angle reduces, the three-shock theory prediction deviates from the present results owing to the curved Mach stem. Stronger vortices are produced near the wall, which are caused by the interaction of two shear layers, and whether the stronger vortices will be generated near the wall depends on the reflection number of the shock wave over the tube wall and wedge. The length of disturbed shock front in the Mach reflection is found to increase nonlinearly due to the unsteady feature of the flow. The growth rate of length reduces as the shock converges because of the geometrical contraction effect. Further the lengths of the Mach stem and the disturbed shock front are compared, and the results show that although the difference exists between them, both of them show a similar variation tendency. Compared with our previous work with varied wedge angles, the variation of the wedge angle has great effects on the Mach stem length and wave

  18. Mantle wedge dynamics from seismic anisotropy (Invited)

    Science.gov (United States)

    Long, M. D.; Wirth, E. A.

    2013-12-01

    The mantle wedge above subducting slabs plays a critical role in many of the physical processes associated with subduction, including water transport into the upper mantle and the generation and transport of melts. Our understanding of mantle wedge dynamics is incomplete; in particular, the mantle flow field above subducting slabs remains poorly understood. Because seismic anisotropy is a consequence of deformation, observations of anisotropy (such as shear wave splitting and P-to-SH converted waves) can constrain the geometry of the wedge flow field. Additionally, because the presence of water (either in nominally anhydrous minerals or as hydrous phases) can have a large effect on anisotropic structure, a detailed understanding of mantle wedge anisotropy can help to constrain processes related to water cycling in subduction systems. We present a global, synoptic view of anisotropy observations in subduction zone mantle wedges, compiled from a large number of individual studies, with the goal of understanding the first-order controls on wedge anisotropy and flow patterns. This compilation allows us to explicitly test the predictions made by many different conceptual models for wedge anisotropy, as well as to explore the relationships between observed anisotropy parameters and other parameters that describe subduction. We find that no simple model can explain all of the trends observed in the global data set. Mantle wedge flow is likely controlled by a combination of downdip motion of the slab, trench migration, ambient mantle flow, small-scale convection, proximity to slab edges, and slab morphology, with the relative contributions of these in any given subduction system controlled by the subduction kinematics and mantle rheology. There is also a likely contribution from B-type olivine and/or serpentinite fabric in many subduction zones, governed by the local thermal structure and volatile distribution.

  19. Dimensions of Velopharyngeal Space following Maxillary Advancement with Le Fort I Osteotomy Compared to Zisser Segmental Osteotomy: A Cephalometric Study

    Directory of Open Access Journals (Sweden)

    Furkan Erol Karabekmez

    2015-01-01

    Full Text Available The objectives of this study are to assess the velopharyngeal dimensions using cephalometric variables of the nasopharynx and oropharynx as well as to compare the Le Fort I osteotomy technique to Zisser’s anterior maxillary osteotomy technique based on patients’ outcomes within early and late postoperative follow-ups. 15 patients with severe maxillary deficiency treated with Le Fort I osteotomy and maxillary segmental osteotomy were assessed. Preoperative, early postoperative, and late postoperative follow-up lateral cephalograms, patient histories, and operative reports are reviewed with a focus on defined cephalometric landmarks for assessing velopharyngeal space dimension and maxillary movement (measured for three different tracing points. A significant change was found between preoperative and postoperative lateral cephalometric measurements regarding the distance between the posterior nasal spine and the posterior pharyngeal wall in Le Fort I osteotomy cases. However, no significant difference was found between preoperative and postoperative measurements in maxillary segmental osteotomy cases regarding the same measurements. The velopharyngeal area calculated for the Le Fort I osteotomy group showed a significant difference between the preoperative and postoperative measurements. Le Fort I osteotomy for advancement of upper jaw increases velopharyngeal space. On the other hand, Zisser’s anterior maxillary segmental osteotomy does not alter the dimension of the velopharyngeal space significantly.

  20. Long-range hybrid wedge plasmonic waveguide.

    Science.gov (United States)

    Zhang, Zhonglai; Wang, Jian

    2014-11-03

    We design a novel long-range hybrid wedge plasmonic (LRHWP) waveguide composed of two identical dielectric nanowires symmetrically placed on two opposed wedges of a diamond shaped metal wire. With strong coupling between the dielectric nanowire mode and long-range surface plasmon polariton (SPP) mode, both deep subwavelength mode confinement and low propagation loss are achieved. On one hand, when compared to the previous long-range hybrid SPP waveguide, LRHWP waveguide can achieve smaller mode size with similar propagation length; on the other hand, when compared to the previous hybrid wedge SPP waveguide, LRHWP waveguide can provide an order of magnitude longer propagation length with similar level of mode confinement. The designed LRHWP waveguide also features an overall advantage of one-order improvement of Figure of Merit. We further evaluate in detail the impacts of possible practical fabrication imperfections on the mode properties. The obtained results of mode properties show that the proposed LRHWP waveguide with an optimized wedge tip angle of 140 degree is fairly tolerant to practical fabrication errors in geometry parameters such as misalignment in the horizontal direction, asymmetry in the vertical direction, variation of wedge tip angle, tilt or rotation of metal wire, and variation of wedge tip curvature radius.

  1. Studying wedge factors and beam profiles for physical and enhanced dynamic wedges

    Directory of Open Access Journals (Sweden)

    Ahmad Misbah

    2010-01-01

    Full Text Available This study was designed to investigate variation in Varian′s Physical and Enhanced Dynamic Wedge Factors (WF as a function of depth and field size. The profiles for physical wedges (PWs and enhanced dynamic wedges (EDWs were also measured using LDA-99 array and compared for confirmation of EDW angles at different depths and field sizes. WF measurements were performed in water phantom using cylindrical 0.66 cc ionization chamber. WF was measured by taking the ratio of wedge and open field ionization data. A normalized wedge factor (NWF was introduced to circumvent large differences between wedge factors for different wedge angles. A strong linear dependence of PW Factor (PWF with depth was observed. Maximum variation of 8.9% and 4.1% was observed for 60° PW with depth at 6 and 15 MV beams respectively. The variation in EDW Factor (EDWF with depth was almost negligible and less than two per cent. The highest variation in PWF as a function of field size was 4.1% and 3.4% for thicker wedge (60° at 6 and 15 MV beams respectively and decreases with decreasing wedge angle. EDWF shows strong field size dependence and significant variation was observed for all wedges at both photon energies. Differences in profiles between PW and EDW were observed on toe and heel sides. These differences were dominant for larger fields, shallow depths, thicker wedges and low energy beam. The study indicated that ignoring depth and field size dependence of WF may result in under/over dose to the patient especially doing manual point dose calculation.

  2. 3D imaging in corrective osteotomy of the distal radius

    NARCIS (Netherlands)

    Vroemen, Joy

    2013-01-01

    The research described in this thesis is on the development, design, implementation and testing of new techniques for corrective osteotomy of the distal radius. The goal of this thesis is threefold. At first, possible pitfalls of conventional corrective osteotomy surgery were determined and quantifi

  3. Mantle wedge serpentinization effects on slab dips

    Directory of Open Access Journals (Sweden)

    Eh Tan

    2017-01-01

    Full Text Available The mechanical coupling between a subducting slab and the overlying mantle wedge is an important factor in controlling the subduction dip angle and the flow in mantel wedge. This paper investigates the role of the amount of mantle serpentinization on the subduction zone evolution. With numerical thermos-mechanical models with elasto-visco-plastic rheology, we vary the thickness and depth extent of mantle serpentinization in the mantle wedge to control the degree of coupling between the slab and mantle wedge. A thin serpentinized mantle layer is required for stable subduction. For models with stable subduction, we find that the slab dip is affected by the down-dip extent and the mantle serpentinization thickness. A critical down-dip extent exists in mantle serpentinization, determined by the thickness of the overriding lithosphere. If the down-dip extent does not exceed the critical depth, the slab is partially coupled to the overriding lithosphere and has a constant dip angle regardless of the mantle serpentinization thickness. However, if the down-dip extent exceeds the critical depth, the slab and the base of the overriding lithosphere would be separated and decoupled by a thick layer of serpentinized peridotite. This allows further slab bending and results in steeper slab dip. Increasing mantle serpentinization thickness will also result in larger slab dip. We also find that with weak mantle wedge, there is no material flowing from the asthenosphere into the serpentinized mantle wedge. All of these results indicate that serpentinization is an important ingredient when studying the subduction dynamics in the mantle wedge.

  4. Triple pelvic osteotomy in the treatment of hip dysplasia

    Directory of Open Access Journals (Sweden)

    Vukašinović Zoran

    2009-01-01

    Full Text Available Introduction. Insufficient femoral head coverage is found in a variety of diseases, with acetabular dysplasia as the most frequent disorder and triple pelvic osteotomy as the most recently introduced surgical treatment. Objective. This study analyses pre- and postoperative pathoanatomic characteristics of triple in comparison to Salter and Chiari osteotomies, with a logistic regression analysis of outcome predictor and effect explanator factors in relation to the chosen type of operation. Methods. The study involved 136 adolescents treated with Salter and Chiari osteotomies or a triple pelvic osteotomy at the Institute of Orthopaedic Surgery 'Banjica' in Belgrade. The patients were between 10-20 years old at the time of operation. We collected and analyzed data from all the patients: illness history, operative parameters, preoperative and postoperative pathoanatomic data. The data was statistically processed using the statistical software SPSS, defining standard descriptive values, and by using the appropriate tests of analytic statistics: t-test for dependent and independent variables, χ2-test, Fisher's exact test, Wilcoxon's test, parameter correlation, one-way ANOVA, multi-factorial ANOVA and logistic regression, according to the type of the analyzed data and the conditions under which the statistical methods were applied. Results. The average CE angle after triple pelvic osteotomy was 43.5°, more improved than after the Salter osteotomy (33.0° and Chiari osteotomy (31.4° (F=16.822; p<0.01. Postoperative spherical congruence was also more frequent after the triple osteotomy than after the other two types of operations, and with a high significance. Preoperative painful discomfort was found to be a valid predictor of indications for the triple osteotomy over both Chiari and Salter osteotomies. The valid explanators of effect for the triple osteotomy are: postoperative joint congruence (compared to the Chiari osteotomy and increase in joint

  5. Polygonal triple (Kotz) osteotomy (over 10 years experience).

    Science.gov (United States)

    Sen, Cengiz; Gunes, Taner; Erdem, Mehmet; Ozger, Harzem; Tozun, I Remzi

    2007-06-01

    We evaluated the results of polygonal triple (Kotz) osteotomy for the treatment of acetabular dysplasia over 10 years. This study included 31 hips of 27 patients who had the Kotz osteotomy for acetabular dysplasia. The mean age was 21.5 years. We performed the original Kotz osteotomy for the first 22 hips (group I), while the modified Kotz osteotomy through an intra-pelvic approach without damage to the abductor muscle was applied for the last 9 hips (group II). Patients were evaluated by clinically and radiologically. The average follow-up was 106 months in group I, and 18 months in group II. The Trendelenburg gait was unchanged for four patients in group I and for one patient in group II. The Harris Hip Score improved in all patients postoperatively. Radiographic assesment showed improvement in both groups in terms of the angle of CE, VCE, and Sharp postoperatively(PTrendelenburg gait compared to the original Kotz osteotomy.

  6. The pelvic support osteotomy: indications and preoperative planning.

    Science.gov (United States)

    Pafilas, Dimitrios; Nayagam, Selvadurai

    2008-09-01

    The pelvic support osteotomy is a double level femoral osteotomy with the objective of eliminating a Trendelenburg and short limb gait in young patients with severe hip joint destruction as a consequence of neonatal septic arthritis. The osteotomy has seen several changes and a brief historical overview is provided to set the evolution of the modifications of the procedure in context. We present an analysis of the preoperative assessment that will assist the surgeon to plan out the procedure. Specifically, we set out to answer the following questions: (a) Where should the first osteotomy be performed and what is the magnitude of valgus and extension correction desired at this level? (b) Where should the second osteotomy be performed and what is the magnitude of varus and derotation desired at this level?

  7. Surgical site infection after osteotomy of the adult spine: does type of osteotomy matter?

    NARCIS (Netherlands)

    Pull ter Gunne, A.F.; Laarhoven, C.J.H.M. van; Cohen, D.B.

    2010-01-01

    BACKGROUND CONTEXT: Surgical site infection after spinal surgery is frequently seen. It occurs between 0.7% and 12% of patients, leading to higher morbidity, mortality, and health-care costs. Osteotomy procedures are known to have increased blood losses and surgical times when compared with other sp

  8. Surgical site infection after osteotomy of the adult spine: does type of osteotomy matter?

    NARCIS (Netherlands)

    Pull ter Gunne, A.F.; Laarhoven, C.J.H.M. van; Cohen, D.B.

    2010-01-01

    BACKGROUND CONTEXT: Surgical site infection after spinal surgery is frequently seen. It occurs between 0.7% and 12% of patients, leading to higher morbidity, mortality, and health-care costs. Osteotomy procedures are known to have increased blood losses and surgical times when compared with other

  9. Surgical site infection after osteotomy of the adult spine: does type of osteotomy matter?

    NARCIS (Netherlands)

    Pull ter Gunne, A.F.; Laarhoven, C.J.H.M. van; Cohen, D.B.

    2010-01-01

    BACKGROUND CONTEXT: Surgical site infection after spinal surgery is frequently seen. It occurs between 0.7% and 12% of patients, leading to higher morbidity, mortality, and health-care costs. Osteotomy procedures are known to have increased blood losses and surgical times when compared with other sp

  10. Intraosseous heat generation during sonic, ultrasonic and conventional osteotomy.

    Science.gov (United States)

    Rashad, Ashkan; Sadr-Eshkevari, Pooyan; Heiland, Max; Smeets, Ralf; Hanken, Henning; Gröbe, Alexander; Assaf, Alexandre T; Köhnke, Robert H; Mehryar, Pouyan; Riecke, Björn; Wikner, Johannes

    2015-09-01

    To assess heat generation in osteotomies during application of sonic and ultrasonic saws compared to conventional bur. Two glass-fiber isolated nickel-chromium thermocouples, connected to a recording device, were inserted into fresh bovine rib bone blocks and kept in 20 ± 0.5 °C water at determined depths of 1.5 mm (cortical layer) and 7 mm (cancellous layer) and 1.0 mm away from the planned osteotomy site. Handpieces, angulated 24-32°, were mounted in a vertical drill stand, and standardized weights were attached to their tops to exert loads of 5, 8, 15 and 20 N. Irrigation volumes of 20, 50 and 80 ml/min were used for each load. Ten repetitions were conducted using new tips each time for each test condition. The Mann-Whitney-U test was used for statistical analysis (p osteotomies were associated with significantly lower heat generation than conventional osteotomy (p osteotomy showed non-significantly lower heat generation than ultrasonic osteotomy. Generated heat never exceeded the critical limit of 47 °C in any system. Variation of load had no effect on heat generation in both bone layers for all tested systems. An increased irrigation volume resulted in lower temperatures in both cortical and cancellous bone layers during all tested osteotomies. Although none of the systems under the conditions of the present study resulted in critical heat generation, the application of ultrasonic and sonic osteotomy systems was associated with lower heat generation compared to the conventional saw osteotomy. Copious irrigation seems to play a critical role in preventing heat generation in the osteotomy site. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  11. Wedged tibial components for total knee arthroplasty.

    Science.gov (United States)

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

    1994-08-01

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

  12. Long polymers near wedges and cones

    Science.gov (United States)

    Hammer, Yosi; Kantor, Yacov

    2015-12-01

    We perform a Monte Carlo study of N -step self-avoiding walks, attached to the corner of an impenetrable wedge in two dimensions (d =2 ), or the tip of an impenetrable cone in d =3 , of sizes ranging up to N =106 steps. We find that the critical exponent γα, which determines the dependence of the number of available conformations on N for a cone or wedge with opening angle α , is in good agreement with the theory for d =2 . We study the end-point distribution of the walks in the allowed space and find similarities to the known behavior of random walks (ideal polymers) in the same geometry. For example, the ratio between the mean square end-to-end distances of a polymer near the cone or wedge and a polymer in free space depends linearly on γα, as is known for ideal polymers. We show that the end-point distribution of polymers attached to a wedge does not separate into a product of angular and radial functions, as it does for ideal polymers in the same geometry. The angular dependence of the end position of polymers near the wedge differs from theoretical predictions.

  13. Commissioning, clinical implementation and quality assurance of Siemen's Virtual Wedge.

    Science.gov (United States)

    Rathee, S; Kwok, C B; MacGillivray, C; Mirzaei, M

    1999-01-01

    This report presents the results of commissioning, clinical implementation and quality assurance of Siemens Virtual Wedge. Our measurements show that: (1) wedge factors are within 2% of unity, (2) percentage depth doses are within 1% of open beam data, and (3) wedged beam profiles can be modeled similarly to a physical wedge and follow a well defined equation to facilitate modeling of an arbitrary wedge angle. The gantry angle dependence of wedge profiles is similar to open beam profiles. The output of wedged fields is linear with delivered monitor units within 1%. Quality assurance results indicate the wedge profiles are very stable over time. Day to day variations of two points measured along the wedge gradient direction are within 1.5%.

  14. Structure of turbulent wedges created by isolated surface roughness

    Science.gov (United States)

    Kuester, Matthew S.; White, Edward B.

    2016-04-01

    Isolated surface roughness in a laminar boundary layer can create a wedge of turbulence that spreads laterally into the surrounding laminar flow. Some recent studies have identified high- and low-speed streaks along the exterior of turbulent wedges. In this experiment, developing turbulent wedges are measured to observe the creation of these streaks. Naphthalene shear stress surface visualization and hotwire measurements are utilized to investigate the details of turbulent wedges created by cylinders in a laminar flat-plate boundary layer. Both the surface visualization and the hotwire measurements show high- and low-speed streaks in the wake of the cylinder that devolve into a turbulent wedge. The turbulent wedge spreading is associated with the emergence of these high- and low-speed streaks along the outside of the wedge. As the wedge evolves in the streamwise direction, these streaks persist inside of the core of the wedge, while new, lower amplitude streaks form along the outside of the wedge. Adding asymmetry to the cylinder moved the virtual origin closer to the roughness and increased the vortex shedding frequency, while adding small-scale roughness features did not strongly affect turbulent wedge development. Intermittency calculations additionally show the origin of the turbulent core inside of the wedge. The structure and spacing of the high-speed streaks along the extremities of the turbulent wedge give insight into the spreading angle of the turbulent wedge.

  15. Analysis of bone formation after cranial osteotomies with a high-speed drill.

    Science.gov (United States)

    Barone, C M; Jimenez, D F; Yule, G J; Strauch, B

    1997-11-01

    Ten New Zealand white 22-week-old rabbits were divided into two groups of five each. The Midas Rex drill with a C-1 drill bit was used to make a full-thickness sagittal osteotomy 2 cm in length. A B-5 bit and footplate attachment were used to make a 2-cm linear osteotomy parallel to the first. Four drill holes 1 mm in diameter were made over the nasal bones on the ipsilateral side. In Group A animals, half of the skull had no irrigation; the other half of the skull was irrigated with room temperature saline. In Group B animals half of the skull was irrigated with iced saline irrigation; the other half of the skull was irrigated with room temperature irrigation fluid, and the osteotomy sites were filled with bone wax. Specimens were harvested at 8 weeks and evaluated grossly and histologically. The results showed that all the drill holes closed in the nasal bones regardless of the type of irrigation used or whether bone wax was used. Iced saline irrigation and room temperature irrigation had similar positive effects on bone formation in contrast to the no-irrigation group, which had inferior bone formation. Bone wax appeared also to have a detrimental effect on bone formation.

  16. [Bernese periacetabular osteotomy (Ganz procedure). First experience].

    Science.gov (United States)

    Chládek, Petr; Trc, T; Schejbalová, A; Rehácek, V

    2009-08-01

    Developmental dysplasia of the hip (DDH), treated either conservatively or surgically, may result in a dysplastic acetabulum. To treat this after bone maturation is completed, Bernese periacetabular osteotomy, also known as the Ganz procedure, has recently been used as the method of choice at our department. The evaluation of the first results is presented here. The group evaluated comprised 25 hips (21 female and 4 male) in 22 patients. Nineteen hips were treated for residual dysplasia of the acetabulum due to DDH, and six for a spastic hip. The average age was 26 years (range, 12 to 44) and 14 right and 11 left hips were involved On pre- and post-operative radiographs the AC index, Wiberg lateral CE angle, Wagner index, improvement in Shenton's line, and lateralisation and anteversion of the acetabulum were compared. Bernese periacetabular osteotomy is an extensive surgical procedure requiring special instrumentation. It may be associated with serious complications and has a relatively long learning curve. The average follow-up was 18 months (range, 2 to 36). The average duration of surgery was 2 hours and 44 min (range, 2 to 31/ 2 h). The average values improved in the AC index by 24 degrees, lateral CE angle by 29 degrees and Wagner index by 18 %. Shenton's line was corrected by surgery in 20 hips and lateral migration in 16 hips. In two hips lateralisation did not changed. Two serious complications were recorded: para-articular ossification requiring excision and concomitant acetabular trimming, and great intra-operative blood loss. Various mechanisms of damage to the hip are discussed and the methods of treatment outlined, together with prerequisites for successful surgery. Potential complications and their treatment are mentioned. Bernese periacetabular osteotomy makes the range of roofing procedures for hip joint treatment wider. These, as well as hip joint reduction techniques, should be performed in major specialized centres.

  17. Complex osteotomies vertebral column resection and decancellation.

    Science.gov (United States)

    Obeid, Ibrahim; Bourghli, Anouar; Boissière, Louis; Vital, Jean-Marc; Barrey, Cédric

    2014-07-01

    Pedicle subtraction osteotomy (PSO) is nowadays widely used to treat sagittal imbalance. Some complex malalignment cases cannot be treated by a PSO, whereas the imbalance is coronal or mixed or the sagittal imbalance is major and cannot be treated by a single PSO. The aim of this article was to review these complex situations--coronal imbalance, mixed imbalance, two-level PSO, vertebral column resection, and vertebral column decancellation, and to focus on their specificities. It wills also to evoke the utility of navigation in these complex cases.

  18. Explicit reconstruction of the entanglement wedge

    CERN Document Server

    Kim, Jung-Wook

    2016-01-01

    The problem of bulk locality, or how the boundary encodes the bulk in AdS/CFT, is still a subject of study today. One of the major issues that needs more elucidation is the problem of subregion duality; what information of the bulk a given boundary subregion encodes. Although proofs given by two teams of researchers, Dong, Harlow, and Wall and Bao, and Kim, state that the entanglement wedge of the bulk should be reconstructible from boudnary subregions, no explicit procedure for reconstructing the entanglement wedge was as of yet given. In this paper, mode sum approach to obtaining smearing functions is generalised to include bulk reconstruction in the entanglement wedge of boundary subregions. It is generally expectated that solutions to the wave equation on a complicated coordinate patch are needed, but this hard problem has been transferred to a less hard but tractable problem of matrix inversion.

  19. Non-Newtonian viscosity wedge in film formation of EHL

    Institute of Scientific and Technical Information of China (English)

    GUOF.; WONGP.L.

    2001-01-01

    This paper aims to evaluate the action of viscosity wedge in the oil film formation ofEHL at opposite sliding and zero entrainment. Using solvers developed for Newtonian and Eyringfluids, the film formation behavior originating from viscosity wedge is investigated. The numericalsimulation displays that lubricant film formation induced by viscosity wedge is different from that bythe well-known geometrical wedge with entrainment in classic EHL. The numerical analyses showthat at high opposite sliding speed the viscosity wedge acts as a leading role in film formation, thenon-Newtonian effects can have a pronounced influence on action of the viscosity wedge.

  20. A review of dynamics modelling of friction wedge suspensions

    Science.gov (United States)

    Wu, Qing; Cole, Colin; Spiryagin, Maksym; Sun, Yan Quan

    2014-11-01

    Three-piece bogies with friction wedge suspensions are the most widely used bogies in heavy haul trains. Fiction wedge suspensions play a key role in these wagon systems. This article reviews current techniques in dynamic modelling of friction wedge suspension with various motivations: to improve dynamic models of friction wedge suspensions so as to improve general wagon dynamics simulations; to seek better friction wedge suspension models for wagon stability assessments in complex train systems; to improve the modelling of other friction devices, such as friction draft gear. Relevant theories and friction wedge suspension models developed by using commercial simulation packages and in-house simulation packages are reviewed.

  1. Graphene Plasmons in Triangular Wedges and Grooves

    DEFF Research Database (Denmark)

    Gonçalves, P. A. D.; Dias, E. J. C.; Xiao, Sanshui

    2016-01-01

    and electric-field distributions. We have found that the dispersion of wedge/groove graphene plasmons follows the same functional dependence as their flat-graphene plasmon counterparts, but now scaled by a (purely) geometric factor in which all the information about the system’s geometry is contained. We...... and tunability of graphene plasmons guided along the apex of a graphene-covered dielectric wedge or groove. In particular, we present a quasi-analytic model to describe the plasmonic eigenmodes in such a system, including the complete determination of their spectrum and corresponding induced potential...

  2. Medial displacement calcaneal osteotomy using minimally invasive technique.

    Science.gov (United States)

    Kheir, Ehab; Borse, Vishal; Sharpe, Jon; Lavalette, David; Farndon, Mark

    2015-03-01

    Medial displacement calcaneal osteotomy is a common procedure often used as part of pes planovalgus deformity correction. Traditionally the osteotomy is performed using a direct lateral or extended lateral approach, which may carry the risk of wound problems, infection and neurovascular injury. The authors describe a minimally invasive technique to perform the osteotomy and achieve the desired correction. The article illustrates our experience and learning curve with the use of this technique as an option for calcaneal osteotomy. We retrospectively reviewed the records of a sequential series of patients since 2011 whose calcaneal osteotomies were performed by 2 surgeons, after cadaveric training using a minimally invasive operative approach. Prior to 2011, similar surgeries, performed by the senior authors, were undertaken using a direct lateral approach. Thirty cases were identified; 29 had tibialis posterior reconstruction coupled with calcaneal osteotomy for acquired flexible planovalgus deformity and 1 patient had surgery for a malunited calcaneal fracture. Radiological and clinical union occurred in all 30 cases (100%). The radiographs of all cases were reviewed by a specialist musculoskeletal radiologist. There were no neurovascular or wound complications. All patients had restoration of neutral hindfoot alignment. One patient required screw removal after union, resolving all symptoms. This series suggests that minimally invasive calcaneal osteotomy surgery can achieve excellent union rates aiding correction of deformity with no observed neurovascular or soft tissue complications. For surgeons experienced in open surgery, there is a short learning curve after appropriate training. © The Author(s) 2014.

  3. Intraoral Zygoma Reduction Using L-shaped Osteotomy

    Science.gov (United States)

    Hong, Seung Eup; Liu, Si You; Kim, Jeong Tae; Lee, Jong Hun

    2014-01-01

    Background Because of the various defects of malarplasty, including a large incision, much bleeding, visible scars after the operation, and so on, caused by the conventional coronal incision or the temporal incision with the intraoral incision approach, the malarplasty by simple intraoral approach is an innovative development. Methods Through the intraoral approach and subperiosteal dissection, we can reach the osteotomy point on the zygomatic body directly and arrive at the osteotomy point at the zygomatic arch end along the medial side of the zygoma. A new L osteotomy is applied with the reciprocating saw. In addition, the osteotomy was performed on the zygomatic arch from the inside out with an angle of 20 degrees horizontally. Results From 1997 to 2010, we were satisfied with the results of 114 cases of malarplasty with the intraoral approach and L osteotomy as the observed objects. There are 103 cases for women and 11 for men. Ages ranged from 16 to 48 years. The mean operation time is approximately 1 hour. We just had a few complications: 3 nonunion at the osteotomy line and needed a second surgery to repair as well as 2 slight cheek drooping during the initial period and required face lifting. Conclusions The method of intraoral approach and L-shaped osteotomy for zygoma reduction can reduce prominent zygoma while maintaining the natural curves of the zygomatic body and arch. Because of the simple procedures, fewer complications, and excellent results, this method will be considered a relatively desirable way. Level of Evidence Therapeutic, III. PMID:24657982

  4. A dual anteroposterior approach to the Bernese periacetabular osteotomy.

    Science.gov (United States)

    Kim, H T; Woo, S H; Lee, J S; Cheon, S J

    2009-07-01

    When the Bernese periacetabular osteotomy is performed through an anterior approach, the ischial and retroacetabular osteotomies and manual fracture of the incompletely osteotomized ischium are conducted with an incomplete view resulting in increased risk and morbidity. We have assessed the dual anteroposterior approach which appears to address this deficiency. We compared the results of the Bernese periacetabular osteotomy performed in 11 patients (13 osteotomies) through a single anterior approach with those in 12 patients (13 osteotomies) in whom the procedure was carried out through a dual anteroposterior approach. The estimated blood loss, the length of anaesthesia, duration of surgery and radiological parameters were measured. The mean operative time and length of anaesthesia were not significantly different in the two groups (p = 0.781 and p = 0.698, respectively). The radiological parameters improved to a similar extent in both groups after the operation but there was significantly less blood loss in the dual osteotomy group (p = 0.034). The dual anteroposterior approach provides a direct view of the retroacetabular and ischial parts of the osteotomy, within a reasonable operating time and with minimal blood loss and gives a satisfactory outcome.

  5. Surgical accuracy in high tibial osteotomy: coronal equivalence of computer navigation and gap measurement.

    Science.gov (United States)

    Schröter, S; Ihle, C; Elson, D W; Döbele, S; Stöckle, U; Ateschrang, A

    2016-11-01

    Medial opening wedge high tibial osteotomy (MOW HTO) is now a successful operation with a range of indications, requiring an individualised approach to the choice of intended correction. This manuscript introduces the concept of surgical accuracy as the absolute deviation of the achieved correction from the intended correction, where small values represent greater accuracy. Surgical accuracy is compared in a randomised controlled trial (RCT) between gap measurement and computer navigation groups. This was a prospective RCT conducted over 3 years of 120 consecutive patients with varus malalignment and medial compartment osteoarthritis, who underwent MOW HTO. All procedures were planned with digital software. Patients were randomly assigned into gap measurement or computer navigation groups. Coronal plane alignment was judged using the mechanical tibiofemoral angle (mTFA), before and after surgery. Absolute (positive) values were calculated for surgical accuracy in each individual case. There was no significant difference in the mean intended correction between groups. The achieved mTFA revealed a small under-correction in both groups. This was attributed to a failure to account for saw blade thickness (gap measurement) and over-compensation for weight bearing (computer navigation). Surgical accuracy was 1.7° ± 1.2° (gap measurement) compared to 2.1° ± 1.4° (computer navigation) without statistical significance. The difference in tibial slope increases of 2.7° ± 3.9° (gap measurement) and 2.1° ± 3.9° (computer navigation) had statistical significance (P osteotomy for individual cases. This work is clinically relevant because coronal surgical accuracy was not superior in either group. Therefore, the increased expense and surgical time associated with navigated MOW HTO is not supported, because meticulously conducted gap measurement yields equivalent surgical accuracy. I.

  6. Three Years of High Resolution Year-Round Monitoring of Ice-Wedge Thermal Contraction Cracking in Svalbard

    Science.gov (United States)

    Christiansen, H. H.

    2006-12-01

    Most likely ice-wedges are the most widespread periglacial landform in lowlands with continuous permafrost. With a changing climate it is important to understand better the geomorphological processes controlling ice- wedge growth and decay, as they might cause large changes to the surface of the landscape, particularly if the active layer thickness increases causing melting of the most ice-rich permafrost top layer. As most settlements on permafrost are located in lowland areas, ice-wedge formation can also influence the infrastructure. Understanding the processes of ice-wedge growth and their thaw transformation into ice-wedge casts are essential when using contemporary ice wedges as analogues of Pleistocene thermal contraction cracking in palaeoenvironmental reconstructions. As ice-wedges are largely controlled by winter conditions, improved understanding of the factors controlling their growth will enable better palaeoclimatic reconstructions both directly from ice-wedges, but also from ice-wedge casts, than just mean winter temperatures. Detailed studies of ice-wedge dynamics, including quantification of movement, have only been done in very few places in the Arctic. In high arctic Svalbard at 78°N climate at sea level locates these islands close to the southern limit of the continuous permafrost zone, with MAAT of as much as -4 to -6°C. However, thermal contraction cracking is demonstrated to be widespread in the Adventdalen study area in Svalbard. The year-round field access from the University Centre in Svalbard, UNIS, has enabled the collection of different continuous or high frequency ice-wedge process monitoring data since 2002 to improve the understanding of the geomorphological activity of this landform. In all the winters the air temperature was below -30°C for shorter or longer periods. During all the winters, the temperature in the top permafrost was below -15°C both in the ice-wedge top for shorter or longer periods. The snow cover was

  7. The biomechanical differences of rotational acetabular osteotomy, Chiari osteotomy and shelf procedure in developmental dysplasia of hip

    Science.gov (United States)

    2014-01-01

    Background Rotational acetabular osteotomy (RAO), Chiari osteotomy and shelf procedure are important treatments to delay the progression of osteoarthritis in developmental dysplasia of hip (DDH) patients, but their biomechanical differences are still unknown. This study was to evaluate the different biomechanical changes of hip joint after these three surgeries. Methods Sixteen DDH models of 8 human cadaver specimens were reconstructed, and treated by different surgeries, and then strain around femoral head was evaluated by strain gauges. Results Hip strain value of DDH model was decreased after treated by shelf procedure (Pleft = 0.016 and Pright = 0.021) and rotational acetabular osteotomy (P = 0.004), but not in Chiari osteotomy (P = 0.856). Moreover, the improved ratio of RAO treatment was better than shelf procedure (P = 0.015) and Chiari osteotomy (P = 0.0007), and the descendent range of shelf procedure was greater than Chiari osteotomy (P = 0.018). Conclusions From biomechanics points, RAO was more effective in relieving hip joint stress compared with shelf procedure and Chiari osteotomy. PMID:24555880

  8. Benchmarking numerical models of brittle thrust wedges

    NARCIS (Netherlands)

    Buiter, Susanne J H; Schreurs, Guido; Albertz, Markus; Gerya, Taras V.; Kaus, Boris; Landry, Walter; le Pourhiet, Laetitia; Mishin, Yury; Egholm, David L.; Cooke, Michele; Maillot, Bertrand; Thieulot, Cedric; Crook, Tony; May, Dave; Souloumiac, Pauline; Beaumont, Christopher

    2016-01-01

    We report quantitative results from three brittle thrust wedge experiments, comparing numerical results directly with each other and with corresponding analogue results. We first test whether the participating codes reproduce predictions from analytical critical taper theory. Eleven codes pass the s

  9. PARADOX SOLUTION ON ELASTIC WEDGE DISSIMILAR MATERIALS

    Institute of Scientific and Technical Information of China (English)

    姚伟岸; 张兵茹

    2003-01-01

    According to the Hellinger-Reissner variational principle and introducing proper transformation of variables, the problem on elastic wedge dissimilar materials can be led to Hamiltonian system, so the solution of the problem can be got by employing the separation of variables method and symplectic eigenfunction expansion under symplectic space, which consists of original variables and their dual variables. The eigenvalue - 1 is a special one of all symplectic eigenvalue for Hamiltonian system in polar coordinate. In general, the eigenvalue - is a single eigenvalue, and the classical solution of an elastic wedge dissimilar materials subjected to a unit concentrated couple at the vertex is got directly by solving the eigenfunction vector for eigenvalue - 1 . But the eigenvalue - 1 becomes a double eigenvalue when the vertex angles and modulus of the materials satisfy certain definite relationships and the classical solution for the stress distribution becomes infinite at this moment, that is, the paradox should occur. Here the Jordan form eigenfunction vector for eigenvalue - 1 exists, and solution of the paradox on elastic wedge dissimilar materials subjected to a unit concentrated couple at the vertex is obtained directly by solving this special Jordan form eigenfunction. The result shows again that the solutions of the special paradox on elastic wedge in the classical theory of elasticity are just Jordan form solutions in symplectic space under Hamiltonian system.

  10. Radiotherapy treatment planning with dynamic wedges--an algorithm for generating wedge factors and beam data.

    Science.gov (United States)

    Thomas, S J; Foster, K R

    1995-09-01

    If the jaws of a linear accelerator are moved under computer control during irradiation, dose distributions similar to those with wedge filters can be produced. Varian linear accelerators utilize this effect to give a 'dynamic wedge', using segmented treatment tables (STTs). An algorithm is described to generate the dose per monitor unit at any point in a beam, using the STT values. Dynamically wedged beams are modelled as the superposition of static asymmetric beams, using an algorithm based on beam data measured for symmetric beams. Predictions of wedge factors, depth doses and profiles generated using the algorithm are compared with measurements. Good agreement is found between predictions and measurements. The calculation time is typically 5 ms/dose point on a PC with a 486DX processor.

  11. A comparison of exact TM plane wave diffraction by coated wedges and impedance wedges

    DEFF Research Database (Denmark)

    Andersen, Lars S.; Breinbjerg, Olav; Moore, John T.

    1996-01-01

    without interference from direct fields or reflected fields. Results have been obtained in the case of illumination by a transverse magnetic (TM) uniform plane wave. The analysis of the coated wedge is based on an integral equation formulation combined with a hybrid technique, while the analysis......The purpose of this work is to numerically investigate the accuracy of the standard impedance boundary condition (SIBC) approximation for edge diffraction. To this end, we compare the scattering by coated wedges and SIBC wedges for which the diffracted field from a single edge can be observed...... of the SIBC wedge is based on Maliuzhinets' solution. Comparisons have been carried out for a series of configurations including lossy coatings as well as lossless coatings permitting unattenuated propagation of surface waves. The results show that the presence of an edge in a coated structure does...

  12. Benchmarking numerical models of brittle thrust wedges

    Science.gov (United States)

    Buiter, Susanne J. H.; Schreurs, Guido; Albertz, Markus; Gerya, Taras V.; Kaus, Boris; Landry, Walter; le Pourhiet, Laetitia; Mishin, Yury; Egholm, David L.; Cooke, Michele; Maillot, Bertrand; Thieulot, Cedric; Crook, Tony; May, Dave; Souloumiac, Pauline; Beaumont, Christopher

    2016-11-01

    We report quantitative results from three brittle thrust wedge experiments, comparing numerical results directly with each other and with corresponding analogue results. We first test whether the participating codes reproduce predictions from analytical critical taper theory. Eleven codes pass the stable wedge test, showing negligible internal deformation and maintaining the initial surface slope upon horizontal translation over a frictional interface. Eight codes participated in the unstable wedge test that examines the evolution of a wedge by thrust formation from a subcritical state to the critical taper geometry. The critical taper is recovered, but the models show two deformation modes characterised by either mainly forward dipping thrusts or a series of thrust pop-ups. We speculate that the two modes are caused by differences in effective basal boundary friction related to different algorithms for modelling boundary friction. The third experiment examines stacking of forward thrusts that are translated upward along a backward thrust. The results of the seven codes that run this experiment show variability in deformation style, number of thrusts, thrust dip angles and surface slope. Overall, our experiments show that numerical models run with different numerical techniques can successfully simulate laboratory brittle thrust wedge models at the cm-scale. In more detail, however, we find that it is challenging to reproduce sandbox-type setups numerically, because of frictional boundary conditions and velocity discontinuities. We recommend that future numerical-analogue comparisons use simple boundary conditions and that the numerical Earth Science community defines a plasticity test to resolve the variability in model shear zones.

  13. Corrective osteotomy assisted by computer simulation for a malunited intra-articular fracture of the distal humerus: two case reports.

    Science.gov (United States)

    Oura, Keiichiro; Kunihiro, Oka; Okada, Kiyoshi; Tanaka, Hiroyuki; Murase, Tsuyoshi

    2016-11-01

    Intra-articular malunion after fractures of the distal humerus can cause pain, stiffness and, consequently, osteoarthritis in the long run. Although corrective osteotomy for intra-articular malunion has been reported, it is still technically challenging and needs careful preoperative evaluation and planning. Here, we present two cases of corrective osteotomy assisted by preoperative three-dimensional (3-D) computer simulation. We present two cases of malunited intra-articular fracture of the distal humerus, which was treated by corrective osteotomy with the aid of 3-D computer simulation. One case was initially treated with closed reduction and pinning, and the other was initially treated with open reduction and internal fixation. Both of them had pain and severely limited range of motion in the elbow due to intra-articular malunion. 3-D models of the bilateral humeri were created on a computer using computed tomography (CT) data. The deformity was analyzed by superimposing the model of the affected humerus on the mirrored model of the contralateral normal humerus. Osteotomy, reduction and fixation were simulated preoperatively on the computer. The actual surgery was performed exactly according to the preoperative 3-D computer simulation. The operative procedures were performed successfully according to the computer simulation. Range-of-motion exercises started 3 days and immediately after the surgery in cases 1 and 2, respectively. Two years after surgery, there were no complaints of pain or instability. The range of elbow motion was 5°-140° and 15°-125° in cases 1 and 2, respectively. Plain radiographs and CT scans showed good reconstruction of the articular surface. 3-D computer simulations can be useful in preoperative planning for intra-articular corrective osteotomy for complex malunion of the distal humerus.

  14. Osteochondritis dissecans after rotational acetabular osteotomy for dysplastic hip

    Energy Technology Data Exchange (ETDEWEB)

    Nozawa, Masahiko; Maezawa, Katsuhiko; Yuasa, Takahito; Morimoto, Kouichi; Asakura, Taro; Kurosawa, Hisashi [Juntendo University School of Medicine, Department of Orthopaedic Surgery, Tokyo (Japan)

    2005-12-01

    We encountered a rare case of osteochondritis dissecans of the femoral head after rotational acetabular osteotomy that recovered with conservative treatment 4 years after the detection of characteristic radiological findings. (orig.)

  15. Evolution of technique and indications for the Bernese periacetabular osteotomy.

    Science.gov (United States)

    Leunig, Michael; Ganz, Reinhold

    2011-01-01

    Acetabular dysplasia is among the most frequent causes of secondary osteoarthritis (OA) of the hip. While hip arthrolasty is a valid option in elderly patients, young and active patients are likely to outlive their implants and therefore may require a different approach. During the last 20 years, the emphasis of these osteotomies shifted from the femoral to the acetabular side, with the Bernese periacetabular osteotomy being one of the most frequently and successfully used techniques today. The procedure combines a polygonal juxta-articular osteotomy using a modified Smith-Peterson approach. During refinement of the technique, the principle osteotomy steps remained unchanged, while the soft-tissue dissection has been modified, in that the abductors are not detached from the iliac wing. Due to a better appreciation of hip deformities, other indications for this technique have continuously evolved over time.

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

    Science.gov (United States)

    Hall, Matthew J; Mandalia, Vipul I

    2016-03-01

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

  17. Trans trochanteric approach with coronal osteotomy of the great trochanter

    Directory of Open Access Journals (Sweden)

    Steffann Francois

    2015-01-01

    Full Text Available Several surgical approaches could be used in hip arthroplasty or trauma surgery: anterior, anterolateral, lateral, posterior (with or without trochanterotomy, using or not an orthopedic reduction table. Subtrochanteric and extra-capsular trochanteric fractures (ECTF are usually treated by internal fixation with mandatory restrictions on weight bearing. Specific complications have been widely described. Mechanical failures are particularly high in unstable fractures. Hip fractures are a major public health issue with a mortality rate of 12%–23% at 1 year. An alternative option is to treat ECTF by total hip arthroplasty (THA to prevent decubitus complications, to help rapid recovery, and to permit immediate weight bearing as well as quick rehabilitation. However, specific risks of THA have to be considered such as dislocation or cardiovascular failure. The classical approach (anterior or posterior requires the opening of the joint and capsule, weakening hip stability and the repair of the great trochanter is sometimes hazardous. For 15 years, we have been treating unstable ECTF by THA with cementless stem, dual mobility cup (DMC, greater trochanter (GT reattachment, and a new surgical approach preserving capsule, going through the fracture and avoiding joint dislocation. Bombaci first described a similar approach in 2008; our trans fractural digastric approach (medial gluteus and lateral vastus is different. A coronal GT osteotomy is performed when there is no coronal fracture line. It allows easy access to the femoral neck and acetabulum. The THA is implanted without femoral internal rotation to avoid extra bone fragment displacement. With pre-operative planning, cup implantation is easy and stem positioning is adjusted referring to the top of the GT after trial reduction and preoperative planning. The longitudinal osteotomy and trochanteric fracture are repaired with wires and the digastric incision is closed. This variant of Bombaci

  18. Salter osteotomy in Legg-Calvé-Perthes disease.

    Science.gov (United States)

    Thompson, George H

    2011-09-01

    Femoral head containment in Legg-Calvé-Perthes disease (LCPD) can be either surgical or nonsurgical. The Salter or innominate osteotomy is a common method of surgical containment. This is a review of the technique and results of this osteotomy in LCPD. The operative technique is relatively simple but requires considerable experience to perform correctly. It can be used alone or in combination with a proximal femoral varus osteotomy. The indications for a Salter osteotomy are essentially the same as in any form of containment treatment in LCPD. This includes: age at clinical onset of 6 to 10 years (perhaps, 5 y in female), more than one-half capital femoral epiphyseal involvement (Catterall groups III or IV, Salter-Thompson group B, and lateral pillar groups B, B/C, and C), and a good range of hip motion before surgery. The osteotomy alone is usually indicated for younger children with recent clinical onset and no femoral head deformity or subluxation. The combined procedure is better suited for older children and those with subluxation or a deformed femoral head. Currently, the results of treatment are best determined at skeletal maturity using the Stulberg et al classification. When used alone, approximately 90% to 95% of the involved hips will have achieved a Stulberg et al class I, II, or III result. When combined with a proximal femoral varus osteotomy, the results are somewhat less because of the older age at onset and/or the presence of a deformed hip. The Salter osteotomy in LCPD is an effective method of surgical treatment that can alter the natural history of the disease process. The main advantage of this osteotomy is its effect on femoral head remodeling during remaining growth.

  19. Supramalleolar osteotomy for realignment of the ankle joint.

    Science.gov (United States)

    Siddiqui, Noman A; Herzenberg, John E; Lamm, Bradley M

    2012-10-01

    Ankle replacement systems have not been as reliable as hip replacements in providing long-term relief of pain, increased motion, and return to full activity. Supramalleolar Osteotomy is an extraarticular procedure that realigns the mechanical axis, thereby restoring ankle function. The literature discussing knee arthritis has shown that realignment osteotomies of the tibia improve function and prolong total knee replacement surgery. The success of the procedure is predicated on understanding the patient's clinical and radiographic presentation and proper preoperative assessment and planning.

  20. Blood flow in rabbit osteotomies studied with radioactive microspheres

    Energy Technology Data Exchange (ETDEWEB)

    Aalto, K. (Department of Surgery, Aurora Hospital, Nordenskioeldinkatu, Helsinki, Finland); Slaetis, P. (Department of Orthopaedic Surgery and Traumatology, Surgical Hospital, University Central Hospital, Helsinki, Finland)

    1984-01-01

    Arterial embolisation with radioactive microspheres was used to measure the proportion of cardiac output to the skeleton and the tibiofibular bone both in unoperated rabbits and in rabbits after tibial osteotomy and subsequent external fixation. The mean uptake of the intact tibiofibula was 0.11 per cent of the cardiac output and, correspondingly, 0.21 per cent after the osteotomy. Maximal uptake occurred 18 days after the operation which was accompanied by a slight decrease in overall skeletal circulation.

  1. Femoral neck non-union treatment by valgus intertrochanteric osteotomy

    Science.gov (United States)

    Schwartsmann, Carlos Roberto; Spinelli, Leandro de Freitas; Yépez, Anthony Kerbes; Boschin, Leonardo Carbonera; Silva, Marcelo Faria

    2015-01-01

    ABSTRACT OBJECTIVE : The purpose of this study was to evaluate the performance of valgus intertrochanteric osteotomy in femoral neck non-union. METHODS : Forty-two patients with femoral neck fractures with non-union treated using Pauwels' intertrochanteric osteotomy were reviewed. Demographics, time elapsed between fracture and surgery, follow--up, osteosynthesis used, Garden's classification, limb shortening, and x-rays were evaluated. RESULTS : Twenty-two men and 20 women were reviewed. The youngest patient was 18 years old and the oldest 65 years old, with a mean age of 42.4 years (±11.2). The minimum follow-up was 2 years, with a mean of 10.2 years. The average time elapsed between initial fracture and osteotomy was 6.5 months. Twel-ve cases were neglected femoral neck fractures. Nineteen patients were classified as Garden III, and 23 patients as Garden IV. After valgus osteotomy, non-union healing was observed in 38 patients (38/42; 90.4%). Healing of thirty-seven cases of pseudoarthrosis were obtained after the first-attempt osteotomy, and one case required two operations for healing. The osteotomy failed in four cases. Conside-ring the healed osteotomies, good to excellent functional results were achieved in 80.9% (34/42) of the patients. Total hip replacement was subsequently performed in 14.2% (6/42) of the patients for unfavoura-ble outcomes (two for cutting out, two for osteonecrosis, and two for osteoarthritis). CONCLUSIONS : Valgus intertrochanteric osteotomy has a high success rate in archiving healing in femoral neck non-union with good functional results. It is a biological and effective method. Level of Evidence IV, Therapeutic Study. PMID:27057146

  2. [Sports activities after osteotomies around the knee].

    Science.gov (United States)

    Paul, J; Heitner, A H; Mauch, M; Imhoff, A B

    2017-07-01

    In the current literature, the rate of return to sports following high tibial osteotomy is high. Patients are largely able to carry out the type of exercise done before the onset of symptoms and are satisfied with the clinical outcome. In general, however, a differentiated view of the sporting ability should be made, and the different requirements of the sport should be considered. A classification according to functional and biomechanical movement analysis seems to advisable. In addition, the recommendations of the treating physician seem to have a high impact on the postoperative level of the sports activities of the patients. A realistic assessment (by both the patient and the treating physician) that considers the sport, its requirements and the level of performance is necessary.

  3. Vascular lesions secondary to osteotomy by corticotomy.

    Science.gov (United States)

    Spinelli, Francesco; Spinelli, Renato; Stilo, Francesco; De Caridi, Giovanni; Mirenda, Francesco

    2007-01-01

    Management of vascular traumas is frequently delayed. Vascular injuries after elective operation for bone lengthening or correction of a deformity are very'rare situations. We describe 3 cases. Case 1: male, aged 22, undergoing corticotomy for bone lengthening; immediately presented acute limb ischaemia due to a partial lesion of the popliteal artery, documented by U.S. After 7 h, direct reconstruction of the artery and fasciotomies were performed. Case 2: male, aged 27, undergoing directional osteotomy for genu varus correction. For 30 days, constant increase in leg volume and decrease in function. US showed an important haematoma at the popliteal level; arteriography documented a partial lesion of the infra-genicular popliteal artery and a voluminous false aneurysm. Direct correction of the artery and fasciotomies were performed. Case 3: male, aged 22, undergoing corticotomy for leg lengthening; immediately presented leg pain with decreased distal pulses. After 4h, there was an increase in leg volume, and arteriography showed a total lesion of the infra-genicular popliteal artery and an arteriovenous fistula. Popliteo-tibial bypass with the contralateral greater saphenous vein and fasciotomies were performed. After 1 month endovascular closure of the fistula was obtained. All patients had recovered after two months with only minor leg insufficiency. Patency of the bypass and absence of infections or delayed false aneurysms were achieved. Vascular injuries after elective orthopaedic procedures are very rare situations. Such lesions are caused by an osteotomy via corticotomy performed percutaneously. The variety of clinical presentations accounts for the difficulty in diagnosing such lesions and for the delays in implementing treatment. It is very important to obtain an early diagnosis complete with an arteriography.

  4. Life at the wedge: the activity and diversity of arctic ice wedge microbial communities.

    Science.gov (United States)

    Wilhelm, Roland C; Radtke, Kristin J; Mykytczuk, Nadia C S; Greer, Charles W; Whyte, Lyle G

    2012-04-01

    The discovery of polygonal terrain on Mars underlain by ice heightens interest in the possibility that this water-bearing habitat may be, or may have been, a suitable habitat for extant life. The possibility is supported by the recurring detection of terrestrial microorganisms in subsurface ice environments, such as ice wedges found beneath tundra polygon features. A characterization of the microbial community of ice wedges from the high Arctic was performed to determine whether this ice environment can sustain actively respiring microorganisms and to assess the ecology of this extreme niche. We found that ice wedge samples contained a relatively abundant number of culturable cells compared to other ice habitats (∼10(5) CFU·mL(-1)). Respiration assays in which radio-labeled acetate and in situ measurement of CO(2) flux were used suggested low levels of microbial activity, though more sensitive techniques are required to confirm these findings. Based on 16S rRNA gene pyrosequencing, bacterial and archaeal ice wedge communities appeared to reflect surrounding soil communities. Two Pseudomonas sp. were the most abundant taxa in the ice wedge bacterial library (∼50%), while taxa related to ammonia-oxidizing Thaumarchaeota occupied 90% of the archaeal library. The tolerance of a variety of isolates to salinity and temperature revealed characteristics of a psychrotolerant, halotolerant community. Our findings support the hypothesis that ice wedges are capable of sustaining a diverse, plausibly active microbial community. As such, ice wedges, compared to other forms of less habitable ground ice, could serve as a reservoir for life on permanently cold, water-scarce, ice-rich extraterrestrial bodies and are therefore of interest to astrobiologists and ecologists alike. .

  5. Radiation pressure on a dielectric wedge

    CERN Document Server

    Mansuripur, Masud; Moloney, Jerome V

    2014-01-01

    The force of electromagnetic radiation on a dielectric medium may be derived by a direct application of the Lorentz law of classical electrodynamics. While the light's electric field acts upon the (induced) bound charges in the medium, its magnetic field exerts a force on the bound currents. We use the example of a wedge-shaped solid dielectric, immersed in a transparent liquid and illuminated at Brewster's angle, to demonstrate that the linear momentum of the electromagnetic field within dielectrics has neither the Minkowski nor the Abraham form; rather, the correct expression for momentum density has equal contributions from both. The time rate of change of the incident momentum thus expressed is equal to the force exerted on the wedge plus that experienced by the surrounding liquid.

  6. Graphene Plasmons in Triangular Wedges and Grooves

    CERN Document Server

    Gonçalves, P A D; Xiao, Sanshui; Vasilevskiy, M I; Mortensen, N Asger; Peres, N M R

    2016-01-01

    The ability to effectively guide electromagnetic radiation below the diffraction limit is of the utmost importance in the prospect of all-optical plasmonic circuitry. Here, we propose an alternative solution to conventional metal-based plasmonics by exploiting the deep subwavelength confinement and tunability of graphene plasmons guided along the apex of a graphene-covered dielectric wedge or groove. In particular, we present a quasi-analytic model to describe the plasmonic eigenmodes in such a system, including the complete determination of their spectrum and corresponding induced potential and electric field distributions. We have found that the dispersion of wedge/groove graphene plasmons follows the same functional dependence as their flat-graphene plasmons counterparts, but now scaled by a (purely) geometric factor in which all the information about the system's geometry is contained. We believe our results pave the way for the development of novel custom-tailored photonic devices for subwavelength waveg...

  7. Percutaneous triplanar femoral osteotomy correction for developmental coxa vara: a new technique.

    Science.gov (United States)

    Sabharwal, Sanjeev; Mittal, Rahul; Cox, Garrick

    2005-01-01

    Developmental coxa vara (DCV) is a well-known pediatric hip disorder that is associated with triplanar deformity of the proximal femur. Several techniques of proximal femur osteotomies have being cited in the literature, with variable outcomes. Recently, the authors have used a percutaneous technique with application of a low-profile Ilizarov external fixator for acute opening wedge correction of the femoral deformity associated with DCV. Five children (six affected hips) underwent the above procedure at an average age of 8 + 4 years. The average improvement in Hilgenreiner's epiphyseal angle was from 74 degrees before surgery to 33 degrees after surgery, the neck-shaft angle improved from 86 degrees to 137 degrees, and the articulo-trochanteric distance improved from -6 mm to +11 mm. Latest follow-up at a mean of 2.1 years after surgery showed satisfactory healing with no significant loss of correction in any case. This percutaneous technique offers several advantages over currently available methods for surgical correction of DCV.

  8. Walking pattern in 9 women with hip dysplasia 18 months after periacetabular osteotomy

    DEFF Research Database (Denmark)

    Pedersen, Eva N G; Alkjaer, Tine; Søballe, Kjeld

    2006-01-01

    BaCKGROUND: Periacetabular osteotomy improves radiographic predictors of osteoarthrosis and diminishes pain and functional impairment. No changes in function quantified by gait analysis have yet been documented. We evaluated the functional outcome of periacetabular osteotomy in relation to gait...

  9. Safety and Efficacy of Derotational Osteotomy for Congenital Radioulnar Synostosis.

    Science.gov (United States)

    Simcock, Xavier; Shah, Apurva S; Waters, Peter M; Bae, Donald S

    2015-12-01

    Congenital radioulnar synostosis (CRUS) refers to an abnormal connection between the radius and ulna due to embryological failure of separation. Derotational osteotomy has been advocated for children with functional limitations, although historically this procedure has been associated with a 36% complication rate including compartment syndrome and loss of correction. A retrospective evaluation of consecutive patients who underwent derotational osteotomy for CRUS at a single institution was performed. Children with functional limitations secondary to excessive pronation were indicated for surgery with a goal of correction to 10 to 20 degrees of pronation. All patients were treated with a standardized surgical technique including careful subperiosteal elevation, rotational osteotomy at the level of the synostosis, control of the osteotomy fragments, appropriate pinning techniques, and prophylactic forearm fasciotomies. Electronic medical records, preoperative radiographs, and postoperative radiographs were reviewed. Derotational osteotomy was performed in 31 forearms in 26 children (13 bilateral, 13 unilateral) with a mean age of 6.8 years (range, 3.0 to 18.8 y). The mean clinical follow-up was 46 months (range, 6 to 148 mo). The mean preoperative pronation deformity was 85 degrees (range, 60 to 100 degrees). The mean correction achieved was 77 degrees (range, 40 to 95 degrees), resulting in a mean final position of 8 degrees of pronation (range, 0 to 30 degrees). All patients successfully achieved union by 8 weeks postoperatively. There were no cases of compartment syndrome, vascular compromise, or loss of fixation. The overall complication rate was 12% (2 transient anterior interosseous nerve palsies, 1 transient radial nerve palsy, 1 symptomatic muscle herniation). Both transient anterior interosseous nerve palsies occurred in patients with rotational corrections exceeding 80 degrees. Derotational osteotomy can be safely and effectively performed in children with

  10. A Comparison between External versus Internal Lateral Osteotomy in Rhinoplasty

    Directory of Open Access Journals (Sweden)

    M Hashemi

    2005-01-01

    Full Text Available Background: Lateral osteotomy is a major part of rhinoplasty for remodeling external facet of the nose and narrowing of nasal base and dorsum after removal of the hump. There are two techniques for lateral osteotomy known as external and internal. Each of these provide advantages and impose limitations. The purpose of our study was to compare the severity of postoperative edema and ecchymosis between internal and external osteotomy techniques. Methods: This study was designed as a clinical trial on 30 cases. With randomization, one side of the nasal bone was selected for internal approach, and the other side, for external approach. Then, on the 1st and 7th days after surgery, the patients were scored for the severity of edema and ecchymosis. Results: On the first day after surgery, not only edema, but also ecchymosis was lower with the external osteotomy than with the internal approach (P = 0.037, P = 0.002, respectively. The severity of ecchymosis, on the 7th postoperative day, was lower with the external approach, and the difference was significant (P = 0.011. The severity of both edema and ecchymosis on the first postoperative day was evaluated higher in females, with statistically significant differences (P = 0.05 for edema and P = 0.003 for ecchymosis. The extension of ecchymosis on the 7th postoperative day was higher in women (P = 0.05. There were no significant differences between the two approaches in medialization of the involved bones and no apparent asymmetries either. Conclusion: According to the results of this study, external osteotomy seems to be the approach of choice, provided that the surgeon has enough experience in doing it. Keywords: Rhinoplasty, Internal osteotomy, External osteotomy, Ecchymosis, Edema

  11. A Simple 3-Dimensional Printed Aid for a Corrective Palmar Opening Wedge Osteotomy of the Distal Radius.

    Science.gov (United States)

    Honigmann, Philipp; Thieringer, Florian; Steiger, Regula; Haefeli, Mathias; Schumacher, Ralf; Henning, Julia

    2016-03-01

    The reconstruction of malunited distal radius fractures is often challenging. Virtual planning techniques and guides for drilling and resection have been used for several years to achieve anatomic reconstruction. These guides have the advantage of leading to better operative results and faster surgery. Here, we describe a technique using a simple implant independent 3-dimensional printed drill guide and template to simplify the surgical reconstruction of a malunited distal radius fracture. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  12. Patterns of healing: a comparison of two proximal tibial osteotomy techniques

    OpenAIRE

    Peek, Anna C.; Timms, Anna; Chin, Kuen F.; Calder, Peter; Goodier, David

    2016-01-01

    Several low-energy osteotomy techniques are described in the literature, but there is limited evidence comparing them. Our study evaluates the patterns of regenerate formation using two different osteotomy techniques. Two cohorts of patients underwent osteotomy of the tibia using a Gigli saw (n = 15) or De Bastiani corticotomy (n = 12) technique. The patient radiographs were assessed by the two senior authors who were blinded to the osteotomy type. Regenerate quality was assessed along the an...

  13. Inicial nasal mucosa detachment using piezoelectric device in the Le Fort I osteotomy: A technical note

    Directory of Open Access Journals (Sweden)

    Elio Hitoshi Shinohara

    2013-01-01

    Full Text Available In maxillary Le Fort I type osteotomy the detachment of the nasal mucosa should be done carefully. Piezoelectric surgery contributed much to increase the safety of osteotomies, despite the initial advantage of minimizing the risk of injury in nervous tissue, mainly in bilateral sagittal split osteotomy; we use the piezoelectric device for the initial detachment of the nasal mucosa in the maxillary osteotomy.

  14. Mantle flow in subduction systems: The mantle wedge flow field and implications for wedge processes

    Science.gov (United States)

    Long, Maureen D.; Wirth, Erin A.

    2013-02-01

    The mantle wedge above subducting slabs is associated with many important processes, including the transport of melt and volatiles. Our understanding of mantle wedge dynamics is incomplete, as the mantle flow field above subducting slabs remains poorly understood. Because seismic anisotropy is a consequence of deformation, measurements of shear wave splitting can constrain the geometry of mantle flow. In order to identify processes that make first-order contributions to the pattern of wedge flow, we have compiled a data set of local S splitting measurements from mantle wedges worldwide. There is a large amount of variability in splitting parameters, with average delay times ranging from ~0.1 to 0.3 s up to ~1.0-1.5 s and large variations in fast directions. We tested for relationships between splitting parameters and a variety of parameters related to subduction processes. We also explicitly tested the predictions made by 10 different models that have been proposed to explain splitting patterns in the mantle wedge. We find that no simple model can explain all of the trends observed in the global data set. Mantle wedge flow is likely controlled by a combination of downdip motion of the slab, trench migration, ambient mantle flow, small-scale convection, proximity to slab edges, and slab morphology, with the relative contributions of these in any given subduction system controlled by the subduction kinematics and mantle rheology. There is also a likely contribution from B-type olivine and/or serpentinite fabric in many subduction zones, governed by the local thermal structure and volatile distribution.

  15. Nanoscale guiding for cold atoms based on surface plasmons along the tips of metallic wedges

    Institute of Scientific and Technical Information of China (English)

    Wang Zheng-Ling; Tang Wei-Min; Zhou Ming; Gao Chuan-Yu

    2013-01-01

    We propose a novel scheme to guide neutral cold atoms in a nanoscale region based on surface plasmons (SPs) of one pair and two pairs of tips of metallic wedges with locally enhanced light intensity and sub-optical wavelength resolution.We analyze the near-field intensity distribution of the tip of the metallic wedge by the FDTD method,and study the total intensity as well as the total potential of optical potentials and van der Waals potentials for 87Rb atoms in the light field of one pair and two pairs of tips of metallic wedges.It shows that the total potentials of one pair and two pairs of tips of metallic wedges can generate a gravito-optical trap and a dark closed trap for nanoscale guiding of neutral cold atoms.Guided atoms can be cooled with efficient intensity-gradient Sisyphus cooling by blue-detuned light field.This provides an important step towards the generation of hybrid systems consisting of isolated atoms and solid devices.

  16. Impingement of water droplets on wedges and diamond airfoils at supersonic speeds

    Science.gov (United States)

    Serafini, John S

    1953-01-01

    An analytical solution has been obtained for the equations of motion of water droplets impinging on a wedge in a two-dimensional supersonic flow field with a shock wave attached to the wedge. The closed-form solution yields analytical expressions for the equation of the droplet trajectory, the local rate of impingement and the impingement velocity at any point on the wedge surface, and the total rate of impingement. The analytical expressions are utilized to determine the impingement on the forward surfaces of diamond airfoils in supersonic flow fields with attached shock waves. The results presented include the following conditions: droplet diameters from 2 to 100 microns, pressure altitudes from sea level to 30,000 feet, free-stream static temperatures from 420 degrees to 460 degrees R. Also, free-stream Mach numbers from 1.1 to 2.0, semi-apex angles for the wedge from 1.14 degrees to 7.97 degrees, thickness-to-chord ratios for the diamond airfoil from 0.02 to 0.14, chord lengths from 1 to 20 feet, and angles of attack from zero to the inverse tangent of the airfoil thickness-to-chord ratio.

  17. A Novel Continuous Extrusion Process to Fabricate Wedge-Shaped Light Guide Plates

    Directory of Open Access Journals (Sweden)

    Wen-Tse Hsiao

    2013-01-01

    Full Text Available Backlight modules are key components in thin-film transistor liquid crystal displays (TFT-LCD. Among the components of a backlight module, the light guide plate (LGP plays the most important role controlling the light projected to the eyes of users. A wedge-shaped LGP, with its asymmetrical structure, is usually fabricated by an injection proces, but the fabrication time of this process is long. This study proposes a continuous extrusion process to fabricate wedge-shaped LGPs. This continuous process has advantages for mass production. Besides a T-die and rollers, this system also has an in situ monitor of the melt-bank that forms during the extrusion process, helping control the plate thickness. Results show that the melt bank has a close relationship with the plate thickness. The temperature of the bottom heater and roller was adjusted to reduce the surface deformation of the wedge-shaped plate. This continuous extrusion system can successfully manufacture wedge-shaped LGPs for mass production.

  18. Modified Mitchell osteotomy alone does not have higher rate of residual metatarsalgia than combined first and lesser metatarsal osteotomy.

    Science.gov (United States)

    Chen, Shu-Jung; Cheng, Yuh-Min; Lin, Sung-Yen; Chen, Chung-Hwan; Huang, Hsuan-Ti; Huang, Peng-Ju

    2015-04-01

    Transfer metatarsalgia (TM) is a common forefoot disorder secondary to hallux valgus (HV). Some authors suggest that a combined lesser metatarsal osteotomy while undergoing HV surgery improves metatarsalgia, whereas others concluded that isolated HV corrective osteotomy can improve symptomatic metatarsalgia. The main purpose of this retrospective study was to compare clinical outcomes in patients with and without combined lesser metatarsal osteotomy while receiving HV correction surgery. We retrospectively reviewed the patients who underwent osteotomy for HV correction between January 2000 and December 2010. All patients underwent HV correction with modified Mitchell osteotomy. Clinical evaluations including the American Orthopaedic Foot and Ankle Society score and residual metatarsalgia were assessed, and radiographic measurements were carried out. Sixty-five patients (83 feet) meeting the selection criteria were enrolled. Thirty feet receiving a combined lesser metatarsal osteotomy were classified as the combined surgery (CS) group, and the others were classified as the control (CN) group (53 feet). The overall rate of persistent symptomatic metatarsalgia was 19.28% after operative treatment. There were six feet with residual metatarsalgia in the CS group, and 10 feet in the CN group. There was no significant difference in the rate of persistent symptoms between the two groups (p = 0.9). According to this result, modified Mitchell osteotomy alone did not have a higher rate of residual metatarsalgia than CS. We also found that the average recovery rate of TM was about 80.7% and those patients whose preoperative HV angle was > 30° had the higher risk of residual metatarsalgia after surgery. Copyright © 2015. Published by Elsevier Taiwan.

  19. Modified Mitchell osteotomy alone does not have higher rate of residual metatarsalgia than combined first and lesser metatarsal osteotomy

    Directory of Open Access Journals (Sweden)

    Shu-Jung Chen

    2015-04-01

    Full Text Available Transfer metatarsalgia (TM is a common forefoot disorder secondary to hallux valgus (HV. Some authors suggest that a combined lesser metatarsal osteotomy while undergoing HV surgery improves metatarsalgia, whereas others concluded that isolated HV corrective osteotomy can improve symptomatic metatarsalgia. The main purpose of this retrospective study was to compare clinical outcomes in patients with and without combined lesser metatarsal osteotomy while receiving HV correction surgery. We retrospectively reviewed the patients who underwent osteotomy for HV correction between January 2000 and December 2010. All patients underwent HV correction with modified Mitchell osteotomy. Clinical evaluations including the American Orthopaedic Foot and Ankle Society score and residual metatarsalgia were assessed, and radiographic measurements were carried out. Sixty-five patients (83 feet meeting the selection criteria were enrolled. Thirty feet receiving a combined lesser metatarsal osteotomy were classified as the combined surgery (CS group, and the others were classified as the control (CN group (53 feet. The overall rate of persistent symptomatic metatarsalgia was 19.28% after operative treatment. There were six feet with residual metatarsalgia in the CS group, and 10 feet in the CN group. There was no significant difference in the rate of persistent symptoms between the two groups (p = 0.9. According to this result, modified Mitchell osteotomy alone did not have a higher rate of residual metatarsalgia than CS. We also found that the average recovery rate of TM was about 80.7% and those patients whose preoperative HV angle was > 30° had the higher risk of residual metatarsalgia after surgery.

  20. Trochanteric osteotomy versus posterolateral approach: Function the first year post surgery. A pilot study

    NARCIS (Netherlands)

    M. van der Grinten (Margot); M. Reijman (Max); F.C. van Biezen (Frans); J.A.N. Verhaar (Jan)

    2011-01-01

    textabstractBackground: Although no prospective studies have compared functional results of trochanteric osteotomy and a non-trochanteric approach, most surgeons feel that trochanteric osteotomy is outdated in simple hip arthroplasty. Reasons not to perform an osteotomy include the fear of longer re

  1. Poly(L-lactide) bone plates and screws for internal fixation of mandibular swing osteotomies

    NARCIS (Netherlands)

    Tams, J; Rozema, FR; Bos, RRM; Roodenburg, JLN; Nikkels, PGJ; Vermey, A

    1996-01-01

    This study evaluated bone healing after mandibular swing osteotomies fixed with biodegradable poly(L-lactide) (PLLA) bone plates in four patients. A step osteotomy treated with two PLLA bone plates (n=3), and a straight osteotomy treated with one PLLA bone plate (n=1) were performed. Bone healing wa

  2. Comparison of the surgical approaches for a Chiari pelvic osteotomy.

    Science.gov (United States)

    Ito, H; Matsuno, T; Minami, A

    2003-03-01

    We present the mid- to long-term results of the Chiari pelvic osteotomy for dysplastic hips. We followed 135 hips in 129 patients, with a mean age at the time of surgery of 24 years, for a mean of 16.2 years We used the anterior iliofemoral approach without trochanteric osteotomy in the initial 31 hips. Thereafter, we used transtrochanteric approaches in an attempt to ensure that the osteotomy was at the most appropriate level, and to advance the high-riding greater trochanter distally. The next 79 hips therefore underwent a posterolateral approach and the most recent 25 hips an Ollier lateral U approach. The clinical result was excellent or good in 103 hips (77%). The outcome in 104 hips in which we used a transtrochanteric approach was superior, the osteotomy level was more appropriate and a Trendelenburg gait less common than in 31 hips in which we used an anterior approach. We therefore recommend the use of a transtrochanteric approach in order to ensure that the osteotomy is at an appropriate level and in order to achieve effective distal advancement of the high-riding greater trochanter.

  3. One-stage rotational osteotomy for congenital radioulnar synostosis.

    Science.gov (United States)

    Hwang, J H; Kim, H W; Lee, D H; Chung, J H; Park, H

    2015-10-01

    We report the results of a one-stage rotational osteotomy of the proximal third of the ulna and distal third of the radius with segmental bone resection for treating congenital radioulnar synostosis. We retrospectively reviewed 25 patients (28 forearms) treated by operation. Patients were divided into two groups according to the method of internal fixation at the osteotomy sites. In Group 1 the ulnar osteotomy was stabilized with an intramedullary pin and in Group 2 no fixation was used. The average forearm position improved from 47° pronation before surgery, to 27° supination after surgery. There were no statistically significant differences between the two groups in surgical outcomes. One-stage rotational osteotomy of the proximal third of the ulna and distal third of the radius with segmental bone resection is a simple and safe treatment for patients with congenital radioulnar synostosis. Internal fixation at the osteotomy site seems to be unnecessary. Level of evidence: Level 4. © The Author(s) 2015.

  4. Non-union following bilateral simultaneos Ganz trochanteric osteotomy

    Directory of Open Access Journals (Sweden)

    Sean M. Dixon

    2010-01-01

    Full Text Available Between January 2003 and December 2004, 13 patients underwent bilateral resurfacing arthroplasty via a Ganz trochanteric osteotomy. This bilateral group was mobilised fully weight-bearing with crutches. During the same period 139 Ganz trochanteric osteoto-mies were performed for unilateral hip resurfacing. These patients were mobilised with crutches, weight-bearing up to 10 kg on the operated leg. Nine osteotomies (32% in the bilateral group subsequently developed a symptomatic non-union requiring revision of fixation. This compares with 10 patients (7% in the unilateral group. Applying the Fisher’s exact test, the difference reached significance (P=0.0004. In two patients a second revision was required to achieve union. In one patient, revision of trochanteric fixation precipitated a deep infection. Protected weight-bearing following a Ganz trochanteric osteotomy is important to the success of the procedure. Simultaneous bilateral hip arthroplasty through a Ganz approach should be avoided. If it is undertaken, we recommend that patients should be non weight-bearing for 6 weeks following surgery. Non-union following a Ganz trochanteric osteotomy for arthroplasty carries a significant morbidity.

  5. Hydrodynamics of slip wedge and optimization of surface slip property

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    The hydrodynamic load support generated by a slip wedge of a slider bearing was studied. The surface slip property was optimized so that a maximum hydrodynamic load support could be obtained. A multi-linearity method was given for the slip control equation of two-dimensional (2-D) wall slip. We investigated 2-D wall slip and the hydrodynamics of a finite length bearing with any values of the surface limiting shear stress. It was found that the hydrodynamic effect of the slip wedge is greater than the traditional geometrical convergent-wedge. Even though the geo- metrical gap is a parallel or divergent sliding gap, the slip wedge still gives rise to a very big hydrodynamic pressure. The optimized slip wedge can give rise to a hy- drodynamic load support as high as 2.5 times of what the geometrical conver- gent-wedge can produce. Wall slip usually gives a small surface friction.

  6. Hydrodynamics of slip wedge and optimization of surface slip property

    Institute of Scientific and Technical Information of China (English)

    MA GuoJun; WU ChengWei; ZHOU Ping

    2007-01-01

    The hydrodynamic load support generated by a slip wedge of a slider bearing was studied. The surface slip property was optimized so that a maximum hydrodynamic load support could be obtained. A multi-linearity method was given for the slip control equation of two-dimensional (2-D) wall slip. We investigated 2-D wall slip and the hydrodynamics of a finite length bearing with any values of the surface limiting shear stress. It was found that the hydrodynamic effect of the slip wedge is greater than the traditional geometrical convergent-wedge. Even though the geometrical gap is a parallel or divergent sliding gap, the slip wedge still gives rise to a very big hydrodynamic pressure. The optimized slip wedge can give rise to a hydrodynamic load support as high as 2.5 times of what the geometrical convergent-wedge can produce. Wall slip usually gives a small surface friction.

  7. Knee abduction angular impulses during prolonged running with wedged insoles.

    Science.gov (United States)

    Lewinson, Ryan T; Worobets, Jay T; Stefanyshyn, Darren J

    2013-07-01

    Wedged insoles may produce immediate effects on knee abduction angular impulses during running; however, it is currently not known whether these knee abduction angular impulse magnitudes are maintained throughout a run when fatigue sets in. If changes occur, this could affect the clinical utility of wedged insoles in treating conditions such as patellofemoral pain. Thus, the purpose of this study was to determine whether knee abduction angular impulses are altered during a prolonged run with wedged insoles. It was hypothesized that knee abduction angular impulses would be reduced following a prolonged run with wedged insoles. Nine healthy runners participated. Runners were randomly assigned to either a 6-mm medial wedge condition or a 6-mm lateral wedge condition and then ran continuously overground for 30 min. Knee abduction angular impulses were quantified at 0 and 30 min using a gait analysis procedure. After 2 days, participants returned to perform the same test but with the other wedge type. Two-way repeated-measures analysis of variance was used to evaluate main effects of wedge condition and time and interactions between wedge condition and time (α = 0.05). Paired t-tests were used for post hoc analysis (α = 0.01). No interaction effects (p = 0.958) were found, and knee abduction angular impulses were not significantly different over time (p = 0.384). Lateral wedge conditions produced lesser knee abduction angular impulses than medial conditions at 0 min (difference of 2.79 N m s, p = 0.006) and at 30 min (difference of 2.76 N m s, p < 0.001). It is concluded that significant knee abduction angular impulse changes within wedge conditions do not occur during a 30-min run. Additionally, knee abduction angular impulse differences between wedge conditions are maintained during a 30-min run.

  8. Plastic deformation of a wedge by a sliding punch

    Science.gov (United States)

    Nepershin, R. I.

    2016-11-01

    We present a self-similar solution of the problem of deformation of an ideally plastic wedge by a sliding punch with regard to contact friction; such a solution generalizes the well-known solutions of the problem of wedge penetration into a plastic half-space and of compression of an ideally plastic wedge by a plane punch. The problem is of interest for modeling the processes of plastic deformation of rough surfaces of metal pieces by a rigid tool.

  9. Optimal clinical implementation of the Siemens virtual wedge.

    Science.gov (United States)

    Walker, C P; Richmond, N D; Lambert, G D

    2003-01-01

    Installation of a modern high-energy Siemens Primus linear accelerator at the Northern Centre for Cancer Treatment (NCCT) provided the opportunity to investigate the optimal clinical implementation of the Siemens virtual wedge filter. Previously published work has concentrated on the production of virtual wedge angles at 15 degrees, 30 degrees, 45 degrees, and 60 degrees as replacements for the Siemens hard wedges of the same nominal angles. However, treatment plan optimization of the dose distribution can be achieved with the Primus, as its control software permits the selection of any virtual wedge angle from 15 degrees to 60 degrees in increments of 1 degrees. The same result can also be produced from a combination of open and 60 degrees wedged fields. Helax-TMS models both of these modes of virtual wedge delivery by the wedge angle and the wedge fraction methods respectively. This paper describes results of timing studies in the planning of optimized patient dose distributions by both methods and in the subsequent treatment delivery procedures. Employment of the wedge fraction method results in the delivery of small numbers of monitor units to the beam's central axis; therefore, wedge profile stability and delivered dose with low numbers of monitor units were also investigated. The wedge fraction was proven to be the most efficient method when the time taken for both planning and treatment delivery were taken into consideration, and is now used exclusively for virtual wedge treatment delivery in Newcastle. It has also been shown that there are no unfavorable dosimetric consequences from its practical implementation.

  10. Vibration frequencies of a constrained cantilever wedge

    Science.gov (United States)

    Craver, W. Lionel, Jr.; Lu, Yangshan

    1989-05-01

    This paper presents the solution for the natural frequencies of a beam tapered in one direction, or a wedge, with both a rotational and a translational constraint at a position along the length of the beam. The eigenfrequencies were determined using an incremental search and bisection method, accurate to the fourth decimal place. The taper ratio was varied from 1.4 to 5.0 and the dimensionless spring constants were varied from 0 to 1000. Graphs are provided to illustrate some results.

  11. Equivalent correction in scarf and chevron osteotomy in moderate and severe hallux valgus: a randomized controlled trial.

    NARCIS (Netherlands)

    Deenik, A.; Mameren, H van; Visser, E. de; Waal Malefijt, M.C. de; Draijer, F.; Bie, R. de

    2008-01-01

    BACKGROUND: Chevron osteotomy is a widely accepted osteotomy for correction of hallux valgus.(18) Algorithms were developed to overcome the limitations of distal osteotomies. Scarf osteotomy has become popular as a versatile procedure that should be able to correct most cases of acquired hallux valg

  12. Severe unilateral scissor bite and bimaxillary protrusion treated by horseshoe Le Fort I osteotomy combined with mid-alveolar osteotomy.

    Science.gov (United States)

    Shimazaki, Kazuo; Otsubo, Kunihiko; Yonemitsu, Ikuo; Kimizuka, Sachiko; Omura, Susumu; Ono, Takashi

    2014-03-01

    This report describes an orthognathic surgical case employing horseshoe Le Fort I osteotomy (HLFO) combined with mid-alveolar osteotomy and bilateral sagittal split ramus osteotomy (BSSRO) for a patient with severe unilateral scissor bite and bimaxillary protrusion. A female patient (aged 26 years, 2 months) presented with a chief complaint of dysmasesis caused by scissor bite on the right side. The clinical examination revealed difficulty in lip closure and a convex profile. Overerupted right maxillary premolars and molars and lingual tipping of the right mandibular premolars and molars were indicated before treatment. After 3 months of presurgical orthodontic treatment, two-jaw surgery involving a combination of HLFO with mid-alveolar osteotomy and BSSRO was performed. A good interdigitation in the right side was established by superior-posterior-medial movement of the dento-alveolar segment of the maxilla. Next, both the maxilla and mandible were moved superiorly and posteriorly to correct the improper lip protrusion, thereby improving the patient's profile. Our results suggest that this new orthognathic surgery technique-achieved by combining HLFO with mid-alveolar osteotomy and BSSRO-is effective for adult patients exhibiting severe unilateral scissor bite and bimaxillary protrusion.

  13. Comparison of two approaches to lateral osteotomy in Saudi patients.

    Science.gov (United States)

    Mirza, Ahmad A; Marglani, Osama A; Farooq, Mian U; Al-Khatib, Talal A; Jameel, Waed S; Sultan, Noran A; Aly, Mohammed S

    2017-01-01

    Nasal deformity is an abnormality in the appearance of the nose due to either congenital defect or trauma. In traumatic cases, patients often present with combined functional and cosmetic complaints. Therefore, otolaryngologists take into account both breathing and aesthetic nasal issues. To evaluate the changes in the nasal dorsum and base; compare breathing and aesthetic satisfaction scores between two approaches to lateral nasal osteotomy: low-to-low and low-to-high. Comparative observational; data gathered retrospectively and prospectively. Head and Neck and Skull Base Center, King Abdullah Medical City, Makkah, Saudi Arabia. Patients who received hump reduction rhinoplasty from 2013 to 2016 met the inclusion criteria. Patients with a low satisfaction level for aesthetic sensibility (neutral and dissatisfied) underwent low-to-high osteotomy. The differences in dorsal (DW) and ventral (VW) widths with a fixed interpupillary distance (IPD). Satisfaction scores for both cosmetic perspective and breathing functionality. We included 46 patients; 28 patients underwent low-to-low osteotomy and 18 patients underwent low-to-high osteotomy. With both approaches, there were statistically decreases from preoperative to postoperative ratios of VW/IPD and DW/IPD. However, differences in DW/IPD ratio and VW/IPD ratio (pre- versus post-op) were significantly higher in the low-to-low group (P osteotomy showed a satisfactory outcome in both objective and subjective measures. However, low-to-low osteotomy was superior in pre- to post-operative differences in DW/IPD and VW/IPD ratios. Sampling was by convenience. The study was conducted in a single tertiary center and was a small sample.

  14. Global Existence of a Shock for the Supersonic Flow Past a Curved Wedge

    Institute of Scientific and Technical Information of China (English)

    Hui Cheng YIN

    2006-01-01

    This note is devoted to the study of the global existence of a shock wave for the supersonic flow past a curved wedge. When the curved wedge is a small perturbation of a straight wedge and the angle of the wedge is less than some critical value, we show that a shock attached at the wedge will exist globally.

  15. Phase transitions and interface fluctuations in double wedges and bi-pyramids with competing surface fields

    Science.gov (United States)

    Müller, M.; Milchev, A.; Binder, K.; Landau, D. P.

    2008-08-01

    The interplay between surface and interface effects on binary AB mixtures that are confined in unconventional geometries is investigated by Monte Carlo simulations and phenomenological considerations. Both double-wedge and bi-pyramid confinements are considered and competing surface fields are applied at the two opposing halves of the system. Below the bulk critical temperature, domains of opposite order parameter are stabilized at the corresponding corners and an interface runs across the middle of the bi-partite geometry. Upon decreasing the temperature further one encounters a phase transition at which the AB symmetry is broken. The interface is localized in one of the two wedges or pyramids, respectively, and the order parameter is finite. In both cases, the transition becomes discontinuous in the thermodynamic limit but it is not a first-order phase transition. In an antisymmetric double wedge geometry the transition is closely related to the wedge-filling transition. Choosing the ratio of the cross-section L × L of the wedge and its length L y according to L y / L 3 = const., simulations and phenomenological consideration show that the new type of phase transition is characterized by critical exponents α = 3/4, β = 0, and γ = 5/4 for the specific heat, order parameter, and susceptibility, respectively. In an antisymmetric bi-pyramid the transition occurs at the cone-filling transition of a single pyramid. The important critical fluctuations are associated with the uniform translation of the interface and they can be described by a Landau-type free energy. Monte Carlo results provide evidence that the coefficients of this Landau-type free energy exhibit a system-size dependence, which gives rise to critical amplitudes that diverge with system size and result in a transition that becomes discontinuous in the thermodynamic limit.

  16. Molecular depth profiling by wedged crater beveling.

    Science.gov (United States)

    Mao, Dan; Lu, Caiyan; Winograd, Nicholas; Wucher, Andreas

    2011-08-15

    Time-of-flight secondary ion mass spectrometry and atomic force microscopy are employed to characterize a wedge-shaped crater eroded by a 40-keV C(60)(+) cluster ion beam on an organic film of Irganox 1010 doped with Irganox 3114 delta layers. From an examination of the resulting surface, the information about depth resolution, topography, and erosion rate can be obtained as a function of crater depth for every depth in a single experiment. It is shown that when measurements are performed at liquid nitrogen temperature, a constant erosion rate and reduced bombardment induced surface roughness is observed. At room temperature, however, the erosion rate drops by ∼(1)/(3) during the removal of the 400 nm Irganox film and the roughness gradually increased to from 1 nm to ∼4 nm. From SIMS lateral images of the beveled crater and AFM topography results, depth resolution was further improved by employing glancing angles of incidence and lower primary ion beam energy. Sub-10 nm depth resolution was observed under the optimized conditions on a routine basis. In general, we show that the wedge-crater beveling is an important tool for elucidating the factors that are important for molecular depth profiling experiments.

  17. Ice-Creams and Wedge Graphs

    CERN Document Server

    Ackerman, Eyal; Pinchasi, Rom

    2011-01-01

    We show that for every compact convex set $S$ in the plane and every $0 < \\alpha < \\pi$, there exist a point $O$ and two supporting lines to $S$ passing through $O$ and touching $S$ at two \\emph{single points} $X$ and $Y$, respectively, such that $|OX|=|OY|$ and the angle between the two lines has measure $\\alpha$. As a consequence, we provide a simplified proof to the following result by Carmi, Katz, Lotker, and Ros\\'en \\cite{CKLR10}. Given a set of $\\frac{\\pi}{3}$-directional antennas (that is, antennas each of which can communicate along a wedge of angle $\\frac{\\pi}{3}$), one can always assign a direction to each antenna such that the resulting communication graph is connected, where two antennas can communicate if and only if each lies in the wedge assigned to the other. In fact we obtain a much stronger and optimal result (see Theorem \\ref{theorem:main}) saying in particular that one can chose the directions of the antennas so that the communication graph has diameter $\\le 4$.

  18. Intra-Articular Osteotomy for Distal Humerus Malunion

    Directory of Open Access Journals (Sweden)

    René K. Marti

    2009-01-01

    Full Text Available Intra-articular osteotomy is considered in the rare case of malunion after a fracture of the distal humerus to restore humeral alignment and gain a functional arc of elbow motion. Traumatic and iatrogenic disruption of the limited blood flow to the distal end of the humerus resulting in avascular necrosis of capitellum or trochlea is a major pitfall of the this technically challenging procedure. Two cases are presented which illustrate the potential problems of intra-articular osteotomy for malunion of the distal humerus.

  19. Dome-shaped osteotomy for distal radius fracture malunions.

    Science.gov (United States)

    Brunelli, Giorgio A

    2003-06-01

    After having hinted to the various component of the malformity caused by malunions of the distal radius fracture, the various possibilities of correcting this deformity are described. The difficulty to correct all the components of the deformity are considered. Then a Dome-shaped osteotomy of the distal radius is described that allows to correct all the deformities in all the directions as the gliding plane of the osteotomy is spherical. The ulnar plus and the DRUJ alterations are corrected by means of an added Sauvé-Kapandji procedure that guarantees against any painful movement of the DRUJ preserving effective prono-supination.

  20. High tibial osteotomy in Sweden, 1998-2007

    DEFF Research Database (Denmark)

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

    2012-01-01

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

  1. Advanced containment methods for the treatment of Perthes disease: Salter plus varus osteotomy and triple pelvic osteotomy.

    Science.gov (United States)

    Wenger, Dennis R; Pandya, Nirav K

    2011-09-01

    The goal of intervention in Legg-Calvé-Perthes disease has been to prevent femoral head deformation by containing the head within the acetabulum, using it as a mold for guiding femoral head development. With appropriate proximal femoral morphology, premature arthritis can hopefully be avoided. Both nonsurgical and surgical methods of treatment have evolved over time, from abduction casts and braces to advanced surgical containment methods, which are now the mainstay of treatment. The purpose of this study is to briefly review the evolution of surgical treatment of Legg-Calvé-Perthes disease, and to concentrate on 2 advanced surgical containment methods: combined Salter innominate osteotomy with femoral varus osteotomy and triple pelvic osteotomy.

  2. [The bare area of the proximal ulna : An anatomical study on optimizing olecranon osteotomy].

    Science.gov (United States)

    Hackl, M; Lappen, S; Neiss, W F; Scaal, M; Müller, L P; Wegmann, K

    2016-10-01

    Olecranon osteotomy is an established approach for the treatment of distal humerus fractures. It should be performed through the bare area of the proximal ulna to avoid iatrogenic cartilage lesions. The goal of this study was to analyze the anatomy of the proximal ulna with regard to the bare area and, thereby, to optimize the hitting area of the bare area when performing olecranon osteotomy. The bare areas of 30 embalmed forearm specimens were marked with a radiopaque wire and visualized three-dimensionally with a mobile C‑arm. By means of 3D reconstructions of the data sets, the following measurements were obtained: height of the bare area; span of the bare area-hitting area in transverse osteotomy; ideal angle for olecranon osteotomy to maximize the hitting area of the bare area; distance of the posterior olecranon tip to the entry point of the transverse osteotomy and the ideal osteotomy. The height of the bare area was 4.92 ± 0.81 mm. The hitting area of the transverse osteotomy averaged 3.73 ± 0.89 mm. The "ideal" angle for olecranon osteotomy was 30.7° ± 4.19°. The distance of the posterior olecranon tip to the entry point was 14.08 ± 2.75 mm for the transverse osteotomy and 24.21 ± 3.15 mm for the ideal osteotomy. The hitting area of the bare area in the ideal osteotomy was enhanced significantly when compared to the transverse osteotomy (p osteotomy of the olecranon. Moreover, a 30° angulation of the osteotomy can significantly increase the hitting area of the bare area.

  3. A guiding oblique osteotomy cut to prevent bad split in sagittal split ramus osteotomy: a technical note

    Directory of Open Access Journals (Sweden)

    Gururaj Arakeri

    2015-06-01

    Full Text Available Aim: To present a simple technical modification of a medial osteotomy cut which prevents its misdirection and overcomes various anatomical variations as well as technical problems. Methods: The medial osteotomy cut is modified in the posterior half at an angle of 15°-20° following novel landmarks. Results: The proposed cut exclusively directs the splitting forces downwards to create a favorable lingual fracture, preventing the possibility of an upwards split which would cause a coronoid or condylar fracture. Conclusion: This modification has proven to be successful to date without encountering the complications of a bad split or nerve damage.

  4. Short lingual osteotomy without fixation: a new strategy for mandibular osteotomy known as "physiological positioning".

    Science.gov (United States)

    Ohba, Seigo; Yoshida, Masashi; Kohara, Haruka; Kawasaki, Takako; Minamizato, Tokutarou; Koga, Takamitsu; Nakatani, Yuya; Wanatabe, Etsuko; Nakao, Noriko; Yoshida, Noriaki; Asahina, Izumi

    2014-02-01

    We describe the strategy of physiological positioning, which we regard as a new alternative treatment to conventional orthognathic operations, and treated 18 patients with skeletal mandibular prognathism using it. The positions of SNB, FMA, and Me were measured postoperatively to assess skeletal stability, changes in the angle and perpendicular length of the upper and lower central incisors were measured to assess dental stability, and we confirmed that both skeletal and dental stability were excellent. The width to which the jaw could be opened recovered early, and we saw only one case of disorder of the temporomandibular joint. Short lingual osteotomy with physiological positioning is an effective new approach to the treatment of deformities of the mandible.

  5. 49 CFR 215.113 - Defective plain bearing wedge.

    Science.gov (United States)

    2010-10-01

    ... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION RAILROAD FREIGHT CAR SAFETY STANDARDS Freight Car Components Suspension System § 215.113 Defective plain bearing wedge. A railroad may not place or continue in service a car, if a plain bearing wedge on that car is— (a) Missing; (b) Cracked; (c) Broken; or (d) Not...

  6. Comparison of wedge resection (Winograd procedure) and wedge resection plus complete nail plate avulsion in the treatment of ingrown toenails.

    Science.gov (United States)

    Huang, Jia-Zhang; Zhang, Yi-Jun; Ma, Xin; Wang, Xu; Zhang, Chao; Chen, Li

    2015-01-01

    The present retrospective study compared the efficacy of wedge resection (Winograd procedure) and wedge resection plus complete nail plate avulsion for the treatment of ingrown toenails (onychocryptosis). Two surgical methods were performed in 95 patients with a stage 2 or 3 ingrown toenail. Each patient was examined weekly until healing and then at 1, 6, and 12 months of follow-up. The outcomes measured were surgical duration, healing time, recurrence rate, the incidence of postoperative infection, and cosmetic appearance after surgery. Of the 95 patients (115 ingrown toenails) included in the present study, 39 (41.1%) underwent wedge resection (Winograd procedure) and 56 (59%), wedge resection plus complete nail plate avulsion. The mean surgical duration for wedge resection (Winograd procedure) and wedge resection plus complete nail plate avulsion was 14.9 ± 2.4 minutes and 15.1 ± 3.2 minutes, respectively (p = .73). The corresponding healing times were 2.8 ± 1.2 weeks and 2.7 ± 1.3 weeks (p = .70). Recurrence developed in 3 (3.2%) patients after wedge resection (Winograd procedure) and in 4 (4.2%) after wedge resection plus complete nail plate avulsion. In addition, postoperative infection occurred in 3 (3.2%) patients after wedge resection (Winograd procedure) and 2 (2.1%) after wedge resection plus complete nail plate avulsion. Both of the surgical procedures were practical and appropriate for the treatment of ingrown toenails, being simple and associated with low morbidity and a high success rate. However, cosmetically, wedge resection (Winograd procedure) would be the better choice because the nail plate remains intact.

  7. Ground penetrating radar estimates of permafrost ice wedge depth

    Science.gov (United States)

    Parsekian, A.; Slater, L. D.; Nolan, J. T.; Grosse, G.; Walter Anthony, K. M.

    2013-12-01

    Vertical ground ice wedges associated with polygonal patterning in permafrost environments form due to frost cracking of soils under harsh winter conditions and subsequent infilling of cracks with snow melt water. Ice wedge polygon patterns have implications for lowland geomorphology, hydrology, and vulnerability of permafrost to thaw. Ice wedge dimensions may exceed two meters width at the surface and several meters depth, however few studies have addressed the question of ice wedge depth due to challenges related to measuring the vertical dimension below the ground. Vertical exposures where ice wedges maybe observed are limited to rapidly retreating lake, river, and coastal bluffs. Coring though the ice wedges to determine vertical extent is possible, however that approach is time consuming and labor intensive. Many geophysical investigations have noted signal anomalies related to the presence of ice wedges, but no reliable method for extracting wedge dimensions from geophysical data has been yet proposed. Here we present new evidence that ground penetrating radar (GPR) may be a viable method for estimating ice wedge depth. We present three new perspectives on processing GPR data collected over ice wedges that show considerable promise for use as a fast, cost effective method for evaluating ice wedge depth. Our novel approaches include 1) a simple frequency-domain analysis, 2) an S-transform frequency domain analysis and 3) an analysis of the returned signal power as a radar cross section (RCS) treating subsurface ice wedges as dihedral corner retro-reflectors. Our methods are demonstrated and validated using finite-difference time domain FDTD) GPR forward models of synthetic idealized ice wedges and field data from permafrost sites in Alaska. Our results indicate that frequency domain and signal power data provide information that is easier to extract from raw GPR data than similar information in the time domain. We also show that we can simplify the problem by

  8. Plasmonic angular momentum on metal-dielectric nano-wedges in a sectorial indefinite metamaterial

    CERN Document Server

    Jin, Dafei

    2013-01-01

    We present an analytical study to the structure-modulated plasmonic angular momentum trapped on periodic metal-dielectric nano-wedges in the core region of a sectorial indefinite metamaterial. Employing a transfer-matrix calculation and a conformal-mapping technique, our theory is capable of dealing with realistic configurations of arbitrary sector numbers and rounded wedge tips. We demonstrate that in the deep-subwavelength regime strong electric field carrying high azimuthal variation can exist within only ten-nanometer length scale close to the structural center, and is naturally bounded by a characteristic radius of the order of hundred-nanometer away from the center. These extreme confining properties suggest that the structure under investigation may be superior to the conventional metal-dielectric waveguides or cavities in terms of nanoscale photonic manipulation.

  9. Experiments on melt-rock reaction in the shallow mantle wedge

    Science.gov (United States)

    Mitchell, Alexandra L.; Grove, Timothy L.

    2016-12-01

    This experimental study simulates the interaction of hotter, deeper hydrous mantle melts with shallower, cooler depleted mantle, a process that is expected to occur in the upper part of the mantle wedge. Hydrous reaction experiments ( 6 wt% H2O in the melt) were conducted on three different ratios of a 1.6 GPa mantle melt and an overlying 1.2 GPa harzburgite from 1060 to 1260 °C. Reaction coefficients were calculated for each experiment to determine the effect of temperature and starting bulk composition on final melt compositions and crystallizing assemblages. The experiments used to construct the melt-wall rock model closely approached equilibrium and experienced phase equilibria, melt compositions, and reaction coefficients provide a framework for understanding how melt-wall rock reaction occurs in the natural system during melt ascent in the mantle wedge.

  10. 用楔子撬开问题%Using a Wedge to Pry Open a Problem

    Institute of Scientific and Technical Information of China (English)

    马提索夫

    2001-01-01

    When I elicited the Pumi word ts6 'wedge' in Kunming (March 1996), I was struck by its resemblance to Lahu jfl 'wedge'. Since the Qiangic languages are not particularly close to Loloish on the TB family tree,this apparent cognate for an item of non-core vocabulary was of interest. The first task in establishing a relationship between the Pumi and the Lahu forms was to reconstruct the PLB ancestor of Lahu jfi. Then possible cognates to the Pumi form in other Qiangic languages had to be examined.Given our present rudimentary knowledge of comparative Qiangic,could parallel examples establish a Proto-Qiangic reconstruction resembling our newly reconstructed PLB form?

  11. First bite syndrome after bimaxillary osteotomy: case report.

    Science.gov (United States)

    Scholey, April Louise; Suida, Mohamed Imran

    2015-07-01

    We present what is to the best of our knowledge the first reported case of first bite syndrome as a delayed complication of bimaxillary osteotomy. Copyright © 2015 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  12. Postoperative contamination of mandibular osteotomy sites with saliva

    NARCIS (Netherlands)

    Koole, Ronald; Egyedi, P.

    1987-01-01

    Postoperative salivary contamination of surgical wounds around the mandible was found in several types of osteotomy and bone grafting procedure. This problem was investigated by determining the amylase content of wound secretions in redon bottles every 24h. The implications for antibiotic

  13. High Tibial Osteotomy: A Systematic Review and Current Concept

    Science.gov (United States)

    Sabzevari, Soheil; Ebrahimpour, Adel; Roudi, Mostafa Khalilipour; Kachooei, Amir R.

    2016-01-01

    High tibia osteotomy is a common procedure in orthopedic surgery. A precise overview on indications, patients selection, pre-operative planning, surgical technique, methods of fixation, and complications have been presented. This paper focused on the points that should be considered to achieve good long-term outcomes. PMID:27517063

  14. [Bernese periacetabular osteotomy for the treatment of severe hip dysplasia].

    Science.gov (United States)

    Huang, Ye; Zhang, Hong; Liu, Qing; Jiang, Zeng-hui; Dou, Yong

    2010-02-15

    To analyze the mid-term clinical and radiographic results obtained with the Bernese periacetabular osteotomy for the treatment of severe hip dysplasia. From October 1997 to December 2002 20 hips of 18 patients were classified as having severe acetabular dysplasia (Severin classification Grade IVb). Preoperatively, all patients had hip pain, and sufficient hip joint congruency on functional radiographs. All 20 hips underwent Bernese periacetabular osteotomy. Postoperatively, the hips were assessed radiographically on center edge angle (CE), acetabular roof obliquity and the progression of osteoarthritis. Clinical results and hip function were measured with the Harris hip score at an average of 6.2 years follow-up. Comparison of preoperative and follow-up radiographs demonstrated significant improvements in the lateral CE angle, the anterior CE angle, and roof obliquity. The average Harris hip score improved from 78.5 points preoperatively to 91.1 points at the time of the latest follow-up. Fourteen of 18 patients were satisfied with the result of the surgery, and 16 of 20 hips had a good or excellent clinical result. Under-correction occurred in 5 hips. The Bernese periacetabular osteotomy is an effective procedure for surgical correction of the severe dysplastic hip. This osteotomy can predictably obtain major reorientation of the acetabulum in all planes. The clinical results in the mid-term follow-up are encouraging.

  15. Comparison of three approaches of Bernese periacetabular osteotomy

    Directory of Open Access Journals (Sweden)

    Luo DZ

    2016-01-01

    Full Text Available Dianzhong Luo, Hong Zhang, Weijia Zhang Division of Joint Surgery and Sport Medicine, Department of Orthopaedics, First Affiliated Hospital of Chinese PLA General Hospital, Beijing, People’s Republic of China Background: Developmental dysplasia of the hip is a common disease and treated with various surgical approaches. Improved ilioinguinal (I-I approach, two-incision Smith-Peterson (TSP approach, and modified Smith-Peterson (MSP approach are three main approaches; however, they are rarely compared. The present study compared the operative time, blood loss, intraoperative and postoperative allogeneic blood transfusion, and postoperative complications of these three different approaches. Hypothesis: Surgical approach does not influence the operation time, blood loss, and complications of periacetabular osteotomy. Level of evidence: Level III. Case–control study. Patients and methods: In a total of 101 hips of 95 cases, from February 2010 to July 2011, three different approaches of Bernese periacetabular osteotomy, I-I, TSP, and MSP, were conducted. The operation time, intraoperative bleeding, allogeneic blood transfusion, and early complications in different operation approaches were compared by a retrospective study when there were similar ages, genders, and lesions. Results: Among the three approaches, I-I had less operation time and more blood loss (P<0.05, TSP had less blood loss (P<0.05 but more complications, and MSP had less blood loss (P<0.05 and less complications. Discussion: The MSP approach is superior to the other two approaches in doing periacetabular osteotomy. Keywords: periacetabular osteotomy, operation approaches, complications

  16. Corrective Osteotomy for Ipsilateral Distal Clavicular and Coracoid Malunions.

    Science.gov (United States)

    Yoshida, Atsushi

    2015-08-01

    Malunion after double disruption injuries of the superior shoulder suspensory complex accompanied by shoulder pain and dysfunction has been reported infrequently. A 37-year-old man had a double disruption injury (fractures of the distal clavicle and the base of the coracoid process). Conservative treatment resulted in malunion. Twelve months after the injury, pain continued in the coracoclavicular interval, and there was only 125° forward shoulder elevation. Radiographs showed 50° inferior angulation of the distal clavicle and elongated base of the coracoid process. Corrective osteotomy was required; however, the concomitant malunion of the coracoid prevented correction of the deformity with osteotomy of the distal clavicle alone. Therefore, osteotomy of the coracoid was performed. Twelve months postoperatively, successful bone union resulted in loss of pain. Forward elevation had recovered to 160°. Distal clavicular fractures with concomitant coracoid fractures are often significantly displaced, which disrupts physiologic coupling of clavicular and scapular motion and limits forward elevation. In the case of such malunions, excessive movement at the clavicle-scapula junction during mobilization causes pain in the coracoclavicular interval. Correction of this deformity requires osteotomy of both the clavicular and coracoid malunions.

  17. Postoperative contamination of mandibular osteotomy sites with saliva

    NARCIS (Netherlands)

    Koole, Ronald; Egyedi, P.

    1987-01-01

    Postoperative salivary contamination of surgical wounds around the mandible was found in several types of osteotomy and bone grafting procedure. This problem was investigated by determining the amylase content of wound secretions in redon bottles every 24h. The implications for antibiotic prophylaxi

  18. Characterization of CNRS Fizeau wedge laser tuner

    Science.gov (United States)

    A fringe detection and measurement system was constructed for use with the CNRS Fizeau wedge laser tuner, consisting of three circuit boards. The first board is a standard Reticon RC-100 B motherboard which is used to provide the timing, video processing, and housekeeping functions required by the Reticon RL-512 G photodiode array used in the system. The sampled and held video signal from the motherboard is processed by a second, custom fabricated circuit board which contains a high speed fringe detection and locating circuit. This board includes a dc level discriminator type fringe detector, a counter circuit to determine fringe center, a pulsed laser triggering circuit, and a control circuit to operate the shutter for the He-Ne reference laser beam. The fringe center information is supplied to the third board, a commercial single board computer, which governs the data collection process and interprets the results.

  19. Isolated lunotriquetral ligament tears treated with ulnar shortening osteotomy.

    Science.gov (United States)

    Mirza, Ather; Mirza, Justin B; Shin, Alexander Y; Lorenzana, Daniel J; Lee, Brian K; Izzo, Brett

    2013-08-01

    To evaluate outcomes in a single-surgeon series of ulnar shortening osteotomy for the treatment of traumatic isolated tears to the lunotriquetral interosseous ligament (LTIL). This study includes 53 consecutive cases of posttraumatic isolated LTIL tears treated with ulnar shortening osteotomy with minimum 1-year follow-up (range, 1.0-10.6 y). We confirmed all LTIL tears via arthroscopy before performing a precision 2.5-mm oblique osteotomy using a modified Rayhack technique. We assessed outcomes using grip strength measurements and Chun and Palmer's modified Gartland Werley wrist scoring system, which includes subjective and objective outcome measures. Preoperatively, 45 cases were graded as fair (28%; n = 15) or poor (57%; n = 30) on the modified Gartland Werley score. There were insufficient data to calculate grades in 8 cases (15%). At final follow-up, most patients exhibited excellent (51%; n = 27) or good (32%; n = 17) scores, some scored fair (17%; n = 9), and none scored as poor. All subjective and objective variables significantly improved over a mean follow-up of 36 months (range, 12-127 mo). Mean grip strength increased from a value of 23 kg before surgery to 33 kg over the same period, a 41% increase. All patients achieved clinical and radiographic union by 10 months. Osteotomy plates were removed routinely in most cases (89%; n = 47) at a mean of 17 months. Ulnar shortening osteotomy reduced symptoms of posttraumatic isolated LTIL tears in this single-surgeon series. Therapeutic IV. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  20. The Tax Wedge in Slovenia: International Comparison and Policy Recommendations

    Directory of Open Access Journals (Sweden)

    Primož Dolenc

    2005-09-01

    Full Text Available When taxes on labor are introduced, a “tax wedge” appears between the labor costs paid by the employer (gross wage and the net wage received by an employee. At a certain level of wage, a higher tax wedge increases unemployment and decreases employment, all other things being equal. The paper tackles three main questions: the characteristics of the tax wedge, unemployment and employment rates in OECD countries in the recent past, tax wedge policy in the EU15 and the new EU members and the tax system and its effects on the unemployment and employment rates in Slovenia. We found that the OECD countries can be classified into two groups of countries if the tax wedge, the unemployment rate and the employment rate are taken into consideration. The first group is the high tax wedge, high unemployment rate and low employment rate group of countries, whereas the other group has the opposite characteristics. European member states (old and new have on average a higher tax burden on labor than the OECD average, consequently suffering from higher unemployment rates. Slovenia has an unreasonably high tax wedge; in the EU only Belgium and Germany have a higher tax burden. According to previous and our empirical findings we suggest that Slovenia could benefit from a reduction in the tax wedge.

  1. Influence of intermolecular forces at critical-point wedge filling.

    Science.gov (United States)

    Malijevský, Alexandr; Parry, Andrew O

    2016-04-01

    We use microscopic density functional theory to study filling transitions in systems with long-ranged wall-fluid and short-ranged fluid-fluid forces occurring in a right-angle wedge. By changing the strength of the wall-fluid interaction we can induce both wetting and filling transitions over a wide range of temperatures and study the order of these transitions. At low temperatures we find that both wetting and filling transitions are first order in keeping with predictions of simple local effective Hamiltonian models. However close to the bulk critical point the filling transition is observed to be continuous even though the wetting transition remains first order and the wetting binding potential still exhibits a small activation barrier. The critical singularities for adsorption for the continuous filling transitions depend on whether retarded or nonretarded wall-fluid forces are present and are in excellent agreement with predictions of effective Hamiltonian theory even though the change in the order of the transition was not anticipated.

  2. Influence of intermolecular forces at critical-point wedge filling

    Science.gov (United States)

    Malijevský, Alexandr; Parry, Andrew O.

    2016-04-01

    We use microscopic density functional theory to study filling transitions in systems with long-ranged wall-fluid and short-ranged fluid-fluid forces occurring in a right-angle wedge. By changing the strength of the wall-fluid interaction we can induce both wetting and filling transitions over a wide range of temperatures and study the order of these transitions. At low temperatures we find that both wetting and filling transitions are first order in keeping with predictions of simple local effective Hamiltonian models. However close to the bulk critical point the filling transition is observed to be continuous even though the wetting transition remains first order and the wetting binding potential still exhibits a small activation barrier. The critical singularities for adsorption for the continuous filling transitions depend on whether retarded or nonretarded wall-fluid forces are present and are in excellent agreement with predictions of effective Hamiltonian theory even though the change in the order of the transition was not anticipated.

  3. Group sequential designs for stepped-wedge cluster randomised trials.

    Science.gov (United States)

    Grayling, Michael J; Wason, James Ms; Mander, Adrian P

    2017-06-01

    The stepped-wedge cluster randomised trial design has received substantial attention in recent years. Although various extensions to the original design have been proposed, no guidance is available on the design of stepped-wedge cluster randomised trials with interim analyses. In an individually randomised trial setting, group sequential methods can provide notable efficiency gains and ethical benefits. We address this by discussing how established group sequential methodology can be adapted for stepped-wedge designs. Utilising the error spending approach to group sequential trial design, we detail the assumptions required for the determination of stepped-wedge cluster randomised trials with interim analyses. We consider early stopping for efficacy, futility, or efficacy and futility. We describe first how this can be done for any specified linear mixed model for data analysis. We then focus on one particular commonly utilised model and, using a recently completed stepped-wedge cluster randomised trial, compare the performance of several designs with interim analyses to the classical stepped-wedge design. Finally, the performance of a quantile substitution procedure for dealing with the case of unknown variance is explored. We demonstrate that the incorporation of early stopping in stepped-wedge cluster randomised trial designs could reduce the expected sample size under the null and alternative hypotheses by up to 31% and 22%, respectively, with no cost to the trial's type-I and type-II error rates. The use of restricted error maximum likelihood estimation was found to be more important than quantile substitution for controlling the type-I error rate. The addition of interim analyses into stepped-wedge cluster randomised trials could help guard against time-consuming trials conducted on poor performing treatments and also help expedite the implementation of efficacious treatments. In future, trialists should consider incorporating early stopping of some kind into

  4. Stable and Critical Noncohesive Coulomb Wedges: Exact Elastic Solutions

    Science.gov (United States)

    Wang, K.; Hu, Y.

    2004-12-01

    The theory of critically tapered Coulomb wedge has been successfully applied to model active fold-and-thrust belts or submarine accretionary prisms. Brittle mountain building is episodic in nature, controlled by changes in basal friction, erosion and sedimentation, and hydrogeology. Sediment accretion may be modulated by great subduction earthquakes. Between deformation episodes and/or during transition between compressional and extensional tectonics, the Coulomb wedges are stable (i.e., supercritical), to which the critical taper theory does not apply. In this work, we provide an exact elastic solution for stable wedges based on Airy stress functions. The stress equilibrium equation and definition of basal friction and basal and internal pore fluid pressure ratios are exactly the same as those used for Dahlen's [1984] exact solution for critical noncohesive Coulomb wedges, but internal friction μ becomes irrelevant. Given elastic - perfectly Coulomb-plastic rheology, for stresses in a wedge on the verge of Coulomb failure there must co-exist a critical taper solution involving μ and a unique equivalent elastic solution not involving μ . Our elastic solution precisely reduces to Dahlen's critical taper solution for critical conditions. For stable conditions, normal stress perpendicular to the surface slope σ z and shear stress τ xz are identical with those in a critical taper, but the slope-parallel normal stress is different. The elastic solution is also generally applicable to purely elastic wedges and useful for modeling geodetic observations. A stable noncohesive Coulomb wedge differs from a general elastic wedge in that its upper and lower surfaces stay at zero curvature during loading. Dahlen, F.A. (1984), Noncohesive critical Coulomb wedges: An exact solution, JGR, 89, 10,125-10,133.

  5. Employment and productivity: The role of the tax wedge

    Directory of Open Access Journals (Sweden)

    Andrea FESTA

    2015-11-01

    Full Text Available After the economic crisis, many countries aim at reducing unemployment and foster productivity. To address these issues one of the most common policy indications recommends lowering the tax wedge on labour in order to increase employment and growth. As a consequence, a review of the empirical studies focused on the relation between tax wedge, employment and productivity is an useful and demanding exercise, especially in those European countries where the topic is on the front page of the domestic policy debate because the productivity growth is low and the tax wedge on labour is high.

  6. Recent movements along the Main Boundary Thrust of the Himalayas: Normal faulting in an over-critical thrust wedge?

    Science.gov (United States)

    Mugnier, Jean-Louis; Huyghe, Pascale; Chalaron, Edouard; Mascle, Georges

    1994-11-01

    The Main Boundary Thrust (MBT) is one of the major Himalayan thrusts occurring during the Cainozoic, and it is presently incorporated within the Himalayan thrust wedge (Lesser and Outer Himalayas) displaced above the Indian lithosphere. Nonetheless the MBT shows recent normal displacement along most of its length. We suggest that the orientation of the major principal stress within the Himalayan thrust wedge deviates significantly from the horizontal and when this deviation exceeds the dip of the vectors normal to back-tilted thrusts, the normal component of displacement may act along these faults. Steep north-dipping segments of the MBT therefore show a normal component of displacement if a geometrical definition is used, but they are faults in a compressional regime where the major principal stress axis has deviated from the horizontal. Micro-structural data recorded along the Surkhet-Ghorahi segment of the MBT are consistent with a strong deviation of the state of stress. The presence of such peculiar normal faulting along the MBT is used to calibrate the mechanical characteristics of the belt considered as a Coulomb wedge. The following characteristics are suggested: (a) very poor strength contrast between basal decollement and rocks in the wedge body, (b) a high pore fluid pressure ratio (probably close to 0.8-0.9) and a higher fluid pressure ratio (close to 1.0) along the active normal faults if a high internal friction angle (close to the Byerlee value) is considered. The strong deviation in principal stress direction may have recently increased, due to a taper of the Himalayan wedge exceeding the stability boundary and may be controlled by erosion and isostatic uplift rebound of the Himalayan range.

  7. Spatial variability of E. coli in an urban salt-wedge estuary.

    Science.gov (United States)

    Jovanovic, Dusan; Coleman, Rhys; Deletic, Ana; McCarthy, David

    2017-01-15

    This study investigated the spatial variability of a common faecal indicator organism, Escherichia coli, in an urban salt-wedge estuary in Melbourne, Australia. Data were collected through comprehensive depth profiling in the water column at four sites and included measurements of temperature, salinity, pH, dissolved oxygen, turbidity, and E. coli concentrations. Vertical variability of E. coli was closely related to the salt-wedge dynamics; in the presence of a salt-wedge, there was a significant decrease in E. coli concentrations with depth. Transverse variability was low and was most likely dwarfed by the analytical uncertainties of E. coli measurements. Longitudinal variability was also low, potentially reflecting minimal die-off, settling, and additional inputs entering along the estuary. These results were supported by a simple mixing model that predicted E. coli concentrations based on salinity measurements. Additionally, an assessment of a sentinel monitoring station suggested routine monitoring locations may produce conservative estimates of E. coli concentrations in stratified estuaries. Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. Groundwater response to tidal fluctuations in wedge-shaped confined aquifers

    Science.gov (United States)

    Cuello, Julián E.; Guarracino, Luis; Monachesi, Leonardo B.

    2017-08-01

    Most of the analytical solutions to describe tide-induced head fluctuations assume that the coastal aquifer has a constant thickness. These solutions have been applied in many practical problems ignoring possible changes in aquifer thickness, which may lead to wrong estimates of the hydraulic parameters. In this study, a new analytical solution to describe tide-induced head fluctuations in a wedge-shaped coastal aquifer is presented. The proposed model assumes that the aquifer thickness decreases with the distance from the coastline. A closed-form analytical solution is obtained by solving a boundary-value problem with both a separation of variables method and a change of variables method. The analytical solution indicates that wedging significantly enhances the amplitude of the induced heads in the aquifer. However, the effect on time lag is almost negligible, particularly near the coast. The slope factor, which quantifies the degree of heterogeneity of the aquifer, is obtained and analyzed for a number of hypothetical scenarios. The slope factor provides a simple criterion to detect a possible wedging of the coastal aquifer.

  9. Curved Periacetabular Osteotomy for the Treatment of Dysplastic Hips

    Science.gov (United States)

    Nakamura, Yoshinari

    2014-01-01

    Curved periacetabular osteotomy (CPO) was developed for the treatment of dysplastic hips in 1995. In CPO, the exposure of osteotomy sites and osteotomy of the ischium are made in the same manner as Bernese periacetabular osteotomy, and iliac and pubic osteotomies are performed in the same manner as rotational acetabular osteotomy. We studied the dynamic instabilities of 25 dysplastic hips before and after CPO using triaxial accelerometry. Overall magnitude of acceleration was significantly decreased from 2.30 ± 0.57 m/sec2 preoperatively to 1.55 ± 0.31 m/sec2 postoperatively. Pain relief and improvement of acetabular coverage resulting from acetabular reorientation seem to be related with reduction of dynamic instabilities of dysplastic hips. Isokinetic muscle strengths of 24 hips in 22 patients were measured preoperatively and after CPO. At 12 months postoperatively, the mean muscle strength exceeded the preoperative values. These results seem to be obtained due to no dissection of abductor muscles in CPO. The preoperative presence of acetabular cysts did not influence the results of CPO. An adequate rotation of the acetabular fragment induced cyst remodeling. Satisfactory results were obtained clinically and radiographically after CPO in patients aged 50 years or older. CPO alone for the treatment of severe dysplastic hips classified as subluxated hips of Severin group IV-b with preoperative CE angles of up to -20° could restore the acetabular coverage, weight-bearing area and medialization of the hip joint. CPO without any other combined procedure, as a treatment for 17 hips in 16 patients with Perthes-like deformities, produced good mid-term clinical and radiographic results. We have been performing CPO in conjunction with osteochondroplasty for the treatment of acatabular dysplasia associated with femoroacetabular impingement since 2006. The combined procedure has been providing effective correction of both acetabular dysplasia and associated femoral head

  10. Safety of modified Stoppa approach for Ganz periacetabular osteotomy: A preliminary cadaveric study.

    Science.gov (United States)

    Elmadağ, Mehmet; Uzer, Gökçer; Yıldız, Fatih; Ceylan, Hasan H; Acar, Mehmet A

    2016-08-01

    The aim of this cadaveric study was to investigate the efficacy of the modified Stoppa approach in Ganz periacetabular osteotomy (PAO). The Ganz PAO was performed on 10 hemipelvises with normal hips, from 5 cadavers using the modified Stoppa approach through the Pfannenstiel incision. All of the osteotomies were performed under fluoroscopic control and direct visualizing the osteotomy site from the same incision. After the osteotomy, the acetabulum was medialized and redirected anterolaterally, and fixed with 2 screws. The neurovascular structures and the joints were examined by dissecting the soft tissues after fixation of the osteotomies. Outcome parameters were center-edge (CE) angle, the distances between the osteotomy and anterior superior iliac spine (ASIS), and between the osteotomy and the sciatic notch, neurovascular and joint penetrations. After the osteotomy, the mean CE angle was improved from 19.8° to 25.2°, mean distance between the osteotomy and ASIS was 3.1 cm, and the mean distance between the osteotomy and the sciatic notch was 10.2 mm. The neurovascular structures and the joints were examined by dissecting the soft tissues after fixation of the osteotomies. No damage to the joint, surrounding arteries, veins or nerves was detected in any of the cadavers. Bilateral dysplastic hips can be treated with a 10 cm, cosmetically more acceptable incision in the same session using this approach. Quadrilateral surface of the acetabulum can be directly seen using this approach and the osteotomy can be safely performed. Copyright © 2016 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

  11. Role of computer-assisted surgery in osteotomies around the knee.

    Science.gov (United States)

    Saragaglia, D; Chedal-Bornu, B; Rouchy, R C; Rubens-Duval, B; Mader, R; Pailhé, R

    2016-11-01

    The goal of this article is to present our experience on navigation for osteotomies around the knee and especially osteotomies for coronal deformities. The first computer-assisted osteotomy was performed in March 2001 and since that time more than 1000 osteotomies have been performed in our department. All the osteotomies were performed with the Orthopilot(®) device (B-Braun-Aesculap, Tuttlingen, Germany). The main indication was for genu varum deformities but several cases were operated for genu valgum. The surgical procedure as well as the indications and the rationale for each osteotomy (high tibial osteotomy-HTO, double-level osteotomy-DLO, femoral osteotomy-FO) are addressed in the article. The results are focused on several papers published by the authors since more than 10 years. Regarding HTO for genu varum, the preoperative goal (HKA angle: 184° ± 2°) was reached in 96 % of cases and the difference was statistically significant compared to the non-navigated series (71 %: p genu varum, the preoperative goal was reached in 92.7 % for the HKA angle and in 88.1 % for the medial proximal tibial mechanical angle (MPTMA). Regarding genu valgum deformity, the preoperative goal was achieved in 86.2 % of cases for the HKA angle and 100 % of cases for the MPTMA. According to these results, one can say that, regardless the type of osteotomy, the procedure is reliable, reproducible and accurate. Since 15 years, all the osteotomies around the knee are navigated in our department. Provided that one uses a reproducible radiograph protocol, navigation allows to perform double-level osteotomies, both for genu varum and genu valgum, with optimal accuracy in order to avoid oblique joint line, which will be difficult to revise to TKA. IV.

  12. PELVIC OSTEOTOMY IN THE COMPLEX TREATMENT OF CHILDREN WITH LEGG-CALVE-PERTHES DISEASE

    OpenAIRE

    Дмитрий Борисович Барсуков; Михаил Михайлович Камоско

    2014-01-01

    At the Scientific and Research Institute for Children’s Orthopedics n. a. G. I. Turner we analyzed survey data of 120 patients aged from 6 to 14 years old with Legg-Calve-Perthes disease with severe epiphysis deformation, in order to improve the outcomes. All patients underwent reconstructive (remodeling) surgery - a corrective hip osteotomy, a pelvic osteotomy by Salter, a combination of these techniques and a triple pelvic osteotomy. Postoperative follow-up period averaged 10 years. It is s...

  13. Flow braking and the substorm current wedge

    Science.gov (United States)

    Birn, J.; Hesse, M.; Haerendel, G.; Baumjohann, W.; Shiokawa, K.

    1999-09-01

    Recent models of magnetotail activity have associated the braking of earthward flow with dipolarization and the reduction and diversion of cross-tail current, that is, the signatures of the substorm current wedge. Estimates of the magnitude of the diverted current by Haerendel [1992] and Shiokawa et al. [1997, 1998] tend to be lower than results from computer simulations of magnetotail reconnection and tail collapse [Birn and Hesse, 1996], despite similar underlying models. An analysis of the differences between these estimates on the basis of the simulations gives a more refined picture of the diversion of perpendicular into parallel currents. The inertial currents considered by Haerendel [1992] and Shiokawa et al. [1997] contribute to the initial current reduction and diversion, but the dominant and more permanent contribution stems from the pressure gradient terms, which change in connection with the field collapse and distortion. The major effect results from pressure gradients in the z direction, rather than from the azimuthal gradients [Shiokawa et al., 1998], combined with changes in By and Bx. The reduction of the current density near the equatorial plane is associated with a reduction of the curvature drift which overcompensates changes of the magnetization current and of the gradient B drift current. In contrast to the inertial current effects, the pressure gradient effects persist even after the burst of earthward flow ends.

  14. Reactive Atom Plasma Processing of Slumped Glass Wedges Project

    Data.gov (United States)

    National Aeronautics and Space Administration — The Reactive Atom Plasma (RAPTM) process will be evaluated as a rapid and practical method for fabricating precision wedges in glass sheets. The glass sheets are to...

  15. Trochanteric osteotomy in total hip replacement for congenital hip disease.

    Science.gov (United States)

    Hartofilakidis, G; Babis, G C; Georgiades, G; Kourlaba, G

    2011-05-01

    We studied the effect of trochanteric osteotomy in 192 total hip replacements in 140 patients with congenital hip disease. There was bony union in 158 hips (82%), fibrous union in 29 (15%) and nonunion in five (3%). The rate of union had a statistically significant relationship with the position of reattachment of the trochanter, which depended greatly on the pre-operative diagnosis. The pre-operative Trendelenburg gait substantially improved in all three disease types (dysplasia, low and high dislocation) and all four categories of reattachment position. A persistent Trendelenburg gait post-operatively was noticed mostly in patients with defective union (fibrous or nonunion). Acetabular and femoral loosening had a statistically significant relationship with defective union and the position of reattachment of the trochanter. These results suggest that the complications of trochanteric osteotomy in total hip replacement for patients with congenital hip disease are less important than the benefits of this surgical approach.

  16. Roentgen stereogrammetry in high tibial osteotomy for gonarthrosis

    Energy Technology Data Exchange (ETDEWEB)

    Tjoernstrand, B.; Selvik, G.; Egund, N.; Lingstrand, A.

    1981-01-01

    In three cases operated with high tibial osteotomy for medial gonarthrosis the exact method of roentgen stereophotogrammetry with tantalum balls as bone markers was used to study angular and translational movements in three dimensions at the operation and during the healing period. Tibial osteotomy caused angular and translational movements even in planes where correction was not intended, and the stereo technique revealed that stability was not present when knee mobilisation started. Correlation between the stereo values and conventional radiographic measurements were best in the frontal plane (root mean square value of discrepancies 1.3/sup 0/). Roentgen stereophotogrammetry gives superior information compared with the conventional radiographic technique, but it is concluded that the latter has sufficient accuracy for the clinical assessment of corrections in the frontal plane.

  17. Extended trochanteric osteotomy: planning, surgical technique, and pitfalls.

    Science.gov (United States)

    Meek, R M; Greidanus, Nelson V; Garbuz, Donald S; Masri, Bassam A; Duncan, Clive P

    2004-01-01

    The extended trochanteric osteotomy is appropriate for a number of surgical indications. It facilitates removal of well-fixed cement mantles with a loose or well-fixed stem and of extensively porous-coated or tapered cementless stems. This exposure is particularly valuable in the presence of varus remodeling of the proximal femur, permitting correction of proximal femoral deformity and reducing the risk of fracture of the greater trochanter. It is also indicated in the removal of a well-fixed cemented stem that is complicated by infection, where it is vital to extract all foreign material for successful eradication of the infection. In addition, when the osteotomy is required for femoral exposure, it enhances acetabular exposure to allow even the most complex reconstruction. Also, as the soft-tissue attachments to the bone fragment are preserved in this approach, abductor muscle tension can be adjusted.

  18. Varus distal femoral osteotomy in young adults with valgus knee

    Science.gov (United States)

    Omidi-Kashani, Farzad; Hasankhani, Ibrahim G; Mazlumi, Mahdi; Ebrahimzadeh, Mohamad H

    2009-01-01

    Background Musculoskeletal disorders specially knee osteoarthritis are the most common causes of morbidity in old patients. Disturbance of the mechanical axis of the lower extremity is one of the most important causes in progression of knee osteoarthritis. The purpose of the present study was to analyze the surgical results of distal femoral varus osteotomy in patients with genu valgum. Methods In this study, after recording history and physical examination, appropriate radiographs were taken. We did varus distal femoral osteotomy by standard medial subvastus approach and 90-angle blade plate fixation then followed the patients clinically and radiographically. Results This study was done on 23 knees (16 patients) age 23.3 years (range, 17 to 41 years). The mean duration of following up was 16.3 months (range, 8 to 25 months). Based on paired T test, there were statistically significant difference between pre- and postoperative tibiofemoral and congruence angles (p genu valgum correction, the patella should be stabilized simultaneously. PMID:19435527

  19. Piezosurgical osteotomy for harvesting intraoral block bone graft

    Directory of Open Access Journals (Sweden)

    Mahalingam Lakshmiganthan

    2012-01-01

    Full Text Available The use of ultrasonic vibrations for the cutting of bone was first introduced two decades ago. Piezoelectric surgery is a minimally invasive technique that lessens the risk of damage to surrounding soft tissues and important structures such as nerves, vessels, and mucosa. It also reduces damage to osteocytes and permits good survival of bony cells during harvesting of bone. Grafting with intraoral bone blocks is a good way to reconstruct severe horizontal and vertical bone resorption in future implants sites. The piezosurgery system creates an effective osteotomy with minimal or no trauma to soft tissue in contrast to conventional surgical burs or saws and minimizes a patient′s psychological stress and fear during osteotomy under local anesthesia. The purpose of this article is to describe the harvesting of intraoral bone blocks using the piezoelectric surgery device.

  20. Scattering of wedges and cones with impedance boundary conditions

    CERN Document Server

    Lyalinov, Mikhail

    2012-01-01

    This book is a systematic and detailed exposition of different analytical techniques used in studying two of the canonical problems, the wave scattering by wedges or cones with impedance boundary conditions. It is the first reference on novel, highly efficient analytical-numerical approaches for wave diffraction by impedance wedges or cones. The applicability of the reported solution procedures and formulae to existing software packages designed for real-world high-frequency problems encountered in antenna, wave propagation, and radar cross section.

  1. Effect of osteotomies during rhinoplasty on intraocular pressure

    Directory of Open Access Journals (Sweden)

    Amr N. Rabie

    2016-07-01

    Full Text Available Objective: To investigate whether rhinoplasty with osteotomies for the treatment of deformed nose induces changes in intraocular pressure (IOP. Design: Prospective, nonrandomized study. Setting: University-affiliated medical center. Patients: Thirty patients who underwent rhinoplasty with osteotomies for the nose were prospectively enrolled in this study. Fifteen patients had lateral osteotomies with the external perforating technique, and fifteen with an internal continuous technique with periosteal elevation. We excluded patients with diabetes mellitus, hypertension, glaucoma, previous ocular trauma, history of ocular surgery, and previous use of topical corticosteroid eye drops. Main outcome measures: The intraocular pressure (IOP in each patient was measured by Goldmann tonometry preoperatively and postoperatively on days 1, 2, and 7. Results: 23 women and 7 men with a mean age of 27 years were enrolled in the study. The mean ± SD IOP of the eye was 15.69 ± 2.37 mmHg preoperatively. Postoperatively, the mean ± SD IOPs were 15.96 ± 1.92 mmHg on day 1, 15.45 ± 2.55 mmHg on day 2, and 15.72 ± 2.86 mmHg on day 7 (P = .863. Conclusions: Although osteotomes during rhinoplasty caused variations in the IOP compartment, the changes in IOP were not statistically significant. Therefore, rhinoplasty should be a safe surgical procedure with respect to ocular physiological function, however monitoring IOP peri-operatively is advised. To our best knowledge, this is the first clinical trial to determine the effect of rhinoplasty with osteotomy on intraocular pressure.

  2. Successful Return to Sport Following Distal Femoral Varus Osteotomy

    Science.gov (United States)

    Voleti, Pramod Babu; Degen, Ryan; Tetreault, Danielle; Krych, Aaron John; Williams, Riley J.

    2016-01-01

    Objectives: Distal femoral varus osteotomy is an effective treatment for unloading valgus knee malalignment; however, there is limited evidence on the ability for patients to return to athletics following this procedure. The purpose of this study is to report the functional outcomes and return to sport for athletic patients that underwent distal femoral varus osteotomy. Methods: A consecutive series of athletic patients that had undergone distal femoral varus osteotomy for symptomatic lateral compartment overload and valgus knee malalignment were prospectively reviewed. All patients had a minimum of 2-year follow-up. Radiographs were assessed to determine pre-operative and post-operative alignment. Details regarding sport of interest, ability to return to sport, and timing of return were obtained from the patients. Prospective institutional registries were utilized to collect pre-operative and post-operative Marx Activity Scale and International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC) scores; these values were compared using paired t-tests with p allografts, 2 partial lateral meniscectomies, 1 lateral meniscus allograft transplantation, and 1 revision anterior cruciate ligament reconstruction. All patients were able to successfully return to their sport of choice (4 soccer, 2 softball, 2 running, 1 football, 1 basketball, 1 ice hockey, 1 volleyball, 1 rowing) at a mean of 11 months (range: 9-13). Furthermore, all 13 patients demonstrated an improvement in both Marx Activity Scale and IKDC scores after surgery. The mean improvement in Marx Activity Scale was 7 (mean pre-op: 4, mean post-op: 11, p ligamentous pathology is addressed. Therefore, distal femoral varus osteotomy should be considered in the athletic population for correction of symptomatic valgus knee malalignment.

  3. Surgical Outcome of Acetabular Fracture Using Trochanteric Flip Osteotomy

    Directory of Open Access Journals (Sweden)

    Espandar R

    2012-01-01

    Full Text Available Background: One of the difficulties in acetabulum surgery is appropriate exposure of the site of surgery. Trochanteric flip osteotomy is one of the surgical methods for superoposterior and posterior acetabulum exposure. However, due to possible complications some surgeons prefer to avoid this procedure. This study was undertaken to determine the outcome of surgical treatment of acetabular fracture using trochanteric flip osteotomy. Methods : In this prospective cohort study, 14 patients with acetabular fracture who had been admitted in Imam Khomeini Hospital in Tehran, Iran, during 2003-2006 underwent trochanteric flip osteotomy. The patients were followed for at least one year post-surgically. Demographics, radiologic findings, intensity of pain using visual analogue scale (VAS, Harris hip score (HHS, force of hip abductors and complications were noted. Data analysis was performed using SPSS ver. 13.Results : The mean HHS was 82.5 (55-95. Heterotopic ossification was observed in three patients. There were no cases of postoperative infection or nonunion. Only two patients showed displacement of osteotomized fragments. Reduction was anatomic in 10 patients. In one patient, the force of hip abductors was three-fifth. The mean hip pain was 3.4 based on VAS. There were no cases of femoral head osteonecrosis. With respect to HHS, the final hip status was excellent and good in four and six patients, respectively. Three patients had fair and only one patient had poor condition.Conclusion: It seems that trochanteric flip osteotomy has much fewer complications in comparison to other methods justifying its use in such cases.

  4. Bone changes after bilateral sagittal split osteotomy for mandibular prognathism

    Energy Technology Data Exchange (ETDEWEB)

    Park, Hyun Jung; Jung, Yun Hoa; Cho, Bong Hae [Pusan National Univ. Collefe of Dentistry, Pusan (Korea, Republic of)

    2006-12-15

    The purpose of this research was to study bone changes after bilateral sagittal split osteotomy through fractal analysis and measurement of mandibular cortical thickness. This study included twenty-two prognathic patients who underwent bilateral sagittal split osteotomy. Panoramic radiographs of these patients were taken immediately before operation and at 1 month, 6 months, and 12 months postoperatively. The fractal dimension was measured by the box-counting method in the region of interest centered on both the basal and interdental bones between the first and second mandibular molars. Measurements of mandibular cortical thickness were taken both in the area between the first and second mandibular molars and at the osteotomy site. Changes of fractal dimension and cortical thickness over four stages were statistically analyzed. The fractal dimension of the mandibular basal bone before surgery and after 1 month, 6 months and 12 months were 1.4099{+-}0.0657, 1.382{+-}0.0595, 1.2995{+-}0.0949, and 1.4166{+-}0.0676. respectively (Repeated-measures ANOVA, P<0.001). However, no statistically significant differences were noted in interdental fractal dimensions among the four stages. Mandibular cortical thickness between the first and second mandibular molars before operation and after 1 month, 6 months and 12 months was 3.74{+-}0.48 mm. 3.63{+-}0.47 mm. 3.41{+-}0.61 mm and 3.55{+-}0.66 mm (P<0.01), respectively. Mandibular cortical thickness at the osteotomy site at each of the four stages was 3.22{+-}0.44 mm, 2.87{+-}0.59 mm, 2.37{+-}0.61 mm and 2.64{+-}0.62 mm, respectively (P<0.001). This study suggests that the mandibular tissue continued decreasing for 6 months postoperatively and then increased over the subsequent 6 months.

  5. Factors That Predict Blood Loss After Bernese Periacetabular Osteotomy.

    Science.gov (United States)

    Novais, Eduardo N; Carry, Patrick M; Kestel, Lauryn A; Koerner, Jason; Tan, Gee Mei

    2016-11-01

    Although strategies to reduce bleeding and avoid allogeneic transfusion have been described, there is controversy about the factors associated with blood loss after Bernese periacetabular osteotomy. This study was conducted to determine risk factors for postoperative blood loss. After institutional review board approval was obtained, a retrospective review was conducted of 41 young patients who underwent periacetabular osteotomy for symptomatic acetabular dysplasia over a 3-year period. Of these patients, two-thirds donated blood before surgery. A Cell Saver Elite autotransfusion system (Haemonetics, Braintree, Massachusetts) was used intraoperatively in all cases. Hemoglobin and hematocrit were obtained before surgery and during the hospital stay. The primary outcome variable was the percentage of total blood volume lost during surgery. Univariate analysis was performed to test the association between potential predictors of blood volume loss. Candidate variables that were significant at alpha=0.15 were tested with multivariate analysis. The average percentage of blood volume lost during surgery was 30.3% (95% confidence interval, 25.1%-35.5%). Univariate analysis showed that operative time, arthrotomy, femoral head-neck osteochondroplasty, labral procedure, male sex, and age were prognostic factors associated with increased blood volume loss. However, operative time (average, 294.6 minutes; range, 204-444 minutes) was the only independent predictor of increased blood loss in the final model. Additional procedures, such as femoral head-neck osteochondroplasty and labral repair or debridement performed through an anterior hip arthrotomy at the time of periacetabular osteotomy, were associated with increased operative time. The findings suggest that all patients undergoing periacetabular osteotomy, including those having concomitant procedures, may benefit from pre- and intraoperative strategies to conserve blood and avoid allogeneic transfusion. [Orthopedics. 2016

  6. Risk factors affecting somatosensory function after sagittal split osteotomy

    DEFF Research Database (Denmark)

    Thygesen, Torben Henrik; Jensen, Allan Bardow; Helleberg, M;

    2008-01-01

    Purpose The aim of this study was to evaluate potential individual and intraoperative risk factors associated with bilateral sagittal split osteotomy (BSSO) and to correlate the findings with postoperative changes in somatosensory function. Patients and Methods A total of 18 men and 29 women (mean...... and free dissection of the inferior alveolar nerve during BSSO increased self-reported changes in lower lip sensation and lower lip tactile threshold after BSSO (P discrimination (P

  7. Optical refractometry based on Fresnel diffraction from a phase wedge.

    Science.gov (United States)

    Tavassoly, M Taghi; Saber, Ahad

    2010-11-01

    A method that utilizes the Fresnel diffraction of light from the phase step formed by a transparent wedge is introduced for measuring the refractive indices of transparent solids, liquids, and solutions. It is shown that, as a transparent wedge of small apex angle is illuminated perpendicular to its surface by a monochromatic parallel beam of light, the Fresnel fringes, caused by abrupt change in refractive index at the wedge lateral boundary, are formed on a screen held perpendicular to the beam propagation direction. The visibility of the fringes varies periodically between zero and 1 in the direction normal to the wedge apex. For a known or measured apex angle, the wedge refractive index is obtained by measuring the period length by a CCD. To measure the refractive index of a transparent liquid or solution, the wedge is installed in a transparent rectangle cell containing the sample. Then, the cell is illuminated perpendicularly and the visibility period is measured. By using modest optics, one can measure the refractive index at a relative uncertainty level of 10(-5). There is no limitation on the refractive index range. The method can be applied easily with no mechanical manipulation. The measuring apparatus can be very compact with low mechanical and optical noises.

  8. Conceptual design of heavy ion beam compression using a wedge

    Directory of Open Access Journals (Sweden)

    Jonathan C. Wong

    2015-10-01

    Full Text Available Heavy ion beams are a useful tool for conducting high energy density physics (HEDP experiments. Target heating can be enhanced by beam compression, because a shorter pulse diminishes hydrodynamic expansion during irradiation. A conceptual design is introduced to compress ∼100  MeV/u to ∼GeV/u heavy ion beams using a wedge. By deflecting the beam with a time-varying field and placing a tailor-made wedge amid its path downstream, each transverse slice passes through matter of different thickness. The resulting energy loss creates a head-to-tail velocity gradient, and the wedge shape can be designed by using stopping power models to give maximum compression at the target. The compression ratio at the target was found to vary linearly with (head-to-tail centroid offset/spot radius at the wedge. The latter should be approximately 10 to attain tenfold compression. The decline in beam quality due to projectile ionization, energy straggling, fragmentation, and scattering is shown to be acceptable for well-chosen wedge materials. A test experiment is proposed to verify the compression scheme and to study the beam-wedge interaction and its associated beam dynamics, which will facilitate further efforts towards a HEDP facility.

  9. Femoral Varus Osteotomy for Hip Instability after Traumatic Fracture Dislocations of the Hip Associated with Femoral Head Fractures: A Report of Two Cases

    Directory of Open Access Journals (Sweden)

    Shuichi Miyamoto

    2016-01-01

    Full Text Available Fracture of the femoral head and the acetabulum with traumatic dislocation of the hip is a severe injury representing various types and unfavorable outcome. We showed a 45-year-old man with Pipkin type-IV fracture and coxa valga. An immediate closed reduction was achieved followed by open reduction and internal fixation via a posterior approach 6 days later. However, dislocation occurred three times without traumatic events after three weeks. CT demonstrated no displacement of posterior fragments or implant failure. Femoral intertrochanteric varus osteotomy was performed to gain concentric stability and successfully resolved recurrent dislocation. Another 45-year-old woman with Pipkin type-IV fracture and coxa valga also underwent closed reduction initially and then continued conservative treatment. After eight weeks, when she started gait training, progressive pain became symptomatic. Persistent hip pain at weight bearing was not improved in spite of arthroscopic synovectomy and osteochondroplasty. Two years after injury, femoral intertrochanteric varus osteotomy was indicated and her refractory pain was resolved gradually. We suggest that femoral varus osteotomy should be considered for superolateral subluxation associated fracture dislocation of the hip in Pipkin type-IV and coxa valga.

  10. Mean 20-year followup of Bernese periacetabular osteotomy.

    Science.gov (United States)

    Steppacher, Simon D; Tannast, Moritz; Ganz, Reinhold; Siebenrock, Klaus A

    2008-07-01

    The goal of the Bernese periacetabular osteotomy is to correct the deficient acetabular coverage in hips with developmental dysplasia to prevent secondary osteoarthrosis. We determined the 20-year survivorship of symptomatic patients treated with this procedure, determined the clinical and radiographic outcomes of the surviving hips, and identified factors predicting poor outcome. We retrospectively evaluated the first 63 patients (75 hips) who underwent periacetabular osteotomy at the institution where this technique was developed. The mean age of the patients at surgery was 29 years (range, 13-56 years), and preoperatively 24% presented with advanced grades of osteoarthritis. Four patients (five hips) were lost to followup and one patient (two hips) died. The remaining 58 patients (68 hips) were followed for a minimum of 19 years (mean, 20.4 years; range, 19-23 years) and 41 hips (60%) were preserved at last followup. The overall mean Merle d'Aubigné and Postel score decreased in comparison to the 10-year value and was similar to the preoperative score. We observed no major changes in any of the radiographic parameters during the 20-year postoperative period except the osteoarthritis score. We identified six factors predicting poor outcome: age at surgery, preoperative Merle d'Aubigné and Postel score, positive anterior impingement test, limp, osteoarthrosis grade, and the postoperative extrusion index. Periacetabular osteotomy is an effective technique for treating symptomatic developmental dysplasia of the hip and can maintain the natural hip at least 19 years in selected patients. Level III, prognostic study.

  11. Comparison of three approaches of Bernese periacetabular osteotomy.

    Science.gov (United States)

    Luo, Dianzhong; Zhang, Hong; Zhang, Weijia

    2016-01-01

    Developmental dysplasia of the hip is a common disease and treated with various surgical approaches. Improved ilioinguinal (I-I) approach, two-incision Smith-Peterson (TSP) approach, and modified Smith-Peterson (MSP) approach are three main approaches; however, they are rarely compared. The present study compared the operative time, blood loss, intraoperative and postoperative allogeneic blood transfusion, and postoperative complications of these three different approaches. Surgical approach does not influence the operation time, blood loss, and complications of periacetabular osteotomy. Level III. Case-control study. In a total of 101 hips of 95 cases, from February 2010 to July 2011, three different approaches of Bernese periacetabular osteotomy, I-I, TSP, and MSP, were conducted. The operation time, intraoperative bleeding, allogeneic blood transfusion, and early complications in different operation approaches were compared by a retrospective study when there were similar ages, genders, and lesions. Among the three approaches, I-I had less operation time and more blood loss (P<0.05), TSP had less blood loss (P<0.05) but more complications, and MSP had less blood loss (P<0.05) and less complications. The MSP approach is superior to the other two approaches in doing periacetabular osteotomy.

  12. [Recovery of maxillary tooth sensibility after Le Fort I osteotomy].

    Science.gov (United States)

    Bonnot, P; Salles, F; Cheynet, F; Blanc, J L; Ricbourg, B; Meyer, C

    2014-11-01

    Upper alveolar nerves, when injured during Le Fort I osteotomies, alter maxillary tooth sensitivity. We had for aim to analyze post-operative maxillary tooth sensitivity recovery. We conducted a prospective study in a series of patients having undergone Le Fort I osteotomy, with, or without mandibular osteotomy or intermaxillary disjunction (IMD). The direction and range of displacement of the maxillary bone were recorded. One tooth in each alveolar sector (incisivocanine, premolar, molar) was tested with an electric stimulator for each patient. The tests were performed before (D-1), and after surgery (D2 or day+2, D+15, M2 (or month +2), M3, and M6). Twenty-two patients were included. Among the tested teeth, 91.9 % were sensitive at D-1. At D2, only 12.7 % of teeth were sensitive. At D15, M2, M3, and M6, the sensitivity was respectively 33.3 %, 43.1 %, 50 %, and 61.8 %. The recovery of sensitivity was faster in young patients (under 35 years of age) and for upper middle and superior alveolar nerves. There was no difference regarding the direction of maxillary movement. Among the teeth that were sensitive before surgery, 87.3 % had not regained sensitivity at D2. The recovery of sensitivity increased at D15. A great displacement of the maxillary bone was an aggravating factor for loss of tooth sensitivity. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  13. Varus distal femoral osteotomy in young adults with valgus knee

    Directory of Open Access Journals (Sweden)

    Mazlumi Mahdi

    2009-05-01

    Full Text Available Abstract Background Musculoskeletal disorders specially knee osteoarthritis are the most common causes of morbidity in old patients. Disturbance of the mechanical axis of the lower extremity is one of the most important causes in progression of knee osteoarthritis. The purpose of the present study was to analyze the surgical results of distal femoral varus osteotomy in patients with genu valgum. Methods In this study, after recording history and physical examination, appropriate radiographs were taken. We did varus distal femoral osteotomy by standard medial subvastus approach and 90-angle blade plate fixation then followed the patients clinically and radiographically. Results This study was done on 23 knees (16 patients age 23.3 years (range, 17 to 41 years. The mean duration of following up was 16.3 months (range, 8 to 25 months. Based on paired T test, there were statistically significant difference between pre- and postoperative tibiofemoral and congruence angles (p Conclusion Distal femoral varus osteotomy with blade plate fixation can be a reliable procedure for the treatment of valgus knee deformity. In this procedure, with more tibiofemoral angle correction, more congruence angle correction can be achieved. Therefore, along with genu valgum correction, the patella should be stabilized simultaneously.

  14. Stem thrust prediction model for W-K-M double wedge parallel expanding gate valves

    Energy Technology Data Exchange (ETDEWEB)

    Eldiwany, B.; Alvarez, P.D. [Kalsi Engineering Inc., Sugar Land, TX (United States); Wolfe, K. [Electric Power Research Institute, Palo Alto, CA (United States)

    1996-12-01

    An analytical model for determining the required valve stem thrust during opening and closing strokes of W-K-M parallel expanding gate valves was developed as part of the EPRI Motor-Operated Valve Performance Prediction Methodology (EPRI MOV PPM) Program. The model was validated against measured stem thrust data obtained from in-situ testing of three W-K-M valves. Model predictions show favorable, bounding agreement with the measured data for valves with Stellite 6 hardfacing on the disks and seat rings for water flow in the preferred flow direction (gate downstream). The maximum required thrust to open and to close the valve (excluding wedging and unwedging forces) occurs at a slightly open position and not at the fully closed position. In the nonpreferred flow direction, the model shows that premature wedging can occur during {Delta}P closure strokes even when the coefficients of friction at different sliding surfaces are within the typical range. This paper summarizes the model description and comparison against test data.

  15. Benchmarking analogue models of brittle thrust wedges

    Science.gov (United States)

    Schreurs, Guido; Buiter, Susanne J. H.; Boutelier, Jennifer; Burberry, Caroline; Callot, Jean-Paul; Cavozzi, Cristian; Cerca, Mariano; Chen, Jian-Hong; Cristallini, Ernesto; Cruden, Alexander R.; Cruz, Leonardo; Daniel, Jean-Marc; Da Poian, Gabriela; Garcia, Victor H.; Gomes, Caroline J. S.; Grall, Céline; Guillot, Yannick; Guzmán, Cecilia; Hidayah, Triyani Nur; Hilley, George; Klinkmüller, Matthias; Koyi, Hemin A.; Lu, Chia-Yu; Maillot, Bertrand; Meriaux, Catherine; Nilfouroushan, Faramarz; Pan, Chang-Chih; Pillot, Daniel; Portillo, Rodrigo; Rosenau, Matthias; Schellart, Wouter P.; Schlische, Roy W.; Take, Andy; Vendeville, Bruno; Vergnaud, Marine; Vettori, Matteo; Wang, Shih-Hsien; Withjack, Martha O.; Yagupsky, Daniel; Yamada, Yasuhiro

    2016-11-01

    We performed a quantitative comparison of brittle thrust wedge experiments to evaluate the variability among analogue models and to appraise the reproducibility and limits of model interpretation. Fifteen analogue modeling laboratories participated in this benchmark initiative. Each laboratory received a shipment of the same type of quartz and corundum sand and all laboratories adhered to a stringent model building protocol and used the same type of foil to cover base and sidewalls of the sandbox. Sieve structure, sifting height, filling rate, and details on off-scraping of excess sand followed prescribed procedures. Our analogue benchmark shows that even for simple plane-strain experiments with prescribed stringent model construction techniques, quantitative model results show variability, most notably for surface slope, thrust spacing and number of forward and backthrusts. One of the sources of the variability in model results is related to slight variations in how sand is deposited in the sandbox. Small changes in sifting height, sifting rate, and scraping will result in slightly heterogeneous material bulk densities, which will affect the mechanical properties of the sand, and will result in lateral and vertical differences in peak and boundary friction angles, as well as cohesion values once the model is constructed. Initial variations in basal friction are inferred to play the most important role in causing model variability. Our comparison shows that the human factor plays a decisive role, and even when one modeler repeats the same experiment, quantitative model results still show variability. Our observations highlight the limits of up-scaling quantitative analogue model results to nature or for making comparisons with numerical models. The frictional behavior of sand is highly sensitive to small variations in material state or experimental set-up, and hence, it will remain difficult to scale quantitative results such as number of thrusts, thrust spacing

  16. Calculating dose distributions and wedge factors for photon treatment fields with dynamic wedges based on a convolution/superposition method.

    Science.gov (United States)

    Liu, H H; McCullough, E C; Mackie, T R

    1998-01-01

    A convolution/superposition based method was developed to calculate dose distributions and wedge factors in photon treatment fields generated by dynamic wedges. This algorithm used a dual source photon beam model that accounted for both primary photons from the target and secondary photons scattered from the machine head. The segmented treatment tables (STT) were used to calculate realistic photon fluence distributions in the wedged fields. The inclusion of the extra-focal photons resulted in more accurate dose calculation in high dose gradient regions, particularly in the beam penumbra. The wedge factors calculated using the convolution method were also compared to the measured data and showed good agreement within 0.5%. The wedge factor varied significantly with the field width along the moving jaw direction, but not along the static jaw or the depth direction. This variation was found to be determined by the ending position of the moving jaw, or the STT of the dynamic wedge. In conclusion, the convolution method proposed in this work can be used to accurately compute dose for a dynamic or an intensity modulated treatment based on the fluence modulation in the treatment field.

  17. Ice wedges as climate archives - opportunities and limitations

    Science.gov (United States)

    Opel, Thomas; Meyer, Hanno; Dereviagin, Alexander; Wetterich, Sebastian; Schirrmeister, Lutz

    2014-05-01

    Permafrost regions are assumed to play a major role for Global Climate Change as they are susceptible to recent warming in particular with regard to the potential release of stored fossil carbon. Permafrost serves as archive of past environmental and climate conditions (such as sedimentation processes, temperature and precipitation regimes as well as landscape and ecosystem development) over tens of thousands of years that can be traced by the study of the frozen deposits, paleontological content and ground ice. Ground ice comprises all types of ice contained in frozen ground, including pore ice, segregation ice and ice wedges. Here, we focus on ice wedges as the most promising climate archive that can be studied by stable water isotope methods analogously to glacier ice. They may be identified by their vertically oriented foliations. Ice wedges form by the repeated filling of wintertime thermal contraction cracks by snow melt water in spring. As the melt water quickly refreezes at negative ground temperature no isotopic fractionation takes place. Hence, the isotopic composition (δ18O, δD, d excess) of wedge ice is assumed to be representative of annual cold period climate conditions, i.e. winter and spring. Ice wedges are widely distributed in non-glaciated high northern latitudes, are diagnostic of permafrost and, in general, indicative of cold and stable climate conditions. They are found in continuous and discontinuous permafrost zones and may also have formed during and survived interglacials. They may provide unique paleo information that is not captured by other climate archives. Usually, ice wedges are dated by radiocarbon dating of organic material incorporated in the ice, but also 36Cl/Cl ratios have been successfully used to date ice wedges. Nevertheless reliable age determination is challenging when studying ice wedges. Here we tackle the potential of ice wedges from the Siberian and American Arctic to trace past climate changes from stable isotope

  18. Anatexis of accretionary wedge, Pacific-type magmatism, and formation of vertically stratified continental crust in the Altai Orogenic Belt

    Science.gov (United States)

    Jiang, Y. D.; Schulmann, K.; Sun, M.; Å típská, P.; Guy, A.; Janoušek, V.; Lexa, O.; Yuan, C.

    2016-12-01

    Granitoid magmatism and its role in differentiation and stabilization of the Paleozoic accretionary wedge in the Chinese Altai are evaluated in this study. Voluminous Silurian-Devonian granitoids intruded a greywacke-dominated Ordovician sedimentary succession (the Habahe Group) of the accretionary wedge. The close temporal and spatial relationship between the regional anatexis and the formation of granitoids, as well as their geochemical similarities including rather unevolved Nd isotopic signatures and the strong enrichment of large-ion lithophile elements relative to many of the high field strength elements, may indicate that the granitoids are product of partial melting of the accretionary wedge rocks. Whole-rock geochemistry and pseudosection modeling show that regional anatexis of fertile sediments could have produced a large amount of melts compositionally similar to the granitoids. Such process could have left a high-density garnet- and/or garnet-pyroxene granulite residue in the deep crust, which can be the major reason for the gravity high over the Chinese Altai. Our results show that melting and crustal differentiation can transform accretionary wedge sediments into vertically stratified and stable continental crust. This may be a key mechanism contributing to the peripheral continental growth worldwide.

  19. Effects of slot closure by soft magnetic powder wedge material in axial-field permanent magnet brushless machines

    Science.gov (United States)

    Gair, S.; Eastham, J. F.; Canova, A.

    1996-04-01

    The article reports on a study of the effects of slot closure in axial-field permanent magnet brushless machines by a two-dimensional finite element method (2D FEM) of analysis. The closure of the slots is made by using soft magnetic powder wedge material. Parameter values and machine performance for the open and closed slot configuration are computed. In order to test the 2D FEM model, calculated results are compared with measurements and favorable agreement is shown.

  20. Effects of filters and wedges on skin sparing and gamma/neutron dose ratios in neutron teletherapy.

    Science.gov (United States)

    Smathers, J; Graves, R; Almond, P; Otte, V; Grant, W

    1980-01-01

    The effects of skin sparing and the gamma/neutron dose ratios in the clinical situations presently in use at the TAMVEC neutron teletherapy facility are not appreciably affected by the presence of filters and/or wedges. It is also shown that if skin sparing is lost due to close proximity of a hydrogenous scattering source, it can be restored by the use of thin lead filters.

  1. The influence of foot geometry on the calcaneal osteotomy angle based on two-dimensional static force analyses

    NARCIS (Netherlands)

    Reilingh, M.L.; Tuijthof, G.J.M.; Van Dijk, C.N.; Blankevoort, L.

    2011-01-01

    Background: Malalignment of the hindfoot can be corrected with a calcaneal osteotomy (CO). A well-selected osteotomy angle in the sagittal plane will reduce the shear force in the osteotomy plane while walking. The purpose was to determine the presence of a relationship between the foot geometry and

  2. Laboratory investigation of water extraction effects on saltwater wedge displacement

    Directory of Open Access Journals (Sweden)

    S. Noorabadi

    2017-12-01

    Full Text Available There is a close connection between saltwater intrusion into aquifers and groundwater extraction. Freshwater extraction in coastal aquifers is one of the most important reasons for the saltwater intrusion into these aquifers. Condition of extraction system such as well depth, discharge rate, saltwater concentration and etc. could affect this process widely. Thus, investigating different extraction conditions comprises many management advantages.  In the present study, the effects of freshwater extraction on saltwater interface displacement have been investigated in a laboratory box. Three different well depths (H were considered with combinations of 3 different extraction rates (Q and 3 saltwater concentrations (C for detailed investigation of the effects of these factors variations on saltwater displacement. SEAWAT model has been used to simulate all the scenarios to numerically study of the process. The experimental and numerical results showed that when the C and Q rates were small and the well depth was shallow, the saltwater interface wouldn’t reach the extraction well, so the extracted water remained uncontaminated. When the C and Q rates were increased and the well was deepened, the salinity of the extracted water became higher. When the Q and C rates were high enough, in the shallow well depth, the final concentration of the extracted water was low but a huge part of the porous media was contaminated by the saltwater, furthermore when the well was deepened enough, the final concentration of the extracted water was increased but a small part of the porous media was contaminated by the saltwater. Finally, the results showed that when the Q and H rates were high enough, the extraction well behaved like a barrier and didn’t allow the advancing saltwater wedge toe to be intruded beyond the wells.

  3. Effect of the high femoral osteotomy upon the vascularity and blood supply of the hip joint

    Energy Technology Data Exchange (ETDEWEB)

    Day, B.; Shim, S.S.; Leung, G.

    1984-05-01

    This investigation was done to study the effects of high femoral osteotomy upon the vascularity and blood supply of the hip and to further our knowledge of its physiologic basis. We have used established methods of study, including bone scans, microangiography, isotope clearance and perosseous venography, and based upon the results of these studies, we have reached certain conclusions. First, high femoral osteotomy increases the blood flow and vascularity in the hip joint, the femoral head and neck and the great trochanter. Second, bone scanning techniques using /sup 99m/Tc labeled diphosphonate have shown increased uptake in the femoral head and neck after high femoral osteotomy. The localization was done using a Digital Gamma III computer, and the activity on the osteotomy side at two weeks was 3.5 times as great as on the control side. By 16 weeks postoperatively, there was still two times as much activity on the osteotomy side. Third, microangiography showed increased vascularity both at the osteotomy site and in the femoral head and neck and the greater trochanter on that side. Such an increase in vascularity first became evident two weeks after osteotomy and persisted during the four month period studied. Fourth, the results of the /sup 99m/Tc diphosphonate clearance study showed a 25 per cent increase in femoral head blood flow on the operative side. Fifth, perosseous venography of the femoral head and neck showed a marked increase in venous drainage through the osteotomy site in the immediate postosteotomy stage.

  4. Reducing the risk of nerve injury during Bernese periacetabular osteotomy: a cadaveric study.

    Science.gov (United States)

    Kalhor, M; Gharehdaghi, J; Schoeniger, R; Ganz, R

    2015-05-01

    The modified Smith-Petersen and Kocher-Langenbeck approaches were used to expose the lateral cutaneous nerve of the thigh and the femoral, obturator and sciatic nerves in order to study the risk of injury to these structures during the dissection, osteotomy, and acetabular reorientation stages of a Bernese peri-acetabular osteotomy. Injury of the lateral cutaneous nerve of thigh was less likely to occur if an osteotomy of the anterior superior iliac spine had been carried out before exposing the hip. The obturator nerve was likely to be injured during unprotected osteotomy of the pubis if the far cortex was penetrated by > 5 mm. This could be avoided by inclining the osteotome 45° medially and performing the osteotomy at least 2 cm medial to the iliopectineal eminence. The sciatic nerve could be injured during the first and last stages of the osteotomy if the osteotome perforated the lateral cortex of ischium and the ilio-ischial junction by > 10 mm. The femoral nerve could be stretched or entrapped during osteotomy of the pubis if there was significant rotational or linear displacement of the acetabulum. Anterior or medial displacement of Bernese peri-acetabular osteotomy. ©2015 The British Editorial Society of Bone & Joint Surgery.

  5. The Bernese peri-acetabular osteotomy through a modified approach. A technical note.

    Science.gov (United States)

    Whittingham-Jones, Paul; Kirit Patel, Nirav; Hashemi-Nejad, Aresh

    2013-03-01

    A modification of the technique for performing the Bernese periacetabular osteotomy is described. A medial approach to the Ischium and a subtle re-orientation of the pubic osteotomy are detailed. Surgical morbidity is likely decreased with a concurrent cosmetic advantage without compromise to surgical correction or patient safety.

  6. Trochanteric osteotomies in revision total hip arthroplasty: contemporary techniques and results.

    Science.gov (United States)

    Jando, Victor T; Greidanus, Nelson V; Masri, Bassam A; Garbuz, Donald S; Duncan, Clive P

    2005-01-01

    Revision total hip arthroplasty (THA) presents several challenges to the orthopaedic surgeon and typically requires the use of a more extensile surgical approach. Osteotomy of the greater trochanter can be considered as the ultimate extensile exposure in revision THA. The methods of trochanteric osteotomy can be categorized into three types: the standard trochanteric osteotomy, the trochanteric slide, and the extended trochanteric osteotomy. Although the standard osteotomy and trochanteric slide osteotomy provide excellent acetabular exposure, in the revision setting they are frequently associated with an unacceptably high rate of nonunion and proximal migration of the trochanteric fragment. The extended trochanteric osteotomy (ETO) has increased in popularity as the number and complexity of revision THAs continue to increase. Two commonly used techniques are the ETO via a posterolateral approach or via a modified direct lateral approach. Both techniques provide wide exposure of the acetabulum, facilitate femoral component exposure and removal, aid in canal preparation and femoral reconstruction, and allow for correction of proximal femoral deformity. The osteotomy fragment is easily secured and may be advanced distally to achieve proper tensioning of the abductors. Recent literature demonstrates that the ETO has a relatively low rate of nonunion and is associated with fewer intraoperative femoral fractures or cortical perforations, as well as decreased surgical time.

  7. The evolving energy budget of accretionary wedges

    Science.gov (United States)

    McBeck, Jessica; Cooke, Michele; Maillot, Bertrand; Souloumiac, Pauline

    2017-04-01

    The energy budget of evolving accretionary systems reveals how deformational processes partition energy as faults slip, topography uplifts, and layer-parallel shortening produces distributed off-fault deformation. The energy budget provides a quantitative framework for evaluating the energetic contribution or consumption of diverse deformation mechanisms. We investigate energy partitioning in evolving accretionary prisms by synthesizing data from physical sand accretion experiments and numerical accretion simulations. We incorporate incremental strain fields and cumulative force measurements from two suites of experiments to design numerical simulations that represent accretionary wedges with stronger and weaker detachment faults. One suite of the physical experiments includes a basal glass bead layer and the other does not. Two physical experiments within each suite implement different boundary conditions (stable base versus moving base configuration). Synthesizing observations from the differing base configurations reduces the influence of sidewall friction because the force vector produced by sidewall friction points in opposite directions depending on whether the base is fixed or moving. With the numerical simulations, we calculate the energy budget at two stages of accretion: at the maximum force preceding the development of the first thrust pair, and at the minimum force following the development of the pair. To identify the appropriate combination of material and fault properties to apply in the simulations, we systematically vary the Young's modulus and the fault static and dynamic friction coefficients in numerical accretion simulations, and identify the set of parameters that minimizes the misfit between the normal force measured on the physical backwall and the numerically simulated force. Following this derivation of the appropriate material and fault properties, we calculate the components of the work budget in the numerical simulations and in the

  8. PELVIC OSTEOTOMY IN THE COMPLEX TREATMENT OF CHILDREN WITH LEGG-CALVE-PERTHES DISEASE

    Directory of Open Access Journals (Sweden)

    Дмитрий Борисович Барсуков

    2014-06-01

    Full Text Available At the Scientific and Research Institute for Children’s Orthopedics n. a. G. I. Turner we analyzed survey data of 120 patients aged from 6 to 14 years old with Legg-Calve-Perthes disease with severe epiphysis deformation, in order to improve the outcomes. All patients underwent reconstructive (remodeling surgery - a corrective hip osteotomy, a pelvic osteotomy by Salter, a combination of these techniques and a triple pelvic osteotomy. Postoperative follow-up period averaged 10 years. It is shown that pelvic osteotomy is an operation of choice for Legg-Calve- Perthes disease along with corrective hip osteotomy, and remodeling of the femoral head is only possible when the degree of bone coverage is equal to one or more. We highlighted radioanatomical structure of the affected hip joint, allowing to precise indications for surgical remodeling type of femoral head.

  9. Implementation of enhanced dynamic wedge in the focus rtp system.

    Science.gov (United States)

    Miften, M; Wiesmeyer, M; Beavis, A; Takahashi, K; Broad, S

    2000-01-01

    The FOCUS RTP system implementation of Varian's enhanced dynamic wedge (EDW) is presented. Calculations of both dose distributions and wedge factors (WFs) are based on segmented treatment tables (STTs). Calculating dose requires a "transmission matrix" derived from an STT to model the modified fluence from the source. The dose calculation is then performed using either the Clarkson or convolution/superposition algorithms. An initial "primary dose/monitor unit (MU) fraction" WF estimate at the weight point of symmetric and asymmetric fields is calculated from the STT as the ratio of MU delivered on the axis of the weight point divided by total MU delivered for the treatment field. In our approach, we go beyond this initial estimate with a "scatter dose" correction. This requires measured 60 degrees WFs for 5 fields. Scatter corrections derived from measured WFs are interpolated for other wedge angles and field sizes in much the same way as arbitrary wedge angle STTs are derived from a "golden STT" using the "ratio of tangents" formalism. Dose comparisons with measured distributions show good agreement to within 3% or 3 mm for 6-MV beams and all EDW angles. Agreement with measurements to within 1% is obtained for WFs in all symmetric and asymmetric fields for 6- and 10-MV beams. For large wedge angles and field sizes, this represents a significant improvement over the 3% to 4% errors often observed using the MU fraction model alone.

  10. Trochanteric osteotomy versus posterolateral approach: function the first year post surgery. A pilot study

    Directory of Open Access Journals (Sweden)

    van Biezen Frans C

    2011-06-01

    Full Text Available Abstract Background Although no prospective studies have compared functional results of trochanteric osteotomy and a non-trochanteric approach, most surgeons feel that trochanteric osteotomy is outdated in simple hip arthroplasty. Reasons not to perform an osteotomy include the fear of longer rehabilitation and worse (final functional outcome. Method This prospective study examines differences in rehabilitation between posterolateral and trochanteric approach one year post-surgery using questionnaires (WOMAC, SF-36, HHS and functional tests (walking, climbing stairs, rising from sitting, and strength tests. Of the 109 patients 24 had a trochanteric osteotomy: the selected approach was based on the surgeon's preference. The trochanteric osteotomy group included more patients with developmental dysplasia of the hip. Before the start of the study no power analysis was performed. Results Data from the questionnaires showed no significant differences between the two groups at 3, 6 and 12-months follow-up. At 3-months follow-up patients in the trochanteric osteotomy group scored lower on the functional tests. This difference had disappeared at 6 and 12-months follow-up, except for abduction force which remained lower in the trochanteric osteotomy group in patients with a non union of the TO. Conclusion For simple hip arthroplasty an approach without osteotomy seems a logical choice. Although the power of this study is low, in experienced hands trochanteric osteotomy seems to give good functional results at 6-12 months post surgery if trochanteric union is obtained. Therefore, one should not hesitate to perform an osteotomy in difficult cases.

  11. Dislocation Nucleation and Pileup under a Wedge Contact at Nanoscale

    Directory of Open Access Journals (Sweden)

    Y. F. Gao

    2008-01-01

    Full Text Available Indentation responses of crystalline materials have been found to be radically different at micrometer and nanometer scales. The latter is usually thought to be controlled by the nucleation of dislocations. To explore this physical process, a dislocation mechanics study is performed to determine the conditions for the nucleation of a finite number of dislocations under a two-dimensional wedge indenter, using the Rice-Thomson nucleation criterion. The configurational force on the dislocation consists of the applied force, the image force, and the interaction force between dislocations. Dislocations reach equilibrium positions when the total driving force equals the effective Peierls stress, giving a set of nonlinear equations that can be solved using the Newton-Raphson method. When the apex angle of the wedge indenter increases, the critical contact size for dislocation nucleation increases rapidly, indicating that dislocation multiplication near a blunt wedge tip is extremely difficult. This geometric dependence agrees well with experimental findings.

  12. Indentation tectonics in the accretionary wedge of middle Manila Trench

    Institute of Scientific and Technical Information of China (English)

    LI Jiabiao; JIN Xianglong; RUAN Aiguo; WU Shimin; WU Ziyin; LIU Jianhua

    2004-01-01

    Based on the multibeam morpho-tectonic analysis of the Manila Trench accretionary wedge and its indentation tectonics and the contrasting researches with other geological and geophysical data, three tectonic zones of the wedge are established, faulting features, tectonic distribution and stress mechanism for the indentation tectonicsareanalyzed,oblique subduction along Manila Trench with convergent stress of NW55. Is presented, and the relationship of the ceasing of Eastern Subbasin spreading of South China Sea Basin to the formation of subduction zone of Manila Trench is discussed. By the model analysis and regional research, it is found that the seamount subduction along Manila Trenchoes not lead to the erosion of the accretionary wedge and the oblique subduction actually is a NWWtrending obducfion of Luzon micro-plate that results from the NWW-trending displacement of the Philippine Sea plate.

  13. Surface Geophysical Measurements for Locating and Mapping Ice-Wedges

    DEFF Research Database (Denmark)

    Ingeman-Nielsen, Thomas; Tomaskovicova, Sonia; Larsen, S.H.

    2012-01-01

    With the presently observed trend of permafrost warming and degradation, the development and availability of effective tools to locate and map ice-rich soils and massive ground ice is of increasing importance. This paper presents a geophysical study of an area with polygonal landforms in order...... to test the applicability of DC electrical resistivity tomography (ERT) and Ground Penetrating Radar (GPR) to identifying and mapping ice-wedge occurrences. The site is located in Central West Greenland, and the ice-wedges are found in a permafrozen peat soil with an active layer of about 30 cm. ERT...... and GPR measurements give a coherent interpretation of possible ice-wedge locations, and active layer probing show a tendency for larger thaw depth in the major trench systems consistent with a significant temperature (at 10 cm depth) increase in these trenches identified by thermal profiling. Three...

  14. Modeling and Stability Analysis of Wedge Clutch System

    Directory of Open Access Journals (Sweden)

    Jian Yao

    2014-01-01

    Full Text Available A wedge clutch with unique features of self-reinforcement and small actuation force was designed. Its self-reinforcement feature, associated with different factors such as the wedge angle and friction coefficient, brings different dynamics and unstable problem with improper parameters. To analyze this system, a complete mathematical model of the actuation system is built, which includes the DC motor, the wedge mechanism, and the actuated clutch pack. By considering several nonlinear factors, such as the slip-stick friction and the contact or not of the clutch plates, the system is piecewise linear. Through the stability analysis of the linearized system in clutch slipping phase, the stable condition of the designed parameters is obtained as α>arctan⁡(μc. The mathematical model of the actuation system is validated by prototype testing. And with the validated model, the system dynamics in both stable and unstable conditions is investigated and discussed in engineering side.

  15. Tricritical wedge filling transitions with short-ranged forces

    Energy Technology Data Exchange (ETDEWEB)

    Romero-Enrique, J M [Departamento de Fisica Atomica, Molecular y Nuclear, Area de Fisica Teorica, Universidad de Sevilla, Apartado de Correos 1065, 41080 Sevilla (Spain); Parry, A O [Department of Mathematics, Imperial College 180 Queen' s Gate, London SW7 2BZ (United Kingdom)

    2005-11-16

    We show that the 3D wedge filling transition in the presence of short-ranged interactions can be first order or second order depending on the strength of the line tension associated with the wedge bottom. This fact implies the existence of a tricritical point characterized by a short-distance expansion which differs from the usual continuous filling transition. Our analysis is based on an effective one-dimensional model for the 3D wedge filling, which arises from the identification of the breather modes as the only relevant interfacial fluctuations. From such analysis we find a correspondence between continuous 3D filling at bulk coexistence and 2D wetting transitions with random-bond disorder.

  16. Experimental fixation of femoral osteotomies by cerclage with nylon straps.

    Science.gov (United States)

    Rhinelander, F W; Stewart, C L

    1983-10-01

    Following the successful experience of Partridge in the fixation of human femoral fractures by nylon-strap cerclage, this research in 23 mature dogs was performed to compare nylon-strap with wire-loop cerclage for healing periods of up to 12 weeks. Supplemented by intramedullary fixation with Steinmann pins, long oblique femoral osteotomies were fixed in one femur of each dog by nylon straps and in the other femur by wire loops, at separate operations. The nylon straps were all secured at the same tension by a special "gun." The wire loops were all secured at the same tension by the Rhinelander tightener-twister. Half of the nylon straps had "bumps" along the inner surface, which were added by Partridge in an effort to circumvent the microvascular disturbance reported with Parham bands. On examination by microangiography and correlated histology, all of the osteotomies, regardless of the type of fixation, showed good progress toward osseous union. After fixation by wire cerclage no loss of position or disturbance of blood supply was noted. After fixation by nylon straps slight (clinically insignificant) longitudinal displacement, attributed to slight lengthening of the straps, with consequent loosening was noted in all cases. This loosening was considered advantageous because it appeared to be responsible for the unexpected lack of impairment of the vascularization of the underlying cortical bone by any of the straps. The bumps on the undersurface of some of the straps were, thus, of no vascular advantage, and their presence made accurate fixation of the ostectomy fragments more difficult on the small bones. These studies support the value of fixation by plain nylon straps and show their advantage over straps with bumps for fixation of long oblique single osteotomies of bones the size of the canine femur.

  17. Static and dynamic loading of mandibular condyles and their positional changes after bilateral sagittal split advancement osteotomies.

    Science.gov (United States)

    Dicker, G J; Tuijt, M; Koolstra, J H; Van Schijndel, R A; Castelijns, J A; Tuinzing, D B

    2012-09-01

    This study analysed the effects of change of direction of masseter (MAS) and medial pterygoid muscles (MPM) and changes of moment arms of MAS, MPM and bite force on static and dynamic loading of the condyles after surgical mandibular advancement. Rotations of the condyles were assessed on axial MRIs. 16 adult patients with mandibular hypoplasia were studied. The mandibular plane angle (MPA) was 39° in Group II (n=8). All mandibles were advanced with a bilateral sagittal split osteotomy (BSSO). In Group II, BSSO was combined with Le Fort I osteotomy. Pre and postoperative moment arms of MAS, MPM and bite force were used in a two-dimensional model to assess static loading of the condyles. Pre and postoperative data on muscle cross-sectional area, volume and direction were introduced in three-dimensional dynamic models of the masticatory system to assess the loading of the condyles during opening and closing. Postsurgically, small increases of static condylar loading were calculated. Dynamic loading decreased slightly. Minor rotations of the condyles were observed. The results do not support the idea that increased postoperative condylar loading is a serious cause for condylar resorption or relapse.

  18. Guidelines for reconstructing the metatarsal parabola with the shortening osteotomy.

    Science.gov (United States)

    Valley, B A; Reese, H W

    1991-08-01

    Lesser metatarsal pathology is difficult to treat surgically. The shortening osteotomy has shown promise as a useful technique. The following objectives are addressed in this study: 1) to discuss present techniques and two new radiographic measurement systems; 2) to establish mean, standard deviation, and normal range values for these measurement systems; 3) to determine if these measurements vary with foot size; and 4) to use the results to establish general guidelines for metatarsal parabola reconstruction. Means and normal ranges for the various radiographic measurements are identified to help the surgeon with preoperative evaluation and planning. The measurements vary mildly with foot size.

  19. Functional outcome in adult patients following Bernese periacetabular osteotomy.

    Science.gov (United States)

    Badra, Mohammad I; Anand, Ashish; Straight, Joseph J; Sala, Debra A; Ruchelsman, David E; Feldman, David S

    2008-01-01

    This study evaluated functional outcome following Bernese periacetabular osteotomy. In 24 patients with mean follow-up of 3.5 years, mean dysfunction score was 15.23 on the Short Musculoskeletal Function Assessment. Eighteen patients (75%) scored = or <20, indicating a high functional level. Irrespective of preoperative Shenton line continuity, most patients demonstrated a high functional level. However, a trend toward a poorer outcome was observed in patients with preoperative noncongruent joints and Tonnis osteoarthritis grade 3. These results suggest patients with less than optimal presentation may still benefit from this surgery, delaying or eliminating the need for total hip arthroplasty.

  20. Approaches and perioperative management in periacetabular osteotomy surgery

    DEFF Research Database (Denmark)

    Søballe, Kjeld; Troelsen, Anders

    2012-01-01

    In the early days of periacetabular osteotomy (PAO), surgical approaches were characterized by extensive soft-tissue dissection. The Smith-Petersen approach (and iliofemoral modifications) and the ilioinguinal approach have traditionally been used for PAO. The optimal surgical approach for PAO.......9 to 8.1 years) of 209 PAOs performed using this approach have shown Kaplan-Meier survivorship rates of 94.7% at 5 years and 88.6% at 8.1 years, with conversion to total hip arthroplasty as the end point. Perioperative management includes a patient education program, optimized pain treatment strategies...

  1. Flow Analysis for the Falkner–Skan Wedge Flow

    DEFF Research Database (Denmark)

    Bararnia, H; Haghparast, N; Miansari, M

    2012-01-01

    the constant coefficients in the approximated solution. The effects of the polynomial terms of HAM are considered and the accuracy of the results is shown, which increases with the increasing polynomial terms of HAM. Analytical results for the dimensionless velocity and temperature profiles of the wedge flow......In this article an analytical technique, namely the homotopy analysis method (HAM), is applied to solve the momentum and energy equations in the case of a two-dimensional incompressible flow passing over a wedge. The trail and error method and Padé approximation strategies have been used to obtain...

  2. Molecular Depth Profiling with Cluster SIMS and Wedges

    Science.gov (United States)

    Mao, Dan; Wucher, Andreas; Winograd, Nicholas

    2009-01-01

    Secondary ion mass spectrometry and atomic force microscopy are employed to characterize a wedge-shaped crater eroded by 40 keV C60+ bombardment of a 395-nm thin film of Irganox 1010 doped with four delta layers of Irganox 3114. The wedge structure creates a laterally magnified cross section of the film. From an examination of the resulting surface, information about depth resolution, topography and erosion rate can be obtained as a function of crater depth in a single experiment. This protocol provides a straightforward way to determine the parameters necessary to characterize molecular depth profiles, and to obtain an accurate depth scale for erosion experiments. PMID:19968247

  3. Surgical treatment of idiopathic syringomyelia: Silastic wedge syringosubarachnoid shunting technique

    Directory of Open Access Journals (Sweden)

    Teck M Soo

    2014-01-01

    Conclusions: Shunting procedures for the syringomyelia disease spectrum have been criticized due to the inconsistent long-term outcomes. This surgical technique used to treat symptomatic idiopathic syringomyelia has been devised based on our intraoperative experience, surgical outcomes, and evaluation of the literature. The purpose of the wedges is to preserve patency of the communication between the syrinx cavity and the expanded subarachnoid space by preventing healing of the myelotomy edges and by maintaining an artificial conduit between the syrinx cavity and the subarachnoid space. Although short-term results are promising, continued long-term follow up is needed to determine the ultimate success of the silastic wedge shunting procedure.

  4. Comparison of Surgical Parameters and Results between Curved Varus Osteotomy and Rotational Osteotomy for Osteonecrosis of the Femoral Head.

    Science.gov (United States)

    Lee, Young-Kyun; Park, Chan Ho; Ha, Yong-Chan; Kim, Do-Yeon; Lyu, Sung-Hwa; Koo, Kyung-Hoi

    2017-06-01

    Various osteotomies have been introduced to treat osteonecrosis of the femoral head. The purpose of this study was to compare surgical parameters, postoperative limb length discrepancy, and minimum 5-year clinical and radiological results between transtrochanteric curved varus osteotomy (TCVO) and transtrochanteric rotational osteotomy (TRO) for osteonecrosis of the femoral head. From 2004 to 2009, 103 consecutive TROs (97 patients) followed by 72 consecutive TCVOs (64 patients) were performed for the treatment of osteonecrosis of the femoral head. Of these, 85 patients (91 hips) in the TRO group and 58 patients (65 hips) in the TCVO group completed minimum 5-year clinical and radiological follow-up. The Kaplan-Meier product-limit method was used to estimate survival. The TCVO group had shorter operation time (p TRO group and 7 hips (10.8%) in the TCVO group (p = 0.007). Osteophyte formation was observed in 34 hips (37.4%) in the TRO group and 13 hips (20%) in the TCVO group (p = 0.020). Fifteen hips (16.5%) in the TRO group and 7 hips (10.8%) in the TCVO group underwent conversion total hip arthroplasty (THA). The survival rate at 9 years with radiographic collapse as the endpoint was 68.7% (95% confidence interval [CI], 58.1% to 79.3%) in the TRO group, and 84.7% (95% CI, 71.5% to 97.9%) in the TCVO group. With conversion to THA as the endpoint, the survival rate was 82.2% (95% CI, 73.1% to 91.3%) in the TRO group and 89.2% (95% CI, 81.7% to 96.7%) in the TCVO group. The comparison indicates that TCVO was better than TRO in terms of surgical parameters including operation time and estimated blood loss while the 9-year survival rates were similar.

  5. Arthroscopic evaluation of persistent pain following supramalleolar osteotomy for varus ankle osteoarthritis.

    Science.gov (United States)

    Kim, Yong Sang; Youn, Hyun Kook; Kim, Bom Soo; Choi, Yun Jin; Koh, Yong Gon

    2016-06-01

    The purposes of this study were to investigate pain experienced by patients after supramalleolar osteotomy for varus ankle osteoarthritis and to analyse correlations between this pain and arthroscopic findings. Twenty-nine patients (31 ankles) who underwent arthroscopic evaluation after supramalleolar osteotomy were reviewed retrospectively. The visual analog scale (VAS) was used to assess pain, and the patients were instructed to record the time point, location, and character of the pain. The tibial-ankle surface angle, talar tilt, and tibial-lateral surface angle were measured on radiographs. The location, time point, and character of the pain experienced by the patients changed after supramalleolar osteotomy. The mean VAS score was significantly improved after supramalleolar osteotomy at the time of the arthroscopic evaluation (P osteotomy was found to be associated with adhesions, synovitis, and soft-tissue impingement in medial and lateral gutters of the ankle. Arthroscopy can be helpful in identifying and treating painful lesions commonly seen after supramalleolar osteotomy. An understanding of these painful lesions will help patients have more realistic expectations regarding the supramalleolar osteotomy. Case series study, Level IV.

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

    Science.gov (United States)

    Sakamoto, Tetsuya; Naito, Masatoshi; Nakamura, Yoshinari

    2015-11-01

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

  7. Radiographic Correction Following Reconstruction of Adult Acquired Flat Foot Deformity Using the Cotton Medial Cuneiform Osteotomy.

    Science.gov (United States)

    Aiyer, Amiethab; Dall, Graham F; Shub, Jeffrey; Myerson, Mark S

    2016-05-01

    The Cotton osteotomy has been used to correct residual forefoot supination in flexible flatfoot deformity reconstruction. The purpose of this study was to delineate the radiographic effects of the Cotton osteotomy by controlling for concomitant procedures used for deformity correction. We retrospectively analyzed 67 patients who underwent a Cotton osteotomy as part of a flatfoot reconstructive procedure. We evaluated 12 radiographic parameters including the articular surface angles of the foot, Meary angle, and a newly defined medial arch sag angle (MASA). Twenty-eight of these patients were matched to a cohort that did not undergo a Cotton osteotomy. In all patients who underwent a Cotton osteotomy, there were statistically significant changes in the articular surface angles and medial arch height (P osteotomy did not improve Meary angle but provided an additional 6.5 degrees correction of the MASA (P = .002). After reliability testing, the intraclass correlation coefficient was found to be substantial for the MASA compared to Meary angle. The data suggest that the MASA was a useful radiographic tool for assessing midfoot collapse in the setting of pes planovalgus. The current study demonstrated the corrective capacity of the Cotton osteotomy on the MASA; at final follow-up, there was no evidence of radiographic instability. This is suggestive that a naviculocuneiform arthrodesis may not be warranted for medial column stabilization in the setting of flatfoot reconstruction. Level III, case control study. © The Author(s) 2015.

  8. Ulnar Shortening Osteotomy After Distal Radius Fracture Malunion: Review of Literature

    Science.gov (United States)

    Barbaric, Katarina; Rujevcan, Gordan; Labas, Marko; Delimar, Domagoj; Bicanic, Goran

    2015-01-01

    Malunion of distal radius fracture is often complicated with shortening of the radius with disturbed radio- ulnar variance, frequently associated with lesions of triangular fibrocartilage complex and instability of the distal radioulnar joint. Positive ulnar variance may result in wrist pain located in ulnar part of the joint, limited ulnar deviation and forearm rotation with development of degenerative changes due to the overloading that occurs between the ulnar head and corresponding carpus. Ulnar shortening osteotomy (USO) is the standard procedure for correcting positive ulnar variance. Goal of this procedure is to minimize the symptoms by restoring the neutral radio - ulnar variance. In this paper we present a variety of surgical techniques available for ulnar shorthening osteotomy, their advantages and drawbacks. Methods of ulnar shortening osteotomies are divided into intraarticular and extraarticular. Intraarticular method of ulnar shortening can be performed arthroscopically or through open approach. Extraarticular methods include subcapital osteotomy and osteotomy of ulnar diaphysis, which depending on shape can be transverse, oblique, and step cut. All of those osteotomies can be performed along wrist arthroscopy in order to dispose and treat possibly existing triangular fibrocartilage complex injuries. At the end we described surgical procedures that can be done in case of ulnar shorthening osteotomy failure. PMID:26157524

  9. Transposition of the acetabulum after iliac ischial osteotomy in the treatment of hip dysplasia in infants

    Directory of Open Access Journals (Sweden)

    Владимир Евгеньевич Басков

    2016-06-01

    Full Text Available Background. Transposition of the acetabulum after pelvic osteotomy is the most effective surgical method to treat dysplastic hip joint disorders in patients of different ages. According to Salter, iliac osteotomy of the pelvis is the main surgical method used to correct dysplastic acetabulum in 7- and 8-year-old children. In older patients, the pubic symphysis and pelvic ligaments become more rigid, which significantly limits the degree of rotation of the acetabulum. In these cases, a triple pelvic osteotomy is performed to enhance the mobility of the acetabular fragment. This pubic bone osteotomy is performed near the femoral neurovascular bundle, which may be damaged during the procedure.Aim. To describe a technique for transposition of the acetabulum after iliac and ischial osteotomy of the pelvis, which was developed to reduce trauma, prevent vascular complications, and increase postoperative stability of the pelvic ring.Materials and methods. A method developed by the authors for transposition of the acetabulum after iliac and sciatic pelvic osteotomy is described in detail. The surgical method was performed 99 times on 89 children with dysplastic hip joint disorders, and the results are presented.Conclusion. Transposition of the acetabulum after iliac and ischial pelvic osteotomy is an effective treatment for dysplastic instability of the acetabulum in children aged 9–16 years. The procedure is indicated when it is necessary to rotate the acetabular fragment by more than 25°, and there is no need for hip medialization.

  10. Biomechanical optimization of different fixation modes for a proximal femoral L-osteotomy

    Directory of Open Access Journals (Sweden)

    Chen Hsih-Hao

    2009-09-01

    Full Text Available Abstract Background Numerous proposed surgical techniques have had minimal success in managing greater trochanter overgrowth secondary to retarded growth of the femoral capital epiphysis. For reconstruction of residual hip deformities, a novel type of proximal femur L-osteotomy was performed with satisfactory results. Although the clinical outcome was good, the biomechanical characteristics of the femur after such an osteotomy have not been clearly elucidated. Therefore, this study presents a three dimensional finite element analysis designed to understand the mechanical characteristics of the femur after the L-osteotomy. Methods A patient with left hip dysplasia was recruited as the study model for L-osteotomy. The normal right hip was used as a reference for performing the corrective surgery. Four FEA models were constructed using different numbers of fixation screws but the same osteotomy lengths together with four FEA models with the same number of fixation screws but different osteotomy lengths. The von Mises stress distributions and femoral head displacements were analyzed and compared. Results The results revealed the following: 1. The fixation devices (plate and screws sustained most of the external loading, and the peak value of von Mises stress on the fixation screws decreased with an increasing number of screws. 2. Additional screws are more beneficial on the proximal segment than on the distal segment for improving the stability of the postoperative femur. 3. The extent of osteotomy should be limited because local stress might be concentrated in the femoral neck region with increasing length of the L-osteotomy. Conclusion Additional screw placement on the proximal segment improves stability in the postoperative femur. The cobra-type plate with additional screw holes in the proximal area might improve the effectiveness of L-osteotomies.

  11. Refinements in osteotomy design to improve structural integrity: a finite element analysis study.

    Science.gov (United States)

    Bujtar, P; Simonovics, János; Váradi, Károly; Sándor, George K B; Pan, Jingzhe; Avery, C M E

    2013-09-01

    Osteotomy cuts are typically made using a saw, and the meeting point acts as a focus for the concentration of stress and failure. We have studied the impact of different designs of osteotomy cut. Cadaver sheep tibias were scanned by computed tomography (CT) and transformed into a computer-aided design (CAD) model. A standard marginal resection defect was created and then modified, and a finite element analysis made. The relative stress concentrations at the intersection of osteotomy cuts were recorded using principal stresses S1, S3, and von Mises stress, von Mises under both 4-point bending and torsion testing. The osteotomy designs studied were: right-angled and bevelled osteotomy end cuts, overcutting, and a stop drill hole. Peak stress values for 4-point bending and torsion were 24-30% greater at the right-angled osteotomy than the bevelled end cut. Overcutting dramatically increased peak stress values caused by bending and torsion by 48% and 71%, respectively. Substantially lower concentrations of stress were noted with a stop hole using both a 90° (bending 38% and torsion 56%), and a tangential (bending 58% and torsion 60%) cut. A bevelled osteotomy has substantially lower concentrations of stress than a right-angled osteotomy. It is important to avoid creating an overcut as this causes an appreciable increase in the concentration of stress, while a stop drill hole substantially reduces the stress. The creation of a stop hole and the use of judicious bevelling techniques are modifications in the design of an osteotomy that are readily applicable to surgical practice. Copyright © 2012 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  12. Valgus osteotomy for nonunion and neglected neck of femur fractures.

    Science.gov (United States)

    Varghese, Viju Daniel; Livingston, Abel; Boopalan, P R; Jepegnanam, Thilak S

    2016-05-18

    Nonunion neck of femur can be a difficult problem to treat, particularly in the young, and is associated with high complication rates of avascular necrosis due to the precarious blood supply and poor biomechanics. The various treatment options that have been described can be broadly divided according to the aim of improving either biology or biomechanics. Surgeries aimed at improving the biology, such as vascularized fibula grafting, have good success rates but require high levels of expertise and substantial resources. A popular surgical treatment aimed at improving the biomechanics-valgus intertrochanteric osteotomy-optimizes conditions for fracture healing by converting shear forces across the fracture site into compressive forces. Numerous variations of this surgical procedure have been developed and successfully applied in clinical practice. As a result, the proximal femoral orientation for obtaining a good functional outcome has evolved over the years, and the present concept of altering the proximal femoral anatomy as little as possible has arisen. This technical objective supports attaining union as well as a good functional outcome, since excessive valgus can lead to increased joint reaction forces. This review summarizes the historical and current literature on valgus intertrochanteric osteotomy treatment of nonunion neck of femur, with a focus on factors predictive of good functional outcome and potential pitfalls to be avoided as well as controversies surrounding this procedure.

  13. locally fabricated metal step wedge for quality assurance in ...

    African Journals Online (AJOL)

    DR. AMINU

    materials, as well as to investigate an alternative wedge material. The values of the ... The use of low performance x-ray machines. b. ... machine in the Radiology Department of. JUTH is .... the x-ray beam, while ms determines the interaction.

  14. Stark effect in a wedge-shaped quantum box

    CERN Document Server

    Reyes-Esqueda, J A; Castillo-Mussot, M; Vazquez, G J; Reyes-Esqueda, Jorge-Alejandro; Mendoza, Carlos I.; Castillo-Mussot, Marcelo del; Vazquez, Gerardo J.

    2005-01-01

    The effect of an external applied electric field on the electronic ground state energy of a quantum box with a geometry defined by a wedge is studied by carrying out a variational calculation. This geometry could be used as an approximation for a tip of a cantilever of an atomic force microscope. We study theoretically the Stark effect as function of the parameters of the wedge: its diameter, angular aperture and thickness; as well as function of the intensity of the external electric field applied along the axis of the wedge in both directions; pushing the carrier towards the wider or the narrower parts. A confining electronic effect, which is sharper as the wedge dimensions are smaller, is clearly observed for the first case. Besides, the sign of the Stark shift changes when the angular aperture is changed from small angles to angles theta>pi. For the opposite field, the electronic confinement for large diameters is very small and it is also observed that the Stark shift is almost independent with respect t...

  15. Thoracoscopic pulmonary wedge resection without post-operative chest drain

    DEFF Research Database (Denmark)

    Holbek, Bo Laksafoss; Hansen, Henrik Jessen; Kehlet, Henrik

    2016-01-01

    : Forced expiratory volume in 1 s (FEV1) ≥60 % of expected, FEV1/forced vital capacity ≥70 %, tumour diameter ≤2 cm, distance from tumour to visceral pleura ≤3 cm, ≤2 separate wedges, no air leak on an intraoperative air leakage test and absence of severe adhesions, bullous/emphysematous disease, pleural...

  16. Wedges, Cones, Cosmic Strings, and the Reality of Vacuum Energy

    CERN Document Server

    Fulling, S A; Truong, P N; Wagner, J

    2012-01-01

    One of J. Stuart Dowker's most significant achievements has been to observe that the theory of diffraction by wedges developed a century ago by Sommerfeld and others provided the key to solving two problems of great interest in general-relativistic quantum field theory during the last quarter of the twentieth century: the vacuum energy associated with an infinitely thin, straight cosmic string, and (after an interchange of time with a space coordinate) the apparent vacuum energy of empty space as viewed by an accelerating observer. In a sense the string problem is more elementary than the wedge, since Sommerfeld's technique was to relate the wedge problem to that of a conical manifold by the method of images. Indeed, Minkowski space, as well as all cone and wedge problems, are related by images to an infinitely sheeted master manifold, which we call Dowker space. We review the research in this area and exhibit in detail the vacuum expectation values of the energy density and pressure of a scalar field in Dowk...

  17. Discrete dislocation plasticity analysis of the wedge indentation of films

    NARCIS (Netherlands)

    Balint, D. S.; Deshpande, V. S.; Needleman, A.; Van der Giessen, E.

    2006-01-01

    The plane strain indentation of single crystal films on a rigid substrate by a rigid wedge indenter is analyzed using discrete dislocation plasticity. The crystals have three slip systems at +/- 35.3 degrees and 90 degrees with respect to the indentation direction. The analyses are carried out for

  18. Fixed Points of Maps of a Nonaspherical Wedge

    Directory of Open Access Journals (Sweden)

    Merrill Keith

    2009-01-01

    Full Text Available Abstract Let be a finite polyhedron that has the homotopy type of the wedge of the projective plane and the circle. With the aid of techniques from combinatorial group theory, we obtain formulas for the Nielsen numbers of the selfmaps of .

  19. Magnetic and structural instabilities of ultrathin Fe(100) wedges

    Energy Technology Data Exchange (ETDEWEB)

    Bader, S.D.; Li, Dongqi; Qiu, Z.Q.

    1994-05-01

    An overview is provided of recent efforts to explore magnetic and related structural issues for ultrathin Fe films grown epitaxially as wedge structures onto Ag(100) and Cu(100). Experiments were carried out utilizing the surface magneto-optic Kerr effect (SMOKE). Ordinary bcc Fe is lattice-matched to the primitive unit cell of the Ag(100) surface. Fe wedges on Ag(100) can be fabricated whose thick end has in-plane magnetic easy axes due to the shape anisotropy, and whose thin end has perpendicular easy axes due to the surface magnetic anisotrophy. A spin-reorientation transition can thus be studied in the center of the wedge where the competing anisotropies cancel. The goal is to test the Mermin-Wagner theorem which states that long-range order is lost at finite temperatures in an isotropic two-dimensional Heisenberg system. Fe wedges on Cu(100) can be studied in like manner, but the lattice matching permits fcc and tetragonally-distorted fcc phases to provide structural complexity in addition to the interplay of competing magnetic anisotropies. The results of these studies are new phase identifications that help both to put previous work into perspective and to define issues to pursue in the future.

  20. Lateral epicondylar osteotomy for severe varus deformity during total knee arthroplasty

    Institute of Scientific and Technical Information of China (English)

    Hong Chen; Wei Huang; Xi Liang; Ning Hu; Wei Xu; Dianming Jiang

    2015-01-01

    In most cases of arthritic varus knees, stepwise osteophytes removal and medial soft tissue release could achieve satisfactory soft tissue balance during total knee arthroplasty.However, in some severe cases, conventional balancing techniques are not enough, necessitating other procedures like epicondylar osteotomy.To the best of our knowledge, no published article has reported the application of lateral epicondylar osteotomy in a severe varus knee.Here we reported a case of successful correction of a severe varus knee following lateral epicondylar osteotomy, and described its underlying rationale.

  1. A Modified Triple Pelvic Osteotomy for the Treatment of Hip Hypoplasia

    Directory of Open Access Journals (Sweden)

    Hassan Rahimi

    2013-09-01

    Full Text Available Background: The prevalence of hip dysplasia is 1 in 1000. Several pelvic osteotomy methods have been developed to prevent early osteoarthritis, such as triple osteotomy. In this study we are going to introduce our new technique that was done on 4 patients with favorable short-term results.   Methods: Four patients underwent triple osteotomy and fixation using a reconstruction plate and early weight bearing was started. Results: The Harris Hip Score, limb length, center-edge angle, and acetabular inclination showed improvement. Conclusion: This modified technique is suggested for corrective surgery on adult dysplastic hips.

  2. A Modified Triple Pelvic Osteotomy for the Treatment of Hip Hypoplasia

    Directory of Open Access Journals (Sweden)

    Hassan Rahimi

    2013-09-01

    Full Text Available   Background: The prevalence of hip dysplasia is 1 in 1000. Several pelvic osteotomy methods have been developed to prevent early osteoarthritis, such as triple osteotomy. In this study we are going to introduce our new technique that was done on 4 patients with favorable short-term results.   Methods: Four patients underwent triple osteotomy and fixation using a reconstruction plate and early weight bearing was started. Results: The Harris Hip Score, limb length, center-edge angle, and acetabular inclination showed improvement. Conclusion: This modified technique is suggested for corrective surgery on adult dysplastic hips.

  3. Osteotomy does not improve early outcome after slipped capital femoral epiphysis.

    Science.gov (United States)

    Diab, Mohammad; Daluvoy, Sanjay; Snyder, Brian D; Kasser, James R

    2006-03-01

    We performed a retrospective, nonrandomized cohort study of unilateral, chronic, severe, stable slipped capital femoral epiphysis comparing five girls and five boys who underwent in-situ screw fixation alone with five girls and five boys who underwent in-situ screw fixation combined with staged flexion intertrochanteric femoral osteotomy to restore proximal femoral alignment. Functional outcome was measured by the Harris hip score, with 20% selected as a goal for improvement in functional outcome after corrective osteotomy. While flexion intertrochanteric femoral osteotomy improved hip range of motion, we found no significant difference in functional outcome between the two groups at early follow-up. This is a level 3 evidence study.

  4. Bernese periacetabular osteotomy in males: is there an increased risk of femoroacetabular impingement (FAI) after Bernese periacetabular osteotomy?

    Science.gov (United States)

    Ziebarth, K; Balakumar, J; Domayer, S; Kim, Y J; Millis, M B

    2011-02-01

    The Bernese periacetabular osteotomy (PAO) is a popular option for treating symptomatic acetabular dysplasia. We noted symptomatic impingement after PAO in several male patients. We therefore determined (1) the incidence of clinical signs of FAI after PAO in the male population; and (2) whether any factors were associated with the positive impingement signs after PAO in males. We retrospectively reviewed 38 males who underwent 46 periacetabular osteotomies (PAO) between 2000 and 2007. Clinical and radiographic data were analyzed with the focus on pre- and postoperative incidence of femoroacetabular impingement. Minimum followup was 12 months (average, 43 months; range, 12-90 months). We found a positive impingement sign in 19 of the 46 hips during the preoperative examination compared to 22 (47.8%) hips postoperatively. The ROM (flexion and internal rotation) decreased postoperatively compared to preoperatively. Radiographic parameters of coverage LCE-, ACE- and Tönnis angle improved into the normal range. Twenty hips had postoperative heterotopic ossification to varying degrees, mostly minor. WOMAC scores improved in the function and pain domains postoperatively. Despite normalization of coverage we found a high postoperative rate of clinical signs of FAI after PAO in males. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

  5. Template-Stripped Multifunctional Wedge and Pyramid Arrays for Magnetic Nanofocusing and Optical Sensing.

    Science.gov (United States)

    Kumar, Shailabh; Johnson, Timothy W; Wood, Christopher K; Qu, Tao; Wittenberg, Nathan J; Otto, Lauren M; Shaver, Jonah; Long, Nicholas J; Victora, Randall H; Edel, Joshua B; Oh, Sang-Hyun

    2016-04-13

    We present large-scale reproducible fabrication of multifunctional ultrasharp metallic structures on planar substrates with capabilities including magnetic field nanofocusing and plasmonic sensing. Objects with sharp tips such as wedges and pyramids made with noble metals have been extensively used for enhancing local electric fields via the lightning-rod effect or plasmonic nanofocusing. However, analogous nanofocusing of magnetic fields using sharp tips made with magnetic materials has not been widely realized. Reproducible fabrication of sharp tips with magnetic as well as noble metal layers on planar substrates can enable straightforward application of their material and shape-derived functionalities. We use a template-stripping method to produce plasmonic-shell-coated nickel wedge and pyramid arrays at the wafer-scale with tip radius of curvature close to 10 nm. We further explore the magnetic nanofocusing capabilities of these ultrasharp substrates, deriving analytical formulas and comparing the results with computer simulations. These structures exhibit nanoscale spatial control over the trapping of magnetic microbeads and nanoparticles in solution. Additionally, enhanced optical sensing of analytes by these plasmonic-shell-coated substrates is demonstrated using surface-enhanced Raman spectroscopy. These methods can guide the design and fabrication of novel devices with applications including nanoparticle manipulation, biosensing, and magnetoplasmonics.

  6. Microchip and wedge ion funnels and planar ion beam analyzers using same

    Science.gov (United States)

    Shvartsburg, Alexandre A; Anderson, Gordon A; Smith, Richard D

    2012-10-30

    Electrodynamic ion funnels confine, guide, or focus ions in gases using the Dehmelt potential of oscillatory electric field. New funnel designs operating at or close to atmospheric gas pressure are described. Effective ion focusing at such pressures is enabled by fields of extreme amplitude and frequency, allowed in microscopic gaps that have much higher electrical breakdown thresholds in any gas than the macroscopic gaps of present funnels. The new microscopic-gap funnels are useful for interfacing atmospheric-pressure ionization sources to mass spectrometry (MS) and ion mobility separation (IMS) stages including differential IMS or FAIMS, as well as IMS and MS stages in various configurations. In particular, "wedge" funnels comprising two planar surfaces positioned at an angle and wedge funnel traps derived therefrom can compress ion beams in one dimension, producing narrow belt-shaped beams and laterally elongated cuboid packets. This beam profile reduces the ion density and thus space-charge effects, mitigating the adverse impact thereof on the resolving power, measurement accuracy, and dynamic range of MS and IMS analyzers, while a greater overlap with coplanar light or particle beams can benefit spectroscopic methods.

  7. Influence of Closed Stator Slots on Cogging Torque

    DEFF Research Database (Denmark)

    Ion, Trifu; Leban, Krisztina Monika; Ritchie, Ewen

    2013-01-01

    Cogging torque results due interaction of magnetic field of magnets and stator slots, and have negative effects on permanent magnet machines such as vibrations, noise, torque ripples and problems during turbine start-up and cut-in. In order to reduce cogging torque this paper presents a study...... of influence of closed stator slots on cogging torque using magnetic slot wedges....

  8. Severe Class II malocclusion with facial asymmetry treated with intraoral vertico-sagittal ramus osteotomy and LeFort I osteotomy.

    Science.gov (United States)

    Kuroda, Shingo; Murakami, Kaoru; Morishige, Yasuko; Takano-Yamamoto, Teruko

    2009-06-01

    In this article, we report the successful treatment of a patient, aged 19 years 11 months, who had a severe Class II malocclusion and facial asymmetry. A combination of intraoral vertical-sagittal ramus osteotomy (IVSRO), intraoral vertical ramus osteotomy (IVRO), and LeFort I osteotomy was used for mandibular advancement and maxillary impaction. The patient had a convex profile because of a retrognathic mandible. She also had severe mandibular deviation and vertical maxillary excess with a canted occlusal plane. A deep overbite of 8.0 mm and an excessive overjet of 10.0 mm were observed. After 16 months of presurgical orthodontic treatment, IVRO in the left ramus and IVSRO in the right ramus were performed with maxillary impaction by LeFort I osteotomy. The mandible was advanced 6.0 mm on the right side, and the maxilla was impacted 4.0 mm at ANS, 2.0 mm at the right first molar, and 5.0 mm at the left first molar. The total active treatment time was 35 months. Both occlusion and facial appearance were significantly improved by the surgical-orthodontic treatment. Occlusion was stable after a year of retention. There were no functional problems during or after treatment. Our results suggest that IVSRO and IVRO combined with LeFort I osteotomy in a patient with severe mandibular retrusion with facial asymmetry might be useful to improve occlusion and facial esthetics.

  9. Minimally Invasive Calcaneal Displacement Osteotomy Site Using a Reference Kirschner Wire: A Technique Tip.

    Science.gov (United States)

    Lee, Moses; Guyton, Gregory P; Zahoor, Talal; Schon, Lew C

    2016-01-01

    As a standard open approach, the lateral oblique incision has been widely used for calcaneal displacement osteotomy. However, just as with other orthopedic procedures that use an open approach, complications, including wound healing problems and neurovascular injury in the heel, have been reported. To help avoid these limitations, a percutaneous technique using a Shannon burr for calcaneal displacement osteotomy was introduced. However, relying on a free-hand technique without direct visualization at the osteotomy site has been a major obstacle for this technique. To address this problem, we developed a technical tip using a reference Kirschner wire. A reference Kirschner wire technique provides a reliable and accurate guide for minimally invasive calcaneal displacement osteotomy. Also, the technique should be easy to learn for surgeons new to the procedure. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  10. Bone grafting with granular biomaterial in segmental maxillary osteotomy: A case report

    Directory of Open Access Journals (Sweden)

    Orion Luiz Haas Junior

    2016-01-01

    Conclusion: This is the first report of bone grafting with a granular biomaterial in segmental maxillary osteotomy. Successful formation of new bone with density greater than that of the surrounding tissue was achieved, preventing pseudarthrosis and postoperative instability.

  11. Shortening Scarf osteotomy for correction of severe hallux valgus. Does shortening affect the outcome?

    Science.gov (United States)

    Karpe, Prasad; Killen, Marie C; Pollock, Raymond D; Limaye, Rajiv

    2016-12-01

    Translation and shortening of Scarf osteotomy allows correction of severe hallux valgus deformity. Shortening may result in transfer metatarsalgia. To evaluate outcome of patients undergoing shortening Scarf osteotomy for severe hallux valgus deformities. Fifteen patients (20feet, mean age 58 years) underwent shortening Scarf osteotomy for severe hallux valgus deformities. Outcomes were pre and postoperative AOFAS scores, IM and HV angles, patient satisfaction. Mean follow-up was 25 months (range 22-30). The IM angle improved from a median of 18.60 (range 13.4-26.20) preoperatively to 9.70 (range 8.0-13.70) postoperatively (8.9; 95% CI=7.6-10.3; posteotomies united. Shortening Scarf osteotomy is a viable option for treating severe hallux valgus deformities with no transfer metatarsalgia. Copyright © 2016 Elsevier Ltd. All rights reserved.

  12. Modified versus classic alar base sutures after LeFort I osteotomy: a systematic review.

    Science.gov (United States)

    Liu, Xianwen; Zhu, Songsong; Hu, Jing

    2014-01-01

    The purpose of this systematic review is to evaluate the efficacy of a new modified alar base cinch suture by comparing it with the commonly used classic alar base suture after LeFort I osteotomy. A comprehensive search strategy was performed to include interventional studies involving the comparisons of alar base suturing methods after LeFort I osteotomy. Data analyses were conducted using the random-effects model. Three studies with 146 participants undergoing LeFort I maxillary osteotomy were included in this review. The results showed that, compared with the classic method, both modified transseptal alar base suture and modified reinsertion sutures significantly decreased postoperative alar and alar base widening. The modified alar base cinch suture was more effective than the classic alar base suture in maintaining preoperative alar and alar base width after LeFort I osteotomy. Copyright © 2014 Elsevier Inc. All rights reserved.

  13. The role of AO external fixation in proximal femoral osteotomies in the pediatric neuromuscular population.

    Science.gov (United States)

    Handelsman, John E; Weinberg, Jacob; Razi, Afshin; Mulley, Debra A

    2004-09-01

    Internal fixation in proximal femoral osteotomies using traditional devices may be sub-optimal in children with neuromuscular disorders who have small or osteopenic bone. In this population, between 1988 and 2000, we performed 36 proximal femoral varus osteotomies in 28 patients. These were controlled by the AO external fixator. The average age at surgery was 7 years (range, 2-13 years). A mean varus correction of 34 degrees (range, 15-90 degrees) was obtained. Complications consisted of one superficial pin tract infection, one skin breakdown, and one non-union. Other than the non-union, all osteotomies were stable at the time of the fixator removal. The AO external fixator is an effective alternative in maintaining corrective proximal femoral osteotomies in children with fragile bones.

  14. Premaxillary osteotomy fixation in bilateral cleft lip/palate: Introducing a new technique

    Directory of Open Access Journals (Sweden)

    Amin Rahpeyma

    2016-04-01

    Conclusion: In protruding premaxilla, osteotomy and fixation of premaxilla with miniplate to the vomer bone during alveolar bone grafting through a lip-split approach yielded satisfactory results in patients requiring secondary functional cheilorhinoplasty.

  15. Split String Formalism and the Closed String Vacuum, II

    CERN Document Server

    Erler, T

    2007-01-01

    In this paper we reconsider a class of generalizations of Schnabl's solution of open bosonic string field theory obtained by replacing the wedge state by an arbitrary combination of wedge states. Contrary to the conclusion of our previous paper hep-th/0611200, we find that under a few modest conditions such generalizations give a sensible deformation of Schnabl's solution for the closed string vacuum--in particular, we can compute their energies and show that they reproduce the value predicted by Sen's conjecture. Though these solutions are apparently gauge equivalent, they are not in general related by midpoint preserving reparameterizations.

  16. Effect of prior Salter or Chiari osteotomy on THA with developmental hip dysplasia.

    Science.gov (United States)

    Tokunaga, Kenji; Aslam, Nadim; Zdero, Rad; Schemitsch, Emil H; Waddell, James P

    2011-01-01

    Controversy exists regarding the outcome of THA after prior pelvic osteotomy. We conducted a retrospective chart and radiographic review to obtain outcome measures for perioperative complications, acetabular and femoral component revisions, Harris hip score, and survivorship and compared these outcomes for patients presenting with developmental dysplasia of the hip treated surgically using THA with and without prior pelvic osteotomy. We performed 103 primary THAs in 87 patients with osteoarthritis secondary to developmental dysplasia of the hip with a minimum 3-year followup. Previous pelvic osteotomy was performed in 52 hips (Salter, 40; Chiari, nine; Salter and Chiari, three), and 51 hips had no previous surgery (control group). The pelvic osteotomy group did not have higher rates of femoral or acetabular intraoperative fracture or dislocation compared with the control group. The overall revision rate was 28.8% in the pelvic osteotomy group compared with 19.6% in the control group. The revision rate for aseptic loosening was 23.1% in the pelvic osteotomy group compared with 17.6% in the control group. Harris hip scores (range, 20-87) were not compromised, and overall survivorship rates 8 years postoperatively were not different at any time between the pelvic osteotomy (83.3%) and control (88.4%) groups. Prior pelvic osteotomy did not lead to a higher perioperative complication rate, higher revision rate, compromised Harris hip score, or shortened survivorship in eventual THA in developmental dysplasia of the hip. Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

  17. Subtrochanteric osteotomy for femoral mal-torsion through a surgical dislocation approach

    Science.gov (United States)

    Kamath, Atul F.; Ganz, Reinhold; Zhang, Hong; Grappiolo, Guido; Leunig, Michael

    2015-01-01

    Missed torsional femur deformities may contribute to reasons for failure after open and more likely arthroscopic hip preservation surgery. A number of surgical approaches have been described for addressing torsion abnormalities. This report describes a subtrochanteric osteotomy technique in a consecutive series of patients with complex hip pathologies, for which intertrochanteric osteotomy is not suitable and precise derotation is required. Subtrochanteric derotation was performed, always in combination with a surgical hip dislocation, in accordance with the authors’ preferred technique. Before osteotomy, a localized decortication was executed. Application of a 4.5-mm broad or narrow plate was undertaken with dynamic compression of the osteotomy. Twenty-eight consecutive subtrochanteric derotational osteotomies were performed in 26 patients. Twenty-one females and five males were treated at an average age of 21.4 years (range, 12–43). Underlying diagnoses included dysplasia, arthrogryposis, cerebral palsy, Down’s syndrome, instability and impingement. The decision to perform derotation was for antetorsion over 20° or less than 0° (retrotorsion). Patients were followed clinically and radiographically till final follow-up. All patients went on to successful osteotomy union. There were two initial failures: one delayed union prompting revision fixation in a chronic smoker and one plate failure due to self-accelerated weight-bearing in a patient status post successful contralateral derotational osteotomy. Rotational deformity of the femur must be considered in the patient undergoing hip preservation surgery. This technique of subtrochanteric derotational osteotomy, with adjunctive surgical hip dislocation, is applicable and reproducible in the setting of complex hip pathologies. Level of evidence: IV, case series. PMID:27011816

  18. Determination of muscle effort at the proximal femur rotation osteotomy

    Science.gov (United States)

    Sachenkov, O.; Hasanov, R.; Andreev, P.; Konoplev, Yu

    2016-11-01

    The paper formulates the problem of biomechanics of a new method for treatment of Legg-Calve-Perthes disease. Numerical calculations of the rotational flexion osteotomy have been carried out for a constructed mathematical model of the hip joint, taking into account the main set of muscles. The work presents the results of the calculations and their analysis. The results have been compared with the clinical data. The calculations of the reactive forces arising in the acetabulum and the proximal part of the femur allowed us to reveal that this reactive force changes both in value and direction. These data may be useful for assessing the stiffness of an external fixation device used in orthopedic intervention and for evaluating the compression in the joint.

  19. Computer and robotic assisted osteotomy around the knee.

    Science.gov (United States)

    Phillips, R; Hafez, M A; Mohsen, A M; Sherman, K P; Hewitt, J R; Browbank, I; Bouazza-Marouf, K

    2000-01-01

    The outcome variability and failures of conventional osteotomy have been attributed to lack of preoperative planning and inaccuracy in performing the correction. We present a computer and robotic assisted surgery system that can aid in accurate surgical planning for realignment, and in precisely implementing the plan in theatre. The approach seeks to avoid the cost and risks associated with the use of CT, and the insertion of fiducial markers, which are characteristic of existing computer assisted surgical systems. The paper details the architecture of the system as a whole, placing particular emphasis on planning technique. It is anticipated that the increased accuracy possible with the system will prove particularly useful for correcting multi-plane deformities, which are more problematic with conventional techniques.

  20. Removal of Deeply Impacted Mandibular Molars by Sagittal Split Osteotomy

    Directory of Open Access Journals (Sweden)

    Erol Cansiz

    2016-01-01

    Full Text Available Mandibular third molars are the most common impacted teeth. Mandibular first and second molars do not share the same frequency of occurrence. In rare cases the occlusal surfaces of impacted molars are united by the same follicular space and the roots pointing in opposite direction; these are called kissing molars. In some cases, a supernumerary fourth molar can be seen as unerupted and, in this case, such a supernumerary, deeply impacted fourth molar is seen neighboring kissing molars. The extraction of deeply impacted wisdom molars from the mandible may necessitate excessive bone removal and it causes complications such as damage to the inferior alveolar nerve and iatrogenic fractures of the mandible. This case report describes the use of the sagittal split osteotomy technique to avoid extensive bone removal and protect the inferior alveolar nerve during surgical extruction of multiple impacted teeth.

  1. [Imaging and preoperative planning for osteotomies around the knee].

    Science.gov (United States)

    Pape, D; Hoffmann, A; Seil, R

    2017-08-01

    Physiologic alignment of the human lower leg is well defined. The etiology for malalignment comprises constitutional, degenerative and posttraumatic conditions. Osteotomies around the knee can correct the malalignment, provided that the origin of deviation is in proximity of the knee center. Crucial factors for the evaluation of axis deviation are the weight-bearing line, the mechanical axes of femur and tibia, the joint line angles and the center of the hip, knee and upper ankle joint. Careful preoperative planning is mandatory for reproducible clinical results. For the treatment of varus osteoarthritis of the knee, a slight overcorrection to the 62% width of the lateral tibial plateau is frequently advocated. In valgus knees, a correction of the postoperative weight-bearing line to physiologic conditions (44% of the lateral tibial width) is regarded to be sufficient. Recently, individualized planning of the correction angle is advocated to better address the underlying pathology of each patient.

  2. Mandibular nerve schwannoma resection using sagittal split ramus osteotomy.

    Science.gov (United States)

    Mahmood, Laith; Demian, Nagi; Weinstock, Yitzchak E; Weissferdt, Annikka

    2013-11-01

    A case is presented of a unique presentation and treatment of a mandibular nerve schwannoma. Its uniqueness stems from the fact that it consisted of 2 distinct tumors along the same nerve: one within the body of the mandible and the other within the ipsilateral pterygomandibular space. Rather than the standard approach of lip split and hemimandibulectomy, a unique approach of a sagittal split ramus osteotomy was used that allowed access to the 2 lesions and avoided the added morbidity of the former approach. The 2 portions of the lesion were successfully removed and the patient was satisfied with the result. Recurrence has not been detected after 6 months. Copyright © 2013 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  3. Distal humeral Salter Harris (Type II) fracture repair by an ulnar osteotomy approach in a horse.

    Science.gov (United States)

    Ahern, Benjamin J; Richardson, Dean W

    2010-08-01

    To report repair of a comminuted distal humeral type II Salter-Harris fracture using an ulnar osteotomy approach and locking compression plates (LCP). Case report. A 3-month-old Standardbred filly with a type II Salter-Harris fracture of the distal humerus. Radiographic and computed tomography examinations were performed to assist surgical planning. The distal humeral fracture was approached by an ulnar osteotomy and repaired using a 7-hole broad LCP and screws inserted in lag fashion. The osteotomy was subsequently repaired using a 7-hole narrow LCP. The distal humeral fracture was successfully approached and stabilized by an ulnar osteotomy approach. At 6-month follow-up, the filly was ambulating comfortably with a normal cosmetic appearance. An ulnar osteotomy approach was readily performed and allowed for repair of a type II Salter-Harris fracture of the distal humerus. The equine distal humerus can be accessed readily using an ulnar osteotomy approach. LCPs allow for repair of complicated fractures that have previously been associated with a grave prognosis.

  4. Effect of Osteoporosis on Bone Density of Orthognathic Osteotomy Sites in Maxillofacial Region.

    Science.gov (United States)

    On, Sung Woon; Kim, Hyun Jun; Kim, Jayoun; Choi, Jin Wook; Jung, Young Wook; Song, Seung Il

    2016-10-01

    The aims of this study were to investigate the availability of Hounsfield unit (HU) measurement of computed tomography (CT) in evaluating the bone density of certain sites by comparing bone density between CT and dual-energy x-ray absorptiometry (DEXA), and to evaluate the effects of osteoporosis on osteotomy sites in orthognathic surgery. This retrospective study included 80 patients who had undergone both facial CT and DEXA at our hospital. We selected 7 regions of interest from among the osteotomy sites in bimaxillary orthognathic surgery. The patients were assigned to either the normal (control) group (n = 40) or the abnormal group (n = 40), and HU values were measured in each region of interest. There were statistically significant differences in the mean HU values between 2 groups at all the osteotomy sites in the maxilla and mandible, with the normal group showing higher values than the abnormal group (P osteotomy sites (P osteotomy sites except for 1 maxillary area, as compared with the normal group. Measurement of HU values on CT can be valuable in assessing bone density of the maxilla and mandible. It is suggested that osteoporosis may affect bone density at the osteotomy sites in orthognathic surgery, and the preoperative measurement of HU values might be useful in predicting unfavorable fracture or the risks involved in such surgery.

  5. Laser-Assisted Osteotomy for Implant Site Preparation: A Literature Review.

    Science.gov (United States)

    Moslemi, Neda; Shahnaz, Aysan; Masoumi, Samane; Torabi, Sepehr; Akbari, Solmaz

    2017-02-01

    The aim of this study was to review the scientific evidence about the laser osteotomy in implant bed preparation. An electronic search was performed on relevant English articles up to April 2016 in the PubMed, Scopus, and Google Scholar databases. Twenty-two articles (1 clinical, 13 animal, and 8 ex vivo studies) were included. Implant sites prepared by erbium family lasers and drill showed comparable results regarding the percentage of bone-to-implant contact, values of biomechanical tests, and healing process. Selection of proper laser wavelength and parameters was of paramount importance to minimize the risk of thermal bone damage. Lack of depth control and long time needed for implant site osteotomy with laser were the most challenging concerns for its clinical applicability. Computer-guided laser osteotomy showed promise for future use of laser osteotomy in clinical settings. Evidence from animal studies shows promising results regarding laser osteotomy in implant site preparation. However, because of the lack of clinical studies, it is not possible to make a conclusive result whether there is superiority of laser osteotomy in clinical practice.

  6. The comparison of edema and ecchymosis after piezoelectric and conventional osteotomy in rhinoplasty.

    Science.gov (United States)

    Taşkın, Ümit; Batmaz, Timur; Erdil, Mehmet; Aydın, Salih; Yücebaş, Kadir

    2017-02-01

    The basic aim of our study is to compare the results of the conventional and piezoelectric osteotomy in rhinoplasty by complete subperiosteal degloving of nasal bone to minimize soft-tissue injury. The study was designed as a prospective, double-blind, randomized, and controlled study. Setting is a tertiary referral hospital in Turkey. Ninety patients who underwent primary open rhinoplasty with osteotomy, performed by either the conventional instruments or the piezoelectric device. The complete subperiosteal degloving of the entire nasal bone was done up to the nasal maxillary sulcus, medial canthus, and nasion in all patients, independent of the type of osteotomy device used. Patients subsequently underwent median-oblique and lateral osteotomy, either with an ultrasonic device or a conventional 2-mm guarded, straight osteotome. The postoperative edema and ecchymosis were evaluated by another surgeon who was blinded to the osteotomy procedure on postoperative days 2 and 7. The edema scores were significantly increased on the second day compared with the seventh day in both groups 1 and 2. However, there was no significant difference between groups. The ecchymosis scores were slightly higher in postoperative day 2, compared with day 7, in both groups 1 and 2, but statistically not significant. This study showed that the main reason edema and ecchymosis are seen post-rhinoplasty is related to soft-tissue injury during osteotomy.

  7. How to Calculate the Exact Angle for Two-level Osteotomy in Ankylosing Spondylitis?

    Science.gov (United States)

    Zheng, Guoquan; Song, Kai; Yao, Ziming; Zhang, Yonggang; Tang, Xiangyu; Wang, Zheng; Zhang, Xuesong; Mao, Keya; Cui, Geng; Wang, Yan

    2016-09-01

    A prospective case series study. To describe and assess a two-level osteotomy method for the management of severe thoracolumbar kyphosis (TLK) in patients with ankylosing spondylitis (AS). To achieve better postoperative outcomes in these patients, a sophisticated preoperative surgical plan is required. Most deformities are managed using a one-level osteotomy and a two-level osteotomy is seldomly reported. Till date, no study has described a two-level osteotomy for these cases. From January 2011 to December 2012, 10 consecutive patients with ankylosing spondylitis who underwent two-level spinal osteotomy were studied. Pre- and postoperative full-length free-standing radiographs, including the whole spine and pelvis, were available for all patients. Pre- and postoperative radiological parameters, including T5-S1 Cobb angles, TLK, lumbar lordosis, pelvic incidence, pelvic tilt, sacral slope, and sagittal vertical axis were measured. Health related quality of life , including Oswestry Disability Index and Scoliosis Research Society-22 surveys were administered before surgery and at 1-year follow up. The preoperative and postoperative T5-S1 Cobb angles was 51.3° and -7.1°, respectively (P osteotomy provides an accurate and reproducible method for ankylosing spondylitis correction. By which, we can obtain satisfactory radiological parameters and clinical outcomes. 4.

  8. New machining and testing method of large angle infrared wedge mirror parts

    Science.gov (United States)

    Su, Ying; Guo, Rui; Zhang, Fumei; Zhang, Zheng; Liu, Xuanmin; Zengqi, Xu; Li, Wenting; Zhang, Feng

    2016-10-01

    Large angle wedge parts were widely used in the optical system that was used for achieving a wide range of scanning. Due to the parts having the characteristic of large difference in the thickness of both ends and high density, the accuracy of the wedge angle was hard to ensure to reach second level in optical processing. Generally, wedge mirror angle was measured by contact comparison method which was easy to damage the surface. In view of the existence of two practical problems, in this paper, based on theoretical analysis, by taking three key measures that were the accurate positioning for the central position of the large angle wedge part, the accuracy control of angle precision machined of wedge mirror and fast and non destructive laser assisted absolute measurement of large angle wedge, the qualified rate of parts were increased to 100%, a feasible, controllable and efficient process route for large angle infrared wedge parts was found out.

  9. Shielding effect of a nano-circular inclusion acting on semi-infinite wedge cracks

    Institute of Scientific and Technical Information of China (English)

    Song Hao-Peng; Gao Cun-Fa

    2013-01-01

    The model of a screw dislocation near a semi-infinite wedge crack tip inside a nano-circular inclusion is proposed to investigate the shielding effect of nano inclusions acting on cracks.Utilizing the complex function method,the closed-form solutions of the stress fields in the matrix and the inclusion region are derived.The stress intensity factor,the image force,as well as the critical loads for dislocation emission are discussed in detail.The results show that the nano inclusion not only enhances the shielding effect exerted by the dislocation,but also provides a shielding effect itself.Moreover,dislocations may be trapped in the nano inclusion even if the matrix is softer than the inclusion.This helps the dislocation shield crack,and reduces the dislocation density within the matrix.

  10. MHD Casson nanofluid flow past a wedge with Newtonian heating

    Science.gov (United States)

    Ahmad, Kartini; Hanouf, Zahir; Ishak, Anuar

    2017-02-01

    The problem of steady Casson nanofluid flow past a wedge is studied in this paper. The presence of magnetic field along with Newtonian heating at the surface is considered. The governing partial differential equations are first transformed into a set of nonlinear ordinary differential equations by similarity transformations, before being solved numerically using the Keller-box method. The effects of the wedge angle Ω from 0° (horizontal plate) to 180° (vertical plate) as well as of as the magnetic parameter M on the non-Newtonian fluid flow and heat transfer characteristics are investigated. It is found that the surface temperature is slightly higher for the flow over a horizontal plate compared to that over a vertical plate. It is also found that the magnetic field decreases the surface temperature but increases the skin friction. The flow of a Newtonian fluid is found to give higher skin friction as compared to that of Casson fluid.

  11. Wedge Diffraction as an Instance of Radiative Shielding

    CERN Document Server

    Grzesik, J A

    2016-01-01

    The celebrated Sommerfeld wedge diffraction solution is reexamined from a null interior field perspective. Exact surface currents provided by that solution, when considered as disembodied half-plane laminae radiating into an ambient, uniform space both inside and outside the wedge proper, do succeed in reconstituting both a specular, mirror field above the exposed face, and a shielding plane-wave field of a sign opposite to that of the incoming excitation which, under superposition, creates both the classical, geometric-optics shadow, and a strictly null interior field at the dominant, plane-wave level. Both mirror and shadow radiated fields are controlled by the residue at just one simple pole encountered during a spectral radiative field assembly, fixed in place by incidence direction $\\phi_{0}$ as measured from the exposed face. The radiated fields further provide diffractive contributions drawn from two saddle points that track observation angle $\\phi.$ Even these, more or less asymptotic contributions, a...

  12. Direct FVM Simulation for Sound Propagation in an Ideal Wedge

    Directory of Open Access Journals (Sweden)

    Hongyu Ji

    2016-01-01

    Full Text Available The sound propagation in a wedge-shaped waveguide with perfectly reflecting boundaries is one of the few range-dependent problems with an analytical solution. This provides a benchmark for the theoretical and computational studies on the simulation of ocean acoustic applications. We present a direct finite volume method (FVM simulation for the ideal wedge problem, and both time and frequency domain results are analyzed. We also study the broadband problem with large-scale parallel simulations. The results presented in this paper validate the accuracy of the numerical techniques and show that the direct FVM simulation could be applied to large-scale complex acoustic applications with a high performance computing platform.

  13. Wedge Splitting Test and Fracture Energy on Particulate Reinforced Composites

    Energy Technology Data Exchange (ETDEWEB)

    Na, Seong Hyeon; Kim, Jae Hoon; Choi, Hoon Seok [Chungnam National Univ., Daejeon (Korea, Republic of); Park, Jae Beom; Kim, Shin Hoe; Jung, Gyoo Dong [Agency for Defense Developmen, Daejeon (Korea, Republic of)

    2016-03-15

    The effect of temperature on the fracture energy, crack propagation, and crack tip opening displacement(CTOD) was determined for particulate reinforced composites using the wedge splitting test. The materials that were used consisted of a polymer binder, an oxidizing agent, and aluminum particles. The test rate of the wedge splitting specimen was 50 mm/min, the temperature conditions were 50℃, room temperature, -40℃, and -60℃. The fracture energy, calculated from splitting load-crack mouth opening displacement(CMOD) curves, increased with decreasing temperature from 50℃ to -40℃. In addition, the strength of the particulate reinforced composites increased sharply at -60℃, and the composites evidenced brittle fracture due to the glass transition temperature. The strain fields near the crack tip were analyzed using digital image correlation.

  14. Modal Analysis in Lined Wedge-Shaped Ducts

    Science.gov (United States)

    Mechel, F. P.

    1998-10-01

    It has been suggested to describe the sound field in a wedge-shaped duct in a cylindrical co-ordinate system in which the boundaries of the wedge lie in a co-ordinate surface. This suggestion was developed in a companion paper [1]. The wave equation can be separated only if the boundaries are ideally reflecting (rigid or soft). Two solutions were proposed in reference [1] for absorbing boundaries. In the first solution the sound field is composed of “ideal modes” (modes in a wedge with ideally reflecting boundaries); the boundary condition at the absorbing boundary then leads to a system of equations for the mode amplitudes. The problem with this method lies in the fact that there is no radial orthogonality of the ideal modes so that the precision of the field synthesis by ideal modes is doubtful. In the second method in reference [1] one defines “fictitious modes” which satisfy the boundary conditions at the flanks exactly and which are based on hypergeometric functions as radial functions, but which produce a “rest” in the wave equation. It was described how this rest can be minimized; this procedure leads to slow numerical integrations. In the present paper, the wedge is subdivided into duct sections with parallel walls (the boundary is stepped); the fields in the sections are composed of duct modes (modes in a straight lined duct); the mode amplitudes are determined from the boundary conditions at the section limits. The advantages of the present method are (analytically) the duct modes are orthogonal across the sections, so the mode amplitudes can be determined with the usual precision of a modal analysis, and (numerically) no numerical integrations are needed.

  15. Large scale test of wedge shaped micro strip gas counters

    Energy Technology Data Exchange (ETDEWEB)

    Ackermann, M.; Atz, S.; Aulchenko, V.; Bachmann, S.; Baiboussinov, B.; Barthe, S.; Beaumont, W.; Beckers, T.; Beissel, F.; Benhammou, Y.; Bergdolt, A.M.; Bernier, K.; Bluem, P.; Bondar, A.; Bouhali, O.; Boulogne, I.; Bozzo, M.; Brom, J.M.; Camps, C.; Chorowicz, V.; Coffin, J.; Commichau, V.; Contardo, D.; Croix, J.; Troy, J. de; Drouhin, F.; Eberle, H.; Fluegge, G.; Fontaine, J.-C.; Geist, W.; Goerlach, U.; Gundlfinger, K.; Hangarter, K.; Haroutunian, R.; Helleboid, J.M.; Henkes, Th.; Hoffer, M.; Hoffman, C.; Huss, D.; Ischebeck, R.; Jeanneau, F.; Juillot, P.; Junghans, S.; Kapp, M.R.; Kaercher, K.; Knoblauch, D.; Kraeber, M.; Krauth, M.; Kremp, J.; Lounis, A.; Luebelsmeyer, K.; Maazouzi, C.; Macke, D.; Metri, R.; Mirabito, L.; Mueller, Th.; Nagaslaev, V.; Neuberger, D.; Nowack, A.; Pallares, A.; Pandoulas, D.; Petertill, M.; Pooth, O.; Racca, C.; Ripp, I.; Ruoff, E.; Sauer, A.; Schmitz, P.; Schulte, R.; Schultz von Dratzig, A.; Schunk, J.P.; Schuster, G.; Schwaller, B.; Shektman, L.; Siedling, R.; Sigward, M.H.; Simonis, H.J.; Smadja, G.; Stefanescu, J.; Szczesny, H.; Tatarinov, A.; Thuemmel, W.H.; Tissot, S.; Titov, V.; Todorov, T.; Tonutti, M.; Udo, F.; Velde, C. Vander. E-mail: vandervelde@hep.iihe.ac.be; Doninck, W. van; Dyck, Ch. van; Vanlaer, P.; Lancker, L. van; Verdini, P.G.; Weseler, S.; Wittmer, B.; Wortmann, R.; Zghiche, A.; Zhukov, V

    1999-11-01

    In order to check the system aspects of the forward-backward MSGC tracker designed for the future CMS experiment at LHC, 38 trapezoidal MSGC counters assembled in six multi-substrates detector modules were built and exposed to a muon beam at the CERN SPS. Results on the gain uniformity along the wedge-shaped strip pattern and across the detector modules are shown together with measurements of the detection efficiency and the spatial resolution.

  16. Large scale test of wedge shaped micro strip gas counters

    CERN Document Server

    Ackermann, M; Aulchenko, V M; Bachmann, S; Baibusinov, B O; Barthe, S; Beaumont, W; Beckers, T; Beissel, F; Benhammou, Ya; Bergdolt, A M; Bernier, K; Blüm, H P; Bondar, A E; Bouhali, O; Boulogne, I; Bozzo, M; Brom, J M; Camps, C; Chorowicz, V; Coffin, J P; Commichau, V; Contardo, D; Croix, J; De Troy, J G; Drouhin, F; Eberle, H; Flügge, G; Fontaine, J C; Geist, Walter M; Goerlach, U; Gundlfinger, K; Hangarter, K; Haroutunian, R; Helleboid, J M; Henkes, T; Hoffer, M; Hoffmann, C; Huss, D; Ischebeck, R; Jeanneau, F; Juillot, P; Junghans, S; Kapp, M R; Kärcher, K; Knoblauch, D; Kräber, M H; Krauth, M; Kremp, J; Lounis, A; Lübelsmeyer, K; Maazouzi, C; Macke, D; Metri, R; Mirabito, L; Müller, T; Nagaslaev, V; Neuberger, D; Nowak, A; Pallarès, A; Pandoulas, D; Petertill, M; Pooth, O; Racca, C; Ripp, I; Ruoff, E; Sauer, A; Schmitz, P; Schulte, R; Schultz von Dratzig, A; Schunk, J P; Schuster, G; Schwaller, B; Shekhtman, L I; Siedling, R; Sigward, M H; Simonis, H J; Smadja, G; Stefanescu, J; Szczesny, H; Tatarinov, A A; Thümmel, W H; Tissot, S; Titov, V; Todorov, T; Tonutti, M; Udo, Fred; Van der Velde, C; Van Doninck, W K; Van Dyck, C; Vanlaer, P; Van Lancker, L; Verdini, P G; Weseler, S; Wittmer, B; Wortmann, R; Zghiche, A; Zhukov, V

    1999-01-01

    In order to check the system aspects of the forward-backward MSGC tracker designed for the future CMS experiment at LHC, 38 trapezoidal MSGC counters assembled in six multi-substrates detector modules were built and exposed to a muon beam at the CERN SPS. Results on the gain uniformity along the wedge-shaped strip pattern and across the detector modules are shown together with measurements of the detection efficiency and the spatial resolution. (8 refs).

  17. DNS of compressible turbulent boundary layer over a blunt wedge

    Institute of Scientific and Technical Information of China (English)

    LI Xinliang; FU Dexun; MA Yanwan

    2005-01-01

    Direct numerical simulation of spatially evolving compressible boundary layer over a blunt wedge is performed in this paper. The free-stream Mach number is 6 and the disturbance source produced by wall blowing and suction is located downstream of the sound-speed point. Statistics are studied and compared with the results in incompressible flat-plate boundary layer. The mean pressure gradient effects on the vortex structure are studied.

  18. Wedge-local quantum fields on a nonconstant noncommutative spacetime

    Energy Technology Data Exchange (ETDEWEB)

    Much, A. [Max-Planck-Institute for Mathematics in the Sciences, 04103 Leipzig (Germany) and Institute for Theoretical Physics, University of Leipzig, 04009 Leipzig (Germany)

    2012-08-15

    Within the framework of warped convolutions we deform the massless free scalar field. The deformation is performed by using the generators of the special conformal transformations. The investigation shows that the deformed field turns out to be wedge-local. Furthermore, it is shown that the spacetime induced by the deformation with the special conformal operators is nonconstant noncommutative. The noncommutativity is obtained by calculating the deformed commutator of the coordinates.

  19. On the acoustic wedge design and simulation of anechoic chamber

    Science.gov (United States)

    Jiang, Changyong; Zhang, Shangyu; Huang, Lixi

    2016-10-01

    This study proposes an alternative to the classic wedge design for anechoic chambers, which is the uniform-then-gradient, flat-wall (UGFW) structure. The working mechanisms of the proposed structure and the traditional wedge are analyzed. It is found that their absorption patterns are different. The parameters of both structures are optimized for achieving minimum absorber depth, under the condition of absorbing 99% of normal incident sound energy. It is found that, the UGFW structure achieves a smaller total depth for the cut-off frequencies ranging from 100 Hz to 250 Hz. This paper also proposes a modification for the complex source image (CSI) model for the empirical simulation of anechoic chambers, originally proposed by Bonfiglio et al. [J. Acoust. Soc. Am. 134 (1), 285-291 (2013)]. The modified CSI model considers the non-locally reactive effect of absorbers at oblique incidence, and the improvement is verified by a full, finite-element simulation of a small chamber. With the modified CSI model, the performance of both decorations with the optimized parameters in a large chamber is simulated. The simulation results are analyzed and checked against the tolerance of 1.5 dB deviation from the inverse square law, stipulated in the ISO standard 3745(2003). In terms of the total decoration depth and anechoic chamber performance, the UGFW structure is better than the classic wedge design.

  20. Wave dynamic processes in cellular detonation reflection from wedges

    Institute of Scientific and Technical Information of China (English)

    Zongmin Hu; Zonglin Jiang

    2007-01-01

    When the cell width of the incident deto-nation wave (IDW) is comparable to or larger than theMach stem height,self-similarity will fail during IDWreflection from a wedge surface.In this paper,the det-onation reflection from wedges is investigated for thewave dynamic processes occurring in the wave front,including transverse shock motion and detonation cellvariations behind the Mach stem.A detailed reactionmodel is implemented to simulate two-dimensional cel-lular detonations in stoichiometric mixtures of H2/O2diluted by Argon.The numerical results show that thetransverse waves,which cross the triple point trajec-tory of Mach reflection,travel along the Mach stem andreflect back from the wedge surface,control the size ofthe cells in the region swept by the Mach stem.It is theenergy carried by these transverse waves that sustainsthe triple-wave-collision with a higher frequency withinthe over-driven Mach stem.In some cases,local wavedynamic processes and wave structures play a dominantrole in determining the pattern of cellular record,lead-ing to the fact that the cellular patterns after the Machstem exhibit some peculiar modes.

  1. The role of fibular for supramalleolar osteotomy in treatment of varus ankle arthritis: a biomechanical and clinical study.

    Science.gov (United States)

    Zhao, Hongmou; Liang, Xiaojun; Li, Yi; Yu, Guangrong; Niu, Wenxin; Zhang, Yan

    2016-10-24

    Supramalleolar osteotomy (SMOT) is a well-accepted treatment method for mid-stage varus ankle osteoarthritis (OA). However, few studies have examined the role of fibular osteotomy in SMOT. The objective of the current study was to compare the biomechanical and clinical outcomes of SMOT with and without fibular osteotomy. Eight cadaveric lower legs with 10° varus/valgus SMOT models were tested using a Tekscan ankle sensor. Tibiotalar joint contact with and without fibular osteotomy conditions were compared. Forty-one varus ankle OA patients treated with SMOT were included; 22 underwent fibular osteotomy, and 19 did not. The Maryland foot score and radiological angles were used for clinical evaluation. The mean contact area and pressure did not differ significantly between normal and varus/valgus conditions with the fibula preserved. After fibular osteotomy, the mean contact area decreased and the mean contact pressure increased significantly in varus and valgus conditions (P osteotomy in varus/valgus conditions. After a mean follow-up of 36.6 months (range 17-61), there was no significant difference in the Maryland scores of the two groups. However, in the fibular osteotomy group, the talar tilt angle decreased (P osteotomy facilitates the translation of tibiotalar contact pressure and is helpful for varus ankle realignment in patients with large talar tilts and small tibiocrural angles.

  2. An investigation on the incidence of neurosensory disturbances of inferior alveolar nerve and condylardisplacement with Choung (IVSRO osteotomy

    Directory of Open Access Journals (Sweden)

    Shirani Gh

    2004-02-01

    Full Text Available The choung osteotomy (Intraoral Vertico- Sagittal Ramus Osteotomy has developed"nsince 1992 in the treatment of mandibular prognathism. In IVSRO, osteotomy plane is theoretically parallel to"nthe original sagittal plane and thereby attempting to decrease the incidence of condylar dispacement. This"nosteotomy designed additionally to decrease neurosensory disturbances."nPurpose: The aim of this study was to evaluate the incidence of neurosensory deficit and condylar"ndisplacement with IVSRO and Sagittal Split Ramus Osteotomy (SSRO."nMaterials and Methods: In this study, mandibular set back surgery was accomplished upon 7 patients by"nchoung osteotomy. In addition to choung osteotomy, in 2 patients Lefort 1 osteomy was performed for"nmaxillary protrusion and for 2 other patients, chain surgery was performed. Variables such as the"nneurosensory disturbances of inferior alveolar nerve and condylar displacement following choung osteotomy"nwere investigated. All the patients were followed up one year after osteotomy. OPG, Lateral Cephalogram and"nSubmentovertex radiographies were take pre and postoperatively for all patients."nResults: No statistically significant differences were found in condylar displacement (P>0.5. However, Mc"nNemar analysis showed significant difference of neurosensory deficit between IVSRO and SSRO (P=0.001."nConclusion: It is suggested that choung osteotomy is a safe procedure for mandibular surgery.

  3. Long-Term Outcome of Step-Cut Ulnar Shortening Osteotomy for Ulnar Impaction Syndrome.

    Science.gov (United States)

    Papatheodorou, Loukia K; Baratz, Mark E; Bougioukli, Sofia; Ruby, Tyler; Weiser, Robert W; Sotereanos, Dean G

    2016-11-02

    Extra-articular ulnar shortening osteotomy is a common procedure for the surgical treatment of ulnar impaction syndrome. Several techniques for this osteotomy have been developed to avoid the morbidity associated with a standard transverse osteotomy. However, these techniques require special instrumentation and are expensive. The purpose of this study was to evaluate the outcome of step-cut ulnar shortening osteotomy without special jigs for ulnar impaction syndrome. A retrospective study of 164 consecutive patients who underwent step-cut ulnar shortening osteotomy between 2000 and 2010 was performed. The long arm of the step-cut osteotomy was oriented in the coronal plane parallel to the long axis of the ulna. The short arms of the osteotomy were perpendicular to the long axis in the axial plane. Fixation was performed with a palmar 3.5-mm standard neutralization plate and a lag screw. The goal of the osteotomy was to reduce ulnar variance, which was assessed in all patients with pronated grip-view radiographs preoperatively and postoperatively. Preoperative ulnar variance ranged from +1 to +6 mm. All patients were followed for at least 24 months. Union of the osteotomy site was achieved at a mean of 8.2 weeks. The union rate was 98.8%. There were 2 cases of nonunion, which required additional surgery. The mean postoperative ulnar variance was +0.2 mm (range, -1 to +1.5 mm) after a mean overall ulnar shortening of 2.5 mm. All patients returned to their previous work, in a mean of 4 months. The plate was removed from 12 patients because of plate-related symptoms. No other complications were encountered. The step-cut ulnar shortening osteotomy provides ample bone-to-bone contact and simplifies control of rotation. Stable internal fixation with standard techniques allowed an early return to functional activities. Palmar placement of the plate diminishes the need for plate removal. This is a simple and less expensive technique for ulnar shortening that does not

  4. Vertebral column decancellation: a new spinal osteotomy technique for correcting rigid thoracolumbar kyphosis in patients with ankylosing spondylitis.

    Science.gov (United States)

    Zhang, X; Zhang, Z; Wang, J; Lu, M; Hu, W; Wang, Y; Wang, Y

    2016-05-01

    The aim of this study is to introduce and investigate the efficacy and feasibility of a new vertebral osteotomy technique, vertebral column decancellation (VCD), for rigid thoracolumbar kyphotic deformity (TLKD) secondary to ankylosing spondylitis (AS). We took 39 patients from between January 2009 and January 2013 (26 male, 13 female, mean age 37.4 years, 28 to 54) with AS and a TLKD who underwent VCD (VCD group) and compared their outcome with 45 patients (31 male, 14 female, mean age 34.8 years, 23 to 47) with AS and TLKD, who underwent pedicle subtraction osteotomy (PSO group), according to the same selection criteria. The technique of VCD was performed at single vertebral level in the thoracolumbar region of AS patients according to classification of AS kyphotic deformity. Pre- and post-operative chin-brow vertical angle (CBVA), sagittal vertical axis (SVA) and sagittal Cobb angle in the thoracolumbar region were reviewed in the VCD and PSO groups. Intra- , post-operative and general complications were analysed in both group. lf patients could lie on their backs and walk with horizontal vision and sagittal profile, radiographic parameters improved significantly post-operatively in both groups. No major acute complications such as death or complete paralysis occurred in either group. In the VCD group, five patients (12.8%) experienced complications such as severe CSF leak (n = 4), deep wound infection (n = 1) and in one patient a transient neurological deficit occurred. In the PSO group, eight patients (17.8%) suffered conditions such as severe CSF leak (n = 5), infections (n = 2) and sagittal translation at osteotomy site (n = 1). Scoliosis Research Society outcomes instrument (SRS-22) improved significantly in both groups. All patients achieved solid fusion at latest follow-up and no implant failures were noted in either group. The VCD technique is a new, safe and effective strategy for correction of rigid TLKD in AS patients. The main advantage of the new

  5. [Closing diastemas].

    Science.gov (United States)

    Vieira, L C; Pereira, J C; Coradazzi, J L; Francischone, C E

    1990-01-01

    The authors describe a clinical case of closing upper central incisives diastema, reconstructiva of a conoid upper lateral and the rechaping of an upper canine to a lateral incisive. The material used was composite resin.

  6. Robustness of oscillatory α2 dynamos in spherical wedges

    Science.gov (United States)

    Cole, E.; Brandenburg, A.; Käpylä, P. J.; Käpylä, M. J.

    2016-10-01

    Context. Large-scale dynamo simulations are sometimes confined to spherical wedge geometries by imposing artificial boundary conditions at high latitudes. This may lead to spatio-temporal behaviours that are not representative of those in full spherical shells. Aims: We study the connection between spherical wedge and full spherical shell geometries using simple mean-field dynamos. Methods: We solve the equations for one-dimensional time-dependent α2 and α2Ω mean-field dynamos with only latitudinal extent to examine the effects of varying the polar angle θ0 between the latitudinal boundaries and the poles in spherical coordinates. Results: In the case of constant α and ηt profiles, we find oscillatory solutions only with the commonly used perfect conductor boundary condition in a wedge geometry, while for full spheres all boundary conditions produce stationary solutions, indicating that perfect conductor conditions lead to unphysical solutions in such a wedge setup. To search for configurations in which this problem can be alleviated we choose a profile of the turbulent magnetic diffusivity that decreases toward the poles, corresponding to high conductivity there. Oscillatory solutions are now achieved with models extending to the poles, but the magnetic field is strongly concentrated near the poles and the oscillation period is very long. By changing both the turbulent magnetic diffusivity and α profiles so that both effects are more concentrated toward the equator, we see oscillatory dynamos with equatorward drift, shorter cycles, and magnetic fields distributed over a wider range of latitudes. Those profiles thus remove the sensitive and unphysical dependence on θ0. When introducing radial shear, we again see oscillatory dynamos, and the direction of drift follows the Parker-Yoshimura rule. Conclusions: A reduced α effect near the poles with a turbulent diffusivity concentrated toward the equator yields oscillatory dynamos with equatorward migration and

  7. Chronology and palaeoenvironmental implications of the ice-wedge pseudomorphs and composite-wedge casts on the Magdalen Islands (eastern Canada)

    DEFF Research Database (Denmark)

    Remillard, A.M.; Hetu, B.; Bernatchez, P.

    2015-01-01

    The Magdalen Islands are a valuable terrestrial record, evidencing the complex glacial and periglacial history of the Gulf of St. Lawrence. Thirteen structures interpreted as ice-wedge pseudomorphs or composite-wedge casts were observed at four sites on the southern Magdalen Islands and testify...

  8. Assessment of computerized treatment planning system accuracy in calculating wedge factors of physical wedged fields for 6 MV photon beams.

    Science.gov (United States)

    Muhammad, Wazir; Maqbool, Muhammad; Shahid, Muhammad; Hussain, Amjad; Tahir, Sajjad; Matiullah; Rooh, Gul; Ahmad, Tanveer; Lee, Sang Hoon

    2011-07-01

    Wedge filters are commonly used in external beam radiotherapy to achieve a uniform dose distribution within the target volume. The main objective of this study was to investigate the accuracy of the beam modifier algorithm of Theraplan plus (TPP version 3.8) treatment planning system and to confirm that either the beam hardening, beam softening and attenuation coefficients along with wedge geometry and measured wedge factor at single depth and multiple fields sizes can be the replacement of wedged profile and wedged cross-sectional data or not. In this regard the effect of beam hardening and beam softening was studied with physical wedges for 6 MV photons. The Normalized Wedge Factors (NWFs) were measured experimentally as well as calculated with the Theraplan plus, as a function of depth and field size in a water phantom for 15°, 30°, 45°, and 60° wedge filters. The beam hardening and softening was determined experimentally by deriving the required coefficients for all wedge angles. The TPP version 3.8 requires wedge transmission factor at single depth and multiple field sizes. Without incorporating the hardening and softening coefficients the percent difference between measured and calculated NFWs was as high as 7%. After the introduction of these parameters into the algorithm, the agreement between measured and TPP (V 3.8) calculated NWFs were improved to within 2 percent for various depths. Similar improvement was observed in TPP version 3.8 while calculating NWFs for various field sizes when the required coefficients were adjusted. In conclusion, the dose calculation algorithm of TPP version 3.8 showed good accuracy for a 6 MV photon beam provided beam hardening and softening parameters are taken into account. From the results, it is also concluded that, the beam hardening, beam softening and attenuation coefficients along with wedge geometry and measured wedge factor at single depth and multiple fields sizes can be the replacement of wedged profile and

  9. Observation of wedge waves and their mode transformation by laser ultrasonic technique

    Institute of Scientific and Technical Information of China (English)

    Jing Jia; Zhonghua Shen; Lijuan Wang; Ling Yuan

    2011-01-01

    Wedge waves (WWs) in wedges, including their dispersion characteristics and mode transformation, are investigated using the laser ultrasound technique. Pulsed laser excitation and optical deflection beam method for detection are used to record WWs. Numerous WWs are detected by scanning the excitation laser along the wedge tip. Dispersions of WWs are obtained by using the two-dimensional (2D) Fourier transformation method, and different WW orders are revealed on the wedges. Mode transformation is determined by fixing the distance between the excitation and detection position, as well as by scanning the samples along the normal direction of the wedge tip.%@@ Wedge waves (WWs) in wedges, including their dispersion characteristics and mode transformation, are investigated using the laser ultrasound technique. Pulsed laser excitation and optical deflection beam method for detection are used to record WWs. Numerous WWs are detected by scanning the excitation laser along the wedge tip. Dispersions of WWs are obtained by using the two-dimensional (2D) Fourier transformation method, and different WW orders are revealed on the wedges. Mode transformation is determined by fixing the distance between the excitation and detection position, as well as by scanning the samples along the normal direction of the wedge tip.

  10. Safe Zone for Neural Structures in Medial Displacement Calcaneal Osteotomy: A Cadaveric and Radiographic Investigation.

    Science.gov (United States)

    Talusan, Paul G; Cata, Ezequiel; Tan, Eric W; Parks, Brent G; Guyton, Gregory P

    2015-12-01

    We aimed to define reference lines on standard lateral ankle radiographs that could be used intraoperatively to minimize iatrogenic nerve injury risk in medial displacement calcaneal osteotomy. Forty cadaveric specimens were used. In 20 specimens, the sural, medial plantar (MP), and lateral plantar (LP) nerves were sutured to radiopaque wire, and a lateral ankle radiograph was obtained. On the radiograph, a line was drawn from the posterior superior apex of the calcaneal tuberosity to the origin of the plantar fascia and labeled as the "landmark line." A parallel line was drawn 2 mm posterior to the most posterior nerve, and the area between these lines was defined as the safe zone. In 20 additional specimens, an osteotomy was performed 1 cm anterior to the landmark line using a percutaneous or open technique. Dissection was performed to assess for laceration of the sural, MP, LP, medial calcaneal (MC), or lateral calcaneal (LC) nerves. The safe zone was determined to be within the area 11.2 ± 2.7 mm anterior to the landmark line. After open osteotomy, lacerations were found in 3 of 10 MC nerves and 3 of 10 LC nerves. After percutaneous osteotomy, lacerations were found in 2 of 10 MC nerves and 1 of 10 LC nerves. No lacerations of the sural, MP, or LP nerves were found with either osteotomy. The safe zone extended 11.2 ± 2.7 mm anterior to the described landmark line. The MC and LC nerves were always at risk during medial displacement calcaneal osteotomy. Nerve injury to both major and minor sensory nerves is likely underrecognized as a source of morbidity after calcaneal osteotomy. The current study provides a ready intraoperative guideline for minimizing this risk. © The Author(s) 2015.

  11. Neurologic Deficit Associated With Lateralizing Calcaneal Osteotomy for Cavovarus Foot Correction.

    Science.gov (United States)

    VanValkenburg, Scott; Hsu, Raymond Y; Palmer, Daniel S; Blankenhorn, Brad; Den Hartog, Bryan D; DiGiovanni, Christopher W

    2016-10-01

    Lateralizing calcaneal osteotomy (LCO) is a frequently used technique to correct hindfoot varus deformity. Tibial nerve palsy following this osteotomy has been described in case reports but the incidence has not been quantified. Eighty feet in 72 patients with cavovarus foot deformity were treated over a 6-year span by 2 surgeons at their respective institutions. Variations of the LCO were employed for correction per surgeon choice. A retrospective chart review analyzed osteotomy type, osteotomy location, amount of translation, and addition of a tarsal tunnel release in relation to the presence of any postoperative tibial nerve palsy. Tibial nerve branches affected and the time to resolution of any deficits was also noted. The incidence of neurologic deficit following LCO was 34%. With an average follow-up of 19 months, a majority (59%) resolved fully at an average of 3 months. There was a correlation between the development of neurologic deficit and the location of the osteotomy in the middle third as compared to the posterior third of the calcaneal tuber. We found no relationship between the osteotomy type, amount of correction, or addition of a tarsal tunnel release and the incidence of neurologic injury. Tibial nerve palsy was not uncommon following LCO. Despite the fact that deficits were found to be transient, physicians should be more aware of this potential problem and counsel patients accordingly. To decrease the risk of this complication, we advocate extra caution when performing the osteotomy in the middle one-third of the calcaneal tuberosity. Although intuitively the addition of a tarsal tunnel release may protect against injury, no protective effect was demonstrated in this retrospective study. Level III, retrospective cohort study. © The Author(s) 2016.

  12. Fixation of Intertrochanteric Valgus Osteotomy with T Plate in Treatment of Developmental Coxa Vara.

    Science.gov (United States)

    Elzohairy, Mohamed Mansour; Khairy, Hosam Mohamed

    2016-09-01

    Although the valgus subtrochanteric osteotomy is considered as a standard surgical treatment for coxa vara, there is no consensus on the optimal method of fixation and osteotomy technique. Fixation of the osteotomy has been achieved by various methods including external fixation and internal fixation with pins and cerclage and a variety of plates. The aim of this study is the evaluation of the results of developmental coxa treated by Y intertrochanteric valgus osteotomy fixed with a T-buttress plate compared with other methods of fixation in the literature. Eighteen corrective valgus intertrochanteric femoral osteotomies were performed in 18 patients (18 hips) for treatment of unilateral developmental coxa vara deformity and fixed with a T plate. There were 12 males and 6 females. The right hip was affected in 10 patients and the left hip in 8 patients. Clinically, patients were evaluated by Larson hip score. Radiographically, anteroposterior view of the pelvis and frog leg lateral views of the affected hip were taken preoperatively and compared with the findings at the final follow-up. The average follow-up was 29 months (range, 24 to 36 months). Clinical results showed improvement of the mean Larson hip score from 57.8 to 97.0 (p osteotomies were completely united in 2.4 months (range, 2 to 3 months) with the achievement of the planned correction angle. The average correction of Hilgenreiner's epiphyseal angle improved from 78.2° to 27.8° (p osteotomy of the proximal femur fixed with a T plate may be efficient for treatment of developmental coxa vara. With careful planning, it can result in a low complication rate and insignificant or minimal recurrence rate.

  13. Rate of Malunion Following Bi-plane Chevron Medial Malleolar Osteotomy.

    Science.gov (United States)

    Bull, Patrick E; Berlet, Gregory C; Canini, Cameron; Hyer, Christopher F

    2016-06-01

    Access to the medial half of the talus can be challenging even with an osteotomy. Although several techniques are presented in the literature, critical evaluation of fixation, union, and alignment is lacking. The chevron medial malleolar osteotomy provides advantages of perpendicular instrumentation access and wide exposure to the medial talus. Postoperative displacement resulting in malunion, and possibly provoking ankle osteoarthritis, is a known complication. The present study describes our experience with the osteotomy. A consecutive series cohort of 50 bi-plane chevron osteotomies performed from 2004 to 2013 were evaluated. Forty-six were secured using 2 lag screws, and 4 were secured using 2 lag screws and a medial buttress plate. Radiographic studies performed at 2, 6, and 12 weeks and at final follow-up were analyzed for postoperative displacement, malunion, non-union, and hardware-related complications. At initial postoperative follow-up, 47 of 50 had adequate radiographs for review, and 18 of 47 (38.3%) showed some displacement when compared to the initial osteotomy fixation position. By final follow-up, 15 of 50 (30.0%) had measurable incongruence. Hardware removal was performed in 13 (26.0%) cases at an average of 2.4 years postoperation. Bi-plane medial malleolar chevron osteotomy fixed with 2 lag screws showed a 30.0% malunion rate with an average of 2 mm of incongruence on final follow-up radiographs, which is higher than what has been reported in the literature. In our practice, we now use a buttress plate and more recently have eliminated postoperative osteotomy displacement. Level IV, retrospective case series. © The Author(s) 2016.

  14. The dawn of computer-assisted robotic osteotomy with ytterbium-doped fiber laser.

    Science.gov (United States)

    Sotsuka, Yohei; Nishimoto, Soh; Tsumano, Tomoko; Kawai, Kenichiro; Ishise, Hisako; Kakibuchi, Masao; Shimokita, Ryo; Yamauchi, Taisuke; Okihara, Shin-ichiro

    2014-05-01

    Currently, laser radiation is used routinely in medical applications. For infrared lasers, bone ablation and the healing process have been reported, but no laser systems are established and applied in clinical bone surgery. Furthermore, industrial laser applications utilize computer and robot assistance; medical laser radiations are still mostly conducted manually nowadays. The purpose of this study was to compare the histological appearance of bone ablation and healing response in rabbit radial bone osteotomy created by surgical saw and ytterbium-doped fiber laser controlled by a computer with use of nitrogen surface cooling spray. An Ytterbium (Yb)-doped fiber laser at a wavelength of 1,070 nm was guided by a computer-aided robotic system, with a spot size of 100 μm at a distance of approximately 80 mm from the surface. The output power of the laser was 60 W at the scanning speed of 20 mm/s scan using continuous wave system with nitrogen spray level 0.5 MPa (energy density, 3.8 × 10(4) W/cm(2)). Rabbits radial bone osteotomy was performed by an Yb-doped fiber laser and a surgical saw. Additionally, histological analyses of the osteotomy site were performed on day 0 and day 21. Yb-doped fiber laser osteotomy revealed a remarkable cutting efficiency. There were little signs of tissue damage to the muscle. Lased specimens have shown no delayed healing compared with the saw osteotomies. Computer-assisted robotic osteotomy with Yb-doped fiber laser was able to perform. In rabbit model, laser-induced osteotomy defects, compared to those by surgical saw, exhibited no delayed healing response.

  15. Double pelvic osteotomy for the treatment of hip dysplasia in young dogs.

    Science.gov (United States)

    Vezzoni, A; Boiocchi, S; Vezzoni, L; Vanelli, A B; Bronzo, V

    2010-01-01

    The aim of this study was to evaluate the feasibility of the double pelvic osteotomy (DPO) (osteotomy of the ilium and pubis) to treat clinical cases of hip dyplasia in young dogs instead of performing a triple pelvic osteotomy (TPO) (osteotomy of the ilium, pubis, and ischium). Candidates for DPO were 4.5- to nine-month-old dogs with coxofemoral joint subluxation and laxity, indicative of susceptibility to future development of severe hip dysplasia. The angle of reduction (AR) and angle of subluxation (AS) with Ortolani's sign, Norberg angle (NA), percentage of femoral head (PC) covered by the acetabulum, and the pelvic diameters and their relationships were measured clinically and radiographically before and after surgery. The surgical technique was similar to the TPO technique, but excluded ischiatic osteotomy. A DPO was carried out in 53 joints of 34 dogs; AR and AS values immediately postoperatively and at the one- and two-month follow-up examinations were significantly lower than the preoperative values (p table (7.5%). Changes in PC and NA values obtained immediately after surgery and at the first and second follow-up examinations were significantly greater (p surgery. Sufficient acetabular ventroversion was achieved to counteract joint subluxation and the modifications of AR and AS. The NA and PC direct postoperative values reflected a significant improvement in the dorsal acetabular coverage. Restoration of normal joint congruity (PC from 50 to 72%) and maintenance of the pelvic geometry without pelvic narrowing were the most intriguing features of DPO. The complications observed were greatly reduced when using dedicated DPO plates. Based on our experience, the morbidity after unilateral and bilateral DPO was lower than after TPO because elimination of the ischiatic osteotomy allowed for increased stability of the pelvis. The surgical technique of DPO was a little more demanding than TPO because of the difficulty in handling and rotating the acetabular

  16. Biomechanical consequences of adding plantar fascia release to metatarsal osteotomies: Changes in forefoot plantar pressures.

    Science.gov (United States)

    Aydogan, Umur; Roush, Evan P; Moore, Blake E; Andrews, Seth H; Lewis, Gregory S

    2017-04-01

    Destruction of the normal metatarsal arch by a long metatarsal is often a cause for metatarsalgia. When surgery is warranted, distal oblique, or proximal dorsiflexion osteotomies of the long metatarsal bones are commonly used. The plantar fascia has anatomical connection to all metatarsal heads. There is controversial scientific evidence on the effect of plantar fascia release on forefoot biomechanics. In this cadaveric biomechanical study, we hypothesized that plantar fascia release would augment the plantar metatarsal pressure decreasing effects of two common second metatarsal osteotomy techniques. Six matched pairs of foot and ankle specimens were mounted on a pressure mat loading platform. Two randomly assigned surgery groups, which had received either distal oblique, or proximal dorsiflexion osteotomy of the second metatarsal, were evaluated before and after plantar fasciectomy. Specimens were loaded up to a ground reaction force of 400 N at varying Achilles tendon forces. Average pressures, peak pressures, and contact areas were analyzed. Supporting our hypothesis, average pressures under the second metatarsal during 600 N Achilles load were decreased by plantar fascia release following proximal osteotomy (p fascia release following modified distal osteotomy, under multiple Achilles loading conditions (p < 0.05). Plantar fasciotomy should not be added to distal metatarsal osteotomy in the treatment of metatarsalgia. If proximal dorsiflexion osteotomy would be preferred, plantar fasciotomy should be approached cautiously not to disturb the forefoot biomechanics. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:800-804, 2017. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  17. Sagittal accuracy of tibial osteotomy position during in vivo tibial plateau levelling osteotomy performed without an alignment jig and cutting guide.

    Science.gov (United States)

    Craig, Andrew; Witte, Philip Georg; Scott, Harry William

    2017-01-16

    To assess the accuracy of tibial osteotomy location for tibial plateau levelling osteotomy (TPLO) in the sagittal plane and its effect on the postoperative tibial plateau angle (TPA), when performed without an alignment jig and saw guide. Also, to document the improvement gained with experience. Medical records and stifle radiographs of dogs undergoing TPLO, without the use of an alignment jig and saw guide, by one surgeon were reviewed (2010-2014). Postoperative radiographs were reviewed to record the distance and direction of eccentricity. Postoperative TPA was also recorded. In a series of 401 TPLO procedures, 231 met the inclusion criteria. The absolute distance of eccentricity (DOE) for all dogs was 3.0 ± 1.6 mm. When evaluating surgical experience, the DOE for the final 77 cases (2.72 ± 1.43 mm), the middle 77 cases (3.18 ± 1.49 mm), and the first 77 cases (3.24 ± 1.7 mm) were not significantly different (p = 0.07157). There was a very weak correlation between DOE and postoperative TPA (R = 0.029). The location of the tibial osteotomy when performing TPLO without an alignment jig and saw guide compared favourably with previously documented use of an alignment jig and saw guide. Whilst the location of the tibial osteotomy has a theoretical impact on the postoperative TPA, other factors appear to be of greater importance. Surgeon experience did not result in significant improvement in accuracy up to 231 procedures.

  18. The interplay between wetting and phase behaviour in binary polymer films and wedges: Monte Carlo simulations and mean field calculations

    Science.gov (United States)

    Müller, M.; Binder, K.

    2005-03-01

    By confining a binary mixture, one can profoundly alter its miscibility behaviour. The qualitative features of miscibility in confined geometry are rather universal and are shared by polymer mixtures as well as small molecules, but the unmixing transition in the bulk and the wetting transition are typically well separated in polymer blends. We study the interplay between wetting and miscibility of a symmetric polymer mixture via large scale Monte Carlo simulations in the framework of the bond fluctuation model and via numerical self-consistent field calculations. The film surfaces interact with the monomers via short-ranged potentials, and the wetting transition of the semi-infinite system is of first order. It can be accurately located in the simulations by measuring the surface and interface tensions and using Young's equation. If both surfaces in a film attract the same component, capillary condensation occurs and the critical point is close to the critical point of the bulk. If surfaces attract different components, an interface localization/delocalization occurs which gives rise to phase diagrams with two critical points in the vicinity of the pre-wetting critical point of the semi-infinite system. The crossover between these two types of phase diagrams as a function of the surface field asymmetry is studied. We investigate the dependence of the phase diagram on the film width Δ for antisymmetric surface fields. Upon decreasing the film width the two critical points approach the symmetry axis of the phase diagram, and below a certain width, Δtri, there remains only a single critical point at symmetric composition. This corresponds to a second order interface localization/delocalization transition even though the wetting transition is of first order. At a specific film width, Δtri, tricritical behaviour is found. The behaviour of antisymmetric films is compared with the phase behaviour in an antisymmetric double wedge. While the former is the analogy of the

  19. The skeletal stability after maxillo-mandibular osteotomy with a "physiological positioning strategy".

    Science.gov (United States)

    Ohba, Seigo; Nakao, Noriko; Nakatani, Yuya; Kawasaki, Takako; Minamizato, Tokutarou; Koga, Takamitsu; Kohara, Haruka; Yoshida, Noriaki; Asahina, Izumi

    2014-12-01

    The aim of this study was to estimate skeletal and dental stability after maxillomandibular osteotomy with physiological positioning. Ten patients (7 men and 3 women) with skeletal mandibular prognathism were treated by conventional Le Fort I osteotomy for the maxilla and unfixed short lingual osteotomy for the mandible together with physiological positioning. We used cephalometric analysis to evaluate the skeletal and dental stability preoperatively, immediately after maxillomandibular osteotomy, and more than 1 year later. The immediately postoperative measurements for the SNA and the SN-palatal planes were 0.15° (p=0.67) and 1.0° (p=0.17), respectively. The positions of the anterior nasal spine, posterior nasal spine, and A point showed minimal changes 1 year postoperatively. The postoperative difference for SNB was 0.76° (p=0.04). Dental stability was apparent postoperatively. We conclude that reliable stability of both the maxilla and the mandible was achieved after maxillomandibular osteotomy with physiological positioning in patients with mandibular prognathism.

  20. L5 pedicle subtraction osteotomy for high-grade isthmic spondylolisthesis.

    Science.gov (United States)

    Radcliff, Kristen E; Jakoi, Andre M

    2015-04-01

    To the authors' knowledge, this is the first article to present a pedicle subtraction osteotomy in the lumbar spine to correct and stabilize a high-grade isthmic spondylolisthesis, which poses many challenges with regard to treatment options and outcomes. The optimal surgical treatment for high-grade spondylolisthesis is controversial, but the goals of treatment are to stabilize the affected spinal levels and to decompress the neural elements. A pedicle subtraction osteotomy is a reconstructive procedure that addresses fixed sagittal imbalance by increasing lumbar lordosis through posterior spinal column shortening. The authors report a 46-year-old patient with chronic, progressively worsening back and leg radiculopathy accompanied by sagittal plane malalignment and for which a pedicle subtraction osteotomy was performed. The procedure yielded stabilization of the patient's lumbar spondylolisthesis and sagittal plane alignment was restoration. At 3 months postoperatively, the patient's pain had fully resolved and her motor and neurologic examination exhibited no deficits. At 24 months postoperatively, she was still symptom-free and ambulating without assistance. This report is the first documented successful pedicle subtraction osteotomy in the treatment of high-grade spondylolisthesis. This report indicates that certain patient populations may be amenable to pedicle subtraction osteotomy as a treatment option for pathology involving high-grade isthmic spondylolisthesis.

  1. An Anatomic Study of the Percutaneous Endoscopically Assisted Calcaneal Osteotomy Technique to Correct Hindfoot Malalignment.

    Science.gov (United States)

    Veljkovic, Andrea; Tennant, Joshua; Rungprai, Chamnanni; Abbas, Kaniza Zahra; Phisitkul, Phinit

    2017-02-01

    Open calcaneal osteotomy using traditional methods is associated with complications such as sural nerve injury and potential wound healing problems. We hypothesized that by using novel minimally invasive techniques, these potential risks could be mitigated. This anatomic cadaveric study serves to assess the safety of percutaneous endoscopically assisted calcaneal osteotomy (PECO) compared to a traditional open osteotomy technique. Anatomic safety of PECO was assessed using 8 fresh-frozen cadaver below-knee specimens. Lateral calcaneal nerve (LCN) damage was primarily noted and then secondly compared to a potential open surgical incision approach. Only 1 of 11 LCN branches (n = 8 limbs) was transected using PECO, compared to up to 8 of 10 LCN branches (n = 6 limbs) that potentially would have been injured during open surgery. Percutaneous endoscopically assisted calcaneal osteotomy is a minimally invasive technique that had fewer nerve injuries in this cadaveric model than traditional open surgery. Percutaneous endoscopically assisted calcaneal osteotomy due to its less invasive nature may result in fewer neurovascular injuries relative to an open procedure.

  2. Virtual Bernese osteotomy using three-dimensional computed tomography in hip dysplasia.

    Science.gov (United States)

    Suh, Dong Hun; Lee, Dae Hee; Jeong, Woong Kyo; Park, Sang Won; Kang, Chang Ho; Lee, Soon Hyuck

    2012-04-01

    Accurate assessment of acetabular morphology and its relationship to the femoral head is essential for planning a periacetabular osteotomy. We observed the acetabular coverage after virtual Bernese osteotomy using computer-aided technique. Three-dimensional computed tomography of 18 normal hips and 3 symptomatic dysplastic hips were analyzed. Through the center of the femoral head, vertical images were obtained at 10° intervals from 0° to 180° of rotation, using multiplanar reformation technique. Subsequently we measured 19 center-edge angles (CEAs) from each acetabulum. Four types of virtual osteotomy were performed on the three dysplastic hips. The adequacy of acetabular coverage after osteotomy was determined by comparing CEAs after correction with normal CEAs. Pearson correlation coefficients between the CEAs measured from normal cases and postoperative cases after lateral rotation of osteotomized fragments were 0.906 in case 1, 0.975 in case 2, 0.976 in case 3. Additional anterior rotation increased anterior acetabular coverage and simultaneously decreased posterior coverage in all three cases. Computer-aided virtual surgery technique based on three-dimensional computed tomography information enabled acetabular coverage to be quantified preoperatively in Bernese osteotomy. Lateral rotation of osteotomized acetabular fragments improved anterior and posterior coverage as well as lateral coverage.

  3. Complications associated with the Bernese periacetabular osteotomy for hip dysplasia in adolescents.

    Science.gov (United States)

    Thawrani, Dinesh; Sucato, Daniel J; Podeszwa, David A; DeLaRocha, Adriana

    2010-07-21

    The Bernese (Ganz) periacetabular osteotomy is an effective surgical procedure to reorient the acetabulum, allowing restoration of anatomic femoral head coverage and medial translation of the hip in adults with hip dysplasia. However, it is a challenging surgical procedure, and we know of no study that has specifically analyzed the complications and associated factors seen with this procedure in adolescent patients. A retrospective clinical and radiographic review of a consecutive series of adolescent patients who underwent a Bernese periacetabular osteotomy for hip dysplasia was conducted. Eighty-three osteotomies were performed in seventy-six patients with an average age (and standard deviation) of 15.6 +/- 2.4 years. Significant improvement from the preoperative to the two-year follow-up evaluation was seen radiographically with regard to the lateral center-edge angle (-0.14 degrees to 35.5 degrees), the ventral center-edge angle (-5.13 degrees to 31.3 degrees), and the femoral head extrusion index (38.4% to 7.7%) (p Bernese periacetabular osteotomy is a joint-preserving procedure that very effectively corrects acetabular dysplasia in adolescent patients, providing improved radiographic results and a low rate of complications. Although the rate of minor complications is increased when there is an underlying diagnosis other than developmental dysplasia, no other predictors were identified. However, a major complication is more likely with a longer duration of surgery and with a concomitant femoral varus osteotomy.

  4. Piezoelectric osteotomy in hand surgery: first experiences with a new technique

    Directory of Open Access Journals (Sweden)

    Kaenel Oliver Von

    2006-04-01

    Full Text Available Abstract Background In hand and spinal surgery nerve lesions are feared complications with the use of standard oscillating saws. Oral surgeons have started using a newly developed ultrasound bone scalpel when performing precise osteotomies. By using a frequency of 25–29 kHz only mineralized tissue is cut, sparing the soft tissue. This reduces the risk of nerve lesions. As there is a lack of experience with this technique in the field of orthopaedic bone surgery, we performed the first ultrasound osteotomy in hand surgery. Method While performing a correctional osteotomy of the 5th metacarpal bone we used the Piezosurgery® Device from Mectron [Italy] instead of the usual oscillating saw. We will report on our experience with one case, with a follow up time of one year. Results The cut was highly precise and there were no vibrations of the bone. The time needed for the operation was slightly longer than the time needed while using the usual saw. Bone healing was good and at no point were there any neurovascular disturbances. Conclusion The Piezosurgery® Device is useful for small long bone osteotomies. Using the fine tip enables curved cutting and provides an opportunity for new osteotomy techniques. As the device selectively cuts bone we feel that this device has great potential in the field of hand- and spinal surgery.

  5. Valgus osteotomy of the tibia with a Puddu plate combined with anterior cruciate ligament reconstruction

    Directory of Open Access Journals (Sweden)

    Albuquerque Roberto Freire da Mota e

    2003-01-01

    Full Text Available Anterior knee instability associated with a varus deformity is a complex condition with several treatment possibilities. Among these, anterior cruciate ligament (ACL associated to a simultaneous valgus tibial osteotomy is a increasing indication. This simultaneous procedure adds technical issues to those related to the isolated surgeries. Thus, the osteotomy plane and location of fixation hardware shouldn?t conflict with tibial tunnel and ACL graft fixation. Authors analyze the relations between a opening tibial valgus osteotomy stabilized with a Puddu plate and ACL reconstruction with a patellar tendon graft fixated with interference screws in 10 human cadaver knees. A straight oblique tibial osteotomy starting on the medial tibial cortex and oriented laterally and proximally was performed on all knees with a 10mm opening medially and stabilized with a Puddu plate on the most posterior aspect of the medial tibia, and a tibial tunnel drilled 50° to tibial plateau. With this technique there was no intersection between tibial tunnel or interference screw and the osteotomy or the plate fixation screws.

  6. Modes of continental extension in a crustal wedge

    KAUST Repository

    Wu, Guangliang

    2015-07-01

    © 2015 Elsevier B.V. We ran numerical experiments of the extension of a crustal wedge as an approximation to extension in an orogenic belt or a continental margin. We study the effects of the strength of the lower crust and of a weak mid-crustal shear zone on the resulting extension styles. A weak mid-crustal shear zone effectively decouples upper crustal extension from lower crustal flow. Without the mid-crustal shear zone, the degree of coupling between the upper and the lower crust increases and extension of the whole crust tends to focus on the thickest part of the wedge. We identify three distinct modes of extension determined by the strength of the lower crust, which are characterized by 1) localized, asymmetric crustal exhumation in a single massif when the lower crust is weak, 2) the formation of rolling-hinge normal faults and the exhumation of lower crust in multiple core complexes with an intermediate strength lower crust, and 3) distributed domino faulting over the weak mid-crustal shear zone when the lower crust is strong. A frictionally stronger mid-crustal shear zone does not change the overall model behaviors but extension occurred over multiple rolling-hinges. The 3 modes of extension share characteristics similar to geological models proposed to explain the formation of metamorphic core complexes: 1) the crustal flow model for the weak lower crust, 2) the rolling-hinge and crustal flow models when the lower crust is intermediate and 3) the flexural uplift model when the lower crust is strong. Finally we show that the intensity of decoupling between the far field extension and lower crustal flow driven by the regional pressure gradient in the wedge control the overall style of extension in the models.

  7. Modes of continental extension in a crustal wedge

    Science.gov (United States)

    Wu, Guangliang; Lavier, Luc L.; Choi, Eunseo

    2015-07-01

    We ran numerical experiments of the extension of a crustal wedge as an approximation to extension in an orogenic belt or a continental margin. We study the effects of the strength of the lower crust and of a weak mid-crustal shear zone on the resulting extension styles. A weak mid-crustal shear zone effectively decouples upper crustal extension from lower crustal flow. Without the mid-crustal shear zone, the degree of coupling between the upper and the lower crust increases and extension of the whole crust tends to focus on the thickest part of the wedge. We identify three distinct modes of extension determined by the strength of the lower crust, which are characterized by 1) localized, asymmetric crustal exhumation in a single massif when the lower crust is weak, 2) the formation of rolling-hinge normal faults and the exhumation of lower crust in multiple core complexes with an intermediate strength lower crust, and 3) distributed domino faulting over the weak mid-crustal shear zone when the lower crust is strong. A frictionally stronger mid-crustal shear zone does not change the overall model behaviors but extension occurred over multiple rolling-hinges. The 3 modes of extension share characteristics similar to geological models proposed to explain the formation of metamorphic core complexes: 1) the crustal flow model for the weak lower crust, 2) the rolling-hinge and crustal flow models when the lower crust is intermediate and 3) the flexural uplift model when the lower crust is strong. Finally we show that the intensity of decoupling between the far field extension and lower crustal flow driven by the regional pressure gradient in the wedge control the overall style of extension in the models.

  8. Splintless surgery : does patient-specific CAD-CAM osteosynthesis improve accuracy of Le Fort I osteotomy?

    NARCIS (Netherlands)

    Kraeima, J.; Jansma, J.; Schepers, R. H.

    2016-01-01

    To analyse the accuracy of maxillary positioning after Le Fort I osteotomy, we retrospectively assessed the outcome in three patients (mean (range) age 40 (21 60) years) who had been treated with patient-specific CAD-CAM osteosynthesis plates as part of a bimaxillary osteotomy. Virtual surgical

  9. Comparison of Postoperative Height Changes of the Second Metatarsal Among 3 Osteotomy Methods for Hallux Valgus Deformity Correction.

    Science.gov (United States)

    Choi, Jun Young; Suh, Yu Min; Yeom, Ji Woong; Suh, Jin Soo

    2017-01-01

    We aimed to compare the postoperative height of the second metatarsal head relative to the first metatarsal head using axial radiographs among 3 different commonly used osteotomy techniques: proximal chevron metatarsal osteotomy (PCMO), scarf osteotomy, and distal chevron metatarsal osteotomy (DCMO). We retrospectively reviewed the radiographs and clinical findings of the patients with painful callosities under the second metatarsal head, complicated by hallux valgus, who underwent isolated PCMO, scarf osteotomy, or DCMO from February 2005 to January 2015. Each osteotomy was performed with 20 degrees of plantar ward obliquity. Along with lateral translation and rotation of the distal fragment to correct the deformity, lowering of the first metatarsal head was made by virtue of the oblique metatarsal osteotomy. Significant postoperative change in the second metatarsal height was observed on axial radiographs in all groups; this value was greatest in the PCMO group (vs scarf: P = .013; vs DCMO: P = .008) but did not significantly differ between the scarf and DCMO groups ( P = .785). The power for second metatarsal height correction was significantly greater in the PCMO group (vs scarf: P = .0005; vs DCMO: P = .0005) but did not significantly differ between the scarf and DCMO groups ( P = .832). Among the 3 osteotomy techniques commonly used to correct hallux valgus deformity, we observed that PCMO yielded the most effective height change of the second metatarsal head. Level III, retrospective comparative series.

  10. Delayed gadolinium-enhanced magnetic resonance imaging of cartilage to predict early failure of Bernese periacetabular osteotomy for hip dysplasia.

    Science.gov (United States)

    Cunningham, Torin; Jessel, Rebecca; Zurakowski, David; Millis, Michael B; Kim, Young-Jo

    2006-07-01

    Hip dysplasia leads to abnormal loading of articular cartilage, which results in osteoarthritis. Pelvic osteotomies such as the Bernese periacetabular osteotomy can improve the mechanics of the joint, but the results are variable and appear to depend on the amount of preexisting arthritis. Delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) is a technique designed to measure early arthritis, and it potentially could be used to select hips with too severe arthritis to benefit from a joint-preserving reconstructive procedure. The purpose of our study was to identify radiographic, clinical, and magnetic resonance imaging measurements that predict failure after pelvic osteotomy. We performed a cohort study of forty-seven patients undergoing a Bernese periacetabular osteotomy for the treatment of hip dysplasia. Our goal was to identify preoperative radiographic factors, such as the grade of arthritis, joint congruency, and the dGEMRIC index, that are associated with a poor outcome after osteotomy. Hips in which the osteotomy did not fail had a significant decrease in pain compared with their status preoperatively (p Bernese periacetabular osteotomy for the treatment of hip dysplasia can decrease pain and improve function in symptomatic dysplastic hips. The dGEMRIC index, as an early measure of osteoarthritis, appears to be useful for identifying poor candidates for a pelvic osteotomy. Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.

  11. Postoperative volume increase of facial soft tissue after percutaneous versus endonasal osteotomy technique in rhinoplasty using 3D stereophotogrammetry

    NARCIS (Netherlands)

    Loon, B. van; Heerbeek, N. van; Maal, T.J.J.; Borstlap, W.A.; Ingels, K.J.A.O.; Schols, J.G.J.H.; Berge, S.J.

    2011-01-01

    BACKGROUND: When lateral osteotomies are performed as part of a rhinoplasty, the nose and paranasal region invariably change in three dimensions. The PURPOSE of this study is to compare the effect of the percutaneous perforating and endonasal continuous osteotomy techniques concerning the degree of

  12. Heat conduction problem of an evaporating liquid wedge

    Directory of Open Access Journals (Sweden)

    Tomas Barta

    2015-02-01

    Full Text Available We consider the stationary heat transfer near the contact line of an evaporating liquid wedge surrounded by the atmosphere of its pure vapor. In a simplified setting, the problem reduces to the Laplace equation in a half circle, subject to a non-homogeneous and singular boundary condition. By classical tools (conformal mapping, Green's function, we reformulate the problem as an integral equation for the unknown Neumann boundary condition in the setting of appropriate fractional Sobolev and weighted space. The unique solvability is then obtained by means of the Fredholm theorem.

  13. Interpretation and inverse analysis of the wedge splitting test

    DEFF Research Database (Denmark)

    Østergaard, Lennart; Stang, Henrik

    2002-01-01

    Determination of the stress-crack opening relationship, s(w) a material parameter in the fictitious crack model by Hillerborg has proven to be problematic and is still not a simple task to perform. However, this paper demonstrates that the cracked non-linear hinge model by Olesen may be applied...... to the wedge splitting test and that it is well suited for the interpretation of test results in terms of s(w). A fine agreement between the hinge and FEM-models has been found. It has also been found that the test and the hinge model form a solid basis for inverse analysis. The paper also discusses possible...

  14. Magmatism significantly alters the thermal structure of the wedge

    Science.gov (United States)

    Rees Jones, D. W.; Katz, R. F.; Rudge, J. F.; Tian, M.

    2016-12-01

    The temperature structure of the mantle wedge is typically modelled as a balance between thermal diffusion and advection by the solid mantle [e.g., 1]. The thermal state of the wedge promotes melting and melt transport in the natural system, but the thermal consequences of these processes have been neglected from previous models. We show that advective transport of sensible and latent heat by liquid magma can locally alter the temperature structure from canonical models by up to 200K. Liquids are liberated from the subducting slab by de-volatilization reactions. They trigger melting and become silicic en route to the surface, where they cause arc volcanism. These liquids transport heat advectively, and consume or supply latent heat as they melt or freeze. To analyse these effects, we parameterise melting in the presence of volatile species. We combine this with a one-dimensional "melting-column model," previously used to understand mid-ocean ridge volcanism. Our calculations highlight the thermal and chemical response to melt transport across the mantle wedge. Finally, we solve two-dimensional geodynamic models with a prescribed slab flux [2]. These models allow us to identify the most thermally significant fluxes of melt in the system. Perturbations of 200K are found at the base of the overriding lithosphere. This thermal signature of melt migration should be considered when interpreting heat flow, petrologic and seismic data [e.g., 3]. Such a thermal perturbation is likely to affect the chemistry of arc volcanoes, the solid mantle flow and, perhaps, the location of the volcanos themselves [4]. [1] van Keken, P. E., Currie, C., King, S. D., Behn, M. D., Cagnioncle, A., He, J., et al. (2008). A community benchmark for subduction zone modeling. PEPI, doi:10.1016/j.pepi.2008.04.015 [2] Wilson, C. R., Spiegelman, M., van Keken, P. E., & Hacker, B. R. (2014). Fluid flow in subduction zones: The role of solid rheology and compaction pressure. EPSL, doi:10.1016/j

  15. Inverse analysis of the wedge-splitting test

    DEFF Research Database (Denmark)

    Skocek, Jan; Stang, Henrik

    2008-01-01

    The amount of information which it is possible to retrieve from the wedge-splitting test is investigated. Inverse analysis is undertaken based on the analytical hinge model for various multi-linear softening curves. This showed that the commonly used bi-linear softening curve can be replaced...... by an tip to quad-linear curve, which is reflected by increased accuracy of the test simulation. Furthermore it was demonstrated that the next refinement of the softening curve leads to convergence problems due to problems with local minima. Finally, the semi-analytically obtained results are verified using...

  16. Electric monopoles in generalised B\\wedge F theories

    CERN Document Server

    Temple-Raston, M

    1996-01-01

    A tensor product generalisation of B\\wedge F theories is proposed to give a Bogomol'nyi structure. Non-singular, stable, finite-energy particle-like solutions to the Bogomol'nyi equations are studied. Unlike Yang-Mills(-Higgs) theory, the Bogomol'nyi structure does not appear as a perfect square in the Lagrangian. Consequently, the Bogomol'nyi energy can be obtained in more than one way. The added flexibility permits electric monopole solutions to the field equations.

  17. Inflammatory Neuropathy of the Lumbosacral Plexus following Periacetabular Osteotomy

    Directory of Open Access Journals (Sweden)

    Stijn Ghijselings

    2016-01-01

    Full Text Available Introduction. During periacetabular osteotomy (PAO, the sciatic, femoral, and obturator nerves are at risk. Most frequently nerve lesions can be attributed to a mechanical cause; however, in the absence of a clear mechanical cause surgeons are faced with a diagnostic problem and in many cases no diagnosis will be established. We report a case of inflammatory neuropathy of the lumbosacral plexus following a PAO. Case Presentation. A 31-year-old female developed weakness of ankle and knee flexion and extension 6 months after a PAO. Electrophysiological studies revealed damage to the obturator, femoral, and sciatic nerve consistent with an inflammatory lumbosacral plexopathy. MRI of the lumbosacral plexus was normal. The patient was treated with multimodal pain therapy and prolonged physiotherapy; nevertheless, symptoms worsened over time. At 2-year follow-up, there were no signs of recovery. Discussion. Inflammatory neuropathy of the lumbosacral plexus is a potential cause of pain and weakness after ipsilateral orthopaedic procedures. It should be distinguished from more frequently encountered mechanical causes of postsurgical neuropathy based on clinical suspicion, electrophysiological studies, MRI, and nerve biopsy. It is important that the orthopaedic community is aware of this complication since there is some evidence that early recognition and initiation of immunosuppressive therapy can lead to improved clinical outcome.

  18. Ulnar or radial shortening osteotomy with a single saw cut.

    Science.gov (United States)

    Sraj, Shafic A; Budoff, Jeffrey E

    2009-09-01

    To determine which currently commercially available saw blades could be held at 45 degrees to the bone to reproducibly provide 2.0, 2.5, and 3.0 mm of ulna or radius shortening. Commercially available saw blades were tested for their ability to achieve the osseous shortening at a 45 degrees angle cut. When held at a 45 degrees angle to the bone, 2 Stryker 0.64-mm-thick blades achieved a mean shortening of 2.0 mm. A single Linvatec 1.2-mm-thick blade achieved a mean osseous shortening of 2.1 mm. Two Dyonics 0.65-mm-thick blades achieved a mean osseous shortening of 2.7 mm. Two Dyonics 0.89-mm-thick saw blades achieved a mean osseous shortening of 3.1 mm. Three Stryker 0.38-mm-thick saw blades mounted with the middle blade "upside down" with regard to the 2 outer blades achieved a mean osseous shortening of 3.2 mm. Two Linvatec 0.8-mm-thick saw blades achieved a mean osseous shortening of 3.1 mm. The findings of this study can help guide surgeons who desire to reproducibly shorten the ulna or radius by 2.0, 2.7, or 3.2 mm using a single saw cut to ensure a parallel osteotomy gap.

  19. Osteotomies through a fusion mass in the lumbar spine.

    Science.gov (United States)

    Vital, Jean-Marc; Boissière, Louis; Bourghli, Anouar; Castelain, Jean-Etienne; Challier, Vincent; Obeid, Ibrahim

    2015-01-01

    Flat-back syndrome is one of the main causes of surgical failure after lumbar fusion and can lead to a revision surgery to correct it. Three-column pedicle subtraction osteotomy is an efficient technique to restore lumbar lordosis (LL) for fixed sagittal malalignment. The fusion mass stemming from the past surgeries makes the procedure demanding as most anatomical landmarks are missing. This review article will focus on the correction of this lack of LL through the fusion mass. We will successively review the preoperative management, the surgical specificities, and various types of clinical cases that can be encountered in flat-back syndromes. PSO in the fixed fusion mass is technically demanding. Preoperative CT-scan and preoperative navigation allow us to push the limits when anatomical landmarks disappear. Bleeding and neurologic are the two major complications feared by the surgeon. The best way to avoid these revision surgeries is to restore a proper lumbar lordosis at the time of initial surgery by considering lumbo-pelvic indexes.

  20. Bone scintigraphy and magnetic resonance imaging after transtrochanteric rotational osteotomy

    Energy Technology Data Exchange (ETDEWEB)

    Iwasada, Seiki; Hasegawa, Yukiharu; Iwase, Tosiki; Kitamura, Shinji; Iwata, Hisashi [Department of Orthopaedic Surgery, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466 (Japan)

    1999-05-01

    Objective. To assess the ability of bone scintigraphy and magnetic resonance imaging (MRI) to predict the outcome of transtrochanteric rotational osteotomy (TRO) for osteonecrosis of the femoral head (ONFH). Design. This study was a prospective evaluation of imaging techniques. Patients and methods. MRI and bone scintigraphy were performed on 20 hips in 18 patients at 3 months after TRO. The radiographic findings at 3 months after TRO, and the MRI and bone scintigraphic findings, were compared with the radiographic findings at final follow-up (mean 39 months). Results and conclusions. On MRI a low-intensity area or a low-intensity band in the new weight-bearing area extending over the acetabular edge on T1-weighted images was related to the presence of collapse on the radiographs at final follow-up. In hips with an area of absent activity in the new weight-bearing surface on bone scintigraphy, collapse was seen more frequently on radiographs at final follow-up than in hips without this feature. Bone scintigraphy was no more specific than radiography in predicting the outcome after TRO. We consider MRI to be superior to bone scintigraphy in predicting the occurrence of collapse, which is one of the major short-term problems after TRO. (orig.) With 8 figs., 4 tabs., 15 refs.

  1. Prediction of neurosensory alterations after sagittal split ramus osteotomy.

    Science.gov (United States)

    Kuroyanagi, N; Miyachi, H; Ochiai, S; Kamiya, N; Kanazawa, T; Nagao, T; Shimozato, K

    2013-07-01

    Prediction of neurosensory deficit in the lower lip and chin after sagittal split ramus osteotomy (SSRO) is challenging. This study aimed to elucidate factors related to the development and improvement of neurosensory disturbance (NSD) after SSRO with respect to surgical procedure and the anatomical and structural characteristics of the craniomaxillofacial skeleton. Subjects comprised 50 patients treated by a single experienced surgeon. Anatomical data and landmarks were obtained by computed tomography (CT) imaging. There was a significant difference between patients with or without NSD for the surgical space on the medial side of mandibular ramus 1 week after SSRO (P=0.006). Less than 15.0mm between the lingula and mandibular notch (relative risk, 6.7; 95% CI, 1.7-33.8) and 195.0mm(2) or more space on the medial side of the mandibular ramus (relative risk, 17.2; 95% CI, 3.9-100.4) indicated a significant risk of NSD development at 6 months postoperatively. These results suggested that the development of NSD is related to the surgical space on the medial side of the mandibular ramus and subsequent manipulation of the inferior alveolar nerve (IAN) in that region. Limited periosteal degloving prevents excessive stretching of the IAN during SSRO, thus lowering NSD incidence.

  2. Cholesteatoma after lateral bulla osteotomy in two brachycephalic dogs.

    Science.gov (United States)

    Schuenemann, Riccarda Martina; Oechtering, Gerhard

    2012-01-01

    This report describes a French bulldog and a pug that presented to the authors' hospital following total ear canal ablation (TECA) and lateral bulla osteotomy (LBO), with signs of recurring otitis media and difficulty opening their mouths. The bulldog also had unilateral facial paralysis and sensory deficits of the trigeminal nerve on the ipsilateral side. Computed tomography and MRI scans suggested cholesteatoma in the bulldog, but showed only slight enlargement of the bulla in the pug. Histopathologic examination of samples yielded cholesteatoma in both cases. The authors suspect that development of the cholesteatomas was linked to the TECA/LBO surgery in both cases. Cholesteatomas may occur more frequently than currently thought. Even if only slight changes of the bulla wall are detected on CT, early-stage cholesteatoma should be considered. The narrow anatomic conditions in brachycephalic dogs possibly predispose such breeds to develop cholesteatoma after middle ear surgery because complete removal of all inflammatory and epithelial tissue can be more difficult than in other breeds. To the authors' knowledge, this is the first report of an aural cholesteatoma causing sensory deficits of the trigeminal nerve.

  3. The effect of shoe design and lateral wedging on knee loading

    DEFF Research Database (Denmark)

    Mølgaard, Carsten; Kersting, Uwe G.

    -dimensional gait analysis. Barefoot walking, walking in a running shoe, an Oxford-type leather shoe, and a rocker shoe were analyzed. The shoes were tested both with and without a 10-degree full length laterally wedged insole. Results: Similar, significant reductions in the peak knee adduction moment with lateral...... wedges were observed in all three types of shoes. However, differences between shoe design were of similar magnitude as the effect of laterally wedged insoles. Only marginal changes in muscle activity for lateral hamstrings during barefoot toe-out walking and gastrocnemius when using the Oxford wedged...

  4. Triangular metal wedges for subwavelength plasmon-polariton guiding at telecom wavelengths

    DEFF Research Database (Denmark)

    Boltasseva, Alexandra; Volkov, V.S.; Nielsen, Rasmus Bundgaard

    2008-01-01

    . Using scanning near-field optical imaging at the wavelengths in the range of 1.43 - 1.52 µm, we demonstrate low-loss (propagation length ~ 120 µm) and well-confined (mode width ≅ 1.3 µm) wedge plasmon-polariton guiding along triangular 6-µm-high and 70.5°- angle gold wedges. Experimental observations......We report on subwavelength plasmon-polariton guiding by triangular metal wedges at telecom wavelengths. A high-quality fabrication procedure for making gold wedge waveguides, which is also mass- production compatible offering large-scale parallel fabrication of plasmonic components, is developed...

  5. Decollement controls on pro versus retro wedge deformation in mountain belts

    Science.gov (United States)

    Grool, Arjan; Huismans, Ritske S.; Ford, Mary

    2017-04-01

    Doubly vergent orogens have a pro-wedge (lower plate) and a retro-wedge (upper plate). Most shortening is accommodated on the pro-wedge while retro-wedge shortening is typically limited. For example, the Eastern Pyrenees have experienced about 145 km of convergence, of which about 125 km (86%) was accommodated in the pro-wedge and about 20 km (14%) in the retro-wedge. Strain partitioning between pro- and retro-wedge is influenced by several factors, some of which have been identified in past work: Extensional inheritance and syn-orogenic sedimentation can help to increase the percentage of total shortening accommodated in the retro-wedge while erosion promotes pro-wedge shortening. We use high-resolution 2D numerical models to investigate factors that control pro- versus retro-wedge shortening. For a total convergence similar to the Eastern Pyrenees, our models predict that variations in extensional inheritance and syn-orogenic sedimentation will result in a maximum of 10% of total shortening being accommodated in the retro-wedge. Here, we investigate the role of 1) the rheology and 2) distribution of a decollement layer. Our models show that: 1) Decollement rheology has a first order control on strain distribution between the pro- and the retro-wedge. After 145 km of total convergence, a model with a weak frictional (φ=2, shale-like) decollement will only accommodate 9% of total shortening in the retro-wedge. In contrast in models with a weak viscous (μ=1018, salt-like) decollement retro-wedge shortening amounts to 18% and a stronger, but still weak, viscous decollement (μ=1019) leads to 21%. 2) Décollement distribution influences the timing of the first outward propagation of thick-skinned deformation in the retro-wedge. In the Eastern Pyrenees, thick-skinned deformation propagated out into the retro-wedge within 145 km of total convergence. In models with a decollement on both sides of the orogen this only occurred after 240 km. If, as in the Eastern

  6. Segmental Maxillary Osteotomies in Conjunction With Bimaxillary Orthognathic Surgery: Indications - Safety - Outcome.

    Science.gov (United States)

    Posnick, Jeffrey C; Adachie, Anayo; Choi, Elbert

    2016-07-01

    The purpose of the present study was to evaluate the indications, safety, and treating orthodontists' assessment of outcomes after bimaxillary orthognathic surgery that included segmental osteotomies. We performed a retrospective cohort study of patients treated by a single surgeon from 2004 to 2013. The index group consisted of a consecutive series of subjects with a bimaxillary dentofacial deformity (DFD) involving the chin and symptomatic chronic obstructive nasal breathing. All the subjects underwent Le Fort I osteotomy, bilateral sagittal ramus osteotomy, septoplasty, inferior turbinate reduction, and osseous genioplasty. The predictor variables included age, gender, pattern of presenting DFD, type of maxillary osteotomy, and maxillary premolar extractions. The outcome variables included orthodontist assessment of the results achieved and the occurrence of maxillary complications. The orthodontist assessment was documented through a survey questionnaire completed 1 to 11 years after surgery. The maxillary complications studied included gingival recession, pulpal injury, oronasal fistula, and the need for hardware removal. During the study period, 262 subjects met the inclusion criteria. Their age at surgery averaged 25 years (range 13 to 63), and 134 were female (51%). The major patterns of the presenting DFD included long face (30%) and maxillary deficiency (25%). Of the 262 subjects, 66 (25%) underwent maxillary premolar extractions to relieve dental compensations. Also, 30% of the subjects presented for preoperative reassessment with a posterior arch form of skeletal anomaly. They underwent 2-segment Le Fort I osteotomy, and 34% presented with both posterior arch form and curve of Spee skeletal anomalies. They underwent 3-segment Le Fort I osteotomy. The subjects who had not undergone preoperative maxillary premolar extractions were more likely to have undergone 3-segment Le Fort I osteotomy (P = .008). No direct surgical injury occurred to a dental root

  7. Triple pelvic osteotomy: Report of our mid-term results and review of literature

    Science.gov (United States)

    Mimura, Tomohiro; Mori, Kanji; Kawasaki, Taku; Imai, Shinji; Matsusue, Yoshitaka

    2014-01-01

    A wide variety of pelvic osteotomies have been developed for the treatment of developmental dysplasia of the hip (DDH). In the present paper, we present a detailed review of previous studies of triple osteotomy as an alternative treatment for DDH. We also report our experience treating 6 adult cases of DDH by triple osteotomy in order to highlight the various aspects of this procedure.The mean age of our patients was 31.2 years with a mean follow-up period of 6 years. We assessed range of motion, center-edge angle, acetabular index angle, Sharp angle, acetabulum head index, head lateralization index, Japanese Orthopedic Association score, Harris hip score, patient satisfaction, and the difference between lower limb lengths before and after the procedure. At final follow-up, clinical scores were significantly improved and radiographic parameters also showed good correction of acetabulum. PMID:24649410

  8. Bone repair inhibited by indomethacin. Effects on bone metabolism and strength of rabbit osteotomies

    Energy Technology Data Exchange (ETDEWEB)

    Keller, J.; Buenger, C.; Andreassen, T.T.; Bak, B.; Lucht, U.

    1987-01-01

    We measured mineral content, maximum bending strength, and regional blood flow after tibial osteotomy fixed with a small metal plate in 38 rabbits. Half of the animals were treated with indomethacin (10 mg/kg/day) while the other half served as controls. After 2 and 6 weeks, the bone mineral content and maximum bending strength were lower in the indomethacin group when compared with the controls. Compared with the controls, the blood flow at the osteotomy site was decreased after 2 weeks and increased after 6 weeks in the indomethacintreated animals. Inhibition of blood flow increase by indomethacin medication in the early period following osteotomy, as well as retarded bone healing, are probably caused by inhibition of the inflammatory reaction.

  9. Reconstruction of neglected developmental dysplasia by total hip arthroplasty with subtrochanteric shortening osteotomy.

    Science.gov (United States)

    Atilla, Bülent

    2016-03-01

    Patients with neglected developmental dysplasia (DDH) face with early osteoarthritis of the hip, limb length inequality and marked disability while total hip reconstruction is the only available choice.DDH has severe morphologic consequences, with distorted bony anatomy and soft tissue contractures around the hip. It is critical to evaluate patients thoroughly before surgery.Anatomic reconstruction at the level of true acetabulum with uncemented implant is the mainstay of treatment. This requires a subtrochanteric shortening osteotomy, which can be realised using different osteotomy and fixation options.Although a demanding technique with a high rate of related complications, once anatomic reconstruction of the hip is achieved, patients have a remarkably good functional capacity and implant survival during long follow-up periods. Cite this article: Atilla B. Reconstruction of neglected developmental dysplasia by total hip arthroplasty with subtrochanteric shortening osteotomy. EFORT Open Rev 2016;1:65-71. DOI: 10.1302/2058-5241.1.000026.

  10. Single-Tooth Osteotomy Using Piezoelectric Devices to Treat an Ankylosed Maxillary Molar.

    Science.gov (United States)

    You, Tae Min; Kang, Joon Hyun; Kim, Kee-Deog; Park, Wonse

    2016-01-01

    Single-tooth osteotomy is a surgical technique in which the tooth and adjacent bone with sufficient soft tissue are repositioned in a single step or moved orthodontically. It is not used in the maxillary posterior region because of poor accessibility, bleeding complications, and anatomical limitations such as the maxillary sinus. However, the development of piezoelectric surgical devices and the popularization of the sinus floor elevation procedure have simplified the approach to the posterior maxillary area. This article reports two cases of single-tooth osteotomy of ankylosed teeth that were performed safely in the posterior maxilla with the use of a piezoelectric device and a sinus membrane elevation. In addition, several merits of this approach as compared with conventional osteotomy are described.

  11. High Le Fort I osteotomy for correction of mid-face deformity in Crouzon syndrome.

    Science.gov (United States)

    Nakajima, Yasumichi; Nakano, Hiroyuki; Sumida, Tomoki; Yamada, Tomohiro; Inoue, Kazuya; Sugiyama, Goro; Mishima, Katsuaki; Mori, Yoshihide

    2016-09-01

    An 18-year-old woman with mild Crouzon syndrome was referred with malocclusion and mandibular protrusion. Examination revealed Class III canine and molar relationships, hypoplastic maxilla, 1-mm overbite, and -2-mm overjet. Analysis showed 69° sella-nasion-A, 73.6° sella-nasion-B, and -4.6° A point-nasion-B point angles. Polysomnography revealed respiratory disturbance and 6.3% oxygen desaturation indices of 5.4/h and 9.0/h. We performed double-jaw surgery using high Le Fort I osteotomy and bilateral sagittal split ramus osteotomy for midfacial deformity correction. Twelve months post-surgery, her measures were 70.8°, 72°, -1.2°, 3.0/h, and 6.1/h, respectively. Esthetics were satisfactory. High Le Fort I osteotomy is effective for midfacial deformity correction in patients with Crouzon syndrome. © 2016 Japanese Teratology Society.

  12. The horizontal and stepped osteotomy technique for mandibular reconstruction using fibular free flap.

    Science.gov (United States)

    Aleid, Wesam; Jones, Keith; Laugharne, David

    2011-09-01

    The mandible is an important component of the orofacial skeleton, and resection of part of the mandible as part of head and neck oncological procedures can have dramatic impact on both function and cosmesis. In this article, we describe a new technique in the resection osteotomy and flap fixation that improves the stability and aesthetic outcome of the reconstruction. The mandibular resection is performed utilizing a horizontal osteotomy above the mandibular angle on one side and a stepped body or angle osteotomy on the other side. Our technique is unique as it allows flexibility in adjusting the chin point projection to give the best possible aesthetic outcome; it allows more bone-to-bone contact, which increases the stability; it reduces rotation; and it allows for use of miniplate fixation, facilitating future rehabilitation with implants. We have been using this technique with great success in our hospital, and we recommend its use for its improved flexibility, stability, and aesthetic outcome.

  13. Pseudoarthrosis of the ilium after periacetabular osteotomy that was treated by cemented total hip arthroplasty: a case report.

    Science.gov (United States)

    Kanaji, Arihiko; Nishiwaki, Toru; Oya, Akihito; Maehara, Kazuyuki; Maehara, Hideki; Oishi, Teruyo; Yamada, Harumoto; Suda, Yasunori; Nakamura, Masaya; Matsumoto, Morio

    2016-05-06

    Preserving the hip joint to delay arthroplasty for patients with acetabular dysplasia-associated early-stage osteoarthritis has become more common, and several surgical procedures have demonstrated pain relief and improved hip joint function. Periacetabular osteotomy, one of the joint-preserving surgical procedures of the hip, provides favorable outcomes, although there are no reports of total hip arthroplasty being used to treat pseudoarthrosis of the periacetabular osteotomy segment. Therefore, we report a case of pseudoarthrosis in the osteotomy segment after periacetabular osteotomy. The patient was treated using modified total hip arthroplasty and achieved a favorable short-term outcome. A 62-year-old Japanese woman was diagnosed with bilateral acetabular dysplasia at the age of 50 years, and underwent right and left periacetabular osteotomy at the ages of 52 and 55 years, respectively. When she was 61-years old, she experienced repeated episodes of left coxalgia during walking, with increasing pain at rest, and subsequently visited our department. Plain radiography and computed tomography of her left hip joint confirmed pseudoarthrosis of the periacetabular osteotomy segment. In addition, narrowing of her left hip joint space was observed, which indicated advanced osteoarthritis of the hip. Therefore, she underwent left total hip arthroplasty when she was 62-years old. During the surgery, fibrous fusion of the periacetabular osteotomy segment was confirmed via fluoroscopy, although no abnormal mobility was observed. Thus, the osteotomy segment was fixed with one absorbable screw and two bone pegs (which were prepared using allogeneic bone), and the acetabular cup was fixed using cement. Her postoperative course was generally favorable and bone fusion of the periacetabular osteotomy segment was confirmed at 3 years and 6 months after surgery. Her modified Harris hip score was 43 before the surgery and had improved to 90 at the final follow-up. Modified total

  14. The effect of femoral neck osteotomy on femoral component position of a primary cementless total hip arthroplasty.

    Science.gov (United States)

    Dimitriou, Dimitris; Tsai, Tsung-Yuan; Kwon, Young-Min

    2015-12-01

    The aim of this study was to quantify the femoral canal diameter and version at different femoral neck osteotomy locations, and to investigate the effect of the osteotomy plane on femoral component position in total hip arthroplasty (THA). Preoperative and postoperative three-dimensional models were reconstructed in 15 patients (19 hips) who underwent primary cementless THA with tapered non-anatomical femoral stem. On the pre-operative models, the osteotomy plane was simulated at different levels (-5, 0, 5, and 10 mm from the femoral saddle [piriformis fossa]) and angles (30, 40, 50, and 60° from the femoral anatomical axis). Medullary canal version and mediolateral diameter were measured on the osteotomy surfaces. On the postoperative models, the femoral neck osteotomy plane, stem anteversion and alignment were measured. The average canal diameter ranged from 22.8 to 26.3 mm at different osteotomy levels and from 20.8 to 29.0 mm at different osteotomy angles. The average canal version ranged from 11.4 to 23.2° at different resection levels and from 12.8 to 21° at different resection angles. The femoral stem anteversion was correlated with neck osteotomy angle (R = 0.72), whereas stem alignment in frontal plane (varus/valgus) was correlated with neck osteotomy level (R = 0.87). The femoral neck osteotomy plane in THA affects the postoperative stem position due to the complex morphology of the proximal femoral medullary canal, suggesting that both femoral neck resection level and angle should be considered in optimizing femoral component alignment in THA patients.

  15. Dying Flow Bursts as Generators of the Substorm Current Wedge

    Science.gov (United States)

    Haerendel, Gerhard

    2016-07-01

    Many theories or conjectures exist on the driver of the substorm current wedge, e.g. rerouting of the tail current, current disruption, flow braking, vortex formation, and current sheet collapse. Magnitude, spatial scale, and temporal development of the related magnetic perturbations suggest that the generator is related to the interaction of the flow bursts with the dipolar magnetosphere after onset of reconnection in the near-Earth tail. The question remains whether it is the flow energy that feeds the wedge current or the internal energy of the arriving plasma. In this presentation I argue for the latter. The current generation is attributed to the force exerted by the dipolarized magnetic field of the flow bursts on the preceding layer of high-beta plasma after flow braking. The generator current is the grad-B current at the outer boundary of the compressed high-beta plasma layers. It needs the sequential arrival of several flow bursts to account for duration and magnitude of the ionospheric closure current.

  16. Growth and mixing dynamics of mantle wedge plumes

    Science.gov (United States)

    Gorczyk, Weronika; Gerya, Taras V.; Connolly, James A. D.; Yuen, David A.

    2007-07-01

    Recent work suggests that hydrated partially molten thermal-chemical plumes that originate from subducted slab as a consequence of Rayleigh-Taylor instability are responsible for the heterogeneous composition of the mantle wedge. We use a two-dimensional ultrahigh-resolution numerical simulation involving 10 × 109 active markers to anticipate the detailed evolution of the internal structure of natural plumes beneath volcanic arcs in intraoceanic subduction settings. The plumes consist of partially molten hydrated peridotite, dry solid mantle, and subducted oceanic crust, which may compose as much as 12% of the plume. As plumes grow and mature these materials mix chaotically, resulting in attenuation and duplication of the original layering on scales of 1-1000 m. Comparison of numerical results with geological observations from the Horoman ultramafic complex in Japan suggests that mixing and differentiation processes related to development of partially molten plumes above slabs may be responsible for the strongly layered lithologically mixed (marble cake) structure of asthenospheric mantle wedges.

  17. Relation of the auroral substorm to the substorm current wedge

    Science.gov (United States)

    McPherron, Robert L.; Chu, Xiangning

    2016-12-01

    The auroral substorm is an organized sequence of events seen in the aurora near midnight. It is a manifestation of the magnetospheric substorm which is a disturbance of the magnetosphere brought about by the solar wind transfer of magnetic flux from the dayside to the tail lobes and its return through the plasma sheet to the dayside. The most dramatic feature of the auroral substorm is the sudden brightening and poleward expansion of the aurora. Intimately associated with this expansion is a westward electrical current flowing across the bulge of expanding aurora. This current is fed by a downward field-aligned current (FAC) at its eastern edge and an upward current at its western edge. This current system is called the substorm current wedge (SCW). The SCW forms within a minute of auroral expansion. FAC are created by pressure gradients and field line bending from shears in plasma flow. Both of these are the result of pileup and diversion of plasma flows in the near-earth plasma sheet. The origins of these flows are reconnection sites further back in the tail. The auroral expansion can be explained by a combination of a change in field line mapping caused by the substorm current wedge and a tailward growth of the outer edge of the pileup region. We illustrate this scenario with a complex substorm and discuss some of the problems associated with this interpretation.

  18. An automated optical wedge calibrator for Dobson ozone spectrophotometers

    Science.gov (United States)

    Evans, R. D.; Komhyr, W. D.; Grass, R. D.

    1994-01-01

    The Dobson ozone spectrophotometer measures the difference of intensity between selected wavelengths in the ultraviolet. The method uses an optical attenuator (the 'Wedge') in this measurement. The knowledge of the relationship of the wedge position to the attenuation is critical to the correct calculation of ozone from the measurement. The procedure to determine this relationship is time-consuming, and requires a highly skilled person to perform it correctly. The relationship has been found to change with time. For reliable ozone values, the procedure should be done on a Dobson instrument at regular intervals. Due to the skill and time necessary to perform this procedure, many instruments have gone as long as 15 years between procedures. This article describes an apparatus that performs the procedure under computer control, and is adaptable to the majority of existing Dobson instruments. Part of the apparatus is usable for normal operation of the Dobson instrument, and would allow computer collection of the data and real-time ozone measurements.

  19. Results of Corrective Osteotomy and Treatment Strategy for Ankylosing Spondylitis with Kyphotic Deformity.

    Science.gov (United States)

    Kim, Ki-Tack; Park, Dae-Hyun; Lee, Sang-Hun; Lee, Jung-Hee

    2015-09-01

    To report the radiological and clinical results after corrective osteotomy in ankylosing spondylitis patients. Furthermore, this study intended to classify the types of deformity and to suggest appropriate surgical treatment options. We retrospectively analyzed ankylosing spondylitis patients who underwent corrective osteotomy between 1996 and 2009. The radiographic assessments included the sagittal vertical axis (SVA), spinopelvic alignment parameters, correction angle, correction loss, type of deformity related to the location of the apex, and the craniocervical range of motion (CCROM). The clinical outcomes were assessed by the Oswestry Disability Index (ODI) scores. A total of 292 corrective osteotomies were performed in 248 patients with a mean follow-up of 40.1 months (range, 24 to 78 months). There were 183 cases of single pedicle subtraction osteotomy (PSO), 19 cases of multiple Smith-Petersen osteotomy (SPO), 17 cases of PSO + SPO, 14 cases of single SPO, six cases of posterior vertebral column resection (PVCR), five cases of PSO + partial pedicle subtraction osteotomy (PPSO), and four cases of PPSO. The mean correction angles were 31.9° ± 11.7° with PSO, 14.3° ± 8.4° with SPO, 38.3° ± 12.7° with PVCR, and 19.3° ± 7.1° with PPSO. The thoracolumbar type was the most common. The outcome analysis showed a significant improvement in the ODI score (p ankylosing spondylitis, resulting in satisfactory outcomes with acceptable complications. The CCROM and postoperative SVA were important factors in determining the outcome.

  20. Mini-Invasive floating metatarsal osteotomy for resistant or recurrent neuropathic plantar metatarsal head ulcers.

    Science.gov (United States)

    Tamir, Eran; Finestone, Aharon S; Avisar, Erez; Agar, Gabriel

    2016-07-11

    Patients with peripheral neuropathy and pressure under a relatively plantar deviated metatarsal head frequently develop plantar foot ulcers. When conservative management with orthotics and shoes does not cure the ulcer, surgical metatarsal osteotomy may be indicated to relieve the pressure and enable the ulcer to heal. The purpose of this study is to evaluate the use of a mini-invasive floating metatarsal osteotomy in treating recalcitrant ulcers or recurrent ulcers plantar to the metatarsal heads in patients with diabetes mellitus (DM) related neuropathy. Computerized medical files of patients with diabetic neuropathy treated with an osteotomy during 2013 and 2014 were retrospectively reviewed. There were 20 osteotomies performed on 17 patients (mean age 58 years). The patients had a diagnosis of DM for a mean of 17 years. All ulcers were University of Texas grade 1A; mean ulcer age was 19 months. After 17/20 operations, the ulcer completely resolved after 6 weeks and did not recur after a mean follow-up of 11.5 months. One patient developed an early post-operative infection with osteomyelitis at the osteotomy site (proximal shaft of the fifth metatarsal) that needed debridement and IV antibiotics. In the other 19 cases, the surgical wound healed within 1 week. Asymptomatic radiological non-union developed in six cases (30 %). Mini-invasive floating metatarsal osteotomy can cure resistant and recurrent University of Texas grade 1A ulcerations plantar to the metatarsal heads in neuropathic patients.

  1. Variables Prognostic for Delayed Union and Nonunion Following Ulnar Shortening Fixed With a Dedicated Osteotomy Plate.

    Science.gov (United States)

    Gaspar, Michael P; Kane, Patrick M; Zohn, Ralph C; Buckley, Taylor; Jacoby, Sidney M; Shin, Eon K

    2016-02-01

    To examine potential risk factors for the development of delayed or nonunion following elective ulnar shortening osteotomy using a dedicated osteotomy plating system. We performed a retrospective review of all patients who underwent elective ulnar shortening using the TriMed single osteotomy dynamic compression plating system by 1 of 2 fellowship-trained hand surgeons over a 5-year period. Demographic data and medical, surgical, and social histories were reviewed. Time to bony union was determined radiographically by a blinded reviewer. Bivariate statistical analysis was performed to examine the effect of explanatory variables on the time to union and the incidence of delayed or nonunion. Those variables associated with the development of delayed or nonunion were used in a multivariate logistic regression model. Complications, including the need for additional surgery, were also recorded. Seventy-two ulnar shortening osteotomy procedures were performed in 69 patients. Delayed union, defined as ≥ 6 months to union, occurred in 8 of 72 cases (11%). Of 72 surgeries, 4 (6%) resulted in nonunions, all of which required additional surgery. Hardware removal was performed in 13 of 72 (18%) of the cases. Time to union was significantly increased in smokers (6 ± 3 months) versus nonsmokers (3 ± 1 months). On multivariable analysis, diabetics and active smokers demonstrated a significantly higher risk of developing delayed union or nonunion. Patient age, sex, body mass index, thyroid disease, worker's compensation status, alcohol use, and amount smoked daily did not have an effect on the time to union or the incidence of delayed or nonunion. Despite the use of an osteotomy-specific plating system, smokers and diabetics were at significantly higher risk for both delayed union and nonunion following elective ulnar shortening osteotomy. Other known risk factors for suboptimal bony healing were not found to have a deleterious effect. Copyright © 2016 American Society for

  2. Surgical Reconstruction of Metatarsal Type Preaxial Polydactyly Using an Amalgamating Osteotomy.

    Science.gov (United States)

    Boyle, Matthew J; Hogue, Grant D; Kasser, James R

    2016-09-01

    Polydactyly of the foot is a relatively common condition. Approximately 15% of cases are preaxial, with one third of these cases involving duplication of the metatarsal [metatarsal type preaxial polydactyly (MTPP)].Surgical reconstruction of polydactyly is indicated to improve shoe tolerance. Reconstruction of MTPP has traditionally involved resection of the hypoplastic lateral ray in addition to soft tissue reconstruction to correct hallux varus. Poor postoperative results have frequently been reported, primarily due to residual hallux varus. We present a novel surgical technique for the treatment of children with MTPP presenting with a cosmetic lateral hallux, involving an amalgamating osteotomy that permits retention of the stable medial metatarsotarsal joint while avoiding the complication of residual hallux varus. This was a retrospective case series describing the surgical technique of an amalgamating osteotomy in the treatment of patients with MTPP and a cosmetic lateral hallux. The surgical technique involves corresponding metatarsal osteotomies of the medial and lateral halluces, with amalgamation of the metatarsals and ablation of the residual medial hallux, without the need for extensive soft tissue reconstruction. Clinical and radiologic outcomes were evaluated at a minimum of 2 years postoperatively in 2 patients who underwent this technique. Two children, 1 female and 1 male, underwent an amalgamating osteotomy at the age of 31 and 18 months, respectively. At latest follow-up, 7.3 and 2.8 years after osteotomy, respectively, both patients displayed an excellent functional result according to the Phelps and Grogan clinical outcome scale. Plain radiographs in both cases demonstrated a well-aligned first ray with no growth abnormality and no hallux varus. We have presented a novel surgical technique for the reconstruction of MTPP presenting with a cosmetic lateral hallux, involving an amalgamating osteotomy without extensive soft tissue reconstruction

  3. Custom-made prefabricated titanium miniplates in Le Fort I osteotomies: principles, procedure and clinical insights.

    Science.gov (United States)

    Philippe, B

    2013-08-01

    This paper describes a new type of miniplate system that is designed and custom made during virtual surgery planning based on an individual patient's osteotomy. These miniplates are prefabricated with commercially pure porous titanium using direct metal laser sintering. The principles that guide the conception and production of this new miniplate are presented. The surgical procedure from the stage of virtual surgery planning until the final Le Fort I osteotomy and bone fixation are described using a case example. Copyright © 2013 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  4. Partial Necrosis of the Mandibular Proximal Segment Following Transoral Vertical Ramus Osteotomy.

    Science.gov (United States)

    Kim, Somi; Kim, Sang Yoon; Kim, Gi-Jung; Jung, Hwi-Dong; Jung, Young-Soo

    2014-05-01

    Transoral vertical ramus osteotomy (TOVRO) procedure can result in a variety of complications. Complications commonly reported include extensive bleeding due to major blood vessel injury, unpredictable fracture, postoperative infection, neurosensory deficit related Inferior alveolar nerve, insufficient osteosynthesis, and temporomandibular joint problem. The authors describe a case of partial necrosis of the mandibular proximal segment following TOVRO, a rarely reported complication. A 37-year-old otherwise healthy woman underwent Lefort l osteotomy and TOVRO to correct mandibular prognathism. Postoperatively, she developed pain and swelling in the right submandibular region and was found to have a partial necrosis of proximal segment.

  5. Brachymetatarsia of the fourth metatarsal, lengthening scarf osteotomy with bone graft

    Directory of Open Access Journals (Sweden)

    Ankit Desai

    2013-09-01

    Full Text Available A 16-year-old girl presented with left fourth metatarsal shortening causing significant psychological distress. She underwent lengthening scarf osteotomy held with an Omnitech® screw (Biotech International, France with the addition of two 1 cm cancellous cubes (RTI Biologics, United States. A lengthening z-plasty of the extensor tendons and skin were also performed. At 6 weeks the patient was fully weight bearing and at one-year follow up, the patient was satisfied and discharged. A modified technique of lengthening scarf osteotomy is described for congenital brachymatatarsia. This technique allows one stage lengthening through a single incision with graft incorporation by 6 weeks.

  6. Duality in nonlinear B$\\wedge$F models equivalence between self-dual and topologically massive Born-Infeld B$\\wedge$F models

    CERN Document Server

    Menezes, R; Ribeiro, R F; Wotzasek, C

    2002-01-01

    We study the dual equivalence between the nonlinear generalization of the self-dual ($NSD_{B\\wedge F}$) and the topologically massive $B\\wedge F$ models with particular emphasis on the nonlinear electrodynamics proposed by Born and Infeld. This is done through a dynamical gauge embedding of the nonlinear self-dual model yielding to a gauge invariant and dynamically equivalent theory. We clearly show that nonpolinomial $NSD_{B\\wedge F}$ models can be mapped, through a properly defined duality transformation, into $TM_{B\\wedge F}$ actions. The general result obtained is then particularized for a number of examples, including the Born-Infeld-BF (BIBF) model that has experienced a revival in the recent literature.

  7. Expanded eggshell procedure combined with closing-opening technique (a modified vertebral column resection) for the treatment of thoracic and thoracolumbar angular kyphosis.

    Science.gov (United States)

    Liu, Xinyu; Yuan, Suomao; Tian, Yonghao; Wang, Lianlei; Zheng, Yanping; Li, Jianmin

    2015-07-01

    The purpose of this study was to determine the efficacy of a modified vertebral column resection for the treatment of thoracolumbar angular kyphosis. A total of 13 patients (8 male, 5 female) with thoracolumbar kyphosis (kyphotic angle > 60°) were included in this study (Group A). There were 3 patients with failure of spinal formation (Type 1 deformity), 6 patients with old thoracic or lumbar compression fracture, and 4 patients with old spinal tuberculosis (including 1 case of T3-5 vertebral malunion). The average preoperative kyphotic angle was 67.3° (range 62°-75°). Each patient underwent an expanded eggshell procedure combined with the closing-opening technique for the treatment of thoracolumbar angular kyphosis. Sixteen patients who were previously treated with a closing-opening wedge osteotomy in the same spine classification group (kyphotic angle > 60°) were used as a control group (Group B). In Group A, the average (± SD) operative time was 400 ± 60 minutes, and the average blood loss was 960 ± 120 ml. There were no surgery-related complications observed during or after the operations. The average local kyphotic angle was 20.3° (range 18°-24.5°), and the average correction rate was 68.7%. In Group B, the average operative time was 470 ± 90 minutes, and the average blood loss was 2600 ± 1600 ml (range 1200-8200 ml). There were segmental vessels and spinal canal venous plexus injury in 1 case, spinal cord injury in 1 case, dural tearing in 2 cases, pleural rupture in 2 cases, and hemothorax and pneumothorax in 1 case. Each patient had more than 2 years of follow-up. At the latest follow-up examination, the average regional kyphotic angle was 19.9° ± 9.1° (range 19°-34°), and there was no significant loss of correction (p > 0.05). There was greater blood loss and a higher complication rate in Group B than in Group A (p < 0.05). An expanded eggshell procedure combined with the closing-opening technique for the treatment of thoracolumbar

  8. Spatial and temporal distribution of deformation at the front of the Andean orogenic wedge in Bolivia and implications for incremental wedge evolution

    Science.gov (United States)

    Weiss, J. R.; Brooks, B. A.; Vergani, G.; Arrowsmith, R.

    2012-12-01

    There is no consensus regarding how orogenic wedges accommodate deformation over seismo-tectonic timescales. Results from the Himalaya and Taiwan suggest differing mechanisms including localized deformation along a single wedge-front structure and distributed shortening across multiple structures respectively. Here we provide the first detailed constraints on the distribution and timing of deformation at the front of the Andean orogenic wedge using industry acquired seismic reflection data from the ~500-km-long thin-skinned fold-and-thrust belt of the Bolivian Subandes (BSA). Almost no information exists on the recent history of BSA wedge-front deformation despite the presence of multiple ~10-m-high topographic scarps on Holocene surfaces and a recent analysis of the GPS-derived velocity field, which suggests the frontal Mandeyapecua thrust fault system (MTFS) is capable of >Mw 8 earthquakes. We use stratigraphic relationships across fault-related folds to depict the onset of deformation for the complete suite of structures comprising the MTFS. For each structure we determine the uncertainty in timing using an envelope of seismic velocity models from ~70 well-logs and published Quaternary sedimentation rates for the region. We further explore fault geometry and fault slip parameters associated with the displacement field of seismic reflection horizons using elastic dislocation theory. Our analyses reveal the presence of at least eight distinct fault segments comprising the MTFS, including previously unrecognized subsurface thrust faults that have been active since ~1 Ma. Shortening rates are generally higher across the younger, northern portion of the fault system but across-strike, in a ~50-km-wide zone from west to east, no distinct pattern of deformation migration exists. We estimate the percentage of whole-wedge deformation accommodated by wedge-front structures using our new fault slip rates combined with the wedge-loading rate of ~10 mm/yr and place our

  9. Editorial Commentary: Limited Data Shows How Little We Know.

    Science.gov (United States)

    Mitchell, Justin J; Chahla, Jorge; LaPrade, Robert F

    2016-10-01

    Lateral compartment osteoarthritis of the knee can be a challenging problem to address in the younger, active population. The challenge is compounded by limited treatment options and high patient expectations, with patients often desiring a return to impact high intensity activity. Distal femoral osteotomy has been reported to be one potential treatment option; however, a highly heterogeneous literature exists for both opening and closing wedge distal femoral osteotomies for the treatment of isolated lateral compartment osteoarthritis with valgus malalignment. The literature does not provide significant direction for surgeons on the appropriate surgical approach; however, opening wedge osteotomies allow for fine adjustment and maintain leg length and joint alignment, and are our preferred approach.

  10. First direct dating of Late Pleistocene ice-wedges by AMS

    NARCIS (Netherlands)

    Vasil'chuk, YK; van der Plicht, J; Jungner, H; Sonninen, E; Vasil'chuk, AC; Vasil'chuk, Yurij K.; Vasil'chuk, Alla C.

    2000-01-01

    We present the first direct dating by C-14-accelerator mass spectrometry of three Late Pleistocene syngenetic ice-wedges from the Seyaha cross-section. They are representative of permafrost with multistage ice-wedges from the North of Western Siberia. The most important result is the clear vertical

  11. Revisit the classical Newmark displacement method for earthquake-induced wedge slide

    Science.gov (United States)

    Yang, Che-Ming; Cheng, Hui-Yun; Wu, Wen-Jie; Hsu, Chang-Hsuan; Dong, Jia-Jyun; Lee, Chyi-Tyi

    2016-04-01

    Newmark displacement method has been widely used to study the earthquake-induced landslides and adopted to explore the initiation and kinematics of catastrophic planar failure in recent years. However, surprisingly few researchers utilize the Newmark displacement method to study the earthquake-induced wedge slide. The classical Newmark displacement method for earthquake-induced wedge sliding assumed the wedge is rigid and the vertical acceleration, as well as the horizontal acceleration perpendicular to the sliding direction, is neglected. Moreover, the friction coefficients on the weak planes are assumed as unchanged during sliding. The purpose of this study is to test the reasonableness of the aforementioned assumptions. This study uses Newmark displacement method incorporating the rigid wedge method (RWM) and maximum shear stress method (MSSM) to evaluate the influence of wedge deformation. We design the geometry of the wedge and input the synthetic seismicity to trigger the wedge slide. The influence for neglecting the vertical and horizontal (perpendicular to the sliding direction) accelerations is also assessed. Besides, this research incorporates the velocity-displacement dependent friction law in the analysis to evaluate the influence of constant friction coefficient assumption. Result of this study illustrated that the aforementioned assumptions have significant effects on the calculated permeant displacement, moving speed, and failure initiation. To conclude, this study provides new insights on the initiation and kinematics of an earthquake induced wedge slide.

  12. Enhancement of linear and second-order hyperpolarizabilities in wedge-shaped nanostructures

    Science.gov (United States)

    Jayabalan, J.; Singh, Manoranjan P.; Rustagi, K. C.

    2003-08-01

    Analytical solutions for the wave functions for free electrons inside a wedge-shaped quantum dot are reported. For silver wedge-shaped quantum dots, linear and second-order hyperpolarizabilities are calculated for various apex angles. It is found that linear and nonlinear hyperpolarizabilities both increase with decreasing apex angle.

  13. Duwamish Waterways Navigation Improvement Study: Analysis of Impacts on Water Quality and Salt Wedge Characteristics.

    Science.gov (United States)

    1981-02-01

    dissolved oxygen consumption in the saltwater wedge is emphasized. A section has also been prepared discussing sediment transport in the estuary...biomass produced and sedimented 23 1,000 800 00 0 400 Xi. . *-*’* 200 ox- :~. ---0 - .....’ ~ ’J FIGURE 6 Annual Dissolved Oxygen Consumption in the wedge

  14. Reflection of a converging cylindrical shock wave segment by a straight wedge

    Science.gov (United States)

    Gray, B.; Skews, B.

    2017-01-01

    As a converging cylindrical shock wave propagates over a wedge, the shock wave accelerates and the angle between the shock wave and the wedge decreases. This causes the conditions at the reflection point to move from what would be the irregular reflection domain for a straight shock wave into the regular reflection domain. This paper covers a largely qualitative study of the reflection of converging shock wave segments with Mach numbers between 1.2 and 2.1 by wedges inclined at angles between 15° and 60° from experimental and numerical results. The sonic condition conventionally used for predicting the type of reflection of straight shock waves was found to also be suitable for predicting the initial reflection of a curved shock wave. Initially regular reflections persisted until the shock was completely reflected by the wedge, whereas the triple point of initially irregular reflections was observed to return to the wedge surface, forming transitioned regular reflection. After the incident shock wave was completely reflected by the wedge, a shock wave focusing mechanism was observed to amplify the pressure on the surface of the wedge by a factor of up to 100 for low wedge angles.

  15. A quantum hybrid with a thin antenna at the vertex of a wedge

    Science.gov (United States)

    Carlone, Raffaele; Posilicano, Andrea

    2017-03-01

    We study the spectrum, resonances and scattering matrix of a quantum Hamiltonian on a "hybrid surface" consisting of a half-line attached by its endpoint to the vertex of a concave planar wedge. At the boundary of the wedge, outside the vertex, homogeneous Dirichlet conditions are imposed. The system is tunable by varying the measure of the angle at the vertex.

  16. Immediate and 1 week effects of laterally wedge insoles on gait biomechanics in healthy females.

    Science.gov (United States)

    Weinhandl, Joshua T; Sudheimer, Sarah E; Van Lunen, Bonnie L; Stewart, Kimberly; Hoch, Matthew C

    2016-03-01

    It is estimated that approximately 45% of the U.S. population will develop knee osteoarthritis, a disease that creates significant economic burdens in both direct and indirect costs. Laterally wedged insoles have been frequently recommended to reduce knee abduction moments and to manage knee osteoarthritis. However, it remains unknown whether the lateral wedge will reduce knee abduction moments over a prolonged period of time. Thus, the purposes of this study were to (1) examine the immediate effects of a laterally wedged insole in individuals normally aligned knees and (2) determine prolonged effects after the insole was worn for 1 week. Gait analysis was performed on ten women with and without a laterally wedged insole. After participants wore the wedges for a week, a second gait analysis was performed with and without the insole. The wedged insole did not affect peak knee abduction moment, although there was a significant increase in knee abduction angular impulse after wearing the insoles for 1 week. Furthermore, there was a significant increase in vertical ground reaction force at the instance of peak knee abduction moment with the wedges. While the laterally wedged insole used in the current study did not alter knee abduction moments as expected, other studies have shown alterations. Future studies should also examine a longer acclimation period, the influence of gait speed, and the effect of different shoe types with the insole.

  17. Pan-Arctic ice-wedge degradation in warming permafrost and its influence on tundra hydrology

    Science.gov (United States)

    Liljedahl, Anna K.; Boike, Julia; Daanen, Ronald P.; Fedorov, Alexander N.; Frost, Gerald V.; Grosse, Guido; Hinzman, Larry D.; Iijma, Yoshihiro; Jorgenson, Janet C.; Matveyeva, Nadya; Necsoiu, Marius; Raynolds, Martha K.; Romanovsky, Vladimir E.; Schulla, Jörg; Tape, Ken D.; Walker, Donald A.; Wilson, Cathy J.; Yabuki, Hironori; Zona, Donatella

    2016-04-01

    Ice wedges are common features of the subsurface in permafrost regions. They develop by repeated frost cracking and ice vein growth over hundreds to thousands of years. Ice-wedge formation causes the archetypal polygonal patterns seen in tundra across the Arctic landscape. Here we use field and remote sensing observations to document polygon succession due to ice-wedge degradation and trough development in ten Arctic localities over sub-decadal timescales. Initial thaw drains polygon centres and forms disconnected troughs that hold isolated ponds. Continued ice-wedge melting leads to increased trough connectivity and an overall draining of the landscape. We find that melting at the tops of ice wedges over recent decades and subsequent decimetre-scale ground subsidence is a widespread Arctic phenomenon. Although permafrost temperatures have been increasing gradually, we find that ice-wedge degradation is occurring on sub-decadal timescales. Our hydrological model simulations show that advanced ice-wedge degradation can significantly alter the water balance of lowland tundra by reducing inundation and increasing runoff, in particular due to changes in snow distribution as troughs form. We predict that ice-wedge degradation and the hydrological changes associated with the resulting differential ground subsidence will expand and amplify in rapidly warming permafrost regions.

  18. Comparison of dosimetric characteristics of Siemens virtual and physical wedges for ONCOR linear accelerator

    Directory of Open Access Journals (Sweden)

    Attalla Ehab

    2010-01-01

    Full Text Available Dosimetric properties of virtual wedge (VW and physical wedge (PW in 6- and 10-MV photon beams from a Siemens ONCOR linear accelerator, including wedge factors, depth doses, dose profiles, peripheral doses, are compared. While there is a great difference in absolute values of wedge factors, VW factors (VWFs and PW factors (PWFs have a similar trend as a function of field size. PWFs have stronger depth dependence than VWF due to beam hardening in PW fields. VW dose profiles in the wedge direction, in general, match very well with those of PW, except in the toe area of large wedge angles with large field sizes. Dose profiles in the nonwedge direction show a significant reduction in PW fields due to off-axis beam softening and oblique filtration. PW fields have significantly higher peripheral doses than open and VW fields. VW fields have similar surface doses as the open fields, while PW fields have lower surface doses. Surface doses for both VW and PW increase with field size and slightly with wedge angle. For VW fields with wedge angles 45° and less, the initial gap up to 3 cm is dosimetrically acceptable when compared to dose profiles of PW. VW fields in general use less monitor units than PW fields.

  19. 楔状缺损临床研究进展%Clinical research progress of wedge shaped defects

    Institute of Scientific and Technical Information of China (English)

    韦界飞

    2012-01-01

    Wedge shaped defects is common non-caries dental disease, which caused by chronic consumption of hard tissue close to lips, huccal and neck. The defects formed by the intersection of two planes, with neatly edge, hard and smooth surface; the defects general had the same color of dental hard tissue, but sometimes could also be with other different colors; the defects were commonly found in the premolars, especially in the first premolar; wedge-shaped defect increase with age growth. In recent years, there were more and more studies focusing on the etiology and clinical progress. Here, we summarized the risk factors, prevalence and clinical treatment for wedge shaped defects.%楔状缺损是非龋性疾病中的常见病,是牙齿唇、颊面牙颈部硬组织发生慢性消耗所致的缺损.其缺损由两个平面相交而成,边缘整齐,表面坚硬光滑,一般均为牙体硬组织本色,有时可有不同程度的着色,好发生于前磨牙,尤其是第一前磨牙,随着年龄增长,楔状缺损有增加的趋势,年龄愈大,楔状缺损愈严重.近年来国内外学者对于楔状缺损的病因学研究更加深入、临床治疗进展的报道也越来越多,本文对楔状缺损的病因、流行情况及治疗进展进行综述.

  20. Investigation of a Wedge Adhesion Test for Edge Seals

    Energy Technology Data Exchange (ETDEWEB)

    Kempe, Michael; Wohlgemuth, John; Miller, David; Postak, Lori; Booth, Dennis; Phillips, Nancy

    2016-09-26

    Many photovoltaic (PV) technologies have been found to be sensitive to moisture that diffuses into a PV package. Even with the use of impermeable frontsheets and backsheets, moisture can penetrate from the edges of a module. To limit this moisture ingress pathway from occurring, manufacturers often use a low permeability polyisobutylene (PIB) based edge seal filled with desiccant to further restrict moisture ingress. Moisture ingress studies have shown that these materials are capable of blocking moisture for the 25-year life of a module; but to do so, they must remain well-adhered and free of cracks. This work focuses on adapting the Boeing Wedge test for use with edge seals laminated using glass substrates as part of a strategy to assess the long-term durability of edge seals. The advantage of this method is that it duplicates the residual stresses and strains that a glass/glass module may have when the lamination process results in some residual glass bending that puts the perimeter in tension. Additionally, this method allows one to simultaneously expose the material to thermal stress, humidity, mechanical stress, and ultraviolet radiation. The disadvantage of this method generally is that we are limited by the fracture toughness of the glass substrates that the edge seal is adhered to. However, the low toughness of typical uncrosslinked or sparsely crosslinked PIB makes them suitable for this technique. We present data obtained during the development of the wedge test for use with PV edge seal materials. This includes development of the measuring techniques and evaluation of the test method with relevant materials. We find consistent data within a given experiment, along with the theoretical independence of fracture toughness measurements with wedge thickness. This indicates that the test methodology is reproducible. However, even though individual experimental sets are consistent, the reproducibility between experimental sets is poor. We believe this may be

  1. Investigation of a wedge adhesion test for edge seals

    Science.gov (United States)

    Kempe, Michael; Wohlgemuth, John; Miller, David; Postak, Lori; Booth, Dennis; Phillips, Nancy

    2016-09-01

    Many photovoltaic (PV) technologies have been found to be sensitive to moisture that diffuses into a PV package. Even with the use of impermeable frontsheets and backsheets, moisture can penetrate from the edges of a module. To limit this moisture ingress pathway from occurring, manufacturers often use a low permeability polyisobutylene (PIB) based edge seal filled with desiccant to further restrict moisture ingress. Moisture ingress studies have shown that these materials are capable of blocking moisture for the 25-year life of a module; but to do so, they must remain well-adhered and free of cracks. This work focuses on adapting the Boeing Wedge test for use with edge seals laminated using glass substrates as part of a strategy to assess the long-term durability of edge seals. The advantage of this method is that it duplicates the residual stresses and strains that a glass/glass module may have when the lamination process results in some residual glass bending that puts the perimeter in tension. Additionally, this method allows one to simultaneously expose the material to thermal stress, humidity, mechanical stress, and ultraviolet radiation. The disadvantage of this method generally is that we are limited by the fracture toughness of the glass substrates that the edge seal is adhered to. However, the low toughness of typical uncrosslinked or sparsely crosslinked PIB makes them suitable for this technique. We present data obtained during the development of the wedge test for use with PV edge seal materials. This includes development of the measuring techniques and evaluation of the test method with relevant materials. We find consistent data within a given experiment, along with the theoretical independence of fracture toughness measurements with wedge thickness. This indicates that the test methodology is reproducible. However, even though individual experimental sets are consistent, the reproducibility between experimental sets is poor. We believe this may be

  2. The effect of shoe design and lateral wedging on knee loading

    DEFF Research Database (Denmark)

    Mølgaard, Carsten; Kersting, Uwe G.

    The increasing number of patients with developing osteoarthritis is accompanied by a growing scientific interest in non-operative early treatment strategies. It is generally believed that laterally wedged insoles can change the distribution of the knee loading, but the importance of footwear design......-dimensional gait analysis. Barefoot walking, walking in a running shoe, an Oxford-type leather shoe, and a rocker shoe were analyzed. The shoes were tested both with and without a 10-degree full length laterally wedged insole. Results: Similar, significant reductions in the peak knee adduction moment with lateral...... wedges were observed in all three types of shoes. However, differences between shoe design were of similar magnitude as the effect of laterally wedged insoles. Only marginal changes in muscle activity for lateral hamstrings during barefoot toe-out walking and gastrocnemius when using the Oxford wedged...

  3. Bonding mechanism of ultrasonic wedge bonding of copper wire on Au/Ni/Cu substrate

    Institute of Scientific and Technical Information of China (English)

    TIAN Yan-hong; WANG Chun-qing; Y. Norman ZHOU

    2008-01-01

    The ultrasonic wedge bonding with d25 μm copper wire was achieved on Au/Ni plated Cu substrate at ambient temperature. Ultrasonic wedge bonding mechanism was investigated by using SEM/EDX, pull test, shear test and microhardness test. The results show that the thinning of the Au layer occurs directly below the center of the bonding tool with the bonding power increasing. The interdiffusion between copper wire and Au metallization during the wedge bonding is assumed negligible, and the wedge bonding is achieved by wear action induced by ultrasonic vibration. The ultrasonic power contributes to enhance the deformation of copper wire due to ultrasonic softening effect which is then followed by the strain hardening of the copper wedge bonding.

  4. Single-Tooth Osteotomy Combined Wide Linear Corticotomy Under Local Anesthesia for Correcting Anterior Protrusion With Ectopically Erupted Canine.

    Science.gov (United States)

    Iskenderoglu, Nur Serife; Choi, Byung-Joon; Seo, Kyung Won; Lee, Yeon-Ji; Lee, Baek-Soo; Kim, Seong-Hun

    2017-01-01

    This article presents the alternative surgical treatments of both anterior protrusion by carrying out retraction on mandibular anterior fragment, meanwhile applying retraction force on maxilla anterior teeth and ectopically erupted canine with using platelet-rich fibrin (PRF). Anterior segmental osteotomy was combined with linear corticotomy under local anesthesia. The correction of right ectopic canine was achieved through 2 stages. First, dento-osseous osteotomy on palatal side was performed. Then second osteotomy with immediate manual repositioning of the canine with concomitant first premolar extraction was enhanced with PRF, which was prepared by centrifuging patient's blood, applied into buccal side of high canine during osteotomy. Mandibular retraction was accomplished by anterior segmental osteotomy. Single-tooth osteotomy is a more effective surgical method for ankylosed or ectopically erupted tooth in orthodontic treatment. It can reduce the total orthodontic treatment time and root resorption, 1 common complication. Significant improved bone formation was seen with the addition of PRF on noncritical size defects in the animal model. It is reasonable to think that PRF can promote bone regeneration. So early bone formation also can reduce the complication such as postoperative infection. As an alternative to anterior protrusion and ectopically erupted canine treatment, segmental osteotomy and corticotomy combined platelet-rich plasma can enhance orthodontic treatment outcome.

  5. In vitro comparison of tibial plateau leveling osteotomy with and without use of a tibial plateau leveling jig.

    Science.gov (United States)

    Schmerbach, Kay Ingo; Boeltzig, Christian Konrad Matthias; Reif, Ullrich; Wieser, Jan Carsten; Keller, Thomas; Grevel, Vera

    2007-02-01

    To evaluate the influence of a tibial plateau leveling jig on osteotomy orientation, fragment reduction, and postoperative tibial plateau angle (TPA) during tibial plateau leveling osteotomy (TPLO). In vitro experimental study. Large-breed canine cadavers (n=20). TPLO was performed on 40 hindlimbs using 4 methods. Group 1: Jig; dogs in dorsal recumbency with the osteotomy parallel to the distal jig pin. Groups 2-4: No jig; dogs in lateral recumbency with the osteotomy in a vertical orientation (group 2: tibia parallel to the table top; group 3: controlled superimposition of the femoral condyles; group 4: internal rotation of the tibia). Postoperative TPA, fragment reduction, and osteotomy orientation relative to the tibial plateau were compared. Positive or negative values denoted deviation from parallel relative to the tibial plateau. Postoperative TPA, fragment reduction, and proximodistal osteotomy orientation were not significantly different between groups. Craniocaudal osteotomy orientation was significantly different (Ptable surface. TPLO without use of a jig reduces surgical trauma, is less time consuming, and reduces cost.

  6. O uso do plasma rico em plaquetas associado ao aspirado de medular óssea na osteotomia tibial tipo puddu The use of platelet rich plasma enriched with bone marrow aspirate in puddu tibial osteotomy

    Directory of Open Access Journals (Sweden)

    Caio Oliveira D'Elia

    2009-01-01

    Full Text Available OBJETIVO: O presente estudo procurou avaliar a aplicação do plasma rico em plaquetas associado ao aspirado de medular óssea como substituto ósseo ao enxerto autólogo do ilíaco nas osteotomias tibiais proximais de cunha de adição medial (OTCAM. MÉTODOS: Foram estudados 25 pacientes submetidos a OTCAM divididos de forma randomizada em dois grupos, grupo ilíaco, 14 pacientes submetidos a OTCAM nos quais se utilizou o enxerto autólogo do ilíaco para preencher o sitio da osteotomia, grupo PRP, 11 pacientes submetidos a OTCAM nos quais se utilizou um composto formado por plasma rico em plaquetas associado ao aspirado de medular ósseo para preencher o sitio da osteotomia. Foram avaliados o sangramento (variação dos níveis de hemoglobina e hematócrito e a dor (escala visual analógica -EVA, comparando os grupos em relação a essas variáveis. RESULTADOS: Não foram observadas diferenças entre os grupos no que se refere à variação dos níveis de hemoglobina (p = 0,820 e hematócrito (p = 0,323. Os grupos não foram diferentes em relação à intensidade da dor segundo a EVA (p = 0,538. CONCLUSÃO: O uso do PRP associado ao aspirado de medular óssea nas OTCAM não demonstrou vantagem sobre a utilização do enxerto autólogo do ilíaco no que se refere a dor e sangramento.OBJECTIVE: The present study was performed in order to evaluate the use of platelet rich plasma associated to bone marrow aspirate, substituting autologous iliac bone graft in medial opening wedge osteotomy (OWHTO. METHODS: Twenty-five patients were submitted to tibial opening wedge osteotomy, being divided into two groups. Iliac group: 14 patients submitted to OWHTO, using autologous iliac bone graft to fill the gap. PRP group: 11 patients using platelet rich plasma associated to bone marrow aspirate to fill the gap. We evaluated bleeding (hemoglobin and hematocrit levels and pain (visual analogic scale-VAS, then we compared the groups regarding these variables

  7. Two-dimensional electronic spectroscopy with birefringent wedges

    Energy Technology Data Exchange (ETDEWEB)

    Réhault, Julien; Maiuri, Margherita; Oriana, Aurelio; Cerullo, Giulio [IFN-CNR, Dipartimento di Fisica, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milano (Italy)

    2014-12-15

    We present a simple experimental setup for performing two-dimensional (2D) electronic spectroscopy in the partially collinear pump-probe geometry. The setup uses a sequence of birefringent wedges to create and delay a pair of phase-locked, collinear pump pulses, with extremely high phase stability and reproducibility. Continuous delay scanning is possible without any active stabilization or position tracking, and allows to record rapidly and easily 2D spectra. The setup works over a broad spectral range from the ultraviolet to the near-IR, it is compatible with few-optical-cycle pulses and can be easily reconfigured to two-colour operation. A simple method for scattering suppression is also introduced. As a proof of principle, we present degenerate and two-color 2D spectra of the light-harvesting complex 1 of purple bacteria.

  8. Percutaneous pelvic osteotomy and intertrochanteric varus shortening osteotomy in nonambulatory GMFCS level IV and V cerebral palsy patients: preliminary report on 30 operated hips.

    Science.gov (United States)

    Canavese, Federico; Gomez, Horacio; Kaelin, André; Ceroni, Dimitri; de Coulon, Geraldo

    2013-01-01

    This study evaluated the outcome of severe cerebral palsy patients (Gross Motor Function Classification System level IV and V) treated by simultaneous percutaneous pelvic osteotomy and intertrochanteric varus shortening osteotomy for hip subluxation or dislocation between 2002 and 2011. Twenty-four patients (30 hips) with an average age of 9.4 years (5-16.5) were reviewed at a mean follow-up of 35.9 months (6-96). Percutaneous pelvic osteotomy lasted on average 30 min/patient per side (25-40) and was always performed through a skin incision of 2-3 cm. The migration percentage and acetabular angle were assessed on plain radiographs. The mean Reimers' migration percentage improved from 67.1% (42-100) preoperatively to 7.7% (0-70) at the last follow-up and the mean acetabular angle improved from 31.8° (22-48) to 15.7° (5-27). Five patients presented complications: one redislocation, one bone graft dislodgement, and three with avascular necrosis of the femoral head. This study should be considered as a pilot study. These results indicate that this combined approach is an effective, reliable, and minimally invasive alternative method for the treatment of spastic dislocated hips in severe cerebral palsy patients with an outcome similar to standard techniques reported in the literature.

  9. Isolating active orogenic wedge deformation in the southern Subandes of Bolivia

    Science.gov (United States)

    Weiss, Jonathan R.; Brooks, Benjamin A.; Foster, James H.; Bevis, Michael; Echalar, Arturo; Caccamise, Dana; Heck, Jacob; Kendrick, Eric; Ahlgren, Kevin; Raleigh, David; Smalley, Robert; Vergani, Gustavo

    2016-08-01

    A new GPS-derived surface velocity field for the central Andean backarc permits an assessment of orogenic wedge deformation across the southern Subandes of Bolivia, where recent studies suggest that great earthquakes (>Mw 8) are possible. We find that the backarc is not isolated from the main plate boundary seismic cycle. Rather, signals from subduction zone earthquakes contaminate the velocity field at distances greater than 800 km from the Chile trench. Two new wedge-crossing velocity profiles, corrected for seasonal and earthquake affects, reveal distinct regions that reflect (1) locking of the main plate boundary across the high Andes, (2) the location of and loading rate at the back of orogenic wedge, and (3) an east flank velocity gradient indicative of décollement locking beneath the Subandes. Modeling of the Subandean portions of the profiles indicates along-strike variations in the décollement locked width (WL) and wedge loading rate; the northern wedge décollement has a WL of ~100 km while accumulating slip at a rate of ~14 mm/yr, whereas the southern wedge has a WL of ~61 km and a slip rate of ~7 mm/yr. When compared to Quaternary estimates of geologic shortening and evidence for Holocene internal wedge deformation, the new GPS-derived wedge loading rates may indicate that the southern wedge is experiencing a phase of thickening via reactivation of preexisting internal structures. In contrast, we suspect that the northern wedge is undergoing an accretion or widening phase primarily via slip on relatively young thrust-front faults.

  10. Three-dimensional virtual simulation of alar width changes following bimaxillary osteotomies

    NARCIS (Netherlands)

    Liebregts, J.; Xi, T.; Schreurs, R; Loon, B. van; Berge, S.; Maal, T.

    2016-01-01

    The aim of this study was to evaluate the accuracy of three-dimensional (3D) soft tissue simulation of nose width changes following bimaxillary osteotomies and to identify patient- and surgery-related factors that may affect the accuracy of simulation. Sixty patients (mean age 26 years) who

  11. Accuracy of three-dimensional soft tissue simulation in bimaxillary osteotomies

    NARCIS (Netherlands)

    Liebregts, J.; Xi, T.; Timmermans, M.; Koning, M.J.J. de; Berge, S.J.; Hoppenreijs, T.J.M.; Maal, T.J.

    2015-01-01

    The purpose of this study was to evaluate the accuracy of an algorithm based on the mass tensor model (MTM) for computerized 3D simulation of soft-tissue changes following bimaxillary osteotomy, and to identify patient and surgery-related factors that may affect the accuracy of the simulation. Sixty

  12. 3D analysis of condylar remodelling and skeletal relapse following bilateral sagittal split advancement osteotomies

    NARCIS (Netherlands)

    Xi, T.; Schreurs, R.; Loon, B. van; Koning, M.J. de; Berge, S.J.; Hoppenreijs, T.J.; Maal, T.J.J.

    2015-01-01

    A major concern in mandibular advancement surgery using bilateral sagittal split osteotomies (BSSO) is potential postoperative relapse. Although the role of postoperative changes in condylar morphology on skeletal relapse was reported in previous studies, no study so far has objectified the precise

  13. Case report - curved femoral osteotomy for management of medial patellar luxation

    DEFF Research Database (Denmark)

    Allpass, Maja; Miles, James Edward

    2015-01-01

    Medial patellaluxation kan forårsages af femoral varus hos hund. Førhen har patienter med excessiv femoralvarus været korrigeret ved en lateralt placeret femoral kile-ostektomi. Her præsenteres en case, hvor en buet osteotomi blev anvendt til behandling af medial patellaluxation....

  14. PLATEAU-PATELLA ANGLE: AN OPTION FOR ASSESSING PATELLAR HEIGHT ON PROXIMAL TIBIA OSTEOTOMY

    Science.gov (United States)

    BONADIO, MARCELO BATISTA; TORRES, JÚLIO AUGUSTO DO PRADO; MAZZARO, VICENTE; HELITO, CAMILO PARTEZANI; GOBBI, RICCARDO GOMES; DEMANGE, MARCO KAWAMURA

    2016-01-01

    ABSTRACT Objective: To compare the plateau-patella angle method to the methods already established for patellar height measurement in patients undergoing high tibial osteotomy. Methods: This is a retrospective study of 13 patients undergoing medial opening tibial osteotomy. The patellar height was measured in pre and post-operative radiographs by the methods from Insall-Salvati, Caton-Deschamps, Blackburne-Peel and patella-plateau angle, as well as the tibial slope and length of the patellar tendon. Measurements were performed by two knee surgeons at two different times. Results: The mean age was 41.33 ± 01.09 years old. The average rates of Caton-Deschamps, Blackburne-Peel, Insall-Salvati and plateau-patella angle were, respectively, 1.00; 0.89; 1.10; and 23.15° preoperatively, and 0.89; 0.78; 1.11; and 20.46°, postoperatively. The correlation of Caton-Deschamps, Blackburne-Pell, and Insall-Salvati indexes and plateau-patellar angle interobserver was 0.72 (p <0.001), 0:54 (p <0.001), 0.65 (p <0.001), and 0.67 (w <0.001), respectively. Conclusion: The plateau-patella angle method undergoes changes that are correlated with changes in tibial slope after osteotomy, unlike the classical methods. This fact may lead to overestimate the reduction of patellar height after osteotomy. Level of evidence IV. Case Series. PMID:27217812

  15. Effect of Maxillary Osteotomy on Speech in Cleft Lip and Palate: Perceptual Outcomes of Velopharyngeal Function

    Science.gov (United States)

    Pereira, Valerie J.; Sell, Debbie; Tuomainen, Jyrki

    2013-01-01

    Background: Abnormal facial growth is a well-known sequelae of cleft lip and palate (CLP) resulting in maxillary retrusion and a class III malocclusion. In 10-50% of cases, surgical correction involving advancement of the maxilla typically by osteotomy methods is required and normally undertaken in adolescence when facial growth is complete.…

  16. An extensive posterior approach of the elbow with osteotomy of the medial epicondyle

    NARCIS (Netherlands)

    Vos, de M.J.; Wagener, M.L.; Verdonschot, N.J.J.; Eygendaal, D.

    2014-01-01

    Background This study describes a posterior approach to the elbow for placement of a total elbow prosthesis. Methods Release of the medial collateral ligament is achieved by performing an osteotomy of the medial epicondyle. This allows anatomic refixation of the origin of the medial collateral liga

  17. An extensive posterior approach of the elbow with osteotomy of the medial epicondyle

    NARCIS (Netherlands)

    Vos, M.J. de; Wagener, M.L.; Verdonschot, N.J.J.; Eygendaal, D.

    2014-01-01

    BACKGROUND: This study describes a posterior approach to the elbow for placement of a total elbow prosthesis. METHODS: Release of the medial collateral ligament is achieved by performing an osteotomy of the medial epicondyle. This allows anatomic refixation of the origin of the medial collateral lig

  18. Heat generation by two different saw blades used for tibial plateau leveling osteotomies.

    Science.gov (United States)

    Bachelez, Andreas; Martinez, Steven A

    2012-01-01

    During tibial plateau leveling osteotomy (TPLO) the saw blade produces frictional heat. The purpose of this study was to evaluate and compare heat generated by two TPLO blade designs (Slocum Enterprises [SE] and New Generation Devices [NDG]), with or without irrigation, on cadaveric canine tibias. Thirty-six paired tibias were used to continuously measure bone temperatures during osteotomy through both cortices (i.e., the cis and trans cortices). Each pair was assigned to either an irrigation or nonirrigation group during osteotomy, and each tibia within a pair was osteotomized using a different saw blade design. Saw blade temperatures were recorded and temperatures were compared for all combinations of blade type, cortex, and irrigation. In the cis cortex group, the SE blade generated more bone heat than the NGD blade (P=0.0258). Significant differences in temperature generation between saw blade types were seen only when the osteotomy site was not irrigated (P=0.0156). For all variables measured, bone and saw blade temperature generation was lower with irrigation (Psaw blade produced a critical duration of damaging temperature ranges in this study. Although saw blade design and irrigation influence heat generation during the TPLO, the potential for bone thermal damage during TPLO