Is Total Femur Replacement a Reliable Treatment Option for Patients With Metastatic Carcinoma of the Femur?

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Sevelda, Florian; Waldstein, Wenzel; Panotopoulos, Joannis; Kaider, Alexandra; Funovics, Philipp Theodor; Windhager, Reinhard

2018-05-01

latter two complications resulted in amputation in two patients. The median MSTS score was 32 (range, 13-57). Despite attempts to select patients who might have anticipated greater life expectancy, eight of 11 patients died by 6 months after surgery, and an additional two patients had undergone an amputation at 8 and at 17 months postoperatively. Most patients undergoing total femur replacement in this series did not recover from the procedure by the time they died, despite our best attempts to perform the procedure in patients whom we thought would live at least 6 months. Based on this, we believe that most patients with extensive metastatic disease to the femur should be offered palliative care, rather than major reconstruction. Level IV, therapeutic study.

Curvature reduces bending strains in the quokka femur

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Kyle McCabe

2017-03-01

Full Text Available This study explores how curvature in the quokka femur may help to reduce bending strain during locomotion. The quokka is a small wallaby, but the curvature of the femur and the muscles active during stance phase are similar to most quadrupedal mammals. Our hypothesis is that the action of hip extensor and ankle plantarflexor muscles during stance phase place cranial bending strains that act to reduce the caudal curvature of the femur. Knee extensors and biarticular muscles that span the femur longitudinally create caudal bending strains in the caudally curved (concave caudal side bone. These opposing strains can balance each other and result in less strain on the bone. We test this idea by comparing the performance of a normally curved finite element model of the quokka femur to a digitally straightened version of the same bone. The normally curved model is indeed less strained than the straightened version. To further examine the relationship between curvature and the strains in the femoral models, we also tested an extra-curved and a reverse-curved version with the same loads. There appears to be a linear relationship between the curvature and the strains experienced by the models. These results demonstrate that longitudinal curvature in bones may be a manipulable mechanism whereby bone can induce a strain gradient to oppose strains induced by habitual loading.

Robust femur condyle disambiguation on biplanar X-rays.

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Serrurier, Antoine; Quijano, Sergio; Nizard, Remy; Skalli, Wafa

2012-12-01

Three-dimensional (3D) reconstruction of the skeleton from biplanar X-rays relies on scarce information digitalised by an operator on both frontal and lateral radiographs. In clinical routine, difficulties occur for non-skilled operators to discriminate the medial from the lateral femur condyle on the lateral view. Our study proposes an algorithm able to detect automatically a possible inversion of the two condyles by the operator at an early stage of the reconstruction process. It relies on the computation of two 3D femur surfaces, one directly from the operator digitalisation and the other from the same digitalisation with medial and lateral condyles automatically swapped. Pairs of virtual biplanar X-rays are computed for both reconstructions and the closest pair to the original X-rays is selected on the basis of similarity measures, pointing the correct 3D surface. The algorithm shows a success rate higher than 85% for both asymptomatic and pathological femurs whatever the initial condyle digitalisation of the operator, bringing automatically non-skilled operators acting in clinical routine to the level of skilled operators. This study validates moreover the proof-of-concept of automatic shape adjustments of a 3D surface on the basis of similarity measures in the process of 3D reconstruction from biplanar X-rays. Copyright © 2012 IPEM. Published by Elsevier Ltd. All rights reserved.

Assessment of Outcomes of Treatment of Fractures of Distal Femur with a Locking Plate Taking into Account Factors Influencing the Result.

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Pakuła, Grzegorz; Kwiatkowski, Krzysztof; Kuczmera, Piotr; Fudalej, Piotr

2015-10-01

The aim of this paper is to evaluate the results of treatment of distal femoral fractures (DFF) fixed with locking plates and analysis of factors that influence the final outcome. The patients were treated at the Department of Traumatology and Orthopedics, Military Medical Institute in Warsaw, and the Department of Orthopedics and Traumatology, 4th Military Research Hospital in Wroclaw. We analysed 39 patients with 42 fractures of the distal femur. Treatment results were analysed using the KOOS and KSS scales. Factors influencing the outcome were also investigated. Statistical analysis was performed using STATISTICA v. 10. Mean KOOS scores indicate a predominance of poor outcomes, while mean KSS scores indicate good outcomes. Treatment outcomes were significantly influenced by pain and limited mobility. 1. Subjective evaluation of treatment of fractures of the distal femur using the KOOS scale per form edworse than a clinical evaluation using the KSS. 2. Post-operative management should emphasise pain relief and restoration of the performance of the treated lower limb to ensure good mobility without crutches. 3. Despite the use of modern operational methods of fracture fixation, treatment of distal femur fractures is still a challenge.

Comparative Study Using Intramedullary K-wire Fixation Over Titanium Elastic Nail in Paediatric Shaft Femur Fractures.

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Kumar, Sanjiv; Anand, Tushar; Singh, Sudhir

2014-11-01

Fracture shaft femur is common paediatric trauma leading to significant morbidity. Conservative treatments available are associated with prolonged periods of immobilization. Use of flexible intramedullary implant allows early rehabilitation in diaphyseal fractures of femur in children. The aim of the present study is to compare fixation of diaphyseal femur fracture by titanium elastic nail and intramedullary K-wires in children. Prospective randomized study in a tertiary care hospital. Fifty-two children between 6 years and 14 years of age with femoral shaft fracture were assigned either in Group I or Group II based on computer generated random numbers. In Group I closed percutaneous intramedullary K- wire fixation and in Group II closed percutaneous intramedullary titanium elastic nail was used to fix the fractures. Partial weight bearing was allowed after 6 weeks of surgery and full weight bearing at clinico-radiological union. Average time of radiological union was 6 to 10 weeks in both groups. In both the groups two cases had entry site irritation which resolved with early implant removal. One case in both the groups had unacceptable mal-alignment. Both the groups had few cases of limb-length discrepancy, which was in acceptable limit, except two cases of TENS. There was no statistically significant difference between the results of both the groups. But, using K-wires significantly reduced the cost of treatment. Most of such fractures in our society are neglected because of high cost of treatment. Providing a cheaper alternative in form of K-wires may be beneficial for the patients from low socio-economic status.

Damage characterization on human femur bone by means of ultrasonics and acoustic emission

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Strantza, M; Boulpaep, F; Van Hemelrijck, D; Aggelis, D G; Polyzos, D; Louis, O

2015-01-01

Human bone tissue is characterized as a material with high brittleness. Due to this nature, visible signs of cracking are not easy to be detected before final failure. The main objective of this work is to investigate if the acoustic emission (AE) technique can offer valuable insight to the fracture process of human femur specimens as in other engineering materials characterization. This study describes the AE activity during fracture of whole femur bones under flexural load. Before fracture, broadband AE sensors were used in order to measure parameters like wave velocity dispersion and attenuation. Waveform parameters like the duration, rise time and average frequency, were also examined relatively to the propagation distance as a preparation for the AE monitoring during fracture. After the ultrasonic study, the samples were partly cast in concrete and fixed as cantilevers. A point load was applied on the femur head, which due to the test geometry resulted in a combination of two different patterns of fracture, bending and torsion. Two AE broadband sensors were placed in different points of the sample, one near the fixing end and the other near the femur head. Preliminary analysis shows that parameters like the number of acquired AE signals and their amplitude are well correlated with the load history. Furthermore, the parameters of rise time and frequency can differentiate the two fracture patterns. Additionally, AE allows the detection of the load at the onset of fracture from the micro-cracking events that occur at the early loading stages, allowing monitoring of the whole fracture process. Parameters that have been used extensively for monitoring and characterization of fracture modes of engineering materials seem to poses characterization power in the case of bone tissue monitoring as well. (paper)

[Treatment of pediatric distal femur fractures by external fixator combined with limited internal fixation].

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Wei, Sheng-wang; Shi, Zhan-ying; Hu, Ju-zheng; Wu, Hao

2016-03-01

To discuss the clinical effects of external fixator combined with limited internal fixation in the treatment of pediatric distal femur fractures. From January 2008 to June 2014, 17 children of distal femur fractures were treated by external fixator combined with limited internal fixation. There were 12 males and 5 females, aged from 6 to 13 years old with an average of 10.2 years, ranged in the course of disease from 1 h to 2 d. Preoperative diagnoses were confirmed by X-ray films in all children. There were 11 patients with supracondylar fracture , and 6 patients with intercondylar comminuted fracture. According to AO/ASIF classification, 9 fractures were type A1, 5 cases were type A2,and 3 cases were type C1. The intraoperative and postoperative complications, postoperative radiological examination, lower limbs length and motion of knee joints were observed. Knee joint function was assessed by KSS score. All the patients were followed up from 6 to 38 months with an average of 24.4 months. No nerve or blood vessel injury was found. One case complicated with the external fixation loosening, 2 cases with the infection of pin hole and 3 cases with the leg length discrepancy. Knee joint mobility and length measurement (compared with the contralateral), the average limited inflexion was 10 degrees (0 degrees to 20 degrees), the average limited straight was 4 degrees (0 degrees to 10), the average varus or valgus angle was 3 degrees (0 degrees to 5 degrees). KSS of the injured side was (96.4 +/- 5.0) points at final follow-up, 16 cases got excellent results and 1 good. All fractures obtained healing and no epiphyseal closed early was found. External fixator combined with limited internal fixation has advantages of simple operation, reliable fixation, early functional exercise in treating pediatric distal femurs fractures.

The shape of the hominoid proximal femur: a geometric morphometric analysis

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Harmon, Elizabeth H

2007-01-01

As part of the hip joint, the proximal femur is an integral locomotor component. Although a link between locomotion and the morphology of some aspects of the proximal femur has been identified, inclusive shapes of this element have not been compared among behaviourally heterogeneous hominoids. Previous analyses have partitioned complex proximal femoral morphology into discrete features (e.g. head, neck, greater trochanter) to facilitate conventional linear measurements. In this study, three-dimensional geometric morphometrics are used to examine the shape of the proximal femur in hominoids to determine whether femoral shape co-varies with locomotor category. Fourteen landmarks are recorded on adult femora of Homo, Pan, Gorilla, Pongo and Hylobates. Generalized Procrustes analysis (GPA) is used to adjust for position, orientation and scale among landmark configurations. Principal components analysis is used to collapse and compare variation in residuals from GPA, and thin-plate spline analysis is used to visualize shape change among taxa. The results indicate that knucklewalking African apes are similar to one another in femoral shape, whereas the more suspensory Asian apes diverge from the African ape pattern. The shape of the human and orangutan proximal femur converge, a result that is best explained in terms of the distinct requirements for locomotion in each group. These findings suggest that the shape of the proximal femur is brought about primarily by locomotor behaviour. PMID:17310545

Herniation pits of the femur neck: incidence and radiologic findings

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Cho, Jae Hyun; Suh, Jin Suk; Lee, Hye Yeon

1994-01-01

In order to assess the incidence and radiologic findings of herniation pit of the femur neck in Korean. In 152 macerated femurs of 88 cadavers, and randomly selected 115 hips of 70 patients, the presence of herniation pit was determined by using fluoroscopy and radiography. It was then examined by CT for inspection of overlying surface and its opening was confirmed by inserting thin steal wire under the fluoroscopic guidance. Seventeen herniation pits in 15 macerated femurs of 13 cadavers were noted. (14.8%, 13/88). Two of 13 individuals showed bilaterality. All lesions were found only in males. Six herniation pit in 6 femurs of 6 patients (8.6%, 6/70) were also noted. All lesions were on anterosuperior aspect of femur neck. Plain radiographs of macerated femurs revealed well marginated and thin sclerosis in 15 lesions. Of all 23 lesions, CT showed cortical breakdown in 3, and overlying cortical thickening in 8. In 15 macerated femurs, roughed area of cortex was found in anterosuperior aspect of femur in all cases, and tiny openings(diameter less than 1 mm) related to cystic lesions were confirmed in 9 lesions. The incidence of herniation pits was 14.8% in 88 cadaver, and 8.6% in 70 patients. All were males

Bone mineral density of the proximal femur after hip resurfacing arthroplasty: 1-year follow-up study

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Anttila Esa

2011-05-01

Full Text Available Abstract Background Hip resurfacing arthroplasty (HRA is considered a bone-preserving procedure and may eliminate proximal femoral stress shielding and osteolysis. However, in addition to implant-related stress-shielding factors, various patient-related factors may also have an effect on bone mineral density (BMD of the proximal femur in patients with HRA. Thus, we studied the effects of stem-neck angle, demographic variables, and physical functioning on the BMD of the proximal femur in a one-year follow-up. Methods Thirty three patients (9 females and 24 males with a mean (SD age of 55 (9 years were included in the study. BMD was measured two days and 3, 6, and 12 months postoperatively and 10 regions of interest (ROI were used. Stem-neck angle was analyzed from anteroposterior radiographs. Results Three months postoperatively, BMD decreased in six out of 10 regions of interest (ROI on the side operated on and in one ROI on the control side (p Conclusions After an early drop, the BMD of the upper femur was restored and even exceeded the preoperative level at one year follow-up. From a clinical standpoint, the changes in BMD in these HRA patients could not be explained by stem-neck angle or patient related factors.

EXPERIMENTAL APPROVAL OF COMBINED FIXATION FOR FEMUR LENGTHENING

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M. A. Stepanov

2017-01-01

Full Text Available Elimination of congenital shortening of lower limb still remains a complex and unsolved orthopaedic task which requires an improved fixation technique as well as adjusted tactics of treatment and rehabilitation procedures.Purpose of the study — experimental approval of femur lengthening technique by external fixation with Ilizarov apparatus and internal fixation by plate.Materials and methods. Femur lengthening was performed in 6 mongrel dogs. Average animal age was 1,5±0,3 years, average weight — 20±5 kg, femur length — 22±2 sm. External apparatus with two supports and a titanium plate of an original design were applied under general anesthesia on the right femur of animals. Lengthening was performed manually at a rate of1 mm per day in 4 stages at a distance of 10% from initial segment length. External apparatus was removed on the last day of distraction after locking the plate. X-ray examination was done on the day of surgery, in 7, 14 and 25 days from the onset of distraction as well as in 14, 30, 60 and 90 days after completion of distraction and removal of external apparatus. Three animals were taken out of experiment in 30 days of fixation, remaining three animals — in 90 days. After euthanasia the authors performed autopsy of the organic femur complex and tissues contacting the plate.Results. The use of operated limb was not restricted during the whole distraction period. The authors observed first roentgenological signs of distraction osteogenesis on 7th day of lengthening. By the end of distraction period, at 25th day, shadows of regenerates demonstrated longitudinal striated structures in all cases. Median lucency area of 1–5 mm was located diagonally and across the regenerate or was intermittent. In 60 days of fixation X-rays demonstrated homogeneous regenerate. External fixation index was 13,9±1,5 days/sm (p≤0,05. The authors observed no cases of implants fracture or deformity during the experiment

The Effect of Weight-Bearing Exercise on the Strength of Femur Bone in Ovariectomized Rats

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GH Sharifi

2011-08-01

Full Text Available Introduction & Objective: Fractures due to osteoporosis after menopause in women is widespread. Osteoporosis may occur in case of inadequate lack of physical activity .The aim of this study was to determine the effect of running training on femur bone strength in ovariectomized rats. Materials & Methods Forty matured Sprague Dawley rats were chosen for this study. A group of 10 were killed randomly to measure their initial femur strength. The remaining rats had ovarian surgery. After three months, in order to reach menopause period, they were randomly divided into 3 groups, including pre test, running training and control groups. The running training program was carried out for one hour a day, five days a week, for eight weeks. Femur bone strength was measured by HOUNSFIELD system. Data was analyzed by using one-way analysis of variance and dependent T- tests by the SPSS software. Results: Results of this study showed that ovariectomy leads to significant decrease of femur bone strength. On the other hand the eight weeks running training lead to significant increase of femur bone strength. Conclusion: The results of this study suggest that life style is important factors in preventing of osteoporosis and running training program had an inhibitory or reversal effect on decrease of menopause-induced femur bone strength.

Three-Dimensional Analysis of the Curvature of the Femoral Canal in 426 Chinese Femurs

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Xiu-Yun Su

2015-01-01

Full Text Available Purpose. The human femur has long been considered to have an anatomical anterior curvature in the sagittal plane. We established a new method to evaluate the femoral curvature in three-dimensional (3D space and reveal its influencing factors in Chinese population. Methods. 3D models of 426 femurs and the medullary canal were constructed using Mimics software. We standardized the positions of all femurs using 3ds Max software. After measuring the anatomical parameters, including the radius of femoral curvature (RFC and banking angle, of the femurs using the established femur-specific coordinate system, we analyzed and determined the relationships between the anatomical parameters of the femur and the general characteristics of the population. Results. Pearson’s correlation analyses showed that there were positive correlations between the RFC and height (r=0.339, p<0.001 and the femoral length and RFC (r=0.369, p<0.001 and a negative correlation between the femoral length and banking angle (r=-0.223, p<0.001. Stepwise linear regression analyses showed that the most relevant factors for the RFC and banking angle were the femoral length and gender, respectively. Conclusions. This study concluded that the banking angle of the femur was significantly larger in female than in male.

Heterogeneous modelling and finite element analysis of the femur

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Zhang Binkai

2017-01-01

Full Text Available As the largest and longest bone in the human body, the femur has important research value and application prospects. This paper introduces a fast reconstruction method with Mimics and ANSYS software to realize the heterogeneous modelling of the femur according to Hu distribution of the CT series, and simulates it in various situations by finite element analysis to study the mechanical characteristics of the femur. The femoral heterogeneous model shows the distribution of bone mineral density and material properties, which can be used to assess the diagnosis and treatment of bone diseases. The stress concentration position of the femur under different conditions can be calculated by the simulation, which can provide reference for the design and material selection of prosthesis.

Sex Specific Association of Physical Activity on Proximal Femur BMD in 9 to 10 Year-Old Children

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Cardadeiro, Graça; Baptista, Fátima; Ornelas, Rui; Janz, Kathleen F.; Sardinha, Luís B.

2012-01-01

The results of physical activity (PA) intervention studies suggest that adaptation to mechanical loading at the femoral neck (FN) is weaker in girls than in boys. Less is known about gender differences associated with non-targeted PA levels at the FN or other clinically relevant regions of the proximal femur. Understanding sex-specific relationships between proximal femur sensitivity and mechanical loading during non-targeted PA is critical to planning appropriate public health interventions. We examined sex-specific associations between non-target PA and bone mineral density (BMD) of three sub-regions of the proximal femur in pre- and early-pubertal boys and girls. BMD at the FN, trochanter (TR) and intertrochanter (IT) regions, and lean mass of the whole body were assessed using dual-energy x-ray absorptiometry in 161 girls (age: 9.7±0.3 yrs) and 164 boys (age: 9.7±0.3 yrs). PA was measured using accelerometry. Multiple linear regression analyses (adjusted for body height, total lean mass and pubertal status) revealed that vigorous PA explained 3–5% of the variability in BMD at all three sub-regions in boys. In girls, vigorous PA explained 4% of the variability in IT BMD and 6% in TR BMD. PA did not contribute to the variance in FN BMD in girls. An additional 10 minutes per day of vigorous PA would be expected to result in a ∼1% higher FN, TR, and IT BMD in boys (pgirls. In conclusion, vigorous PA can be expected to contribute positively to bone health outcomes for boys and girls. However, the association of vigorous PA to sub-regions of the proximal femur varies by sex, such that girlś associations are heterogeneous and the lowest at the FN, but stronger at the TR and the IT, when compared to boys. PMID:23209801

A comparative study on BMD of lumbar spine and proximal femur in post-menopausal women using dual energy X-ray absorptiometry

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Yoon, Han Sik; Mo, Eun Hee

1999-01-01

Osteoporosis, which causes mainly fracture of the spine, proximal femur and distal radius by minimal trauma, is a major public health problem and its prevalence is steadily increasing in Korea according to the development of public health care. There are reliable methods for diagnosis based on bone densitometry. Early detection and intervention are important for reducing the incidence of fractures. A consensus definition of osteoporosis, based on bone density measurement, has been developed by the World Health Organization(WHO). In this study, bone mineral density(BMD) was measured by dual energy x-ray absorptiometry(DEXA) at the proximal femur and lumbar spine in 132 post-menopausal women. The purpose of this study is to find influential factors on the BMD of the proximal femur and the lumbar spine and to analyze correlation between BMD and the problematic factors. We obtained the following results : 1. Mean BMD score, T-score and Z-score of the proximal femur were 0.81(g/cm 2 ), -2.45(S.D.) and -2.09(S.D.) respectively and in the lumber spine were 0.83(g/cm 2 ), -2.02(S.D.), -2.43(S.D.) respectively. 2. In correlation analysis between BMD and many factors, correlation coefficients were -0.467, 0.212, -0.321 and 0.241 in age, height, duration after menopause respectively. BMI and the residuals were comparatively small. 3. Correlation coefficients to age matched BMD, in height and body weight were 0.222 and 0.241, in age and duration after menopause were -0.268, -0.282. 4. The fracture threshold of proximal femur BMD to the 90th percentile was 0.845(g/cm 2 ). 5. At the result of multiple regression analysis, age, body weight, BMI(kg/m 2 ) and duration after menopause described as significant variables

A comparative study on BMD of lumbar spine and proximal femur in post-menopausal women using dual energy X-ray absorptiometry

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Yoon, Han Sik [Wonkwang Health Science College, Iksan (Korea, Republic of); Mo, Eun Hee [College of Medicine, Wonkwang Univ., Iksan (Korea, Republic of)

1999-04-01

Osteoporosis, which causes mainly fracture of the spine, proximal femur and distal radius by minimal trauma, is a major public health problem and its prevalence is steadily increasing in Korea according to the development of public health care. There are reliable methods for diagnosis based on bone densitometry. Early detection and intervention are important for reducing the incidence of fractures. A consensus definition of osteoporosis, based on bone density measurement, has been developed by the World Health Organization(WHO). In this study, bone mineral density(BMD) was measured by dual energy x-ray absorptiometry(DEXA) at the proximal femur and lumbar spine in 132 post-menopausal women. The purpose of this study is to find influential factors on the BMD of the proximal femur and the lumbar spine and to analyze correlation between BMD and the problematic factors. We obtained the following results : 1. Mean BMD score, T-score and Z-score of the proximal femur were 0.81(g/cm{sup 2}), -2.45(S.D.) and -2.09(S.D.) respectively and in the lumber spine were 0.83(g/cm{sup 2}), -2.02(S.D.), -2.43(S.D.) respectively. 2. In correlation analysis between BMD and many factors, correlation coefficients were -0.467, 0.212, -0.321 and 0.241 in age, height, duration after menopause respectively. BMI and the residuals were comparatively small. 3. Correlation coefficients to age matched BMD, in height and body weight were 0.222 and 0.241, in age and duration after menopause were -0.268, -0.282. 4. The fracture threshold of proximal femur BMD to the 90th percentile was 0.845(g/cm{sup 2}). 5. At the result of multiple regression analysis, age, body weight, BMI(kg/m{sup 2}) and duration after menopause described as significant variables.

Concept and development of an orthotropic FE model of the proximal femur.

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Wirtz, Dieter Christian; Pandorf, Thomas; Portheine, Frank; Radermacher, Klaus; Schiffers, Norbert; Prescher, Andreas; Weichert, Dieter; Niethard, Fritz Uwe

2003-02-01

In contrast to many isotropic finite-element (FE) models of the femur in literature, it was the object of our study to develop an orthotropic FE "model femur" to realistically simulate three-dimensional bone remodelling. The three-dimensional geometry of the proximal femur was reconstructed by CT scans of a pair of cadaveric femurs at equal distances of 2mm. These three-dimensional CT models were implemented into an FE simulation tool. Well-known "density-determined" bony material properties (Young's modulus; Poisson's ratio; ultimate strength in pressure, tension and torsion; shear modulus) were assigned to each FE of the same "CT-density-characterized" volumetric group. In order to fix the principal directions of stiffness in FE areas with the same "density characterization", the cadaveric femurs were cut in 2mm slices in frontal (left femur) and sagittal plane (right femur). Each femoral slice was scanned into a computer-based image processing system. On these images, the principal directions of stiffness of cancellous and cortical bone were determined manually using the orientation of the trabecular structures and the Haversian system. Finally, these geometric data were matched with the "CT-density characterized" three-dimensional femur model. In addition, the time and density-dependent adaptive behaviour of bone remodelling was taken into account by implementation of Carter's criterion. In the constructed "model femur", each FE is characterized by the principal directions of the stiffness and the "CT-density-determined" material properties of cortical and cancellous bone. Thus, on the basis of anatomic data a three-dimensional FE simulation reference model of the proximal femur was realized considering orthotropic conditions of bone behaviour. With the orthotropic "model femur", the fundamental basis has been formed to realize realistic simulations of the dynamical processes of bone remodelling under different loading conditions or operative procedures

EVALUATION OF FUNCTIONAL OUTCOME AFTER OPEN REDUCTION AND INTERNAL FIXATION OF DISTAL FEMUR FRACTURES BY LOCKING COMPRESSION PLATE

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L. Lokanadha Rao

2016-09-01

Full Text Available BACKGROUND In the supra and intercondylar fractures of femur particularly with intra articular extension, patient may develop stiffness of knee, shortening, rotational deformities, internal derangement of knee with instability, varus and valgus deformities which affect patient’s routine lifestyle. If these cases were treated with locking compression plate, the results obtained were successful, superior, timesaving providing early ambulation and least disability improving the functional outcome. MATERIALS AND METHODS This is a prospective interventional study. This study includes 25 supracondylar and intercondylar fractures of femur (both Muller’s Type ‘A’, Type B and Type ‘C’ fractures treated with open reduction and internal fixation by Locking Compression Plate in the Department of Orthopaedics, King George Hospital, Visakhapatnam from September 2013 to September 2015. There are 16 males and 9 females with age ranging from 20 to 80 years with an average of 44.6 years. Average age for males is 28.9 years and average age for females is 25 years. 18 fractures were due to road traffic accidents and 6 cases are due to fall from significant heights, 1 case due to simple fall from standing (osteoporosis. 15 cases were in right femur (60% and 10 cases were in left femur (40%. RESULTS 25 cases were included in the study. There is an increase in the rate of union, decreased time taken for union, increased knee range of motion, decreased time for weight-bearing, postoperative complications and duration for hospital stay. CONCLUSION LCP proved to be a good implant which could take the challenges like poor bone stock, severe comminution both metaphyseal and articular and prove successful. The locking head screws distally have prevented varus collapse, even in cases of osteoporosis. The Condylar LCP can be used in either an open or a minimally invasive manner.

Improving consent in patients undergoing surgery for fractured neck of femur.

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Thiruchandran, Gajendiran; McKean, Andrew R; Rudran, Branavan; Imam, Mohamed A; Yeong, Keefai; Hassan, Abdel

2018-05-02

Background Neck of femur fractures and their subsequent operative fixation are associated with high rates of perioperative morbidity and mortality. Consenting in this setting is suboptimal with the Montgomery court ruling changing the perspective of consent. This quality improvement project assessed the adequacy of consenting against British Orthopaedic Association-endorsed guidance and implemented a series of changes to improve the documentation of risks associated with surgery for fractured neck of femur. Methods Seventy consecutive patients who underwent any operative fixation of a neck of femur fracture were included over a 6-month period at a single centre. Patients unable to consent or without electronic notes were excluded. Consent forms were analysed and the documented potential risks or complications associated with surgery were compared to British Orthopaedic Association-endorsed guidance. A series of changes (using the plan, do study, act (PDSA) approach) was implemented to improve the adequacy of consent. Results Documentation of four out of 12 potential risks or complications was recorded in <50% of cases for patients with intracapsular fractures (n=35), and documentation of seven out of 12 potential risks or complications was recorded in <50% of cases for patients with extracapsular fractures (n=35). Re-audit following raising awareness and attaching consent guidance showed 100% documentation of potential risks or complications in patients with intracapsular and extracapsular fractures (n=70). A neck of femur fracture-specific consent form has been implemented which will hopefully lead to sustained improvement. Conclusions Consenting patients with fractured neck of femur for surgery in the authors' unit was suboptimal when compared to British Orthopaedic Association-endorsed consent guidance. This project has shown that ensuring such guidance is readily available has improved the adequacy of consent. The authors hope that introduction of a neck of

Combined spinal epidural anesthesia in achondroplastic dwarf for femur surgery

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Rochana Girish Bakhshi

2011-11-01

Full Text Available Achondroplasia is the commonest form of short-limbed dwarfism and occurs in 1:26,000- 40,000 live births. This is an autosomal dominant disorder with abnormal endochondral ossification whereas periosteal and intramembranous ossification are normal. The basic abnormality is a disturbance of cartilage formation mainly at the epiphyseal growth plates and at the base of the skull. The anesthetic management of achondroplastic dwarfs is a challenge to the anesthesiologist. Both regional as well as general anesthesia have their individual risks and consequences. We report a case of an achondroplastic dwarf in whom combined spinal epidural anesthesia was used for fixation of a fractured femur. The patient had undergone previous femur surgery under general anesthesia since he had been informed that spinal anesthesia could be very problematic. There was no technical difficulty encountered during the procedure and an adequate level was achieved with low-dose local anesthetics without any problem. Postoperative pain relief was offered for three consecutive postoperative days using epidural tramadol. We discuss the anesthetic issues and highlight the role of combined spinal epidural anesthesia with low-dose local anesthetics in this patient. This approach also helped in early ambulation and postoperative pain relief.

Modular endoprosthetic replacement for metastatic tumours of the proximal femur

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Carter Simon R

2008-11-01

Full Text Available Abstract Background and aims Endoprosthetic replacements of the proximal femur are commonly required to treat destructive metastases with either impending or actual pathological fractures at this site. Modular prostheses provide an off the shelf availability and can be adapted to most reconstructive situations for proximal femoral replacements. The aim of this study was to assess the clinical and functional outcomes following modular tumour prosthesis reconstruction of the proximal femur in 100 consecutive patients with metastatic tumours and to compare them with the published results of patients with modular and custom made endoprosthetic replacements. Methods 100 consecutive patients who underwent modular tumour prosthetic reconstruction of the proximal femur for metastases using the METS system from 2001 to 2007 were studied. The patient, tumour and treatment factors in relation to overall survival, local control, implant survival and complications were analysed. Functional scores were obtained from surviving patients. Results and conclusion There were 45 male and 55 female patients. The mean age was 60.2 years. The indications were metastases. Seventy five patients presented with pathological fracture or with failed fixation and 25 patients were at a high risk of developing a fracture. The mean follow up was 15.9 months [range 0–77]. Three patients died within 2 weeks following surgery. 69 patients have died and 31 are alive. Of the 69 patients who were dead 68 did not need revision surgery indicating that the implant provided single definitive treatment which outlived the patient. There were three dislocations (2/5 with THR and 1/95 with unipolar femoral heads. 6 patients had deep infections. The estimated five year implant survival (Kaplan-Meier analysis was 83.1% with revision as end point. The mean TESS score was 64% (54%–82%. We conclude that METS modular tumour prosthesis for proximal femur provides versatility; low implant related

Paediatric diaphyseal femur fracture treated with intramedullary titanium elastic nail system

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Shrawan Kumar Thapa

2015-11-01

Full Text Available noBackground & Objectives: Over the few years there has been a marked increase in the use of intramedullary fixation in the management of fracture of shaft of femur in children. The goals should be to stabilize the fracture, to control length and alignment, to promote bone healing and to minimize the morbidity and complications for the child. In this prospective study we intend to evaluate the functional and radiological outcome of diaphyseal fracture of shaft of femur treated with elastic intramedullary nail.Materials & Methods: All 56 patients with diaphyseal fracture shaft of femur were treated with titanium elastic nail and followed for period of 32 weeks.Results: The In this study, outcome was assessed by using Flynn’s criteria of titanium flexible nail outcome score and we found excellent result in 49 cases, satisfactory in six cases and poor in one case. We faced one major complication in form of implant failure and six minor complications inform of superficial wound infection.Conclusion: Elastic intramedullary nail used in treatment of diaphyseal fracture shaft of femur yield excellent functional and radiological outcome. It is easy and simple procedure has low rate of complication. It is physeal-protective, cost effective, does not involve heavy instrumentation and can be performed in small set up. It has minimal risk of infection and no risk of injury to the neurovascular structure.JCMS Nepal. 2015; 11(2:20-22

Antibiotic impregnated total femur spacers: a technical tip

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Colin D. Canham, MD

2018-03-01

Full Text Available Simultaneous prosthetic joint infection of ipsilateral hip and knee arthroplasties is often accompanied by significant bone loss and presents a challenging reconstructive problem. Two-stage reconstruction is favored and requires the placement of a total femur spacer, which is not a commercially available device. We describe a surgical technique, reporting on 2 cases in which a customized total femur antibiotic impregnated spacer was created by combining an articulating knee spacer and an articulating hip spacer with a reinforced cement dowel construct connecting the 2 spacers. Custom total femoral spacers are useful in the management of infected femoral megaprostheses and cases with ipsilateral injected hip and knee arthroplasties and severe femoral bone loss. Keywords: total femur spacer, revision arthroplasty, total hip arthroplasty, total knee arthroplasty, prosthetic joint infection

Sex specific association of physical activity on proximal femur BMD in 9 to 10 year-old children.

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Graça Cardadeiro

Full Text Available The results of physical activity (PA intervention studies suggest that adaptation to mechanical loading at the femoral neck (FN is weaker in girls than in boys. Less is known about gender differences associated with non-targeted PA levels at the FN or other clinically relevant regions of the proximal femur. Understanding sex-specific relationships between proximal femur sensitivity and mechanical loading during non-targeted PA is critical to planning appropriate public health interventions. We examined sex-specific associations between non-target PA and bone mineral density (BMD of three sub-regions of the proximal femur in pre- and early-pubertal boys and girls. BMD at the FN, trochanter (TR and intertrochanter (IT regions, and lean mass of the whole body were assessed using dual-energy x-ray absorptiometry in 161 girls (age: 9.7±0.3 yrs and 164 boys (age: 9.7±0.3 yrs. PA was measured using accelerometry. Multiple linear regression analyses (adjusted for body height, total lean mass and pubertal status revealed that vigorous PA explained 3-5% of the variability in BMD at all three sub-regions in boys. In girls, vigorous PA explained 4% of the variability in IT BMD and 6% in TR BMD. PA did not contribute to the variance in FN BMD in girls. An additional 10 minutes per day of vigorous PA would be expected to result in a ∼1% higher FN, TR, and IT BMD in boys (p<0.05 and a ∼2% higher IT and TR BMD in girls. In conclusion, vigorous PA can be expected to contribute positively to bone health outcomes for boys and girls. However, the association of vigorous PA to sub-regions of the proximal femur varies by sex, such that girlś associations are heterogeneous and the lowest at the FN, but stronger at the TR and the IT, when compared to boys.

Study of Ender’s Nailing in Shaft Femur Fractures of Older Children

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Ladani HG

2014-12-01

Full Text Available Background: Fractures in shaft femur in children are relatively common. Various methods of treating these fractures starting from non operative to methods like closed intramedullary nailing are at our disposal. Traditionally non operative methods are acceptable and find wide acceptance even today in very young children. However in older children certain problems are encountered like failure to control angulation and shortening, prolonged immobilization which causes very much discomfort & the overgrowth phenomenon. In view of above difficulties, closed intramedullary nailing was attempted in older children and adolescents. I have tried to study 23 cases of shaft femur fractures in older children treated by Ender’s nails. Methodology: 22 pts., out of which one having bilateral # shaft femur (total 23 #s with age ranging from 7 to 16 yrs. were studied. 3 pts. having polio limbs studied separately. Fracture was in upper third shaft femur in 5 pts., middle third in 13 pts., lower third in 3pts. & involving more than one region in 2 pts. Fracture was transverse in 6 pts., spiral in 3 pts., oblique in 12 pts.& comminuted in 2 pts.. Results: Average union time was 10 weeks except in polio pts. where it was delayed. No nonunion, no infection. Excellent hip & knee movements in almost all pts. Out of 20 pts. ( except polio pts. limb length was equal in 17 pts., one pt. was having 1 cm. lengthening & 2 pts. were having shortening ( 1cm. & 2 cm.. Conclusion: Results of this study strongly favor the use of Ender’s nailing in shaft femur fractures in older children. Second surgery of implant removal is mandatory. Closed reduction can usually be achieved if surgery is performed earlier.

Bone mineral density of lumbar spine and proximal femur in healthy males

International Nuclear Information System (INIS)

Akin, S.; Isikli, S.; Korkusuz, F.; Ungan, M.; Senkoylu, A.

2004-01-01

Relationship between BMD and age at lumbar spine and proximal femur in Turkish males was investigated. Two hundred ninety healthy males (aged 20-59 years) were investigated. BMD of the lumbar spine had its peak at ages 30-39, however, the peak for the proximal femur was between the ages of 20 and 29. There was a significant decrease in BMD at proximal femur after these peak values with increasing age. There was a significant correlation between age and the proximal femoral BMD in males and age has a strong predictive power on proximal femur BMD score. (author)

Late radiation damage to the rat femur and the NSD formula

International Nuclear Information System (INIS)

Pitkaenen, M.A.; Hietanen, T.

1984-01-01

The extraction of 86 Rb chloride, the red blood cell volume and the mineral content in the rat femur have been studied 7 months after local X-irradiation. Doses were given as 3, 6 and 9 fractions over three weeks. The total doses used were based on NSD value of 1450 and 1900 on the basis of the results from our previous single dose irradiation studies. The reduction in the extraction of 86 Rb chloride was statistically significant for all fractionation schemes and at both NSD levels. In the whole femur, with bone marrow, the extraction was reduced by 33% to 46%. In the hard bone the reduction was less only 18% to 38%. There was no significant difference between the fractionation schemes used at each NSD level. The red blood cell volume was significantly reduced in the whole femur, with bone marrow, with no difference between the fractionation schemes. However, there was no change in the hard bone. The dry bone weight was reduced by 3 to 6% with no significant difference between the different fractionation schemes. The dose levels predicted by the NSD formula produced approximately the same damage to the rat femur 7 months after the irradiation when the dry weight and the extraction of 86 Rb chloride were used as end points for the evaluation of the severity of late radiation damage. (orig.) [de

Osteosynthesis of a periprosthetic fracture of the proximal femur with the distal femur LISS system

DEFF Research Database (Denmark)

Tarnowski, Jan Robert; Holck, Kim

2008-01-01

In this case report, we show how it is possible to perform osteosynthesis using minimal invasive techniques instead of conventional methods. In this instance the osteosynthesis was performed on a patient in poor general condition who had presented a periprosthetic fracture of the proximal femur. ...

Comparison of Primary Hip Spica with Crossed Retrograde Intramedullary Rush Pins for the Management of Diaphyseal Femur Fractures in Children: A Prospective, Randomized Study

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Mohammad Ruhullah

2013-12-01

Conclusions: Intra-medullary crossed Rush pinning is an effective method of paediatric diaphyseal femur fracture fixation as compared to primary hip spica in terms of early weight bearing and restoration of normal anatomy.

Pilot study on proximal femur strains during locomotion and fall-down scenario

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Klodowski, Adam, E-mail: adam.klodowski@lut.fi; Valkeapaeae, Antti, E-mail: antti.valkeapaa@lut.fi; Mikkola, Aki, E-mail: aki.mikkola@lut.fi [Lappeenranta University of Technology (Finland)

2012-09-15

The most common and severe type of fracture among the elderly is known as a proximal femur fracture. Aging-related bone loss is one of the major contributing factors to increased likelihood of bone fracture. Specific exercises can be used to strain bones and increase bone strength to counter the effects of bone loss. The flexible multibody simulation approach can be used as a non-invasive method for estimating bone strains caused by physical activity. This method was recently used to analyze the strain of locomotion in regard to human femur and tibia leg bones. The current study focuses on strain analysis of the femoral neck. The research test person was a clinically healthy 65-year old Caucasian male. The computed tomography was used to build a geometrically accurate finite element model of the femur with inhomogeneous material properties derived from the voxel data. The anthropometric data was used to model the musculoskeletal system of the test person. The multibody skeletal model was utilized to estimate loading on the femoral neck during walking, which represents a routine daily activity. The flexible multibody simulation results were compared to strains that occurred during a simulated fall onto the greater trochanter of the femur. The fall simulation was made entirely using finite element software. Results from the finite element analysis were compared with the previous study showing that the test person does not belong to the high-risk hip fracture group. Finally, the estimated strains gathered from the walking simulation were compared to the strain values from the simulated fall-down scenario.

Longitudinal shapes of the tibia and femur are unrelated and variable.

Science.gov (United States)

Howell, Stephen M; Kuznik, Kyle; Hull, Maury L; Siston, Robert A

2010-04-01

In general practice, short films of the knee are used to assess component position and define the entry point for intramedullary femoral alignment in TKAs; however, whether it is justified to use the short film commonly used in research settings and everyday practice as a substitute for the whole leg view is controversial and needs clarification. In 138 long leg CT scanograms we measured the angle formed by the anatomic axis of the proximal fourth of the tibia and the mechanical axis of the tibia, the angle formed by the anatomic axis of the distal fourth of the femur and the mechanical axis of the femur, the "bow" of the tibia (as reflected by the offset of the anatomic axis from the center of the talus), and the "bow" of the femur (as reflected by the offset of the anatomic axis from the center of the femoral head). Because the angle formed by these axes and the bow of the tibia and femur have wide variability in females and males, a short film of the knee should not be used in place of the whole leg view when accurate assessment of component position and limb alignment is essential. A previous study of normal limbs found that only 2% of subjects have a neutral hip-knee-ankle axis, which can be explained by the wide variability of the bow in the tibia and femur and the lack of correlation between the bow of the tibia and femur in a given limb as shown in the current study.

Test Bench Development for Femur Stability Assessment

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Samuel SANCHEZ-CABALLERO

2015-01-01

Full Text Available This paper shows the design and development of a test bench for humanfemurs. The main uses of this test bench will run from artificial femurs comparisonwith real femurs, to join stability assessment after bone a fracture repair. Amongthis uses is specially designed for condylar fractures testing. The test bench isdeveloped from a self-made existing tensile/compression testing machine. Thedesign procedure is supported by a literature review about the bone mechanicalbehavior and composition generally and the knee joint performance and repairparticularly. On the basis of this review, the machine was designed to simulate theadduction and abduction movements of the joint. The magnitudes to be measuredare: the compression force, the bone displacement (vertical and the knee jointrotation

Bone mineral content in the senescent rat femur: an assessment using single photon absorptiometry

International Nuclear Information System (INIS)

Kiebzak, G.M.; Smith, R.; Howe, J.C.; Sacktor, B.

1988-01-01

The single photon absorptiometry technique was evaluated for measuring bone mineral content (BMC) of the excised femurs of the rat, and the system was used to examine the changes in cortical and trabecular bone from young adult (6 mo), mature adult (12 mo), and senescent (24 mo) male and female animals. BMC of the femur midshaft, representing cortical bone, apparently increased progressively with advancing age. The width of the femur at the scan site also increased with age. Normalizing the midshaft BMC by width partially compensated for the age-associated increase. However, when bone mineral values were normalized by the cortical area at the scan site, to take into account the geometric differences in the femurs of different aged animals, maximum bone densities were found in the mature adult and these values decreased slightly in the femurs from senescent rats. In contrast, the BMC of the femur distal metaphysis, representing trabecular bone, decreased markedly in the aged rat. The loss of trabecular bone was also evident from morphological examination of the distal metaphysis. These findings indicated that bone mineral loss with age was site specific in the rat femur. These studies provided additional evidence that the rat might serve as a useful animal model for specific experiments related to the pathogenesis of age-associated osteopenia

X-Ray Exam: Femur (Upper Leg)

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... Staying Safe Videos for Educators Search English Español X-Ray Exam: Femur (Upper Leg) KidsHealth / For Parents / X- ... Muscles, and Joints Broken Bones Getting an X-ray (Video) X-Ray (Video) View more Partner Message About Us ...

Anthropometry of the distal femur in a Kenyan population and its ...

African Journals Online (AJOL)

Background: No local study has been done to determine the anthropometric features of the distal femur, compared it with other studied populations and some of the total knee replacement implants available. Objective: To determine the Medio-Lateral (ML) width of the condyles of the femur, the anteroposterior (AP) diameter ...

Effect of nonphytate phosphorus and phytase levels on broiler femur.

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Luana Martins Schaly

2009-03-01

Full Text Available This experiment was carried out to evaluate the effect of nonphytate phosphorus (NPP and phytase levels on the weight, morphometry and weight/length index (WLI of broiler femurs at 21 and 42 days of age. One thousand, two hundred chicks were allocated in a completely randomized design and 4 x 3 factorial arrangement (NPP x phytase levels, with four replicates. The NPP levels, at each phase were of 0.45, 0.37, 0.29 and 0.21% in the initial phase, 0.41, 0.33, 0.25 and 0.17% in the growth phase, and of 0.37, 0.29, 0.21 and 0.13% in the final phase. The phytase levels used were 0, 500 and 1000U/kg of diet. At 21 and 42 days of age, 48 birds were sacrificed for femur collection. At 21 days, there was no effect (P > 0.05 of NPP x phytase interaction on bone parameters, but the NPP reduction decreased (P < 0.05 the weight, length and WLI of the femurs, and the inclusion of 500U/kg of phytase improved (P < 0.05 the weight and WLI of the bones. At 42 days of age, NPP x phytase interaction was significant (P < 0.05 for the weight and length, and birds fed diets with no phytase had femurs that were lighter and shorter when the lowest NPP levels were evaluated. However, the inclusion of 500 or 1000U/kg of phytase produced weights and lengths similar to those produced by treatment with recommended NPP levels, and the lower NPP levels evaluated caused a reduction (P < 0.05 in the diameter and WLI of femurs. It was concluded that diets with 0.29, 0.25 or 0.21% of NPP, with 500 U/kg of phytase, could be used with no negative effect on the femur quality in broilers from one to 42 days of age.

Effects of intravenously injected lanthanum chloride on the femur of rats

International Nuclear Information System (INIS)

Miyagawa, Makoto; Daimon, Tateo

2010-01-01

Lanthanum (La) is widely used in industry and medicine. Because of lanthanum's physicochemical resemblance to calcium, the possible effects of it on bone have to be considered. The aim of this study was to examine the effects of La on bone toxicity. Rats were intravenously administrated with lanthanum chloride at 5 mg La/kg per week for five weeks. Histomorphometric analysis of femurs were performed using micro-CT scan. Compared with normal controls, the total bone area of the femur did not show any change in La-administrated rats, whereas the trabecular area slightly decreased. The trabecular bone mineral density in the experimented rats was higher than that in the normal controls, although the mineral density of the cortical bone and cancerou one was unchanged after the administration of La. La did not alter mechanical barometers of the femur such as mean cross-sectional moment of inertia, minimum cross-sectional moment of inertia and polar moment of inertia. Additionally, light microscopic analysis of the femurs revealed that histological features of osteoid, calcification front and bone matrix were normal after the administration of La. La was detected in the macrophages in the bone marrow, but not in the bone matrix by histological stain for La and X-ray fluorescence microanalysis. Thus, these micro-CT imaging and microscopy of the femurs did not reveal toxic changes due to La. (author)

[New anterolateral approach of distal femur for treatment of distal femoral fractures].

Science.gov (United States)

Zhang, Bin; Dai, Min; Zou, Fan; Luo, Song; Li, Binhua; Qiu, Ping; Nie, Tao

2013-11-01

To assess the effectiveness of the new anterolateral approach of the distal femur for the treatment of distal femoral fractures. Between July 2007 and December 2009, 58 patients with distal femoral fractures were treated by new anterolateral approach of the distal femur in 28 patients (new approach group) and by conventional approach in 30 patients (conventional approach group). There was no significant difference in gender, age, cause of injury, affected side, type of fracture, disease duration, complication, or preoperative intervention (P > 0.05). The operation time, intraoperative blood loss, intraoperative fluoroscopy frequency, hospitalization days, and Hospital for Special Surgery (HSS) score of knee were recorded. Operation was successfully completed in all patients of 2 groups, and healing of incision by first intention was obtained; no vascular and nerves injuries occurred. The operation time and intraoperative fluoroscopy frequency of new approach group were significantly less than those of conventional approach group (P 0.05). All patients were followed up 12-36 months (mean, 19.8 months). Bone union was shown on X-ray films; the fracture healing time was (12.62 +/- 2.34) weeks in the new approach group and was (13.78 +/- 1.94) weeks in the conventional approach group, showing no significant difference (t=2.78, P=0.10). The knee HSS score at last follow-up was 94.4 +/- 4.2 in the new approach group, and was 89.2 +/- 6.0 in the conventional approach group, showing significant difference between 2 groups (t=3.85, P=0.00). New anterolateral approach of the distal femur for distal femoral fractures has the advantages of exposure plenitude, minimal tissue trauma, and early function rehabilitation training so as to enhance the function recovery of knee joint.

Effect of calcium citrate on bone integration in a rabbit femur defect model.

Science.gov (United States)

Zhang, Wei; Wang, Wei; Chen, Qing-Yu; Lin, Zhong-Qin; Cheng, Shao-Wen; Kou, Dong-Quan; Ying, Xiao-Zhou; Shen, Yue; Cheng, Xiao-Jie; Nie, Peng-Fei; Li, Xiu-Cui; Rompis, Ferdinand An; Huang, Hang; Zhang, Hua; Mu, Zhong-Lin; Peng, Lei

2012-04-01

To explore effect of calcium citrate on bone integration in a rabbit femur defect model, and to compare the bone formation with different sizes by radiological and histological study. Twenty-four male Japanese white rabbits were randomly divided into three groups (Group A, B, C) in this study. Under anesthesia, defects of four sizes (1.2, 1.5, 2.0 and 2.5 mm) were created in each of the rabbits. Commercially pure calcium citrate powder was placed inside the medullary compartment of the femur (Experimental), while in the contralateral femur (Control) nothing was implanted. The defects were analyzed using radiography and histological analysis by using Imagepro-Plus 6.0 software after animal was sacrificed at 4th(Group A), 6th(Group B) and 8th(Group C) weeks postoperatively. Four samples were analyzed for each size of defect and each healing period. The histological and the radiologic evaluation were performed after sacrification of all rabbits on postoperative 4th and 6th weeks, It showed significant difference between the experimental group and the control group when these defects were less than or equal to 2.0 mm. No statistical difference was observed when these defects were larger than 2.0 mm at all healing periods except at the 4th week. Calcium citrate affects the early periods of bone defects healing mechanism in Japanese white rabbits positively, especially when the defect is not too large. We suggest further studies on calcium citrate to determine the effects of various dosages, administration ways and the experimental time on the bone defects. Copyright © 2012 Hainan Medical College. Published by Elsevier B.V. All rights reserved.

Comparative element analysis on femur of antler hemo-treated ovariectomized wistar rats by SRXRF

International Nuclear Information System (INIS)

Yang Jianhong; Fei Yurong; Wang Ruilin; Cao Yi; Huang Yuying; He Wei

2007-01-01

To investigate the relationship between bone element contents and bone m/neral density (BMD), left femur of sham-operated rats (SHAM, n=5), ovariectomized rats (OVX, n=5) and antler hemo-treated ovariectomized rats (OVX + antler hemo, n=5) were analyzed by synchrotron radiation X-ray fluorescence (SRXRF) microprobe. The results showed that there were very good positive correlations among contents of Ca, P, Zn and Sr. In comparison to the SHAM group, decreased relative intensities of Ca, P, Zn and Sr (especially Ca and P, p<0.05) were observed in femur of the OVX group, which showed significant decrease (p<0.05) of the BMD. The results indicate that loss of Ca and P in bone will cause osteoporosis. On the other hand, increased relative intensities of Ca, P and Zn in femur, and the BMD (p<0.05), of the anlter hemo-treated OVX group were found, in comparison to the OVX group. This suggests that anlter hemo may help cure osteoporosis through maintaining bone contents of Zn, Ca and P, and increasing the BMD. (authors)

Osteoporotic fractures of proximal femur: clinical and epidemiological features in a population of the city of São Paulo

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Ana Claudia Ramalho

Full Text Available CONTEXT: It is believed that about 25% of menopausal women in the USA will exhibit some kind of fracture as a consequence of osteoporosis. Fractures of the proximal femur are associated with a greater number of deaths and disabilities and higher medical expenses than all the other osteoporotic fractures together. OBJECTIVE: To study the clinical and epidemiological features of patients with proximal femur fracture in hospitals in São Paulo. DESIGN: Transversal and retrospective study. LOCAL: Hospital São Paulo and Hospital Servidor Público Estadual "Francisco Morato Oliveira". PARTICIPANTS: Patients aged sixty-five years or more hospitalized because of proximal femur fracture, from March to November 1996 (N = 73. This group was compared to patients of the same age without fracture of the proximal femur. INTERVENTION: Evaluation of weight, height, body mass index; lifestyle habits (physical activity at home, ingestion of dairy calcium, drinking of coffee, smoking habit, gynecological history (ages at menarche and menopause, number of pregnancies and lactations, previous morbidity, use of medications, history of previous fractures, family history of osteoporosis. MEASUREMENT: The comparison of the different data regarding lifestyle habits between the two groups was made using the chi-squared test. Other data were analyzed using the Mann -- Whitney test. P £ 0.05 was considered significant. RESULTS: We noted a predominance of proximal femur fracture among females in relation to males (a female/male ratio of 3.3:1 with a progressive increase in the frequency of proximal femur fracture with age in both sexes. The group with proximal femur fracture, in comparison with the control group, showed a lower body mass index, less physical activity, and a greater number of pregnancies and lactations. Other data were not different. CONCLUSION: In accordance with the literature, we found a predomination of proximal femur fracture in women in relation to men

Comparative morphometric analysis of the proximal femur of African hominids and felids

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Andrew Gallagher

2015-09-01

Full Text Available Size and shape of the mammalian proximal femur and taxon-specific distinctions in the relative proportions of the proximal articulation, the femoral neck and the proximal femoral diaphysis, are critical determinants in its adaptation to differential biomechanical stresses and observed locomotor habitus in different taxa. The morphometrics of the proximal femur are considered equally critical in the assessment of locomotor habitus of extinct fossil mammals, particularly extinct Miocene anthropoids and Plio-Pleistocene hominins. Analyses of size and shape of k=10 dimensions of the proximal femur were undertaken for a large sample series of two extant mammal families the Felidae and Hominidae using conventional multivariate statistical procedures, commonly used size-correction methods, and post-hoc tests of significance. While significant differences in form do exist, there are equally striking convergences in the functional morphology of extant hominid and felid taxa. Multivariate and bivariate allometric analyses confirm that the proximal femur of these two mammalian families share a common underlying structure manifest in a shared first common principal component. Nevertheless, while considerable convergences in general form of the proximal femur of African hominids and large-bodied felids are apparent, there exist equally discreet distinctions which are consistent with the differential structural demands imposed by their distinct locomotor and behavioural habitus.

Ontogeny of the female femur: geometric morphometric analysis applied on current living individuals of a Spanish population

Science.gov (United States)

Pujol, Aniol; Rissech, Carme; Ventura, Jacint; Badosa, Joaquim; Turbón, Daniel

2014-01-01

In this study we describe the development of the female femur based on the analysis of high-resolution radiographic images by means of geometric morphometrics, while assessing the usefulness of this method in these kinds of studies. The material analysed consisted of digital images in DICOM format (telemetries), corresponding to 184 left femora in anterior view, obtained from the database of the Hospital Sant Joan de Déu of Barcelona (Spain). Bones analysed corresponded to individuals from 9 to 14 years old. Size and shape variation of the entire femur was quantified by 22 two-dimensional landmarks. Landmark digitisation errors were assessed using Procrustes anova test. Centroid size (CS) variation with age was evaluated by an anova test. Shape variation was assessed by principal component analysis. A mancova test between the first five principal components and age, using the CS as covariable, was applied. Results indicated that both size and shape vary significantly with age. Several age-related shape changes remained significant after removing the allometric effect. In general, an increase in the robustness of the bone and noticeable phenotypic changes in certain areas of the femur were observed. During growth in the proximal region of the femur, the collo-diaphyseal angle decreases, the neck of the femur widens and the fovea moves to a lower position, standing more in line with the plane of the neck. Likewise, the size of the greater and lesser trochanters increase. In the distal region, a significant increase of epiphyseal dimensions was recorded, mainly in the medial condyle. The angular remodelling of the neck and the bicondylar region of the femur in females continues until 13 years old. The information provided in the present study increases our knowledge on the timing and morphology of the femur during development, and in particular the morphology of the different femoral ossification centres during development. PMID:24975495

Lateral gastrocnemius myocutaneous flap transposition to the midlateral femur: extending the arc of rotation.

Science.gov (United States)

Agarwal, Rishi Raj; Broder, Kevin; Kulidjian, Anna; Bodor, Richard

2014-05-01

We report the successful use of an extended lateral gastrocnemius myocutaneous flap for coverage of the midlateral femur using successive delayed elevations. A 62-year-old man underwent wide resection of a liposarcoma of the right anterior thigh with free flap reconstruction and subsequent radiation therapy 10 years before. Four years later, the patient fractured his irradiated femur and was treated with a retrograde intramedullary nail, which subsequently became infected, causing osteomyelitis of the distal femur, septic arthritis of the knee joint, and nonunion of his pathologic fracture. Although advised by numerous surgeons to undergo above-knee amputation, we offered our motivated patient a multidisciplinary approach to clear his infection and pathology; implanted new orthopedic hardware; performed delayed flap reconstruction; and rehabilitated him back to painless, unassisted ambulation. The extended lateral gastrocnemius myocutaneous flap used provided perfused soft tissues and durable coverage for the patient's exposed orthopedic hardware of the midlateral femur, 14 cm above the joint line of the knee. By using this flap to cover a femur defect well above published heights, our patient avoided amputation after years of worsening incapacitation.

Endoscopic Surgery for Symptomatic Unicameral Bone Cyst of the Proximal Femur.

Science.gov (United States)

Miyamoto, Wataru; Takao, Masato; Yasui, Youichi; Miki, Shinya; Matsushita, Takashi

2013-11-01

Recently, surgical treatment of a symptomatic unicameral cyst of the proximal femur has been achieved with less invasive procedures than traditional open curettage with an autologous bone graft. In this article we introduce endoscopic surgery for a symptomatic unicameral cyst of the proximal femur. The presented technique, which includes minimally invasive endoscopic curettage of the cyst and injection of a bone substitute, not only minimizes muscle damage around the femur but also enables sufficient curettage of the fibrous membrane in the cyst wall and the bony septum through direct detailed visualization by an endoscope. Furthermore, sufficient initial strength after curettage can be obtained by injecting calcium phosphate cement as a bone substitute.

[Remodeling simulation of human femur under bed rest and spaceflight circumstances based on three dimensional finite element analysis].

Science.gov (United States)

Yang, Wenting; Wang, Dongmei; Lei, Zhoujixin; Wang, Chunhui; Chen, Shanguang

2017-12-01

Astronauts who are exposed to weightless environment in long-term spaceflight might encounter bone density and mass loss for the mechanical stimulus is smaller than normal value. This study built a three dimensional model of human femur to simulate the remodeling process of human femur during bed rest experiment based on finite element analysis (FEA). The remodeling parameters of this finite element model was validated after comparing experimental and numerical results. Then, the remodeling process of human femur in weightless environment was simulated, and the remodeling function of time was derived. The loading magnitude and loading cycle on human femur during weightless environment were increased to simulate the exercise against bone loss. Simulation results showed that increasing loading magnitude is more effective in diminishing bone loss than increasing loading cycles, which demonstrated that exercise of certain intensity could help resist bone loss during long-term spaceflight. At the end, this study simulated the bone recovery process after spaceflight. It was found that the bone absorption rate is larger than bone formation rate. We advise that astronauts should take exercise during spaceflight to resist bone loss.

Comparison of Percutaneous Cementoplasty with and Without Interventional Internal Fixation for Impending Malignant Pathological Fracture of the Proximal Femur

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Tian, Qing-Hua, E-mail: ddqinghua-tian@163.com; He, Cheng-Jian, E-mail: tianhechengjian@163.com; Wu, Chun-Gen, E-mail: 649514608@qq.com; Li, Yong-Dong, E-mail: tianliyongdong@163.com; Gu, Yi-Feng, E-mail: tianyifenggu@163.com; Wang, Tao, E-mail: tianandwangtao@163.com; Xiao, Quan-Ping, E-mail: tianxiaoquanping@163.com; Li, Ming-Hua, E-mail: tianminghuali@163.com [Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Department of Diagnostic and Interventional Radiology (China)

2016-01-15

PurposeTo compare the efficacy of percutaneous cementoplasty (PCP) with and without interventional internal fixation (IIF) on malignant impending pathological fracture of proximal femur.MethodsA total of 40 patients with malignant impending pathological fracture of proximal femur were selected for PCP and IIF (n = 19, group A) or PCP alone (n = 21, group B) in this non-randomized prospective study. Bone puncture needles were inserted into the proximal femur, followed by sequential installation of the modified trocar inner needles through the puncture needle sheath. Then, 15–45 ml cement was injected into the femur lesion.ResultsThe overall excellent and good pain relief rate during follow-ups were significantly higher in group A than that in group B (89 vs. 57 %, P = 0.034). The average change of VAS, ODI, KPS, and EFES in group A were significantly higher than those in group B at 1-, 3-, 6-month, 1-year (P < 0.05). Meanwhile, The stability of the treated femur was significantly higher in group A than that in group B (P < 0.05).ConclusionPCP and IIF were not only a safe and effective procedure, but resulted in greater pain relief, bone consolidation, and also reduced the risk of fracture than the currently recommended approach of PCP done on malignant proximal femoral tumor.

Comparison of Percutaneous Cementoplasty with and Without Interventional Internal Fixation for Impending Malignant Pathological Fracture of the Proximal Femur

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Tian, Qing-Hua; He, Cheng-Jian; Wu, Chun-Gen; Li, Yong-Dong; Gu, Yi-Feng; Wang, Tao; Xiao, Quan-Ping; Li, Ming-Hua

2016-01-01

PurposeTo compare the efficacy of percutaneous cementoplasty (PCP) with and without interventional internal fixation (IIF) on malignant impending pathological fracture of proximal femur.MethodsA total of 40 patients with malignant impending pathological fracture of proximal femur were selected for PCP and IIF (n = 19, group A) or PCP alone (n = 21, group B) in this non-randomized prospective study. Bone puncture needles were inserted into the proximal femur, followed by sequential installation of the modified trocar inner needles through the puncture needle sheath. Then, 15–45 ml cement was injected into the femur lesion.ResultsThe overall excellent and good pain relief rate during follow-ups were significantly higher in group A than that in group B (89 vs. 57 %, P = 0.034). The average change of VAS, ODI, KPS, and EFES in group A were significantly higher than those in group B at 1-, 3-, 6-month, 1-year (P < 0.05). Meanwhile, The stability of the treated femur was significantly higher in group A than that in group B (P < 0.05).ConclusionPCP and IIF were not only a safe and effective procedure, but resulted in greater pain relief, bone consolidation, and also reduced the risk of fracture than the currently recommended approach of PCP done on malignant proximal femoral tumor

A STUDY OF CLINICAL AND SURGICAL OUTCOME OF FRACTURE NECK OF FEMUR

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Anish G. Cherian

2016-09-01

Full Text Available BACKGROUND Fracture neck of femur has high incidence of complications even with treatment, hence it is also termed as unsolved fracture. Factors making treatment difficult are the blood supply to head, which gets cut off and difficulty in achieving reduction. Impacted fractures can be treated conservatively. If the fracture is undisplaced, a conservative approach may be done or multiple cancellous screws can be used. If the patient’s age is less than 60 years, a closed reduction under C-arm control can be tried. If the reduction is possible, then multiple screw fixations can be done. If reduction is not achieved, then open screw reduction and screw fixation can be done. If the patient is above 60 years of age, then it is preferable to excise the head off and replace it with prosthesis. If the hip is normal, then hemiarthroplasty with a unipolar or bipolar prosthesis can be done. If the hip has pre-existing arthritis, then total hip replacement surgery is advisable. A sincere effort has been put to understand the clinical and surgical outcome of fracture neck of femur in elderly. This paper is intended to help the practicing orthopaedicians to understand the various treatment modalities which is commonly used in practice and also the complications which are associated with the pathology. METHODS  The study was done in the Department of Orthopaedics, Travancore Medical College at Kollam.  The study was done from August 2014 to June 2016.  Eighty cases who attended in the Department of Orthopaedics were taken for the study.  Detailed History and Clinical Examination was conducted. INCLUSION CRITERIA  Both traumatic and pathological fractures were taken up for the study.  Individuals who were aged more than 55 years were taken up for the study. EXCLUSION CRITERIA  Aged less than 55 years were not considered.  All the statistical analysis was done using the latest SPSS software 2015 (California. RESULT Fracture neck of femur

Hemi replacement arthroplasty for unstable inter-trochanteric fractures of femur.

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Singh, Sudhir; Shrivastava, Chetan; Kumar, Sanjiv

2014-10-01

Unstable inter-trochanteric fracture in the geriatric population is a common injury and is associated with poor bone quality, excessive collapse, loss of fixation, and cut-out of the lag screw, are the common problems of attempts to fix these fractures. Present study is an attempt to evaluate the functional outcome of primary cemented bipolar hemiarthroplasty in unstable inter-trochanteric fractures in elderly patients. This prospective study included 25 cases with unstable inter-trochanteric fracture of femur between 60 -75 y of age in whom primary Cemented Bipolar hemi - arthroplasty was performed. The patients were followed up at six week, three month, six month and one year postoperatively and assessed using Harris Hip Score (HHS), Lower Extremity Functional Scale (LEFS), Visual analogue scale (VAS) for evaluation of outcome. The mean HHS score was 78.86+8.13 by the end of one year. Similarly mean LEFS score was 34.36+7.01 by the end of one year, whereas the mean pain score on VAS Scale by the year end was 1.04+1.02. The changes in HHS, LEFS and VAS up to six months periods are much greater which starts showing a stable trend thereafter. Fair to good scores were observed in all the patients. We compared our results with those reported by other authors and our study gave quite comparable results. We also used lower extremity function status score (LEFS) for assessment of functional ability. The purpose of its use was that while Harris Hip Score (HHS) provides information on a multitude of factors, LEFS is more patient oriented and provides the correct information about the level of activities a patient can resume post-operatively and can be offered as a self assessment tool. No significant complication except for grade I pressure sores in four patients were seen in postoperative period but they all resolved with proper nursing care by six week follow up. No patient required revision surgery. The authors believe that primary cemented bipolar hemiarthroplasty for

Use of anti-depressants and the risk of fracture of the hip or femur.

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van den Brand, M W M; Pouwels, S; Samson, M M; van Staa, T P; Thio, B; Cooper, C; Leufkens, H G M; Egberts, A C G; Verhaar, H J J; de Vries, F

2009-10-01

Anti-depressants are used largely, but have serious side effects. We show that both selective serotonin re-uptake inhibitors (SSRIs) and tricyclic anti-depressants (TCAs) increase the risk of hip/femur fracture and that this risk is time related and depends on the degree of serotonin transporter inhibition. This should be considered when prescribing anti-depressants to patients. Anti-depressants are known to have serious side effects. We examined the association between the use of anti-depressants and the risk of hip/femur fractures with a special focus on the relation with the degree of 5-hydroxytryptamine transporter (5-HTT) inhibition and the duration of use. A case-control study was conducted within the Dutch PHARMO-RLS database. Cases (n = 6,763) were adult patients with a first hip/femur fracture during the study period. For each case, four controls (n = 26341) were matched by age, gender and geographic region. The risk of hip/femur fracture increased with current use of SSRIs (adjusted odds ratio (OR(adj)) 2.35 [95% confidence interval (CI) 1.94-2.84]) and TCAs (ORadj 1.76 [95% CI 1.45-2.15]). The risk of hip/femur fracture declined rapidly after discontinuation of use. The risk of hip/femur fracture increased as the degree of 5-HTT inhibition of all anti-depressants increased from OR(adj) 1.64 [95% CI 1.14-2.35] for drugs with low 5-HTT inhibition to OR(adj) 2.31 [95% CI 1.94-2.76] for those with high 5-HTT inhibiting properties. Current use of both SSRIs and TCAs increase hip/femur fracture risk. Further studies are needed to elucidate the mechanistic pathways and the relation with the underlying pathophysiology. Until then, the elevated fracture risk should be considered when prescribing anti-depressants.

Early Clinical and Radiographic Results of Minimally Invasive Anterior Approach Hip Arthroplasty

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Tamara Alexandrov

2014-01-01

consecutive patients with 43 total hip arthroplasties performed through an anterior muscle sparing minimally invasive approach. We found the early complication rates and radiographic outcomes comparable to those reported from arthroplasties performed via traditional approaches. Complications included dislocation (2%, femur fracture (2%, greater trochanteric fracture (12%, postoperative periprosthetic intertrochanteric fracture (2%, femoral nerve palsy (5%, hematoma (2%, and postoperative iliopsoas avulsion (2%. Radiographic analysis revealed average cup anteversion of 19.6°±6.6, average cup abduction angle of 48.4°±7, stem varus of 0.9°±2, and a mean leg length discrepancy of 0.7 mm. The anterior approach to the hip is an attractive alternative to the more traditional approaches. Acceptable component placement with comparable complication rates is possible using a muscle sparing technique which may lead to faster overall recovery.

ASYMMETRICAL BILATERAL HIP DISLOCATION WITH SEGMENTAL FRACTURE FEMUR: AN UNUSUAL CASE REPORT AND LITERATURE REVIEW

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Ramesh

2015-01-01

Full Text Available Bilateral traumatic hip dislocation is rarely seen. A unique case is presented, consisting of asymmetric bilateral hip dislocation with associated segmental fracture femur, resulting from fall from bus. This case represents an unusual, severe combination of injuries resulting from the fall from bus under influence of alcohol. Traumatic hip dislocation represents a true orthopaedic emergency . Given the severity of associated complications, every effort should be made to ensure pr ompt diagnosis and immediate therapy. We report our experience in the management of this complex injury pattern and review the pertinent literature on this subject. Keywords: Bilateral hip dislocation , Asymmetric hip dislocation , Segmental femur fracture , Closed reduction , Fall from bus .

Proximal and distal alignment of normal canine femurs: A morphometric analysis.

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Kara, Mehmet Erkut; Sevil-Kilimci, Figen; Dilek, Ömer Gürkan; Onar, Vedat

2018-05-01

Many researchers are interested in femoral conformation because most orthopaedic problems of the long bones occur in the femur and its joints. The neck-shaft (NSA) and the anteversion (AVA) angles are good predictors for understanding the orientation of the proximal end of the femur. The varus (aLDFA) and procurvatum (CDFA) angles have also been used to understand the orientation of the distal end of the femur. The purposes of this study were to investigate the relationship between the proximal and distal angles of the femur and to compare the distal femoral angles in male and female dogs in order to investigate the sexual dimorphism. The measurements of normal CDFAs, which have not been previously reported, may also provide a database of canine distal femoral morphology. A total of 75 cleaned healthy femora from different breeds or mixed breed of dogs were used. The three-dimensional images were reconstructed from computed tomographic images. The AVA, NSA, aLDFA and CDFA were measured on the 3D images. The correlation coefficients were calculated among the measured angles. The distal femoral angles were also compared between male and female femora. The 95% confidence intervals of the AVA and the NSA were calculated to be 24.22°-29.50° and 144.97°-147.50°, respectively. The 95% confidence intervals of the aLDFA and the CDFA for all studied dogs were 92.62°-94.08° and 89.09°-91.94°, respectively. The NSA showed no correlation with either the aLDFA or CDFA. There was a weak inverse correlation between the AVA and CDFA and a weak positive correlation between the AVA and aLDFA. The differences in the aLDFA and CDFA measurements between male and female dog were not significant. In conclusion, femoral version, regardless of the plane, might have little influence on distal femoral morphology in normal dogs. Besides this, there is no evidence of a sexual dimorphism in the varus and procurvatum angles of the dog distal femur. The data from this study may be used in

Bone Morphology in 46 BXD Recombinant Inbred Strains and Femur-Tibia Correlation

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Yueying Zhang

2015-01-01

Full Text Available We examined the bone properties of BXD recombinant inbred (RI mice by analyzing femur and tibia and compared their phenotypes of different compartments. 46 BXD RI mouse strains were analyzed including progenitor C57BL/6J (n=16 and DBA/2J (n=15 and two first filial generations (D2B6F1 and B6D2F1. Strain differences were observed in bone quality and structural properties (P<0.05 in each bone profile (whole bone, cortical bone, or trabecular bone. It is well known that skeletal phenotypes are largely affected by genetic determinants and genders, such as bone mineral density (BMD. While genetics and gender appear expectedly as the major determinants of bone mass and structure, significant correlations were also observed between femur and tibia. More importantly, positive and negative femur-tibia associations indicated that genetic makeup had an influence on skeletal integrity. We conclude that (a femur-tibia association in bone morphological properties significantly varies from strain to strain, which may be caused by genetic differences among strains, and (b strainwise variations were seen in bone mass, bone morphology, and bone microarchitecture along with bone structural property.

A comparison of bone mineral density in osteoporotic fracture of the proximal femur using dual energy X-ray absorptiometry

International Nuclear Information System (INIS)

Lee, Jong Seok; Yoo, Beong Gyu; Kim, Keung Sik

2000-01-01

There were some controversies about direct cause of hip fracture. We attempted to look at 40 osteoporotic proximal femur fractures in women over 50 years between March in 1999 and February in 2000. The bone density of the fracture group and the healthy 85 control group was measured by Dual Energy X-ray absorptiometry (DEXA). The result was compared using age matched paired T test. The results were as follows: The femoral neck fractures were 14 cases and the trochanteric fractures were 26 cases. Mean age at a fracture was 67.1 years in neck fracture group and 76.5 years in trochanteric fracture. In the control group, the bone density of both side of the proximal femur was measured and it showed statistically no difference between both sides in same person. The bone density of neck, Ward's triangle, trochanter (P<0.05) and lumbar spine (P<0.001) was significantly reduced in the proximal femoral fracture group comparing with the control group. The bone density of neck, Ward's triangle, trochanter (P<0.05) was significantly reduced in the proximal femoral neck fracture group comparing with the control group, but there was no statistical difference in lumbar spine comparing with the control group. The bone density of neck, Ward's triangle, trochanter and lumbar spine (P<0.001) was significantly reduced in the proximal femoral neck fracture group comparing with the control group. We concluded that the bone mineral densities (BMD) of proximal femur and lumbar spine had decreased in hip fractures but that the bone mineral density and T-score % of the proximal femur were statistically lower than that of the lumbar spine. We suggest that measuring the bone mineral density of the proximal femur may reflect the weakness of the proximal femur more precisely than measuring the bone mineral density of the lumbar spine

A comparison of bone mineral density in osteoporotic fracture of the proximal femur using dual energy X-ray absorptiometry

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Lee, Jong Seok; Yoo, Beong Gyu [Wonkwang Health Science College, Iksan (Korea, Republic of); Kim, Keung Sik [Yonsei University Yong Dong Severance Hospital, Seoul (Korea, Republic of)

2000-04-15

There were some controversies about direct cause of hip fracture. We attempted to look at 40 osteoporotic proximal femur fractures in women over 50 years between March in 1999 and February in 2000. The bone density of the fracture group and the healthy 85 control group was measured by Dual Energy X-ray absorptiometry (DEXA). The result was compared using age matched paired T test. The results were as follows: The femoral neck fractures were 14 cases and the trochanteric fractures were 26 cases. Mean age at a fracture was 67.1 years in neck fracture group and 76.5 years in trochanteric fracture. In the control group, the bone density of both side of the proximal femur was measured and it showed statistically no difference between both sides in same person. The bone density of neck, Ward's triangle, trochanter (P<0.05) and lumbar spine (P<0.001) was significantly reduced in the proximal femoral fracture group comparing with the control group. The bone density of neck, Ward's triangle, trochanter (P<0.05) was significantly reduced in the proximal femoral neck fracture group comparing with the control group, but there was no statistical difference in lumbar spine comparing with the control group. The bone density of neck, Ward's triangle, trochanter and lumbar spine (P<0.001) was significantly reduced in the proximal femoral neck fracture group comparing with the control group. We concluded that the bone mineral densities (BMD) of proximal femur and lumbar spine had decreased in hip fractures but that the bone mineral density and T-score % of the proximal femur were statistically lower than that of the lumbar spine. We suggest that measuring the bone mineral density of the proximal femur may reflect the weakness of the proximal femur more precisely than measuring the bone mineral density of the lumbar spine.

Role of gamma nail in management of pertrochanteric fractures of femur

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Sharma Vipin

2008-01-01

Full Text Available Background: Pertrochanteric fractures which involve trochanteric fractures with varying fracture geometry pose a significant challenge to the treating orthopedic surgeon. The aim of this study is to evaluate the management of pertrochanteric fractures of the femur using gamma nail [Asia pacific (AP]. Materials and Methods: Sixty patients of pertrochanteric fractures were treated by closed reduction internal fixation by gamma nail from 1 January 1993 to 31 December 2000. Four patients were lost to follow-up. The remaining 56 patients were followed for a mean period of 3.2 years (range 2-4 years.The results were evaluated by assessing the patients regarding their clinical and functional outcome at follow-up as per Kyle′s criteria. Results: Peroperative jamming of nail ( n = 1, failed distal locking ( n = 1, superior cut out of lag screw ( n = 1 and postoperative varus malreduction ( n = 1 were the complications observed. End results were excellent in 46.34%, good in 36.58%, fair in 14.64%, poor in 2.43%. Conclusion: Gamma nail in expert hands is a suitable implant for management of pertrochanteric fractures of the femur.

Comparison of two interpolation methods for empirical mode decomposition based evaluation of radiographic femur bone images.

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Udhayakumar, Ganesan; Sujatha, Chinnaswamy Manoharan; Ramakrishnan, Swaminathan

2013-01-01

Analysis of bone strength in radiographic images is an important component of estimation of bone quality in diseases such as osteoporosis. Conventional radiographic femur bone images are used to analyze its architecture using bi-dimensional empirical mode decomposition method. Surface interpolation of local maxima and minima points of an image is a crucial part of bi-dimensional empirical mode decomposition method and the choice of appropriate interpolation depends on specific structure of the problem. In this work, two interpolation methods of bi-dimensional empirical mode decomposition are analyzed to characterize the trabecular femur bone architecture of radiographic images. The trabecular bone regions of normal and osteoporotic femur bone images (N = 40) recorded under standard condition are used for this study. The compressive and tensile strength regions of the images are delineated using pre-processing procedures. The delineated images are decomposed into their corresponding intrinsic mode functions using interpolation methods such as Radial basis function multiquadratic and hierarchical b-spline techniques. Results show that bi-dimensional empirical mode decomposition analyses using both interpolations are able to represent architectural variations of femur bone radiographic images. As the strength of the bone depends on architectural variation in addition to bone mass, this study seems to be clinically useful.

Bone Mineral Density, Mechanical, Microstructural Properties and Mineral Content of the Femur in Growing Rats Fed with Cactus Opuntia ficus indica (L.) Mill. (Cactaceae) Cladodes as Calcium Source in Diet.

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Hernández-Becerra, Ezequiel; Gutiérrez-Cortez, Elsa; Del Real, Alicia; Rojas-Molina, Alejandra; Rodríguez-García, Mario; Rubio, Efraín; Quintero-García, Michelle; Rojas-Molina, Isela

2017-02-04

Mechanical, microstructural properties, mineral content and bone mineral density (BMD) of the femur were evaluated in growing rats fed with Opuntia ficus indica (L.) Mill. (Cactaceae) cladodes at different maturity stages as calcium source. Male weanling rats were fed with cladodes at early maturity stage (25 and 60 days of age, belonging to groups N-60 and N-200, respectively) and cladodes at late maturity stage (100 and 135 days of age, belonging to groups N-400 and N-600, respectively) for 6 weeks. Additionally, a control group fed with calcium carbonate as calcium source was included for comparative purposes. All diets were fitted to the same calcium content (5 g/kg diet). The failure load of femurs was significantly lower ( p ≤ 0.05) in groups N-60 and N-200 in comparison to N-400, N-600 and control groups. The cortical width (Ct.Wi) and trabecular thickness (Tb.Th) of the femurs in control and N-600 groups were significantly higher ( p ≤ 0.05) than Ct.Wi and Tb.Th of femurs in groups N-60 and N-200. Trabecular separation of the femurs in N-60 and N-200 groups showed the highest values compared with all experimental groups. The highest calcium content in the femurs were observed in control, N-600 and N-400 groups; whereas the lowest phosphorus content in the bones were detected in N-200, N-600 and N-400 groups. Finally, the BMD in all experimental groups increased with age; nevertheless, the highest values were observed in N-600 and control groups during pubertal and adolescence stages. The results derived from this research demonstrate, for the first time, that the calcium found in Opuntia ficus indica cladodes is actually bioavailable and capable of improving mineral density and mechanical and microstructural properties of the bones. These findings suggest that the consumption of cladodes at late maturity stage within the diet might have a beneficial impact on bone health.

Bone Mineral Density, Mechanical, Microstructural Properties and Mineral Content of the Femur in Growing Rats Fed with Cactus Opuntia ficus indica (L. Mill. (Cactaceae Cladodes as Calcium Source in Diet

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Ezequiel Hernández-Becerra

2017-02-01

Full Text Available Mechanical, microstructural properties, mineral content and bone mineral density (BMD of the femur were evaluated in growing rats fed with Opuntia ficus indica (L. Mill. (Cactaceae cladodes at different maturity stages as calcium source. Male weanling rats were fed with cladodes at early maturity stage (25 and 60 days of age, belonging to groups N-60 and N-200, respectively and cladodes at late maturity stage (100 and 135 days of age, belonging to groups N-400 and N-600, respectively for 6 weeks. Additionally, a control group fed with calcium carbonate as calcium source was included for comparative purposes. All diets were fitted to the same calcium content (5 g/kg diet. The failure load of femurs was significantly lower (p ≤ 0.05 in groups N-60 and N-200 in comparison to N-400, N-600 and control groups. The cortical width (Ct.Wi and trabecular thickness (Tb.Th of the femurs in control and N-600 groups were significantly higher (p ≤ 0.05 than Ct.Wi and Tb.Th of femurs in groups N-60 and N-200. Trabecular separation of the femurs in N-60 and N-200 groups showed the highest values compared with all experimental groups. The highest calcium content in the femurs were observed in control, N-600 and N-400 groups; whereas the lowest phosphorus content in the bones were detected in N-200, N-600 and N-400 groups. Finally, the BMD in all experimental groups increased with age; nevertheless, the highest values were observed in N-600 and control groups during pubertal and adolescence stages. The results derived from this research demonstrate, for the first time, that the calcium found in Opuntia ficus indica cladodes is actually bioavailable and capable of improving mineral density and mechanical and microstructural properties of the bones. These findings suggest that the consumption of cladodes at late maturity stage within the diet might have a beneficial impact on bone health.

MR imaging of proximal femur: age-related changes

International Nuclear Information System (INIS)

Kim, Ju Heon; Jeon, Woo Jin; Sohn, Cheol Ho; Park, Mi Ok; Lee, Seong Mun; Joo, Yang Gu; Suh, Soo Jhi; Pyun, Young Sik

1995-01-01

The purpose of this study is to illustrate MR patterns of signal intensity of proximal femur in normal subjects according to the age distribution. T1-weighted MR images of the proximal femur in 125 subjects, aged 13 days to 25 years, were retrospectively analyzed. Age distribution was classified to 4 groups; below 4 months, 5 months to 4 years, 5 years to 14 years, and 15 years to 25 years. By the age of 4 months, the non-ossified femoral epiphysis was seen as intermediate-signal-intensity cartilage. At 5 months-4 years, the ossified femoral capital epiphysis was seen within intermediate-signal-intensity cartilage and appeared as decreased or increased signal-intensity red or yellow marrow surrounded by a rim of low-signal-intensity cortical bone. At 5-14 years, the ossified femoral capital and greater trochanteric epiphysis were seen within the intermediate-signal-intensity cartilage and appeared as decreased or increased signal-intensity red or yellow marrow. At 15-25 years, the proximal metaphyseal marrow showed increased signal intensity. Four patterns of the metaphyseal marrow were recognized by Ricci et al. The frequency of pattern 1 a progressively decreased with age. Pattern 2 and 3 were visible in the 15-25 years age group. An understanding of the spectrum of normal age-related change of the proximal femoral cartilage and marrow patterns serves as the foundation for interpretation of proximal femur pathologies

Compartment syndrome of the thigh complicating surgical treatment of ipsilateral femur and ankle fractures

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Moore, M. R.; Garfin, S. R.; Hargens, A. R.

1987-01-01

A 26-year-old man presented with ipsilateral femur and ankle fractures. The patient was treated with interlocking nail of his femur fracture, followed by open reduction and internal fixation of his ankle fracture under tourniquet control. Postoperatively, the patient developed compartment syndrome of his thigh with elevated pressures, requiring decompressive fasciotomies. This case illustrates the possible complication of treating a femur fracture with intramedullary nailing and then immediately applying a tourniquet to treat an ipsilateral extremity fracture. Because of the complication with this patient, we feel the procedure should be staged, or a tourniquet should be avoided if possible.

Case report 473: Tuberculosis of the distal metaphysis of the femur

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Abdelwahab, I.F.; Gould, E.; Present, D.A.; Klein, M.J.; Nelson, J.

1988-04-01

In summary, a case of tuberculous osteomyelitis of the femur in a 16-month-old male child has been presented. The parents illegally immigrated to the United States from Central America before the birth of their child. Both parents had active pulmonary tuberculosis and the child presented with calcified granulomas in his lungs in addition to the lesion in the femur. This presentation is uncommon among the white population in the United States and Europe and is usually limited to non-white immigrants. (orig./SHA).

Case report 473: Tuberculosis of the distal metaphysis of the femur

International Nuclear Information System (INIS)

Abdelwahab, I.F.; Gould, E.; Present, D.A.; Klein, M.J.; Nelson, J.

1988-01-01

In summary, a case of tuberculous osteomyelitis of the femur in a 16-month-old male child has been presented. The parents illegally immigrated to the United States from Central America before the birth of their child. Both parents had active pulmonary tuberculosis and the child presented with calcified granulomas in his lungs in addition to the lesion in the femur. This presentation is uncommon among the white population in the United States and Europe and is usually limited to non-white immigrants. (orig./SHA)

Percutaneous Stabilization of Impending Pathological Fracture of the Proximal Femur

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Deschamps, Frederic, E-mail: frederic.deschamps@igr.fr; Farouil, Geoffroy, E-mail: g.farouil@gmail.com; Hakime, Antoine, E-mail: thakime@yahoo.com; Teriitehau, Christophe, E-mail: cteriitehau@me.com; Barah, Ali, E-mail: ali.barah@gmail.com; Baere, Thierry de, E-mail: debaere@igr.fr [Institut Gustave Roussy, Interventional Radiology Department (France)

2012-12-15

Objective: Percutaneous osteosynthesis plus cementoplasty (POPC) is a minimally invasive technique that has never been reported before and that we have prospectively evaluated for patients with impending pathological fracture of the proximal femur. Methods: We performed POPC in 12 patients (3 males, 9 females) with metastasis of the proximal femur with a high risk of fracture (Mirels' score {>=}8) between February 2010 and July 2011. Patients were not candidates for standard surgical stabilization. We analyzed the feasibility, duration, and complication of the procedure, the risk of fracture, the decrease in pain (Visual Analog Scale, VAS), and length of stay in hospital. Data were prospectively collected in all patients. Results: The mean Mirels' score was 9.8 {+-} 1.2 (range, 8-11). The technical success was 100%. POPC was performed under general anesthesia (n = 6) or conscious sedation (n = 6). The mean duration was 110 {+-} 43 (range, 60-180) minutes. All patients stood up and walked the second day after the procedure. The average length of stay in the hospital was 4 {+-} 1.6 (range, 2-7) days. We experienced two hematomas in two patients and no thromboembolic complication. For symptomatic patients (n = 8), VAS decreased from 6.5/10 (range, 2-9) before treatment to 1/10 (range, 0-3) 1 month after. No fracture occurred after a median follow-up of 145 (range, 12-608) days. Conclusions: POPC for impending pathological fracture of the proximal femur seems to be a promising alternative for cancer patients who are not candidates for surgical stabilization. Further studies are required to confirm this preliminary experience.

Percutaneous Stabilization of Impending Pathological Fracture of the Proximal Femur

International Nuclear Information System (INIS)

Deschamps, Frederic; Farouil, Geoffroy; Hakime, Antoine; Teriitehau, Christophe; Barah, Ali; Baere, Thierry de

2012-01-01

Objective: Percutaneous osteosynthesis plus cementoplasty (POPC) is a minimally invasive technique that has never been reported before and that we have prospectively evaluated for patients with impending pathological fracture of the proximal femur. Methods: We performed POPC in 12 patients (3 males, 9 females) with metastasis of the proximal femur with a high risk of fracture (Mirels’ score ≥8) between February 2010 and July 2011. Patients were not candidates for standard surgical stabilization. We analyzed the feasibility, duration, and complication of the procedure, the risk of fracture, the decrease in pain (Visual Analog Scale, VAS), and length of stay in hospital. Data were prospectively collected in all patients. Results: The mean Mirels’ score was 9.8 ± 1.2 (range, 8–11). The technical success was 100%. POPC was performed under general anesthesia (n = 6) or conscious sedation (n = 6). The mean duration was 110 ± 43 (range, 60–180) minutes. All patients stood up and walked the second day after the procedure. The average length of stay in the hospital was 4 ± 1.6 (range, 2–7) days. We experienced two hematomas in two patients and no thromboembolic complication. For symptomatic patients (n = 8), VAS decreased from 6.5/10 (range, 2–9) before treatment to 1/10 (range, 0–3) 1 month after. No fracture occurred after a median follow-up of 145 (range, 12–608) days. Conclusions: POPC for impending pathological fracture of the proximal femur seems to be a promising alternative for cancer patients who are not candidates for surgical stabilization. Further studies are required to confirm this preliminary experience.

Morphometric Evaluation of Korean Femurs by Geometric Computation: Comparisons of the Sex and the Population

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Ho-Jung Cho

2015-01-01

Full Text Available We measured 28 parameters of 202 femurs from Koreans by an automated geometric computation program using 3D models generated from computed tomography images. The measurement parameters were selected with reference to physical and forensic anthropology studies as well as orthopedic implant design studies. All measurements were calculated using 3D reconstructions on a computer using scientific computation language. We also analyzed sex and population differences by comparison with data from previous studies. Most parameters were larger in males than in females. The height, head diameter, head center offset, and chord length of the diaphysis, most parameters in the distal femur, and the isthmic width of the medullary canal were smaller in Koreans than in other populations. However, the neck-shaft angle, subtense, and width of the intercondylar notch in the distal femur were larger than those in other populations. The results of this study will be useful as a reference for physical and forensic anthropology as well as the design of medical devices suitable for Koreans.

Semi-automated landmark-based 3D analysis reveals new morphometric characteristics in the trochlear dysplastic femur.

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Van Haver, Annemieke; De Roo, Karel; De Beule, Matthieu; Van Cauter, Sofie; Audenaert, Emmanuel; Claessens, Tom; Verdonk, Peter

2014-11-01

The authors hypothesise that the trochlear dysplastic distal femur is not only characterised by morphological changes to the trochlea. The purpose of this study is to describe the morphological characteristics of the trochlear dysplastic femur in and outside the trochlear region with a landmark-based 3D analysis. Arthro-CT scans of 20 trochlear dysplastic and 20 normal knees were used to generate 3D models including the cartilage. To rule out size differences, a set of landmarks were defined on the distal femur to isotropically scale the 3D models to a standard size. A predefined series of landmark-based reference planes were applied on the distal femur. With these landmarks and reference planes, a series of previously described characteristics associated with trochlear dysplasia as well as a series of morphometric characteristics were measured. For the previously described characteristics, the analysis replicated highly significant differences between trochlear dysplastic and normal knees. Furthermore, the analysis showed that, when knee size is taken into account, the cut-off values of the trochlear bump and depth would be 1 mm larger in the largest knees compared to the smallest knees. For the morphometric characteristics, the analysis revealed that the trochlear dysplastic femur is also characterised by a 10% smaller intercondylar notch, 6-8% larger posterior condyles (lateral-medial) in the anteroposterior direction and a 6% larger medial condyle in the proximodistal direction compared to a normal femur. This study shows that knee size is important in the application of absolute metric cut-off values and that the posterior femur also shows a significantly different morphology.

A Systematic Review and Meta-Analysis of Ilizarov Methods in the Treatment of Infected Nonunion of Tibia and Femur.

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Peng Yin

Full Text Available Infected nonunion of tibia and femur are common in clinical practice, however, the treatment of these diseases has still been a challenge for orthopaedic surgeons. Ilizarov methods can eradicate infection, compensate bone defects and promote the bone union through progressive bone histogenesis. The objective of this systematic review was to review current available studies reporting on Ilizarov methods in the treatment of infected nonunion of tibia and femur, and to perform meta-analysis of bone and functional results and complications to evaluate the efficacy of Ilizarov methods.A comprehensive literature search was performed from the SCI, PubMed, Cochrane Library; and Embase between January 1995 and August 2015. Some major data were statistically analyzed using weighted means based on the sample size in each study by SPSS 13.0, including number of patients, mean age, mean previous surgical procedures, mean bone defects, mean length of follow-up, bone union, complications per patient, external fixation time, and external fixation index(EFI. Bone results (excellent, good, fair and poor rate, functional results (excellent, good, fair and poor rate and complications were analyzed by Stata 9.0.A total of 590 patients from 24 studies were included in this systematic review. The average of bone union rate was 97.26% in all included studies. The poor rate in bone results and functional results was 8% (95%CI, 0.04-0.12; I2 = 44.1%, P = 0.065 and 10% (95%CI, 0.05-0.14; I2 = 34.7%, P = 0.121 in patients with infected nonunion of tibia and femur treated by Ilizarov methods. The rate of refracture, malunion, infectious recurrence, knee stiffness, amputation, limb edema and peroneal nerve palsy was respectively 4%, 7%, 5%, 12%, 4%, 13% and 13%.Our systematic review showed that the patients with infected nonunion of tibia and femur treated by Ilizarov methods had a low rate of poor bone and functional results. Therefore, Ilizarov methods may be a good choice

Mineral to matrix ratio determines biomaterial and biomechanical properties of rat femur--application of Fourier transform infrared spectroscopy.

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Takata, Shinjiro; Yonezu, Hiroshi; Shibata, Akira; Enishi, Tetsuya; Sato, Nori; Takahashi, Mitsuhiko; Nakao, Shigetaka; Komatsu, Koji; Yasui, Natsuo

2011-08-01

We studied the changes of biomaterial and biomechanical properties of the rat femur during development. Thirty male Wistar rats were allocated to 6 groups: aged 6 weeks (n=5), 9 weeks (n=5), 12 weeks (n=5), 15 weeks (n=5), 24 weeks (n=5), and 36 weeks (n=5). The mineral to matrix ratio (M/M ratio) of rat femur by Fourier transform infrared spectroscopy was 0.97 ± 0.10 at the age of 6 weeks, and reached the maximum of 1.52 ± 0.17 at the age of 36 weeks. Total bone mineral density (BMD) by peripheral quantitative computed tomography of the femoral shaft aged 6 weeks was 479.1 ± 58.7 mg/cm(3), and reached the maximum of 1022.2 ± 42.3 mg/cm(3) at the age of 36 weeks. The ultimate load to failure of the femur of the rat aged 6 weeks by the three-point bending test was 29.6 ± 6.1 N. At the age of 36 weeks, the ultimate load to failure of the rat femur increased to the maximum of 283.5 ± 14.7 N. The results showed that the M/M ratio increased with development as total BMD and bone strength increased. The results suggest that the M/M ratio is one of the determinants of the biomaterial and biomechanical properties of bone.

Accuracy of dual photon absorptiometry in excised femurs

International Nuclear Information System (INIS)

Erman, J.; Ott, S.M.

1988-01-01

We investigated the accuracy of assessment of bone mineral content (BMC) by dual photon absorptiometry (DPA). Measurements were compared between BMC and ashed weight using two related scanners. The BMC in different locations of the femur was determined. Twelve cadaver femurs were cleaned of all soft tissue, divided into four parts (head, neck, trochanteric region, and shaft), and measured for BMC in an ethanol/water solution. The bones were then ashed and weighed. Volumetric density was also determined. The correlation coefficient between ash weight and BMC was 0.99 with an s.e.e. of 0.51 g and relative error of 4.8%. Similar correlations were seen within each region. The correlation between the machines was 0.99. Differences in volumetric density were found, with the density of the shaft greater than other regions, and the neck greater than the head or trochanteric regions

Study of treatment of short oblique and transverse fractures near isthmus of femur

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Soumya Ghosh

2014-01-01

Full Text Available Background: Currently, the standard treatment for femoral shaft fractures in adults is intramedullary nailing. Objectives: Comparative assessment of results with open Kuntscher′s nailing (K-nailing and closed interlocking intramedullary nail in case of fracture shaft femur. Materials and Methods: This pilot project was conducted in a tertiary care hospital of a developing country on 40 patients in a time period of 1 year. A total of 20 patients were treated with intramedullary nailing in the tertiary care hospital while twenty received open fixation with K-nailing in a rural center. Results: There was no significant difference with regard to union rate, implant failure, infection, and fracture alignment between both groups. Conclusion: Open fixation with unlocked femoral nailing is technically less demanding and requires less operating time; additionally, there is no exposure to radiation and cost of the implant is cheaper. So, open K-nailing is still remains an option for the management of noncomminuted isthmus fractures of the femur in a developing country.

[MRI characteristic of proximal femur bone marrow edema syndrome].

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Wu, Xi-Yuan

2014-07-01

To study the MRI features of proximal femur bone marrow edema syndrome for further improve the understanding of the disease. MRI imaging of 10 patients with proximal femur bone marrow edema syndrome was retrospectively reviewed,including 6 males and 4 females with an average age of 41.5 years old ranging from 36 to 57. The courses of diseases ranged from 1 week to 3 months. Among them, 9 cases had clinical manifestations of sudden hip pain, 7 cases had limited ability of walking and hip movement;all patients had no obvious injury history, non of the female patients was pregnant. All patients were followed up from 3 to 12 months, the following-up were topped after MRI when the symptoms disappeared for 3 months. The MRI demonstrated diffuse bone marrow edema involving the femoral head, neck and the inter-trochanteric region, 13 hips of 10 patients with bone marrow edema included 6 cases in grade 1, 5 cases in grade 2,2 cases in grade 3; 9 hips with hip hydrarthrosis included 6 hips in grade I ,1 hip in grade II, 2 hips in grade III. After treatment for 3 to 12 months the hip symptoms of the patients disappeared and MRI images were normal. MRI is useful in defining the location and extent of proximal femur bone marrow edema syndrome.

Adverse Effects of Caffeine on Development of Femur of BALB/c Mice and Protective Role of Vitamin D/sub 3/

International Nuclear Information System (INIS)

Khan, M.; Butt, S. A.

2017-01-01

Objective: To determine the effects of caffeine ingestion on the development of femur and role of vitamin D3 in preventing these effects in BALB/c mice. Study Design: Experimental study. Place and Duration of Study: Department of Anatomy, Army Medical College, Rawalpindi, in cooperation with NIH(National Institute of Health), Islamabad, from October 2014 to October 2015. Methodology: Thirty (100%) BALB/c mice, 50% male and female each, three weeks old, weighing 12-14 grams were taken and divided equally and randomly into three groups, each having 10 (33.3%) mice; 5 (16.6%) male and female. G1 (control group) was given normal diet with water ad libitum. G2 and G3 (experimental groups) were given 10 mg of caffeine per 100g body weight, three days a week, through oral gavage for 60 days on alternate days. However, experimental group G3 was additionally provided 0.1 micro g vitamin D3 daily, through oral gavage for 60 days. Experimental groups were compared with control group and data was analyzed statistically. Results: The mean weight of mice femur of G1(control group) was 0.387+-0.019 g; while mean weights of right femur of G2 and G3 (experimental groups) were 0.316+-0.020 g and 0.345+-0.020 g, respectively. Similarly, mean right femur length of group G1 was 20.70 +- 0.609 mm; while for groups G2 and G3, it was 24.382 +- 1.087 mm and 22.966 +- 0.822 mm, respectively. In comparison with group G1 for groups G2 and G3, femur weight decreased, however femur length increased. Conclusion: Caffeine intake caused femur length to increase and weight to decrease, but treatment with vitamin D3 ameliorated these effects of caffeine. (author)

Burkitt`s lymphoma involving the femur in a 12 year old girl a rare ...

African Journals Online (AJOL)

The Diagnosis of Burkitt`s lymphoma with multicentre involvement of the left femur and abdominal visceral was reached.However it was not established whether femur was the primary or secondarily involved. This patient was started on Chemotherapy and she recovered well. Burkitt`s Lymphoma of a long bone are very rare ...

Intact and Implanted Femur Behavior During Walking and Jogging

National Research Council Canada - National Science Library

Papathanasopoulou, V

2001-01-01

... not only at a single moment in time, but during the complete range of motion. In this study, a three-dimensional dynamic finite element model of the human femur during the gait cycle is developed...

The effect of rapid decompression on femur blood flow of rabbits

International Nuclear Information System (INIS)

Yu Shaoning; Tian Wuxun; Zhu Xiangqi

1997-01-01

PURPOSE: To study the influence of regional blood flow in femur trochanter (FT) of rabbits' under rapid decompression after exposure to hyperbaric air. METHODS: Rabbits were placed in a hyperbaric chamber and exposed to the pressure of 0.5 MPa for 1.5 h, and the pressure was reduced to the atmosphere pressure at a uniform rate of 0.03 mPa/min. The regional blood flow of FT in rabbits were measured with 133 Xe washout methods. RESULTS: The normal average regional blood flow in left and right FT were 14.5 +- 1.7 and 14.1 +- 1.9 ml/(min·100g) respectively. After exposure to hyperbaric air with rapid decompression, the average regional blood flow of left and right FT were 11.1 +- 1.2 and 10.5 +- 1.6 ml/(min·100g) respectively. But the symptoms of dysbarism in these rabbits were various each other. CONCLUSIONS: After being exposed to hyperbaric air with rapid decompression, the blood flow of rabbits' femur trochanter were noticeably reduced

Prediction on fracture risk of femur with Osteogenesis Imperfecta using finite element models: Preliminary study

Science.gov (United States)

Wanna, S. B. C.; Basaruddin, K. S.; Mat Som, M. H.; Mohamad Hashim, M. S.; Daud, R.; Majid, M. S. Abdul; Sulaiman, A. R.

2017-10-01

Osteogenesis imperfecta (OI) is a genetic disease which affecting the bone geometry. In a severe case, this disease can cause death to patients. The main issue of this disease is the prediction on bone fracture by the orthopaedic surgeons. The resistance of the bone to withstand the force before the bones fracture often become the main concern. Therefore, the objective of the present preliminary study was to investigate the fracture risk associated with OI bone, particularly in femur, when subjected to the self-weight. Finite element (FEA) was employed to reconstruct the OI bone model and analyse the mechanical stress response of femur before it fractures. Ten deformed models with different severity of OI bones were developed and the force that represents patient self-weight was applied to the reconstructed models in static analysis. Stress and fracture risk were observed and analysed throughout the simulation. None of the deformed model were observed experienced fracture. The fracture risk increased with increased severity of the deformed bone. The results showed that all deformed femur models were able to bear the force without experienced fracture when subjected to only the self-weight.

A Prospective Study to Evaluate the Management of Sub-trochanteric Femur Fractures with Long Proximal Femoral Nail.

Science.gov (United States)

Kumar, M; Akshat, V; Kanwariya, A; Gandhi, M

2017-11-01

Introduction: Sub-trochanteric fractures of the femur remains one of the most challenging fractures faced by orthopaedic surgeons. This study was done to analyse the management and complications of sub-trochanteric fractures using long proximal femoral nail (PFN). Materials and Methods: This was a prospective study of 50 patients with sub-trochanteric fractures of femur who were treated with long PFN at a tertiary care center from July 2012 to June 2016. The fractures were classified according to Seinsheimer classification. All patients were assessed functionally by Harris Hip Score. Results: Average duration of union was 17.08 weeks (range 13 to 32 weeks), union was achieved in 92% cases. Closed reduction was achieved in 68% cases and open reduction was required in 32% cases. Various intraoperative complications were seen in 12% and delayed complications in 26% of cases. Good anatomical results were achieved in 86% of cases and 14% were fair. As per Harris Hip score, excellent results were noted in 28% cases, good in 56% cases and fair in 16% cases. Conclusion: The long PFN is a reliable implant for subtrochanteric femur fractures, with high rate of bone union and minimal soft tissue damage. Intramedullary fixation has biological and biomechanical advantages, but the surgery is technically demanding.

A Prospective Study to Evaluate the Management of Sub-trochanteric Femur Fractures with Long Proximal Femoral Nail

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Kumar M

2017-11-01

Full Text Available INTRODUCTION: Sub-trochanteric fractures of the femur remains one of the most challenging fractures faced by orthopaedic surgeons. This study was done to analyse the management and complications of sub-trochanteric fractures using long proximal femoral nail (PFN. MATERIALS AND METHODS: This was a prospective study of 50 patients with sub-trochanteric fractures of femur who were treated with long PFN at a tertiary care center from July 2012 to June 2016. The fractures were classified according to Seinsheimer classification. All patients were assessed functionally by Harris Hip Score. RESULTS: Average duration of union was 17.08 weeks (range 13 to 32 weeks, union was achieved in 92% cases. Closed reduction was achieved in 68% cases and open reduction was required in 32% cases. Various intraoperative complications were seen in 12% and delayed complications in 26% of cases. Good anatomical results were achieved in 86% of cases and 14% were fair. As per Harris Hip score, excellent results were noted in 28% cases, good in 56% cases and fair in 16% cases. CONCLUSION: The long PFN is a reliable implant for sub-trochanteric femur fractures, with high rate of bone union and minimal soft tissue damage. Intramedullary fixation has biological and biomechanical advantages, but the surgery is technically demanding.

Subtrochanteric and Distal Femur Fractures in a Patient with ...

African Journals Online (AJOL)

This study reports the surgical management for this rare case and the treatment ... car accident and presented closed femoral shaft fracture associated with a ... to fix the distal femur fracture, enhancing the construction stability [Figures 4 and 5].

The use of 18F-fluoride and 18F-FDG PET scans to assess fracture healing in a rat femur model

Science.gov (United States)

Hsu, W. K.; Feeley, B. T.; Krenek, L.; Stout, D. B.; Chatziioannou, A. F.; Lieberman, J. R.

2011-01-01

Purpose Currently available diagnostic techniques can be unreliable in the diagnosis of delayed fracture healing in certain clinical situations, which can lead to increased complication rates and costs to the health care system. This study sought to determine the utility of positron emission tomography (PET) scanning with 18F-fluoride ion, which localizes in regions of high osteoblastic activity, and 18F-fluorodeoxyglucose (FDG), an indicator of cellular glucose metabolism, in assessing bone healing in a rat femur fracture model. Methods Fractures were created in the femurs of immuno-competent rats. Animals in group I had a fracture produced via a manual three-point bending technique. Group II animals underwent a femoral osteotomy with placement of a 2-mm silastic spacer at the fracture site. Fracture healing was assessed with plain radiographs, 18F-fluoride, and 18F-FDG PET scans at 1, 2, 3, and 4-week time points after surgery. Femoral specimens were harvested for histologic analysis and manual testing of torsional and bending strength 4 weeks after surgery. Results All fractures in group I revealed abundant callus formation and bone healing, while none of the nonunion femurs were healed via assessment with manual palpation, radiographic, and histologic evaluation at the 4-week time point. 18F-fluoride PET images of group I femurs at successive 1-week intervals revealed progressively increased signal uptake at the union site during fracture repair. In contrast, minimal tracer uptake was seen at the fracture sites in group II at all time points after surgery. Data analysis revealed statistically significant differences in mean signal intensity between groups I and II at each weekly interval. No significant differences between the two groups were seen using 18F-FDG PET imaging at any time point. Conclusion This study suggests that 18F-fluoride PET imaging, which is an indicator of osteoblastic activity in vivo, can identify fracture nonunions at an early time point

Usefullness of three-dimensional templating software to quantify the contact state between implant and femur in total hip arthroplasty.

Science.gov (United States)

Inoue, Daisuke; Kabata, Tamon; Maeda, Toru; Kajino, Yoshitomo; Fujita, Kenji; Hasegawa, Kazuhiro; Yamamoto, Takashi; Takagi, Tomoharu; Ohmori, Takaaki; Tsuchiya, Hiroyuki

2015-12-01

It would be ideal if surgeons could precisely confirm whether the planned femoral component achieves the best fit and fill of implant and femur. However, the cortico-cancellous interfaces can be difficult to standardize using plain radiography, and therefore, determining the contact state is a subjective decision by the examiner. Few reports have described the use of CT-based three-dimensional templating software to quantify the contact state of stem and femur in detail. The purpose of this study was to use three-dimensional templating software to quantify the implant-femur contact state and develop a technique to analyze the initial fixation pattern of a cementless femoral stem. We conducted a retrospective review of 55 hips in 53 patients using a short proximal fit-and-fill anatomical stem (APS Natural-Hip™ System). All femurs were examined by density mapping which can visualize and digitize the contact state. We evaluated the contact state of implant and femur by using density mapping. The varus group (cases that had changed varus 2° by 3 months after surgery) consisted of 11 hips. The varus group showed no significant difference with regard to cortical contact in the proximal medial portion (Gruen 7), but the contact area in the distal portion (Gruen 3 and Gruen 5) was significantly lower than that of non-varus group. Density mapping showed that the stem only has to be press-fit to the medial calcar, but also must fill the distal portion of the implant in order to achieve the ideal contact state. Our results indicated that quantifying the contact state of implant and femur by using density mapping is a useful technique to accurately analyze the fixation pattern of a cementless femoral stem.

[Individual difference of coronal bowing of femur and its influence on the lower limbs alignment after the total knee arthroplasty].

Science.gov (United States)

Wu, W; Guo, W S; Cheng, L M; Liu, Z H; Zhang, Q D; Zhang, N F

2017-04-04

Objective: To disclose the correlation between the femur bowing angle(FBA) and vulgas correction angle(VCA), anlysys its influence on the total knee arthroplasty and the lower limbs alignment. Methods: From Janurary 2013 to December 2015, 699 patients who had received total knee arthroplasty(TKA)were collected in the Department of Joint Surgery, China-Japan Friendship. The FBA, VCA, offset of the proximal femur, the lengh of the femur, the neck shaft angle of the femur of the eligible cases from the long leg X-ray were measured.All the data were analysed for the following steps: the FBA's mean value and characteristics of distributation of all the cases; the VCA's mean value and characteristics of distributation of all the cases; correlations between the VCA and the other parameters; divide all the cases into four groups based on the value of FBA : group A(FBA3°, 236)and then plan to cut the distal femur with 5° and 6°, respectively. The percent of ideal alignmental outcome's percentage of every group were compared. Results: The mean Value of the FBA is -7.1--12.1(1.4±2.4)°; the mean Value of the VCA is 2.5--11.9(6.5±1.3)°. The correlation index between VCA and FBA, the neck shaft angle of the femur , offset of the hip joint, the lengh of the femur is 0.72, -0.26, 0.45 and -0.08, perspectively. The theoretical ideal alignment percentage of the 5 degree-valgus-bone cut and 6 degree-valgus-bone cut in every group is group A: 89.7% and 66.5%; group B: 93.7% and 95.7%; group C: 71.9% and 94.6%; group D: 21.2% and 50.8%, respectively. Conclusion: The cases whose femur bowing angles are outliers are common in daily medical practice, so the vulgas correction angles need be ajusted for its significant correlation with FBA. 5 degree-valgus-bone cut or 6 degree-valgus-bone cut could not get the ideal alignment some times.

Rare Event; Not Undergoing Surgical Treatment of Proximal Femur Fracture

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Mehmet Balik

2013-06-01

Full Text Available In concordance with the increase in elderly population, incidence of proximal femur fracture (PFF increases. In elderly people, decreased physical activity and bone density, and visual impairments increase the likelihood of falls and fracture of the long bones. Fractures in this population are most commonly due to low-energy traumas. These elderly patient commonly present with co-morbidities. Therefore the treatment of the fracture poses additional risks. Seventy-eight-years old male presents with inability to walk and pain on the right groin following a fall at home. Right intertrochanteric femur fracture was diagnosed. His medical history consisted of ischemic heart disease, hypertension and hypercholesterolemia. The patient was offered hospitalization for surgery, however the patient and his family declined the surgery.

Outcomes in closed reamed interlocking nail in fractures of shaft of femur

International Nuclear Information System (INIS)

Mohammad, T.; Sawati, A.; Ahmed, A.

2015-01-01

Femoral shaft fracture is one of the common fractures seen in accident and emergency department of our hospital. Violent forces are required to break this and strongest of human bones. There are various treatment modalities for femoral shaft fractures in adults like traction, brace, platting, intramedullary nail (IMN), external fixators and inter locking nails. The study was done with an objective to evaluate the results of closed reamed interlocking nail in fractures of shaft of femur. Methods: A prospective study of 114 cases of femoral shaft fractures was carried out at orthopaedic unit of Ayub Teaching Hospital Abbottabad during 1 year. All these cases were treated with statically locked nails under spinal or general anaesthesia. These cases were followed up for up to one year and Results of the interlocking nail were observed in terms of union and complications. Results: Out of 114 patients, 95 underwent union in 90-150 days with a mean of 110.68 days. Ten patients had dynamization within six weeks because of obvious fracture gap in radiograph. There were 3 patients who had non-union, and 6 patients had delayed union which was treated with dynamization. Conclusion: Close reamed interlocking intramedullary nail in femoral shaft fractures is the treatment of choice. Patient rehabilitation is early, hospitalization is short, and fracture healing response is good. (author)

Bone mineral density of lumbar spine and femur in acromegaly. Knochendichte an Lendenwirbelsaeule und Femur bei Akromegalie

Energy Technology Data Exchange (ETDEWEB)

Huebsch, P. (Ludwig-Boltzmann-Institut fuer Radiologisch-Physikalische Tumordiagnostik, Vienna (Austria)); Kotzmann, H. (Universitaetsklinik fuer Innere Medizin 3, Vienna (Austria)); Svoboda, T. (Universitaetsklinik fuer Innere Medizin 3, Vienna (Austria)); Kainberger, F.M. (Ludwig-Boltzmann-Institut fuer Radiologisch-Physikalische Tumordiagnostik, Vienna (Austria)); Bankier, A. (Ludwig-Boltzmann-Institut fuer Radiologisch-Physikalische Tumordiagnostik, Vienna (Austria)); Seidl, G. (Ludwig-Boltzmann-Institut fuer Radiologisch-Physikalische Tumordiagnostik, Vienna (Austria))

1993-08-01

Acromegaly is regarded as a cause for secondary osteoporosis, whereas recent papers suggest that growth hormone increases bone mineral density (BMD). In 16 patients with active acromegaly we found an increased BMD compared to normal controls in the lumbar spine and the proximal femur by means of dual energy X-ray absoptiometry. This increase in BMD was statistically significant in the femoral neck and in Ward's triangle (P=0.05). Moreover, no signs of osteoporosis were found radiologically. (orig.)

Magnetic resonance perfusion and diffusion imaging characteristics of transient bone marrow edema, avascular necrosis and subchondral insufficiency fractures of the proximal femur

Energy Technology Data Exchange (ETDEWEB)

Mueller, Dirk, E-mail: d.mueller@uk-koeln.de [Department of Radiology, University of Cologne (Germany); Department of Radiology, Technische Universität München (Germany); Schaeffeler, Christoph, E-mail: schaeffeler@me.com [Department of Radiology, Cantonal Hospital Graubuenden, Chur (Switzerland); Department of Radiology, Cantonal Hospital Graubuenden, Chur (Switzerland); Baum, Thomas, E-mail: thomas-baum@gmx.de [Department of Radiology, Technische Universität München (Germany); Walter, Flavia, E-mail: flavia_walter2000@yahoo.de [Department of Radiology, Technische Universität München (Germany); Rechl, Hans, E-mail: rechl@tum.de [Department of Orthopaedics, Technische Universität München (Germany); Rummeny, Ernst J., E-mail: rummeny@tum.de [Department of Radiology, Technische Universität München (Germany); Woertler, Klaus, E-mail: klaus.woertler@tum.de [Department of Radiology, Technische Universität München (Germany)

2014-10-15

Highlights: • DCE-MRI may add information to the pathophysiology of bone marrow edema (BME) of the proximal femur. • Patients with transient bone marrow edema (TBME) or subchondral insufficiency fractures (SIF) and avascular osteonecrosis (AVN) showed different MR perfusion patterns. • Perfusion characteristics suggest different pathophysiology for AVN compared with TBME or SIF. • Diffusion weighted imaging (DWI) was not able to discriminate necrotic from edematous bone marrow. • DWI is of limited value to evaluate BME of the proximal femur. - Abstract: Purpose: To evaluate magnetic resonance (MR) perfusion and diffusion imaging characteristics in patients with transient bone marrow edema (TBME), avascular necrosis (AVN), or subchondral insufficiency fractures (SIF) of the proximal femur. Materials and methods: 29 patients with painful hip and bone marrow edema pattern of the proximal femur on non-contrast MR imaging were examined using diffusion-weighted and dynamic gadolinium-enhanced sequences. Apparent diffusion coefficients (ADCs) and perfusion parameters were calculated for different regions of the proximal femur. Regional distribution and differences in ADC values and perfusion parameters were evaluated. Results: Seven patients presented with TBME, 15 with AVN and seven with SIF of the proximal femur. Perfusion imaging showed significant differences for maximum enhancement values (E{sub max}), slope (E{sub slope}) and time to peak (TTP) between the three patient groups (p < 0.05). In contrast, no significant differences for ADC values were calculated when comparing TBME, AVN, and SIF patients. Conclusion: Diffusion weighted imaging of bone marrow of the proximal femur did not show significant differences between patients with TBME, AVN or SIF. In contrast, MR perfusion imaging demonstrated significant differences for the different patient groups and may as a complementary imaging technique add information to the understanding of the pathophysiology

Magnetic resonance perfusion and diffusion imaging characteristics of transient bone marrow edema, avascular necrosis and subchondral insufficiency fractures of the proximal femur

International Nuclear Information System (INIS)

Mueller, Dirk; Schaeffeler, Christoph; Baum, Thomas; Walter, Flavia; Rechl, Hans; Rummeny, Ernst J.; Woertler, Klaus

2014-01-01

Highlights: • DCE-MRI may add information to the pathophysiology of bone marrow edema (BME) of the proximal femur. • Patients with transient bone marrow edema (TBME) or subchondral insufficiency fractures (SIF) and avascular osteonecrosis (AVN) showed different MR perfusion patterns. • Perfusion characteristics suggest different pathophysiology for AVN compared with TBME or SIF. • Diffusion weighted imaging (DWI) was not able to discriminate necrotic from edematous bone marrow. • DWI is of limited value to evaluate BME of the proximal femur. - Abstract: Purpose: To evaluate magnetic resonance (MR) perfusion and diffusion imaging characteristics in patients with transient bone marrow edema (TBME), avascular necrosis (AVN), or subchondral insufficiency fractures (SIF) of the proximal femur. Materials and methods: 29 patients with painful hip and bone marrow edema pattern of the proximal femur on non-contrast MR imaging were examined using diffusion-weighted and dynamic gadolinium-enhanced sequences. Apparent diffusion coefficients (ADCs) and perfusion parameters were calculated for different regions of the proximal femur. Regional distribution and differences in ADC values and perfusion parameters were evaluated. Results: Seven patients presented with TBME, 15 with AVN and seven with SIF of the proximal femur. Perfusion imaging showed significant differences for maximum enhancement values (E max ), slope (E slope ) and time to peak (TTP) between the three patient groups (p < 0.05). In contrast, no significant differences for ADC values were calculated when comparing TBME, AVN, and SIF patients. Conclusion: Diffusion weighted imaging of bone marrow of the proximal femur did not show significant differences between patients with TBME, AVN or SIF. In contrast, MR perfusion imaging demonstrated significant differences for the different patient groups and may as a complementary imaging technique add information to the understanding of the pathophysiology of

Mathematical modeling of deformation of reinforced femur during prolonged static loads

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Vladimir P. Radchenko

2015-12-01

Full Text Available A two-layer mathematical model of a human femur neck reinforced implants of different design for modeling stress-strain state which occurs during a surgical procedure to prevent femur neck fractures by the forced introduction of metallic implants is proposed. Engineered implant designs are provided. Methods and software for geometric modeling of femur embedded with the implants are developed. New boundary value problems to evaluate kinetics in creep conditions of the stress-strain state of reinforced and non-reinforced femoral neck during prolonged static loads corresponding to human foot traffic are formulated. Effective elastic properties of cortical and cancellous bone, power and kinematic boundary value problems. A phenomenological creep model for compact bone tissue is constructed. The technique of identifying the parameters is developed. A check of its adequacy to experimental data is carried out. Based on the finite element method the numerical method for solving the provided boundary value problems at macro level of continuum mechanics is developed. A lot of variative calculations allowed developing recommendations for the rational positioning of the implant in order to minimize stress concentrations. The performed analysis showed that there is a significant relaxation of stresses in the most loaded areas due to creep. Relaxation is more intense in reinforced femoral neck than in the unreinforced. Thus the tension in the most loaded femoral neck area due to creep is reduced by 49 % with respect to the intensity of the initial time of loading for femur which is reinforced by the spoke-spoke-type implant when loading duration is 1 year under natural loads corresponding to human foot traffic. It was found that the time component (long-term fixed load does not impair the positive effect of reducing the stress concentration due to a femoral neck reinforcement which is a positive fact from the medical practice point of view.

Early x-ray diagnosis of coxarthrosis

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Lingg, G.; Nebel, G.

Radiological and pathological comparisons on specimen of femur head and neck at autopsy have shown a statistical relationship between osteophytosis of the femoral head and ulcerations of the joint cartilage. Especially, there are highly significant relationships between the length of osteophytes and the diameter of the ulcera. The 'plaque'-sign is shown to be a very sensitive indicator of early arthrosis. So there exist semiquantitative parameters for the X-ray diagnosis of early coxarthrosis.

Primary non-Hodgkin lymphoma of the right femur and subsequent metastasis to the left femur: A case report and literature review.

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Hu, Jing-Yu; Yu, Dan; Wu, Yao-Hui

2018-04-01

Non-Hodgkin lymphoma of the bone is rare and typically causes an extensive bone lesion. The present study describes a case of diffuse large B-cell primary non-Hodgkin lymphoma of the bone, which occurred in the right femur, and was initially treated with surgery and chemotherapy. Following a 7-year period of complete remission, a new, similar lesion was identified in the left femur. With both lesions, there was no accompanying destruction of any other bones or organ involvement. Metastasis of PLB to the contralateral side is extremely rare and, to the best of our knowledge, this is the first report of this particular presentation in China or worldwide. We hypothesized that the present situation arose due to mechanisms involving the tumor microenvironment, circulating tumor cells, lymphocyte homing and self-seeding. The present report describes the case in detail, and discusses the possible underlying mechanisms and their potential contribution to the treatment of non-Hodgkin lymphoma, as well as the prevention of metastasis and recurrence, which may be of considerable clinical significance.

Femur morphometry, densitometry, geometry and mechanical properties in young pigs fed a diet free of inorganic phosphorus and supplemented with phytase.

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Skiba, Grzegorz; Sobol, Monika; Raj, Stanisława

2017-02-01

The study investigated in piglets the effect of replacing dietary inorganic P by addition of microbial phytase and its impact on performance, nutrient digestibility and on the geometrical characteristics and mineralisation of the femur. Sixteen pigs on day 58 of age were divided into two groups and fed either a diet free of additional inorganic phosphorus (P) and supplemented with phytase (Diet LP, 4.23 g total P/kg diet) or a diet with a mineral source of P and not supplemented with phytase (Diet SP, 5.38 g total P/kg diet). Performance data and the apparent total tract digestibility of nutrients were estimated between days 58 and 114, and 72 and 86 of age, respectively. On day 114 of age, the pigs were slaughtered, the femur was dissected and the mineral content and mineral density, maximum strength and maximum elastic strength, cortical wall thickness, cross-sectional area and cortical index were analysed. The growth performance and digestibility of nutrient fractions (with exception of P) did not differ between treatment groups. The P-digestibility was significantly higher in Group LP. The femur of pigs in Group LP had significantly greater cortical wall thickness, cortical index, bone mineral content, bone mineral density, maximum strength and maximum elastic strength than Group SP. Femur maximum strength and maximum elastic strength were correlated with cortical wall thickness and cortical index. Resulting from the different supply of digestible P, the femur geometrical, densitometric and mechanical properties of Group LP were better than those of Group SP. The mechanical properties of the femur of pigs depended more on its geometrical characteristics than on the degree of its mineralisation.

Ipsilateral Fracture Shaft Femur with Neglected Dislocation of Prosthesis: A Case Report

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Mantu Jain

2013-10-01

Full Text Available Introduction: Neglected hip dislocation is rare in today’s world and after prosthesis replacement even rarer finding. However such patients may not report to surgeons until they develop secondary complications. Management of such patient’s is a challenge to the treating surgeon and need to be tailored suiting to patient’s demands, expectations and constraints of financial resources. We did not find a similar case in the electronic and print media and therefore report this case which was innovatively managed. Case Report: A 60 year farmer presented with fracture shaft femur and ipsilateral dislocation prosthesis of right hip. He had a hemiarthroplasty done for fracture neck of femur in the past but used to walk with a lurch since he started to ambulate after discharge. However he was satisfied despite “some problems” which had caused shortening of his limb. The patient was informed of the various treatment options and their possible complications. He expressed his inability to afford a Total Hip Arthroplasty (THA at any stage and consented for other options discussed with him. The patient was positioned supine and adductor tenotomy done. Next he was positioned laterally and the fracture was fixed with heavy duty broad dynamic compression plate and screws. The wound was temporarily closed. Now through the previous scar via posterior approach the hip was exposed. The prosthesis was found to be firmly fixed to the proximal femur. The acetabulum was cleared with fibrous tissue. All attempts the prosthesis to relocate the prosthesis failed after several attempts and it was best decided to leave alone. Post operatively period was uneventful. At follow up he refused for any further manoeuvre in future inform of heavy traction and attempts to reduce the same. At one year when he was walking unaided and his X-rays showed that fracture had well united his SF-36 score was PCS – 49.6 and MCS – 51.9. Conclusion: Ipsilateral shaft femur fracture

The shifting trajectory of growth in femur length during gestation.

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Bjørnerem, Ashild; Johnsen, Synnøve L; Nguyen, Tuan V; Kiserud, Torvid; Seeman, Ego

2010-05-01

Bone size is a determinant of bone strength and tracks in its percentile of origin during childhood and adolescence. We hypothesized that the ranking of an individual's femur length (FL) is established in early gestation and tracks thereafter. Fetal FL was measured serially using 2D ultrasound in 625 Norwegian fetuses. Tracking was assessed using Pearson correlation, a generalized estimating equation model, and by calculating the proportion of fetuses whose FL remained within the same quartile. Baseline FL Z-score (weeks 10 to 19) and later measurements correlated, but more weakly as gestation advanced: r = 0.59 (weeks 20 to 26); r = 0.45 (weeks 27 to 33); and r = 0.32 (weeks 34 to 39) (p baseline FL Z-score, placental weight (150 g), maternal height (5 cm), and weight (10 kg), was associated with a 0.25, 0.15, 0.10, and 0.05 SD higher FL Z-score at the end of gestation, respectively (p ranging from <0.001 to 0.02). Tracking within the same percentile throughout the whole of gestation, as suggest by growth charts, is uncommon. Deviation from tracking is more common and is the result of changes in growth velocity within and between fetuses and is partly influenced by maternal, fetal, and placental factors. (c) 2010 American Society for Bone and Mineral Research.

Early medical skull surgery for treatment of post-traumatic osteomyelitis 5,000 years ago.

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Pierpaolo Petrone

Full Text Available Here we describe the findings of a unique example of the early techniques adopted in neurosurgery around 5000 years ago, consisting in a double well healed skull trephination associated with a post-cranial traumatic event occurring intra vitam to a young male from the Early Chalcolithic cemetery of Pontecagnano (South Italy, ca. 4,900 - 4,500 cal BP. Morphological, X-ray and 3D-CT scan skull-cap evaluation revealed that the main orifice was produced by scraping, obtained by clockwise rotary motion of a right-handed surgeon facing the patient, while the partial trephination was carried out by using a stone point as a drilling tool. In both cases, bone regrowth is indicative of the individual's prolonged postoperative survival and his near-complete recovery. The right femur shows a poorly healed mid-shaft fracture presumably induced by a high energy injury, and a resulting chronic osteomyelitis, affecting both femurs by hematogenous spread of the infection. Our observations on the visual and radiological features of skull and femur lesions, along with evidence on the timing of experimental bone regrowth vs. healing of lower limb fractures associated to long-term bone infections now suggest that this young man underwent a double skull trephination in order to alleviate his extremely painful condition induced by chronic osteomyelitis, which is thought to have been the cause of death.

Age-predicted values for lumbar spine, proximal femur, and whole-body bone mineral density: results from a population of normal children aged 3 to 18 years

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Webber, C.E. [Hamilton Health Sciences, Dept. of Nuclear Medicine, Hamilton, Ontario (Canada); McMaster Univ., Dept. of Radiology, Hamilton, Ontario (Canada)]. E-mail: webber@hhsc.ca; Beaumont, L.F. [Hamilton Health Sciences, Dept. of Nuclear Medicine, Hamilton, Ontario (Canada); Morrison, J. [McMaster Children' s Hospital, Hamilton, Ontario (Canada); Sala, A. [McMaster Children' s Hospital, Hamilton, Ontario (Canada); McMaster Univ., Dept. of Pediatrics, Hamilton, Ontario (Canada); Univ. of Milan-Bicocca, Monza (Italy); Barr, R.D. [McMaster Children' s Hospital, Hamilton, Ontario (Canada); McMaster Univ., Dept. of Pediatrics, Hamilton, Ontario (Canada)

2007-02-15

We measured areal bone mineral density (BMD) with dual-energy X-ray absorptiometry (DXA) at the lumbar spine and the proximal femur and for the total body in 179 subjects (91 girls and 88 boys) with no known disorders that might affect calcium metabolism. Results are also reported for lumbar spine bone mineral content (BMC) and for the derived variable, bone mineral apparent density (BMAD). Expected-for-age values for each variable were derived for boys and girls by using an expression that represented the sum of a steady increase due to growth plus a rapid increase associated with puberty. Normal ranges were derived by assuming that at least 95% of children would be included within 1.96 population standard deviations (SD) of the expected-for-age value. The normal range for lumbar spine BMD derived from our population of children was compared with previously published normal ranges based on results obtained from different bone densitometers in diverse geographic locations. The extent of agreement between the various normal ranges indicates that the derived expressions can be used for reporting routine spine, femur, and whole-body BMD measurements in children and adolescents. The greatest difference in expected-for-age values among the various studies was that arising from intermanufacturer variability. The application of published conversion factors derived from DXA measurements in adults did not account fully for these differences, especially in younger children. (author)

Age-predicted values for lumbar spine, proximal femur, and whole-body bone mineral density: results from a population of normal children aged 3 to 18 years

International Nuclear Information System (INIS)

Webber, C.E.; Beaumont, L.F.; Morrison, J.; Sala, A.; Barr, R.D.

2007-01-01

We measured areal bone mineral density (BMD) with dual-energy X-ray absorptiometry (DXA) at the lumbar spine and the proximal femur and for the total body in 179 subjects (91 girls and 88 boys) with no known disorders that might affect calcium metabolism. Results are also reported for lumbar spine bone mineral content (BMC) and for the derived variable, bone mineral apparent density (BMAD). Expected-for-age values for each variable were derived for boys and girls by using an expression that represented the sum of a steady increase due to growth plus a rapid increase associated with puberty. Normal ranges were derived by assuming that at least 95% of children would be included within 1.96 population standard deviations (SD) of the expected-for-age value. The normal range for lumbar spine BMD derived from our population of children was compared with previously published normal ranges based on results obtained from different bone densitometers in diverse geographic locations. The extent of agreement between the various normal ranges indicates that the derived expressions can be used for reporting routine spine, femur, and whole-body BMD measurements in children and adolescents. The greatest difference in expected-for-age values among the various studies was that arising from intermanufacturer variability. The application of published conversion factors derived from DXA measurements in adults did not account fully for these differences, especially in younger children. (author)

Forensic Applicability of Femur Subtrochanteric Shape to Ancestry Assessment in Thai and White American Males.

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Tallman, Sean D; Winburn, Allysha P

2015-09-01

Ancestry assessment from the postcranial skeleton presents a significant challenge to forensic anthropologists. However, metric dimensions of the femur subtrochanteric region are believed to distinguish between individuals of Asian and non-Asian descent. This study tests the discriminatory power of subtrochanteric shape using modern samples of 128 Thai and 77 White American males. Results indicate that the samples' platymeric index distributions are significantly different (p≤0.001), with the Thai platymeric index range generally lower and the White American range generally higher. While the application of ancestry assessment methods developed from Native American subtrochanteric data results in low correct classification rates for the Thai sample (50.8-57.8%), adapting these methods to the current samples leads to better classification. The Thai data may be more useful in forensic analysis than previously published subtrochanteric data derived from Native American samples. Adapting methods to include appropriate geographic and contemporaneous populations increases the accuracy of femur subtrochanteric ancestry methods. © 2015 American Academy of Forensic Sciences.

Reconstruction of juxta-articular huge defects of distal femur with vascularized fibular bone graft and Ilizarov's distraction osteogenesis.

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Lai, Davy; Chen, Chuan-Mu; Chiu, Fang-Yao; Chang, Ming-Chau; Chen, Tain-Hsiung

2007-01-01

We evaluate the effect of reconstructing huge defects (mean, 15.8 cm) of the distal femur with Ilizarov's distraction osteogenesis and free twin-barreled vascularized fibular bone graft (TVFG). We retrospectively reviewed a consecutive series of five patients who had cases of distal femoral fractures with huge defects and infection that were treated by the Ilizarov's distraction osteogenesis. After radical debridement, two of the five cases had free TVFG and monolocal distraction osteogenesis, and another two cases had multilocal distraction osteogenesis with knee fusion because of loss of the joint congruity. The other case with floating knee injury had bilocal distraction osteogenesis and a preserved knee joint. The mean defect of distal femur was 15.8 cm (range, 14-18 cm) in length. The mean length of distraction osteogenesis by Ilizarov's apparatus was 8.2 cm. The mean length of TVFG was 8 cm. The average duration from application of Ilizarov's apparatus to achievement of bony union was 10.2 months (range, 8-13 months). At the end of the follow-up, ranges of motion of three knees were 0 to 45 degrees, 0 to 60 degrees, and 0 to 90 degrees. Two cases had knee arthrodesis with bony fusion because of loss of the joint congruity. There were no leg length discrepancies in all five patients. In addition, three patients had pin tract infections and one case had a 10 degree varus deformity of the femur. Juxta-articular huge defect (>10 cm) of distal femur remains a challenge to orthopedic surgeons. Ilizarov's technique provides the capability to maintain stability, eradicate infection, restore leg length, and to perform adjuvant reconstructive procedure easily. In this study, we found that combining Ilizarov's distraction osteogenesis with TVFG results in improved patient outcome for patients with injuries such as supracondylar or intercondylar infected fractures or nonunion of distal femur with huge bone defect.

Bone Parameters and Risk of Hip and Femur Fractures in Patients on Hemodialysis

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Hazzan, Azzour D.; Jhaveri, Kenar D.; Ma, Lin; Lacson, Eduardo

2016-01-01

Background and objectives Patients on hemodialysis have a high rate of hip fractures. In this study, we performed a contemporary analysis of mineral and bone parameters and their relationship to hip and femur fracture risk. Design, setting, participants, & measurements Patients on hemodialysis treated between 2000 and 2013 in Fresenius Medical Care North America facilities were included. Predictors were on the basis of data as of December 31 of each baseline year and time-averaged values of selected laboratory parameters and medication doses throughout the year. Four period cohorts were constructed from baseline years: 2000, 2003, 2006, and 2009. Follow-up for each cohort was ≤3 years. Results The incidence of hip and femur fractures remained generally unchanged (P=0.40), except among patients who were white and >65 years of age, in whom the rate decreased significantly over the 14-year period (P<0.01). Results from combined multivariable models indicated that the lowest quartiles of time–averaged intact parathyroid hormone were independently associated with higher hip fracture risk (intact parathyroid hormone =181–272 pg/ml: hazard ratio, 1.20; 95% confidence interval [95% CI], 1.03 to 1.41 and intact parathyroid hormone <181 pg/ml: hazard ratio, 1.20; 95% CI, 1.01 to 1.44; referent third quartile, 273 to <433 pg/ml). The lowest quartile of time–averaged serum calcium was also associated with higher risk (calcium <8.7 mg/dl; hazard ratio, 1.17; 95% CI, 1.00 to 1.37) compared with the referent third quartile of 9.1 to <9.5 mg/dl. Conclusions We found an association between lower levels of intact parathyroid hormone and serum calcium and greater risk for hip and femur fractures among patients on hemodialysis. These findings support additional research toward elucidating long-term safety of treatment approaches for hyperparathyroidism in patients with ESRD. PMID:27026521

Finite element analysis of functionally graded bone plate at femur bone fracture site

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Satapathy, Pravat Kumar; Sahoo, Bamadev; Panda, L. N.; Das, S.

2018-03-01

This paper focuses on the analysis of fractured Femur bone with functionally graded bone plate. The Femur bone is modeled by using the data from the CT (Computerized Tomography) scan and the material properties are assigned using Mimics software. The fracture fixation plate used here is composed of Functionally Graded Material (FGM). The functionally graded bone plate is considered to be composed of different layers of homogeneous materials. Finite element method approach is adopted for analysis. The volume fraction of the material is calculated by considering its variation along the thickness direction (z) according to a power law and the effective properties of the homogeneous layers are estimated. The model developed is validated by comparing numerical results available in the literature. Static analysis has been performed for the bone plate system by considering both axial compressive load and torsional load. The investigation shows that by introducing FG bone plate instead of titanium, the stress at the fracture site increases by 63 percentage and the deformation decreases by 15 percentage, especially when torsional load is taken into consideration. The present model yields better results in comparison with the commercially available bone plates.

TH-EF-207A-06: High-Resolution Optical-CT/ECT Imaging of Unstained Mice Femur, Brain, Spleen, and Tumor

International Nuclear Information System (INIS)

Yoon, S; Dewhirst, M; Oldham, M; Boss, M; Birer, S

2016-01-01

Purpose: Optical transmission and emission computed tomography (optical-CT/ECT) provides high-resolution 3D attenuation and emission maps in unsectioned large (∼1cm 3 ) ex vivo tissue samples at a resolution of 12.9µm 3 per voxel. Here we apply optical-CT/ECT to investigate high-resolution structure and auto-fluorescence in a range of optically cleared mice organs, including, for the first time, mouse bone (femur), opening the potential for study of bone metastasis and bone-mediated immune response. Methods: Three BALBc mice containing 4T1 flank tumors were sacrificed to obtain spleen, brain, tumor, and femur. Tissues were washed in 4% PFA, fixed in EtOH solution (for 5, 10, 10, and 2 days respectively), and then optically cleared for 3 days in BABBs. The femur was also placed in 0.25M aqueous EDTA for 15–30 days to remove calcium. Optical-CT/ECT attenuation and emission maps at 633nm (the latter using 530nm excitation light) were obtained for all samples. Bi-telecentric optical-CT was compared side-by-side with conventional optical projection tomography (OPT) imaging to evaluate imaging capability of these two rival techniques. Results: Auto-fluorescence mapping of femurs reveals vasculatures and fluorescence heterogeneity. High signals (A.U.=10) are reported in the medullary cavity but not in the cortical bone (A.U.=1). The brain strongly and uniform auto-fluoresces (A.U.=5). Thick, optically dense organs such as the spleen and the tumor (0.12, 0.46OD/mm) are reconstructed at depth without significant loss of resolution, which we attribute to the bi-telecentric optics of optical-CT. The attenuation map of tumor reveals vasculature, attenuation heterogeneity, and possibly necrotic tissue. Conclusion: We demonstrate the feasibility of optical-CT/ECT imaging of un-sectioned mice bones (femurs) and spleen with high resolution. This result, and the characterization of unstained organs, are important steps enabling future studies involving optical-CT/ECT applied

Sex determination in femurs of modern Egyptians: A comparative study between metric measurements and SRY gene detection

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Iman F. Gaballah

2014-12-01

Conclusion: The SRY gene detection method for sex determination is quick and simple, requiring only one PCR reaction. It corroborates the results obtained from anatomical measurements and further confirms the sex of the femur bone in question.

Theoretical effects of fully ductile versus fully brittle behaviors of bone tissue on the strength of the human proximal femur and vertebral body.

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Nawathe, Shashank; Yang, Haisheng; Fields, Aaron J; Bouxsein, Mary L; Keaveny, Tony M

2015-05-01

The influence of the ductility of bone tissue on whole-bone strength represents a fundamental issue of multi-scale biomechanics. To gain insight, we performed a computational study of 16 human proximal femurs and 12 T9 vertebral bodies, comparing the whole-bone strength for the two hypothetical bounding cases of fully brittle versus fully ductile tissue-level failure behaviors, all other factors, including tissue-level elastic modulus and yield stress, held fixed. For each bone, a finite element model was generated (60-82 μm element size; up to 120 million elements) and was virtually loaded in habitual (stance for femur, compression for vertebra) and non-habitual (sideways fall, only for femur) loading modes. Using a geometrically and materially non-linear model, the tissue was assumed to be either fully brittle or fully ductile. We found that, under habitual loading, changing the tissue behavior from fully ductile to fully brittle reduced whole-bone strength by 38.3±2.4% (mean±SD) and 39.4±1.9% for the femur and vertebra, respectively (p=0.39 for site difference). These reductions were remarkably uniform across bones, but (for the femur) were greater for non-habitual (57.1±4.7%) than habitual loading (pductile cases. These theoretical results suggest that the whole-bone strength of the proximal femur and vertebra can vary substantially between fully brittle and fully ductile tissue-level behaviors, an effect that is relatively insensitive to bone morphology but greater for non-habitual loading. Copyright © 2015 Elsevier Ltd. All rights reserved.

Anthropometric Measurements of the Human Distal Femur: A Study of the Adult Malay Population

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Fitdriyah Hussain

2013-01-01

Full Text Available The distal femurs of 100 subjects (50 men, 50 women from the Malay population aged between 19 and 38 years were scanned to measure the anterior-posterior (AP and medial-lateral (ML width. The mean AP values were 64.02 ± 3.38 mm and 57.33 ± 3.26 mm for men and women, respectively, and the mean ML values were 74.91 ± 3.52 mm and 64.53 ± 3.07 mm. We compared our data to that published previously for the Chinese and Indian populations. It was found that the Malay population had smaller distal femur than that of the Chinese but was larger than that of the Indian population (P < 0.05. In conclusion, although it is well established that Asians have a smaller distal femur size than that of the Western population, the variations in different Asian ethnicities may need to be considered when designing the appropriate knee implant.

Anthropometric measurements of the human distal femur: a study of the adult Malay population.

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Hussain, Fitdriyah; Abdul Kadir, Mohammed Rafiq; Zulkifly, Ahmad Hafiz; Sa'at, Azlin; Aziz, Azian Abd; Hossain, Golam; Kamarul, T; Syahrom, Ardiyansyah

2013-01-01

The distal femurs of 100 subjects (50 men, 50 women) from the Malay population aged between 19 and 38 years were scanned to measure the anterior-posterior (AP) and medial-lateral (ML) width. The mean AP values were 64.02 ± 3.38 mm and 57.33 ± 3.26 mm for men and women, respectively, and the mean ML values were 74.91 ± 3.52 mm and 64.53 ± 3.07 mm. We compared our data to that published previously for the Chinese and Indian populations. It was found that the Malay population had smaller distal femur than that of the Chinese but was larger than that of the Indian population (P < 0.05). In conclusion, although it is well established that Asians have a smaller distal femur size than that of the Western population, the variations in different Asian ethnicities may need to be considered when designing the appropriate knee implant.

Osteoporosis or Low Bone Mass at the Femur Neck or Lumbar Spine in Older Adults: United States, 2005-2008

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... Osteoporosis or Low Bone Mass at the Femur Neck or Lumbar Spine in Older Adults: United States, ... on bone mineral density at either the femur neck or lumbar spine? Nine percent of persons aged ...

Periosteal osteoblastoma of the distal femur

Energy Technology Data Exchange (ETDEWEB)

Nakatani, Tetsuya; Yamamoto, Tetsuji; Akisue, Toshihiro; Marui, Takashi; Hitora, Toshiaki; Kawamoto, Teruya; Nagira, Keiko; Yoshiya, Shinichi; Kurosaka, Masahiro [Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe (Japan); Fujita, Ikuo; Matsumoto, Keiji [Department of Orthopaedic Surgery, Hyogo Medical Center for Adults, Akashi, Hyogo (Japan)

2004-02-01

Osteoblastomas located on the surface of the cortical bone, so-called periosteal osteoblastomas, are extremely rare. We report on a case of periosteal osteoblastoma arising from the posterior surface of the right distal femur in a 17-year-old man. Roentgenographic, computed tomographic, magnetic resonance imaging, and histologic features of the case are presented. Periosteal osteoblastoma should be radiologically and histologically differentiated from myositis ossificans, avulsive cortical irregularity syndrome, osteoid osteoma, parosteal osteosarcoma, periosteal osteosarcoma, and high-grade surface osteosarcoma. Although periosteal osteoblastoma is rare, this tumor should be included in the differential diagnosis of surface-type bone tumors. (orig.)

Effects of administration of four different doses of Escherichia coli phytase on femur properties of 16-week-old turkeys.

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Tatara, Marcin R; Krupski, Witold; Kozłowski, Krzysztof; Drażbo, Aleksandra; Jankowski, Jan

2015-03-18

The enzyme phytase is able to initiate the release of phosphates from phytic acid, making it available for absorption within gastrointestinal tract and following utilization. The aim of the study was to determine effects of Escherichia coli phytase administration on morphological, densitometric and mechanical properties of femur in 16-week-old turkeys. One-day-old BUT Big-6 males were assigned to six weight-matched groups. Turkeys receiving diet with standard phosphorus (P) and calcium (Ca) content belonged to the positive control group (Group I). Negative control group (Group II) consisted of birds fed diet with lowered P and Ca content. Turkeys belonging to the remaining groups have received the same diet as group II but enriched with graded levels of Escherichia coli phytase: 125 (Group III), 250 (Group IV), 500 (Group V) and 1000 (Group VI) FTU/kg. At the age of 112 days of life, the final body weights were determined and the turkeys were sacrificed to obtain right femur for analyses. Geometric and densitometric properties of femur were determined using quantitative computed tomography (QCT) technique, while mechanical evaluation was performed in three-point bending test. Phytase administration increased cross-sectional area, second moment of inertia, mean relative wall thickness, cortical bone mineral density and maximum elastic strength decreasing cortical bone area of femur (P phytase administration on geometric, densitometric and mechanical properties of femur were observed in turkeys receiving 125 and 250 FTU/kg of the diet. Phytase administration at the dosages of 500 and 1000 FTU/kg of the diet improved the final body weight in turkeys. The results obtained in this study indicate a possible practical application of Escherichia coli phytase in turkey feeding to improve skeletal system properties and function.

Biomechanical Evaluations of Hip Fracture Using Finite Element Model that Models Individual Differences of Femur

OpenAIRE

田中, 英一; TANAKA, Eiichi; 山本, 創太; YAMAMOTO, Sota; 坂本, 誠二; SAKAMOTO, Seiji; 中西, 孝文; NAKANISHI, Takafumi; 原田, 敦; HARADA, Atsushi; 水野, 雅士; MIZUNO, Masashi

2004-01-01

This paper is concerned with an individual finite element modeling system for femur and biomechanical evaluations of the influences of loading conditions, bone shape and bone density on risks of hip fracture. Firstly, a method to construct an individual finite element model by morphological parameters that represent femoral shapes was developed. Using the models with different shapes constructed by this method, the effects of fall direction, posture of upper body, femur shape and bone density...

Flexible Intramedullary Nailing for Paediatric Shaft of Femur Fractures – Does the Number of Nails Alter the Outcome?

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B Kanthimathi

2011-07-01

Full Text Available BACKGROUND: The use of flexible intramedullary nailing, allowing micro movement at the fracture site, results in excellent outcomes regardless of the number of nails used. We undertook analysis of the outcomes of flexible nailing with reference to the number of nails used. METHODS: Twenty patients with diaphyseal femur fracture aged 5-15 years were treated with retrograde flexible intramedullary nailing. The number of nails varied from single to multiple. The results were analysed with regard to the number of nails used. RESULTS: The mean patient age was 7.9 years; patients were followed up for a mean duration of 13.2 months. Those with two and three nails had similar results. CONCLUSION: A minimum of two flexible nails is needed for optimal fixation in paediatric femur shaft fractures. Also, limiting the number of implants to two is cost effective, decreases operative time, reduces radiation exposure and offers equal results to that of three nails.

Use of a statistical model of the whole femur in a large scale, multi-model study of femoral neck fracture risk.

Science.gov (United States)

Bryan, Rebecca; Nair, Prasanth B; Taylor, Mark

2009-09-18

Interpatient variability is often overlooked in orthopaedic computational studies due to the substantial challenges involved in sourcing and generating large numbers of bone models. A statistical model of the whole femur incorporating both geometric and material property variation was developed as a potential solution to this problem. The statistical model was constructed using principal component analysis, applied to 21 individual computer tomography scans. To test the ability of the statistical model to generate realistic, unique, finite element (FE) femur models it was used as a source of 1000 femurs to drive a study on femoral neck fracture risk. The study simulated the impact of an oblique fall to the side, a scenario known to account for a large proportion of hip fractures in the elderly and have a lower fracture load than alternative loading approaches. FE model generation, application of subject specific loading and boundary conditions, FE processing and post processing of the solutions were completed automatically. The generated models were within the bounds of the training data used to create the statistical model with a high mesh quality, able to be used directly by the FE solver without remeshing. The results indicated that 28 of the 1000 femurs were at highest risk of fracture. Closer analysis revealed the percentage of cortical bone in the proximal femur to be a crucial differentiator between the failed and non-failed groups. The likely fracture location was indicated to be intertrochantic. Comparison to previous computational, clinical and experimental work revealed support for these findings.

Unstable intertrochanteric femur fractures in geriatric patients treated with the DLT trochanteric nail.

Science.gov (United States)

Temiz, Aytun; Durak, Aslihan; Atici, Teoman

2015-07-01

To evaluate clinical-functional and radiological results of geriatric patients with unstable intertrochanteric femur fracture treated with intramedullary nail. Thirty-two patients treated with intramedullary nail (DLT trochanteric nail) due to unstable intertrochanteric femur fractures were reviewed retrospectively. Fractures 31-A2 and 31-A3 (AO classification) were evaluated. Operation time, blood loss, and blood transfusion requirements, hospitalization period, time to fracture union were evaluated and perioperative and postoperative complications were recorded. According to the modified Baumgaertner criteria fracture reduction was analyzed radiologically, and nail tip-apex distance was measured. Femoral neck-shaft angle was also evaluated. Harris Hip Score for clinical evaluation and Kyo criteria for walking capacity were used. The mean age was 72 years (65-81), mean follow up time was 18.3 months (12-26). Nineteen patients had type 31-A2 and 13 had type 31-A3 fractures. Mean operation time was 36.3min (25-45), blood loss 185.9ml (100-250). Blood transfusion was required in 7 patients. The average hospitalization duration was 6 days (4-14) while the time to surgery from admission was 2.9 days (2-6). Radiologically, in 21 of the cases fracture reduction was well (65.6%), acceptable in 9 (28.1%), and poor in 2 (6.3%). In early postoperative period, the mean collo-diaphyseal angle was 129.1° (120-140°), mean tip-apex distance was 15.5mm (10-27). The mean Harris Hip Score was 63.4 (38-90). Two patients (6.3%) had excellent, 21 patients (65.6%) had good, 7 patients (21.8%) had moderate, and 2 patients (6.3%) had poor results. Walking capacity in the last follow-up in 20 of the cases (62.5%) was pre-fracture level. While complications were observed in seventeen patients (53.1%) (5 superficial wound infections, 5 fractures of the greater trochanter, 3 cases of secondary varus angulation and 4 cases of heterotopic ossification) none of them required additional surgery

[Finite element analysis of lumbar pelvic and proximal femur model with simulate lumbar rotatory manipulation].

Science.gov (United States)

Hu, Hua; Xiong, Chang-Yuan; Han, Guo-Wu

2012-07-01

To study the changes of displacement and stress in the model of lumbar pelvic and proximal femur during lumbar rotatory manipulation. The date of lumbar pelvic and proximal femur CT scan by Mimics 10.01 software was established a lumbar pelvic and proximal femur geometric model, then the model was modified with Geomagic 9, at last the modified model was imported into hypermesh 10 and meshed with tetrahedron, at the same time,add disc and ligaments. According to the principle of lumbar rotatory manipulation,the lumbar rotatory manipulation were decomposed. The mechanical parameters assigned into the three-dimensional finite element model. The changes of displacement and stress in the model of lunbar pelvic and proximal femur under the four conditions were calculated with Abaqus model of Hypermesh 10. 1) Under the same condition,the displacement order of lumbar was L1>L2>L3>L5 L5, anterior column > middle column > posterior column. 2) Under the different conditions, the displacement order of lumbar,case 3>case 1>case 4>case 2. 3) Under the same conditions, the displacement order of lumbar inter-vertebral disc from L1,2 to L5S1 was L1,2>L2,3>L3,4>L4,5>L5S1, as for the same inter-vertebral disc, the order was: second quadrant>third quadrant>first quadrant>fourth quadrant. 4) Under the different conditions,the displacement order of the inter-vertebral disc was L1,2>L2,3>L3,4>L4,5>L5S1, but to same inter-vertebral disc: case 3>case 4>case 1 >case 2. 5) There were apparent displacement and stress concentration in pelvis and hip during the manipulation. 1) The principles of lumbar rotation manipulation closely related to the relative displacement caused by rotation of various parts of lumbar pelvic and proximal femur model; 2) During the process of lumbar rotatory manipulation, the angle of lateral bending and flexion can not be randomly increased; 3) During the process of lumbar rotatory manipulation, all the conditions of lumbar pelvic and proximal femur must be

[Antero-medial incision of knee joint for the treatment of intercondylar fracture of femur].

Science.gov (United States)

Yin, Zi-Fei; Sun, Bin-Feng; Yang, Xiao-Hai; Wang, Qing; Qian, Ping-Kang; Wu, Xiao-Feng; Xu, Feng

2017-12-25

To explore the clinical effect of antero-medial incision of knee joint in treating intercondylar fracture of femur. From September 2012 to March 2015, 24 patients with intercondylar fracture of femur were selected, including 17 males and 7 females, aged from 20 to 65 years old with an average of(38.3±9.5) years old. Among them, 12 cases were caused by traffic accident, 8 cases were caused by falling injury and 4 cases were caused by falling down. All patients were closed fractures. The time from injury to hospital was from 30 min to 8 h with an average of(2.2±0.3) h. According to AO classification, 4 cases were type B1, 3 type B2, 2 type B3, 5 type C1, 6 type C2 and 4 type C3. All patients were treated with antero-medial incision of knee joint. Operative time, blood loss and postoperative complications were observed and recovery of keen function was evaluated by Kolmert scoring. All patients were followed-up from 6 to 12 months with average of (9.0±1.7) months. Operative time ranged from 50 to 90 min with an average of (70.0±8.2) min; blood loss ranged from 90 to 400 ml with an average of (180±36) ml; negative pressure flow was from 30 to 90 ml, with an average of (50.0±7.1) ml. All fracture were healed at stage I without loosening of internal fixator, fracture nonunion, and deep vein thrombosis. According to Kolmert scoring, 16 patients got excellent result, 5 patients good and 3 fair. Antero-medial incision of knee joint in treating intercondylar fracture of femur, which has advantages of good fracture reduction, less injury of soft tissue and simple operation, could obtain good clinical results.

Effects of ethanol consumption and alcohol detoxification on the biomechanics and morphology the bone in rat femurs.

Science.gov (United States)

Garcia, J A D; Souza, A L T; Cruz, L H C; Marques, P P; Camilli, J A; Nakagaki, W R; Esteves, A; Rossi-Junior, W C; Fernandes, G J M; Guerra, F D; Soares, E A

2015-11-01

The objective of this study was to verify the effects of ethanol consumption and alcohol detoxification on the biomechanics, area and thickness of cortical and trabecular bone in rat femur. This was an experimental study in which 18 male Wistar rats were used, with 40 days of age, weighing 179 ± 2.5 g. The rats were divided into three groups (n=06): CT (control), AC (chronic alcoholic), DT (detoxification). After experimental procedures, the animals were euthanized by an overdose of the anesthetic and their femurs were collected for mechanical testing and histological processing. All animals did not present malnutrition or dehydration during experimentation period. Morphometric analysis of cortical and trabecular bones in rat femurs demonstrated that AC animals showed inferior dimensions and alcohol detoxification (DT) allowed an enhancement in area and thickness of cortical and trabecular bone. Material and structural properties data of AC group highlighted the harmful effects of ethanol on bone mechanical properties. The results of this study demonstrated that chronic alcoholic rats (AC) presented major bone damage in all analyzed variables. Those findings suggested that alcohol detoxification is highly suggested in pre-operative planning and this corroborates to the success of bone surgery and bone tissue repair. Thanks to the financial support offered by PROBIC - UNIFENAS.

Effects of ethanol consumption and alcohol detoxification on the biomechanics and morphology the bone in rat femurs

Directory of Open Access Journals (Sweden)

J. A. D. Garcia

Full Text Available Abstract The objective of this study was to verify the effects of ethanol consumption and alcohol detoxification on the biomechanics, area and thickness of cortical and trabecular bone in rat femur. This was an experimental study in which 18 male Wistar rats were used, with 40 days of age, weighing 179±2.5 g. The rats were divided into three groups (n=06: CT (control, AC (chronic alcoholic, DT (detoxification. After experimental procedures, the animals were euthanized by an overdose of the anesthetic and their femurs were collected for mechanical testing and histological processing. All animals did not present malnutrition or dehydration during experimentation period. Morphometric analysis of cortical and trabecular bones in rat femurs demonstrated that AC animals showed inferior dimensions and alcohol detoxification (DT allowed an enhancement in area and thickness of cortical and trabecular bone. Material and structural properties data of AC group highlighted the harmful effects of ethanol on bone mechanical properties. The results of this study demonstrated that chronic alcoholic rats (AC presented major bone damage in all analyzed variables. Those findings suggested that alcohol detoxification is highly suggested in pre-operative planning and this corroborates to the success of bone surgery and bone tissue repair. Thanks to the financial support offered by PROBIC – UNIFENAS.

Rehabilitation after proximal femur surgery in the elderly

OpenAIRE

Holečková, Kristýna

2017-01-01

of thesis This thesis deals with physiotherapy after proximal femur surgery in elderly people. The aim of the thesis is to show the particularities of physiotherapy for elderly people and to determine the influence of nutritional status on the progress and outcome of physiotherapy. The thesis is divided into theoretical and practical part. The theoretical part is focused on old age period, and changes associated with aging, geriatric physiotherapy and its components, namely classical physioth...

Subtrochanteric Femur Fractures in an Irish Trauma Centre over 9 years: How the Impact of Hospital Coding on Diagnosis of Subtrochanteric Femur Fractures Leads to Inaccurate Occurrence Rates

LENUS (Irish Health Repository)

Coveney, EI

2018-06-01

Our aim was to assess the occurrence rates of subtrochanteric femur fractures in an orthopaedic tertiary referral centre and to assess the correlation of patient’s actual diagnosis with national hospital inpatient enquiry data.

Ununited fracture neck of femur treated with closed reduction and internal fixation with cancellous screw and fibular strut graft

Directory of Open Access Journals (Sweden)

Singh Daria

2006-01-01

Full Text Available Background: Ununited fracture neck of femur in young adults has been tackled in various ways. Methods: Twenty five patients of ununited fracture neck of femur in age group 21-55 years were treated by closed reduction, cancellous screw fixation and fibular strut graft and followed up for 2-6 years. Time gap between injury and operation was 6 weeks to 58 weeks. Five cases were previously fixed with various fixation devices. Results: Osseous union was achieved in 24 cases with average time of 18.16 weeks. Main complication encountered in follow-up was avascular necrosis of femoral head, others were joint stiffness and shortening. Functional end results were good to excellent in 24 cases. Conclusion: Closed reduction with internal fixation by cancellous screw and fibular strut grafting is easy and useful procedure.

Body mass index as a prognostic factor for fracturing of the proximal extremity of the femur: a case-control study,

Directory of Open Access Journals (Sweden)

Renato Cavanus Pagani

2014-10-01

Full Text Available Objectives:To compare the body mass index (BMI of patients with fractures in the proximal extremity of the femur with the BMI of patients without any previous history of fractures.Methods:We investigated patients of both sexes, aged 65 years or over, who were admitted to Hospital Independência, Hospital Beneficência Portuguesa or ULBRA University Hospital, between December 2007 and December 2010, with histories of low-energy trauma such as falling from a standingposition. These individuals were compared with patients of the same age but without any history of fracturing of the proximal extremity of the femur (n = 89, who were attended at the geriatrics outpatient clinic of the Sociedade Porto-Alegrense de Auxílio aos Necessitados (SPAAN.Results:The age group of the patients with fractures in the proximal extremity of the femur ranged from 65 to 96 years (mean: 77.58. The main type of fracture was trochanteric (47; 62.2%, followed by femoral neck fractures (27; 36%. Among the patients who presented on fracturing the proximal extremity of the femur, 12% had low weight, 62.7% normal weight, 24% overweight, and 1.3% obesity. Among the patients without any history of fractures, 5.6% presented low weight, 43.8% normal weight, 33.7% overweight, and 9.8% obesity. It was observed that the patients with fractures in the proximal extremity of the femur (n = 75 presented a mean BMI of 22.6, while the patients without fractures presented a mean BMI of 25.5.Conclusion:The patients in the group with fractures were significantly taller than those in the group without fractures and presented significantly lower BMI than those in the group without fractures.

Steroid Induced Bilateral Avascular Necrosis of Head of Femur in an Adult Male Patient - A Case Report.

Science.gov (United States)

Jadeja, Dharamvirsinh; Solanki, Vipul; Chavada, Bhavesh; Tripathi, Chandrabhanu

2016-01-01

A 28 year old male patient, known case of pemphigus vulgaris was on dexamethasone pulse therapy. Total 7 pulses were given after that he developed avascular necrosis of head of femur on both sides, which was confirmed by digital X- ray and MRI. Avascular necrosis is a disabling and progressive condition in young patients gradually leads to femoral head collapse and eventual total hip arthroplasty. As per WHO-UMC causality assessment criteria, the association between reaction and drug was possible, Naranjo's score was 7. According to Modified Schumock and Thornton's criteria, this reaction was not preventable. The Modified Hartwig and Siegel's scale showed that the reaction was severe (level 6). Here we present a case where the use of steroid for pemphigus vulgaris resulting in the development of bilateral avascular necrosis of head of femur.

Transplantation of human neonatal foreskin stromal cells in ex vivo organotypic cultures of embryonic chick femurs

DEFF Research Database (Denmark)

Aldahmash, Abdullah; Vishnubalaji, Radhakrishnan

2017-01-01

NSSCs in ex vivo organotypic cultures of embryonic chick femurs. Isolated embryonic chick femurs (E10 and E11) were cultured for 10 days together with micro-mass cell pellets of hNSSCs, human umbilical vein endothelial cells (HUVEC) or a combination of the two cell types. Changes in femurs gross morphology......We have previously reported that human neonatal foreskin stromal cells (hNSSCs) promote angiogenesis in vitro and in chick embryo chorioallantoic membrane (CAM) assay in vivo. To examine the in vivo relevance of this observation, we examined in the present study the differentiation potential of h......NSSC + HUVEC cultures. Our data suggest that organotypic cultures can be employed to test the differentiation potential of stem cells and demonstrate the importance of stem cell interaction with 3D-intact tissue microenvironment for their differentiation....

COMPARISON OF UNIPOLAR (MOORE’S PROSTHESIS AND BIPOLAR HEMIARTHROPLASTY IN FRACTURE NECK OF FEMUR IN THE ELDERLY- A SHORT-TERM PROSPECTIVE STUDY

Directory of Open Access Journals (Sweden)

Mahendra Bendale

2016-11-01

Full Text Available BACKGROUND Femoral neck fractures are common in postmenopausal elderly females as a result of osteoporosis due to trivial trauma or in the young due to high energy trauma. The goal of the surgeon is to return the patient to his/her prefracture functional status. Femoral neck fracture could be impacted and undisplaced or displaced. Femoral neck fractures are also considered “fractures of necessity”, best treated surgically irrespective of displacement. Surgery permits early patient mobilisation and minimises the complications of prolonged recumbence. The bipolar prosthesis has advantage over the unipolar in having two bearings for the movements to occur. This study intends to compare the functional outcome of unipolar Moore’s hemi-replacement and fixed bipolar replacement in elderly patients with fracture neck of femur. In this scenario, the null hypothesis would be that there is no significant difference in the results between the patients treated with Moore’s prosthesis and those treated with bipolar prosthesis. The aim of the study is to compare the results of unipolar and bipolar hemi-arthroplasty for fracture neck of femur in the elderly patients. MATERIALS AND METHODS 30 elderly postmenopausal women with fracture neck femur were included in the study. They were divided into 2 groups and were operated upon by using unipolar and bipolar implants respectively after thorough investigation. The functional outcome was assessed using the Harris Hip Score (HHS. RESULTS Femoral neck fractures belonged to 53.3% with type III fracture and 46.7 had type IV fractures. Fifteen patients had replacement with Austin Moore prosthesis and fifteen patients with bipolar prosthesis. The average HHS at 6 weeks for unipolar and bipolar groups was 65.2 and 66.0, respectively. The average HHS at 12 months for unipolar and bipolar group was 81.0 and 83.6, respectively. 19 (65.5% patients had good HHS at the end of one year. Corrected chi-square value is 2

Retrograde nailing for distal femur fractures in the elderly

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Giddie Jasdeep

2015-01-01

Full Text Available Introduction: We report the results of treating a series of 56 fractures in 54 elderly patients with a distal femur fracture with a retrograde femoral nail. Methods: Fifty-four of the nails were inserted percutaneously with a closed reduction. After surgery all patients were allowed to weight bear as tolerated. Four fractures were supported in a temporary external splint. Results: The mean age of patients was 80.6 years (range 51–103 years, 52/54 (96% were females. There were no cases of nail related complications and no re-operations were required. One patient was lost to follow up. The 30-day mortality was 5/54 (9.3% and the one year mortality was 17/54 (31.5%. Conclusions: Distal femoral nail fixation provides a good method of fixation allowing immediate mobilisation for this group of patients.

The chondrogenic response to exercise in the proximal femur of normal and mdx mice

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Nye David J

2010-09-01

Full Text Available Abstract Background Submaximal exercise is used in the management of muscular dystrophy. The effects of mechanical stimulation on skeletal development are well understood, although its effects on cartilage growth have yet to be investigated in the dystrophic condition. The objective of this study was to investigate the chondrogenic response to voluntary exercise in dystrophin-deficient mice. Methods Control and dystrophin-deficient (mdx mice were divided into sedentary and exercise-treated groups and tested for chondral histomorphometric differences at the proximal femur. Results Control mice ran 7 km/week further than mdx mice on average, but this difference was not statistically significant (P > 0.05. However, exercised control mice exhibited significantly enlarged femur head diameter, articular cartilage thickness, articular cartilage tissue area, and area of calcified cartilage relative to sedentary controls and exercised mdx mice (P Conclusions Mdx mice exhibit a reduced chondrogenic response to increased mechanical stimulation relative to controls. However, no significant reduction in articular dimensions was found, indicating loss of chondral tissue may not be a clinical concern with dystrophinopathy.

A MULTIDISCIPLINARY APPROACH IN THE TREATMENT OF FRACTURES OF THE PROXIMAL FEMUR ON THE BACKGROUND OF SENILE OSTEOPOROSIS

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N. V. Zagorodniy

2016-01-01

Full Text Available The article presents a review of published data on the problem of osteoporosis in patients older than 75 years who have had fractures of the proximal femur. We used descriptive and analytical methods. Search publications have done in accessible to free search databases. Based on our analysis, it was found: the majority of researchers in Russia and abroad are united in the opinion that this issue requires a multidisciplinary approach; surgical treatment should be initiated as early as possible after the onset of fracture, before the complications from side of the internal organs; patients with fractures on the background of senile osteoporosis should receive drugs that affect to the quantitative and qualitative components of bone.

Metallographic examination of a failed Jewett nail-plate from a human femur

International Nuclear Information System (INIS)

Gray, R.J.; Zirkel, L.G. Jr.

1976-01-01

A type 316L wrought stainless steel Jewett nail-plate is one of several implant designs for bridging fractures in the proximal end of the femur. A soldier received a high velocity projectile in the trochanteric region of the femur. He was treated for a subtrochanteric fracture and greater trochanteric bone loss. After 9 months, hip varus angulation was progressively increasing. A Jewett nail-plate was inserted after valgus osteotomy and bone grafting of the unhealed fracture. The nail-plate fractured three weeks after surgery. Optical and scanning electron microscopy related the origin of failure to an impactor failure and subsequent microscopic scoring of the nail-plate during insertion into the abnormally hard femoral head. Photomicrographs showing the implant failure and evidences of corrosion after the short time in the body are presented. 12 figs

Histomorphometry and cortical robusticity of the adult human femur.

Science.gov (United States)

Miszkiewicz, Justyna Jolanta; Mahoney, Patrick

2018-01-13

Recent quantitative analyses of human bone microanatomy, as well as theoretical models that propose bone microstructure and gross anatomical associations, have started to reveal insights into biological links that may facilitate remodeling processes. However, relationships between bone size and the underlying cortical bone histology remain largely unexplored. The goal of this study is to determine the extent to which static indicators of bone remodeling and vascularity, measured using histomorphometric techniques, relate to femoral midshaft cortical width and robusticity. Using previously published and new quantitative data from 450 adult human male (n = 233) and female (n = 217) femora, we determine if these aspects of femoral size relate to bone microanatomy. Scaling relationships are explored and interpreted within the context of tissue form and function. Analyses revealed that the area and diameter of Haversian canals and secondary osteons, and densities of secondary osteons and osteocyte lacunae from the sub-periosteal region of the posterior midshaft femur cortex were significantly, but not consistently, associated with femoral size. Cortical width and bone robusticity were correlated with osteocyte lacunae density and scaled with positive allometry. Diameter and area of osteons and Haversian canals decreased as the width of cortex and bone robusticity increased, revealing a negative allometric relationship. These results indicate that microscopic products of cortical bone remodeling and vascularity are linked to femur size. Allometric relationships between more robust human femora with thicker cortical bone and histological products of bone remodeling correspond with principles of bone functional adaptation. Future studies may benefit from exploring scaling relationships between bone histomorphometric data and measurements of bone macrostructure.

Insights into the effects of tensile and compressive loadings on human femur bone.

Science.gov (United States)

Havaldar, Raviraj; Pilli, S C; Putti, B B

2014-01-01

Fragile fractures are most likely manifestations of fatigue damage that develop under repetitive loading conditions. Numerous microcracks disperse throughout the bone with the tensile and compressive loads. In this study, tensile and compressive load tests are performed on specimens of both the genders within 19 to 83 years of age and the failure strength is estimated. Fifty five human femur cortical samples are tested. They are divided into various age groups ranging from 19-83 years. Mechanical tests are performed on an Instron 3366 universal testing machine, according to American Society for Testing and Materials International (ASTM) standards. The results show that stress induced in the bone tissue depends on age and gender. It is observed that both tensile and compression strengths reduces as age advances. Compressive strength is more than tensile strength in both the genders. The compression and tensile strength of human femur cortical bone is estimated for both male and female subjecting in the age group of 19-83 years. The fracture toughness increases till 35 years in male and 30 years in female and reduces there after. Mechanical properties of bone are age and gender dependent.

operative treatment of primary bone tumours of the femur and the tibia

African Journals Online (AJOL)

can cause infection, pseudoarthrosis and pathological fracture. Objective: The purpose of ... after several re-surgeries. Key words: Bone tumour, Femur, Tibia, Resection, Allograft .... stress, the length of the graft, the realization of an arthrodesis ...

Measurements of bone mineral density of the proximal femur by two commercially available dual energy X-ray absorptiometric systems

International Nuclear Information System (INIS)

Svendsen, O.L.; Marslew, U.; Hassager, C.; Christiansen, C.

1992-01-01

Two dual energy X-ray absorptiometric (DXA) instruments have recently become commercially available for local bone densitometry: the QDR-1000 (Hologic Inc.) and the DPX (Lunar Radiation Corp.). We report the precision, influence of femoral, rotation, correlation and agreement of bone mineral measurements of the proximal fermur by these two instruments. In vitro (femur phantom) short-term precision was 1.1%-3.5%, and the long-term precision was 1.2%-3.8%. In vivo (groups of 10 premenopausal and 10 postmenopausal women) short-term precision of duplicate measurements was 1.6%-4.7%, and long-term precision was 1.9%-5.5%. Overall, the precision for Ward's triangle was over 3% and that for the femoral neck and trochanter, 2%-3%. Rotation of the femur phantom produced a statistically significant change in the bone mineral density (BMD) of the femoral neck. Within a clinically relevant range of femoral rotation (20deg inward rotation ±5deg) the coefficient of variation (CV%) increased by a mean factor of 1.1-1.4. Although the correlation (r<0.9) between BMD measurements of the proximal femur by the DPX and QDR-1000 in 30 postmenopausal women was high, there was lack of agreement between the two instruments. We found no statistically significant differences between the right and left femur in 30 postmenopausal women. A bilateral femur scan took a mean total time of about 22 min. We conclude that with the introduction of DXA instruments, the precision of bone mineral measurments of the proximal femur has improved. However, for comparability between commercially available DXA instruments, it might be advantageous if units were standardized. (orig.)

The use of 18F-fluoride and 18F-FDG PET scans to assess fracture healing in a rat femur model

International Nuclear Information System (INIS)

Hsu, W.K.; Feeley, B.T.; Krenek, L.; Stout, D.B.; Chatziioannou, A.F.; Lieberman, J.R.

2007-01-01

Currently available diagnostic techniques can be unreliable in the diagnosis of delayed fracture healing in certain clinical situations, which can lead to increased complication rates and costs to the health care system. This study sought to determine the utility of positron emission tomography (PET) scanning with 18 F-fluoride ion, which localizes in regions of high osteoblastic activity, and 18 F-fluorodeoxyglucose (FDG), an indicator of cellular glucose metabolism, in assessing bone healing in a rat femur fracture model. Fractures were created in the femurs of immunocompetent rats. Animals in group I had a fracture produced via a manual three-point bending technique. Group II animals underwent a femoral osteotomy with placement of a 2-mm silastic spacer at the fracture site. Fracture healing was assessed with plain radiographs, 18 F-fluoride, and 18 F-FDG PET scans at 1, 2, 3, and 4-week time points after surgery. Femoral specimens were harvested for histologic analysis and manual testing of torsional and bending strength 4 weeks after surgery. All fractures in group I revealed abundant callus formation and bone healing, while none of the nonunion femurs were healed via assessment with manual palpation, radiographic, and histologic evaluation at the 4-week time point. 18 F-fluoride PET images of group I femurs at successive 1-week intervals revealed progressively increased signal uptake at the union site during fracture repair. In contrast, minimal tracer uptake was seen at the fracture sites in group II at all time points after surgery. Data analysis revealed statistically significant differences in mean signal intensity between groups I and II at each weekly interval. No significant differences between the two groups were seen using 18 F-FDG PET imaging at any time point. This study suggests that 18 F-fluoride PET imaging, which is an indicator of osteoblastic activity in vivo, can identify fracture nonunions at an early time point and may have a role in the

Fully automatic segmentation of femurs with medullary canal definition in high and in low resolution CT scans.

Science.gov (United States)

Almeida, Diogo F; Ruben, Rui B; Folgado, João; Fernandes, Paulo R; Audenaert, Emmanuel; Verhegghe, Benedict; De Beule, Matthieu

2016-12-01

Femur segmentation can be an important tool in orthopedic surgical planning. However, in order to overcome the need of an experienced user with extensive knowledge on the techniques, segmentation should be fully automatic. In this paper a new fully automatic femur segmentation method for CT images is presented. This method is also able to define automatically the medullary canal and performs well even in low resolution CT scans. Fully automatic femoral segmentation was performed adapting a template mesh of the femoral volume to medical images. In order to achieve this, an adaptation of the active shape model (ASM) technique based on the statistical shape model (SSM) and local appearance model (LAM) of the femur with a novel initialization method was used, to drive the template mesh deformation in order to fit the in-image femoral shape in a time effective approach. With the proposed method a 98% convergence rate was achieved. For high resolution CT images group the average error is less than 1mm. For the low resolution image group the results are also accurate and the average error is less than 1.5mm. The proposed segmentation pipeline is accurate, robust and completely user free. The method is robust to patient orientation, image artifacts and poorly defined edges. The results excelled even in CT images with a significant slice thickness, i.e., above 5mm. Medullary canal segmentation increases the geometric information that can be used in orthopedic surgical planning or in finite element analysis. Copyright © 2016 IPEM. Published by Elsevier Ltd. All rights reserved.

A comparison of more and less aggressive bone debridement protocols for the treatment of open supracondylar femur fractures.

Science.gov (United States)

Ricci, William M; Collinge, Cory; Streubel, Philipp N; McAndrew, Christopher M; Gardner, Michael J

2013-12-01

This study compared results of aggressive and nonaggressive debridement protocols for the treatment of high-energy, open supracondylar femur fractures after the primary procedure, with respect to the requirement for secondary bone grafting procedures, and deep infection. Retrospective review. Level I and level II trauma centers. Twenty-nine consecutive patients with high-grade, open (Gustilo types II and III) supracondylar femur fractures (OTA/AO 33A and C) treated with debridement and locked plating. Surgeons at 2 different level I trauma centers had different debridement protocols for open supracondylar femur fractures. One center used a more aggressive (MA) protocol in their patients (n = 17) that included removal of all devitalized bone and placement of antibiotic cement spacers to fill large segmental defects. The other center used a less aggressive (LA) protocol in their patients (n = 12) that included debridement of grossly contaminated bone with retention of other bone fragments and no use of antibiotic cement spacers. All other aspects of the treatment protocol at the 2 centers were similar: definitive fixation with locked plates in all cases, IV antibiotics were used until definitive wound closure, and weight bearing was advanced upon clinical and radiographic evidence of fracture healing. Healing after the primary procedure, requirement for secondary bone grafting procedures, and the presence of deep infection. Demographics were similar between included patients at each center with regard to age, gender, rate of open fractures, open fracture classification, mechanism, and smoking (P > 0.05). Patients at the MA center were more often diabetic (P debridement (35% vs. 0%, P debridement (71% vs. 8%, P debridement (92% vs. 35%, P debrided after a high-energy, high-grade, open supracondylar femur fracture is a matter of surgeon judgment and falls along a continuous spectrum. Based on the results of the current study, the theoretic trade-off between infection

[Simultaneous existence of unicameral bone cysts involving the femur and ischium].

Science.gov (United States)

Makris, Vassilios; Papavasiliou, Kyriakos A; Bobos, Mattheos; Hytiroglou, Prodromos; Kirkos, John M; Kapetanos, George A

2009-01-01

We report a 30-year-old male patient with two unicameral bone cysts (UBC) simultaneously located in the proximal third of the right femur and ipsilateral ischium ramus, respectively. Fine needle biopsies were attempted for both lesions. Biopsy of the femoral lesion under local anesthesia was unsuccessful, so an open biopsy was performed which confirmed the diagnosis of UBC. Biopsy of the ischial lesion was not sufficient for diagnosis. Cytological examination of both specimens showed no other benign or malignant pathology. The femoral lesion was treated with intralesional (due to its large size) excision-curettage, bone grafting, and the introduction of a long gamma locking intramedullary nail to prevent the occurrence of a pathological fracture. The ischial lesion was left untreated and followed conservatively. The patient was free of any symptoms and complications three years postoperatively. This is the first report of an adult patient with UBCs simultaneously located both in a long tubular bone (femur) and a flat bone (ischium ramus).

Radiographic anatomy of the proximal femur: femoral neck fracture vs. transtrochanteric fracture

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Ana Lecia Carneiro Leão de Araújo Lima

Full Text Available ABSTRACT OBJECTIVE: To evaluate the correlation between radiographic parameters of the proximal femur with femoral neck fractures or transtrochanteric fractures. METHODS: Cervicodiaphyseal angle (CDA, femoral neck width (FNW, hip axis length (HAL, and acetabular tear drop distance (ATD were analyzed in 30 pelvis anteroposterior view X-rays of patients with femoral neck fractures (n = 15 and transtrochanteric fractures (n = 15. The analysis was performed by comparing the results of the X-rays with femoral neck fractures and with transtrochanteric fractures. RESULTS: No statistically significant differences between samples were observed. CONCLUSION: There was no correlation between radiographic parameters evaluated and specific occurrence of femoral neck fractures or transtrochanteric fractures.

Three-dimensional microarchitecture of the proximal femur in osteoarthritis and rheumatoid arthritis

DEFF Research Database (Denmark)

Wang, B. L.; Ding, Ming; Overgaard, Søren

2015-01-01

microstructure has an important impact on bone quality. Recently, the quantification of bone architecture based on micro-CT has been widely used in the research of various bone diseases. OBJECTIVE: To observe the osteoarthritis- and rheumatoid arthritis-related changes in the properties of the proximal femur...... based on micro-CT, thus to compare the bone microstructure in osteoarthritis and rheumatoid arthritis patients. METHODS: Femoral heads were collected from primary osteoarthritis (n=10) and rheumatoid arthritis (n=7) patients undergoing total hip replacement. A 10-mm segment of the femoral neck was cut...... from each individual femur, perpendicular to the main trabecular direction on X-ray films. The specimens were analyzed by using micro-CT system. After scanning, the data were transferred to three-dimensional images, and then detailed structural parameters of the cortical bone, cancellous bone...

Interval hypoxic training in complex treatment of fractures of trochanteric area of the femur

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Василь Михайлович Шимон

2015-05-01

Full Text Available The method of interval hypoxic training (IHT is used to increase physical endurance of athletes and for treatment of certain systemic diseases, due to the ability of IHT affect metabolism, homeostasis and the immune system. The aims of the article are improving the results of treatment and rehabilitation of patients with fractures of the trochanteric area of the femur by the method of interval hypoxic training and study its influence on bone metabolism.Materials and methods. 17 patients who were hospitalized in the clinic of general surgery UzhNU with fractures of the trochanteric area of the femur are examined in the period from 2012 to 2015.The first group consisted of 6 patients who from day-patient treatment is conducted IHT by gas mixture of 12 % oxygen. The second group consisted of 4 patients with thyrotoxicosis who are also receiving IHT by gas mixture of 12% oxygen.The control group consisted of 7 patients with fractures of the trochanteric area of the femur who refused from IHT.Results and its discussion. The best physical activity is observed in the first group. Starting physical activity is the lowest in the second group, but its development is faster. Slowly increase the duration of physical activity compared with the first two groups is observed in the control group.In the control study after 1 month it is noted that calcium level increased in all three groups. Increase in the second group is biggest. The level of phosphorus decreased in the first and the control group and increased in the second group.The levels of osteocalcin and alkaline phosphatase increased. Rates were higher and increase was substantial in the first two groups in comparison with the control group.Conclusions.• Intensive growth of length of one-time physical activity most notably in patients with thyrotoxicosis is observed in patients who are receiving IHT.• Improvement of the activity of bone metabolism is observed in patients after IHT

Use of femur bone density to segregate wild from farmed Dybowski's frog (Rana dybowskii).

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Yang, Shu Hui; Huang, Xiao Ming; Xia, Rui; Xu, Yan Chun; Dahmer, Thomas D

2011-04-15

Wildlife has been utilized by humans throughout history and demand continues to grow today. Farming of wildlife can supplement the supply of wild-harvested wildlife products and, in theory, can reduce pressure on free-ranging populations. However, poached wildlife products frequently enter legal markets where they are fraudulently sold as farmed wildlife products. To effectively close this illegal trade in wild-captured wildlife, there is a need to discriminate wild products from farmed products. Because of the strong market demand for wild-captured frog meat and the resulting strong downward pressure on wild populations, we undertook research to develop a method to discriminate wild from farmed Dybowski's frog (Rana dybowskii) based on femur bone density. We measured femur bone density (D(f)) as the ratio of bone mass to bone volume. D(f) of wild frogs revealed a slightly increasing linear trend with increasing age (R(2)=0.214 in males and R(2)=0.111 in females, p=0.000). Wild males and wild females of age classes from 2 to ≥ 5 years had similar D(f) values. In contrast, 2-year-old farmed frogs showed significantly higher D(f) values (p=0.000) among males (mean D(f)=0.623 ± 0.011 g/ml, n=32) than females (mean D(f)=0.558 ± 0.011 g/ml, n=27). For both sexes, D(f) of wild frogs was significantly higher than that of farmed frogs (p=0.000). Among males, 87.5% (28 of 32 individuals) of farmed frogs were correctly identified as farmed frogs and 86.3% (69 of 80 individuals) of wild frogs were correctly identified as wild frogs. These results suggest that femur bone density is one reliable tool for discriminating between wild and farmed Dybowski's frog. This study also highlights a novel strategy with explicit forensic potential to discriminate wild from captive bred wildlife species. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Bone density of the radius, spine, and proximal femur in osteoporosis

International Nuclear Information System (INIS)

Mazess, R.B.; Barden, H.; Ettinger, M.; Schultz, E.

1988-01-01

Bone mineral density (BMD) was measured in 140 normal young women (aged 20 to 39 years) and in 423 consecutive women over age 40 referred for evaluation of osteoporosis. Lumbar spine and proximal femur BMD was measured using dual-photon absorptiometry ( 153 Gd), whereas the radius shaft measurement used single-photon absorptiometry ( 125 I). There were 324 older women with no fractures, of which 278 aged 60 to 80 years served as age-matched controls. There were 99 women with fractures including 32 with vertebral and 22 with hip fractures. Subsequently, another 25 women with hip fractures had BMD measured in another laboratory; their mean BMD was within 2% of that of the original series. The mean age in both the nonfracture and fracture groups was 70 +/- 5 years. The BMD in the age-matched controls was 20% to 25% below that of normal young women for the radius, spine, and femur, but the Ward's triangle region of the femur showed even greater loss (35%). The mean BMD at all sites in the crush fracture cases was about 10% to 15% below that of age-matched controls. Spinal abnormality was best discriminated by spine and femoral measurements (Z score about 0.9). In women with hip fractures, the BMD was 10% below that of age-matched controls for the radius and the spine, and the BMD for the femoral sites was about 25% to 30% below that of age-matched control (Z score about 1.6). Femoral densities gave the best discrimination of hip fracture cases and even reflected spinal osteopenia. In contrast, neither the spine nor the radius reflected the full extent of femoral osteopenia in hip fracture

A case of monostotic fibrous dysplasia of proximal femur managed with curettage and cortical bone grafting

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A D Sud

2013-01-01

Full Text Available We present a case report of a young military personnel with monostotic fibrous dysplasia of proximal femur with painful, dysplasticlesion of the femoral neck and fatigue fracture who underwent cortical bone grafting using autogenous fibular strut graft and iliac crest bone graft. The fibular cortical grafts was used to bridge the lesion in the femoral neck and were securely anchored to the normal bone of the lateral femoral cortex and a head of the femur. No supplemental internal fixation was required.

Indomethacin induced avascular necrosis of head of femur

Science.gov (United States)

Prathapkumar, K; Smith, I; Attara, G

2000-01-01

Chemically induced avascular necrosis of bone is a well documented entity. Indomethacin is one of the causes of this condition but is often difficult to recognise. Review of the literature shows that only one case of indomethacin induced avascular necrosis has been reported in the English language between 1966 and the present.
The case of a young healthy man, who developed avascular necrosis of head of femur after prolonged administration of indomethacin, is reported here.


Keywords: indomethacin; avascular necrosis PMID:10964124

Does Computer-Assisted Femur First THR Improve Musculoskeletal Loading Conditions?

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Tim A. Weber

2015-01-01

Full Text Available We have developed a novel, computer-assisted operation method for minimal-invasive total hip replacement (THR following the concept of “femur first/combined anteversion,” which incorporates various aspects of performing a functional optimization of the prosthetic stem and cup position (CAS FF. The purpose of this study is to assess whether the hip joint reaction forces and patient’s gait parameters are being improved by CAS FF in relation to conventional THR (CON. We enrolled 60 patients (28 CAS FF/32 CON and invited them for gait analysis at three time points (preoperatively, postop six months, and postop 12 months. Data retrieved from gait analysis was processed using patient-specific musculoskeletal models. The target parameters were hip reaction force magnitude (hrf, symmetries, and orientation with respect to the cup. Hrf in the CAS FF group were closer to a young healthy normal. Phase-shift symmetry showed an increase in the CAS FF group. Hrf orientation in the CAS FF group was closer to optimum, though no edge or rim-loading occurred in the CON group as well. The CAS FF group showed an improved hrf orientation in an early stage and a trend to an improved long-term outcome.

Systematic review of spica casting for the treatment of paediatric diaphyseal femur fractures.

Science.gov (United States)

Tisherman, R T; Hoellwarth, J S; Mendelson, S A

2018-04-01

Paediatric femur fractures are commonly encountered and often successfully managed with spica casting. Despite spica casting's long history there is little formal guidance for optimal outcomes and no consolidation of existing literature. The purpose of this study is to review the available literature regarding the use of spica casting for the management of paediatric diaphyseal femur fractures. The PubMed database was queried for all research articles including the phrase "spica". A total of 788 abstracts were reviewed for relevance to the current study. Data was extracted from all available research studies which specified tolerance for fracture angulation or shortening in the cast. Additionally, all articles describing alternative materials, methods for spica application, and complications of spica casting were reviewed. In all, 106 articles were found relevant to the management of diaphyseal femur fractures in the paediatric population. The aggregated, accepted fracture shortening decreased from 16 mm to 18 mm before age ten years to 12 mm to 14 mm after puberty. Aggregated, accepted angulation decreased from 14° to 16° varus/valgus and 18° to 22° pro/recurvatum before age two years, to 6° to 8° and 10° to 12° by puberty, respectively. The overall reported complication rate was 19.6%, with the most common complication being skin compromise in 8.2% of patients, followed by unacceptable angulation at the fracture site in 4.2% of patients and excessive limb shortening in 1.9% of patients. This article reviews the available spica casting literature and compiles the available data. Spica casting offers a safe, effective means for definitive management of paediatric diaphyseal femur fractures. Future research identifying the rate and pattern of remodelling as it relates to angulation and shortening at various patient ages, particularly beyond the aforementioned norms, would be valuable to identify true biological tolerances versus accepted expert opinion

Study of the variations of fall induced hip fracture risk between right and left femurs using CT-based FEA.

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Faisal, Tanvir R; Luo, Yunhua

2017-10-03

Hip fracture of elderly people-suffering from osteoporosis-is a severe public health concern, which can be reduced by providing a prior assessment of hip fracture risk. Image-based finite element analysis (FEA) has been considered an effective computational tool to assess the hip fracture risk. Considering the femoral neck region is the weakest, fracture risk indicators (FRI) are evaluated for both single-legged stance and sideways fall configurations and are compared between left and right femurs of each subject. Quantitative Computed Tomography (QCT) scan datasets of thirty anonymous patients' left and right femora have been considered for the FE models, which have been simulated with an equal magnitude of load applied to the aforementioned configurations. The requirement of bilateral hip assessment in predicting the fracture risk has been explored in this study. Comparing the sideways fall and single-legged stance, the FRI varies by 64 to 74% at the superior aspects and by 14 to 19% at the inferior surfaces of both the femora. The results of this in vivo analysis clearly substantiate that the fracture is expected to initiate at the superior surface of femoral neck region if a patient falls from his/her standing height. The distributions of FRI between the femurs vary considerably, and the variability is significant at the superior aspects. The p value (= 0.02) obtained from paired sample t-Test yields p value ≤ 0.05, which shows the evidence of variability of the FRI distribution between left and right femurs. Moreover, the comparison of FRIs between the left and right femur of men and women shows that women are more susceptible to hip fracture than men. The results and statistical variation clearly signify a need for bilateral hip scanning in predicting hip fracture risk, which is clinically conducted, at present, based on one hip chosen randomly and may lead to inaccurate fracture prediction. This study, although preliminary, may play a crucial role in

Comparative evaluation of femoral nerve block and intravenous fentanyl for positioning during spinal anaesthesia in surgery of femur fracture

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Ashok Jadon

2014-01-01

Full Text Available Background: Spinal anaesthesia is the preferred technique to fix fracture of the femur. Extreme pain does not allow ideal positioning for this procedure. Intravenous fentanyl and femoral nerve block are commonly used techniques to reduce the pain during position for spinal anaesthesia however; results are conflicting regarding superiority of femoral nerve block over intravenous fentanyl. Aims: We conducted this study to compare the analgesic effect provided by femoral nerve block (FNB and intra- venous (IV fentanyl prior to positioning for central neuraxial block in patients undergoing surgery for femur fracture. Patients and Methods: In this randomized prospective study 60 patients scheduled for fracture femur operation under spinal were included. Patients were distributed in two groups through computer generated random numbers table; Femoral nerve block group (FNB and Intravenous fentanyl group (FENT. In FNB group patients received FNB guided by a peripheral nerve stimulator (Stimuplex; B Braun, Melsungen, AG 5 minutes prior to positioning. 20mL, 1.5% lidocaine with adrenaline (1:200,000 was injected incrementally after a negative aspiration test. Patients in the fentanyl group received injection fentanyl 1 μg/kg IV 5 mins prior to positioning. Spinal block was performed and pain scores before and during positioning were recorded. Statistical analysis was done with Sigmaplot version-10 computer software. Student t-test was applied to compare the means and P < 0.05 was taken as significant. Results: VAS during positioning in group FNB: 0.57 ± 0.31 versus FENT 2.53 ± 1.61 (P = 0.0020. Time to perform spinal anesthesia in group FNB: 15.33 ± 1.64 min versus FENT 19.56 ± 3.09 min (P = 0.000049. Quality of patient positioning for spinal anesthesia in group FNB 2.67± 0.606 versus FENT 1.967 ± 0.85 (P = 0.000027. Patient acceptance was less in group FENT (P = 0.000031. Conclusion: Femoral nerve block provides better analgesia, patient

Correlation between quantitative ultrasound parameters of the calcinosis and bone density of the spine and femur in Arabian women: Relation to menopausal status

International Nuclear Information System (INIS)

Al Suhaili, A.R.; Saadi, H.F.; Reed, R.L.; Carter, A.O.

2002-01-01

Aims: Quantitative ultrasound (QUS) of the calcaneus is being frequently used to screen for osteoporosis. This technique correlates very well with dual-energy X-ray absorptiometry (DXA) of the spine and femur, and predicts fracture risk in postmenopausal women. The correlation between QUS and DXA in premenopausal women with prevalent vitamin D deficiency however is not known. We assessed the correlation between both techniques in 55 pre- and postmenopausal Arabian women, a population with high prevalence of vitamin D deficiency. Methods: BMD of the right calcaneus was estimated by Sahara ultrasound (Hologic, Waltham, MA). Spine and right total femur BMD was determined by DXA scan (Lunar Expert XL, Madison, WI). Results: Overall, the correlation between calcaneal BMD estimated by QUS and spine and femur BMD measured by DXA in pre- and postmenopausal United Arab Emirates women was statistically significant (r=0.41; p=0.002 for spine and r=0.44; p=0.001 for femur, respectively). In postmenopausal women, all correlations between DXA and QUS parameters were statistically significant. In contrast, only BUA and SOS correlated significantly with spine BMD in premenopausal women. Conclusion: The correlation between DXA and QUS is statistically significant in postmenopausal United Arab Emirates women. However, this correlation is much weaker in premenopausal UAE women suggesting that other factors such as vitamin D deficiency may influence this correlation

Implant failure caused by non-union of bisphosphonate-associated subtrochanteric femur fracture.

LENUS (Irish Health Repository)

O'Neill, Barry James

2014-04-03

Bisphosphonate use has been identified as a contributory factor in atypical subtrochanteric fracture of the femur. These fractures are commonly treated with an intramedullary device. We present a case of implant failure of an intrameduallary device caused by non-union of an atypical subtrochanteric fracture.

Trabecular bone analysis in CT and X-ray images of the proximal femur for the assessment of local bone quality.

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Fritscher, Karl; Grunerbl, Agnes; Hanni, Markus; Suhm, Norbert; Hengg, Clemens; Schubert, Rainer

2009-10-01

Currently, conventional X-ray and CT images as well as invasive methods performed during the surgical intervention are used to judge the local quality of a fractured proximal femur. However, these approaches are either dependent on the surgeon's experience or cannot assist diagnostic and planning tasks preoperatively. Therefore, in this work a method for the individual analysis of local bone quality in the proximal femur based on model-based analysis of CT- and X-ray images of femur specimen will be proposed. A combined representation of shape and spatial intensity distribution of an object and different statistical approaches for dimensionality reduction are used to create a statistical appearance model in order to assess the local bone quality in CT and X-ray images. The developed algorithms are tested and evaluated on 28 femur specimen. It will be shown that the tools and algorithms presented herein are highly adequate to automatically and objectively predict bone mineral density values as well as a biomechanical parameter of the bone that can be measured intraoperatively.

Successful reconstruction for complex malunions and nonunions of the tibia and femur

NARCIS (Netherlands)

Buijze, Geert A.; Richardson, Shawn; Jupiter, Jesse B.

2011-01-01

Information regarding the long-term outcomes of the treatment of lower-extremity fracture malunion and nonunion is lacking. Twenty-nine secondarily referred patients with complex malunion or nonunion of the tibia or femur, treated by a single surgeon, were followed for a median of twenty years

A comparative approach to computer aided design model of a dog femur.

Science.gov (United States)

Turamanlar, O; Verim, O; Karabulut, A

2016-01-01

Computer assisted technologies offer new opportunities in medical imaging and rapid prototyping in biomechanical engineering. Three dimensional (3D) modelling of soft tissues and bones are becoming more important. The accuracy of the analysis in modelling processes depends on the outline of the tissues derived from medical images. The aim of this study is the evaluation of the accuracy of 3D models of a dog femur derived from computed tomography data by using point cloud method and boundary line method on several modelling software. Solidworks, Rapidform and 3DSMax software were used to create 3D models and outcomes were evaluated statistically. The most accurate 3D prototype of the dog femur was created with stereolithography method using rapid prototype device. Furthermore, the linearity of the volumes of models was investigated between software and the constructed models. The difference between the software and real models manifests the sensitivity of the software and the devices used in this manner.

Is the rotation of the femural head a potential initiation for cutting out? A theoretical and experimental approach

LENUS (Irish Health Repository)

Lenich, Andreas

2011-04-22

Abstract Background Since cut-out still remains one of the major clinical challenges in the field of osteoporotic proximal femur fractures, remarkable developments have been made in improving treatment concepts. However, the mechanics of these complications have not been fully understood. We hypothesize using the experimental data and a theoretical model that a previous rotation of the femoral head due to de-central implant positioning can initiate a cut-out. Methods In this investigation we analysed our experimental data using two common screws (DHS\\/Gamma 3) and helical blades (PFN A\\/TFN) for the fixation of femur fractures in a simple theoretical model applying typical gait pattern on de-central positioned implants. In previous tests during a forced implant rotation by a biomechanical testing machine in a human femoral head the two screws showed failure symptoms (2-6Nm) at the same magnitude as torques acting in the hip during daily activities with de-central implant positioning, while the helical blades showed a better stability (10-20Nm). To calculate the torque of the head around the implant only the force and the leverarm is needed (N [Nm] = F [N] * × [m]). The force F is a product of the mass M [kg] multiplied by the acceleration g [m\\/s2]. The leverarm is the distance between the center of the head of femur and the implant center on a horizontal line. Results Using 50% of 75 kg body weight a torque of 0.37Nm for the 1 mm decentralized position and 1.1Nm for the 3 mm decentralized position of the implant was calculated. At 250% BW, appropriate to a normal step, torques of 1.8Nm (1 mm) and 5.5Nm (3 mm) have been calculated. Comparing of the experimental and theoretical results shows that both screws fail in the same magnitude as torques occur in a more than 3 mm de-central positioned implant. Conclusion We conclude the center-center position in the head of femur of any kind of lag screw or blade is to be achieved to minimize rotation of the femoral head

Safe zones and a technical guide for cerclage wiring of the femur: a computed topographic angiogram (CTA) study.

Science.gov (United States)

Apivatthakakul, Theerachai; Siripipattanamongkol, P; Oh, Chang-Wug; Sananpanich, K; Phornphutkul, C

2018-01-01

Cerclage wiring for reduction of complex femoral shaft fractures can create iatrogenic vascular injury. To describe the anatomical relation of blood vessels to the femur and develop a technical guide for safe passage of cerclage wire. CT lower-limb angiographs (CTA) of 80 patients were reviewed and analysed to identify the superficial femoral artery (SFA) and the deep femoral artery (DFA) as well as the relation of those arteries to the femoral cortex. The total length of the femur was measured and divided into eight equal segments (seven levels). At each level, the medial half of the femur was divided into eight sectors labelled A through H and the position of the SFA and DFA was recorded. The shortest distance between the femoral cortex and the SFA and DFA at each level was measured. The data was analysed using STATA version 10.0. The average total femoral length from the tip of greater trochanter to lateral joint line was 402.98 ± 26.16 cm. The average distances from the SFA to the femur (d1) for levels 1 through 7 were 37.20 ± 5.0, 32.09 ± 4.74, 27.13 ± 4.19, 27.71 ± 5.46, 23.71 ± 4.40, 13.63 ± 3.59 and 10.08 ± 3.09 mm, respectively. The average distances between the DFA and the femur (d2) for levels 1 through 3 were 26.70 ± 4.13, 14.76 ± 3.27 and 9.58 ± 3.79 mm, respectively. The position of the SFA is located in sectors B through E at levels 1-3 and in sectors E through H at levels 4-7 and the position of the DFA located in sectors B through F at levels 1-3. Cerclage wiring should be started from the posterior intermuscular septum at the linea aspera. The safe area is the proximal half (midshaft) of the femur where the SFA and DFA lie at a safe distance from the femur. Between the midshaft and the distal 1/4, insertion of the passer must be done meticulously with the tip kept close to posteromedial cortex. Below the distal 1/4, the tip of the passer should be kept close to the posterior cortex to avoid injury to the SFA and

CLINICAL STUDY OF MANAGEMENT OF INTRACAPSULAR FRACTURE NECK OF THE FEMUR IN ELDERLY WITH BIPOLAR HEMIARTHROPLASTY

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Pavan Kumar

2015-03-01

Full Text Available Hemiarthroplasty is a common treatment for fracture neck of femur in elderly patients. Unipolar hemiarthroplasty has shown good results, though there is high incidence of erosion, protrusion and needs revision in future. The concept of dual bearing surfaces results in sharing of motion at the two surfaces and hence reduction of net wears at either surface, thus reducing erosion at the acetabular - joint interface. From our relatively short term prospective non - randomized study, we conclude that bipolar hemiarthroplasty gives good results

Short-term muscle atrophy caused by botulinum toxin-A local injection impairs fracture healing in the rat femur.

Science.gov (United States)

Hao, Yongqiang; Ma, Yongcheng; Wang, Xuepeng; Jin, Fangchun; Ge, Shengfang

2012-04-01

Damaged bone is sensitive to mechanical stimulation throughout the remodeling phase of bone healing. Muscle damage and muscular atrophy associated with open fractures and subsequent fixation are not beneficial to maintaining optimum conditions for mechanical stability. The aim of this study was to investigate whether local muscle atrophy and dysfunction affect fracture healing in a rat femur fracture model. We combined the rat model of a short period atrophy of the quadriceps with femur fracture. Forty-four-month-old male Wistar rats were adopted for this study. Two units of botulinum toxin-A (BXTA) were administered locally into the right side of the quadriceps of each rat, while the same dose of saline was injected into the contralateral quadriceps. After BXTA had been fully absorbed by the quadriceps, osteotomy was performed in both femurs with intramedullary fixation. Gross observation and weighing of muscle tissue, X-ray analysis, callus histology, and bone biomechanical testing were performed at different time points up to 8 weeks post-surgery. Local injection of BXTA led to a significant decrease in the volume and weight of the quadriceps compared to the control side. At the eighth week, the left side femurs of the saline-injected quadriceps almost reached bony union, and fibrous calluses were completely calcified into woven bone. However, a gap was still visible in the BXTA-treated side on X-ray images. As showed by bone histology, there were no mature osseous calluses or woven bone on the BXTA-treated side, but a resorption pattern was evident. Biomechanical testing indicated that the femurs of the BXTA-treated side exhibited inferior mechanical properties compared with the control side. The inferior outcome following BXTA injection, compared with saline injection, in terms of callus resistance may be the consequence of unexpected load and mechanical unsteadiness caused by muscle atrophy and dysfunction. Copyright © 2011 Orthopaedic Research Society.

Evaluation of femur of orchiectomized Guinea pigs by bone densitometry using dual-energy X-ray absorptiometry (DXA) and mechanical testing

International Nuclear Information System (INIS)

Estanislau, Cristiane de Abreu; Rahal, Sheila Canavese; Araujo, Fabio Andre Pinheiro de; Sergio Swain Muller; Louzada, Mario Jefferson Quirino; Estanislau, Caroline de Abreu

2010-01-01

The aim of this study was to evaluate the effects of castration on bones in the male guinea pigs and to observe whether mechanical testing correlates with dual-energy X-ray absorptiometry (DXA). Twelve male guinea pigs (Cavia porcellus), aged 21-27 days, and with average initial weight of 279 grams were used. The animals were equally allocated to two groups: GI - orchiectomized animals and GII - intact control animals. They underwent euthanasia at seven months following surgery. DXA measurement was performed at the mid third of the right femoral diaphysis in the cortical region and at the left femoral neck in order to verify its correlation with results of mechanical testing. Three-point bending test of right femur and axial compression test of left femur were performed. Bone mineral density of GI was significantly lower only at femoral neck. No differences were observed in the maximum load values between GI and GII for both bending and axial compression tests. The bending test revealed lower bone stiffness in GI compared to GII, but in the axial compression test no differences between groups were observed. Only left femur showed positive correlation coefficient between maximum load and bone mineral density according to Pearson's correlation coefficient. The results suggest that hormonal deprivation in guinea pigs induces reduction of bone mineral density, especially in the femoral neck area and reduction of bone stiffness in the mid-femoral diaphysis. (author)

Evaluation of femur of orchiectomized Guinea pigs by bone densitometry using dual-energy X-ray absorptiometry (DXA) and mechanical testing

Energy Technology Data Exchange (ETDEWEB)

Estanislau, Cristiane de Abreu; Rahal, Sheila Canavese; Araujo, Fabio Andre Pinheiro de, E-mail: crisestanislau@hotmail.co, E-mail: sheilacr@fmvz.unesp.b, E-mail: fabioandre@fmvz.unesp.b [Universidade Estadual Paulista (UNESP), Botucatu, SP (Brazil). Faculdade de Medicina, Veterinaria e Zootecnia. Dept. de Cirurgia e Anestesiologia Veterinaria; Sergio Swain Muller, E-mail: diretoria@fmb.unesp.b [Universidade Estadual Paulista (UNESP), Botucatu, SP (Brazil). Faculdade de Medicina, Veterinaria e Zootecnia. Dept. de Cirurgia e Ortopedia; Louzada, Mario Jefferson Quirino, E-mail: louzada@fmva.unesp.b [Universidade Estadual Paulista (UNESP), Aracatuba, SP (Brazil). Faculdade de Medicina Veterinaria; Estanislau, Caroline de Abreu, E-mail: caestanis@hotmail.co

2010-03-15

The aim of this study was to evaluate the effects of castration on bones in the male guinea pigs and to observe whether mechanical testing correlates with dual-energy X-ray absorptiometry (DXA). Twelve male guinea pigs (Cavia porcellus), aged 21-27 days, and with average initial weight of 279 grams were used. The animals were equally allocated to two groups: GI - orchiectomized animals and GII - intact control animals. They underwent euthanasia at seven months following surgery. DXA measurement was performed at the mid third of the right femoral diaphysis in the cortical region and at the left femoral neck in order to verify its correlation with results of mechanical testing. Three-point bending test of right femur and axial compression test of left femur were performed. Bone mineral density of GI was significantly lower only at femoral neck. No differences were observed in the maximum load values between GI and GII for both bending and axial compression tests. The bending test revealed lower bone stiffness in GI compared to GII, but in the axial compression test no differences between groups were observed. Only left femur showed positive correlation coefficient between maximum load and bone mineral density according to Pearson's correlation coefficient. The results suggest that hormonal deprivation in guinea pigs induces reduction of bone mineral density, especially in the femoral neck area and reduction of bone stiffness in the mid-femoral diaphysis. (author)

Bone architecture analyses of rat femur with 3D microtomographics images

International Nuclear Information System (INIS)

Lima, I.C.B.; Lopes, R.T.; Oliveira, L.F.

2006-01-01

One of the great 3D micro tomography (3D-μCT) applications in the medical area is the characterization of bone architecture, especially when it is spoken in osteoporosis because, among other factors, is characterized by the deterioration of the architecture. This work shows the 3D quantification, based on stereological concepts, of the bone tissue through 3D-μCT in real time. The analyses were carried out in femur rat and the 3D visualizations helped to understand bones morphology. The results showed the potential of this computational technique to verify the capability of characterization of the internal bone structures and the importance of the threshold level in the binarization process. (author)

Three-Dimensional Bone Adaptation of the Proximal Femur

DEFF Research Database (Denmark)

Bagge, Mette

1998-01-01

The bone remodeling of a three-dimensional model of the proximal femur is considered. The bone adaptation is numerically described as an evolution in time formulated such that the structural change goes in an optimal direction within each time step for the optimal boundary conditions. In the bone...... remodeling scheme is included the memory of past loadings to account for the delay in the bone response to the load changes. In order to get a realistic bone adaptation process, the bone structure at the onset of the remodeling needs to be realistic too. A start design is obtained by structural optimization...

Metachronous bilateral subtrochanteric fracture of femur in an osteopetrotic bone: A case report with technical note.

Science.gov (United States)

Kumar, Dharmendra; Jain, Vijay Kumar; Lal, Hitesh; Arya, Rajinder Kumar; Sinha, Skand

2012-12-01

Osteopetrosis is a rare inherited skeletal disorder characterized by increased density. The increased fragility of such dense bone results in a greater incidence of fractures, especially around hip and proximal femur. The surgical treatment of such fractures is difficult due to hard but brittle structure of bone. Herein we report a case of bilateral subtrochanteric fracture in an osteopetrotic patient. It was fixed using a dynamic hip screw with plate.

Clinical case for the use of intramedullary osteosynthesis in the treatment of pathological fractures of the femur in 6-day newborn girls with a high partial intestinal obstruction

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Evgeny G. Skryabin

2017-06-01

Full Text Available Abstract. Skeletal bone fractures in newborns present a problem of modern traumatology. Aim. The goal is to present the use of the method of intramedullary osteosynthesis in the treatment of a pathological fracture of the right femur in a newborn girl to a wide audience of pediatric orthopedic traumatologists. Material and methods. We have experience in the treatment of a 6-day-old girl, who was born with intrauterine growth retardation and bowel disease. On the second day of stay in the intensive care unit, she had a pathological fracture of the right femur. Diagnosis of the pathological fracture was established based upon the results of clinical examination and radiography of the injured limb segment. Results. Immediately after the diagnosis, the right lower limb of the child was fixed with a plaster bandage. On the control radiographs, the standing of the bone fragments were unsatisfactory, and a decision was made to use the intramedullary osteosynthesis method with a knitting needle on the 6th day after birth of the child. The need for surgical treatment of a fracture of the femur was due to a congenital abnormality of the intestine in the child, and a need to perform surgery on the abdominal organs. Discussion. Spontaneous fracture of the right femur occurred in the child in treatment in the intensive care unit. The cause of the fracture was osteopenic syndrome, which developed as a result of vitamin D deficiency. During the first 12 days of her life, the newborn had two laparoscopic operations to address the intestinal pathology. Four weeks after the operation using osteosynthesis, the metal from the bone marrow channel of the right femur was removed. After the removal of the needle, the correct axis of the operated segment was fixed to the same length of the lower extremities. The patient had absence of pathological mobility in the fracture region, and full amplitude of movements in the knee and hip joints. Conclusion. When receiving

Outcomes of Distal Femur Fracture Treated with Dynamic Condylar Screw

International Nuclear Information System (INIS)

Razaq, M. N. U.; Muhammad, T.; Ahmed, A.; Adeel, M.; Ahmad, S.; Ahmad, S.; Sultan, S.

2016-01-01

Background: Implants for open reduction and internal fixation of distal femoral fracture includes angle blade plate, rush nails, enders nail and interlocking nails. But all these devices are technically demanding and less effective in providing inter-fragmentary compression in osteoporotic bones. These problems can be solved with dynamic condylar screw (DCS).The objective of the study was to determine the frequency of different outcomes of distal femoral fracture treated with dynamic condylar screw Methods: This case series study was carried out in the Department of Trauma and Orthopaedics, Ayub Teaching Hospital Abbottabad from 1st October 2014 to August 2015, after approval of the ethical committee of the institution. Data of all patients with distal femoral fractures aged 20-70 years, recruited through emergency, OPD or consultant clinic collected on a proforma. Standard treatment of trauma was given to the patients. Detailed history was taken including the past medical and surgical history. Detailed examination including air-way, breathing and circulation, general physical examination and abdomino-pelvic examination was done in each patient. Investigations including urinalysis, haemoglobin percent, full blood count, X-ray (both AP and lateral view) of the involved femur (including hip and knee) was done. Results: Mean age of the patients was 43.18±14.647 ranging from 20 to 70 years. Mean duration of hospital stay in days was 2.21±1.111 ranging from 1 to 6 days. Patients follow-up assessment after 4 months of surgery for union of femoral fracture treated with dynamic condylar screw was found in 96 (94.1 percent), wound infection was found in 7 (6.9 percent), knee stiffness was found in 21 (20.6 percent) and limb shortening was found in 7 (6.9 percent). Conclusion: Dynamic condylar screw is an easy, scientifically less difficult and satisfying method of treatment for fractures of femur. (author)

Dutch population specific sex estimation formulae using the proximal femur.

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Colman, K L; Janssen, M C L; Stull, K E; van Rijn, R R; Oostra, R J; de Boer, H H; van der Merwe, A E

2018-05-01

Sex estimation techniques are frequently applied in forensic anthropological analyses of unidentified human skeletal remains. While morphological sex estimation methods are able to endure population differences, the classification accuracy of metric sex estimation methods are population-specific. No metric sex estimation method currently exists for the Dutch population. The purpose of this study is to create Dutch population specific sex estimation formulae by means of osteometric analyses of the proximal femur. Since the Netherlands lacks a representative contemporary skeletal reference population, 2D plane reconstructions, derived from clinical computed tomography (CT) data, were used as an alternative source for a representative reference sample. The first part of this study assesses the intra- and inter-observer error, or reliability, of twelve measurements of the proximal femur. The technical error of measurement (TEM) and relative TEM (%TEM) were calculated using 26 dry adult femora. In addition, the agreement, or accuracy, between the dry bone and CT-based measurements was determined by percent agreement. Only reliable and accurate measurements were retained for the logistic regression sex estimation formulae; a training set (n=86) was used to create the models while an independent testing set (n=28) was used to validate the models. Due to high levels of multicollinearity, only single variable models were created. Cross-validated classification accuracies ranged from 86% to 92%. The high cross-validated classification accuracies indicate that the developed formulae can contribute to the biological profile and specifically in sex estimation of unidentified human skeletal remains in the Netherlands. Furthermore, the results indicate that clinical CT data can be a valuable alternative source of data when representative skeletal collections are unavailable. Copyright © 2017 Elsevier B.V. All rights reserved.

Forecasting Proximal Femur and Wrist Fracture Caused by a Fall to the Side during Space Exploration Missions to the Moon and Mars

Science.gov (United States)

Lewandowski, Beth E.; Myers, Jerry G.; Sulkowski, C.; Ruehl, K.; Licata, A.

2008-01-01

The possibility of bone fracture in space is a concern due to the negative impact it could have on a mission. The Bone Fracture Risk Module (BFxRM) developed at the NASA Glenn Research Center is a statistical simulation that quantifies the probability of bone fracture at specific skeletal locations for particular activities or events during space exploration missions. This paper reports fracture probability predictions for the proximal femur and wrist resulting from a fall to the side during an extravehicular activity (EVA) on specific days of lunar and Martian exploration missions. The risk of fracture at the proximal femur on any given day of the mission is small and fairly constant, although it is slightly greater towards the end of the mission, due to a reduction in proximal femur bone mineral density (BMD). The risk of wrist fracture is greater than the risk of hip fracture and there is an increased risk on Mars since it has a higher gravitational environment than the moon. The BFxRM can be used to help manage the risk of bone fracture in space as an engineering tool that is used during mission operation and resource planning.

Time domain optical coherence tomography investigation of bone matrix interface in rat femurs

Science.gov (United States)

Rusu, Laura-Cristina; Negruá¹±iu, Meda-Lavinia; Sinescu, Cosmin; Hoinoiu, Bogdan; Topala, Florin-Ionel; Duma, Virgil-Florin; Rominu, Mihai; Podoleanu, Adrian G.

2013-08-01

The materials used to fabricate scaffolds for tissue engineering are derived from synthetic polymers, mainly from the polyester family, or from natural materials (e.g., collagen and chitosan). The mechanical properties and the structural properties of these materials can be tailored by adjusting the molecular weight, the crystalline state, and the ratio of monomers in the copolymers. Quality control and adjustment of the scaffold manufacturing process are essential to achieve high standard scaffolds. Most scaffolds are made from highly crystalline polymers, which inevitably result in their opaque appearance. Their 3-D opaque structure prevents the observation of internal uneven surface structures of the scaffolds under normal optical instruments, such as the traditional light microscope. The inability to easily monitor the inner structure of scaffolds as well as the interface with the old bone poses a major challenge for tissue engineering: it impedes the precise control and adjustment of the parameters that affect the cell growth in response to various mimicked culture conditions. The aim of this paper is to investigate the interface between the femur rat bone and the new bone that is obtained using a method of tissue engineering that is based on different artificial matrixes inserted in previously artificially induced defects. For this study, 15 rats were used in conformity with ethical procedures. In all the femurs a round defect was induced by drilling with a 1 mm spherical Co-Cr surgical drill. The matrixes used were Bioss and 4bone. These materials were inserted into the induced defects. The femurs were investigated at 1 week, 1 month, 2 month and three month after the surgical procedures. The interfaces were examined using Time Domain (TD) Optical Coherence Tomography (OCT) combined with Confocal Microscopy (CM). The optical configuration uses two single mode directional couplers with a superluminiscent diode as the source centered at 1300 nm. The scanning

Locked plating of distal femur fractures leads to inconsistent and asymmetric callus formation.

Science.gov (United States)

Lujan, Trevor J; Henderson, Chris E; Madey, Steven M; Fitzpatrick, Dan C; Marsh, J Lawrence; Bottlang, Michael

2010-03-01

Locked plating constructs may be too stiff to reliably promote secondary bone healing. This study used a novel imaging technique to quantify periosteal callus formation of distal femur fractures stabilized with locking plates. It investigated the effects of cortex-to-plate distance, bridging span, and implant material on periosteal callus formation. Retrospective cohort study. One Level I and one Level II trauma center. Sixty-four consecutive patients with distal femur fractures (AO types 32A, 33A-C) stabilized with periarticular locking plates. Osteosynthesis using indirect reduction and bridge plating with periarticular locking plates. Periosteal callus size on lateral and anteroposterior radiographs. Callus size varied from 0 to 650 mm2. Deficient callus (20 mm2 or less) formed in 52%, 47%, and 37% of fractures at 6, 12, and 24 weeks postsurgery, respectively. Callus formation was asymmetric, whereby the medial cortex had on average 64% more callus (P=0.001) than the anterior or posterior cortices. A longer bridge span correlated minimally with an increased callus size at Week 6 (P=0.02), but no correlation was found at Weeks 12 and 24 postsurgery. Compared with stainless steel plates, titanium plates had 76%, 71%, and 56% more callus at Week 6 (P=0.04), Week 12 (P=0.03), and Week 24 (P=0.09), respectively. Stabilization of distal femur fractures with periarticular locking plates can cause inconsistent and asymmetric formation of periosteal callus. A larger bridge span only minimally improves callus formation. The more flexible titanium plates enhanced callus formation compared with stainless steel plates.

Risk of septic knee following retrograde intramedullary nailing of open and closed femur fractures

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Halvorson Jason J

2012-02-01

Full Text Available Abstract Background One potential complication of retrograde femoral nailing in the treatment of femur fractures is the risk of septic knee. This risk theoretically increases in open fractures as a contaminated fracture site has the potential to seed the instrumentation being passed in and out of the sterile intraarticular starting point. There are few studies examining this potential complication in a relatively commonly practiced technique. Methods All patients who received a retrograde femoral nail for femur fracture between September 1996 and November 2006 at a Level 1 trauma center were retrospectively reviewed. This yielded 143 closed fractures, 38 open fractures and 4 closed fractures with an ipsilateral traumatic knee arthrotomy. Patient follow-up records were reviewed for documentation of septic knee via operative notes, wound culture or knee aspirate data, or the administration of antibiotics for suspected septic knee. Results No evidence of septic knee was found in the 185 fractures examined in the dataset. Utilizing the Wilson confidence interval, the rate of septic knee based on our population was no greater than 2%, with that of the open fracture group alone being 9%. Conclusions Based on these results and review of the literature, the risk of septic knee in retrograde femoral nailing of both open and closed femoral shaft fractures appears low but potentially not insignificant. Funding There was no outside source of funding from either industry or other organization for this study.

Atypical location of osteonecrosis of the proximal femur: a case report

International Nuclear Information System (INIS)

Álvarez López, Alejandro; García Lorenzo, Yenima

2016-01-01

Background: avascular necrosis of the femoral head is an infrequent lesion, especially when it is located in other areas of the proximal femur like the femoral neck. Objective: to present the case of a patient with atypical location of avascular necrosis in the proximal femur. Clinical case: a forty-nine-year-old white female patient with a personal medical record who six months ago started presenting pain in the right hip. The intensity and duration of the pain gradually increased. It also got worse at walking and standing for long periods of time, associated with limp. A simple radiographic examination showed an osteolytic image of well-defined edges in the anteroposterior side of the right hip. To check the presence of this image, a CT scan was performed. A sliding screw fixation was placed to keep the normal anatomical structure and avoid a pathological fracture. Conclusion: the location of avascular necrosis out of the femoral head is extremely infrequent. In these cases other surgical procedures, like resection and fixation with nails and screws, are needed particularly when the location is at the level of the femoral neck and there are risks of a pathological fracture. (author)

Brown tumors of the femur and pelvis secondary to a parathyroid carcinoma: Report of one case

OpenAIRE

Radulescu, Dan; Chis, Bogdan; Donca, Valer; Münteanu, Valentin

2014-01-01

Brown tumors result from excess osteoclast activity and consist of collections of osteoclasts intermixed with fibrous tissue and poorly mineralized woven bone. They are secondary to hyperparathyroidism (HPT). Their incidence is higher in primary than in secondary hyperparathyroidism. We report a 69 years-old male, admitted in a state of confusion, lethargy and bedridden, with a pathological fracture of the femur caused by a brown tumor. The laboratory examination revealed a hypercalcemia (8.8...

Locking plate and fibular strut-graft augmentation in the reconstruction of unicameral bone cyst of proximal femur in the paediatric population.

Science.gov (United States)

Jamshidi, Khodamorad; Mirkazemi, Masoud; Izanloo, Azra; Mirzaei, Alireza

2018-01-01

Several therapeutic strategies have been used for managing unicameral bone cyst (UBC) of the proximal femur. However, there is insufficient evidence to support one treatment over another, and the optimal treatment is controversial. This study aims at describing our experience with surgical reconstruction of paediatric UBCs of the proximal femur using a proximal locking plate and fibular strut allograft. In total, 14 consecutive paediatric patients with Dormans types IB (four cases) and IIB (10 cases) UBC were assessed. Mean patient age was 8.6 ± 2.3 years, and mean follow-up period was 41.7 ± 29.8 months. Six patients (42.8%) were referred with a pathologic fracture. Clinical/radiological outcome and complication rates were evaluated at the final follow-up session. No cysts were Capanna's class III (recurrence) or IV (no response). Complete healing (Capanna's class I) was seen in ten cysts, while four other cysts healed with residual radiolucent areas (Capanna's class II). Mean healing period was 14.1 ± 5.1 (9-24 months). One patient had superficial infection, one heterotopic ossification, and one mild coxa vara, and mean Musculoskeletal Tumor Society (MSTS) score was 99.5%. According to our results, locking plate and fibular strut graft in Dormans classification types IB and IIB results in a favorable outcome in managing UBC of the proximal femur in the paediatric population.

Vertebral metastasis of femur primary osteosarcoma: a case report and literature review; Metastase vertebral de osteossarcoma primario de femur: relato de caso e revisao da literatura

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Cioni, Claudia Helena [Universidade Federal de Sao Paulo (UNIFESP/EPM), SP (Brazil). Radiologia Pediatrica; Francisco, Marina Celli; Lederman, Henrique Manoel [Universidade Federal de Sao Paulo (UNIFESP/EPM), SP (Brazil). Dept. de Diagnostico por Imagem]. E-mail: nana_celli@hotmail.com; Francisco, Fabiano Celli [Hospital de Caridade Sao Braz, Porto Uniao, SC (Brazil); Oliveira, Andrea Alencar de [Universidade Federal de Sao Paulo (UNIFESP/EPM), SP (Brazil). Oncologia Pediatrica; Neves, Felipe Trentin [Hospital Ipiranga, Sao Paulo, SP (Brazil). Cirurgia Geral

2006-10-15

We present a case of a 21-year-old patient, bearer of femur primary osteosarcoma, who began with pain in the thoracic column. The metastasis of primary osteosarcoma has greater incidence on lungs, rarely affecting vertebras. We reviewed the literature about this disease and emphasized the image's characteristics on the several methods used (traditional radiographic exams, bone scintigraphy, computed tomography, magnetic resonance) and the main differential diagnostics. (author)

The effect of canal fill on paediatric femur fractures treated with titanium elastic nails.

Science.gov (United States)

Nielsen, E; Bonsu, N; Andras, L M; Goldstein, R Y

2018-02-01

Traditional teaching for fixation of paediatric femur fractures recommends 80% nail diameter/medullary canal diameter ratio (ND/MCD) for successful maintenance of reduction. Prior studies have investigated this with stainless steel Enders nails. Our aim was to assess the impact of ND/MCD on maintenance of reduction and malunion rates in paediatric femur fractures treated with flexible intramedullary nails (FINs). Retrospective data was collected on all paediatric patients treated with FINs for diaphyseal femur fractures at a single tertiary care institution over a ten-year period. Patients with co-morbidities affecting bone quality were excluded. Patients were subdivided into groups based on ND/MCD. A total of 66 patients met inclusion criteria. Mean ND/MCD was 76.3% (32.9% to 98.8%, SD 14.3). In all, 50% (n = 33/66) of patients had > 80% ND/MCD, and only 13.6% (n = 9/66) of patients had less than 60% ND/MCD. When controlling for fracture stability, ND/MCD had no correlation with mean shortening (p = 0.07) There was no correlation between ND/MCD and angulation in the sagittal (p = 0.96) or coronal plane (p = 0.20). Three patients fit malunion criteria. ND/MCD for these patients were 40%, 67% and 79%. There was no correlation between ND/MCD and shortening or malangulation. The majority of patients in this series with less than 80% fill with FIN healed within acceptable parameters. III.

Simultaneous Bilateral Femur Neck Fracture in A Young Adult with Chronic Renal Failure- A Case Report and Review of Literature.

Science.gov (United States)

V, Sathyanarayana; Patel, Maulik Tulsibhai; S, Raghavan; D, Naresh

2015-01-01

Pathological bilateral femoral neck fracture due to renal osteodystrophy is rare. This is a report of a chronic renal failure patient who had sustained bilateral intra-capsular displaced fracture neck of femur following an episode of convulsion and the difficulties encountered in early diagnosis and treatment. The pathophysiology of renal osteodystrophy and the treatment of hip fractures in patients with renal failure are also discussed. A 23 years old male patient admitted with h/o dysuria, pyuria and loss of appetite since 3 months. He was a known case of chronic renal failure and reflux nephropathy. On investigating, patient's renal parameters were high and he was started with haemodialysis. The next day patient had c/o bilateral hip pain and inability to move bilateral lower limbs following an episode of seizure. Radiograph of pelvis showed vertical sub capital fractures of bilateral neck of femur. In this patient, considering his age, general condition & prognosis, an elective surgery in the form of bilateral uncemented modular bipolar hemiarthroplasty was done. Overall risk of hip fracture among patients with chronic renal failure is considerably higher than in the general population, independent of age and gender. Simultaneous spontaneous bilateral fractures of the femoral neck are rare and a delayed diagnosis is usual. The study of etiological factors of these fractures is essential to guide us in choosing the treatment of choice. Obviously patient's age, life expectancy as well as renal co morbidity has an influence over deciding treatment and outcome.

Cell therapy in femur fractures

International Nuclear Information System (INIS)

Gonzalez Gonzalez, Jorge Arturo; Gamez Perez, Anadely; Rodriguez Orta, Celia

2012-01-01

Regenerative medicine has opened another opportunity for effective consolidation and rapid recovery of patients with traumatic injuries. We present a 46 year-old white male patient with a history of traffic accident. A middle third left femur fracture was diagnosed and plain radiographs showed IV grade comminution. He was released after 20 days of hospitalization with persistent pain despite of pain medication every 4-6 hours. Cell therapy was prescribed and it was performed on outpatient basis. After 48 hours the improvement was increased progressively, stability was achieved and pain disappeared in the fracture site, this was a symptom present since the accident. 8 weeks after cell therapy, radiological improvement was observed. In general, his evolution was considered satisfactory for the fast recovery and its incorporation into social life. This is the first patient in Artemisa province who underwent this new type of therapy and as far as we know at the time of this writing, it is also the first reported in the scientific literature in Cuba

Anthropometric Measurements of the Human Distal Femur: A Study of the Adult Malay Population

Science.gov (United States)

Hussain, Fitdriyah; Abdul Kadir, Mohammed Rafiq; Zulkifly, Ahmad Hafiz; Sa'at, Azlin; Aziz, Azian Abd.; Hossain, Md. Golam; Kamarul, T.; Syahrom, Ardiyansyah

2013-01-01

The distal femurs of 100 subjects (50 men, 50 women) from the Malay population aged between 19 and 38 years were scanned to measure the anterior-posterior (AP) and medial-lateral (ML) width. The mean AP values were 64.02 ± 3.38 mm and 57.33 ± 3.26 mm for men and women, respectively, and the mean ML values were 74.91 ± 3.52 mm and 64.53 ± 3.07 mm. We compared our data to that published previously for the Chinese and Indian populations. It was found that the Malay population had smaller distal femur than that of the Chinese but was larger than that of the Indian population (P population, the variations in different Asian ethnicities may need to be considered when designing the appropriate knee implant. PMID:24294597

Associations of Age, BMI, and Years of Menstruation with Proximal Femur Strength in Chinese Postmenopausal Women: A Cross-Sectional Study

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Huili Kang

2016-01-01

Full Text Available This study aimed to elucidate the associations of age, BMI, and years of menstruation with proximal femur strength in Chinese postmenopausal women, which may improve the prediction of hip fracture risk. A cross-sectional study was conducted in 1322 Chinese postmenopausal women recruited from communities. DXA images were used to generate bone mineral density (BMD and geometric parameters, including cross-sectional area (CSA, outer diameter (OD, cortical thickness (CT, section modulus (SM, buckling ratio (BR at the narrow neck (NN, intertrochanter (IT, and femoral shaft (FS. Relationships of age, BMI, and years of menstruation with bone phenotypes were analyzed with the adjustment of height, age at menarche, total daily physical activity, education, smoking status, calcium tablet intake, etc. Age was associated with lower BMD, CSA, CT, SM, and higher BR (p < 0.05, which indicated a weaker bone strength at the proximal femur. BMI and years of menstruation had the positive relationships with proximal femur strength (p < 0.05. Further analyses showed that the ranges of absolute value of change slope per year, per BMI or per year of menstruation were 0.14%–1.34%, 0.20%–2.70%, and 0.16%–0.98%, respectively. These results supported that bone strength deteriorated with aging and enhanced with higher BMI and longer time of years of menstruation in Chinese postmenopausal women.

Gender differences of the morphology of the distal femur and proximal tibia in a Korean population.

Science.gov (United States)

Lim, Hong-Chul; Bae, Ji-Hoon; Yoon, Ji-Yeol; Kim, Seung-Ju; Kim, Jae-Gyoon; Lee, Jae-Moon

2013-01-01

We conducted this study to determine whether the sizes of distal femurs and proximal tibiae in Korean men and women are different, and to assess suitability of the sizes of prostheses currently used in Korea. We performed morphological analysis of proximal tibia and distal femur on 115 patients (56 male, 59 female) using MRI to investigate a gender difference. Tibial mediolateral dimension (tMAP), tibial medial anteroposterior dimension (tMAP), tibial lateral anteroposterior dimension (tLAP) femoral mediolateral dimension (fML), femoral medial anteroposterior dimension (fMAP), and femoral lateral anteroposterior dimension (fLAP) were measured. The ratio of tMAP and tLAP to tML (plateau aspect ratio, tAP/tML×100%), and that of fMAP and fLAP to fML (condylar aspect ratio, fAP/fML×100%) were calculated. The measurements were compared with the similar dimensions of four total knee implants currently used. The tML and tAP lengths showed a significant gender difference (PtMAP/tML) revealed a significant difference between male (0.74±0.05) and female (0.68±0.04, P<0.05). For morphotype of distal femur, males were found to have significantly large values (P<0.05) in the parameters, except for fLAP. With regards to the ratio of the ML width to the AP length, the women showed a narrower ML width than the men. Both genders were distributed within the range of the dimensions of the prostheses currently used prostheses. Korean population revealed that women have smaller dimensions than male counterparts. In both genders, a relatively small size of prostheses matches distal femur and proximal tibia better among the implants currently used in Korea. Copyright © 2012 Elsevier B.V. All rights reserved.

Development and testing of texture discriminators for the analysis of trabecular bone in proximal femur radiographs

International Nuclear Information System (INIS)

Huber, M. B.; Carballido-Gamio, J.; Fritscher, K.; Schubert, R.; Haenni, M.; Hengg, C.; Majumdar, S.; Link, T. M.

2009-01-01

Purpose: Texture analysis of femur radiographs may serve as a potential low cost technique to predict osteoporotic fracture risk and has received considerable attention in the past years. A further application of this technique may be the measurement of the quality of specific bone compartments to provide useful information for treatment of bone fractures. Two challenges of texture analysis are the selection of the best suitable texture measure and reproducible placement of regions of interest (ROIs). The goal of this in vitro study was to automatically place ROIs in radiographs of proximal femur specimens and to calculate correlations between various different texture analysis methods and the femurs' anchorage strength. Methods: Radiographs were obtained from 14 femoral specimens and bone mineral density (BMD) was measured in the femoral neck. Biomechanical testing was performed to assess the anchorage strength in terms of failure load, breakaway torque, and number of cycles. Images were segmented using a framework that is based on the usage of level sets and statistical in-shape models. Five ROIs were automatically placed in the head, upper and lower neck, trochanteric, and shaft compartment in an atlas subject. All other subjects were registered rigidly, affinely, and nonlinearly, and the resulting transformation was used to map the five ROIs onto the individual femora. Results: In each ROI, texture features were extracted using gray level co-occurence matrices (GLCM), third-order GLCM, morphological gradients (MGs), Minkowski dimensions (MDs), Minkowski functionals (MFs), Gaussian Markov random fields, and scaling index method (SIM). Coefficients of determination for each texture feature with parameters of anchorage strength were computed. In a stepwise multiregression analysis, the most predictive parameters were identified in different models. Texture features were highly correlated with anchorage strength estimated by the failure load of up to R 2 =0.61 (MF

The Analysis of Treatment Modes of Juxta-articular Fractures of Proximal Part of a Femur and their Effect (Literature Review

Directory of Open Access Journals (Sweden)

O.A. Kauts

2010-03-01

Full Text Available The article concerns the current status of the topical problem in traumatology - treatment of juxta-articular fractures of proximal part of a femur and their effect. Analytical review of domestic and foreign literature has allowed to determine the basic problems in treatment of the particular group of patients and to define long-term trends of osteosynthesis of juxta-articular fractures of proximal part of a femur at the present stage

Bone mineral density of lumbar spine and femur in acromegaly

International Nuclear Information System (INIS)

Huebsch, P.; Kotzmann, H.; Svoboda, T.; Kainberger, F.M.; Bankier, A.; Seidl, G.

1993-01-01

Acromegaly is regarded as a cause for secondary osteoporosis, whereas recent papers suggest that growth hormone increases bone mineral density (BMD). In 16 patients with active acromegaly we found an increased BMD compared to normal controls in the lumbar spine and the proximal femur by means of dual energy X-ray absoptiometry. This increase in BMD was statistically significant in the femoral neck and in Ward's triangle (P=0.05). Moreover, no signs of osteoporosis were found radiologically. (orig.) [de

Diaphyseal pseudarthrosis of the femur in a patient with poliomyelitis. A special case study

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J.A. Enríquez-Castro

2018-04-01

Full Text Available Introduction: The incidence of long bone pseudarthrosis ranges from 2% to 10%, with the femur being the second most commonly affected bone. There are local and systemic factors that influence the development of this condition. Various implants such as plates, nails, external fixators and combinations of the foregoing, plus grafts and materials to facilitate consolidation are reported in the literature to treat pseudarthrosis. Objective: To present the special case study of a patient diagnosed with pseudarthrosis of the femur who presented with poliomyelitis sequelae. Case report: A 40-year-old man with a history of poliomyelitis previously treated with osteosynthesis on 2 occasions due a fracture of the left femur. He was assessed and diagnosed with pseudarthrosis of the left femur with poliomyelitis sequelae. He underwent surgery with Luque rod fixation, frozen fibular graft and bone graft chips. His bones consolidated 12 months after the operation and he was able to resume normal activities at 16 months. Resumen: Introducción: La pseudoartrosis en los huesos largos tiene una incidencia del 2 al 10%; el fémur ocupa el segundo lugar en frecuencia. Existen factores locales y sistémicos en el desarrollo de esta patología. Para su tratamiento está descrito el uso de diversos implantes, placas, clavos, fijadores externos y combinaciones entre los mismos, más aplicación de injerto y materiales que coadyuven en la consolidación. Objetivo: Presentación de un caso especial con diagnóstico de pseudoartrosis en fémur que presenta secuelas de poliomielitis. Caso clínico: Hombre de 40 años con antecedente de poliomielitis, inicialmente tratado con osteosíntesis en 2 ocasiones por fractura de fémur izquierdo. Es valorado y se hace diagnóstico de pseudoartrosis de fémur izquierdo y secuelas de poliomielitis. Tratamiento enclavado con una barra de Luque, injerto de peroné congelado y chips. Tuvo una consolidación a los 12 meses postcirug

Fracture prevention by prophylactic femoroplasty of the proximal femur--metallic compared with cemented augmentation.

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Springorum, Hans-Robert; Gebauer, Matthias; Mehrl, Alexander; Stark, Olaf; Craiovan, Benjamin; Püschel, Klaus; Amling, Michael; Grifka, Joachim; Beckmann, Johannes

2014-07-01

To compare 2 different femoral neck augmentation techniques at improving the mechanical strength of the femoral neck. Twenty pairs of human cadaveric femora were randomly divided into 2 groups. In 1 group, the femora were augmented with a steel spiral; the other group with the cemented technique. The untreated contralateral side served as an intraindividual control. Fracture strength was evaluated using an established biomechanical testing scenario mimicking a fall on the greater trochanter (Hayes fall). The peak load to failure was significantly higher in the steel spiral group (P = 0.0024) and in the cemented group (P = 0.001) compared with the intraindividual controls. The peak load to failure showed a median of 3167 N (1825-5230 N) in the spiral group and 2485 N (1066-4395 N) in the spiral control group. The peak load to failure in the cemented group was 3698 N (SD ± 1249 N) compared with 2763 N (SD ± 1335 N) in the cement control group. Furthermore, fracture displacement was clearly reduced in the steel spiral group. Femoral augmentations using steel spirals or cement-based femoroplasty are technically feasible procedures. Our results demonstrate that a prophylactic reinforced proximal femur has higher strength when compared with the untreated contralateral limb. Prophylactic augmentation has potential to become an auxiliary treatment option to protect the osteoporotic proximal femur against fracture.

Effects of chronic lead exposure on bone mineral properties in femurs of growing rats

International Nuclear Information System (INIS)

Álvarez-Lloret, Pedro; Lee, Ching Ming; Conti, María Inés; Terrizzi, Antonela Romina; González-López, Santiago; Martínez, María Pilar

2017-01-01

Lead exposure has been associated with several defective skeletal growth processes and bone mineral alterations. The aim of the present study is to make a more detailed description of the toxic effects of lead intoxication on bone intrinsic material properties as mineral composition, morphology and microstructural characteristics. For this purpose, Wistar rats were exposed (n = 12) to 1000 ppm lead acetate in drinking water for 90 days while control group (n = 8) were treated with sodium acetate. Femurs were examined using inductively coupled plasma optical emission spectrometry (ICP-OES), Attenuated Total Reflection Fourier transform infrared spectroscopy (ATR-FTIR), X-ray diffraction (XRD), and micro-Computed Tomography (μCT). Results showed that femur from the lead-exposed rats had higher carbonate content in bone mineral and (Ca 2+ + Mg 2+ + Na + )/P ratio values, although no variations were observed in crystal maturity and crystallite size. From morphological analyses, lead exposure rats showed a decreased in trabecular bone surface and distribution while trabecular thickness and cortical area increased. These overall effects indicate a similar mechanism of bone maturation normally associated to age-related processes. These responses are correlated with the adverse actions induced by lead on the processes regulating bone turnover mechanism. This information may explain the osteoporosis diseases associated to lead intoxication as well as the risk of fracture observed in populations exposed to this toxicant.

Results of Austin Moore replacement.

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Jadhav A

1996-04-01

Full Text Available Forty cases of Austin Moore Replacement done for transcervical fractures of the femur in patients were reviewed after a period of 12 to 48 months postoperatively (mean 26 mth. 30 cases (75% had mild to severe pain of non-infective origin, starting as early as 6 months postoperatively. This was irrespective of the make, size or position (varus/valgus of the prosthesis. Though the Aufranc and Sweet clinical scoring was satisfactory in 65% cases, radiological evidence of complications like sinking, protrusion, etc. were seen in majority of the cases. Calcar resorption was seen in 34 cases (85% as early as 4 months postoperatively. Results of THR and bipolar replacement done for transcervical fractures in recent literature show 85% pain-free cases at 5 years. We feel that Austin Moore Replacement should be reserved for patients more than 65 years of age and those who are less active or debilitated because of other factors, because of increased acetabular wear with time in the younger individual. This is corroborated by unsatisfactory results in patients less than 65 years of age (p < 0.05.

Incidence rates and trends of hip/femur fractures in five European countries

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Requena, G; Abbing-Karahagopian, V; Huerta, C

2014-01-01

Hip fractures represent a major public health challenge worldwide. Multinational studies using a common methodology are scarce. We aimed to estimate the incidence rates (IRs) and trends of hip/femur fractures over the period 2003-2009 in five European countries. The study was performed using seven......, P European countries. With the exception of Denmark, no decreasing trend was observed over the study period....

Unusual proximal femur fracture in children treated with PHILOS plate and review of literature

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Mukesh Kumar

2017-01-01

Full Text Available Fractures of the hip are uncommon in children with incidence is less than 1% in all paediatrics fracture. It requires careful attention because of the incidence of complications is high. There is no consensus over ideal treatment of each group, but there are different options for each group has been described in literature, we report a case of unusual proximal femur fracture in ten-year-old girl which is not described in literature in best of our knowledge. A 10 years old girl was brought to us with pain in right hip joint and inability to bear weight on right lower limb after road traffic accident (child was hit by a car while walking on the road. Evaluated and found to have fracture of proximal femur. fracture was fixed with long PHILOS plate, which united in eight weeks duration, implant was removed at 10 month. At present after 14 months, she is able to perform her routine activities comfortably. and her Harris hip score is 95. We propose to add this type of fracture as 5th type of Delbet's classification as the fracture pattern in my patient was not fitting in any group of Delbet's classification and it belongs to proximal femur group and anatomically this fracture pattern was next to type IV fracture. Uncommon fracture of hip in children can be expected, this type of fracture can be added as 5th type in Delbet's classification. Long term outcome and ideal treatment yet to be described.

A novel framework for the temporal analysis of bone mineral density in metastatic lesions using CT images of the femur

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Knoop, Tom H.; Derikx, Loes C.; Verdonschot, Nico; Slump, Cornelis H.

2015-03-01

In the progressive stages of cancer, metastatic lesions in often develop in the femur. The accompanying pain and risk of fracture dramatically affect the quality of life of the patient. Radiotherapy is often administered as palliative treatment to relieve pain and restore the bone around the lesion. It is thought to affect the bone mineralization of the treated region, but the quantitative relation between radiation dose and femur remineralization remains unclear. A new framework for the longitudinal analysis of CT-scans of patients receiving radiotherapy is presented to investigate this relationship. The implemented framework is capable of automatic calibration of Hounsfield Units to calcium equivalent values and the estimation of a prediction interval per scan. Other features of the framework are temporal registration of femurs using elastix, transformation of arbitrary Regions Of Interests (ROI), and extraction of metrics for analysis. Build in Matlab, the modular approach aids easy adaptation to the pertinent questions in the explorative phase of the research. For validation purposes, an in-vitro model consisting of a human cadaver femur with a milled hole in the intertrochanteric region was used, representing a femur with a metastatic lesion. The hole was incrementally stacked with plates of PMMA bone cement with variable radiopaqueness. Using a Kolmogorov-Smirnov (KS) test, changes in density distribution due to an increase of the calcium concentration could be discriminated. In a 21 cm3 ROI, changes in 8% of the volume from 888 ± 57mg • ml-1 to 1000 ± 80mg • ml-1 could be statistically proven using the proposed framework. In conclusion, the newly developed framework proved to be a useful and flexible tool for the analysis of longitudinal CT data.

Coffee consumption and CYP1A2 genotype in relation to bone mineral density of the proximal femur in elderly men and women: a cohort study

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Lind Lars

2010-02-01

Full Text Available Abstract Background Drinking coffee has been linked to reduced calcium conservation, but it is less clear whether it leads to sustained bone mineral loss and if individual predisposition for caffeine metabolism might be important in this context. Therefore, the relation between consumption of coffee and bone mineral density (BMD at the proximal femur in men and women was studied, taking into account, for the first time, genotypes for cytochrome P450 1A2 (CYP1A2 associated with metabolism of caffeine. Methods Dietary intakes of 359 men and 358 women (aged 72 years, participants of the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS, were assessed by a 7-day food diary. Two years later, BMD for total proximal femur, femoral neck and trochanteric regions of the proximal femur were measured by Dual-energy X-ray absorptiometry (DXA. Genotypes of CYP1A2 were determined. Adjusted means of BMD for each category of coffee consumption were calculated. Results Men consuming 4 cups of coffee or more per day had 4% lower BMD at the proximal femur (p = 0.04 compared with low or non-consumers of coffee. This difference was not observed in women. In high consumers of coffee, those with rapid metabolism of caffeine (C/C genotype had lower BMD at the femoral neck (p = 0.01 and at the trochanter (p = 0.03 than slow metabolizers (T/T and C/T genotypes. Calcium intake did not modify the relation between coffee and BMD. Conclusion High consumption of coffee seems to contribute to a reduction in BMD of the proximal femur in elderly men, but not in women. BMD was lower in high consumers of coffee with rapid metabolism of caffeine, suggesting that rapid metabolizers of caffeine may constitute a risk group for bone loss induced by coffee.

One-Piece Zirconia Ceramic versus Titanium Implants in the Jaw and Femur of a Sheep Model: A Pilot Study.

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Siddiqi, A; Duncan, W J; De Silva, R K; Zafar, S

2016-01-01

Reports have documented titanium (Ti) hypersensitivity after dental implant treatment. Alternative materials have been suggested including zirconia (Zr) ceramics, which have shown predictable osseointegration in animal studies and appear free of immune responses. The aim of the research was to investigate the bone-to-implant contact (BIC) of one-piece Zr, compared with one-piece Ti implants, placed in the jaws and femurs of domestic sheep. Ten New Zealand mixed breed sheep were used. A One-piece prototype Ti (control) and one Zr (test) implant were placed in the mandible, and one of each implant (Ti and Zr) was placed into the femoral epicondyle of each animal. The femur implants were submerged and unloaded; the mandibular implants were placed using a one-stage transgingival protocol and were nonsubmerged. After a healing period of 12 weeks, %BIC was measured. The overall survival rate for mandibular and femur implants combined was 87.5%. %BIC was higher for Zr implants versus Ti implants in the femur (85.5%, versus 78.9%) ( p = 0.002). Zirconia implants in the mandible showed comparable %BIC to titanium implants (72.2%, versus 60.3%) ( p = 0.087). High failure rate of both Zr and Ti one-piece implants in the jaw could be attributed to the one-piece design and surface characteristics of the implant that could have influenced osseointegration. Further clinical trials are recommended to evaluate the performance of zirconia implants under loading conditions.

What is the risk of death or severe harm due to bone cement implantation syndrome among patients undergoing hip hemiarthroplasty for fractured neck of femur? A patient safety surveillance study

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Rutter, Paul D; Panesar, Sukhmeet S; Darzi, Ara; Donaldson, Liam J

2014-01-01

Objective To estimate the risk of death or severe harm due to bone cement implantation syndrome (BCIS) among patients undergoing hip hemiarthroplasty for fractured neck of femur. Setting Hospitals providing secondary and tertiary care throughout the National Health Service (NHS) in England and Wales. Participants Cases reported to the National Reporting and Learning System (NRLS) in which the reporter clearly describes severe acute patient deterioration associated with cement use in hip hemiarthroplasty for fractured neck of femur (assessed independently by two reviewers). Outcome measures Primary—number of reported deaths, cardiac arrests and periarrests per year. Secondary—timing of deterioration and outcome in relation to cement insertion. Results Between 2005 and 2012, the NRLS received 62 reports that clearly describe death or severe harm associated with the use of cement in hip hemiarthroplasty for fractured neck of femur. There was one such incident for every 2900 hemiarthroplasties for fractured neck of femur during the period. Of the 62 reports, 41 patients died, 14 were resuscitated from cardiac arrest and 7 from periarrest. Most reports (55/62, 89%) describe acute deterioration occurring during or within a few minutes of cement insertion. The vast majority of deaths (33/41, 80%) occurred on the operating table. Conclusions These reports provide narrative evidence from England and Wales that cement use in hip hemiarthroplasty for fractured neck of femur is associated with instances of perioperative death or severe harm consistent with BCIS. In 2009, the National Patient Safety Agency publicised this issue and encouraged the use of mitigation measures. Three-quarters of the deaths in this study have occurred since that alert, suggesting incomplete implementation or effectiveness of those mitigation measures. There is a need for stronger evidence that weighs the risks and benefits of cement in hip hemiarthroplasty for fractured neck of femur. PMID

[Analysis of the results of bone healing in femurs lengthened by the gradual distraction method in children and adolescents].

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Jochymek, J; Skvaril, J; Ondrus, S

2009-10-01

Treatment of leg length inequality via lengthening of the shorter extremity is an infrequent orthopedic procedure due to the requirement of special distraction devices and possible serious complications. Essential qualitative changes in operative technique development are associated with the name of G. A. Ilizarov, who paved the way for the autoregenerate gradual distraction method in the 1950s. In the years 1990 through 2007 a total of 67 patients underwent femur lengthening via gradual distraction using various types of external fixators at the Department of Pediatric Surgery, Orthopedics, and Traumatology, Faculty Hospital in Brno. The quality of bone healing was monitored and a number of parameters followed and statistically evaluated using regularly scheduled X-ray examinations. In 13 cases we had to remove the external fixator following the distraction phase, perform an osteosynthesis via a splint and fill the distraction gap via spongioplasty. The bone healing was satisfactory in the remaining 54 patients and the lengthened bone required no other fixation method. The analysis showed statistically significant deceleration in bone healing following distraction in female patients over 12 years of age, and in boys over 14 years of age. Lack of periosteal callus five weeks after surgery always signified serious problems in further healing. Severe complications were recorded in 11 cases during the distraction phase, and in 12 cases after the removal of the distraction apparatus. Our results fully correspond with the data and experience of others cited authors. In addition our study showed deceleration in bone healing in girls over 12 years and in boys over 14 years of age and serious problem in healing when is lack of periostal callus five weeks after surgery. The aim of this report was to present the results of our study of distraction gap bone healing using the gradual lengthening approach. Key words: leg lengthening, gradual distraction, external fixation, leg

Associations of vitamin D deficiency with postoperative gait and mortality among patients with fractures of the proximal femur

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David Nicoletti Gumieiro

2015-04-01

Full Text Available OBJECTIVE: To assess whether serum vitamin D concentration is associated with gait status and mortality among patients with fractures of the proximal femur, six months after suffering the fracture.METHODS: Consecutive patients aged ≥65 years with fractures of the proximal femur, who were admitted to the orthopedics and traumatology ward of our service between January and December 2011, were prospectively evaluated. Clinical, radiological, epidemiological and laboratory analyses were performed, including vitamin D. The patients underwent surgery and were followed up as outpatients, with return visits 15, 30, 60 and 180 days after discharge, at which the outcomes of gait and mortality were evaluated.RESULTS: Eighty-eight patients were evaluated. Two of them were excluded because they presented oncological fractures. Thus, 86 patients of mean age 80.2 ± 7.3 years were studied. In relation to serum vitamin D, the mean was 27.8 ± 14.5 ng/mL, and 33.7% of the patients presented deficiency of this vitamin. In relation to gait, univariate and multivariate logistic regression showed that vitamin D deficiency was not associated with gait recovery, even after adjustment for gender, age and type of fracture (OR: 1.463; 95% CI: 0.524-4.088; p = 0.469. Regarding mortality, Cox regression analysis showed that vitamin D deficiency was not related to its occurrence within six months, even in multivariate analysis (HR: 0.627; 95% CI: 0.180-2.191; p = 0.465.CONCLUSION: Serum vitamin D concentration was not related to gait status and/or mortality among patients with fractures of the proximal femur, six months after suffering the fracture.

CORRELATION BETWEEN TIME UNTIL SURGICAL TREATMENT AND MORTALITY AMONG ELDERLY PATIENTS WITH FRACTURES AT THE PROXIMAL END OF THE FEMUR.

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Arliani, Gustavo Gonçalves; da Costa Astur, Diego; Linhares, Glauber Kazuo; Balbachevsky, Daniel; Fernandes, Hélio Jorge Alvachian; Dos Reis, Fernando Baldy

2011-01-01

The primary aim of this study was to analyze the possible association between delay in receiving surgical treatment and mortality among elderly patients with fractures at the proximal end of the femur. 269 patients with fractures at the proximal end of the femur (femur neck and intertrochanteric fractures) who were treated surgically at Hospital São Paulo, UNIFESP, São Paulo, between January 2003 and December 2007, were studied. The following attributes were analyzed and compared with the literature relating to this subject: sex, age, type of fracture, classification of the fracture, affected side, synthesis used, trauma mechanism, length of hospitalization, waiting time for surgery, associated comorbidities, hemogram on admission, type of anesthesia, need for blood transfusion, day of the week and season of the year of the fracture. The study showed that higher mortality correlated with higher numbers of clinical comorbidities, longer hospitalization and use of general anesthesia during the surgery. There was no association between the time spent waiting for surgery and mortality.

Decreased 133Xe clearance in the proximal femur in acromegaly

International Nuclear Information System (INIS)

Kapitola, J.; Marek, J.; Jahoda, I.; Vilimovska, D.

1986-01-01

Using the 133 Xe tissue clearance method, the blood flow in the greater trochanter of the femur was studied in 30 patients with acromegaly. Both the washout rate constant (k 2 ) and blood flow (P 2 ) values are significantly decreased in acromegaly (p < 0.01). There is a significant negative correlation (r = -0.42, p < 0.05) between the flow values and mean daily concentrations of growth hormone in serum of acromegalic patients. The observation is presented as a preliminary evidence of a possible influence of growth hormone on the blood flow in bone. (author)

Femur-sparing pattern of abnormal fetal growth in pregnant women from New York City after maternal Zika virus infection.

Science.gov (United States)

Walker, Christie L; Merriam, Audrey A; Ohuma, Eric O; Dighe, Manjiri K; Gale, Michael; Rajagopal, Lakshmi; Papageorghiou, Aris T; Gyamfi-Bannerman, Cynthia; Adams Waldorf, Kristina M

2018-05-05

Zika virus is a mosquito-transmitted flavivirus, which can induce fetal brain injury and growth restriction following maternal infection during pregnancy. Prenatal diagnosis of Zika virus-associated fetal injury in the absence of microcephaly is challenging due to an incomplete understanding of how maternal Zika virus infection affects fetal growth and the use of different sonographic reference standards around the world. We hypothesized that skeletal growth is unaffected by Zika virus infection and that the femur length can represent an internal standard to detect growth deceleration of the fetal head and/or abdomen by ultrasound. We sought to determine if maternal Zika virus infection is associated with a femur-sparing pattern of intrauterine growth restriction through analysis of fetal biometric measures and/or body ratios using the 2014 International Fetal and Newborn Growth Consortium for the 21st Century Project and World Health Organization Fetal Growth Chart sonographic references. Pregnant women diagnosed with a possible recent Zika virus infection at Columbia University Medical Center after traveling to an endemic area were retrospectively identified and included if a fetal ultrasound was performed. Data were collected regarding Zika virus testing, fetal biometry, pregnancy, and neonatal outcomes. The 2014 International Fetal and Newborn Growth Consortium for the 21st Century Project and World Health Organization Fetal Growth Chart sonographic standards were applied to obtain Z-scores and/or percentiles for fetal head circumference, abdominal circumference, and femur length specific for each gestational week. A novel 2014 International Fetal and Newborn Growth Consortium for the 21st Century Project standard was also developed to generate Z-scores for fetal body ratios with respect to femur length (head circumference:femur length, abdominal circumference:femur length). Data were then grouped within clinically relevant gestational age strata (34 weeks) to

The best location for proximal locking screw for femur interlocking nailing: A biomechanical study

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Ahmet A Karaarslan

2016-01-01

Conclusion: According to our findings, there is twice as much difference in locking screw bending resistance between these two application levels. To avoid proximal locking screw deformation, locking screws should be placed in the level of the lesser trochanter in nailing of 1/3 middle and distal femur fractures.

99mTc-MDP bone uptake in secondary hyperparathyroidism: comparison among mandible, cranium, radius and femur

International Nuclear Information System (INIS)

Boasquevisque, Edson; Silva, Jorge Wagner Esteves da; Bernardo, Vanessa V. de Albuquerque; Macedo, Sara Mello Santana de; Boasquevisque, Camila S.

2008-01-01

Full text: Objective: Evaluating bone involvement in secondary hyperparathyroidism (SHPT) by 99m Tc-MDP uptake in the mandible, cranium, radius and femur and with data correlation with PTHi serum (Intact Parathyroid Hormone). Materials and Methods: In a prospective study of 54 patients with SHPT due to chronic renal disease and 15 normal individuals (control group), all patients had elevated serum PTHi, concentration and positive 99m Tc-MDP bone scintigraphy. Bone uptake measurements were carried out drawing regions-of-interest (ROI) on the mandible, posterior cranium, distal radius and proximal femur. Additionally, soft tissue uptake was measured with one region-of-interest on the internal tight soft tissue (BG). The ROI-BG ratio used as the index of normalized bone uptake. Results: The uptake differences from SHPT and control groups mainly for mandible (p = 0,001) and cranium (p = 0,002) were statistically significant, even when the SHPT groups were separated according to serum PTHi levels. There was increased bone uptake with the increased levels of PTHi serum. All of the mandibles of the SHPT patients were abnormal with 33% having focal lesions. Conclusions: The bone uptake in SHPT group was abnormal in all areas evaluated, with high uptake of 99m Tc-MDP correlated to the increase of PTHi serum concentration. (author)

A COMPARATIVE STUDY OF PROXIMAL FEMUR LOCKING COMPRESSION PLATE VERSUS PROXIMAL FEMORAL NAILING IN THE MANAGEMENT OF COMMINUTED TROCHANTERIC AND SUBTROCHANTERIC FRACTURE

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Satish Koti

2016-11-01

Full Text Available BACKGROUND Fractures of proximal femur and hip are relatively common injuries in elderly individuals constituting 11.6% of total fractures. The latest implant for management of intertrochanteric fracture is Proximal Femoral Locking Compression Plate (PF-LCP. In this study, we compare the clinical outcome of fractures treated by proximal femoral nail with that of proximal femur locking compression plate. MATERIALS AND METHODS The present study consists of 24 elderly patients of peritrochanteric factures of femur satisfying the inclusion criteria who were treated with PF-LCP or PFN in Department of Orthopaedics, S.V.R.R.G.G.H, Tirupati, during a period between December 2013 to October 2015. RESULTS 24 cases were treated with PF-LCP or PFN in a randomised pattern who satisfied inclusion criteria. Intraoperative complication were found to be more with PF-LCP in contrast to PFN. Postoperative rehabilitation was easier with PFN though not statistically significant functional and anatomical outcomes were found to be better with PFN. CONCLUSION Both PFN and PF-LCP have good effectiveness in the treatment of intertrochanteric fractures with the lateral unsubstantial femoral wall in the elderly patients. Each has its own advantages and disadvantages. Further studies with large number of patients and long-term follow up is needed to determine the optimal implant for the internal fixation of comminuted pertrochanteric femoral fractures.

Effects of chronic lead exposure on bone mineral properties in femurs of growing rats.

Science.gov (United States)

Álvarez-Lloret, Pedro; Lee, Ching Ming; Conti, María Inés; Terrizzi, Antonela Romina; González-López, Santiago; Martínez, María Pilar

2017-02-15

Lead exposure has been associated with several defective skeletal growth processes and bone mineral alterations. The aim of the present study is to make a more detailed description of the toxic effects of lead intoxication on bone intrinsic material properties as mineral composition, morphology and microstructural characteristics. For this purpose, Wistar rats were exposed (n=12) to 1000ppm lead acetate in drinking water for 90days while control group (n=8) were treated with sodium acetate. Femurs were examined using inductively coupled plasma optical emission spectrometry (ICP-OES), Attenuated Total Reflection Fourier transform infrared spectroscopy (ATR-FTIR), X-ray diffraction (XRD), and micro-Computed Tomography (μCT). Results showed that femur from the lead-exposed rats had higher carbonate content in bone mineral and (Ca 2+ +Mg 2+ + Na + )/P ratio values, although no variations were observed in crystal maturity and crystallite size. From morphological analyses, lead exposure rats showed a decreased in trabecular bone surface and distribution while trabecular thickness and cortical area increased. These overall effects indicate a similar mechanism of bone maturation normally associated to age-related processes. These responses are correlated with the adverse actions induced by lead on the processes regulating bone turnover mechanism. This information may explain the osteoporosis diseases associated to lead intoxication as well as the risk of fracture observed in populations exposed to this toxicant. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Development and testing of texture discriminators for the analysis of trabecular bone in proximal femur radiographs

Energy Technology Data Exchange (ETDEWEB)

Huber, M. B.; Carballido-Gamio, J.; Fritscher, K.; Schubert, R.; Haenni, M.; Hengg, C.; Majumdar, S.; Link, T. M. [Department of Radiology and Biomedical Imaging, University of California, 400 Parnassus Avenue, San Francisco, California 94143 (United States); University of Health Sciences, Medical Informatics and Technology, 6060 Hall (Austria); AO Development Institute, 7270 Davos Platz (Switzerland); Medical University Innsbruck, 6020 Innsbruck (Austria); Department of Radiology and Biomedical Imaging, University of California, 400 Parnassus Avenue, San Francisco, California 94143 (United States)

2009-11-15

Purpose: Texture analysis of femur radiographs may serve as a potential low cost technique to predict osteoporotic fracture risk and has received considerable attention in the past years. A further application of this technique may be the measurement of the quality of specific bone compartments to provide useful information for treatment of bone fractures. Two challenges of texture analysis are the selection of the best suitable texture measure and reproducible placement of regions of interest (ROIs). The goal of this in vitro study was to automatically place ROIs in radiographs of proximal femur specimens and to calculate correlations between various different texture analysis methods and the femurs' anchorage strength. Methods: Radiographs were obtained from 14 femoral specimens and bone mineral density (BMD) was measured in the femoral neck. Biomechanical testing was performed to assess the anchorage strength in terms of failure load, breakaway torque, and number of cycles. Images were segmented using a framework that is based on the usage of level sets and statistical in-shape models. Five ROIs were automatically placed in the head, upper and lower neck, trochanteric, and shaft compartment in an atlas subject. All other subjects were registered rigidly, affinely, and nonlinearly, and the resulting transformation was used to map the five ROIs onto the individual femora. Results: In each ROI, texture features were extracted using gray level co-occurence matrices (GLCM), third-order GLCM, morphological gradients (MGs), Minkowski dimensions (MDs), Minkowski functionals (MFs), Gaussian Markov random fields, and scaling index method (SIM). Coefficients of determination for each texture feature with parameters of anchorage strength were computed. In a stepwise multiregression analysis, the most predictive parameters were identified in different models. Texture features were highly correlated with anchorage strength estimated by the failure load of up to R{sup 2

Early postradiation recovery of precursor cells of hemopoietic stroma

International Nuclear Information System (INIS)

Todriya, T.V.

1984-01-01

Ability of stroma precursor cells to early postradiation recovery was studied in male mices using the method of fraction irradiation of bone marrow. Donor mices of bone marrow were irradiated in vivo once by the total dose (nonfraction irradiation) and fractionally with 6 h interval between two irradiation doses. The cumulative irradiation doses equal to 10, 12, 14, 16 Gr were investigated. Irradiation was carried out using gamma facility. Bone marrow of the femur was implanted immediately after irradiation under kidney capsule of nonirradiated syngeneic recipient. The ability of stroma precursor cells to intracellular repair (repair index) was evaluated according to the ratio of the number of hemopoietic cells formed in heterotropic transplants in groups with fraction irradiation to the same one in groups with nonfraction irradiation. The obtained results testify to the fact that slowly regenerated highly radioresistant population of precursor cells of hemopoietic stroma is capable to early postradiation recovery

Vertebral metastasis of femur primary osteosarcoma: a case report and literature review

International Nuclear Information System (INIS)

Cioni, Claudia Helena; Oliveira, Andrea Alencar de; Neves, Felipe Trentin

2006-01-01

We present a case of a 21-year-old patient, bearer of femur primary osteosarcoma, who began with pain in the thoracic column. The metastasis of primary osteosarcoma has greater incidence on lungs, rarely affecting vertebras. We reviewed the literature about this disease and emphasized the image's characteristics on the several methods used (traditional radiographic exams, bone scintigraphy, computed tomography, magnetic resonance) and the main differential diagnostics. (author)

A Study of Inflammatory/Necrosis Biomarkers in the Fracture of the Femur Treated with Proximal Femoral Nail Antirotation

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Mariapaola Marino

2015-01-01

Full Text Available Pertrochanteric fractures are common injuries in adults and source of morbidity and mortality among the elderly. Different surgical techniques were recommended for their treatment but undoubtedly they add an additional inflammatory trauma along the fracture itself. Many attempts to quantify the degree of approach-related trauma are carried out through measurements of systemic inflammatory parameters. In this study we prospectively analyzed laboratory data of 20 patients over eighty with pertrochanteric fracture of the femur treated with proximal femoral nail antirotation (PFNA. This is an excellent device for osteosynthesis because it can be easily and quickly inserted by a mini-incision providing stable fixation and early full mobilization. Serum tumor necrosis factor-alpha (TNF-α, interleukin-6 (IL-6, C-reactive protein (CRP, and plasma creatin kinase (CK were evaluated 1 hour preoperatively and 24 hours postoperatively. Our results show that PFNA did not induce significant increments in serum levels of inflammatory cytokines TNF-α and IL-6; CRP was elevated preoperatively in correlation with waiting time for surgery; CRP and CK showed a significant increment in the first postoperatory day; CK increment was correlated with surgical time length. We conclude that, for the markers we analyzed, PFNA shows a low biomechanical-inflammatory profile that represents an advantage over other techniques.

FUNCTIONAL OUTCOME OF SUPRACONDYLAR FRACTURES OF FEMUR MANAGED BY OPEN REDUCTION AND INTERNAL FIXATION WITH LOCKING COMPRESSION PLATE

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Madhusudhana

2015-10-01

Full Text Available INTRODUCTION : Incidence of distal femur fractures is approximately 37 per 1 , 00,000 person - years.¹Distal femoral fractures has two different injury mechanisms, high energy trauma and low energy trauma. In high - energy trauma, the problem of restoring the function in a destroyed knee joint persists. Complex knee ligament injuries frequently occur additionally to extensive cartilage injuries. In elderly patients, extreme osteoporosis represents a particular problem for anchoring the implant. 2 Supracondylar and inter condylar fractures often are unstable and comminuted and tend to occur in the elderly or those with multiple injuries. Treatment options are many with varied results. The final outcome would depend upon the type of fracture, stabilization of fixation and and perhaps patient general condition. 3 The options for operative treatment are traditional plating techniques that require compression of the implant to the femoral shaft (blade plate, Dynamic Condylar Screw, non - locking condylar buttress plate, antegrade nailing fixation, retrograde nailing, sub muscular locked internal fixation and external fixation. 4 However, as the complexity of fractures needing treatment has changed from simple extra - articular supra - condylar types to inter - condylar and metaphyseal comminuted types, these implants may not be ideal. Double plating, and more recently, locked plating techniques have been advocated 5 . However with double plating there is often extensive soft tissue stripping on both sides of the femur, resulting in reduced blood supply and potential non - union and failure of the implants 6 . The LCP is a single beam construct where the strength of its fixation is equal to the sum of all screw - bone interfaces rather than a single screw’s axial stiffness or pullout resistance as seen in unlocked plates 7,8 . Its unique biomechanical function is based on splinting rather than compression resulting in flexible stabilization

Epigenetic regulation during fetal femur development: DNA methylation matters.

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María C de Andrés

Full Text Available Epigenetic modifications are heritable changes in gene expression without changes in DNA sequence. DNA methylation has been implicated in the control of several cellular processes including differentiation, gene regulation, development, genomic imprinting and X-chromosome inactivation. Methylated cytosine residues at CpG dinucleotides are commonly associated with gene repression; conversely, strategic loss of methylation during development could lead to activation of lineage-specific genes. Evidence is emerging that bone development and growth are programmed; although, interestingly, bone is constantly remodelled throughout life. Using human embryonic stem cells, human fetal bone cells (HFBCs, adult chondrocytes and STRO-1(+ marrow stromal cells from human bone marrow, we have examined a spectrum of developmental stages of femur development and the role of DNA methylation therein. Using pyrosequencing methodology we analysed the status of methylation of genes implicated in bone biology; furthermore, we correlated these methylation levels with gene expression levels using qRT-PCR and protein distribution during fetal development evaluated using immunohistochemistry. We found that during fetal femur development DNA methylation inversely correlates with expression of genes including iNOS (NOS2 and COL9A1, but not catabolic genes including MMP13 and IL1B. Furthermore, significant demethylation was evident in the osteocalcin promoter between the fetal and adult developmental stages. Increased TET1 expression and decreased expression of DNA (cytosine-5--methyltransferase 1 (DNMT1 in adult chondrocytes compared to HFBCs could contribute to the loss of methylation observed during fetal development. HFBC multipotency confirms these cells to be an ideal developmental system for investigation of DNA methylation regulation. In conclusion, these findings demonstrate the role of epigenetic regulation, specifically DNA methylation, in bone development

Case report 387: Gaucher disease affecting the skeleton (left femur)

International Nuclear Information System (INIS)

Tabas, J.H.; Daffner, R.H.; Hartsock, R.J.; Blakley, J.B.

1986-01-01

A case is described of a non-Jewish (Italian) 49-year-old man who presented to the hospital with pain in the left hip. Radionuclide studies showed decreased tracer activity with 99m Tc MDP over a lytic area in the subtrochanteric region of the left femur. Increased activity, however, was present in the right temporal bone, low anterior rib cage and right tenth posterior rib. The presence of subendosteal sclerosis with some cortical thickening adjacent to the femoral lesion, suggested the possibility of malignant neoplasm, (e.g. chondrosarcoma). Biopsy of the bone marrow showed the presence of Gaucher disease. (orig./SHA)

Case report 387: Gaucher disease affecting the skeleton (left femur)

Energy Technology Data Exchange (ETDEWEB)

Tabas, J.H.; Daffner, R.H.; Hartsock, R.J.; Blakley, J.B.

1986-08-01

A case is described of a non-Jewish (Italian) 49-year-old man who presented to the hospital with pain in the left hip. Radionuclide studies showed decreased tracer activity with /sup 99m/Tc MDP over a lytic area in the subtrochanteric region of the left femur. Increased activity, however, was present in the right temporal bone, low anterior rib cage and right tenth posterior rib. The presence of subendosteal sclerosis with some cortical thickening adjacent to the femoral lesion, suggested the possibility of malignant neoplasm, (e.g. chondrosarcoma). Biopsy of the bone marrow showed the presence of Gaucher disease. (orig./SHA).

Mechanical torque measurement in the proximal femur correlates to failure load and bone mineral density ex vivo

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Stefan Grote

2013-06-01

Full Text Available Knowledge of local bone quality is essential for surgeons to determine operation techniques. A device for intraoperative measurement of local bone quality has been developed by the AO-Research Foundation (DensiProbe®. We used this device to experimentally measure peak breakaway torque of trabecular bone in the proximal femur and correlated this with local bone mineral density (BMD and failure load. Bone mineral density of 160 cadaver femurs was measured by ex situ dual-energy X-ray absorptiometry. The failure load of all femurs was analyzed by side-impact analysis. Femur fractures were fixed and mechanical peak torque was measured with the DensiProbe® device. Correlation was calculated whereas correlation coefficient and significance was calculated by Fisher’s Z-transformation. Moreover, linear regression analysis was carried out. The unpaired Student’s t-test was used to assess the significance of differences. The Ward triangle region had the lowest BMD with 0.511 g/cm2 (±0.17 g/cm2, followed by the upper neck region with 0.546 g/cm2 (±0.16 g/cm2, trochanteric region with 0.685 g/cm2 (±0.19 g/cm2 and the femoral neck with 0.813 g/cm2 (±0.2 g/cm2. Peak torque of DensiProbe® in the femoral head was 3.48 Nm (±2.34 Nm. Load to failure was 4050.2 N (±1586.7 N. The highest correlation of peak torque measured by Densi Probe® and load to failure was found in the femoral neck (r=0.64, P<0.001. The overall correlation of mechanical peak torque with T-score was r=0.60 (P<0.001. A correlation was found between mechanical peak torque, load to failure of bone and BMD in vitro. Trabecular strength of bone and bone mineral density are different aspects of bone strength, but a correlation was found between them. Mechanical peak torque as measured may contribute additional information about bone strength, especially in the perioperative testing.

Effects of different loading patterns on the trabecular bone morphology of the proximal femur using adaptive bone remodeling.

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Banijamali, S Mohammad Ali; Oftadeh, Ramin; Nazarian, Ara; Goebel, Ruben; Vaziri, Ashkan; Nayeb-Hashemi, Hamid

2015-01-01

In this study, the changes in the bone density of human femur model as a result of different loadings were investigated. The model initially consisted of a solid shell representing cortical bone encompassing a cubical network of interconnected rods representing trabecular bone. A computationally efficient program was developed that iteratively changed the structure of trabecular bone by keeping the local stress in the structure within a defined stress range. The stress was controlled by either enhancing existing beam elements or removing beams from the initial trabecular frame structure. Analyses were performed for two cases of homogenous isotropic and transversely isotropic beams.Trabecular bone structure was obtained for three load cases: walking, stair climbing and stumbling without falling. The results indicate that trabecular bone tissue material properties do not have a significant effect on the converged structure of trabecular bone. In addition, as the magnitude of the loads increase, the internal structure becomes denser in critical zones. Loading associated with the stumbling results in the highest density;whereas walking, considered as a routine daily activity, results in the least internal density in different regions. Furthermore, bone volume fraction at the critical regions of the converged structure is in good agreement with previously measured data obtained from combinations of dual X-ray absorptiometry (DXA) and computed tomography (CT). The results indicate that the converged bone architecture consisting of rods and plates are consistent with the natural bone morphology of the femur. The proposed model shows a promising means to understand the effects of different individual loading patterns on the bone density.

Epidemiology of fractures of the proximal third of the femur in elderly patients ☆

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Daniel Daniachi

2015-08-01

Full Text Available ABSTRACTOBJECTIVE: This was an epidemiological study on fractures of the proximal third of the femur in elderly patients who were treated at a teaching hospital in the central region of São Paulo. METHODS: The subjects were patients over the age of 60 years who were attended over a 1-year period. A questionnaire seeking basic sociodemographic data and information on comorbidities presented and medications used was drawn up. The circumstances of the fractures and their characteristics, the treatment instituted and the intra-hospital mortality rate were evaluated. RESULTS: The 113 patients included in the study presented a mean age of 79 years. The ratio between the sexes was three women to each man. Only 30.4% of the patients reported having osteoporosis and only 0.9% had had treatment for the disease. Low-energy trauma was the cause of 92.9% of the fractures. Femoral neck fractures accounted for 42.5% of the fractures and trochanteric fractures, 57.5%. Five patients did not undergo operations; 39 underwent joint replacement; and 69 underwent osteosynthesis. The mean length of hospital stay was 13.5 days and the mean length of waiting time until surgery was 7 days. The intra-hospital mortality rate was 7.1%. CONCLUSION: The patients attended at this institution presented an epidemiological profile similar to what is found in the Brazilian literature. Chronic kidney failure is a significant factor with regard to intra-hospital mortality. Preventive measures such as early diagnosis and treatment of osteoporosis and regular physical activity practices were not implemented.

The Relationship Between Fractures and DXA Measures of BMD in the Distal Femur of Children and Adolescents With Cerebral Palsy or Muscular Dystrophy

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Henderson, Richard C; Berglund, Lisa M; May, Ryan; Zemel, Babette S; Grossberg, Richard I; Johnson, Julie; Plotkin, Horacio; Stevenson, Richard D; Szalay, Elizabeth; Wong, Brenda; Kecskemethy, Heidi H; Harcke, H Theodore

2010-01-01

Children with limited or no ability to ambulate frequently sustain fragility fractures. Joint contractures, scoliosis, hip dysplasia, and metallic implants often prevent reliable measures of bone mineral density (BMD) in the proximal femur and lumbar spine, where BMD is commonly measured. Further, the relevance of lumbar spine BMD to fracture risk in this population is questionable. In an effort to obtain bone density measures that are both technically feasible and clinically relevant, a technique was developed involving dual-energy X-ray absorptiometry (DXA) measures of the distal femur projected in the lateral plane. The purpose of this study is to test the hypothesis that these new measures of BMD correlate with fractures in children with limited or no ability to ambulate. The relationship between distal femur BMD Z-scores and fracture history was assessed in a cross-sectional study of 619 children aged 6 to 18 years with muscular dystrophy or moderate to severe cerebral palsy compiled from eight centers. There was a strong correlation between fracture history and BMD Z-scores in the distal femur; 35% to 42% of those with BMD Z-scores less than −5 had fractured compared with 13% to 15% of those with BMD Z-scores greater than −1. Risk ratios were 1.06 to 1.15 (95% confidence interval 1.04–1.22), meaning a 6% to 15% increased risk of fracture with each 1.0 decrease in BMD Z-score. In clinical practice, DXA measure of BMD in the distal femur is the technique of choice for the assessment of children with impaired mobility. © 2010 American Society for Bone and Mineral Research PMID:19821773

Case report 373: Diametaphyseal chrondroblastoma of the upper portion of the left femur

Energy Technology Data Exchange (ETDEWEB)

Sotelo-Avila, C.; Sundaram, M.; Graviss, E.R.; Kyriakos, M.; Tayob, A.A.

1986-06-01

In summary, a case has been presented of a chondroblastoma of the diametaphysis of the upper end of the left femur in an 11-year-old girl. Despite its atypical location, the tumor proved to be a characteristic chondroblastoma on microscopic examination. The literature was reviewed comprehensively and it was noted that 12 examples of chondroblastoma arising outside an epiphysis (or apophysis) were noted. (orig./SHA).

Fracture of the Femur of A Newborn after Cesarean Section for Breech Presentation and Fibroid Uterus :A Case Report and Literature Review

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Ibrahima Farikou

2014-01-01

Full Text Available Introduction: The practice of cesarean section is known to decrease the occurrence of long bone fractures. We present here an unusual diaphyseal fracture of the femur of a newborn after cesarean section, the only case observed in our 14 years of practice. Case Report: The patient was a 3.4-kg female child born at 38 weeks of gestation. The mother was a primipara and aged 39 years. Ultrasound examination at 20th week revealed intrauterine fibroids with a breech presentation. Therefore, elective cesarean section was indicated. There was no apparent bone disorder that could predispose to sustain femur fracture. The fracture was treated successfully with a bilateral spica cast. The cesarean section was indicated in an aged primipara, bearer of uterine fibroids, and breech presentation. She had a good general health status, but her bone density was unknown since this examination is not routinely performed in our clinical settings in Africa. Conclusion: Elderly age, primipara status, presence of uterine fibroids, and breech presentation are usual indications for cesarean section. However, there are not many reports on femur fracture after cesarean section. Our present case suggests that despite the latest advances in delivery techniques, cesarean section for breech presentation predisposes the neonate to femoral fractures. Keywords: Femur fracture; Cesarean section; Fibroid; Breech presentation; Africa.

Study on validation method for femur finite element model under multiple loading conditions

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Guan, Fengjiao; Zhang, Guanjun; Liu, Jie; Wang, Shujing; Luo, Xu

2018-03-01

Acquisition of accurate and reliable constitutive parameters related to bio-tissue materials was beneficial to improve biological fidelity of a Finite Element (FE) model and predict impact damages more effectively. In this paper, a femur FE model was established under multiple loading conditions with diverse impact positions. Then, based on sequential response surface method and genetic algorithms, the material parameters identification was transformed to a multi-response optimization problem. Finally, the simulation results successfully coincided with force-displacement curves obtained by numerous experiments. Thus, computational accuracy and efficiency of the entire inverse calculation process were enhanced. This method was able to effectively reduce the computation time in the inverse process of material parameters. Meanwhile, the material parameters obtained by the proposed method achieved higher accuracy.

Peculiarities of X-ray appearances of aseptic necrosis of head of the femur in adults and children and their connection with bio mechanical factors

International Nuclear Information System (INIS)

Suslova, O.Ya.; Shargorodskij, C.S.; Antipova, A.A.; Naumenko, N.A.; Kresnyj, D.I.

1987-01-01

260 patients aged from 3 to 56 with aseptic necrosis of head of the femur are examined. Experimental biomechanical simulation of load conditions on femur head and cotyloid cavity was carried out at phantom devices using tensiometry, ichnographic and polarization-optical methods. Peculiarities of X-ray appearances of asceptic necrosis with respect to age are studied. A definite connection between asceptic necrosis and biomechanical factors is established

Effect of Guava Extract Administration on Megakaryocytes Amount in Mice Femur

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Nur Atik

2017-06-01

Full Text Available Dengue fever is a disease spread by mosquito’s bite. Dengue fever is marked by the presence of thrombocytopenia. Traditional crops such as guava are commonly used to treat dengue fever. This research aims to know the effect of guava extract administration towards megakaryocytes amount in mice femur. The study was conducted at the Laboratory of Pharmacology and Therapy, Histology Laboratory of Faculty of Medicine at Universitas Padjadjaran, Eijkman, Bandung from September until November 2016 using laboratory experimental study design. 20 Swiss webster mice strains were divided randomly into 4 groups. Group I and II were administered quinine 2.8 mg/20 grBW/day for 14 days to decrease amount of trombocytes. Group II and III were administered guava extract 0.785 mg/20 grBW/day for 5 days. Group IV was administered aquadest for 19 days. In the 27th day, the mice left femurs were collected and made into paraffin section preparations with hematoxylin-eosin staining and then observed under microscope. Group IV had the most megakaryocytes followed by Group II, III, and I. Based on Kruskal-Wallis test, a significant difference was shown (p<0.05. Mann-Whitney test showed that there were significant differences between Group I and Group II, III, and IV. Meanwhile there was no significant difference between normal mice and extract-given mice. Guava extract is proven statistically significant to increase the megakaryocytes amount in thrombocytopenic mice without increasing number of megakaryocytes in normal mice.

Dual-energy radiographic absorptiometry of the lumbar spine and proximal femur

International Nuclear Information System (INIS)

Moscona, A.; Gundry, C.; Sartoris, D.J.; Barrett-Connor, E.; Stein, J.A.; Resnick, D.

1988-01-01

Dual-energy radiographic absorptiometry (DRA), dual-photon absorptiometry (DPA), and single-photon absorptiometry (SPA) were used for comprehensive densitometry of 500 men and women aged 65-100 years, within an epidemiologic study of osteoporosis risk factors. DRA and DPA of the lumbar spine (L1-L4) and proximal femur were performed with a Hologic QDR-100 system and a Lunar DP3 system, respectively, and SPA of the 33% shaft and ultradistal forearm sites was performed with a Lunar SP2 system. DRA and DPA results showed high correlation at both sites (tau=.9,P<.001); data conversion factors were derived. SPA results for the ultradistal site correlated better with vertebral and femoral density (tau=.6,P<.1) than did those for the shaft site (tau=.4,P<.5) but neither forearm measurement was reliable predictive of axial mineral status. The various measurements displayed an age-dependent interrelationship. The DRA method offers the advantage of short examination times (about 5 minutes per site) and high precision (about 1%)

Associations of Age, BMI, and Years of Menstruation with Proximal Femur Strength in Chinese Postmenopausal Women: A Cross-Sectional Study.

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Kang, Huili; Chen, Yu-Ming; Han, Guiyuan; Huang, Hua; Chen, Wei-Qing; Wang, Xidan; Zhu, Ying-Ying; Xiao, Su-Mei

2016-01-23

This study aimed to elucidate the associations of age, BMI, and years of menstruation with proximal femur strength in Chinese postmenopausal women, which may improve the prediction of hip fracture risk. A cross-sectional study was conducted in 1322 Chinese postmenopausal women recruited from communities. DXA images were used to generate bone mineral density (BMD) and geometric parameters, including cross-sectional area (CSA), outer diameter (OD), cortical thickness (CT), section modulus (SM), buckling ratio (BR) at the narrow neck (NN), intertrochanter (IT), and femoral shaft (FS). Relationships of age, BMI, and years of menstruation with bone phenotypes were analyzed with the adjustment of height, age at menarche, total daily physical activity, education, smoking status, calcium tablet intake, etc. Age was associated with lower BMD, CSA, CT, SM, and higher BR (p menstruation had the positive relationships with proximal femur strength (p menstruation were 0.14%-1.34%, 0.20%-2.70%, and 0.16%-0.98%, respectively. These results supported that bone strength deteriorated with aging and enhanced with higher BMI and longer time of years of menstruation in Chinese postmenopausal women.

Mortality and morbidity in elderly patients with fracture neck of femur treated by hemi arthroplasty

International Nuclear Information System (INIS)

Ahmad, I.

2006-01-01

To determine mortality and morbidity in elderly patients with fracture neck of femur treated by hemiarthroplasty (Austin Moore Prosthesis) during one year postoperatively. During the study period, all patients with fracture neck of femur, who were 65 years of age or above and treated by Austin Moore Prosthesis (AMP), were included. The patients were followed for one year at intervals of 2 weeks, 4 weeks, 6 months, and one year. All surviving patients were assessed for complications, both general and mechanical, related to the implant. The mortality and morbidity were compared for various age subgroups, and in patients with and without systemic co-morbidities.Chi square test was applied to see the significance of results. The total number of patients was 46 with average age of 70 years. Male to female ratio was 1:2. There were 70% patients who had one or more associated systemic disease. The mortality at 2 weeks was 4.3%, 17.4% at 6 months and 26% at one year. The overall dislocation rate was 4.3%. Two patients had infection and 17.4% patients had thigh pain at one year. The mortality and morbidity was high in patients with systemic comorbidities, and those above 70 years of age, but this was statistically not significant (p value >0.05). The functional assessment of surviving patients at one year was graded as excellent or good in 76.4% of patients. (author)

The study of bone mineral density and structure in proximal femur by quantitative CT in elderly Chinese women

International Nuclear Information System (INIS)

Cheng Xiaoguang; Liu Xia; Wang Yusheng; Li Jin; Qu Hui; Li Jing; Genant, H.; Lang, T.

2009-01-01

Objective: To evaluate the bone mineral density (BMD) and structure of proximal femur in elderly Chinese women by quantatitive computed tomography (QCT) and dual energy X-ray absorptiometry (DXA), and to further compare the results of these two methods. Methods: Sixty-six healthy Chinese women over 65 years old participated in this study. The left hips of all subjects were measured with DXA and the BMD of femoral neck and trochanteric region were calculated. With QCT, the BMD and tissue volume of cortical, trabecular and integral bone were calculated for femoral neck, trochanteric and total femur regions in both hips. Appropriate statistical analyses were performed with SPSS 11.5. Results: The BMD and structural parameters in different regions and different compartments of the proximal femur could be precisely assessed with QCT technique. The BMD of cortical bone in femoral neck [(0.52±0.04) g/cm 3 ], BMD of cortical bone in trochanteric region [(0.49±0.03) g/cm 3 ] and BMD of integral bone in troehanteric region [(0.22±0.04) g/cm 3 ] were greater in the fight than those in the left [(0.51±0.04), (0.48±0.03), (0.21±0.04)g/cm 3 ]. The difference had statistical signification (P 2 (0.78±0.13) g/cm 2 , 5.80 cm 3 (0.06±0.03) g/cm 3 , (5.19 ± 1.40) cm 3 , (0.25 ± 0.04)g/cm 3 , 15.66 cm 3 , (21.74±3.43) cm 3 , (0.08 ± 0.03)g/cm 3 , (34.27±6.09) cm 3 and (76.12±11.11) cm 3 respectively, in the fight the corresponding parameters being (0.52±0.10) g/cm 2 (0.78±0.13) g/cm 2 6.01 cm 3 , (0.06±0.02) g/cm 3 , (5.17±1.27) cm 3 , (0.25±0.04)g/cm 3 , 15.62 cm 3 , (22.12±3.60) cm 3 , (0.09±0.03) g/cm 3 , (34.17±5.94) cm 3 and (76.53±10.71) cm 3 respectively. There were no significant difference between the left and right parameters above (P>0.0 ). All QCT parameters of the right hip correlated well with their corresponding ones of left hip with correlation coefficients ranging from 0.656-0.955, P<0.05. QCT-derived simulated DXA femoral neck and trochanteric

Customization of a generic 3D model of the distal femur using diagnostic radiographs.

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Schmutz, B; Reynolds, K J; Slavotinek, J P

2008-01-01

A method for the customization of a generic 3D model of the distal femur is presented. The customization method involves two steps: acquisition of calibrated orthogonal planar radiographs; and linear scaling of the generic model based on the width of a subject's femoral condyles as measured on the planar radiographs. Planar radiographs of seven intact lower cadaver limbs were obtained. The customized generic models were validated by comparing their surface geometry with that of CT-reconstructed reference models. The overall mean error was 1.2 mm. The results demonstrate that uniform scaling as a first step in the customization process produced a base model of accuracy comparable to other models reported in the literature.

The pattern of trabecular bone microarchitecture in the distal femur of typically developing children and its effect on processing of magnetic resonance images.

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Modlesky, Christopher M; Whitney, Daniel G; Carter, Patrick T; Allerton, Brianne M; Kirby, Joshua T; Miller, Freeman

2014-03-01

Magnetic resonance imaging (MRI) is used to assess trabecular bone microarchitecture in humans; however, image processing can be labor intensive and time consuming. One aim of this study was to determine the pattern of trabecular bone microarchitecture in the distal femur of typically developing children. A second aim was to determine the proportion and location of magnetic resonance images that need to be processed to yield representative estimates of trabecular bone microarchitecture. Twenty-six high resolution magnetic resonance images were collected immediately above the growth plate in the distal femur of 6-12year-old typically developing children (n=40). Measures of trabecular bone microarchitecture [i.e., apparent trabecular bone volume to total volume (appBV/TV), trabecular number (appTb.N), trabecular thickness (appTb.Th) and trabecular separation (appTb.Sp)] in the lateral aspect of the distal femur were determined using the twenty most central images (20IM). The average values for appBV/TV, appTb.N, appTb.Th and appTb.Sp from 20IM were compared to the average values from 10 images (10IM), 5 images (5IM) and 3 images (3IM) equally dispersed throughout the total image set and one image (1IM) from the center of the total image set using linear regression analysis. The resulting mathematical models were cross-validated using the leave-one-out technique. Distance from the growth plate was strongly and inversely related to appBV/TV (r(2)=0.68, p0.05). However, there was a progressive decrease in the strength of the relationships as a smaller proportion of images were used to predict estimates from 20IM (r(2)=0.98 to 0.99 using 10IM, 0.94 to 0.96 using 5IM, 0.87 to 0.90 using 3IM and 0.66 to 0.72 using 1IM; all pimage sets agreed extremely well with estimates from 20IM. The findings indicate that partial magnetic resonance image sets can be used to provide reasonable estimates of trabecular bone microarchitecture status in the distal femur of typically

Ligament of the head of femur: A comprehensive review of its anatomy, embryology, and potential function.

Science.gov (United States)

Perumal, Vivek; Woodley, Stephanie J; Nicholson, Helen D

2016-03-01

The functional significance of the ligament of the head of femur (LHF), or ligamentum teres has often been debated. Having gained recent attention in clinical practice, it is suggested to partly provide some mechanical stability to the hip joint. However, the anatomy of this ligament is not well studied. This paper systematically reviews the anatomy of the LHF with the aim of exploring our current understanding of this structure and identifying any gaps in knowledge regarding its morphology and function. A systematic search of Medline, Embase, ProQuest, Web of Science, and Scopus databases was undertaken and relevant data extracted, analyzed. A total of 69 references were obtained, that included 53 full text articles, three published abstracts, and 13 textbooks. Many publications related to clinical studies (n = 11) rather than gross anatomy (n = 7), with one report on variation of the LHF. Considerable inconsistency in the naming and description of the LHF morphology was observed. Variable attachment sites were reported except for the acetabular notch, transverse acetabular ligament, and the femoral fovea. Presence and patency of the ligamental arteries supplying the head of the femur and their exact location were variably described and were often incomplete. The LHF is believed to be taught in extreme hip adduction, but there is little evidence to support this. In conclusions, further investigation of the anatomy of the LHF is recommended, particularly to clarify its mechanical role, innervation, and vascular contribution to the developing and adult femur, so to better inform clinical practice. © 2015 Wiley Periodicals, Inc.

Subtrochanteric and diaphyseal femur fractures in patients treated with alendronate: a register-based national cohort study

DEFF Research Database (Denmark)

Abrahamsen, Bo; Eiken, Pia; Eastell, Richard

2009-01-01

Alendronate (aln) is a potent bisphosphonate with a prolonged duration of action. Recent reports have found long-term aln use to be common in patients with subtrochanteric or proximal diaphyseal femur fracture, raising concerns that these fractures could be a consequence of excessive suppression...

Early Eocene birds from La Borie, southern France

DEFF Research Database (Denmark)

Bourdon, Estelle; Mourer-Chauviré, Cécile; Laurent, Yves

2016-01-01

The Early Eocene locality of La Borie is located in the village of Saint-Papoul, in southern France. These Eocene fluvio-lacustrine clay deposits have yielded numerous vertebrate remains. Mammalian taxa found in the fossiliferous levels indicate an age near the reference level MP 8–9, which...... corresponds to the middle Ypresian, Lower Eocene. Here we provide a detailed description of the avian remains that were preliminarily reported in a recent study of the vertebrate fauna from La Borie. A maxilla, a quadrate, cervical vertebrae, a femur and two tibiotarsi are assigned to the giant ground bird...... Gastornis parisiensis Hébert, 1855 (Gastornithidae). These new avian remains add to the fossil record of Gastornis, which is known from the Upper Paleocene to Middle Eocene of Europe, Early Eocene of Asia, and Early Eocene of North America. Gastornis parisiensis differs from the North American Gastornis...

Bioceramic inlays do not improve mechanical incorporation of grit-blasted titanium stems in the proximal sheep femur.

Science.gov (United States)

Keränen, Pauli; Koort, Jyri; Itälä, Ari; Ylänen, Heimo; Dalstra, Michel; Hupa, Mikko; Kommonen, Bertel; Aro, Hannu T

2010-03-15

The aim of the present study was to determine, if bioactive glass (BG) surface inlays improve osseointegration of titanium implants in the proximal femur of adult sheep. In simulation of uncemented primary stems (nine animals), only the proximal part of the implants was grit-blasted and three surface slots of the grit-blasted region were filled with sintered BG microspheres. Primary stems were implanted using press-fit technique. In revision stem simulation (eight animals), grit-blasting was extended over the whole implant and seven perforating holes of the stem were filled by sintered BG granules. Revision stems were implanted with a mixture of autogenous bone graft and BG granules. Comparison with solid partially or fully grit-blasted control stems implanted in the contralateral femurs was performed in the primary and revision stem experiments at 12 and 25 weeks, respectively. Implant incorporation was evaluated by torsional failure testing and histomorphometry. Only one-third of the primary stems anchored mechanically to bone. The revision stems incorporated better and the BG inlays of the revision stems showed ingrowth of new bone. However, there were no significant differences in the torsional failure loads between the stems with BG inlays and the control stems. In conclusion, surface BG inlays gave no measurable advantage in mechanical incorporation of grit-blasted titanium implants. Overall, the proximal sheep femur, characterized by minimal amount of cancellous bone and the presence of adipocytic bone marrow, seemed to present compromised bone healing conditions. (c) 2009 Wiley Periodicals, Inc.

Minimally invasive computer-navigated total hip arthroplasty, following the concept of femur first and combined anteversion: design of a blinded randomized controlled trial

Directory of Open Access Journals (Sweden)

Woerner Michael

2011-08-01

study has been designed to compare minimally invasive computer-navigated "femur first" THA with a conventional technique for minimally invasive THA. The results of this trial will be presented as soon as they become available. Trial registration number DRKS00000739

Bone mineral density changes of lumbar spine and femur in osteoporotic patient treated with bisphosphonates and beta-hydroxy-beta-methylbutyrate (HMB): Case report.

Science.gov (United States)

Tatara, Marcin R; Krupski, Witold; Majer-Dziedzic, Barbara

2017-10-01

Currently available approaches to osteoporosis treatment include application of antiresorptive and anabolic agents influencing bone tissue metabolism. The aim of the study was to present bone mineral density (BMD) changes of lumbar spine in osteoporotic patient treated with bisphosphonates such as ibandronic acid and pamidronic acid, and beta-hydroxy-beta-methylbutyrate (HMB). BMD and volumetric BMD (vBMD) of lumbar spine were measured during the 6 year observation period with the use of dual-energy X-ray absorptiometry (DEXA) and quantitative computed tomography (QCT). The described case report of osteoporotic patient with family history of severe osteoporosis has shown site-dependent response of bone tissue to antiosteoporotic treatment with bisphosphonates. Twenty-five-month treatment with ibandronic acid improved proximal femur BMD with relatively poor effects on lumbar spine BMD. Over 15-month therapy with pamidronic acid was effective to improve lumbar spine BMD, while in the proximal femur the treatment was not effective. A total of 61-week long oral administration with calcium salt of HMB improved vBMD of lumbar spine in the trabecular and cortical bone compartments when monitored by QCT. Positive effects of nearly 2.5 year HMB treatment on BMD of lumbar spine and femur in the patient were also confirmed using DEXA method. The results obtained indicate that HMB may be applied for the effective treatment of osteoporosis in humans. Further studies on wider human population are recommended to evaluate mechanisms influencing bone tissue metabolism by HMB.

Image-Based Macro-Micro Finite Element Models of a Canine Femur with Implant Design Implications

Science.gov (United States)

Ghosh, Somnath; Krishnan, Ganapathi; Dyce, Jonathan

2006-06-01

In this paper, a comprehensive model of a bone-cement-implant assembly is developed for a canine cemented femoral prosthesis system. Various steps in this development entail profiling the canine femur contours by computed tomography (CT) scanning, computer aided design (CAD) reconstruction of the canine femur from CT images, CAD modeling of the implant from implant blue prints and CAD modeling of the interface cement. Finite element analysis of the macroscopic assembly is conducted for stress analysis in individual components of the system, accounting for variation in density and material properties in the porous bone material. A sensitivity analysis is conducted with the macroscopic model to investigate the effect of implant design variables on the stress distribution in the assembly. Subsequently, rigorous microstructural analysis of the bone incorporating the morphological intricacies is conducted. Various steps in this development include acquisition of the bone microstructural data from histological serial sectioning, stacking of sections to obtain 3D renderings of void distributions, microstructural characterization and determination of properties and, finally, microstructural stress analysis using a 3D Voronoi cell finite element method. Generation of the simulated microstructure and analysis by the 3D Voronoi cell finite element model provides a new way of modeling complex microstructures and correlating to morphological characteristics. An inverse calculation of the material parameters of bone by combining macroscopic experiments with microstructural characterization and analysis provides a new approach to evaluating properties without having to do experiments at this scale. Finally, the microstructural stresses in the femur are computed using the 3D VCFEM to study the stress distribution at the scale of the bone porosity. Significant difference is observed between the macroscopic stresses and the peak microscopic stresses at different locations.

Evaluation of bone repair in the femur of rats submitted to laser therapy in different wavelengths: An image segmentation method of analysis

Science.gov (United States)

Queiroga, A. S.; Sousa, F. B.; Araújo, J. M. S.; Santos, S. D.; Sousa, C. D'f. S.; Quintans, T. C.; Almeida, T. P.; Nonaka, C. F. W.; Batista, L. V.; Limeira Junior, F. A.

2008-09-01

The aim of this study was to histologically assess the effect of laser therapy (LILT, 660 and 780 nm) on the repair of standardized bone defects on the femur of Wistar albinus rats. The sample was composed of 12 Wistar albinus young adult rats of both genders. Three randomized groups were studied: group I (control, n = 4), group II (LILT, 660 nm, n = 4), and group III (LILT, 780 nm, n = 4). Samples were prepared using a bone defect on the left-side femur surface of the animals, with a total dimension of approximately 3 mm3. Groups II and III were irradiated every 48 h from the second application, where the first dose was given immediately after surgery and the second application came 24 h after surgery. The irradiations were applied transcutaneously at four points around the wound for 14 days. At each point, a dose of 50 J/cm2 (2 J) was given ( s ˜ 0.04 cm2, 40 mW) and the total dose per session was 200 J/cm2 (8 J). The sacrifices were made 15 days after surgery and the specimens were routinely processed to wax, serially cut, stained with an H&E stain, and analyzed under light microscopy. The images were submitted to morphometric analysis using the image segmentation method using the K-means algorithm. The data obtained through the morphometric analysis were submitted to statistical analysis using the Tukey test. The results showed that the group treated with laser therapy in the infrared spectrum resulted in an increase in the repair of bone defects when compared with the group treated with the laser in the red spectrum and control group, which, in turn, had a very similar pattern of repair. A statistical significance ( p spectrum produced a positive biomodulation effect on the repair of bone defects in the femur of rats.

Small and similar amounts of micromotion in an anatomical stem and a customized cementless femoral stem in regular-shaped femurs. A 5-year follow-up randomized RSA study.

Science.gov (United States)

Nysted, Mona; Foss, Olav A; Klaksvik, Jomar; Benum, Pål; Haugan, Kristin; Husby, Otto Schnell; Aamodt, Arild

2014-04-01

High primary stability is important for long-term survival of uncemented femoral stems. Different stem designs are currently in use. The ABG-I is a well-documented anatomical stem with a press-fit design. The Unique stem is designed for a tight customized fit to the cortical bone of the upper femur. This implant was initially developed for patients with abnormal anatomy, but the concept can also be used in patients with normal femoral anatomy. We present 5-year radiostereometric analysis (RSA) results from a randomized study comparing the ABG-I anatomical stem with the Unique femoral stem. 100 hips with regular upper femur anatomy were randomized to either the ABG-I stem or the Unique femoral stem. RSA measurements were performed postoperatively and after 3, 6, 12, 24, and 60 months. RSA measurements from 80 hips were available for analysis at the 5-year follow-up. Small amounts of movement were observed for both stems, with no statistically significant differences between the 2 types. No improvement in long-term stability was found from using a customized stem design. However, no patients with abnormal geometry of the upper femur were included in this study.

"Effect of Hydroxyapatite to Load Failure Value in Rat with Diaphyseal Femur Fracture"

OpenAIRE

Rinartha, Adi Surya; Rahyussalim, Rahyussalim

2011-01-01

Introduction. Calcium hydroxyapatite are non organic compound of the bone formed the fracture healing. In fracture healing, the parts of the compounds make up unordinary scaffold and producing an incredible amount of me- senchymal stem cell under bearing of the scaffold. This study is aimed to determine the effect of hydroxyapatite administration to load failure value in mice with diaphyseal femur fracture. Materials and methods. Research was done using Sprague Dawley rat undergone ...

Relationship of homocysteine levels with lumbar spine and femur neck BMD in postmenopausal women

Directory of Open Access Journals (Sweden)

Elton Bahtiri

2015-10-01

Full Text Available Objective: The focus of several studies in recent years has been the association between increased plasma concentrations of homocysteine (Hcy, reduced bone mineral density and increased risk of bone fractures. Nevertheless, inconsistencies persist in the literature. Thus, the objective of this study was to investigate the possible relationship between serum Hcy and vitamin B12 status, and bone mineral density, on a group of post-menopausal women. Materials and methods: One hundred thirty-nine postmenopausal women were recruited to enter this cross-sectional study. Bone mineral density (BMD of total hip, femoral neck and lumbar spine was measured by dual-energy X-ray absorptiometry (DXA and serum Hcy, vitamin B12, parathyroid hormone (PTH, total calcium and magnesium levels were determined. In addition, we investigated the relationship of Hcy and vitamin B12 and BMD using a meta-analysis approach. Results: Serum Hcy levels were significantly higher in osteoporotic women when compared to other BMD groups, and were inversely related to lumbar spine BMD and femur neck BMD. Body mass index and serum Hcy levels were shown to be significant predictors of BMD at lumbar spine, femur neck and total hip. The performed meta-analysis showed that serum Hcy levels were significantly higher in osteoporotic subjects compared to normal BMD subjects. Conclusion: This study shows that Hcy status, but not vitamin B12 status, is associated with BMD in this cohort of postmenopausal women. We therefore confirm that high Hcy levels are an independent risk factor for osteoporosis. BMD evaluation in women at post menopause with high Hcy levels may be helpful in advising precautionary measures.

Cyclic hydrostatic pressure stimulates enhanced bone development in the foetal chick femur in vitro.

Science.gov (United States)

Henstock, J R; Rotherham, M; Rose, J B; El Haj, A J

2013-04-01

Mechanical loading of bone and cartilage in vivo results in the generation of cyclic hydrostatic forces as bone compression is transduced to fluid pressure in the canalicular network and the joint synovium. It has therefore been suggested that hydrostatic pressure is an important stimulus by which osteochondral cells and their progenitors sense and respond to mechanical loading in vivo. In this study, hydrostatic pressure regimes of 0-279kPa at 0.005-2Hz were applied to organotypically cultured ex vivo chick foetal femurs (e11) for 1hour per day in a custom designed bioreactor for 14days and bone formation assessed by X-ray microtomography and qualified by histology. We found that the mineralised portion of the developing femur cultured under any cyclic hydrostatic pressure regime was significantly larger and/or denser than unstimulated controls but that constant (non-cycling) hydrostatic pressure had no effect on bone growth. Further experiments showed that the increase in bone formation was directly proportional to stimulation frequency (R(2)=0.917), but independent of the magnitude of the pressure applied, whilst even very low frequencies of stimulation (0.005Hz) had significant effects on bone growth. Expression of Type-II collagen in both epiphyses and diaphysis was significantly upregulated (1.48-fold and 1.95-fold respectively), together with osteogenic genes (osteonectin and osteopontin) and the osteocyte maturation marker CD44. This work demonstrates that cyclic hydrostatic pressure promotes bone growth and mineralisation in a developmental model and supports the hypothesis that hydrostatic forces play an important role in regulating bone growth and remodelling in vivo. Copyright © 2013 Elsevier Inc. All rights reserved.

Effects of 1.8 GHz radiofrequency field on microstructure and bone metabolism of femur in mice.

Science.gov (United States)

Guo, Ling; Zhang, Jun-Ping; Zhang, Ke-Ying; Wang, Huan-Bo; Wang, Huan; An, Guang-Zhou; Zhou, Yan; Meng, Guo-Lin; Ding, Gui-Rong

2018-04-30

To investigate the effects of 1.8 GHz radiofrequency (RF) field on bone microstructure and metabolism of femur in mice, C57BL/6 mice (male, age 4 weeks) were whole-body exposed or sham exposed to 1.8 GHz RF field. Specific absorption rates of whole body and bone were approximately 2.70 and 1.14 W/kg (6 h/day for 28 days). After exposure, microstructure and morphology of femur were observed by microcomputed tomography (micro-CT), Hematoxylin and Eosin (HE) and Masson staining. Subsequently, bone parameters were calculated directly from the reconstructed images, including structure model index, bone mineral density, trabecular bone volume/total volume, connectivity density, trabecular number, trabecular thickness, and trabecular separation. Biomarkers that reflect bone metabolism, such as serum total alkaline phosphatase (ALP), bone-specific alkaline phosphatase (BALP), and tartrate-resistant acid phosphatase 5b (TRACP-5b), were determined by biochemical assay methods. Micro-CT and histology results showed that there was no significant change in bone microstructure and the above parameters in RF group, compared with sham group. The activity of serum ALP and BALP increased 29.47% and 16.82%, respectively, in RF group, compared with sham group (P microstructure; however, it might promote metabolic function of osteoblasts in mice. Bioelectromagnetics. © 2018 Wiley Periodicals, Inc. © 2018 Wiley Periodicals, Inc.

Trabecular bone microstructure is impaired in the proximal femur of human immunodeficiency virus-infected men with normal bone mineral density.

Science.gov (United States)

Kazakia, Galateia J; Carballido-Gamio, Julio; Lai, Andrew; Nardo, Lorenzo; Facchetti, Luca; Pasco, Courtney; Zhang, Chiyuan A; Han, Misung; Parrott, Amanda Hutton; Tien, Phyllis; Krug, Roland

2018-02-01

-infected patients and healthy controls. Our results suggest that high-resolution imaging is a powerful tool to assess trabecular bone microstructure and can be used to assess bone health in HIV-infected men who show no differences to healthy males by DXA aBMD. Advances in MRI technology have made microstructural imaging at the proximal femur possible. Further studies in larger patient cohorts are clearly warranted.

Primary desmoplastic small round cell tumor of the femur

International Nuclear Information System (INIS)

Yoshida, Akihiko; Garcia, Joaquin; Edgar, Mark A.; Meyers, Paul A.; Morris, Carol D.; Panicek, David M.

2008-01-01

Desmoplastic small round cell tumor (DSRCT) is a rare malignant neoplasm typically involving the abdominal cavity of a young male. Extra-abdominal occurrence of this tumor is very rare. We report a 10-year-old girl with primary DSRCT arising within the left femur. The patient presented with knee pain, and radiological findings were strongly suggestive of osteogenic sarcoma. In addition to the typical microscopic appearance and immunophenotype, RT-PCR demonstrated the chimeric transcript of EWS-WT1, which is diagnostic of DSRCT. Pulmonary metastases were present at initial staging studies, but no abdominal or pelvic lesion was present. Despite chemotherapy and complete tumor excision, the patient developed progressive lung and bone metastases and died 3 years after initial presentation. This is the second reported case of primary DSRCT of bone with genetic confirmation. (orig.)

Primary desmoplastic small round cell tumor of the femur

Energy Technology Data Exchange (ETDEWEB)

Yoshida, Akihiko; Garcia, Joaquin [Memorial Sloan-Kettering Cancer Center, Department of Pathology, New York, NY (United States); Edgar, Mark A. [Memorial Sloan-Kettering Cancer Center, Department of Pathology, New York, NY (United States); Weill Medical College of Cornell University, New York, NY (United States); Meyers, Paul A. [Weill Medical College of Cornell University, New York, NY (United States); Memorial Sloan-Kettering Cancer Center, Department of Pediatrics, New York, NY (United States); Morris, Carol D. [Weill Medical College of Cornell University, New York, NY (United States); Memorial Sloan-Kettering Cancer Center, Department of Surgery, Orthopaedic Service, New York, NY (United States); Panicek, David M. [Weill Medical College of Cornell University, New York, NY (United States); Memorial Sloan-Kettering Cancer Center, Department of Radiology, New York, NY (United States)

2008-09-15

Desmoplastic small round cell tumor (DSRCT) is a rare malignant neoplasm typically involving the abdominal cavity of a young male. Extra-abdominal occurrence of this tumor is very rare. We report a 10-year-old girl with primary DSRCT arising within the left femur. The patient presented with knee pain, and radiological findings were strongly suggestive of osteogenic sarcoma. In addition to the typical microscopic appearance and immunophenotype, RT-PCR demonstrated the chimeric transcript of EWS-WT1, which is diagnostic of DSRCT. Pulmonary metastases were present at initial staging studies, but no abdominal or pelvic lesion was present. Despite chemotherapy and complete tumor excision, the patient developed progressive lung and bone metastases and died 3 years after initial presentation. This is the second reported case of primary DSRCT of bone with genetic confirmation. (orig.)

The efficacy of single-stage open intramedullary nailing of neglected femur fractures.

Science.gov (United States)

Boopalan, P R J V C; Sait, Azad; Jepegnanam, Thilak Samuel; Matthai, Thomas; Varghese, Viju Daniel

2014-02-01

Neglected femur fractures are not rare in the developing world. Treatment options include single-stage open reduction and intramedullary nailing, or open release, skeletal traction, and then second-stage open intramedullary nailing, with bone grafting. Single-stage procedures have the potential advantage of avoiding neurovascular complications secondary to acute lengthening, but they require a second operation, with potentially increased resource use and infection risk. We sought to determine the (1) likelihood of union, (2) complications and reoperations, and (3) functional results with single-stage open intramedullary nailing without bone grafting in patients with neglected femur fractures. Between January 2003 and December 2007, 17 consecutive patients presented to our practice with neglected femoral shaft fractures. All were treated with single-stage nailing without bone grafting. There were 15 men and two women with a median age of 27 years. The average time from fracture to treatment was 13 weeks (range, 4-44 weeks). Eleven patients underwent open nailing with interlocked nails and six were treated with cloverleaf Kuntscher nails. Patients were followed for a minimum of 6 months (mean, 33 months; range, 6-72 months). The mean preoperative ROM of the knee was 28° (range, 10°-150°) and femoral length discrepancy was 3.1 cm (range, 1-5 cm). All fractures united and the mean time to union was 16 weeks (range, 7-32 weeks). There were no neurologic complications secondary to acute lengthening. The mean postoperative ROM of the knee was 130° (range, 60°-150°). All patients were able to return to preinjury work. Sixteen patients regained their original femoral length. One-stage open intramedullary nailing of neglected femoral diaphyseal fractures without bone grafting was safe and effective, and obviated the need for a two-stage approach. Although the findings need to be replicated in larger numbers of patients, we believe this technique may be useful in

Comparison of the effectiveness of phalanges vs. humeri and femurs to estimate lizard age with skeletochronology

Energy Technology Data Exchange (ETDEWEB)

Comas, M.; Reguera, S.; Zamora-Camacho, F.J.; Salvado, H.; Moreno-Rueda, G.

2016-07-01

Skeletochronology allows estimation of lizard age with a single capture (from a bone), making long–term monitoring unnecessary. Nevertheless, this method often involves the death of the animal to obtain the bone. We tested the reliability of skeletochronology of phalanges (which may be obtained without killing) by comparing the estimated age from femurs and humeri with the age estimated from phalanges. Our results show skeletochronology of phalanges is a reliable method to estimate age in lizards as cross–section readings from all bones studied presented a high correlation and repeatability regardless of the bone chosen. This approach provides an alternative to the killing of lizards for skeletochronology studies. (Author)

Comparison of the effectiveness of phalanges vs. humeri and femurs to estimate lizard age with skeletochronology

International Nuclear Information System (INIS)

Comas, M.; Reguera, S.; Zamora-Camacho, F.J.; Salvado, H.; Moreno-Rueda, G.

2016-01-01

Skeletochronology allows estimation of lizard age with a single capture (from a bone), making long–term monitoring unnecessary. Nevertheless, this method often involves the death of the animal to obtain the bone. We tested the reliability of skeletochronology of phalanges (which may be obtained without killing) by comparing the estimated age from femurs and humeri with the age estimated from phalanges. Our results show skeletochronology of phalanges is a reliable method to estimate age in lizards as cross–section readings from all bones studied presented a high correlation and repeatability regardless of the bone chosen. This approach provides an alternative to the killing of lizards for skeletochronology studies. (Author)

Sensitivity and specificity of CT- and MRI-scanning in evaluation of occult fracture of the proximal femur

DEFF Research Database (Denmark)

Haubro, M; Stougaard, C; Torfing, T

2015-01-01

AND METHODS: 67 patients (27 males, 40 females, mean age 80.5) seen in the emergency room with hip pain after fall, inability to stand and a primary X-ray without fracture were evaluated with both CT and MRI. The images were analysed by a senior consulting musculoskeletal radiologist, a resident in radiology...... and a resident in orthopaedic surgery. Sensitivity and specificity were estimated with MRI as the golden standard. Kappa value was used to assess level of agreement in both MRI and CT finding. RESULTS: 15 fractures of the proximal femur were found (7 intertrochanteric-, 3 femoral neck and 5 fractures...

Risk of refracture through unicameral bone cysts of the proximal femur.

Science.gov (United States)

Norman-Taylor, Fabian H; Hashemi-Nejad, Aresh; Gillingham, Bruce L; Stevens, David; Cole, William G

2002-01-01

The authors determined the results after traction or traction and hip spica treatment of the initial fractures through unicameral bone cysts of the proximal femur in 20 children. All of the eight displaced fractures healed, but with coxa vara and avascular necrosis in one, coxa vara in a second, and coxa breva in a third. Spontaneous healing of the cyst occurred in three of the eight children; satisfactory healing was achieved and maintained after intralesional corticosteroid injections in four of the eight children. In the remaining child with a displaced fracture, reactivation of the cyst and exercise-related pain, indicative of an incipient refracture, occurred 3 years after initial presentation. All of the 12 undisplaced fractures healed without deformity or avascular necrosis. Intralesional corticosteroids were used in all of the 12 children because none of them showed spontaneous healing of their cysts. Satisfactory radiographic healing was achieved 1 year after presentation in all of the 12 children. However, one or more refractures resulting from reactivation of the cyst occurred in 6 of the 12 children 2 to 5 years after initial presentation. The results of this study indicate that satisfactory radiographic healing needs to be achieved by the end of the first year and needs to be maintained thereafter to prevent refractures.

What Triggers Early Retirement. Results from Swiss Pension Funds

OpenAIRE

Monika Bütler; Olivia Huguenin; Federica Teppa

2004-01-01

Early retirement is predominantly considered as the result of incentives set by social security and the tax system. But people seem to retire early even in the absence of such distortions as the Swiss example demonstrates. We look for determinants of early retirement, in particular the role of lifetime income and family status, using individual data from a selection of Swiss pension funds. Our findings suggest that affordability is a key determinant in retirement decisions: More affluent men,...

In-vivo study of adhesion and bone growth around implanted laser groove/RGD-functionalized Ti-6Al-4V pins in rabbit femurs

Energy Technology Data Exchange (ETDEWEB)

Chen, J., E-mail: jianboc@gmail.com [Princeton Institute of Science and Technology of Materials and Department of Mechanical and Aerospace Engineering, Princeton University, Princeton, NJ 08544 (United States); Bly, R.A. [Princeton Institute of Science and Technology of Materials and Department of Mechanical and Aerospace Engineering, Princeton University, Princeton, NJ 08544 (United States); Saad, M.M.; AlKhodary, M.A.; El-Backly, R.M. [Tissue Engineering laboratories, Faculty of Dentistry, Alexandria University, Alexandria (Egypt); Cohen, D.J.; Kattamis, N. [Princeton Institute of Science and Technology of Materials and Department of Mechanical and Aerospace Engineering, Princeton University, Princeton, NJ 08544 (United States); Fatta, M.M.; Moore, W.A. [Tissue Engineering laboratories, Faculty of Dentistry, Alexandria University, Alexandria (Egypt); Arnold, C.B. [Princeton Institute of Science and Technology of Materials and Department of Mechanical and Aerospace Engineering, Princeton University, Princeton, NJ 08544 (United States); Marei, M.K. [Tissue Engineering laboratories, Faculty of Dentistry, Alexandria University, Alexandria (Egypt); Soboyejo, W.O. [Princeton Institute of Science and Technology of Materials and Department of Mechanical and Aerospace Engineering, Princeton University, Princeton, NJ 08544 (United States)

2011-07-20

Titanium surfaces were designed, produced, and evaluated for levels of osseointegration into the femurs of rabbits. A total of 36 Ti-6Al-4V pins (15 mm length, 1.64 mm diameter) were prepared into three experimental groups. These were designed to test the effects of osseointegration on laser grooved, RGD coated, and polished control surfaces, as well as combined effects. Circumferential laser grooves were introduced onto pin surfaces (40 {mu}m spacing) using a UV laser ({lambda} = 355 nm). The tripeptide sequence, Arginine-Glycine-Aspartic acid (RGD), was functionalized onto laser grooved surfaces. Of the prepared samples, surface morphology and chemistry were analyzed using scanning electron microscopy (SEM) and Immunoflourescence (IF) spectroscopy, respectively. The experimental pin surfaces were surgically implanted into rabbit femurs. The samples were then harvested and evaluated histologically. Sections of the sample were preserved in a methylmethacralate mold, sliced via a hard microtome, and polished systematically. In the case of the RGD coated and laser grooved surfaces, histological results showed accelerated bone growth into the implant, pull-out tests were also used to compare the adhesion between bone and the titanium pins with/without laser textures and/or RGD coatings. - Research highlights: {yields} Circumferential laser grooves were introduced onto pin surfaces using a UV laser. {yields} The tripeptide sequence, RGD, was functionalized onto laser grooved surfaces. {yields} The experimental pin surfaces were surgically implanted into rabbit femurs. {yields} RGD coated laser groove surfaces accelerated bone growth into the implant. {yields} RGD coated laser grooved surfaces enhanced the adhesion between the bone and implant.

In-vivo study of adhesion and bone growth around implanted laser groove/RGD-functionalized Ti-6Al-4V pins in rabbit femurs

International Nuclear Information System (INIS)

Chen, J.; Bly, R.A.; Saad, M.M.; AlKhodary, M.A.; El-Backly, R.M.; Cohen, D.J.; Kattamis, N.; Fatta, M.M.; Moore, W.A.; Arnold, C.B.; Marei, M.K.; Soboyejo, W.O.

2011-01-01

Titanium surfaces were designed, produced, and evaluated for levels of osseointegration into the femurs of rabbits. A total of 36 Ti-6Al-4V pins (15 mm length, 1.64 mm diameter) were prepared into three experimental groups. These were designed to test the effects of osseointegration on laser grooved, RGD coated, and polished control surfaces, as well as combined effects. Circumferential laser grooves were introduced onto pin surfaces (40 μm spacing) using a UV laser (λ = 355 nm). The tripeptide sequence, Arginine-Glycine-Aspartic acid (RGD), was functionalized onto laser grooved surfaces. Of the prepared samples, surface morphology and chemistry were analyzed using scanning electron microscopy (SEM) and Immunoflourescence (IF) spectroscopy, respectively. The experimental pin surfaces were surgically implanted into rabbit femurs. The samples were then harvested and evaluated histologically. Sections of the sample were preserved in a methylmethacralate mold, sliced via a hard microtome, and polished systematically. In the case of the RGD coated and laser grooved surfaces, histological results showed accelerated bone growth into the implant, pull-out tests were also used to compare the adhesion between bone and the titanium pins with/without laser textures and/or RGD coatings. - Research highlights: → Circumferential laser grooves were introduced onto pin surfaces using a UV laser. → The tripeptide sequence, RGD, was functionalized onto laser grooved surfaces. → The experimental pin surfaces were surgically implanted into rabbit femurs. → RGD coated laser groove surfaces accelerated bone growth into the implant. → RGD coated laser grooved surfaces enhanced the adhesion between the bone and implant.

Segmentation of radiographic images under topological constraints: application to the femur.

Science.gov (United States)

Gamage, Pavan; Xie, Sheng Quan; Delmas, Patrice; Xu, Wei Liang

2010-09-01

A framework for radiographic image segmentation under topological control based on two-dimensional (2D) image analysis was developed. The system is intended for use in common radiological tasks including fracture treatment analysis, osteoarthritis diagnostics and osteotomy management planning. The segmentation framework utilizes a generic three-dimensional (3D) model of the bone of interest to define the anatomical topology. Non-rigid registration is performed between the projected contours of the generic 3D model and extracted edges of the X-ray image to achieve the segmentation. For fractured bones, the segmentation requires an additional step where a region-based active contours curve evolution is performed with a level set Mumford-Shah method to obtain the fracture surface edge. The application of the segmentation framework to analysis of human femur radiographs was evaluated. The proposed system has two major innovations. First, definition of the topological constraints does not require a statistical learning process, so the method is generally applicable to a variety of bony anatomy segmentation problems. Second, the methodology is able to handle both intact and fractured bone segmentation. Testing on clinical X-ray images yielded an average root mean squared distance (between the automatically segmented femur contour and the manual segmented ground truth) of 1.10 mm with a standard deviation of 0.13 mm. The proposed point correspondence estimation algorithm was benchmarked against three state-of-the-art point matching algorithms, demonstrating successful non-rigid registration for the cases of interest. A topologically constrained automatic bone contour segmentation framework was developed and tested, providing robustness to noise, outliers, deformations and occlusions.

Segmentation of radiographic images under topological constraints: application to the femur

International Nuclear Information System (INIS)

Gamage, Pavan; Xie, Sheng Quan; Delmas, Patrice; Xu, Wei Liang

2010-01-01

A framework for radiographic image segmentation under topological control based on two-dimensional (2D) image analysis was developed. The system is intended for use in common radiological tasks including fracture treatment analysis, osteoarthritis diagnostics and osteotomy management planning. The segmentation framework utilizes a generic three-dimensional (3D) model of the bone of interest to define the anatomical topology. Non-rigid registration is performed between the projected contours of the generic 3D model and extracted edges of the X-ray image to achieve the segmentation. For fractured bones, the segmentation requires an additional step where a region-based active contours curve evolution is performed with a level set Mumford-Shah method to obtain the fracture surface edge. The application of the segmentation framework to analysis of human femur radiographs was evaluated. The proposed system has two major innovations. First, definition of the topological constraints does not require a statistical learning process, so the method is generally applicable to a variety of bony anatomy segmentation problems. Second, the methodology is able to handle both intact and fractured bone segmentation. Testing on clinical X-ray images yielded an average root mean squared distance (between the automatically segmented femur contour and the manual segmented ground truth) of 1.10 mm with a standard deviation of 0.13 mm. The proposed point correspondence estimation algorithm was benchmarked against three state-of-the-art point matching algorithms, demonstrating successful non-rigid registration for the cases of interest. A topologically constrained automatic bone contour segmentation framework was developed and tested, providing robustness to noise, outliers, deformations and occlusions. (orig.)

Segmentation of radiographic images under topological constraints: application to the femur

Energy Technology Data Exchange (ETDEWEB)

Gamage, Pavan; Xie, Sheng Quan [University of Auckland, Department of Mechanical Engineering (Mechatronics), Auckland (New Zealand); Delmas, Patrice [University of Auckland, Department of Computer Science, Auckland (New Zealand); Xu, Wei Liang [Massey University, School of Engineering and Advanced Technology, Auckland (New Zealand)

2010-09-15

A framework for radiographic image segmentation under topological control based on two-dimensional (2D) image analysis was developed. The system is intended for use in common radiological tasks including fracture treatment analysis, osteoarthritis diagnostics and osteotomy management planning. The segmentation framework utilizes a generic three-dimensional (3D) model of the bone of interest to define the anatomical topology. Non-rigid registration is performed between the projected contours of the generic 3D model and extracted edges of the X-ray image to achieve the segmentation. For fractured bones, the segmentation requires an additional step where a region-based active contours curve evolution is performed with a level set Mumford-Shah method to obtain the fracture surface edge. The application of the segmentation framework to analysis of human femur radiographs was evaluated. The proposed system has two major innovations. First, definition of the topological constraints does not require a statistical learning process, so the method is generally applicable to a variety of bony anatomy segmentation problems. Second, the methodology is able to handle both intact and fractured bone segmentation. Testing on clinical X-ray images yielded an average root mean squared distance (between the automatically segmented femur contour and the manual segmented ground truth) of 1.10 mm with a standard deviation of 0.13 mm. The proposed point correspondence estimation algorithm was benchmarked against three state-of-the-art point matching algorithms, demonstrating successful non-rigid registration for the cases of interest. A topologically constrained automatic bone contour segmentation framework was developed and tested, providing robustness to noise, outliers, deformations and occlusions. (orig.)

The use of small interfering RNAs to inhibit adipocyte differentiation in human preadipocytes and fetal-femur-derived mesenchymal cells

International Nuclear Information System (INIS)

Xu, Y.; Mirmalek-Sani, S.-H.; Yang, X.; Zhang, J.; Oreffo, R.O.C.

2006-01-01

RNA interference (RNAi) has been used in functional genomics and offers innovative approaches in the development of novel therapeutics. Human mesenchymal stem cells offer a unique cell source for tissue engineering/regeneration strategies. The current study examined the potential of small interfering RNAs (siRNA) against human peroxisome proliferator activated receptor gamma (PPARγ) to suppress adipocyte differentiation (adipogenesis) in human preadipocytes and fetal-femur-derived mesenchymal cells. Adipogenesis was investigated using cellular and biochemical analysis. Transient transfection with PPARγ-siRNA using a liposomal-based strategy resulted in a significant inhibition of adipogenesis in human preadipocytes and fetal-femur-derived mesenchymal cells, compared to controls (cell, liposomal and negative siRNA). The inhibitory effect of PPARγ-siRNA was supported by testing human PPARγ mRNA and adipogenic associated genes using reverse transcription polymerase chain reaction (RT-PCR) to adiponectin receptor 1 and 2 as well as examination of fatty acid binding protein 3 (FABP 3 ) expression, an adipocyte-specific marker. The current studies indicate that PPARγ-siRNA is a useful tool to study adipogenesis in human cells, with potential applications both therapeutic and in the elucidation of mesenchymal cell differentiation in the modulation of cell differentiation in human mesenchymal cells

Effect of Pentoxifylline Administration on an Experimental Rat Model of Femur Fracture Healing With Intramedullary Fixation.

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Vashghani Farahani, Mohammad Mahdi; Masteri Farahani, Reza; Mostafavinia, Ataroalsadat; Abbasian, Mohammad Reza; Pouriran, Ramin; Noruzian, Mohammad; Ghoreishi, Seyed Kamran; Aryan, Arefe; Bayat, Mohammad

2015-12-01

Globally, musculoskeletal injuries comprise a major public health problem that contributes to a large burden of disability and suffering. Pentoxifylline (PTX) has been originally used as a hemorheologic drug to treat intermittent claudication. Previous test tube and in vivo studies reported the beneficial effects of PTX on bony tissue. This study aims to evaluate the effects of different dosages of PTX on biomechanical properties that occur during the late phase of the fracture healing process following a complete femoral osteotomy in a rat model. We applied intramedullary pin fixation as the treatment of choice. This experimental study was conducted at the Shahid Beheshti University of Medical Sciences, Tehran, Iran. We used the simple random technique to divide 35 female rats into five groups. Group 1 received intraperitoneal (i.p.) PTX (50 mg/kg, once daily) injections, starting 15 days before surgery, and group 2, group 3, and group 4 received 50 mg/kg, 100 mg/kg, and 200 mg/kg i.p. PTX injections, respectively, once daily after surgery. All animals across groups received treatment for six weeks (until sacrificed). Complete surgical transverse osteotomy was performed in the right femur of all rats. At six weeks after surgery, the femurs were subjected to a three-point bending test. Daily administration of 50 mg/kg PTX (groups 1 and 2) decreased the high stress load in repairing osteotomized femurs when compared with the control group. The highest dose of PTX (200 mg/kg) significantly increased the high stress load when compared with the control group (P = 0.030), group 1 (P = 0.023), group 2 (P = 0.008), and group 3 (P = 0.010), per the LSD findings. Treatment with 200 mg/kg PTX accelerated fracture healing when compared with the control group.

Removal of well-fixed components in femoral revision arthroplasty with controlled segmentation of the proximal femur.

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Megas, Panagiotis; Georgiou, Christos S; Panagopoulos, Andreas; Kouzelis, Antonis

2014-12-31

The transfemoral and the extended trochanteric osteotomies are the most common osteotomies used in femoral revision, both when proximal or diaphyseal fixation of the new component has been decided. We present an alternative approach to the trochanteric osteotomies, most frequently used with distally fixated stems, to overcome their shortcomings of osteotomy migration and nonunion, but, most of all, the uncontrollable fragmentation of the femur. The procedure includes a complete circular femoral osteotomy just below the stem tip to prevent distal fracture propagation and a subsequent preplanned segmentation of the proximal femur for better exposure and fast removal of the old prosthesis. The bone fragments are reattached with cerclage wires to the revision prosthesis, which is safely anchored distally. A modified posterolateral approach is used, as the preservation of the continuity of the abductors, the greater trochanter, and the vastus lateralis is a prerequisite. Between 2006 and 2012, 47 stems (33 women, 14 men, mean age 68 years, range 39-88 years) were revised using this technique. They were 12 (26%) stable and 35 (74%) loose prostheses and were all revised to tapered, fluted, grit-blasted stems. No fracture of the trochanters or the distal femur occurred intraoperatively. Mean follow-up was 28 months (range 6-70 months). No case of trochanteric migration or nonunion of the osteotomies was recorded. Restoration of the preexisting bone defects occurred in 83% of the patients. Three patients required repeat revision due to dislocation and one due to a postoperative periprosthetic fracture. None of the failures was attributed to the procedure itself. This new osteotomy technique may seem aggressive at first, but, at least in our hands, has effectively increased the speed of the femoral revision, particularly for the most difficult well-fixed components, but not at the expense of safety.

Are Albumin levels a good predictor of mortality in elderly patients with neck of femur fractures?

OpenAIRE

Harrison, S.J.; Leeder, D.J.; Stephenson, John; Sidhom, S.A.

2015-01-01

Background\\ud Neck of femur (NOF) fractures are associated with significant morbidity and mortality in elderly people with multiple co-morbidities; making management of this patient subgroup challenging. Predictors of an increase in morbidity and mortality would therefore provide a useful framework for the assessment and management of this demographic. Within the current literature, hypoalbuminaemia (

Uncemented allograft-prosthetic composite reconstruction of the proximal femur

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Li Min

2014-01-01

Full Text Available Background: Allograft-prosthetic composite can be divided into three groups names cemented, uncemented, and partially cemented. Previous studies have mainly reported outcomes in cemented and partially cemented allograft-prosthetic composites, but have rarely focused on the uncemented allograft-prosthetic composites. The objectives of our study were to describe a surgical technique for using proximal femoral uncemented allograft-prosthetic composite and to present the radiographic and clinical results. Materials and Methods: Twelve patients who underwent uncemented allograft-prosthetic composite reconstruction of the proximal femur after bone tumor resection were retrospectively evaluated at an average followup of 24.0 months. Clinical records and radiographs were evaluated. Results: In our series, union occurred in all the patients (100%; range 5-9 months. Until the most recent followup, there were no cases with infection, nonunion of the greater trochanter, junctional bone resorption, dislocation, allergic reaction, wear of acetabulum socket, recurrence, and metastasis. But there were three periprosthetic fractures which were fixed using cerclage wire during surgery. Five cases had bone resorption in and around the greater trochanter. The average Musculoskeletal Tumor Society (MSTS score and Harris hip score (HHS were 26.2 points (range 24-29 points and 80.6 points (range 66.2-92.7 points, respectively. Conclusions: These results showed that uncemented allograft-prosthetic composite could promote bone union through compression at the host-allograft junction and is a good choice for proximal femoral resection. Although this technology has its own merits, long term outcomes are yet not validated.

Bilateral undisplaced insufficiency neck of femur fractures associated with short-term steroid use: a case report

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Gurdezi Sabahat

2008-03-01

Full Text Available Abstract Introduction We present an interesting and unusual case of a 61-year-old woman with bilateral, undisplaced, stress neck of femur fractures associated with short-term steroid use. Insufficiency fractures of the neck of femur without preceding trauma have been described in the literature, although bilateral involvement is infrequent. These fractures have been associated with strenuous exercise, seizures, renal osteodystrophy, fluoride treatment, long-term corticosteroid use, amenorrhoea, abnormal anatomy and osteomalacia due to nutritional and/or hormonal factors. Case Presentation The case we present differs from other published reports, in that the patient's symptoms developed acutely after only a short course of steroids and with no associated trauma or strenuous exercise. It is also the only case described where no operative intervention was required. Conclusion Our case reiterates the importance of considering insufficiency or stress fractures in high-risk patients who present with musculoskeletal pain. Institution of bone protection should also be considered in these patients. Morbidity related to delayed treatment has been well documented, so a high level of clinical suspicion is imperative.

Mathematical representation of the normal proximal human femur: application in planning of cam hip surgery.

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Masjedi, Milad; Harris, Simon J; Davda, Kinner; Cobb, Justin P

2013-04-01

Precise modelling of the proximal femur can be used for detecting and planning corrective surgery for subjects with deformed femurs using robotic technology or navigation systems. In this study, the proximal femoral geometry has been modelled mathematically. It is hypothesised that it is possible to fit a quadratic surface or combinations of them onto different bone surfaces with a relatively good fit. Forty-six computed tomography datasets of normal proximal femora were segmented. A least-squares fitting algorithm was used to fit a quadratic surface on the femoral head and neck such that the sum of distances between a set of points on the femoral neck and the quadratic surface was minimised. Furthermore, the position of the head-neck articular margin was also measured. The femoral neck was found to be represented as a good fit to a hyperboloid with an average root mean-squared error of 1.0 ± 0.13 mm while the shape of the femoral articular margin was a reproducible sinusoidal wave form with two peaks. The mathematical description in this study can be used for planning corrective surgery for subjects with cam-type femoroacetabular impingement.

Acute postoperative osteomyelitis in femur fracture: contribution of bone scintilography (case report)

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Borges, Natalie Ferreira; Rezende, Cleuza Maria de Faria; Sanchez-Ucros, Natalia; Laguardia, Priscilla [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Escola de Veterinaria; Diniz, Simone Odilia Fernandes; Cardoso, Valbert Nascimento [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Faculdade de Farmacia; Rodrigues, Carlos Jorge Simal [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Faculdade de Medicina; Santos, Raquel Gouvea dos [Centro de Desenvolcimento da Tecnologia Nuclear (CDTN/CNEN-MG), Belo Horizonte, MG (Brazil). Lab. de Radiobiologia

2009-07-01

The treatment of bone fractures is aimed at consolidating and returns of function as soon as possible and can be performed by different methods. Treatment with the plate in fractures of the femur in bridge aims not to address the location of fracture and stabilize it, maintaining the anatomical axis by the fixation of proximal and distal segments. Postoperative follow-up of the fracture is necessary to evaluate the irrigation of the bone structure and the effect of the method. The scintigraphy is a method capable of assessing the degree of bone remodeling and the presence or absence of local bone homeostasis. The objective of this report is to present the case of a rabbit, male, which was subjected to osteotomy and fixation of the femoral diaphysis by means of the plate in the bridge. After 10 days the animal was subjected to scintigraphic and radiographic evaluations. The animal came to death and an autopsy was performed on the same when it was observed macroscopy consistent with acute osteomyelitis due to contamination postoperative time. Radiographic evaluation in acute osteomyelitis is unclear. The methods assist in the scintigraphic diagnosis of osteomyelitis by allowing the detection of functional changes in this infectious process. The bone scintigraphy with diphosphonates labeled with technetium-99m shows increased bone turnover in the infected area and its high sensitivity, even in an early stage makes it the method of choice in the diagnosis of acute osteomyelitis in patients without prior bone disease and bone radiologically normal. (author)

Acute postoperative osteomyelitis in femur fracture: contribution of bone scintilography (case report)

International Nuclear Information System (INIS)

Borges, Natalie Ferreira; Rezende, Cleuza Maria de Faria; Sanchez-Ucros, Natalia; Laguardia, Priscilla; Diniz, Simone Odilia Fernandes; Cardoso, Valbert Nascimento; Rodrigues, Carlos Jorge Simal; Santos, Raquel Gouvea dos

2009-01-01

The treatment of bone fractures is aimed at consolidating and returns of function as soon as possible and can be performed by different methods. Treatment with the plate in fractures of the femur in bridge aims not to address the location of fracture and stabilize it, maintaining the anatomical axis by the fixation of proximal and distal segments. Postoperative follow-up of the fracture is necessary to evaluate the irrigation of the bone structure and the effect of the method. The scintigraphy is a method capable of assessing the degree of bone remodeling and the presence or absence of local bone homeostasis. The objective of this report is to present the case of a rabbit, male, which was subjected to osteotomy and fixation of the femoral diaphysis by means of the plate in the bridge. After 10 days the animal was subjected to scintigraphic and radiographic evaluations. The animal came to death and an autopsy was performed on the same when it was observed macroscopy consistent with acute osteomyelitis due to contamination postoperative time. Radiographic evaluation in acute osteomyelitis is unclear. The methods assist in the scintigraphic diagnosis of osteomyelitis by allowing the detection of functional changes in this infectious process. The bone scintigraphy with diphosphonates labeled with technetium-99m shows increased bone turnover in the infected area and its high sensitivity, even in an early stage makes it the method of choice in the diagnosis of acute osteomyelitis in patients without prior bone disease and bone radiologically normal. (author)

MR assessment of red marrow distribution and composition in the proximal femur: correlation with clinical and laboratory parameters

International Nuclear Information System (INIS)

Berg, B.C. vande; Lecouvet, F.E.; Moysan, P.; Maldague, B.; Malghem, J.; Jamart, J.

1997-01-01

Objective. To correlate the MR appearance of the proximal femur marrow with clinical and blood parameters. Design and patients. The proportion of the femoral neck surface area occupied by red marrow was determined on T1-weighted magnetic resonance (MR) images of the hip in a series of 120 subjects, aged from 15 to 75 years, with ten females and ten males per decade, and correlated with clinical data. This parameter and the bulk T1 values of femoral red marrow were determined in 30 other subjects 25-46 years of age and correlated with their blood parameters. Results. In the series of 120 subjects, the proportion of red marrow surface area decreased with age (P -4 ) and was higher in female than male subjects (P -4 ). Within each decade, the proportion of red marrow surface area was higher in females than in males between 25 and 65 years but neither before 25 nor after 65 years. In the series of 30 subjects, the proportion of red marrow surface area and bulk T1 values of femoral red marrow were significantly negatively correlated with hemoglobin blood levels but not with blood cell counts. Conclusion. The MR appearance of proximal femur red marrow is influenced by age and sex. A relationship with hemoglobin blood level is demonstrated. (orig.)

Use of anti-depressants and the risk of fracture of the hip or femur

OpenAIRE

van den Brand, M. W. M.; Samson, M. M.; Pouwels, S.; van Staa, T. P.; Thio, B.; Cooper, C.; Leufkens, H. G. M.; Egberts, A. C. G.; Verhaar, H. J. J.; de Vries, F.

2009-01-01

Summary Anti-depressants are used largely, but have serious side effects. We show that both selective serotonin re-uptake inhibitors (SSRIs) and tricyclic anti-depressants (TCAs) increase the risk of hip/femur fracture and that this risk is time related and depends on the degree of serotonin transporter inhibition. This should be considered when prescribing anti-depressants to patients. Introduction Anti-depressants are known to have serious side effects. We examined the association between t...

Increase in tartrate-resistant acid phosphatase of bone at the early stage of ascorbic acid deficiency in the ascorbate-requiring Osteogenic Disorder Shionogi (ODS) rat.

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Goto, A; Tsukamoto, I

2003-08-01

The effect of ascorbic acid deficiency on bone metabolism was evaluated using the ascorbate-requiring Osteogenic Disorder Shionogi (ODS) rat model. Ascorbic acid (Asc)-deficient rats gained body weight in a manner similar to Asc-supplemented rats (control) during 3 weeks, but began to lose weight during the 4th week of Asc deficiency. The tartrate-resistant acid phosphatase (TRAP) activity in serum increased to about 2-fold the control value in the rats fed the Asc-free diet for 2, 3, and 4 weeks (AscD2, AscD3, and AscD4), while a decrease in the alkaline phosphatase (ALP) activity was observed only in AscD4 rats. The serum pyridinoline cross-linked carboxyterminal telopeptide of type I collagen (ICTP) level significantly increased to 1.3-, 1.4-, and 1.9-fold of that in the controls in AscD2, D3, and D4, respectively. The ALP activity in the distal femur was unchanged in AscD1, D2, and D3, but decreased to 50% of the control level in AscD4 rats. The TRAP activity in the distal femur increased to about 2-fold of that in the controls in the AscD2 and D3 and decreased to the control level in the AscD4 rats. The amount of hydroxyproline in the distal femur significantly decreased to about 80%, 70%, and 60% of the control in AscD2, D3, and D4 rats, respectively. These decreases were associated with a similar reduction in the calcium content of the distal femur. Histochemical analysis of the distal femur showed an increase in TRAP-positive cells in AscD2 and AscD3 rats and a decrease in the trabecular bone in AscD2, D3, and D4 rats. These results suggested that a deficiency of Asc stimulated bone resorption at an early stage, followed by a decrease in bone formation in mature ODS rats which already had a well-developed collagen matrix and fully differentiated osteoblasts.

Effects of diet-induced obesity and voluntary wheel running on the microstructure of the murine distal femur

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Timonen Jussi

2011-01-01

Full Text Available Abstract Background Obesity and osteoporosis, two possibly related conditions, are rapidly expanding health concerns in modern society. Both of them are associated with sedentary life style and nutrition. To investigate the effects of diet-induced obesity and voluntary physical activity we used high resolution micro-computed tomography (μCT together with peripheral quantitative computed tomography (pQCT to examine the microstructure of the distal femoral metaphysis in mice. Methods Forty 7-week-old male C57BL/6J mice were assigned to 4 groups: control (C, control + running (CR, high-fat diet (HF, and high-fat diet + running (HFR. After a 21-week intervention, all the mice were sacrificed and the left femur dissected for pQCT and μCT measurements. Results The mice fed the high-fat diet showed a significant weight gain (over 70% for HF and 60% for HFR, with increased epididymal fat pad mass and impaired insulin sensitivity. These obese mice had significantly higher trabecular connectivity density, volume, number, thickness, area and mass, and smaller trabecular separation. At the whole bone level, they had larger bone circumference and cross-sectional area and higher density-weighted maximal, minimal, and polar moments of inertia. Voluntary wheel running decreased all the cortical bone parameters, but increased the trabecular mineral density, and decreased the pattern factor and structure model index towards a more plate-like structure. Conclusions The results suggest that in mice the femur adapts to obesity by improving bone strength both at the whole bone and micro-structural level. Adaptation to running exercise manifests itself in increased trabecular density and improved 3D structure, but in a limited overall bone growth

Cortical thickness estimation of the proximal femur from multi-view dual-energy X-ray absorptiometry (DXA)

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Tsaousis, N.; Gee, A. H.; Treece, G. M.; Poole, K. E. S.

2013-02-01

Hip fracture is the leading cause of acute orthopaedic hospital admission amongst the elderly, with around a third of patients not surviving one year post-fracture. Although various preventative therapies are available, patient selection is difficult. The current state-of-the-art risk assessment tool (FRAX) ignores focal structural defects, such as cortical bone thinning, a critical component in characterizing hip fragility. Cortical thickness can be measured using CT, but this is expensive and involves a significant radiation dose. Instead, Dual-Energy X-ray Absorptiometry (DXA) is currently the preferred imaging modality for assessing hip fracture risk and is used routinely in clinical practice. Our ambition is to develop a tool to measure cortical thickness using multi-view DXA instead of CT. In this initial study, we work with digitally reconstructed radiographs (DRRs) derived from CT data as a surrogate for DXA scans: this enables us to compare directly the thickness estimates with the gold standard CT results. Our approach involves a model-based femoral shape reconstruction followed by a data-driven algorithm to extract numerous cortical thickness point estimates. In a series of experiments on the shaft and trochanteric regions of 48 proximal femurs, we validated our algorithm and established its performance limits using 20 views in the range 0°-171°: estimation errors were 0:19 +/- 0:53mm (mean +/- one standard deviation). In a more clinically viable protocol using four views in the range 0°-51°, where no other bony structures obstruct the projection of the femur, measurement errors were -0:07 +/- 0:79 mm.

Nontraumatic femur fracture in an oligomenorrheic athlete.

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Dugowson, C E; Drinkwater, B L; Clark, J M

1991-12-01

Exercise-associated amenorrhea is the cessation of menses in a woman following onset of training or an increase in training intensity. Its physiologic basis is characterized by consistently low levels of gonadotropin and ovarian hormones, but the underlying cause of this phenomenon is unknown. Although osteopenia has been described in amenorrheic women athletes, it has been primarily a laboratory diagnosis. Several recent studies have described a significantly lower bone mineral density (BMD) in the lumbar spine of amenorrheic athletes. Marcus et al. also reported an increased number of metatarsal and tibial stress fractures in a group of amenorrheic women. We report here the first case of a nontraumatic femur fracture in an amenorrheic athlete. A 32-yr-old white female, with four prior fibular stress fractures, suffered a left femoral shaft fracture during the 13th mile of a half-marathon. The fracture was successfully internally fixed. Biochemical studies showed no metabolic abnormality. Bone mineral density of the lumbar spine, femoral neck, tibia, and fibula were below the mean for both eumenorrheic and amenorrheic female athletes. Exercise-associated amenorrhea is a medical problem that may have serious implications for both competitive and high-intensity recreational female athletes.

Coffee consumption and CYP1A2 genotype in relation to bone mineral density of the proximal femur in elderly men and women: a cohort study.

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Hallström, Helena; Melhus, Håkan; Glynn, Anders; Lind, Lars; Syvänen, Ann-Christine; Michaëlsson, Karl

2010-02-22

Drinking coffee has been linked to reduced calcium conservation, but it is less clear whether it leads to sustained bone mineral loss and if individual predisposition for caffeine metabolism might be important in this context. Therefore, the relation between consumption of coffee and bone mineral density (BMD) at the proximal femur in men and women was studied, taking into account, for the first time, genotypes for cytochrome P450 1A2 (CYP1A2) associated with metabolism of caffeine. Dietary intakes of 359 men and 358 women (aged 72 years), participants of the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS), were assessed by a 7-day food diary. Two years later, BMD for total proximal femur, femoral neck and trochanteric regions of the proximal femur were measured by Dual-energy X-ray absorptiometry (DXA). Genotypes of CYP1A2 were determined. Adjusted means of BMD for each category of coffee consumption were calculated. Men consuming 4 cups of coffee or more per day had 4% lower BMD at the proximal femur (p = 0.04) compared with low or non-consumers of coffee. This difference was not observed in women. In high consumers of coffee, those with rapid metabolism of caffeine (C/C genotype) had lower BMD at the femoral neck (p = 0.01) and at the trochanter (p = 0.03) than slow metabolizers (T/T and C/T genotypes). Calcium intake did not modify the relation between coffee and BMD. High consumption of coffee seems to contribute to a reduction in BMD of the proximal femur in elderly men, but not in women. BMD was lower in high consumers of coffee with rapid metabolism of caffeine, suggesting that rapid metabolizers of caffeine may constitute a risk group for bone loss induced by coffee.

"Push back" technique: A simple method to remove broken drill bit from the proximal femur.

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Chouhan, Devendra K; Sharma, Siddhartha

2015-11-18

Broken drill bits can be difficult to remove from the proximal femur and may necessitate additional surgical exploration or special instrumentation. We present a simple technique to remove a broken drill bit that does not require any special instrumentation and can be accomplished through the existing incision. This technique is useful for those cases where the length of the broken drill bit is greater than the diameter of the bone.

INCIDENCE AND CHARACTERIZATION OF ELDERLY IN THE ORTHOPEDIC CLINIC FOR FEMUR FRACTURE, CACERES MT

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Andréia Costa Ferreira

2013-05-01

Full Text Available Introduction:The elderly population is growing gradually in recent years, it increases theincidence of elderly people at risk of falls and hip fractures develop.Objective:To identifythe incidence and characterize elderly patients hospitalized with hip fractures in theOrthopedic Clinic of the Hospital Regional Dr º Antonio Cáceres sources.Methodology:Thisis an epidemiological, descriptive, quantitative and retrospective data collection documentbasis. The study population comprised 105.Results:It was found that the fracture of thefemur showed predominance in females, comprising 40.90% of the cases and the right lowerlimb most affected. As for location, the trochanteric fractures showed 39.04%, followed byfractures of the femoral shaftwith 27.61% of the cases. The treatment applied in 62.85% ofpatients went to surgery.Conclusion:It is concluded that the femur fracture may preclude theelderly in their daily activities.

Fecal Fistula Communicating with a Femur Shaft Fracture Secondary to a Malpositioned Suprapubic Catheter: A Case Report.

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Guled, Uday; Goni, Vijay G; Honnurappa, Arjun R H; John, Rakesh; Vardhana, Harsha; Sharma, Gaurav; Pattabhiraman, Kirubakaran S

2015-10-06

Suprapubic catheter (SPC) insertion is a common urological procedure. Though considered a simple and safe procedure, complications are bound to occur if proper precautions are not taken during the procedure. The reported complications include gross hematuria, post-obstruction diuresis, insertion site skin-related complications, and intra-abdominal visceral injuries. Iatrogenic bowel injuries have been reported to occur as a complication in around 2.5% of cases. We report a very rare case of a bowel injury due to improper insertion of a SPC leading to fecal matter tracking along the muscle planes to reach the fracture site of the femur shaft and formation of an external fecal fistula along the lateral aspect of thigh, which according to us is the first reported case in the literature. This case report shows the devastating complication of a technically simple procedure done in an improper manner and successful management of a rare case of femur fracture with communicating fecal fistula. The purpose of this case report is to highlight the importance of taking proper precautions before the procedure.

A seasonal variation of calcitropic hormones, bone turnover and bone mineral density in early and mid-puberty girls - a cross-sectional study

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Viljakainen, H.T.; Palssa, A.; Karkkainen, M.

2006-01-01

-six girls, mean age 11 center dot 4 (sd 0 center dot 4) years, in Tanner stage 2 (early puberty) and 3 (mid-puberty) were studied during September to March. The BMD was measured from the lumbar vertebrae and the left femur by dual-energy X-ray absoptiometry. Their serum 25-hydroxyvitamin D (S-25-OHD), serum...

Identify fracture-critical regions inside the proximal femur using statistical parametric mapping

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Li, Wenjun; Kornak, John; Harris, Tamara; Keyak, Joyce; Li, Caixia; Lu, Ying; Cheng, Xiaoguang; Lang, Thomas

2009-01-01

We identified regions inside the proximal femur that are most strongly associated with hip fracture. Bone densitometry based on such fracture-critical regions showed improved power in discriminating fracture patients from controls. Introduction Hip fractures typically occur in lateral falls, with focal mechanical failure of the sub-volumes of tissue in which the applied stress exceeds the strength. In this study, we describe a new methodology to identify proximal femoral tissue elements with highest association with hip fracture. We hypothesize that bone mineral density (BMD) measured in such sub-volumes discriminates hip fracture risk better than BMD in standard anatomic regions such as the femoral neck and trochanter. Materials and Methods We employed inter-subject registration to transform hip QCT images of 37 patients with hip fractures and 38 age-matched controls into a voxel-based statistical atlas. Within voxels, we performed t-tests between the two groups to identify the regions which differed most. We then randomly divided the 75 scans into a training set and a test set. From the training set, we derived a fracture-driven region of interest (ROI) based on association with fracture. In the test set, we measured BMD in this ROI to determine fracture discrimination efficacy using ROC analysis. Additionally, we compared the BMD distribution differences between the 29 patients with neck fractures and the 8 patients with trochanteric fractures. Results By evaluating fracture discrimination power based on ROC analysis, the fracture-driven ROI had an AUC (area under curve) of 0.92, while anatomic ROIs (including the entire proximal femur, the femoral neck, trochanter and their cortical and trabecular compartments) had AUC values between 0.78 and 0.87. We also observed that the neck fracture patients had lower BMD (p=0.014) in a small region near the femoral neck and the femoral head, and patients with trochanteric fractures had lower BMD in trochanteric regions

The Effect of Gabapentin and Tramadol in Cancer Pain Induced by Glioma Cell in Rat Femur.

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Corona-Ramos, Janette Nallely; Déciga-Campos, Myrna; Romero-Piña, Mario; Medina, Luis A; Martínez-Racine, Issac; Jaramillo-Morales, Osmar A; García-López, Patricia; López-Muñoz, Francisco Javier

2017-08-01

Preclinical Research The presence of pain as part of the cancer process is variable. Glioblastoma multiform (GBM) can produce bone metastasis, a condition that involves other pathological phenotypes including neuropathic and inflammatory pain. Tramadol and gabapentin are drugs used in the treatment of neuropathic pain. However, there are no studies evaluating their analgesic effects in bone metastasis. We produced a pain model induced by the inoculation of glioma cells (10 5 ) into the rat femur, by perforating the intercodiloid fossa. Painful behavior was evaluated by measuring mechanical allodynia using the Von Frey test while thermal hyperalgesia was assessed in the plantar test. Histopathological features were evaluated and antinociceptive responses were compared using tramadol and gabapentin. The inoculation of cells inside the right femur produced nociceptive behaviors. Tramadol and gabapentin produced an anti-allodynic effect in this condition, but tramadol did not produce an anti-hyperalgesic response. The development of this model will allow us to perform tests to elucidate the pathology of bone metastasis, cancer pain, and in particular the pain produced by glioma. Drug Dev Res 78 : 173-183, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Robotic technique improves entry point alignment for intramedullary nailing of femur fractures compared to the conventional technique: a cadaveric study.

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Suero, Eduardo M; Westphal, Ralf; Citak, Musa; Hawi, Nael; Liodakis, Emmanouil; Krettek, Christian; Stuebig, Timo

2017-08-11

We aimed to test whether a robotic technique would offer more accurate access to the proximal femoral medullary cavity for insertion of an intramedullary nail compared to the conventional manual technique. The medullary cavity of ten femur specimens was accessed in a conventional fashion using fluoroscopic control. In ten additional femur specimens, ISO-C 3D scans were obtained and a computer program calculated the ideal location of the cavity opening based on the trajectory of the medullary canal. In both techniques, the surgeon opened the cavity using a drill and inserted a radiopaque tube that matched the diameter of the cavity. The mean difference in angle between the proximal opening and the medullary canal in the shaft of the femur was calculated for both groups. Robotic cavity opening was more accurate than the manual technique, with a mean difference in trajectory between the proximal opening and the shaft canal of 2.0° (95% CI 0.6°-3.5°) compared to a mean difference of 4.3° (95% CI 2.11°-6.48°) using the manual technique (P = 0.0218). The robotic technique was more accurate than the manual procedure for identifying the optimal location for opening the medullary canal for insertion of an intramedullary nail. Additional advantages may include a reduction in total radiation exposure, as only one ISO-C 3D scan is needed, as opposed to multiple radiographs when using the manual technique.

Chondrosarcoma of the femur with histology-imaging correlation of tumor growth--preliminary observations concerning periosteal new bone formation and soft tissue extension.

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Steiner, German C; Schweitzer, Mark E; Kenan, Samuel; Abdelwahab, Ibrahim F

2011-01-01

periosteum. As far as we know, a first literature histologic description of the thickened CHS periosteum also was accomplished. PNBF is a common imaging manifestation of CHS of the femur, which correlated with the degree of cortical destruction. A grey line between the cortex and periosteum is an MRI finding described in this study and may facilitate the evaluation of periosteal thickening and tumor invasion in CHS. PNBF often occurs in the absence of direct periosteal involvement. Periosteal imaging abnormalities suggestive of tumor infiltration should be interpreted with caution on MRI, and early soft tissue extension in CHS may be difficult to determine on MRI.

Dysmorphic choroid plexuses and hydrocephalus associated with increased nuchal translucency: early ultrasound markers of de novo thanatophoric dysplasia type II with cloverleaf skull (Kleeblattschaedel).

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Tonni, Gabriele; Palmisano, Marcella; Ginocchi, Vladimiro; Ventura, Alessandro; Baldi, Maurizia; Baffico, Ave Maria

2014-11-01

Prenatal diagnosis of thanatophoric dysplasia (TD) type II presenting in the first trimester with increased nuchal translucency (NT) and cloverleaf skull (Kleeblattschaedel) have been scantly reported in the medical record. Abnormal choroid plexus has been seen in association with fetal anomalies. Here we described a case of increased NT associated with indented choroid plexuses, early onset hydrocephalus and cloverleaf skull in a fetus subsequently diagnosed at early second trimester to carry a de novo mutation encoding for TD type II. The findings of dysmorphic choroid plexus, early onset hydrocephalus and cloverleaf skull at first trimester scan may be early, useful ultrasound markers of TD type II. Molecular analysis to control for possible overlapping syndromes were performed and resulted negative. Postmortem X-ray and 3D-CT scan confirmed the cloverleaf skull, narrow thorax, straight femur with rhizomelic shortening of the limbs and the presence of a communicating hydrocephalus. © 2014 Japanese Teratology Society.

Spectroscopic studies of cow femurs and porites species coral from Sabah

International Nuclear Information System (INIS)

Fadhlia Zafarina Zakaria; Fauziah Abdul Aziz; Nahulan Thevarajah

2007-01-01

Some cortical bone specimens from the femurs of adult cows and sea coral of Porites species were studied by using Fourier Transform Infrared Spectroscopy, FTIR. Carbonate were shown to be present by indication of C-O stretch found between 1510-1410 cm -1 in both cortical bone and porites. Based on the comparison of the relative intensity of CO 3 2- bands with respect to the PO 4 3- bands, peak intensity of porites was found to be higher than peak intensity of cortial bone at carbonated band. This explains that porites skeleton is made up of CaCO 3 while bone consists of a mineral, hydroxyapatite Ca 5 (PO 4 ) 3 OH with the present of carbonate ions, typically from 3 to 7 wt %. (Author)

Atypical femur fractures associated with bisphosphonates: from prodrome to resolution

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Braulio Sastre-Jala

2015-10-01

Full Text Available Atypical fractures related to the prolonged use of bisphosphonates are caused by low energy mechanisms and are characterized by oblique and transverse lines and frequent bilateralism. We present a clinical case of a patient who we believe illustrates, both in clinical and radiological aspects, the new definition of atypical femur fracture related to treatment using bisphosphonates treated conservatively and successfully with discharge and teriparatide 20 mcg/80 mcl s.c./24h. The appearance of painful symptoms in the upper thigh, especially if bilateral, in patients treated with bisphosphonates for long periods of time, makes it necessary to dismiss bone lesions that might otherwise suggest atypical fracture. In those cases where the fracture is incomplete, restoring bone metabolism through the administration of teriparatide 20 mcg/80 mcl s.c./24h could prevent displaced fractures.

Study of the boron levels in serum after implantation of different ratios nano-hexagonal boron nitride-hydroxy apatite in rat femurs.

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Atila, Alptug; Halici, Zekai; Cadirci, Elif; Karakus, Emre; Palabiyik, Saziye Sezin; Ay, Nuran; Bakan, Feray; Yilmaz, Sahin

2016-01-01

Boron and its derivatives are effective in bone recovery and osteointegration. However, increasing the boron levels in body liquids may cause toxicity. The aim of our study is to investigate serum boron levels using ICP-MS after implantation of different ratios of nano-hBN-HA composites in rat femurs. All rats were (n=126) divided into five experimental groups (n=24) and one healthy group (6 rats); healthy (Group1), femoral defect + %100 HA (Group2), femoral defect + %2.5 hBN + %97.5 HA (Group3), femoral defect + %5 hBN + %95 HA (Group4), femoral defect + %10 hBN + %90 HA (Group5), femoral defect + %100 hBN (Group6). The femoral defect was created in the distal femur (3mm drill-bit). Each implant group was divided into four different groups (n=24) also 6 rats sacrificed for each groups in one week intervals during four weeks. In our results; at 1, 2, 3, and 4 weeks after implantation near bone tissue, serum levels of boron were evaluated using ICP-MS. We demonstrated that neither short-term nor long-term implantation of hBN-HA composite resulted in statistically increased serum boron levels in experimental groups compared to healthy group. In conclusion, this study investigated the implant material produced form hBN-HA for the first time. Our data suggest that hBN is a new promising target for biomaterial and implant bioengineers. Copyright © 2015 Elsevier B.V. All rights reserved.

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

International Nuclear Information System (INIS)

Ascenzi, Maria-Grazia; Kawas, Neal P.; Lutz, Andre; Kardas, Dieter; Nackenhorst, Udo; Keyak, Joyce H.

2013-01-01

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

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

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

2013-07-01

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

Lateral Cortical Thickening and Bone Heterogeneity of the Subtrochanteric Femur Measured With Quantitative CT as Indicators for Early Detection of Atypical Femoral Fractures in Long-Term Bisphosphonate Users.

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Lee, Seung Hyun; Lee, Young Han; Suh, Jin-Suck

2017-10-01

The objective of our study was to compare subtrochanteric femur bone mineral density (BMD) and bone quality of long-term bisphosphonate (BP) users who sustained an atypical femoral fracture (AFF) with BP users who did not sustain a femoral fracture and BP-naïve patients with no history of femoral fracture using quantitative CT (QCT). Fourteen female BP users with an AFF (mean age, 72.6 years; mean duration of BP use, 6.2 years; mean body mass index, 21.9) who had undergone QCT before fracture events were sex-, age-, BP use duration-, and body mass index-matched to 14 BP users who did not sustain a fracture and 14 BP-naïve patients. The lateral cortical thickness index (CTI) and the mean BMD (BMD mean ) and SD of the BMD (BMD SD ) within the lateral cortex and within the entire cross-sectional area of the subtrochanteric femur were measured on axial QCT. Femoral neck-shaft angles were measured on the QCT scout image. Parameters were analyzed using the Kruskal-Wallis test. Lateral CTIs were greater in the BP users with an AFF (median, 0.28) than in the BP users without a femoral fracture (median, 0.21) (p = 0.038) and the BP-naïve group (median, 0.21) (p = 0.009). The lateral cortex BMD SD was significantly higher in the BP users with an AFF (median, 59.59 mg/cm 3 ) than the BP users without a femoral fracture (median, 39.27 mg/cm 3 ; p = 0.049) and the BP-naïve group (median, 31.02 mg/cm 3 ; p = 0.037). There was no significant difference among groups in lateral cortex BMD mean , BMD mean and BMD SD of the entire cross-sectional area, and femoral neck-shaft angle. Long-term BP users with a subsequent AFF had a thicker lateral cortex and higher lateral cortex BMD SD at the subtrochanteric area before the fracture on QCT than BP users who did not sustain a femoral fracture and BP-naïve patients.

Recurrent Proximal Femur Fractures in a Teenager With Osteogenesis Imperfecta on Continuous Bisphosphonate Therapy: Are We Overtreating?

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Vasanwala, Rashida F; Sanghrajka, Anish; Bishop, Nicholas J; Högler, Wolfgang

2016-07-01

Long-term bisphosphonate (BP) therapy in adults with osteoporosis is associated with atypical femoral fractures, caused by increased material bone density and prolonged suppression of bone remodeling which may reduce fracture toughness. In children with osteogenesis imperfecta (OI), long-term intravenous BP therapy improves bone structure and mass without further increasing the already hypermineralized bone matrix, and is generally regarded as safe. Here we report a teenage girl with OI type IV, who was started on cyclical intravenous pamidronate therapy at age 6 years because of recurrent fractures. Transiliac bone biopsy revealed classical structural features of OI but unusually low bone resorption surfaces. She made substantial improvements in functional ability, bone mass, and fracture rate. However, after 5 years of pamidronate therapy she started to develop recurrent, bilateral, nontraumatic, and proximal femur fractures, which satisfied the case definition for atypical femur fractures. Some fractures were preceded by periosteal reactions and prodromal pain. Pamidronate was discontinued after 7 years of therapy, following which she sustained two further nontraumatic femur fractures, and continued to show delayed tibial osteotomy healing. Despite rodding surgery, and very much in contrast to her affected, untreated, and normally mobile mother, she remains wheelchair-dependent. The case of this girl raises questions about the long-term safety of BP therapy in some children, in particular about the risk of oversuppressed bone remodeling with the potential for microcrack accumulation, delayed healing, and increased stiffness. The principal concern is whether there is point at which benefit from BP therapy could turn into harm, where fracture risk increases again. This case should stimulate debate whether current adult atypical femoral fracture guidance should apply to children, and whether low-frequency, low-dose cyclical, intermittent, or oral treatment

Mechanical evaluation of hip pads to protect against fracture of elderly femurs in falls.

Science.gov (United States)

Tadano, Shigeru; Nakatsuchi, Hiroki; Goto, Naoko; Fujisaki, Kazuhiro; Nakatsuchi, Yukio

2011-01-01

Hip fracture in the aged easily occurs by falls and may cause these persons to become bedridden. Hip pads are effective in protecting hip fracture as they directly deflect and absorb the impact forces by falls. It is necessary for the material and the structure of hip pads to be designed to realize both high impact absorption and compliance (comfort during wearing). In this report, an impact testing system was developed to test the impact absorbing performance of hip pad with air cushions designed by the research group. The impact absorbing performance was evaluated by the impact load, collision time, and maximum load. To confirm the effectiveness in protecting against hip fracture, an impact force was applied to the greater trochanter of the human femur and the degree of fracture was measured by X-ray examination. As a result, the hip pad with air cushions had a high impact absorbing performance and was sufficiently effective to protect against hip fracture.

Treatment outcomes of intertrochanteric femur fractures treated with DLT™ nail

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Mehmet Arıcan

2015-12-01

Full Text Available Objective: Intramedullary nails frequently use in proximal femur fractures. In this study, 49 patients with intertrochanteric fractures were evaluated clinical and radiological results treated with dyna locking trochanteric (DLT™ nail retrospectively. Methods: Twenty-two (44.9% patients were male and 27 (55.1% patients were female. Mean age was 74.29±1.98 (28-99 years and Followed up for a mean of 14.35±3.43 (9-24 months. Thirty-seven (75.6% of the fractures resulted from simple falls while 6 (12.2% caused from traffic accidents and 6 (12.2% fall down from height. There were 24 (49.0% left and 25 (51.0% right lower extremities fractured. According to Orthopaedic Trauma Association classification system; 21 (42.9%, 21 (42.9% and 7 (14.2% fractures were classified as 31A1, 31A2, and 31A3 respectively. One (2.0% patient had claviculae fracture, 3 (6.1% patients had radius distal fracture and 1 (2.0% patient had total knee arthroplasty. After surgery, X-ray was used for radiological results and functional outcomes were evaluated according to the Harris hip scoring system. Results: The average waiting time for the surgery was 2.02±0.18 (1-7 days and hospitalization time was 6.23±0.29 (4-15 days. Mean fracture healing time was 11.74±1.82 (8-15 weeks. Three patients had screw cut-out in the follow-up time and performed hemiarthroplasty. The average Harris hip score was 88.02±1.21 (42-97 points and included 29 (59.2% excellent cases, 17 (34.7% good and 3 (6.1% poor. Conclusion: DLT ™ nail is a safe and successful method because of low complication rates, and capability of detection.

Relationship of homocysteine levels with lumbar spine and femur neck BMD in postmenopausal women.

Science.gov (United States)

Bahtiri, E; Islami, H; Rexhepi, S; Qorraj-Bytyqi, H; Thaçi, K; Thaçi, S; Karakulak, C; Hoxha, R

2015-01-01

The focus of several studies in recent years has been the association between increased plasma concentrations of homocysteine (Hcy), reduced bone mineral density and increased risk of bone fractures. Nevertheless, inconsistencies persist in the literature. Thus, the objective of this study was to investigate the possible relationship between serum Hcy and vitamin B12 status, and bone mineral density, on a group of post-menopausal women. One hundred thirty-nine postmenopausal women were recruited to enter this cross-sectional study. Bone mineral density (BMD) of total hip, femoral neck and lumbar spine was measured by dual-energy X-ray absorptiometry (DXA) and serum Hcy, vitamin B12, parathyroid hormone (PTH), total calcium and magnesium levels were determined. In addition, we investigated the relationship of Hcy and vitamin B12 and BMD using a meta-analysis approach. Serum Hcy levels were significantly higher in osteoporotic women when compared to other BMD groups, and were inversely related to lumbar spine BMD and femur neck BMD. Body mass index and serum Hcy levels were shown to be significant predictors of BMD at lumbar spine, femur neck and total hip. The performed meta-analysis showed that serum Hcy levels were significantly higher in osteoporotic subjects compared to normal BMD subjects. This study shows that Hcy status, but not vitamin B12 status, is associated with BMD in this cohort of postmenopausal women. We therefore confirm that high Hcy levels are an independent risk factor for osteoporosis. BMD evaluation in women at post menopause with high Hcy levels may be helpful in advising precautionary measures.

A large parosteal ossifying lipoma of lower limb encircling the femur

Science.gov (United States)

2014-01-01

Introduction Lipoma is a benign soft tissue neoplasm that may contain mesenchymal elements, as a result of metaplastic process. Ossification in benign and malignant soft tissue tumors can also manifest due to metaplastic process. Case presentation A 45 year old woman presented with a large thigh mass. The mass was developed one and a half year ago which insidiously increased in size and was associated with movement restriction. Radiological findings revealed soft tissue neoplasm on antero-medial aspect of thigh encircling the femur and displacing adjacent muscles. Fine trabeculations were seen in neoplasm suggestive of ossification. Excision of the mass was performed and histopathology revealed adipocytes with mature bony trabeculae possessing prominent osteoblastic rimming suggestive of ossifying lipoma. Conclusion It is important to recognize this variant of lipoma as it is associated with a better clinical outcome in contrast to most of the deep seated soft tissue neoplasms. Secondly it should also be differentiated from myositis ossificans and heterologous differentiation in other soft tissue neoplasms. We suggest an algorithmic approach to the diagnosis of ossifying soft tissue neoplasms histopathologically. Mature bony trabeculae with prominent osteoblastic rimming in a soft tissue lesion are due to a metaplastic process and should not be confused with osteosarcoma. PMID:24433545

Accumulation of heavy metals and As in liver, hair, femur, and lung of Persian jird (Meriones persicus) in Darreh Zereshk copper mine, Iran.

Science.gov (United States)

Khazaee, Manoochehr; Hamidian, Amir Hossein; Alizadeh Shabani, Afshin; Ashrafi, Sohrab; Mirjalili, Seyyed Ali Ashghar; Esmaeilzadeh, Esmat

2016-02-01

Rodents frequently serve as bioindicator to monitor the quality of the environment. Concentrations of 11 elements (Cd, Co, Ti, Fe, Mn, Cu, Sb, As, Sr, Ni, and Cr) were investigated and compared in liver, hair, femur, and lung of the Persian jird (Meriones persicus) from Darreh Zereshk copper mine, Iran. Metals were determined in different tissues of 39 individuals of Persian jird, collected by snap trap in 2014 from five areas of Darreh Zereshk copper mine. Samples were prepared by wet digestion method, and the contents of elements were analyzed with ICP-OES (VARIAN, 725-ES) instrument. Cadmium, Sb, and Co were below the limit of detection, and Mn and As were found only in hair and liver tissues. We detected the highest concentration of Cu, As, Ti, Fe, Mn, Cr, and Ni in hair in comparison with other tissues. Significant higher levels of Ti in femur and hair; Fe in liver and hair; Mn in liver; As in hair; Sr in lung; Cr in lung, hair, femur, and liver; Cu in femur; and Ni in liver and lung tissues were observed in females. Nearly all element concentrations in the tissues of Persian jird from flotation site, Darreh Zereshk and Hasan Abad villages and leaching site (mining areas) were higher than those from tailing dump site (reference site). We found the highest concentrations of As in liver and hair; Ni and Cr in liver, hair, and lung; and Sr in lung and hair tissues of Persian jird in leaching site. We tried to specify the status of elements before fully exploitation of Darreh Zereshk copper mine by using bioindicator species. Based on our achievements, initial activities did not strongly pollute the surrounded environment of the mine. The high abundance of Persian jird as well as their several proper features makes them a suitable species for biomonitoring programs especially for further studies will be performed after full exploitation of Darreh Zereshk copper mine.

Relationship between number of spleen colonies and 125IdUrd incorporation into spleen and femur

International Nuclear Information System (INIS)

Inoue, T.; Bullis, J.E.; Cronkite, E.P.; Hubner, G.E.

1983-01-01

Graded numbers of bone marrow (BM) cells were injected into fatally irradiated mice. Eight days later the mice were given 3.0 μCi (1 Ci = 3.7 x 10 10 Bq) of 125 IdUrd to label proliferating cells in the spleen and BM. On day 9 the mice were killed and the spleens and femurs were removed for splenic colony assay and measurement of radioactivity in the spleen and femurs. The number of splenic colonies shows a linear relationship with dose of marrow cells injected from 10 4 to 10 5 cells. The slope of the curve of spleen colonies versus number of cells injected is 5 and below 10 4 there is a striking departure from the simple linearity. Below 2 x 10 3 cells injected, the logarithm of the observed colony yield is linear with logarithm of the number of cells injected. Poisson calculation of the average number of pluripotent stem cells that should be present with numbers of marrow cells injected below 2 x 10 3 followed closely the actual observations. The data show that there is no detectible proliferation in the BM until the dose of marrow cells exceeds 3.5 x 10 4 cells. Induction of cells into cycle increases the seeding into the BM, and thymidine cytocide drastically reduces seeding in the BM, leading us to conclude that the BM is repopulated almost exclusively by stem cells in DNA synthesis

99mTc-MDP bone uptake in secondary hyperparathyroidism. Comparison of the mandible, cranium, radius, and femur

International Nuclear Information System (INIS)

Boasquevisque, Edson; Mandarim-de-Lacerda, Carlos A.; Silva, Jorge Wagner Esteves da; Albuquerque Bernardo, V.V. de; Macedo, S. Mello Santana de; Oliveira, Andre Ribeiro Nogueira de; Pires Kasai, Erika Tami; Boasquevisque, Camila S.

2008-01-01

The objective of this study to evaluate the bone involvement of the mandible, cranium, radius, and femur in secondary hyperparathyroidism (SHPT) using 99m Tc-methylene diphosphonate sodium (MDP) uptake correlated with the serum intact parathyroid hormone (PTHi). In a prospective study of 54 patients with SHPT due to chronic renal disease and 15 normal individuals (control group), all patients had elevated serum PTHi and 99m Tc-MDP bone scintigraphy. Bone uptake was measured in regions of interest (ROIs) in the mandible posterior cranium, distal radius, and proximal femur. In addition, soft tissue uptake was measured in one ROI in the soft tissues of the medial thigh (BG). The ROI-BG ratio was used as an index of the normalized bone uptake. The uptake differences in the SHPT and control groups were statistically significant for the mandible (P=0.001) and cranium (P=0.002). When the SHPT group was subclassified according to serum PTHi levels, the bone uptake increased with the serum PTHi level. All mandibles of the patients with SHPT were abnormal, and 33% had focal lesions. The bone uptake in the SHPT group was abnormal in all areas evaluated, and a high uptake of 99m Tc-MDP was correlated with an increased serum PTHi. (author)

IDENTIFYING THE ROTATIONAL AXES OF DISTAL FEMUR IN SOUTH ANDHRA POPULATION OF INDIA USING IMAGE TOOL SOFTWARE

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Sharmila Bhanu

2015-08-01

Full Text Available AIM : To study the normal relationship of the anteroposterior (APA, transepicondylar (TEA and posterior condylar (PCA axis of normal cadaveric femoral bones using digital technology and special computer program. MATERIAL AND METHOD: The study comprised of 196 dry adult femora from 98 right and 98 left sides irrespective of sex and age b elonging to Andhra Pradesh population of India. The bone collections were obtained from the Anatomy department, Narayana medical college, Nellore, India. The femurs were kept in normal anatomical position on OB. The photographs were taken from the distal e nd of all the femurs placing the camera lens 10cm constantly away from it with a digital camera. Using the reference points, angle between APA - TEA, APA - PCA and TEA - PCA were identified. The statistical significance of difference between the right and left g roups was evaluated by using Student paired t - test. Data were presented as mean±SD. P - value less than 0.05 were considered statistically significant. RESULTS : The relationship of the angle between the APA - TEA, APA - PCA and TEA - PCA were observed. The angle o f AP - TE, AP - PC and TE - PC was 94.84±3.43°, 87.64±1.62° and 6.84±2.71° respectively on right side. On the left side, the angle of AP - TE, AP - PC and TE - PC was 92.36±4.06°, 93.61±2.54° and 3.19±0.99° respectively. CONCLUSION: The normal femoral rotational alignment from cadaveric bone study using computer aided software can be helpful to the surgeon in selecting appropriate reference axis in any particular knee surgeries. In this regard the present data can be taken into consi deration for the femoral rotational alignment during any intraoperative surgeries of knee and in total knee arthroplasty

Cumulative Alendronate Dose and the Long-Term Absolute Risk of Subtrochanteric and Diaphyseal Femur Fractures: A Register-Based National Cohort Analysis

DEFF Research Database (Denmark)

Abrahamsen, Bo; Eiken, Pia Agnete; Eastell, Richard

2010-01-01

are currently the subject of a U.S. Food and Drug Administration review. Objective: Our objective was to examine the risk of subtrochanteric/diaphyseal femur fractures in long term users of alendronate. Design: We conducted an age- and gender-matched cohort study using national healthcare data. Patients...

Early Diagnosis of Avascular Necrosis of Bone Following Renal Transplantation By Bone Scan

International Nuclear Information System (INIS)

Shin, Hyun Ho; Kim, Han Su; Ihn, Chun Gyoo; Kim, Myung Jae

1982-01-01

Avascular necrosis of bone has become a well-recognized complication of renal transplantation. While preexisting metabolic bone disease, especially hyperparathyroidism, and metabolic disturbances induced by steroids have been implicated as etiological factors, the pathogenesis is controversial. The diagnosis of avascular necrosis of bone had been based on a history of joint pain and radiographic demonstration of bone necrosis. Recently the bone scan using 99m Tc-methylene diphosphonate is helpful in determining the early stage of bone necrosis. We report two cases of avascular necrosis of femur head, of which diagnosis was made by the bone scan using 99m Tc-methylene diphosphonate.

Radiotherapy Results of Early Uterine Cervix Cancer

International Nuclear Information System (INIS)

Choi, Doo Ho; Huh, Seung Jae

1996-01-01

Purpose : This study was done to analyze survivals, patterns of failure, and complications of early uterine cervix cancer after curative radiotherapy. Methods and Materials : Eighty patients with uterine cervix cancer FIGO Stage IB (48 cases) and Stage IIA (32 cases) treated with radiotherapy were analyzed retrospectively. Patients were treated from November 1985 to May 1993, and minimum follow up period was 24 months. and 6 cases were lost to follow up. All of them were treated with external radiotherapy and different fractions of high dose rate intracavitary radiotherapy. Survival rates, failure patterns, complication rates and degrees of severity were analyzed according to several factors. Results : Overall 5 year survival rate and relapse free survival rate were 72.3%, and 72.8% respectively. Prognostic factors were stage, size, pathology, RT response and there was no significant survival difference among the reasons of radiotherapy choice. There were 19 cases of treatment failure, another 3 cases were not tumor related death, and most of treatment related failure occurred within 24 months. Late complication rate of bladder and rectum were 8.8%, 15% respectively, frequency and severity of complication were correlated with ICR fractionation dose and total dose. Conclusion : These results showed that survival rates of early stage radiation treated cervix cancer patients were comparable to surgical series, but more aggressive treatment methods needed for stage IIA poor prognostic patients, To decrease late complication, choice of proper ICR dose and meticulous vaginal packing is needed

Study of the boron levels in serum after implantation of different ratios nano-hexagonal boron nitride–hydroxy apatite in rat femurs

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Atila, Alptug, E-mail: alptugatila@yahoo.com [Department of Analytical Chemistry, Faculty of Pharmacy, Ataturk University, Erzurum 25240 (Turkey); Halici, Zekai; Cadirci, Elif [Department of Pharmacology, Faculty of Medicine, Ataturk University, Erzurum 25240 (Turkey); Karakus, Emre [Department of Pharmacology and Toxicology, School of Veterinary Medicine, Ataturk University, Erzurum 25240 (Turkey); Palabiyik, Saziye Sezin [Department of Pharmaceutical Toxicology, Faculty of Pharmacy, Ataturk University, Erzurum 25240 (Turkey); Ay, Nuran [Department of Material Science and Engineering, Faculty of Engineering, Anadolu University, Eskisehir 26555 (Turkey); Bakan, Feray [Sabancı University Nanotechnology Research and Application Center (SUNUM), Istanbul 34956 (Turkey); Yilmaz, Sahin [Department of Genetics and Bioengineering, Faculty of Engineering and Architecture, Yeditepe University, Istanbul 34755 (Turkey)

2016-01-01

ABSTRACT: Boron and its derivatives are effective in bone recovery and osteointegration. However, increasing the boron levels in body liquids may cause toxicity. The aim of our study is to investigate serum boron levels using ICP-MS after implantation of different ratios of nano-hBN–HA composites in rat femurs. All rats were (n = 126) divided into five experimental groups (n = 24) and one healthy group (6 rats); healthy (Group1), femoral defect + %100HA (Group2), femoral defect + %2.5hBN + %97.5HA (Group3), femoral defect + %5hBN + %95HA (Group4), femoral defect + %10hBN + %90 HA (Group5), femoral defect + %100hBN (Group6). The femoral defect was created in the distal femur (3 mm drill-bit). Each implant group was divided into four different groups (n = 24) also 6 rats sacrificed for each groups in one week intervals during four weeks. In our results; at 1, 2, 3, and 4 weeks after implantation near bone tissue, serum levels of boron were evaluated using ICP-MS. We demonstrated that neither short-term nor long-term implantation of hBN–HA composite resulted in statistically increased serum boron levels in experimental groups compared to healthy group. In conclusion, this study investigated the implant material produced form hBN–HA for the first time. Our data suggest that hBN is a new promising target for biomaterial and implant bioengineers. - Highlights: • Nano-hBN–HA composites are new targets for biomaterial and implant bioengineers. • Serum boron levels were researched after implantation of nano-hBN–HA composites. • Implantation of hBN–HA composite did not result in increased serum boron levels. • The use of boron in composite form with HA did not change the stability of the implant.

CHONDROSARCOMA OF BONE - ONCOLOGIC AND FUNCTIONAL RESULTS

NARCIS (Netherlands)

VANLOON, CJM; VETH, RPH; PRUSZCZYNSKI, M; WOBBES, T; LEMMENS, JAM; VANHORN, J

1994-01-01

A retrospective review of 27 patients (21 males and 6 females) with chondrosarcoma of bone was performed to evaluate the oncologic and functional results. The average age of the patients was 48 years (range: 17-76). The tumor sites were pelvis in 10 cases, distal femur in 2, proximal tibia in 3, rib

Comparative limb bone loading in the humerus and femur of the tiger salamander: testing the 'mixed-chain' hypothesis for skeletal safety factors.

Science.gov (United States)

Kawano, Sandy M; Economy, D Ross; Kennedy, Marian S; Dean, Delphine; Blob, Richard W

2016-02-01

Locomotion imposes some of the highest loads upon the skeleton, and diverse bone designs have evolved to withstand these demands. Excessive loads can fatally injure organisms; however, bones have a margin of extra protection, called a 'safety factor' (SF), to accommodate loads that are higher than normal. The extent to which SFs might vary amongst an animal's limb bones is unclear. If the limbs are likened to a chain composed of bones as 'links', then similar SFs might be expected for all limb bones because failure of the system would be determined by the weakest link, and extra protection in other links could waste energetic resources. However, Alexander proposed that a 'mixed-chain' of SFs might be found amongst bones if: (1) their energetic costs differ, (2) some elements face variable demands, or (3) SFs are generally high. To test whether such conditions contribute to diversity in limb bone SFs, we compared the biomechanical properties and locomotor loading of the humerus and femur in the tiger salamander (Ambystoma tigrinum). Despite high SFs in salamanders and similar sizes of the humerus and femur that would suggest similar energetic costs, the humerus had lower bone stresses, higher mechanical hardness and larger SFs. SFs were greatest in the anatomical regions where yield stresses were highest in the humerus and lowest in the femur. Such intraspecific variation between and within bones may relate to their different biomechanical functions, providing insight into the emergence of novel locomotor capabilities during the invasion of land by tetrapods. © 2016. Published by The Company of Biologists Ltd.

Investigations into the visualisation of osseous and hyaline cartilaginous surface structures of the femural head using X-ray computed tomography

International Nuclear Information System (INIS)

Laemmermann, G.

1989-01-01

This study investigates into the extent to which fine osseous structures in the head of the femur and hyaline cartilaginous surfaces of the hip joint are accessible to X-ray computed tomography as a method of diagnosis. At first, a true model of the femural head (post-mortem preparation embedded in methylacrylate) was tomographed to compare the sectional displays thus obtained with hard-microtome sections of similar thickness made at the same levels. This permitted preliminary evaluations to be carried out and confirmed that those structures can be visualised by high-resolution CT (1 mm sections). Methods using high-resolution sectional imaging have a role in examinations of congruence in the the hip joint. Particularly useful here are three-dimensional displays of osseous and cartilaginous surfaces of the joint parts examined. Further research is needed until a more refined method of reconstruction can be made available, the usefulness of which in actual practice will depend on the degree of geometrical congruence achieved between a patient's joint and its display on the screen. (orig./GDG) [de

Computed tomographic evaluation of the proximal femur: A predictive classification in displaced femoral neck fracture management

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Narender Kumar Magu

2014-01-01

Full Text Available Background: Femoral neck fracture is truly an enigma due to the high incidence of avascular necrosis and nonunion. Different methods have been described to determine the size of the femoral head fragment, as a small head has been said to be associated with poor outcome and nonunion due to inadequate implant purchase in the proximal fragment. These methods were two dimensional and were affected by radiography techniques, therefore did not determine true head size. Computed tomography (CT is an important option to measure true head size as images can be obtained in three dimensions. Henceforth, we subjected patients to CT scan of hip in cases with displaced fracture neck of femur. The study aims to define the term "small head or inadequate size femoral head" objectively for its prognostic significance. Materials and Methods: 70 cases of displaced femoral neck fractures underwent CT scan preoperatively for proximal femoral geometric measurements of both hips. Dual energy X-ray absorptiometry scan was done in all cases. Patients were treated with either intertrochanteric osteotomy or lag screw osteosynthesis based on the size of the head fragment on plain radiographs. Results: The average femoral head fragment volume was 57 cu cm (range 28.3-84.91 cu cm; standard deviation 14 cu cm. Proximal fragment volume of >43 cu cm was termed adequate size (type I and of ≤43 cu cm as small femoral head (type II. Fractures which united (n = 54 had a relatively large average head size (59 cu cm when compared to fractures that did not (n = 16, which had a small average head size (49 cu cm and this difference was statistically significant. In type I fractures union rate was comparable in both osteotomy and lag screw groups (P > 0.05. Lag screw fixation failed invariably, while osteotomy showed good results in type II fractures (P < 0.05. Conclusion: Computed tomography scan of the proximal femur is advisable for measuring true size of head fragment. An objective

Three-dimensional quantitative CT of the proximal femur: Relationship to vertebral trabecular bone density

International Nuclear Information System (INIS)

Bhasin, S.; Zlatkin, M.B.; Sartoris, D.J.; Andre, M.; Resnick, D.

1987-01-01

Integrated cancellous, cortical, and total bone density in the femoral neck and inter-trochanteric region was measured bilaterally in 25 women aged 35-90 years (mean age, 65). Contiguous-section (1-cm-thick) data were analyzed using three-dimensional histogram software on a Cemax 1000 image processor. Single-section quantitative CT was used to determine mean mineral equivalent values for vertebral cancellous bone from T-11 to L-3 in each woman. Significant correlation was found between cancellous bone density at the two sites. Cortical and total bone densities in the proximal femur were predicted less well with vertebral cancellous data, suggesting a greater dependence on weight-bearing and activity factors

A numerical investigation into the influence of the properties of cobalt chrome cellular structures on the load transfer to the periprosthetic femur following total hip arthroplasty.

Science.gov (United States)

Hazlehurst, Kevin Brian; Wang, Chang Jiang; Stanford, Mark

2014-04-01

Stress shielding of the periprosthetic femur following total hip arthroplasty is a problem that can promote the premature loosening of femoral stems. In order to reduce the need for revision surgery it is thought that more flexible implant designs need to be considered. In this work, the mechanical properties of laser melted square pore cobalt chrome molybdenum cellular structures have been incorporated into the design of a traditional monoblock femoral stem. The influence of incorporating the properties of cellular structures on the load transfer to the periprosthetic femur was investigated using a three dimensional finite element model. Eleven different stiffness configurations were investigated by using fully porous and functionally graded approaches. This investigation confirms that the periprosthetic stress values depend on the stiffness configuration of the stem. The numerical results showed that stress shielding is reduced in the periprosthetic Gruen zones when the mechanical properties of cobalt chrome molybdenum cellular structures are used. This work identifies that monoblock femoral stems manufactured using a laser melting process, which are designed for reduced stiffness, have the potential to contribute towards reducing stress shielding. Copyright © 2014 IPEM. Published by Elsevier Ltd. All rights reserved.

Salubrinal improves mechanical properties of the femur in osteogenesis imperfecta mice.

Science.gov (United States)

Takigawa, Shinya; Frondorf, Brian; Liu, Shengzhi; Liu, Yang; Li, Baiyan; Sudo, Akihiro; Wallace, Joseph M; Yokota, Hiroki; Hamamura, Kazunori

2016-10-01

Salubrinal is an agent that reduces the stress to the endoplasmic reticulum by inhibiting de-phosphorylation of eukaryotic translation initiation factor 2 alpha (eIF2α). We and others have previously shown that the elevated phosphorylation of eIF2α stimulates bone formation and attenuates bone resorption. In this study, we applied salubrinal to a mouse model of osteogenesis imperfecta (Oim), and examined whether it would improve Oim's mechanical property. We conducted in vitro experiments using RAW264.7 pre-osteoclasts and bone marrow derived cells (BMDCs), and performed in vivo administration of salubrinal to Oim (+/-) mice. The animal study included two control groups (wildtype and Oim placebo). The result revealed that salubrinal decreased expression of nuclear factor of activated T cells cytoplasmic 1 (NFATc1) and suppressed osteoclast maturation, and it stimulated mineralization of mesenchymal stem cells from BMDCs. Furthermore, daily injection of salubrinal at 2 mg/kg for 2 months made stiffness (N/mm) and elastic module (GPa) of the femur undistinguishable to those of the wildtype control. Collectively, this study supported salubrinal's beneficial role to Oim's femora. Unlike bisphosphonates, salubrinal stimulates bone formation. For juvenile OI patients who may favor strengthening bone without inactivating bone remodeling, salubrinal may present a novel therapeutic option. Copyright © 2016 The Authors. Production and hosting by Elsevier B.V. All rights reserved.

Open grade III fractures of femoral shaft: Outcome after early reamed intramedullary nailing.

Science.gov (United States)

Singh, D; Garg, R; Bassi, J L; Tripathi, S K

2011-09-01

Open grade III fractures of femur are a challenging therapeutic problem as most of them are associated with multiple trauma. Method used for skeletal stabilization of these fractures should limit further soft tissue damage, bacterial spread and morbidity in addition to its ease of application, providing mechanical support and restoring normal alignment. Forty-six patients with open grade III fractures of femoral shaft were included in the study. There were 10 grade IIIA, 34 grade IIIB and two grade IIIC fractures that were treated with early reamed intramedullary nailing with adequate management of soft tissue. Patients were reviewed retrospectively. Mean time of union was 27 weeks. Infection rate was 4% and non-union rate was 9%. There were two cases (4%) with limb shortening. No case of angular or rotational deformity was noted. Early reamed intramedullary nailing for open grade III fractures of femoral shaft, after giving due respect to the soft tissue injury, gives satisfactory results with proper alignment, good range of motion, short rehabilitation period and low infection rate. Level IV. Retrospective therapeutic study. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

The results of radiation therapy for early glottic carcinoma

International Nuclear Information System (INIS)

Yamamoto, Michinori; Hada, Yoshihiro; Shirane, Makoto

2000-01-01

To analyze various parameters affect local control, we reviewed the results of radiotherapy for early glottic carcinoma. Between 1977 and 1997, 64 patients with untreated early glottic carcinoma and four patients with recurrent early glottic carcinoma were analyzed retrospectively. All tumors were classified as follows; T1 (n=56), T2 (n=12); well differentiated (n=33), moderately (n=25), poorly (n=1), unknown (n=9); very small tumor (VST) (n=46), small tumor (ST) (n=22). All patients were treated utilizing a cobalt-60 unit to a total dose that ranged from 56 Gy to 64 Gy (mean 60 Gy). The mean treatment time was 44 days (range 38-49). The local control rates at 2 years and 5 years for all patients were 85% and 78%, respectively. On univariate analysis, tumor size (p=0.0146) and recurrent or untreated tumor (p=0.0226) affected local control. On multivariate analysis, tumor size (p=0.0273) and recurrent or untreated tumor (p=0.0495) were also significant factors that affected local control. (author)

Multiobjective topology optimization of trabecular Bone Structure in the spine and the femur: Implications for biomimcry

Science.gov (United States)

Elbanna, Ahmed; Peetz, Darin

Bone is classically considered to be a self-optimizing structure in accordance with Wolff's law. However, while the structure's ability to adapt to changing stress patterns has been well documented, whether it is fully optimal for compliance is less certain (Sigmund, 2002). Given the complexity of many biological systems, it is expected that this structure serves several purposes. We present a multi-objective topology optimization formulation for trabecular bone in the human body at two locations: the vertebrae and the femur. We account for the effect of different conflicting objectives such as maximization of stiffness, maximization of surface area, and minimization of buckling susceptibility. Our formulation enables us to determine the relative role of each of these objective in optimizing the structure. Moreover, it provides an opportunity to explore what structural features have to evolve to meet a certain objective requirements that may have been absent otherwise. For example, inclusion of stability considerations introduce numerous horizontal and diagonal members in the topology in the case of human vertebrae under vertical loading. However, the stability is found to play a lesser role in the case of the femur bone optimization. Our formulation enables investigation of bone adaptation at different locations of the body as well as under different loading and boundary conditions (e.g. healthy and diseased discs for the case of the spine). We discuss the implications of our findings on developing design rules for bio-inspired and bio-mimetic architectured materials. National Science Foundation: CMMI.

Age-related proximal femur bone mineral loss in South Indian women: a dual energy X-ray absorptiometry study.

Science.gov (United States)

Anburajan, M; Rethinasabapathi, C; Korath, M P; Ponnappa, B G; Kumar, K S; Panicker, T M; Govindan, A; Jagadeesan, G N

2001-04-01

i) To collect normative data for proximal femur bone mineral density (BMD) in South Indian women using dual energy X-ray absorptiometry (DXA) and ii) to study the rate and significance of hip bone mineral loss with advancing age in this population. Forty five women, whose age ranged from 16 to 84 years were studied. This sample was drawn randomly from general medical practice at KJ Hospital, Chennai, South India during November, 1997 to April, 1998. Of these 45 cases, 21 were pre-menopausal (mean +/- SD age = 30.9+/-8.8 years) and 24 post-menopausal (mean +/- SD age = 62.1+/-11.0 years). Subjects with secondary bone diseases were excluded. Also excluded were those taking any drugs known to affect calcium metabolism e.g., thiazide diuretics, oestrogen and calcium. Subjects were divided into seven decadal age groups from 15-24 years to 75-84 years. BMD of the right proximal femur was evaluated using a QDR-1000 DXA bone densitometer (Hologic Inc., Waltham, Massachusetts, USA). Data analysis was done with SPSS/PC statistical software package. Linear regression analysis showed significant (p India women have been evaluated and it may prove useful for diagnosing osteoporosis in the women of South India.

Association of insulin resistance with near peak bone mass in the femur and lumbar spine of Korean adults aged 25-35: The Korean National Health and Nutrition Examination Survey 2008-2010

Science.gov (United States)

Choo, Min Soo; Choi, Se Rin; Han, Jun Hyun; Lee, Seong Ho

2017-01-01

Objective This study aimed to evaluate the relationship between insulin resistance and the bone mineral density (BMD) of femur and lumbar spine in Korean adults who are expected to exhibit near peak bone mass. Methods Data from the Korean National Health and Nutrition Examination Survey 2008–2010 were analyzed. A total of 2,750 participants aged 25−35 years were included. Insulin resistance was assessed using a homeostatic model assessment of insulin resistance (HOMA-IR) and serum fasting insulin. Results In a multivariate linear regression analysis, the HOMA-IR was significantly inversely associated with the BMD of the total hip (TH, β = −0.052, P = 0.002), femoral neck (FN, β = −0.072, Pinsulin was significantly inversely associated with the BMD of the TH (β = −0.055, P = 0.001), FN (β = −0.072, Pinsulin resistance may be independently and inversely associated with the near peak bone mass of the femur and lumbar spine. PMID:28704413

Proximal focal femoral deficiency: A case report

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Shashank Sharma

2015-01-01

Full Text Available Proximal focal femoral deficiency (PFFD is a rare congenital anomaly resulting in limb shortening and disability in young. The exact cause of the disease is not known and it may present as varying grades of affection involving the proximal femur and the acetabulum. Recognition of this rare abnormality on radiographs can help manage these cases better since early institution of therapy may help in achieving adequate growth of the femur.

Bone marrow oedema - an early form of necrosis of the head of femur. Knochenmarkoedem - Fruehform der Hueftkopfnekrose

Energy Technology Data Exchange (ETDEWEB)

Neuhold, A [Inst. fuer Bildgebende Diagnostik, Krankenhaus Rudolfinerhaus, Vienna (Austria); Hofmann, S [Universitaetsklinik fuer Orthopaedie, Vienna (Germany); Engel, A [Universitaetsklinik fuer Orthopaedie, Vienna (Germany); Leder, K [2. Abt. des Orthopaedischen Krankenhauses Speising, Vienna (Austria); Kramer, J [Universitaetsklinik fuer Radiodiagnostik, Vienna (Austria); Stiskal, M [Inst. fuer Bildgebende Diagnostik, Krankenhaus Rudolfinerhaus, Vienna (Austria); Plenk, H [Inst. fuer Osteologie der AUVA, Vienna (Austria); Wicke, L [Inst. fuer Bildgebende Diagnostik, Krankenhaus Rudolfinerhaus, Vienna (Austria)

1993-08-01

We examined 15 patients (16 hips) with painful hips whose radiographs were either normal (n=9) or showed a minimal decrease in radiodensity (n=7). The available bone scintigrams of 9 cases were positive. T[sub 1]-weighted images visualised a diffuse signal loss of the bone marrow in all hips, with various extensions in the head, neck, and intertrochanteric area. These regions were hyperintensive on T[sub 2]-weighted images. Focal anomalies were not seen in any of the cases. All patients underwent core decompression treatment. Histology of 13 hips confirmed not only the presence of bone marrow oedema but of bone changes corresponding to those of avascular necrosis. Follow-up examinations with MR after core decompression showed normal signal intensity in all cases. Magnetic resonance represents a viable diagnostic tool for identifying bone marrow oedema. Due to our histological results bone marrow oedema should be included in the differential diagnosis as an early stage of necrosis of the hip. (orig.)

A method for assessment of the shape of the proximal femur and its relationship to osteoporotic hip fracture.

Science.gov (United States)

Gregory, J S; Testi, D; Stewart, A; Undrill, P E; Reid, D M; Aspden, R M

2004-01-01

The shape of the proximal femur has been demonstrated to be important in the occurrence of fractures of the femoral neck. Unfortunately, multiple geometric measurements frequently used to describe this shape are highly correlated. A new method, active shape modeling (ASM) has been developed to quantify the morphology of the femur. This describes the shape in terms of orthogonal modes of variation that, consequently, are all independent. To test this method, digitized standard pelvic radiographs were obtained from 26 women who had suffered a hip fracture and compared with images from 24 age-matched controls with no fracture. All subjects also had their bone mineral density (BMD) measured at five sites using dual-energy X-ray absorptiometry. An ASM was developed and principal components analysis used to identify the modes which best described the shape. Discriminant analysis was used to determine which variable, or combination of variables, was best able to discriminate between the groups. ASM alone correctly identified 74% of the individuals and placed them in the appropriate group. Only one of the BMD values (Ward's triangle) achieved a higher value (82%). A combination of Ward's triangle BMD and ASM improved the accuracy to 90%. Geometric variables used in this study were weaker, correctly classifying less than 60% of the study group. Logistic regression showed that after adjustment for age, body mass index, and BMD, the ASM data was still independently associated with hip fracture (odds ratio (OR)=1.83, 95% confidence interval 1.08 to 3.11). The odds ratio was calculated relative to a 10% increase in the probability of belonging to the fracture group. Though these initial results were obtained from a limited data set, this study shows that ASM may be a powerful method to help identify individuals at risk of a hip fracture in the future.

Dual-energy X-ray absorptiometry in the lumbar spine, proximal femur and distal radius in children

International Nuclear Information System (INIS)

Tsukahara, H.; Sudo, M.; Umezaki, M.; Hiraoka, M.; Yamamoto, K.; Ishii, Y.; Haruki, S.

1992-01-01

Dual-energy X-ray absorptiometry was used to measure bone mineral density (BMD) in the lumbar spine, proximal femur and distal radius in 48 Japanese children aged 3-18 years. In the normal children (n=32), BMD increased with age in all locations, with a nearly twofold increase from preschool age to adolescence. Most of the children with chronic diseases known to affect bone metabolism (e.g., steroid osteoporosis) (n=16) had low BMD in every region, indicating that these disease states probably affect multiple sites of the skeleton in children. (orig.)

Early results from Magsat. [studies of near-earth magnetic fields

Science.gov (United States)

Langel, R. A.; Estes, R. H.; Mayhew, M. A.

1981-01-01

Papers presented at the May 27, 1981 meeting of the American Geophysical Union concerning early results from the Magsat satellite program, which was designed to study the near-earth magnetic fields originating in the core and lithosphere, are discussed. The satellite was launched on October 30, 1979 into a sun-synchronous (twilight) orbit, and re-entered the atmosphere on June 11, 1980. Instruments carried included a cesium vapor magnetometer to measure field magnitudes, a fluxgate magnetometer to measure field components and an optical system to measure fluxgate magnetometer orientation. Early results concerned spherical harmonic models, fields due to ionospheric and magnetospheric currents, the identification and interpretation of fields from lithospheric sources. The preliminary results confirm the possibility of separating the measured field into core, crustal and external components, and represent significant developments in analytical techniques in main-field modelling and the physics of the field sources.

Early Eocene birds from La Borie, southern France

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Estelle Bourdon

2016-02-01

Full Text Available The early Eocene locality of La Borie is located in the village of Saint-Papoul, in southern France. These Eocene flu-vio-lacustrine clay deposits have yielded numerous vertebrate remains. Mammalian taxa found in the fossiliferous levels indicate an age near the reference level MP 8–9, which corresponds to the middle Ypresian, early Eocene. Here we provide a detailed description of the avian remains that were preliminarily reported in a recent study of the vertebrate fauna from La Borie. A maxilla, a quadrate, cervical vertebrae, a femur and two tibiotarsi are assigned to the giant ground bird Gastornis parisiensis (Gastornithidae. These new avian remains add to the fossil record of Gastornis, which is known from the late Paleocene to middle Eocene of Europe, early Eocene of Asia and early Eocene of North America. Gastornis parisiensis differs from the North American Gastornis giganteus in several features, including the more ventral position of the narial openings and the slender orbital process of quadrate. Two tibiotarsi and one tarsometatarsus are assigned to a new genus and species of Geranoididae, Galligeranoides boriensis gen. et sp. nov. So far, this family was known only from the early and middle Eocene of North America. The fossils from La Borie constitute the first record of the Geranoididae in Europe. We show that Gastornis coexisted with the Geranoididae in the early Eocene of both Europe (La Borie and North America (Willwood Formation. The presence of Geranoididae and the large flightless bird Gastornis on either side of the present-day North Atlantic provides further evidence that a high-latitude land connection existed between Europe and North America in the early Eocene.

Construction and early commissioning results of the AGS Booster

International Nuclear Information System (INIS)

Weng, W.T.; Ahrens, L.; Damm, R.; McNerney, A.J.

1991-01-01

The AGS Booster synchrotron has been designed to accelerate protons from 200 MeV to 1.5 GeV and heavy ions from several MeV per nucleon to several hundred MeV per nucleon for all the nuclei up to gold. The design requirements and measurements results of major accelerator components and systems are presented. The early commissioning results of the injection is also presented. 12 refs., 9 figs., 2 tabs

[The rotationally stable screw-anchor with trochanteric stabilizing plate (RoSA/TSP) : First results in unstable trochanteric femur fractures].

Science.gov (United States)

Maier, K-J; Bücking, B; Horst, K; Andruszkow, H; Hildebrand, F; Knobe, M

2017-12-01

In unstable trochanteric fractures, the extramedullary rotationally stable screw-anchor (RoSA) combines the benefits of the load and rotational stability of the blade with the advantages of the screw (pull-out resistance, compression capability) in a single load carrier, and was designed to prevent femoral neck shortening by using an additional locked trochanteric stabilizing plate (TSP). The aim of the current prospective cohort study was the clinical evaluation of the RoSA/TSP system regarding the mechanical re-operation rate and the amount of postoperative femoral neck shortening. From September 2011 to January 2014 80 patients with unstable trochanteric fractures underwent internal extramedullary fixation with the RoSA/TSP (Königsee Implantate GmbH, Allendorf, Germany). Due to fracture stability and after induction of compression, additional long locked antitelescoping screws (AT, n = 1-4) were placed reaching the femoral head. Radiological (femoral neck shortening) and clinical re-examination of patients (n = 61) was performed 6-10 weeks and 6-10 months later. In the 61 re-examined patients (76 %) femoral neck shortening was very low with 2 mm 6-10 months after operation. Re-operations occurred in 8 % (n = 6) and in 4 % (n = 3) as prophylactic surgical intervention. Whereas one-third (4 %) of re-operations occurred due to iatrogenic surgical problems from the first operation two-thirds of patients (8 %) had a re-operation due to delay of bone union (3× nonunion, 3 planned removals of AT-screws to improve healing). The in-hospital mortality was 3 % (n = 2). The fixation of unstable trochanteric femur fractures using the RoSA/TSP in a first clinical setting led to a great primary stability, with significant advantages with regard to limited femoral neck shortening. However, the rigidity of the construct with its consequences regarding bone healing can be challenging for the surgeon. Nevertheless, in some cases of revision it could be beneficial

Long versus short cephalomedullary nail for trochanteric femur fractures (OTA 31-A1, A2 and A3): a systematic review.

Science.gov (United States)

Dunn, John; Kusnezov, Nicholas; Bader, Julia; Waterman, Brian R; Orr, Justin; Belmont, Philip J

2016-12-01

Both long and short cephalomedullary nails (CMN) may be used to treat trochanteric femur fractures. The objective of this paper was to compare the clinical outcomes between long and short CMN in the treatment of trochanteric hip fractures. A literature search was performed, identifying 135 papers; 4 of which met inclusion and exclusion criteria. Papers included were those that compared cohorts of long and short nails for stable trochanteric femur fractures of level III evidence or superior. Data was pooled and analyzed, focusing on reoperation rate, secondary femoral shaft fracture rate, estimated blood loss, transfusion rate, operative time and length of stay. Included in the analysis were 1276 patients, with 438 short and 838 long CMN. The average age was 82.0 years for short CMN and 79.0 years for long CMN (P = 0.0002). The average follow up was 18 months, 46 % were male, and 71 % had an ASA (American Society of Anesthesiologists score) classification ≥3. The rate of reoperation was 5.0 % and 3.8 % for short and long CMN, respectively (P = 0.31). The rate of refracture was 1.6 % and 0.95 % for short and long CMN, respectively (P = 0.41). As compared to long nails, short nails had an average blood loss of 39 mL less (P = 0.0003), an 8.8 % decrease in transfusion rate (P = 0.07), and incurred 19 min less operative time (P trochanteric femur fractures, short CMN have a low reoperation rate while significantly decreasing operative time and estimated blood loss with the additional benefit of being cost effective. Level 3.

Analysis of microstructure in mouse femur and decalcification effect on microstructure by electron microscopy

Directory of Open Access Journals (Sweden)

Taehoon Jeon

2010-10-01

Full Text Available Microstructure and decalcification effect by ethylenediaminetetraacetic acid (EDTA on microstructure were studied for the compact bone of mouse femur by optical and electron microscopy. Especially the (002 reflection plane on the selected area electron diffraction (SAED of hydroxyapatite (HA was analyzed in detail. Two types of HA crystals were observed by transmission electron microscopy (TEM. One was needle-like crystals known as general HA crystals, and the other was flake-like crystals. Major constituents of two types of crystals were calcium, phosphorus, and oxygen. The Ca/P ratios of two types of crystals were close to the ideal value of HA within experimental error. Intensity data obtained from each crystals were also very similar. These results indicated that two types of crystals were actually same HA crystals. It was noticed that the (002 reflection plane on SAED displayed ring, spot, or arc patterns in accordance with orientations of HA crystals. Decalcification by EDTA process obsecured outline of osteons and havarsian canals, and changed morphology of the bone section. As the results of decalcification it was observed by TEM-EDS (Energy Dispersive Spectroscopy that all peaks of calcium and phosphorus disappeared, and intensity of oxygen peak was substantially reduced. Moreover, collagen appeared to be disaggreated.

Early Diagnosis of Avascular Necrosis of Bone Following Renal Transplantation By Bone Scan

Energy Technology Data Exchange (ETDEWEB)

Shin, Hyun Ho; Kim, Han Su; Ihn, Chun Gyoo; Kim, Myung Jae [Kyung Hee University College of Medicine, Seoul (Korea, Republic of)

1982-09-15

Avascular necrosis of bone has become a well-recognized complication of renal transplantation. While preexisting metabolic bone disease, especially hyperparathyroidism, and metabolic disturbances induced by steroids have been implicated as etiological factors, the pathogenesis is controversial. The diagnosis of avascular necrosis of bone had been based on a history of joint pain and radiographic demonstration of bone necrosis. Recently the bone scan using {sup 99m}Tc-methylene diphosphonate is helpful in determining the early stage of bone necrosis. We report two cases of avascular necrosis of femur head, of which diagnosis was made by the bone scan using {sup 99m}Tc-methylene diphosphonate.

Early versus late enteral nutrition in intensive care units. Analysis of results

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Sara Bermejo de las Heras

2017-08-01

Full Text Available Introduction: Malnutrition is particularly prevalent in Intensive Care Units (ICU and associated with poor clinical outcomes. Enteral nutrition (EN has multiple benefits in critically ill patients, particularly when started early at the ICU. A series of studies corroborate this fact; however, other studies present conflicting results. Objective: To assess the clinical results of ICU patients receiving EN, according to EN starting time (early versus late. Patients and method: Basic variables were recorded in all ICU patients who received NE along the study period, as well as time from ICU admission to the start of EN, ICU length of stay, characteristic gastrointestinal complications of EN (gastric residue, constipation, diarrhea, vomiting, regurgitation, abdominal distension and bronchoaspiration and mortality. Results: There was a significant association between early EN and mortality reduction. However, there were no differences in ICU length of stay according to EN starting time. The most frequent complications in the sample were high gastric residue (17.9%, abdominal distension (22.5% and constipation (42.2%. However, no significant differences were observed as a function of the EN starting time. Discussion: Our results, although discrepant at times, do not contradict with those of other studies. EN has shown to be effective as a therapeutic strategy. Therefore, it is recommended the early start of EN in the ICU.

Evaluation of the generality and accuracy of a new mesh morphing procedure for the human femur.

Science.gov (United States)

Grassi, Lorenzo; Hraiech, Najah; Schileo, Enrico; Ansaloni, Mauro; Rochette, Michel; Viceconti, Marco

2011-01-01

Various papers described mesh morphing techniques for computational biomechanics, but none of them provided a quantitative assessment of generality, robustness, automation, and accuracy in predicting strains. This study aims to quantitatively evaluate the performance of a novel mesh-morphing algorithm. A mesh-morphing algorithm based on radial-basis functions and on manual selection of corresponding landmarks on template and target was developed. The periosteal geometries of 100 femurs were derived from a computed tomography scan database and used to test the algorithm generality in producing finite element (FE) morphed meshes. A published benchmark, consisting of eight femurs for which in vitro strain measurements and standard FE model strain prediction accuracy were available, was used to assess the accuracy of morphed FE models in predicting strains. Relevant parameters were identified to test the algorithm robustness to operative conditions. Time and effort needed were evaluated to define the algorithm degree of automation. Morphing was successful for 95% of the specimens, with mesh quality indicators comparable to those of standard FE meshes. Accuracy of the morphed meshes in predicting strains was good (R(2)>0.9, RMSE%0.05) and partially to the number of landmark used. Producing a morphed mesh starting from the triangularized geometry of the specimen requires on average 10 min. The proposed method is general, robust, automated, and accurate enough to be used in bone FE modelling from diagnostic data, and prospectively in applications such as statistical shape modelling. Copyright © 2010 IPEM. Published by Elsevier Ltd. All rights reserved.

Prenatal programming of skeletal development in the offspring: effects of maternal treatment with beta-hydroxy-beta-methylbutyrate (HMB) on femur properties in pigs at slaughter age.

Science.gov (United States)

Tatara, Marcin R; Sliwa, Ewa; Krupski, Witold

2007-06-01

Alteration in fetal growth and development in response to prenatal environmental conditions such as nutrition has long-term or permanent effects during postnatal life. The aim of this study was to investigate effects of beta-hydroxy-beta-methylbutyrate (HMB) treatment of sows during the last 2 weeks of pregnancy on programming of skeletal development in the offspring. The study was performed on 141 pigs born by 12 sows of Polish Landrace breed. Two weeks before delivery, pregnant sows were divided into two groups. The first group consisted of control sows (N=6) that were treated with placebo. Sows that were orally treated with beta-hydroxy-beta-methylbutyrate (N=6) at the dosage of 0.05 g/kg of body weight per day belonged to the second group. Newborn piglets were weighed and subjected to blood collection for determination of serum levels of growth hormone (GH), insulin-like growth factor-1 (IGF-1), insulin, leptin, glucose and bone alkaline phosphatase (BAP) activity and lipid profile. At the age of 6 months, the piglets were slaughtered, their femur was isolated for analysis and assessment of lean meat content of carcasses was performed. The effects of maternal administration with HMB on skeletal properties in the offspring were evaluated in relation to bone mineral density and geometrical and mechanical properties. Maternal treatment with HMB increased serum levels of GH, IGF-1 and BAP activity in the newborns by 38.0%, 20.0% and 26.0%, respectively (PHMB administration significantly increased volumetric bone mineral density of the trabecular and cortical bone of femur in the offspring at the age of 6 months (PHMB treatment (PHMB induced higher values of maximum elastic strength and ultimate strength of femur (PHMB-treated sows (PHMB has positive long-term effects on bone tissue and improves volumetric bone mineral density, geometrical and mechanical properties of femur in the offspring. These effects were connected with increased level of GH and IGF-1 in the

Results of cemented bipolar hemiarthroplasty for fracture of the femoral neck - 10 year study

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Maini P

2006-01-01

Full Text Available Background : One of the most common treatments of displaced fracture of femoral neck in elderly is bipolar hemiarthroplasty. Method : Two hundred and seventy patients of displaced fracture of femoral neck were treated by bipolar hemiarthroplasty. The Mean age of the patients at the time of surgery was 69.80 years. Results : Follow up ranged between 12 months and 120 months. There were 8 cases each of acetabular erosion and protrusion with 10 cases of femoral stem loosening. Eight cases had post operative dislocation requiring open reduction. Eighteen patients got revision surgery to total hip replacement. The overall incidence of DVT/PE was 9.9% which declined after regular use of low molecular weight heparin. Eleven patients had post operative infection. There were 54.2 % excellent results, 21.0 % good results, 10.7 % fair and 3.7% poor results. Conclusion : Elderly patients with displaced fracture of neck femur are able to ambulate early after Cemented bipolar hemi arthroplasty. The complication rate is low, the component survival long and pre injury functional status is restored in majority of patients.

Assessment of femur length for fetal biometry in Malaysian pregnant women

Science.gov (United States)

Ramli, Ramzun Maizan; Adam, Noraina; Jaafar, Mohamad Suhaimi; Rahman, Azhar Abdul; Mustafa, Iskandar Shahrim; Radzi, Yasmin; Nordin, Suriani; Kamarudin, Izyani

2013-05-01

The fetal biometry assessment of femur length (FL) was developed in most countries to evaluate the foetus growth. In this study, the FL values for Malaysia population were determined. A prospective study was conducted and a number of 6501 pregnant women were involved with 12372 FL data were collected, performed at antenatal care clinic of Hospital Pulau Pinang, Malaysia. The SPSS software version 17 (regression analysis and paired sample t-test) were used for analysis. The FL values of this study were constructed and rapid FL growth rate in second trimester (2.59 mm/week) than third trimester (1.43 mm/week) was observed. By ethnicity, no significant difference (p ≥ 0.05) was found between the FL values for fetuses of Malay and Indian ethnic's mother (t = -2.042), however these two groups shows significantly (p Chinese ethnic's mother (t = 4.019, 4.083; accordingly). The FL values of Malaysian resulted as significant difference with the common reference FL values from USA and UK, and also with selected Asian populations (India, China, Korea and Japan). As conclusion, it is strong suggested that medical practitioner in Malaysia should avoid in using biometry references based on other population to avoid under- or over-estimation and for accurate assessment of the fetus growth. As this study involved local Malaysian fetuses, therefore the medical practitioner can use the FL values of this study as reference value for fetus biometry assessment in Malaysia.

[The primary stability between manual and robot assisted implantation of hip prostheses: A biomechanical study on synthetic femurs].

Science.gov (United States)

Decking, J; Gerber, A; Kränzlein, J; Meurer, A; Böhm, B; Plitz, W

2004-01-01

We investigated the initial stability of cementless stems implanted with robotic milling and conventional manual broaching. Proximally porous structured stems (G2, ESKA-Implants, Luebeck, Germany) were implanted into synthetic femora. In one group, the femoral cavity was prepared by a CT-based robot (CASPAR, URS-Ortho, Germany) with a high-speed milling head. In the other group, femora were rasped manually with broaches. The broaches had 1 mm proximal press-fit, the robotic cavities 1.5 mm. The implants were exposed to 15 000 loading cycles with 1 000 +/- 500 N. The direction of forces on the implant head were chosen to simulate stair climbing. Internal rotation and translation (caudal, dorsal and lateral) of the implants were measured by linear transducers. The robotic group showed significantly less reversible motion regarding translation in caudal, dorsal and lateral directions. The standard deviations of implant motions were smaller in the robotic group. Using robotic preparation of the femur, initial stability was higher and more consistent than with manual broaching, but differences in undersizing of the cavities created in the femur in relation to the implant may have contributed to these differences for the most part. In-vitro-loading experiments focusing on femoral cavities with varying press-fits are recommended before the introduction of new implants or operating procedures.

Preoperative morphometric differences in the distal femur are based on skeletal size in Japanese patients undergoing total knee arthroplasty.

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Nishikawa, Masataka; Owaki, Hajime; Kaneshiro, Shoichi; Fuji, Takeshi

2014-12-01

The objectives of this study were to measure the morphometric parameters of preoperative distal femurs to determine the differences by diagnosis and gender after accounting for skeletal size. One-hundred and seventy-nine Japanese patients who underwent total knee arthroplasty (TKA) (25 males and 154 females) were assessed. The anteroposterior length (AP), mediolateral width (ML), aspect ratio (AR), surgical epicondylar axis (SEA) to posterior condylar axis (PCA) angle, and Whiteside to SEA angle were measured on preoperative computed tomography scans. The AP/ML, AR/ML, SEA/PCA, and Whiteside/PCA relationships were evaluated and compared by patient diagnosis and gender. The results were also compared with the sizes of 10 currently available TKA implants in Japan. The mean AP, ML, AR, SEA/PCA angle, and Whiteside/PCA angle were 58.8 mm, 64.7 mm, 0.91, external rotation (ER) 3.5°, and ER 1.6°, respectively. AP and AR each were significantly correlated with ML (p different between patients diagnosed with osteoarthritis and rheumatoid arthritis. AP/ML and AR/ML were significantly correlated within each diagnosis (p differences between the diagnoses. AP and ML were significantly longer (p gender. However, the analysis of covariance showed no significant differences between gender in the AP/ML and AR/MR correlations. The AP/ML ratio of our data was similar to the size variations of the 10 TKA implants, but the AR/ML ratio was quite different from almost all the implants. No differences in preoperative femur morphometry were found between patients with different diagnoses, but the gender difference in AR was related to the difference in skeletal size between males and females. Case series with no comparison groups, Level IV.

Early 13 TeV Results from the ATLAS Experiment

CERN Multimedia

CERN. Geneva

2015-01-01

The ATLAS experiment has recorded almost 200 pb-1 of collision data at 13 TeV centre-of-mass energy. The seminar presents the status of the data taking, the commissioning of the event reconstruction, focusing on the key techniques that have allowed to quickly reach a good understanding of the basic physics objects, and early physics results.

Recognizing different tissues in human fetal femur cartilage by label-free Raman microspectroscopy

Science.gov (United States)

Kunstar, Aliz; Leijten, Jeroen; van Leuveren, Stefan; Hilderink, Janneke; Otto, Cees; van Blitterswijk, Clemens A.; Karperien, Marcel; van Apeldoorn, Aart A.

2012-11-01

Traditionally, the composition of bone and cartilage is determined by standard histological methods. We used Raman microscopy, which provides a molecular "fingerprint" of the investigated sample, to detect differences between the zones in human fetal femur cartilage without the need for additional staining or labeling. Raman area scans were made from the (pre)articular cartilage, resting, proliferative, and hypertrophic zones of growth plate and endochondral bone within human fetal femora. Multivariate data analysis was performed on Raman spectral datasets to construct cluster images with corresponding cluster averages. Cluster analysis resulted in detection of individual chondrocyte spectra that could be separated from cartilage extracellular matrix (ECM) spectra and was verified by comparing cluster images with intensity-based Raman images for the deoxyribonucleic acid/ribonucleic acid (DNA/RNA) band. Specific dendrograms were created using Ward's clustering method, and principal component analysis (PCA) was performed with the separated and averaged Raman spectra of cells and ECM of all measured zones. Overall (dis)similarities between measured zones were effectively visualized on the dendrograms and main spectral differences were revealed by PCA allowing for label-free detection of individual cartilaginous zones and for label-free evaluation of proper cartilaginous matrix formation for future tissue engineering and clinical purposes.

Automatic allograft bone selection through band registration and its application to distal femur.

Science.gov (United States)

Zhang, Yu; Qiu, Lei; Li, Fengzan; Zhang, Qing; Zhang, Li; Niu, Xiaohui

2017-09-01

Clinical reports suggest that large bone defects could be effectively restored by allograft bone transplantation, where allograft bone selection acts an important role. Besides, there is a huge demand for developing the automatic allograft bone selection methods, as the automatic methods could greatly improve the management efficiency of the large bone banks. Although several automatic methods have been presented to select the most suitable allograft bone from the massive allograft bone bank, these methods still suffer from inaccuracy. In this paper, we propose an effective allograft bone selection method without using the contralateral bones. Firstly, the allograft bone is globally aligned to the recipient bone by surface registration. Then, the global alignment is further refined through band registration. The band, defined as the recipient points within the lifted and lowered cutting planes, could involve more local structure of the defected segment. Therefore, our method could achieve robust alignment and high registration accuracy of the allograft and recipient. Moreover, the existing contour method and surface method could be unified into one framework under our method by adjusting the lift and lower distances of the cutting planes. Finally, our method has been validated on the database of distal femurs. The experimental results indicate that our method outperforms the surface method and contour method.

Implant Material, Type of Fixation at the Shaft, and Position of Plate Modify Biomechanics of Distal Femur Plate Osteosynthesis.

Science.gov (United States)

Kandemir, Utku; Augat, Peter; Konowalczyk, Stefanie; Wipf, Felix; von Oldenburg, Geert; Schmidt, Ulf

2017-08-01

To investigate whether (1) the type of fixation at the shaft (hybrid vs. locking), (2) the position of the plate (offset vs. contact) and (3) the implant material has a significant effect on (a) construct stiffness and (b) fatigue life in a distal femur extraarticular comminuted fracture model using the same design of distal femur periarticular locking plate. An extraarticular severely comminuted distal femoral fracture pattern (OTA/AO 33-A3) was simulated using artificial bone substitutes. Ten-hole distal lateral femur locking plates were used for fixation per the recommended surgical technique. At the distal metaphyseal fragment, all possible locking screws were placed. For the proximal diaphyseal fragment, different types of screws were used to create 4 different fixation constructs: (1) stainless steel hybrid (SSH), (2) stainless steel locked (SSL), (3) titanium locked (TiL), and (4) stainless steel locked with 5-mm offset at the diaphysis (SSLO). Six specimens of each construct configuration were tested. First, each specimen was nondestructively loaded axially to determine the stiffness. Then, each specimen was cyclically loaded with increasing load levels until failure. Construct Stiffness: The fixation construct with a stainless steel plate and hybrid fixation (SSH) had the highest stiffness followed by the construct with a stainless steel plate and locking screws (SSL) and were not statistically different from each other. Offset placement (SSLO) and using a titanium implant (TiL) significantly reduced construct stiffness. Fatigue Failure: The stainless steel with hybrid fixation group (SSH) withstood the most number of cycles to failure and higher loads, followed by the stainless steel plate and locking screw group (SSL), stainless steel plate with locking screws and offset group (SSLO), and the titanium plate and locking screws group (TiL) consecutively. Offset placement (SSLO) as well as using a titanium implant (TiL) reduced cycles to failure. Using the

Total femur arthroplasty for revision hip failure in osteogenesis imperfecta: limits of biology

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Pablo Sanz-Ruiz, PhD, MD

2017-09-01

Full Text Available Osteogenesis imperfecta (OI is a rare congenital disease characterized by alterations in bone quality, with susceptibility to fractures, instability, deformities, and osteoarthrosis. Prosthetic surgery in these patients is associated with an abnormally high rate of implant failures. On the other hand, abnormal bone fragility adds to the complexity of revision surgery in such individuals—thus representing a genuine challenge for the orthopaedic surgeon. We present a case of femoral reconstruction in a patient with OI and prosthetic loosening after reconstruction secondary to femoral septic pseudoarthrosis. Intramedullary total femoral reconstruction was carried out after exceeding the biological reconstruction limits. This is the first reported instance of the use of an intramedullary total femur arthroplasty as salvage technique in an OI patient. This technique should be considered when we have exceeded biological limits for femoral fixation.

Influence of Lateral Muscle Loading in the Proximal Femur after Fracture Stabilization with a Trochanteric Gamma Nail (TGN)

Science.gov (United States)

Sitthiseripratip, Kriskrai; Mahaisavariya, Banchong; Suwanprateeb, Jintamai; Bohez, Erik; Vander Sloten, Jos

The purpose of this study was to investigate the influence of lateral muscle loading on the stress/strain distributions of the trochanteric Gamma nail (TGN) fixation within the healed, trochanteric and subtrochanteric femoral fractures by means of a finite element method. The effect of three muscle groups, the abductors (ABD), the vastus lateralis (VL) and the iliotibial band (ITB), were investigated. The analytical results showed that addition of lateral muscle forces, iliotibial band and vastus lateralis, produced compensation of forces and reduction of bending moments in the bone and in the trochanteric Gamma nail especially in the lateral aspect. The iliotibial band produced a higher impact as compared to the vastus lateralis. Therefore in the finite element analysis of the proximal femur with the trochanteric Gamma nail fracture fixation should include the lateral muscle forces to simulate load condition with maximal physiological relevance to the closed nailing technique.

Planck early results. XIV. ERCSC validation and extreme radio sources

DEFF Research Database (Denmark)

Lähteenmäki, A.; Lavonen, N.; León-Tavares, J.

2011-01-01

Planck's all-sky surveys at 30-857 GHz provide an unprecedented opportunity to follow the radio spectra of a large sample of extragalactic sources to frequencies 2-20 times higher than allowed by past, large-area, ground-based surveys. We combine the results of the Planck Early Release Compact So...

A belt charging system for the Vivitron - design, early results

International Nuclear Information System (INIS)

Helleboid, J.M.; Gaudiot, G.

1990-10-01

A specific belt charging system has been designed, built and assembled for the 35 MV Vivitron. 100 m long belt is used. Together with main features of the design, experimental studies, tests in a pilot machine and the results of the very early tests of the real system are reviewed

Pre-operative urinary tract infection: is it a risk factor for early surgical site infection with hip fracture surgery? A retrospective analysis

OpenAIRE

Yassa, Rafik RD; Khalfaoui, Mahdi Y; Veravalli, Karunakar; Evans, D Alun

2017-01-01

Objective The aims of the current study were to determine whether pre-operative urinary tract infections in patients presenting acutely with neck of femur fractures resulted in a delay to surgery and whether such patients were at increased risk of developing post-operative surgical site infections. Design A retrospective review of all patients presenting with a neck of femur fracture, at a single centre over a one-year period. The hospital hip fracture database was used as the main source of ...

Efeitos do treinamento físico sobre a resistência mecânica do terço proximal do fêmur de ratos Effects of physical training on the mechanical resistance of rat femur proximal thirds

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Andreo Fernando Aguiar

2010-01-01

Full Text Available OBJETIVO: Analisar o comportamento mecânico do terço proximal do fêmur de ratos submetidos ao treinamento aeróbio e resistido crônicos. MÉTODOS: Ratos Wistar machos (80 dias, 300 a 350 g foram divididos em 3 grupos (n=8 por grupo: Treinamento aeróbio/8 semanas (TA, Treinamento resistido/8 semanas (TR e controle/8 semanas (CO. Ao término do período de treinamento os animais foram sacrificados e o fêmur direito coletado. Para análise do comportamento mecânico do fêmur foram realizados ensaios de flexo-compressão. RESULTADOS: O treinamento resistido ocasionou redução significante da força máxima (Fmáx do fêmur. Por outro lado, promoveu um aumento (23,7% relevante, porém não significante, da deformação da força máxima (DFmáx. O treinamento aeróbio não afetou a Fmáx, porém promoveu uma redução (26,6% considerável, também não significante, da DFmáx. CONCLUSÕES: Os resultados demonstram que o treinamento resistido e aeróbio, promoveram redução da Fmáx e da DFmáx óssea, respectivamente. Os dados evidenciam uma ação diferencial de ambos os modelos de treinamento físico sobre as propriedades mecânicas do fêmur de ratos.OBJECTIVE: To analyze the mechanical behavior of rat femur proximal thirds submitted to chronic aerobic and resistance training. METHODS: Male Wistar rats (80 days of age, weighing 300 to 350 g were divided into 3 groups (n=8 per group: control (CO, aerobic training (TA and resistance training (TR. At the end of the training, the animals were euthanized and the right femur was collected. Flexion-compression tests were carried out to analyze the mechanical behavior of the femurs. RESULTS: The resistance training promoted a significant reduction in maximum force (Fmáx of the femur. However, it also promoted a relevant increase (23.7%, though without statistical significance, in maximum force deformation (DFmáx. The aerobic training did not affect maximum force, however, it caused a

Computer-navigated minimally invasive total knee arthroplasty for patients with retained implants in the femur

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Sung-Yen Lin

2014-08-01

Full Text Available Total knee arthroplasty (TKA in patients with knee arthritis and retained implants in the ipsilateral femur is a challenge for knee surgeons. Use of a conventional intramedullary femoral cutting guide is not practical because of the obstruction of the medullary canal by implants. Previous studies have shown that computer-assisted surgery (CAS can help restore alignment in conventional TKA for patients with knee arthritis with retained femoral implants or extra-articular deformity, without the need for implant removal or osteotomy. However, little has been published regarding outcomes with the use of navigation in minimally invasive surgery (MIS-TKA for patients with this complex knee arthritis. MIS has been proven to provide less postoperative pain and faster recovery than conventional TKA, but MIS-TKA in patients with retained femoral implants poses a greater risk in limb malalignment. The purpose of this study is to report the outcome of CAS-MIS-TKA in patients with knee arthritis and retained femoral implants. Between April 2006 and March 2008, eight patients with knee arthritis and retained femoral implants who underwent the CAS-MIS-TKA were retrospectively reviewed. Three of the eight patients had extra-articular deformity, including two femur bones and one tibia bone, in the preoperative examination. The anteroposterior, lateral, and long-leg weight-bearing radiographs carried out at 3-month follow-up was used to determine the mechanical axis of lower limb and the position of components. The mean preoperative femorotibial angle in patients without extra-articular deformity was 3.8° of varus and was corrected to 4.6° of valgus. With the use of navigation in MIS-TKA, the two patients in this study with extra-articular femoral deformity also obtained an ideal postoperative mechanical axis within 2° of normal alignment. Overall, there was a good restoration of postoperative mechanical alignment in all cases, with a mean angle of 0.4° of

In vivo strains in the femur of the Virginia opossum (Didelphis virginiana) during terrestrial locomotion: testing hypotheses of evolutionary shifts in mammalian bone loading and design.

Science.gov (United States)

Butcher, Michael T; White, Bartholomew J; Hudzik, Nathan B; Gosnell, W Casey; Parrish, John H A; Blob, Richard W

2011-08-01

Terrestrial locomotion can impose substantial loads on vertebrate limbs. Previous studies have shown that limb bones from cursorial species of eutherian mammals experience high bending loads with minimal torsion, whereas the limb bones of non-avian reptiles (and amphibians) exhibit considerable torsion in addition to bending. It has been hypothesized that these differences in loading regime are related to the difference in limb posture between upright mammals and sprawling reptiles, and that the loading patterns observed in non-avian reptiles may be ancestral for tetrapod vertebrates. To evaluate whether non-cursorial mammals show loading patterns more similar to those of sprawling lineages, we measured in vivo strains in the femur during terrestrial locomotion of the Virginia opossum (Didelphis virginiana), a marsupial that uses more crouched limb posture than most mammals from which bone strains have been recorded, and which belongs to a clade phylogenetically between reptiles and the eutherian mammals studied previously. The presence of substantial torsion in the femur of opossums, similar to non-avian reptiles, would suggest that this loading regime likely reflects an ancestral condition for tetrapod limb bone design. Strain recordings indicate the presence of both bending and appreciable torsion (shear strain: 419.1 ± 212.8 με) in the opossum femur, with planar strain analyses showing neutral axis orientations that placed the lateral aspect of the femur in tension at the time of peak strains. Such mediolateral bending was unexpected for a mammal running with near-parasagittal limb kinematics. Shear strains were similar in magnitude to peak compressive axial strains, with opossum femora experiencing similar bending loads but higher levels of torsion compared with most previously studied mammals. Analyses of peak femoral strains led to estimated safety factor ranges of 5.1-7.2 in bending and 5.5-7.3 in torsion, somewhat higher than typical mammalian values

Tissue responses to low protracted doses of high let radiations or photons: Early and late damage relevant to radio-protective countermeasures

International Nuclear Information System (INIS)

Ainsworth, E.J.; Afzal, S.M.J.; Crouse, D.A.; Hanson, W.R.; Fry, R.J.M.

1988-01-01

Early and late murine tissue responses to single or fractionated low doses of heavy charged particles, fission-spectrum neutrons or gamma rays are considered. Damage to the hematopoietic system is emphasized, but results on acute lethality, host response to challenge with transplanted leukemia cells and life-shortening are presented. Low dose rates per fraction were used in some neutron experiments. Split-dose lethality studies (LD 50/30) with fission neutrons indicated greater accumulation of injury during a 9 fraction course (over 17 days) than was the case for γ-radiation. When total doses of 96 or 247 cGy of neutrons or γ rays were given as a single dose or in 9 fractions, a significant sparing effect on femur CFU-S depression was observed for both radiation qualities during the first 11 days, but there was not an earlier return to normal with dose fractionation. During the 9 fraction sequence, a significant sparing effect of low dose rate on CFU-S depression was observed in both neutron and γ-irradiated mice. CFU-S content at the end of the fractionation sequence did not correlate with measured LD 50/30. Sustained depression of femur and spleen CFU-S and a significant thrombocytopenia were observed when a total neutron dose of 240 cGy was given in 72 fractions over 24 weeks at low dose rates. The temporal aspects of CFU-S repopulation were different after a single versus fractionated neutron doses. The sustained reduction in the size of the CFU-S population was accompanied by an increase in the fraction in DNA synthesis. The proliferation characteristics and effects of age were different for radial CFU-S population closely associated with bone, compared with the axial population that can be readily aspirated from the femur. In aged irradiated animals, the CFU-S proliferation/redistribution response to typhoid vaccine showed both an age and radiation effect. 63 refs., 6 figs., 7 tabs

The early assessment of avascular necrosis of femur head in dogs by dynamic bone imaging

International Nuclear Information System (INIS)

Li Peiyong; Zhang Huan; Zhang Jixian; Zhu Chengmo; Sun Zhengming; Yang Qingming

1998-01-01

Avascular necrosis of femoral head (AVN) was induced unilaterally in 10 dogs by frozen. Dynamic bone imaging was performed before, and 1,3,5,7,12,19 and 33 days after operation. The perfusion index of femoral head (FPI) was calculated by the graphical approach of time-activity curves and quantitation of data. Based on histological examination, pathological lesions on 10 dogs could be classified into four stages: edema, hemorrhage, liquidation, and granulation formation with focal fibrosis, etc. Decreased FPI index was found in all lesions of 10 dogs by dynamic bone imaging. Until 19 days after operation, the uptake was reduced compared to the normal side, whereas after 33 days, its uptake was increased. Perfusion index was considered to reveal the blood flow condition in femoral head. It can be used to detect the early stage of AVN and to understand the effects of various modes of therapy

A morphometric and taxonomic assessment of a hominine femur from the lower member, Koobi Fora, Lake Turkana.

Science.gov (United States)

Kennedy, G E

1983-08-01

Previous research by this author and others has indicated that species-level differentiation within the hominines can be detected in the femur. The femoral shaft of Homo erectus, relative to H. sapiens, demonstrates small anteroposterior diameters, a distally placed point of minimum shaft breadth, and increased cortical thickness resulting in medullary stenosis. This pattern has been identified in specimens from Choukoutien (I and IV), Olduvai (OH 28), and Lake Turkana (KNM ER 737). Findings reported here include anatomical comparisons and univariate and multivariate analyses based on external and internal shaft morphology. These results indicate that the femoral pattern characteristic of H. erectus can be identified in KNM ER 1481a recovered at Lake Turkana below the KBS tuff. Recent dating of that tuff indicates a date of ca. 1.8 mya, thereby yielding a date for KNM ER 1481a of congruent to 2.0 mya. Known H. erectus femora extend over a broad span and yet show very low variability; this pronounced stasis would strongly suggest that, at least in this portion of the postcranium, H. erectus was in a period of profound morphological stasis.

Progress towards in vitro quantitative imaging of human femur using compound quantitative ultrasonic tomography

International Nuclear Information System (INIS)

Lasaygues, Philippe; Ouedraogo, Edgard; Lefebvre, Jean-Pierre; Gindre, Marcel; Talmant, Marilyne; Laugier, Pascal

2005-01-01

The objective of this study is to make cross-sectional ultrasonic quantitative tomography of the diaphysis of long bones. Ultrasonic propagation in bones is affected by the severe mismatch between the acoustic properties of this biological solid and those of the surrounding soft medium, namely, the soft tissues in vivo or water in vitro. Bone imaging is then a nonlinear inverse-scattering problem. In this paper, we showed that in vitro quantitative images of sound velocities in a human femur cross section could be reconstructed by combining ultrasonic reflection tomography (URT), which provides images of the macroscopic structure of the bone, and ultrasonic transmission tomography (UTT), which provides quantitative images of the sound velocity. For the shape, we developed an image-processing tool to extract the external and internal boundaries and cortical thickness measurements. For velocity mapping, we used a wavelet analysis tool adapted to ultrasound, which allowed us to detect precisely the time of flight from the transmitted signals. A brief review of the ultrasonic tomography that we developed using correction algorithms of the wavepaths and compensation procedures are presented. Also shown are the first results of our analyses on models and specimens of long bone using our new iterative quantitative protocol

Determination of composition and structure of spongy bone tissue in human head of femur by Raman spectral mapping.

Science.gov (United States)

Kozielski, M; Buchwald, T; Szybowicz, M; Błaszczak, Z; Piotrowski, A; Ciesielczyk, B

2011-07-01

Biomechanical properties of bone depend on the composition and organization of collagen fibers. In this study, Raman microspectroscopy was employed to determine the content of mineral and organic constituents and orientation of collagen fibers in spongy bone in the human head of femur at the microstructural level. Changes in composition and structure of trabecula were illustrated using Raman spectral mapping. The polarized Raman spectra permit separate analysis of local variations in orientation and composition. The ratios of ν₂PO₄³⁻/Amide III, ν₄PO₄³⁻/Amide III and ν₁CO₃²⁻/ν₂PO₄³⁻ are used to describe relative amounts of spongy bone components. The ν₁PO₄³⁻/Amide I ratio is quite susceptible to orientation effect and brings information on collagen fibers orientation. The results presented illustrate the versatility of the Raman method in the study of bone tissue. The study permits better understanding of bone physiology and evaluation of the biomechanical properties of bone.

The study of mechanical behavior on the interface between calcar-defect femur and restorations by means of finite element analysis

International Nuclear Information System (INIS)

Shi, X.H.; Jiang, W.; Chen, H.Z.; Zou, W.; Wang, W.D.; Guo, Z.; Luo, J.M.; Gu, Z.W.; Zhang, X.D.

2008-01-01

The mechanical behaviors of calcar-defected femur and restorations under physiological load are the key factors that will greatly influence the success of femur calcar defect repairing, especially the stress distribution on the bone-restoration interface. 3D finite elements analysis (FEA) was used to analyze the mechanical characters on the interfaces between femoral calcar defects and bone cement or HA restorations. Under the load of two times of a human weight (1436.03 N) and with the increase of the defect dimension from 6 mm to 12 mm, the maximal stresses on the surface of restorations are from 7.06 MPa to 11.89 MPa for bone cement and 2.97-9 MPa for HA separately. In this condition, HA restoration will probably be broken on the bone-restoration interface when the defect diameter is beyond 8 mm. Furthermore, under the load of 1.5 times of a human weight, HA restoration would not be safe unless the defect dimension is smaller than 10 mm, because the maximal stress (4.62 MPa) on the restoration is only a little lower than compressive strength of HA, otherwise the bone fixation device should be applied to ensure the safety. It is relatively safe for all restorations under all the tested defect sizes when the load is just the weight of a human body

Label-free Raman spectroscopy provides early determination and precise localization of breast cancer-colonized bone alterations.

Science.gov (United States)

Zhang, Chi; Winnard, Paul T; Dasari, Sidarth; Kominsky, Scott L; Doucet, Michele; Jayaraman, Swaathi; Raman, Venu; Barman, Ishan

2018-01-21

Breast neoplasms frequently colonize bone and induce development of osteolytic bone lesions by disrupting the homeostasis of the bone microenvironment. This degenerative process can lead to bone pain and pathological bone fracture, a major cause of cancer morbidity and diminished quality of life, which is exacerbated by our limited ability to monitor early metastatic disease in bone and assess fracture risk. Spurred by its label-free, real-time nature and its exquisite molecular specificity, we employed spontaneous Raman spectroscopy to assess and quantify early metastasis driven biochemical alterations to bone composition. As early as two weeks after intracardiac inoculations of MDA-MB-435 breast cancer cells in NOD-SCID mice, Raman spectroscopic measurements in the femur and spine revealed consistent changes in carbonate substitution, overall mineralization as well as crystallinity increase in tumor-bearing bones when compared with their normal counterparts. Our observations reveal the possibility of early stage detection of biochemical changes in the tumor-bearing bones - significantly before morphological variations are captured through radiographic diagnosis. This study paves the way for a better molecular understanding of altered bone remodeling in such metastatic niches, and for further clinical studies with the goal of establishing a non-invasive tool for early metastasis detection and prediction of pathological fracture risk in breast cancer.

MR imaging of the bone marrow in myeloid leukemia and myelodysplastic syndrome. Comparison of the lumbar spine and femur

International Nuclear Information System (INIS)

Tanaka, Osamu; Kobayashi, Yasuyuki; Ichikawa, Tamaki; Matsuura, Katsuhiko; Nagai, Jun; Takagi, Shojiro

1995-01-01

MR imaging of the lumber spine and the femur was performed with T1-weighted SE sequence and comparison of the MRI findings of the lumber vertebral body and the femoral marrow was made in 15 patients with acute myeloid leukemia (AML), 5 chronic myelogenous leukemia (CML), and 9 myelodysplastic syndrome (MDS). The MRI appearance of the bone marrow was classified into four patterns: 1) fatty marrow; 2) faint signal; 3) heterogeneous infiltration; and 4) diffuse infiltration. The MRI of the lumber vertebral body showed a diffuse marrow infiltration pattern in over the half of the cases of AML and MDS. On the MRI of the femoral marrow, the signal intensity alteration, a low signal on T1-weighted SE image, began in the proximal femurs almost symmetrically. The abnormal low signal intensity area tended to gradually extend towards the distal portion of the femoral marrow with progression of the disease in the patients with AML and MDS. M2 type of AML tended to be demonstrated as a faint signal pattern, which was significantly different from the other types of AML. In all the cases of CML, a diffuse cellular infiltration pattern was noted with total replacement of the fatty marrow on both lumbar spinal and femoral MRI, and the femoral marrow involvement was more downwardly extended than AML. We concluded that MRI of the femoral marrow was more efficient than that of the lumbar spine in the assessment of myeloid leukemia and MDS. (author)

A biomechanical comparison of proximal femoral nails and locking proximal anatomic femoral plates in femoral fracture fixation A study on synthetic bones

Directory of Open Access Journals (Sweden)

Korhan Ozkan

2015-01-01

Conclusion: The proximal femoral intramedullary nail provides more stability and allows for earlier weight bearing than the locking plate when used for the treatment of unstable intertrochanteric fractures of the femur. Clinicians should be cautious for early weight bearing with locking plate for unstable intertrochanteric femur fractures.

Early and long-term results of a valve-sparing operation for Marfan syndrome.

Science.gov (United States)

Birks, E J; Webb, C; Child, A; Radley-Smith, R; Yacoub, M H

1999-11-09

We have previously described the experience, rationale, and development of a valve preserving technique, but its role in patients with Marfan syndrome has not previously been defined. Here, we attempt to determine the early and long-term results, timing, and determinants of outcome of this operation in patients with Marfan syndrome. Since 1979, 82 patients (73.2% of all patients with Marfan syndrome undergoing resection of aneurysm of the ascending aorta) were operated on using this technique. Ages ranged from 2 to 69 years (mean, 33.9 years). In all, there were 4 early deaths (4.9%), 2 with acute dissection and 2 with chronic aneurysm operated on as emergencies. There were no early deaths in 67 patients operated on electively. Actuarial survival for patients operated for chronic aneurysm was 94.2%, 94.2%, and 94.2% at 1, 5, and 10 years, respectively; that for acute dissection was 72.7%, 63. 6%, and 63.6%; and that for chronic dissection was 100%, 85.7%, and 75.0%. The probability of needing reoperation was 5.7%, 17.3%, and 17.3% at 1, 5, and 10 years. There were no instances of infective endocarditis or thromboembolic complications except in 2 patients operated on early in the series who had cusp extension. At the end of the follow-up, trivial or no aortic regurgitation was demonstrated in 33.3%, mild in 45.6%, moderate in 21.1%, and severe in 0. Valve-sparing operations are feasible in most patients with Marfan syndrome; they are applicable to patients with both dissection and chronic aneurysm. The early and long-term results are encouraging. Results are better in the absence of dissection, and prophylactic operation is warranted in some cases.

The results of early physiotherapy on a child with incontinentia pigmenti with encephalocele

Science.gov (United States)

Kara, Ozgun Kaya; Mutlu, Akmer; Gunel, Mintaze Kerem

2010-01-01

This study aimed to exhibit the effects of early physiotherapy and discusses post-treatment results on a patient with incontinentia pigmenti (IP) with encephalocele. Physiotherapy evaluations of the child included cognitive, fine and gross motor development assessed with the Bayley Scales of Infant and Toddler Development – Third Edition (Bayley-III), disability level with the gross motor function classification system, gross motor function with the gross motor function measurement (GMFM), and tonus evaluation with the Modified Ashworth Scale. The child was included in a physiotherapy and rehabilitation programme based on neurodevelopmental treatment three times a week. Although cognitive and motor development according to Bayley-III improved in the present case, motor and cognitive retardation became more apparent with growth. GMFM results indicated a large improvement from 5.88% to 47.73%. Presentation of this case shows the significance of early physiotherapy in this first study on physiotherapy for IP during the early rehabilitation process. PMID:22767665

Early Results from NICER Observations of Accreting Neutron Stars

Science.gov (United States)

Chakrabarty, Deepto; Ozel, Feryal; Arzoumanian, Zaven; Gendreau, Keith C.; Bult, Peter; Cackett, Ed; Chenevez, Jerome; Fabian, Andy; Guillot, Sebastien; Guver, Tolga; Homan, Jeroen; Keek, Laurens; Lamb, Frederick; Ludlam, Renee; Mahmoodifar, Simin; Markwardt, Craig B.; Miller, Jon M.; Psaltis, Dimitrios; Strohmayer, Tod E.; Wilson-Hodge, Colleen A.; Wolff, Michael T.

2018-01-01

The Neutron Star Interior Composition Explorer (NICER) offers significant new capabilities for the study of accreting neuton stars relative to previous X-ray missions including large effective area, low background, and greatly improved low-energy response. The NICER Burst and Accretion Working Group has designed a 2 Ms observation program to study a number of phenomena in accreting neutron stars including type-I X-ray bursts, superbursts, accretion-powered pulsations, quasi-periodic oscillations, and accretion disk reflection spectra. We present some early results from the first six months of the NICER mission.

[The effect of verticalization of the resulting force (R) of weight bearing in the hip joint on morphologic characteristics of the medullary canal in the femoral shaft in patients with coxarthrosis].

Science.gov (United States)

Jovanović, S

1992-01-01

An influence of verticalization of the resulting force of weight-bearing on the hip joint "R" on the morphological characteristics of the medullar canal on the proximal edge of the shaft of femur was researched. Progressive degenerative changes of the hip joint with a consequent sideways limping or changes of the collodiaphysial angle (ccd angle) were the cause of the verticalization of the resulting force "R". The analysis of patients treated and operated on The Orthopaedic Department of the General Hospital Osijek and The Orthopaedic Clinic of The Medical Faculty of The University of Zagreb. The research, undoubtedly, proved that the patients with coxarthrosis and side-ways in the hip or with changed collodiaphysial angle experienced verticalization of the resulting force of weigh-bearing of the hip joint and the proximal edge of femur which caused morphological changes of the medular canal of the shaft of femur.

Tissue responses to low protracted doses of high LET radiations or photons: Early and late damage relevant to radio-protective countermeasures

Science.gov (United States)

Ainsworth, E. J.; Afzal, S. M. J.; Crouse, D. A.; Hanson, W. R.; Fry, R. J. M.

Early and late murine tissue responses to single or fractionated low doses of heavy charged particles, fission-spectrum neutrons or gamma rays are considered. Damage to the hematopoietic system is emphasized, but results on acute lethality, host response to challenge with transplanted leukemia cells and life-shortening are presented. Low dose rates per fraction were used in some neutron experiments. Split-dose lethality studies (LD 50/30) with fission neutrons indicated greater accumulation of injury during a 9 fraction course (over 17 days) than was the case for γ-radiation. When total doses of 96 or 247 cGy of neutrons or γ rays were given as a single dose or in 9 fractions, a significant sparing effect on femur CFU-S depression was observed for both radiation qualities during the first 11 days, but there was not an earlier return to normal with dose fractionation. During the 9 fraction sequence, a significant sparing effect of low dose rate on CFU-S depression was observed in both neutron and γ-irradiated mice. CFU-S content at the end of the fractionation sequence did not correlate with measured LD 50/30. Sustained depression of femur and spleen CFU-S and a significant thrombocytopenia were observed when a total neutron dose of 240 cGy was given in 72 fractions over 24 weeks at low dose rates. The temporal aspects of CFU-S repopulation were different after a single versus fractionated neutron doses. The sustained reduction in the size of the CFU-S population was accompanied by an increase in the fraction in DNA synthesis. The proliferation characteristics and effects of age were different for radial CFU-S population closely associated with bone, compared with the axial population that can be readily aspirated from the femur. In aged irradiated animals, the CFU-S proliferation/redistribution response to typhoid vaccine showed both an age and radiation effect. After high single doses of neutrons or γ rays, a significant age- and radiation-related deficiency

Morphological analysis of the proximal femur by computed tomography in Japanese subjects

International Nuclear Information System (INIS)

Hagiwara, Masashi

1995-01-01

In order to evaluate the morphological features of the proximal femur in the Japanese, 100 femora of normal Japanese subjects (normal group) and 60 femora of 43 Japanese patients with secondary osteoarthrosis of the hip (OA group) were analyzed using CT images. The scans for the dried bones (normal group) were done at a setting of 80 kV and 20 mA, for 2 sec duration. The scans were reconstructed using the soft tissue algorithm built into the GE-9800 scanner. The patient scans (OA group) were done at 120 kV and 170 mA also for 2 sec duration, and reconstructed using the same bone algorithm. The results were as follows: Thinning of the femoral cortex occurred in normal females over 60 years of age. The canal flare index at the proximal part of the femoral diaphysis was negatively correlated with the canal diameter at the isthmus. The index at the upper part was greater than that at the lower part. The two groups showed no statistical difference in this index. In the metaphysis, the canal flare index at the anterior portion was twice that at the posterior portion. In absolute terms, the OA group had a reduced flare or curve along the medial portion. In cross-section, the canal shape of the diaphysis was more elliptical in the OA group than in the normal group. The longitudinal axis of the canal was directed more sagittally in the OA group than in the normal group. (author)

Femur-bending properties as influenced by gravity. V - Strength vs. calcium and gravity in rats exposed for 2 weeks

Science.gov (United States)

Wunder, Charles C.; Cook, Kenneth M.; Watkins, Stanley R.; Moressi, William J.

1987-01-01

The dependence of gravitationally related changes in femur bone strength on the comparable changes in calcium content was investigated in rats exposed to chronic simulations of altered gravity from the 28th to 42nd day of age. Zero G was simulated by harness suspension and 3 G by centrifugation. Bone strength (S) was determined by bending (using modified quasi-static cantilever bending methods and equipment described by Wunder et al., 1977 and 1979) and Ca content (C, by mass pct) determined by atomic absorption spectrometry; results were compared with data obtained on both normal and harnessed control animals at 1 G. Multiple regression showed significant dependence of S upon earth's gravity, independent from C, for which there was no significant coefficient of partial regression. It is suggested that the lack of S/C correlation might have been due to the fact that considerable fraction of the calcium in these young, developing bones has not yet crystallized into the hydroxyapatite which provides strength.

Early bone changes after incorporation of low quantities of alpha emitters in male rats

International Nuclear Information System (INIS)

Laengle, U.W.

1988-09-01

This work shows the early effects of cancergenic doses of alpha emitters in long bones of rats. The investigations were based on radiographic, morphologic, angiographic, histologic and electronmicroscopic methods. A special method for bone angiography in the rat was elaborated and a new method was developed for measurement of the femur neck-head angle. Numerous disturbances in bone growth and bone structure, in the blood supply of bone and also of the bone building cells were observed. There was a correlation between the severity of the damage and the radiation dose, the spacial distribution of the nuclide and partially the age of the rats. The bone injury due to plutonium was markedly reduced by administration of the chelating agent Zn-DTPA. (orig.) [de

Treatment of Unicameral Bone Cysts of the Proximal Femur With Internal Fixation Lessens the Risk of Additional Surgery.

Science.gov (United States)

Wilke, Benjamin; Houdek, Matthew; Rao, Rameshwar R; Caird, Michelle S; Larson, A Noelle; Milbrandt, Todd

2017-09-01

Little data exist to guide the treatment of unicameral bone cysts in the proximal femur. Methods of treatment include corticosteroid injections, curettage and bone grafting, and internal fixation. The authors completed a multi-institutional, retrospective review to evaluate their experience with proximal femoral unicameral bone cysts. They posed the following questions: (1) Does internal fixation reduce the risk of further procedures for the treatment of a unicameral bone cyst? (2) Is radiographic healing faster with internal fixation? Following institutional review board approval, the authors conducted a retrospective review of 36 patients treated for a unicameral bone cyst of the proximal femur at their institutions between 1974 and 2014. Medical records and radiographs were reviewed to identify patient demographics and treatment outcomes. Tumor locations included femoral neck (n=13), intertrochanteric (n=16), and subtrochanteric (n=7). Initial treatment included steroid injection (n=2), curettage and bone grafting (n=9), and internal fixation with curettage and bone grafting (n=25). Mean time was 9 months to radiographic healing and 15 months to return to full activity. The number of patients requiring additional surgeries was increased among those who did not undergo internal fixation. There was no difference in time to radiographic healing. However, time to return to normal activities was reduced if patients had received internal fixation. A significant reduction in additional procedures was observed when patients had been treated with internal fixation. Although this did not influence time to radiographic healing, patients did return to normal activities sooner. Internal fixation should be considered in the treatment of proximal femoral unicameral bone cysts. [Orthopedics. 2017; 40(5):e862-e867.]. Copyright 2017, SLACK Incorporated.

Radiation injuries of the pelvis and proximal parts of the femur after irradiation of carcinoma of the cervix uteri

International Nuclear Information System (INIS)

Shimanovskaya, K.; Shiman, A.D.

1983-01-01

Data relating to 244 patients with carcinoma of the cervix uteri treated by intensive radiotherapy are given. Radiation injury of bone was diagnosed in 12 cases (4.9 +/- 1.4 percent). After x-ray therapy alone they were found in five of 59 patients treated (8.5 +/- 3.6 percent), and after γ-ray therapy in one of 171 cases (0.6 +/- 0.6 percent). The minimal focal dose of x-ray therapy causing radiation injury to bone was 5,000 rads. With an increase in dose, the frequency of injuries also increased. Radiation injury was found after γ-ray therapy with an absorbed dose of 7,000 rads. The radiological features of radiation injury of bones after irradiation of malignant tumors of the pelvis are increasing osteoporosis and the appearance of foci of sclerosis and osteolysis. Necrotic areas of various sizes may be formed. A fracture of the neck of the femur may be prevented in some cases by taking precautionary measures. Healing of an injured part depends on the size of the dose given. Large doses completely suppressed the reparative powers of the bone. Unlike changes that are traumatic in nature, radiation fractures of the pelvic bones and the proximal part of the femur have a mild clinical course; sometimes the patients continue to use the lower limb, simply complaining of pain that may vary in severity. Metastasization of tumors of the uterus to the pelvic bones is possible but infrequent. Metastases are usually associated with increasing pain

Cosmetic results of conservative treatment for early breast cancer

International Nuclear Information System (INIS)

Kim, Bo Kyoung; Shin, Seong Soo; Kim, Seong Deok; Ha, Sung Whan; Noh, Dong Young

2001-01-01

This study was performed to evaluate the cosmetic outcome of conservative treatment for early breast cancer and to analyze the factors influencing cosmetic outcome. From February 1992 through January 1997, 120 patients with early breast cancer were treated with conservative surgery and postoperative radiotherapy. The types of conservative surgery were quadrantectomy and axillary node dissection for 108 patients (90%) and lumpectomy or excisional biopsy for 10 patients (8.3%). Forty six patients (38%) received adjuvant chemotherapy (CMF or CAF). Cosmetic result evaluation was carried out between 16 and 74 months (median, 33 months) after surgery. The cosmetic results were classified into four categories, i.e., excellent, good, fair, and poor. The appearances of the patients' breasts were also analyzed for symmetry using the differences in distances from the stemal notch to right and left nipples. A logistic regression analysis was performed to identify independent variables influencing the cosmetic outcome. Cosmetic score was excellent or good in 76% (91/120), fair in 19% (23/120) and poor in 5% (6/ 120) of the patients. Univariate analysis showed that tumor size (T1 versus T2) (p=0.04), axillary node status (NO versus N1) (p=0.0002), extent of surgery (quadrantectomy versus lumpectomy or excisional biopsy) (p=0.02), axillary node irradiation (p=0.0005) and chemotherapy (p=0,0001) affected cosmetic score. Multivariate analysis revealed that extent of surgery (p=0.04) and chemotherapy (p=0.0002) were significant factors. For breast symmetry, univariate analysis confirmed exactly the same factors as above. Multivariate analysis revealed that tumor size (p=0.003) and lymph node status (p=0.007) affected breast symmetry. Conservative surgery and postoperative radiotherapy resulted in excellent or good cosmetic outcome in a large portion of the patients. Better cosmetic results were achieved generally in the group of patients with smaller tumor size, without axillary

Importance of radiologic early symptoms in diagnosis and therapy of necrosis of the head of the femur

International Nuclear Information System (INIS)

Stahl, C.; Kang, C.H.; Phlvers, E.; Haasters, J.; Thuemler, P.

1985-01-01

Early roentgenographic signs of aseptic necrosis are changes after infarction without flattening of the femoral head or subchondral decalcification (crescent sign). 121 patients with femoral head necrosis, in 99 of idiopathic origin and in 22 after cortisone treatment, were examined. The first sign of infarction is represented by the intensification of the bright regions at the lateral and medial aspect of the femoral head with emphasis on the lateral aspect near to the femoral neck. Special radiographic changes after infarction are discussed. The diagnosis of bilateral involvement determines the prognosis of the disease and its treatment. A careful study of the anamnesis is most important for prognostic reasons. (author)

Importance of radiologic early symptoms in diagnosis and therapy of necrosis of the head of the femur

Energy Technology Data Exchange (ETDEWEB)

Stahl, C; Kang, C H; Phlvers, E; Haasters, J; Thuemler, P [Essen Univ. (Gesamthochschule) (Germany, F.R.)

1985-02-01

Early roentgenographic signs of aseptic necrosis are changes after infarction without flattening of the femoral head or subchondral decalcification (crescent sign). 121 patients with femoral head necrosis, in 99 of idiopathic origin and in 22 after cortisone treatment, were examined. The first sign of infarction is represented by the intensification of the bright regions at the lateral and medial aspect of the femoral head with emphasis on the lateral aspect near to the femoral neck. Special radiographic changes after infarction are discussed. The diagnosis of bilateral involvement determines the prognosis of the disease and its treatment. A careful study of the anamnesis is most important for prognostic reasons.

Functional outcome of diaphyseal fractures of femur managed by ...

African Journals Online (AJOL)

nail offers the added advantages of early joint mobilization, early weight bearing, early muscle rehabilitation, shortened hospital stay, and ... one of the principal load-bearing bones in the lower extremity ..... rotational stability and axial length.

Atypical Femur Fractures in Patients Treated with Bisphosphonates: Identification, Management, and Prevention

Directory of Open Access Journals (Sweden)

Judith Sarah Bubbear

2016-10-01

Full Text Available Osteoporosis is a common condition with significant health care costs. First-line therapy is with bisphosphonates, which have proven anti-fracture efficacy. Around 10 years after the introduction of bisphosphonates reports began to be published of atypical femoral fractures (AFFs that may be associated with this therapy. These fractures are associated with significant morbidity although lower mortality than the more common osteoporotic neck-of-femur fractures. A case definition has been described to allow identification of this class of fracture. Further work has established a high relative risk of AFFs in patients treated with bisphosphonates, but a low absolute risk in comparison to that of osteoporotic fractures. Proposed pathological mechanisms include low bone turnover states leading to stress/insufficiency fractures. Clinicians should be aware of the risk of AFFs and in particular the high rate of prodromal thigh/groin pain that warrants investigation in a patient receiving a bisphosphonate. If an incomplete fracture is diagnosed then bisphosphonate therapy needs to be stopped and prophylactic surgery may be considered. Due to these rare side effects patients on bisphosphonates require regular review, and this is particularly advised after 5 years of oral or 3 years of intravenous therapy.

Early glottic carcinoma: results of treatment by radiotherapy

International Nuclear Information System (INIS)

Smee, R.; Williams, J.; Fisher, R.; Bridger, G.P.

2000-01-01

The purpose of the present paper was to review the results of treating early stages glottic, squamous cell carcinoma by radiotherapy in the Department of Radiation Oncology, Prince of Wales Hospital, Sydney. A retrospective review was carried out of all patients seen in the department from 1967 to 1994, inclusive. To be eligible, patients had to have newly diagnosed cancer and to have been treated with curative intent by radiotherapy alone. Three hundred and sixty-nine patients satisfied the eligibility requirements. The mean follow-up time was 12.2 years (maximum: 28 years). At 5 years the actuarial local control rate was 80% (84% for stage T 1 and 72% for T 2 ). The ultimate local control rate was 96%. The overall survival rates at 5 and 10 years were 73% and 52%, respectively. The risk of nodal recurrence was much higher after persisting disease or local recurrence. Our results confirm the high cure rates achieved with this modality of treatment and are comparable with those reported in the literature. Copyright (1999) Blackwell Science Pty. Ltd

Infected Textiloma, 35 Years after the Operation for Femur Fracture, an extermly rare occurance.

Science.gov (United States)

Sadeghifar, Amir R; Saeed, Ali R

2013-09-01

Retained gauze after surgery is an uncommon error and it may be associated with many complications. We are reporting our case to call attention to the fact that retained gauze may become symptomatic even after a very long interval. Herein we report on a patient who developed infection and fistula with discharge from this error 35 years after a surgery for femur fracture and insertion of a IM nail. The diagnosis was easily made because of a marker in the gauze. Removal of the gauze and irrigation and debridement of the wound in two stages led to complete recovery of the patient as was shown in the 1 year follow up. Retained gauze after surgery is a preventable complication and may be asymptomatic for a very long period, but can become a complication post-operatively at any time. Hence, if diagnosed immediately after the surgery or at any other time, the gauze should be removed.

Plant exploitation during the early Natufian in north-eastern Jordan: preliminary results from Shubayqa 1

DEFF Research Database (Denmark)

Otaegui, Amaia Arranz; Richter, Tobias

-woody plant analyses from two in situ hearth structures, along with a summary of the available evidence at other contemporary early Natufian sites. In terms of past vegetation, the results show the presence of wetland species indicating a more forested and wet environment during the early Natufian, which...

Functional bracing for delayed union of a femur fracture associated with Paget's disease of the bone in an Asian patient: a case report

Directory of Open Access Journals (Sweden)

Fukuta Masashi

2010-05-01

Full Text Available Abstract Paget's disease of the bone is a common metabolic bone disease in most European countries, Australia, New Zealand, and North America. Conversely, this disease is rare in Scandinavia, Asia, and Africa. In Japan, it is extremely rare, with a prevalence of 0.15/100000. Paget's disease is a localized disorder of bone remodeling. Excessive bone resorption and abnormal bone formation result in biomechanically weakened bone and predispose patients to fracture. Delayed union and non-union of fractures have been reported in patients with Paget's disease. Therefore, open reduction and internal fixation of fractures has been recommended to prevent such complications. Here we report an unusual case of a 63-year-old Asian woman with delayed union of a femur fracture secondary to Paget's disease, which was treated successfully by functional bracing.

Case report 353: Giant cell tumor of distal end of the femur, containing a fluid level as demonstrated by computed tomography

International Nuclear Information System (INIS)

Resnik, C.S.; Steffe, J.W.; Wang, S.E.

1986-01-01

In summary, a 22-year-old man presented after sustaining a minor injury to his left knee while playing football. Radiological studies showed the characteristic stigmata of a giant cell tumor in the distal end of the femur involving the medial femoral condyle. On computed tomography with the proper window settings a fluid level was demonstrated in the osteolytic lesion. At surgery, yellowish sanguinous fluid was aspirated from the lesion which was completely curetted. Pathological studies showed the typical stigmata of a giant cell tumor. (orig./SHA)

The effects of glucocorticoid on microarchitecture, collagen, mineral and mechanical properties of sheep femur cortical bone

DEFF Research Database (Denmark)

Ding, Ming; Danielsen, Carl Christian; Overgaard, Søren

2011-01-01

of 3 months without treatment. Group 3 was left untreated and served as controls. All sheep received a restricted diet with low calcium and phosphorus. At sacrifice, cortical bone samples from the femur midshaft of each sheep were harvested, micro-CT scanned and subjected to three-point bending...... and tensile strength testing. Bone collagen and mineral were determined. Cortical porosity was significantly increased in the glucocorticoid-2 compared with the glucocorticoid-1 and control groups. Apparent density was significantly decreased in the glucocorticoid-2 compared with the glucocorticoid-1 group....... Collagen content was significantly increased in the glucocorticoid-2 compared with the glucocorticoid-1 and control groups. Bone mineral content did not differ between the groups. Neither the three-point bending mechanical properties nor the tensile mechanical properties differed significantly between...

The effects of glucocorticoid on microarchitecture, collagen, mineral and mechanical properties of sheep femur cortical bone

DEFF Research Database (Denmark)

Ding, Ming; Danielsen, Carl C; Overgaard, Søren

2010-01-01

The effects of glucocorticoid on microarchitecture, collagen, mineral and mechanical properties of sheep femur cortical bone – Validation of large animal model for tissue engineering and biomaterial research Ming Ding,1* Carl Christian Danielsen,2 Søren Overgaard1 1Orthopaedic Research Laboratory......, Department of Orthopaedics and Traumatology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark 2Department of Connective Tissue Biology, Institute of Anatomy, University of Aarhus, Aarhus C, Denmark Osteopenia in sheep has been successfully induced...... by glucocorticoid treatment and the changes in properties of cancellous bone were comparable with those observed in humans after long-term glucocorticoid treatment. However, the influence on cortical bone has not been thoroughly elucidated. This study aimed to investigate the influence of glucocorticoid on sheep...

Quantitative T2-Mapping and T2⁎-Mapping Evaluation of Changes in Cartilage Matrix after Acute Anterior Cruciate Ligament Rupture and the Correlation between the Results of Both Methods

OpenAIRE

Hongyue Tao; Yang Qiao; Yiwen Hu; Yuxue Xie; Rong Lu; Xu Yan; Shuang Chen

2018-01-01

Objectives. To quantitatively assess changes in cartilage matrix after acute anterior cruciate ligament (ACL) rupture using T2- and T2⁎-mapping and analyze the correlation between the results of both methods. Methods. Twenty-three patients and 23 healthy controls were enrolled and underwent quantitative MRI examination. The knee cartilage was segmented into six compartments, including lateral femur (LF), lateral tibia (LT), medial femur (MF), medial tibia (MT), trochlea (Tr), and patella (Pa)...

Pseudoaneurysm of the deep femoral artery caused by a guide wire following femur intertrochanteric fracture with a hip nail: A case report

Directory of Open Access Journals (Sweden)

Ji Wan Kim

2017-05-01

Full Text Available An 85-year-old woman developed severe swelling and pain in the proximal thigh after internal fixation of an intertrochanteric fracture of the femur with a hip nail. In order to identify the causes and determine the effective treatment, angiography was performed. The results of the angiography revealed a pseudoaneurysm of a branch of deep femoral artery. Endovascular embolization was used to treat the pseudoaneurysm. After reviewing all possible causes, we found a mistake in insertion of a guide wire for hip nail. Using intraoperative fluoroscopic images, we found the mal-positioned guide wire located posterior to trochanter on lateral view of hip. This case study reminds us that pseudoaneurysm can occur in a guide wire during hip nailing. Surgeons can avoid this complication with confirmation of lateral and anteroposterior view of hip.

Acceptable results of early closure of loop ileostomy to protect low rectal anastomosis

DEFF Research Database (Denmark)

Perdawid, Sharafaden Karim; Andersen, Ole Bjørn; Perdawood, Sharaf

2011-01-01

INTRODUCTION: This was a pilot project performed prior to full implementation of early loop ileostomy closure (within two weeks) following low anterior resection of the rectum in a group of patients selected according to previously recommended criteria for safe, early ileostomy closure. MATERIAL......, closure operation, the postoperative closure period and follow-up. RESULTS: Eleven patients were included (men, n = 4) with a median age of 58 years (range 47-79 years). Ileostomy closure was performed at a median of ten days (range 8-13 days) following rectum resection. The median hospital stay was 16...

Higgs couplings and supersymmetry in the light of early LHC results

International Nuclear Information System (INIS)

Stefaniak, Tim

2014-07-01

We present phenomenological studies investigating the implications of early results from the Large Hadron Collider (LHC) for models beyond the Standard Model (BSM), mostly focusing on Supersymmetry (SUSY). Our work covers different aspects in this wide field of research. We describe the development and basic concepts of the public computer codes HiggsBounds (version 4) and HiggsSignals. These confront the Higgs sector predictions of BSM models with results from LEP, Tevatron and LHC Higgs searches. While HiggsBounds tests the model against experimental null-results, HiggsSignals evaluates the model's chi-squared compatibility with the signal rate and mass measurements of the Higgs boson, that was discovered by the LHC in 2012. We then perform a systematic study of potential deviations in the Higgs couplings from their Standard Model (SM) prediction. No significant deviations are found. Future capabilities of Higgs coupling determination at the later LHC stages and at the International Linear Collider (ILC) are explored. We also study the implications of the Higgs discovery for the Minimal Supersymmetric Standard Model (MSSM), considering either the light or the heavy CP-even Higgs boson as the discovered state. We show that both interpretations are viable and discuss their phenomenology. Finally, we study the LHC signatures of resonant scalar lepton production, which may arise in SUSY models with R-parity violation (RPV). These are confronted with early LHC results, yielding constraints on the relevant RPV operators.

Bisphosphonate-associated atypical sub-trochanteric femur fractures: paired bone biopsy quantitative histomorphometry before and after teriparatide administration.

Science.gov (United States)

Miller, Paul D; McCarthy, Edward F

2015-04-01

Bisphosphonate-associated atypical sub-trochanteric femur fractures (ASFF) may be seen with long-term bisphosphonate use, though these fractures are also seen in patients never exposed to bisphosphonates. One theory for the mechanism of action whereby bisphosphonates may induce these ASFF is over-suppression of bone turnover. Bisphosphonates suppress bone turnover, but in bisphosphonate clinical trials, over-suppression defined whether by maintaining the biochemical markers of bone turnover below the defined reference range or by quantitative bone histomorphometry, has not been observed. We studied 15 clinic patients referred to The Colorado Center for Bone Research (CCBR) after they had a bisphosphonate-associated ASFF and performed quantitative bone histomorphometry both before and after 12 months of teriparatide (20µg SQ/day). All patients had been on long-term alendronate (mean = 7 years, range: 6-11 years) and had already had intramedullary rods placed when first seen (6 weeks to 7 months after rod placement). Alendronate had been discontinued in all patients at the time of their first clinic visit to CCBR. All of the fractures fulfilled The American Society for Bone and Mineral Research major radiological criteria for ASFF. Three key dynamic histomorphometric features show that 7 of the 15 patients had unmeasurable bone formation, mineralizing surface, and mineral apposition, while the other 8 patients had measurable dynamic parameters; although for all 15 patients, the mean values for all 3 dynamic parameters was far below the average for the published normal population. Administration of teriparatide was associated with an increase in all 3 dynamic histomorphometric parameters. Baseline bone turnover markers did not correlate with the baseline histomorphometry. While there is heterogeneity in the bone turnover in patients with bisphosphonate ASFF, there is a large portion in this uncontrolled series that had absent bone turnover at the standard biopsy site

Heating produced by therapeutic ultrasound in the presence of a metal plate in the femur of canine cadavers

Directory of Open Access Journals (Sweden)

A.O. Andrades

2014-10-01

Full Text Available The present study aimed to assess the heat generated by a therapeutic ultrasound (TUS in a metal bone plate and adjacent structures after fixation to the femur of canine cadavers. Ten pairs of hind limbs were used, and they were equally distributed between groups that were subjected to 1- and 3-MHz frequencies, with each frequency testing 1- and 2-W/cm² intensities. The right hind limb was defined as the control group (absence of the metal plate, and the left hind limb was the test group (presence of the metal plate. Therefore, the control groups (CG were denominated CGI, using TUS with 1-MHz frequency and 1-W/cm² intensity; CGII, using 1-MHz frequency and 2-W/cm² intensity; CGIII, using 3-MHz frequency and 1-W/cm² intensity; and CGIV, using 3-MHz frequency and 2-W/cm² intensity. For each control group, its respective test group (TG was denominated TGI, TGII, TGIII and TGIV. The TUS was applied to the lateral aspect of the thigh using the continuous mode and a 3.5-cm² transducer in a 6.25-cm² area for 2 minutes. Sensors were coupled to digital thermometers that measured the temperature in different sites before (t0 and after (t1 of the TUS application. The temperatures in t1 were higher in all tested groups. The intramuscular temperature was significantly higher (P<0.05 in the groups used to test the 3-MHz frequency in the presence of the metal plate. The therapeutic ultrasound in the continuous mode using frequencies of 1 and 3 MHz and intensities of 1 and 2 W/cm2 for 2 minutes caused heating of the metal plate and adjacent structures after fixation to the femur of canine cadavers.

Planck early results. VIII. The all-sky early Sunyaev-Zeldovich cluster sample

DEFF Research Database (Denmark)

Poutanen, T.; Natoli, P.; Polenta, G.

2011-01-01

We present the first all-sky sample of galaxy clusters detected blindly by the Planck satellite through the Sunyaev-Zeldovich (SZ) effect from its six highest frequencies. This early SZ (ESZ) sample is comprised of 189 candidates, which have a high signal-to-noise ratio ranging from 6 to 29. Its ...

Western gulf culture-density study-early results

Science.gov (United States)

Mohd S. Rahman; Michael G. Messina; Richard F. Fisher; Alan B. Wilson; Nick Chappell; Conner Fristoe; Larry Anderson

2006-01-01

The Western Gulf Culture-Density Study is a collaborative research effort between Texas A&M University and five forest products companies to examine the effects of early silvicultural treatment intensity and a wide range of both densities and soil types on performance of loblolly pine. The study tests 2 silvicultural intensities, 5 planting densities (200 to 1,200...

Low cost continuous femoral nerve block for relief of acute severe cancer related pain due to pathological fracture femur

Directory of Open Access Journals (Sweden)

Rachel Cherian Koshy

2010-01-01

Full Text Available Pathological fractures in cancer patient cause severe pain that is difficult to control pharmacologically. Even with good pain relief at rest, breakthrough and incident pain can be unmanageable. Continuous regional nerve blocks have a definite role in controlling such intractable pain. We describe two such cases where severe pain was adequately relieved in the acute phase. Continuous femoral nerve block was used as an efficient, cheap and safe method of pain relief for two of our patients with pathological fracture femur. This method was proved to be quite efficient in decreasing the fracture-related pain and improving the level of well being.

The Advanced Photon Source: Performance and results from early operation

International Nuclear Information System (INIS)

Moncton, D.E.

1997-01-01

The Advanced Photon Source at Argonne National Laboratory is now providing researchers with extreme-brilliance undulator radiation in the hard x-ray region of the spectrum. All technical facilities and components are operational and have met design specifications. Fourteen research teams, occupying 20 sectors on the APS experiment hall floor, are currently installing beamline instrumentation or actively taking data. An overview is presented for the first operational years of the Advanced Photon Source. Emphasis is on the performance of accelerators and insertion devices, as well as early scientific results and future plans

Silver oxide-containing hydroxyapatite coating supports osteoblast function and enhances implant anchorage strength in rat femur.

Science.gov (United States)

Eto, Shuichi; Miyamoto, Hiroshi; Shobuike, Takeo; Noda, Iwao; Akiyama, Takayuki; Tsukamoto, Masatsugu; Ueno, Masaya; Someya, Shinsuke; Kawano, Shunsuke; Sonohata, Motoki; Mawatari, Masaaki

2015-09-01

Antibacterial silver with hydroxyapatite (Ag-HA) is a promising coating material for imparting antibacterial properties to implants. We previously reported that 3% (w/w) silver with HA (3% Ag-HA) has both antibacterial activity and osteoconductivity. In this study, we investigated the effects of Ag-HA on the in vitro osteoblast function and the in vivo anchorage strength and osteoconductivity of implants. Production of the osteoblast marker alkaline phosphatase, but not cytotoxicity, was observed in cells of the osteoblast cell line MC3T3-E1 cultured on the 3% Ag-HA-coated surface. These results were similar to those observed with silver-free HA coating. In contrast, a significant high level of cytotoxicity was observed when the cells were cultured on a 50% Ag-HA-coated surface. The anchorage strength of implants inserted into the femur of Sprague-Dawley (SD) rats was enhanced by coating the implants with 3% Ag-HA. On the 3% Ag-HA-coated surface, both metaphyseal and diaphyseal areas were largely covered with new bone and had adequate osteoconductivity. These results suggest that 3% Ag-HA, like conventional HA, promotes osteogenesis by supporting osteoblast viability and function and thereby contributes to sufficient anchorage strength of implants. Application of 3% Ag-HA, which combines the osteoconductivity of HA and the antibacterial activity of silver, to prosthetic joints will help prevent postoperative infections. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

The influence of process and patient factors on the recall of consent information in mentally competent patients undergoing surgery for neck of femur fractures

OpenAIRE

Khan, SK; Karuppaiah, K; Bajwa, AS

2012-01-01

INTRODUCTION Informed consent is an ethical and legal prerequisite for major surgical procedures. Recent literature has identified ‘poor consent’ as a major cause of litigation in trauma cases. We aimed to investigate the patient and process factors that influence consent information recall in mentally competent patients (abbreviated mental test score [AMTS] ≥6) presenting with neck of femur (NOF) fractures. METHODS A prospective study was conducted at a tertiary unit. Fifty NOF patients (cas...

Intraoperative Ir-192 implantation for early breast cancer. Techniques and results

International Nuclear Information System (INIS)

Mansfield, C.M.

1990-01-01

Patients with early breast cancer (T1-2 N0-1) can be treated by lumpectomy and irradiation with a local control and survival equal to more radical surgery. Between 1982 and 1988, 323 patients with early breast cancer were treated, when possible, with Ir-192 implants at the time of lumpectomy to a local dose of 2000 cGy in 40-50 hours. Ten to 14 days later, the whole breast was treated to 4500 cGy at 180 per fraction in 5 weeks. The 6-year actuarial survival for stages I and II disease was 98% and 91%, respectively, and the recurrence-free survival was 96% and 98%, respectively. When these 323 patients were evaluated by T status, a local control of 97% was the same for T1 and T2 lesions. The cosmetic results were good to excellent in 95% of the patients. This approach has improved our ability to accurately place the boost dose in the breast

'Real world' imprecision of dual-energy x-ray absorptiometry (DEXA) at L2-4 and femur neck

International Nuclear Information System (INIS)

Phillipov, G.; Sigalas, V.; Seaborn, C.; Phillips, P.; Rowe, C.; Kitchener, M.

1998-01-01

Full text: While measurement of bone density (BMD) by DEXA is routinely used to diagnose osteoporosis and estimate future fracture risk, data on what constitutes a significant change between serial BMD measurements has received much less attention. The use of repeat BMD measurements is particularly important to either assess the rate of bone loss or treatment efficacy for individual patients. However to estimate a statistically significant change between consecutive bone mineral density (BMD) measurements requires an accurate knowledge of dual-energy x-ray absorptiometry (DEXA) imprecision under actual day-to-day working conditions. DEXA imprecision, based on in vitro models, such as manufacturers' phantoms, leads to a marked under-estimation of true imprecision, since significant sources of variance (patient positioning, inter- and intra-operator variability etc) are ignored. In an attempt to provide a robust estimate of imprecision for our Lunar DPXplus, 28 females and one male(age 72.8 + 7.8 yr)were recruited to have multiple DEXA scans at approximately four week intervals. The subjects were handled using exactly the same procedure as that for our referred patients. Initial findings after each subject has had am average of 6.6 DEXA scans showed that the within subject variability (CV w ) associated with the AP lumbar spine (L2-4)and femur-neck was 1.83 and 2.24% respectively. No significant correlation was found between BMD values and CV w at either site. Since instrument variability is about 0.7% (derived from phantom studies), it is apparent that operator variation accounts for the majority of total variability. From the derived imprecision, the percentage difference for a significant change at a predefined probability limit is 5.1 and 6.2% for the spine and femur-neck sites respectively, when the probability of a false alarm is 5% (bi-directional). Knowledge of the critical difference required between successive measurements, combined with the known rate of

Synthesis and characterization of bovine femur bone hydroxyapatite containing silver nanoparticles for the biomedical applications

International Nuclear Information System (INIS)

Nirmala, R.; Sheikh, Faheem A.; Kanjwal, Muzafar A.; Lee, John Hwa; Park, Soo-Jin; Navamathavan, R.; Kim, Hak Yong

2011-01-01

Bovine femur bone hydroxyapatite (HA) containing silver (Ag) nanoparticles was synthesized by thermal decomposition method and subsequent reduction of silver nitrate with N,N-dimethylformamide (DMF) in the presence of poly(vinylacetate) (PVAc). The structural, morphological, and chemical properties of the HA–Ag nanoparticles were characterized using X-ray diffraction (XRD), scanning electron microscopy (SEM), field-emission scanning electron microscopy (FE-SEM), transmission electron microscopy (TEM), and X-ray photoelectron spectroscopy (XPS). TEM images showed that the Ag nanoparticles with size ranging from 8 to 20 nm and were arranged at the periphery of HA crystals. Bactericidal activity of HA–Ag with different concentration of Ag nanoparticles immobilized on the surface of HA was investigated against gram-positive Staphylococcus aureus (S. aureus, non-MRSA), Methicillin resistant S. aureus (MRSA) and gram-negative Escherichia coli (E.coli) by the disc diffusion susceptibility test. The HA–Ag nanoparticles showed that broad spectrum activity against non-MRSA, MRSA, and E. coli bacterial strains.

Effects of feed supplementation on mineral composition, mechanical properties and structure in femurs of Iberian red deer hinds (Cervus elaphus hispanicus).

Science.gov (United States)

Olguin, Cesar A; Landete-Castillejos, Tomas; Ceacero, Francisco; García, Andrés J; Gallego, Laureano

2013-01-01

Few studies in wild animals have assessed changes in mineral profile in long bones and their implications for mechanical properties. We examined the effect of two diets differing in mineral content on the composition and mechanical properties of femora from two groups each with 13 free-ranging red deer hinds. Contents of Ca, P, Mg, K, Na, S, Cu, Fe, Mn, Se, Zn, B and Sr, Young's modulus of elasticity (E), bending strength and work of fracture were assessed in the proximal part of the diaphysis (PD) and the mid-diaphysis (MD). Whole body measures were also recorded on the hinds. Compared to animals on control diets, those on supplemented diets increased live weight by 6.5 kg and their kidney fat index (KFI), but not carcass weight, body or organ size, femur size or cortical thickness. Supplemental feeding increased Mn content of bone by 23%, Cu by 9% and Zn by 6%. These differences showed a mean fourfold greater content of these minerals in supplemental diet, whereas femora did not reflect a 5.4 times greater content of major minerals (Na and P) in the diet. Lower content of B and Sr in supplemented diet also reduced femur B by 14% and Sr by 5%. There was a subtle effect of diet only on E and none on other mechanical properties. Thus, greater availability of microminerals but not major minerals in the diet is reflected in bone composition even before marked body effects, bone macro-structure or its mechanical properties are affected.

Effects of feed supplementation on mineral composition, mechanical properties and structure in femurs of Iberian red deer hinds (Cervus elaphus hispanicus.

Directory of Open Access Journals (Sweden)

Cesar A Olguin

Full Text Available Few studies in wild animals have assessed changes in mineral profile in long bones and their implications for mechanical properties. We examined the effect of two diets differing in mineral content on the composition and mechanical properties of femora from two groups each with 13 free-ranging red deer hinds. Contents of Ca, P, Mg, K, Na, S, Cu, Fe, Mn, Se, Zn, B and Sr, Young's modulus of elasticity (E, bending strength and work of fracture were assessed in the proximal part of the diaphysis (PD and the mid-diaphysis (MD. Whole body measures were also recorded on the hinds. Compared to animals on control diets, those on supplemented diets increased live weight by 6.5 kg and their kidney fat index (KFI, but not carcass weight, body or organ size, femur size or cortical thickness. Supplemental feeding increased Mn content of bone by 23%, Cu by 9% and Zn by 6%. These differences showed a mean fourfold greater content of these minerals in supplemental diet, whereas femora did not reflect a 5.4 times greater content of major minerals (Na and P in the diet. Lower content of B and Sr in supplemented diet also reduced femur B by 14% and Sr by 5%. There was a subtle effect of diet only on E and none on other mechanical properties. Thus, greater availability of microminerals but not major minerals in the diet is reflected in bone composition even before marked body effects, bone macro-structure or its mechanical properties are affected.

Radiographic signs of radiolesions of the pelvis (excluding the femur) after irradiation for epithelioma of the cervix uteri

International Nuclear Information System (INIS)

Zenny, J.C.; Bergiron, C.; Chassagne, D.; Couanet, D.; Ibrahim, E.; Masselot, J.

1980-01-01

Radiolesions of the pelvic bones (excluding the femur) were observed in 29 patients after irradiation therapy for cervix uteri cancer. Three regions can be affected corresponding to the areas irradiated: the sacrum and internal part of the iliac wings, the pubis, and the cotyles. In most cases the lesions appeared after 1 to 4 years. Their radiological appearances are characteristic, the principal sign being irregular bone condensation in a demineralized bone, without true cavitation. The only lytic lesions observed were in the pubis. Calcification of soft tissues may occur and fractures are frequent. There is a slow progression of the lesions over long periods. Clinical, radiological, and progression signs differentiate radiolesions from other affections: metastases, invasion by contiguity, infections, and radio-induced sarcoma [fr

Rapid detection of K650E mutation in FGFR3 using uncultured amniocytes in a pregnancy affected with fetal cloverleaf skull, occipital pseudoencephalocele, ventriculomegaly, straight short femurs, and thanatophoric dysplasia type II

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Chih-Ping Chen

2013-09-01

Conclusion: A prenatal diagnosis of cloverleaf skull, short limbs, straight femurs, and occipital pseudoencephalocele should include a differential diagnosis of TD2. A molecular analysis of FGFR3 using uncultured amniocytes is useful for the rapid confirmation of TD2 at prenatal diagnosis.

Morphometric analysis of the femur in cerebral palsy: 3-dimensional CT study.

Science.gov (United States)

Gose, Shinichi; Sakai, Takashi; Shibata, Toru; Murase, Tsuyoshi; Yoshikawa, Hideki; Sugamoto, Kazuomi

2010-09-01

The cause of hip disorder in cerebral palsy (CP) has been thought to involve muscle imbalance, flexion, and adduction contracture of the hip joint, acetabular dysplasia, and femoral growth abnormalities. The aim of this study was to quantitatively evaluate the 3-dimensional femoral geometry and subluxation/dislocation of the hip in spastic CP using 3D-CT reconstructed images of the pelvis and the femur, focusing on the femoral growth abnormalities in CP. Between June 2006 and September 2009, 186 hips in 93 bilateral spastic CP patients, including spastic diplegia (SD) in 73 patients and spastic quadriplegia (SQ) in 20 patients, who had not received any surgical treatment, were investigated using 3D-CT at our hospital. There were 59 boys and 34 girls with an average age of 5.3 years (range: 2.6 to 6.8 y). As an index for the femoral geometry, the neck-shaft angle, the femoral anteversion, and the femoral offset were 3-dimensionally measured. The center of the acetabulum and the femoral head were determined to calculate the CT migration percentage as the distance between these centers divided by the femoral head diameter. To elucidate the factors related to hip subluxation/dislocation, the relationships between the neck-shaft angle, the femoral anteversion, the femoral offset, and the CT migration percentage were investigated. The mean neck-shaft angle was 150.4+/-9.4 degrees (range: 129.4 to 173.2 degrees). The mean femoral anteversion was 44.4+/-13.6 degrees (range: 5.8 to 84.0 degrees). The mean CT migration percentage was 22.4+/-22.7% (range: 3 to 129%). There was positive correlation between the CT migration percentage and the neck-shaft angle (r=0.49). Hips with large CT migration percentage tended to show coxa valga. There was an inverse correlation between the neck-shaft angle and the femoral offset (r=-0.90), but no correlation between the CT migration percentage and the femoral anteversion (r=0.26), between the femoral offset and the femoral anteversion (r

Nonunion of the femoral neck: possibilities and limitations of the various treatment modalities

NARCIS (Netherlands)

Raaymakers, Ernst L. F. B.; Marti, René K.

2008-01-01

Nowadays in cases of nonunions of the femoral neck, the surgeon is tempted to perform prosthetic replacement of the hip, more so if there is also evidence of avascular necrosis of the head of femur. This provides rapid pain relief and allows early mobilization. However, long-term results of hip

Study of the anatomical position of the femoral nerve by magnetic resonance imaging in patients with fractured neck of femur: relevance to femoral nerve block.

LENUS (Irish Health Repository)

Mehmood, Shehzad

2012-01-31

STUDY OBJECTIVE: To determine the anatomical location of the femoral nerve in patients who have sustained fracture of the neck of femur, and its relevance to femoral nerve block technique. DESIGN: Prospective, observational clinical study. SETTING: Orthopedic and Radiology departments of a regional hospital. SUBJECTS: 10 consecutive adult ASA physical status II and III patients (mean age, 78.5 yrs) and 4 adult healthy volunteers. INTERVENTIONS: A T1 magnetic resonance imaging scan was performed of both upper thighs in patients and healthy volunteers successfully. MEASUREMENTS: The distance (mm) between the midpoint of the femoral artery and the midpoint of the femoral nerve, and the distance of the femoral nerve from the skin was measured at the mid-inguinal ligament, the pubic tubercle, and at the mid-inguinal crease. Data are shown as means (SD). Differences between both sides were compared using paired Student\\'s t-tests. P < 0.05 was significant. MAIN RESULTS: In patients the mean distance (mm) between the midpoint of the femoral nerve from the midpoint of femoral artery at the mid-inguinal crease on the fractured and non-fractured sides was 10.7 and 11.0, respectively (P = 0.87). The mean distance (mm) between the midpoint of the femoral nerve from the midpoint of the femoral artery at the mid-inguinal ligament on the fractured and non-fractured sides was 9.64 and 12.5, respectively (P = 0.03). The mean distance (mm) between the midpoint of the femoral nerve from the midpoint of the femoral artery at the pubic tubercle on the fractured and non-fractured sides was 8.74 and 10.49, respectively (P = 0.18). CONCLUSIONS: Blockade of the femoral nerve may be easier to perform at the mid-inguinal crease in patients with fractured neck of femur.

The impact of nicotine on osseointegration. An experimental study in the femur and tibia of rabbits

DEFF Research Database (Denmark)

Balatsouka, Dimitra; Gotfredsen, Klaus; Lindh, Christian H

2005-01-01

OBJECTIVES: The aim of the present study was to analyze the effect of an enhanced systematic dose of nicotine on osseointegration of titanium implants. MATERIAL AND METHODS: Sixteen female rabbits received either nicotine (n=8) or saline (n=8) administered subcutaneously via mini-osmotic pumps...... for 2 months. The pump delivered 6 mug/kg/min of nicotine for the animals in the test group. Blood was withdrawn and plasma cotinine levels were measured weekly. Thirty-two titanium implants were inserted into the femur and tibia of all rabbits after 4 weeks and after 6 weeks of nicotine...... and the peri-implant BD-i showed no significant differences between the test and the control group after 2 or after 4 weeks. CONCLUSION: Nicotine exposure for a short period of time even in a high dose did not have a significant impact on implant osseointegration in rabbits....

Early postoperative cartilage evaluation by magnetic resonance imaging using T2 mapping after arthroscopic partial medial meniscectomy.

Science.gov (United States)

Kato, Kammei; Arai, Yuji; Ikoma, Kazuya; Nakagawa, Shuji; Inoue, Hiroaki; Kan, Hiroyuki; Matsuki, Tomohiro; Fujiwara, Hiroyoshi; Kubo, Toshikazu

2015-12-01

This study was performed to quantitatively evaluate postoperative changes in cartilage by T2 mapping after arthroscopic partial medial meniscectomy. The study enrolled 17 patients with 20 knees that underwent arthroscopic partial medial meniscectomy. MRI was performed preoperatively and at six months postoperatively, with subjects evaluated by T2 mapping of the central part of the medial condyle of the femur in the sagittal plane. Regions of interest (ROIs) were set at 10 points between the point of intersection of the anatomical axis of the femur and the articular surface of the medial condyle and posterior area approximately 90 degrees to the anatomical axis. Pre- and postoperative T2 values at each ROI were evaluated. Postoperative T2 values were significantly longer than preoperative values at approximately 20, 30, 40, and 50 degrees to the anatomical axis of the femur. The maximum change between pre- and postoperative T2 values was +6.65% at 30 degrees to the anatomical axis. Mechanical stress at positions approximately 20, 30, 40, and 50 degrees relative to the anatomical axis of the femur increased soon after arthroscopic medial meniscectomy. These findings indicate the start of degeneration, via disorganization of collagen arrays, of the articular cartilage and increased water content. Copyright © 2015. Published by Elsevier Inc.

Proximal femoral fractures: Principles of management and review of literature

Science.gov (United States)

Mittal, Ravi; Banerjee, Sumit

2012-01-01

Purpose The purpose of this study was to review the principles involved in the management of proximal femoral fractures as reported in the literature. Methods: A medical literature search in the MEDLINE (PubMed) and Cochrane database was undertaken to review strategies and principles in proximal femoral fracture treatment. Randomized control trials and meta analysis were given preference while case reports/small series were rejected. Results and conclusions: Early anatomical reduction and surgical fixation remains the best option to reduce the risk of complications like non-union and avascular necrosis in treating fracture neck femurs. Cancellous screws continue to be the preferred treatment for fixation of neck femur fractures in younger population until the benefit of using sliding hip screws is validated by large multicentric studies. In the geriatric age group, early prosthetic replacement brings down the mortality and morbidity associated with neck femur fractures. Sliding hip screw (DHS) is the best available option for stable inter trochanteric fractures. The use of intramedullary nails e.g. PFN is beneficial in treating inter trochanteric fractures with comminution and loss of lateral buttress. Intramedullary implants have been proven to have increased success rates in subtrochanteric fractures and should be preferred over extramedullary plate fixation systems. PMID:25983451

Systemic Inflammatory Effects of Traumatic Brain Injury, Femur Fracture, and Shock: An Experimental Murine Polytrauma Model

Directory of Open Access Journals (Sweden)

C. Probst

2012-01-01

Full Text Available Objective. Despite broad research in neurotrauma and shock, little is known on systemic inflammatory effects of the clinically most relevant combined polytrauma. Experimental investigation in an animal model may provide relevant insight for therapeutic strategies. We describe the effects of a combined injury with respect to lymphocyte population and cytokine activation. Methods. 45 male C57BL/6J mice (mean weight 27 g were anesthetized with ketamine/xylazine. Animals were subjected to a weight drop closed traumatic brain injury (WD-TBI, a femoral fracture and hemorrhagic shock (FX-SH. Animals were subdivided into WD-TBI, FX-SH and combined trauma (CO-TX groups. Subjects were sacrificed at 96 h. Blood was analysed for cytokines and by flow cytometry for lymphocyte populations. Results. Mortality was 8%, 13% and 47% for FX-SH, WD-TBI and CO-TX groups (P<0.05. TNFα (11/13/139 for FX-SH/WD-TBI/CO-TX; P<0.05, CCL2 (78/96/227; P<0.05 and IL-6 (16/48/281; P=0.05 showed significant increases in the CO-TX group. Lymphocyte populations results for FX-SH, WD-TBI and CO-TX were: CD-4 (31/21/22; P= n.s., CD-8 (7/28/34, P<0.05, CD-4-CD-8 (11/12/18; P= n.s., CD-56 (36/7/8; P<0.05. Conclusion. This study shows that a combination of closed TBI and femur-fracture/ shock results in an increase of the humoral inflammation. More attention to combined injury models in inflammation research is indicated.

[A therapeutic effect analysis of femur first principle and combined anteversion technique during total hip arthroplasty].

Science.gov (United States)

Wang, X Q; Wu, C S; Sun, S; Wang, J; Li, W; Zhang, W

2018-04-01

Objective: To investigate the situation of hip dislocation with the application of "femur first" principle and "combined anteversion technique" during total hip arthroplasty. Methods: A retrospective analysis has been done on the clinical data about 104 patients(133 hips)who were diagnosed as hip disease and were treated with total hip arthroplasty by the doctors from the Department of Joint Orthorpaedics of Shandong Provincial Hospital Affiliated to Shandong University from June 2014 to June 2016, and all the prostheses applied in the operation were cementless ones.Among them, 65 patients were males, 39 females and their age was 46.6 years (ranging from 23 to 76 years) .And 29 of them underwent bilateral hip operations and 75 unilateral ones.Seventy-six cases of aseptic necrosis of the femoral head in the terminal stage, 28 cases of hip dysplasia and osteoarthritis.Surgical approach: of all the operations, 103 hips were operated on with hardinge approach, 30 with posterolateral approach.During the operation, first of all, the femoral medullary cavity was broached and then the anteversion of intramedullary broacher was measured.After that, the anteversion of the acetabular cup was calculated as 37° minus the anteversion of the broacher, and the acetabular cup was implanted at that angle.The patients' prosthesis combined anteversion, range of motion of the hip joint, operation time, hemorrhage amount, and complications had been kept record.One, three, and six months respectively after the operation, all the patients received outpatient review, and took anteroposterior and lateral position X-ray examination.Harris hip score had been applied to evaluate their hip function before the operation and six months after the operation. Results: All the patients had been operated on smoothly, with the operation time of(57.6±14.5)minutes(36-115 minutes)and hemorrhage amount of (336.5±50.8)ml(180-620 ml). The operation finding showed that the combined anteversion by employing"femur

[Early results after varicose vein surgery--a multicenter patient inquiry].

Science.gov (United States)

Hermanns, H-J

2008-08-01

Beside varicose vein surgery, endovenous procedures (endovenous laser therapy, VNUS and foam sclerotherapy) are now therapeutic options with the following advantages: low invasiveness, only out-patient operations, quick resumption of general activities. Whether or not classical vein surgery today still fulfills patient demands was analysed by a study group of German vascular surgeons (ANG) as a multicentre patient questioning. The questionnaire was subdivided into eight main complexes with 24 questions about the early results of stripping operations (from start of preparation until suture removal) and the patients answers were analysed. Answers with points (1-6) and free answers were possible. Between 1.1.2005 and 31.3.2005 18 centres for vascular surgery collected 1708 questionnaires from patients after stripping operations. The complex "preparation and information about the operation" was scored with 1.33 to 1.39. The "general organisation" of the vascular centre was scored between 1.22 and 1.30. "Pain after operation" was rated at 1.98 (immediately), 2.26 (first day) and 2.12 (third day after operation). Reasons for other problems after surgery were haematoma (3.09), problems with the compression dressing (1.67), circulatory collapse (1.51), headache (1.33), nausea (1.25). The total score for all centres was 1.47. The early results after varicose vein surgery are good up to very good. The patients' reconvalescence time is short and there is a quick resumption of general activities. The invasiveness of vein surgery seems to be overestimated. Comparative studies to evaluate the new methods are necessary. Benchmarking projects like this study are essential parts of current quality control systems.

Early cessation of pressure garment therapy results in scar contraction and thickening.

Science.gov (United States)

DeBruler, Danielle M; Zbinden, Jacob C; Baumann, Molly E; Blackstone, Britani N; Malara, Megan M; Bailey, J Kevin; Supp, Dorothy M; Powell, Heather M

2018-01-01

Pressure garment therapy is often prescribed to improve scar properties following full-thickness burn injuries. Pressure garment therapy is generally recommended for long periods of time following injury (1-2 years), though it is plagued by extremely low patient compliance. The goal of this study was to examine the effects of early cessation of pressure garment therapy on scar properties. Full-thickness burn injuries were created along the dorsum of red Duroc pigs. The burn eschar was excised and wound sites autografted with split-thickness skin. Scars were treated with pressure garments within 1 week of injury and pressure was maintained for either 29 weeks (continuous pressure) or for 17 weeks followed by cessation of pressure for an additional 12 weeks (pressure released); scars receiving no treatment served as controls. Scars that underwent pressure garment therapy were significantly smoother and less contracted with decreased scar height compared to control scars at 17 weeks. These benefits were maintained in the continuous pressure group until week 29. In the pressure released group, grafts significantly contracted and became more raised, harder and rougher after the therapy was discontinued. Pressure cessation also resulted in large changes in collagen fiber orientation and increases in collagen fiber thickness. The results suggest that pressure garment therapy effectively improves scar properties following severe burn injury; however, early cessation of the therapy results in substantial loss of these improvements.

The healing process of intracorporeally and in situ devitalized distal femur by microwave in a dog model and its mechanical properties in vitro.

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Zhenwei Ji

Full Text Available BACKGROUND: Limb-salvage surgery has been well recognized as a standard treatment and alternative to amputation for patients with malignant bone tumors. Various limb-sparing techniques have been developed including tumor prosthesis, allograft, autograft and graft-prosthesis composite. However, each of these methods has short- and long-term disadvantages such as nonunion, mechanical failures and poor limb function. The technique of intracorporeal devitalization of tumor-bearing bone segment in situ by microwave-induced hyperthermia after separating it from surrounding normal tissues with a safe margin is a promising limb-salvage method, which may avoid some shortcomings encountered by the above-mentioned conventional techniques. The purpose of this study is to assess the healing process and revitalization potential of the devitalized bone segment by this method in a dog model. In addition, the immediate effect of microwave on the biomechanical properties of bone tissue was also explored in an in vitro experiment. METHODS: We applied the microwave-induced hyperthermia to devitalize the distal femurs of dogs in situ. Using a monopole microwave antenna, we could produce a necrotic bone of nearly 20 mm in length in distal femur. Radiography, bone scintigraphy, microangiography, histology and functional evaluation were performed at 2 weeks and 1, 2, 3, 6, 9 and 12 months postoperatively to assess the healing process. In a biomechanical study, two kinds of bone specimens, 3 and 6 cm in length, were used for compression and three-point bending test respectively immediately after extracorporeally devitalized by microwave. FINDINGS: An in vivo study showed that intracorporeally and in situ devitalized bone segment by microwave had great revitalization potential. An in vitro study revealed that the initial mechanical strength of the extracorporeally devitalized bone specimen may not be affected by microwave. CONCLUSION: Our results suggest that the

Use of sentinel-1 data for vessel detection in South African oceans: Early results

CSIR Research Space (South Africa)

Kleynhans, Waldo

2015-08-01

Full Text Available taking into consideration local incident angles. Early experimental results show promising vessel detection accuracy using the Sentinel-1 data but that polarization and incidence angle are important parameters to take into consideration when working...

Cosmetic results in early stage breast cancer patients with high-dose brachytherapy after conservative surgery

International Nuclear Information System (INIS)

Torres, Felipe; Pineda, Beatriz E

2004-01-01

Purpose: to reveal cosmetic results in patients at early stages of low risk breast cancer treated with partial accelerated radiotherapy using high dose rate brachytherapy. Methods and materials: from March 2001 to July 2003,14 stages l and ll breast cancer patients were treated at the Colombian national cancer institute in Bogota with conservative surgery and radiotherapy upon the tumor bed (partial accelerated radiotherapy), using interstitial implants with iridium 192 (high dose rate brachytherapy) with a dose of 32 Gys, over 4 days, at 8 fractions twice a day. Results: with an average follow up of 17.7 months, good cosmetic results were found among 71.4 % of patients and excellent results among 14.3% of patients, furthermore none of the patients neither local nor regional or distant relapses. Conclusion: among patients who suffer from breast cancer at early stages, it showed is possible to apply partial accelerated radiotherapy upon the tumor bed with high doses over 4 days with good to excellent cosmetic results

Evaluation of Bone Mineral Density in Children with Thalassemia Major

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Betül Bakan

2012-12-01

Full Text Available Aim: Fragile bones develop due to various factors in thalassemic patients. Even with optimum management, osteoporosis occurs, contributing to morbidity in majority of patients with thalassemia major (TM. Our aim was to evaluate bone health of thalassemic children using biochemical parameters and bone mineral density (BMD, and to emphasize the precautionary measures and early diagnosis of osteoporosis. Material and Methods: Thirteen children (5 females, 8 males, age <18 years with TM were included in the study. Age, duration, weight, height, transfusion frequency, medication use were recorded. Following laboratory analysis were obtained: Whole blood count, fasting blood glucose, ferritin, alanine aminotransferase, aspartate aminotransferase, calcium, phosphorus, alkaline phosphatase, thyroid stimulating hormone, free thyroxin, and intact parathyroid hormone (iPTH. BMD was determined using dual energy X-ray absorptiometry (DXA from femur and lumbar vertebrae. Patients with DXA Z-score <-2 was defined as osteoporotic. Results: The mean age was 7.85±3.17 years and body mass index (BMI was 14.68±1.93 kg/m2. The rest of the results were as follows: Lumbar BMD 0.464±0.108 g/cm2; total femur BMD 0.581± 0.114 g/cm2; lumbar DEXA Z-score 2.44±1.60; total femur DEXA -0.93±1.19. Osteoporosis ratio was determined as 69% in the lumbar vertebrae and 10% in the femur. A significant positive correlation was found between lumbar-femoral BMD and BMI, and a significant negative correlation was observed between femoral BMD and iPTH. Conclusion: BMD is low in thalassemic children. Despite regular transfusions and chelation therapy, osteoporosis starts early in life. (Turkish Journal of Osteoporosis 2012;18: 72-7

Comparative study for evaluating efficacy of fascia iliaca compartment block for alleviating pain of positioning for spinal anesthesia in patients with hip and proximal femur fractures

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Nirav Jentilal Kacha

2018-01-01

Full Text Available Background: Patient positioning for performing spinal blockade causes severe pain in hip and femur fracture. Adequate pain relief before administrating spinal blockade will increase patient's cooperation. This study was done to assess analgesic effect of fascia iliaca compartment block (FICB for positioning for spinal anesthesia. Materials and Methods: This was a randomized, double blind, controlled prospective study that included 100 patients of the American Society of Anesthesiologists physical statuses I to III, of either sex, between 30 and 90 years, posted for hip or proximal femoral surgery, with visual analogue scale (VAS >3 in preoperative period. The two groups were assigned randomly. In Group 1, FICB was given half an hour before shifting the patients in operation theater with 30 ml of 0.25% ropivacaine, and in Group 2, sham block was given with 30 ml normal saline. Each group included 50 patients. Thirty minutes after FICB, spinal anesthesia was given and patients' vitals were monitored before and after block, at the time of positioning for spinal anesthesia, intraoperative and postoperative periods. Results: In Group 1, mean VAS before FICB was 8.02 which reduced to 2.28, which is statistically significant (P = 7.8813E-50, whereas in Group 2, mean VAS before sham block was 7.98 which reduced to 7.90, which is statistically nonsignificant (P = 0.6694. Mean total duration of analgesia in Group 1 was 428.3 min after spinal anesthesia, whereas in Group 2, mean total duration of analgesia was 240.1 min. Conclusion: FICB effectively provides analgesia for positioning for spinal anesthesia to patients in hip and proximal femur surgeries. It also provides analgesia in postoperative period without having significant alteration in the hemodynamic profile of patients.

Is It Time to Change Our Reference Curve for Femur Length? Using the Z-Score to Select the Best Chart in a Chinese Population

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Yang, Huixia; Wei, Yumei; Su, Rina; Wang, Chen; Meng, Wenying; Wang, Yongqing; Shang, Lixin; Cai, Zhenyu; Ji, Liping; Wang, Yunfeng; Sun, Ying; Liu, Jiaxiu; Wei, Li; Sun, Yufeng; Zhang, Xueying; Luo, Tianxia; Chen, Haixia; Yu, Lijun

2016-01-01

Objective To use Z-scores to compare different charts of femur length (FL) applied to our population with the aim of identifying the most appropriate chart. Methods A retrospective study was conducted in Beijing. Fifteen hospitals in Beijing were chosen as clusters using a systemic cluster sampling method, in which 15,194 pregnant women delivered from June 20th to November 30th, 2013. The measurements of FL in the second and third trimester were recorded, as well as the last measurement obtained before delivery. Based on the inclusion and exclusion criteria, we identified FL measurements from 19996 ultrasounds from 7194 patients between 11 and 42 weeks gestation. The FL data were then transformed into Z-scores that were calculated using three series of reference equations obtained from three reports: Leung TN, Pang MW et al (2008); Chitty LS, Altman DG et al (1994); and Papageorghiou AT et al (2014). Each Z-score distribution was presented as the mean and standard deviation (SD). Skewness and kurtosis and were compared with the standard normal distribution using the Kolmogorov-Smirnov test. The histogram of their distributions was superimposed on the non-skewed standard normal curve (mean = 0, SD = 1) to provide a direct visual impression. Finally, the sensitivity and specificity of each reference chart for identifying fetuses 95th percentile (based on the observed distribution of Z-scores) were calculated. The Youden index was also listed. A scatter diagram with the 5th, 50th, and 95th percentile curves calculated from and superimposed on each reference chart was presented to provide a visual impression. Results The three Z-score distribution curves appeared to be normal, but none of them matched the expected standard normal distribution. In our study, the Papageorghiou reference curve provided the best results, with a sensitivity of 100% for identifying fetuses with measurements 95th percentile, and specificities of 99.9% and 81.5%, respectively. Conclusions It

Stress Fractures of the Distal Femur Involving Small Nonossifying Fibromas in Young Athletes.

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Robertson, Michael; Gilley, Jasen; Nicholas, Richard

2016-11-01

Small nonossifying fibromas (ie, fibrocortical defects) are incidental findings commonly seen on radiographs of young patients evaluated for extremity pain or sport-related trauma. Although pathological fractures have been reported in larger lesions, the subcentimeter, intracortical defects are not generally thought to predispose to pathological fractures. The authors report on 2 young athletes who presented with knee pain after initiating conditioning exercise programs (cross-training). Both were diagnosed with transverse metaphyseal stress fractures involving fibrous cortical defects of the distal femur. Initial radiographs were interpreted without evidence of fractures. However, subsequent magnetic resonance imaging was informative, suggesting that magnetic resonance imaging may have value in identifying potential stress reactions in young athletes. In addition, subsequent plain radiographs of both patients showed subperiosteal new bone formation in these nondisplaced fractures, suggesting that serial radiographs and close clinical follow-up are warranted for patients with persistent symptoms. The authors propose that, in the appropriate clinical setting, the presence of a small nonossifying fibroma may be a clinical indication that further evaluation is needed when plain radiographs show normal findings, as the defect could be an unrecognized area of fracture initiation. [Orthopedics. 2016; 39(6):e1197-e1200.]. Copyright 2016, SLACK Incorporated.

Measurements of bone mineral density in the lumbar spine and proximal femur using lunar prodigy and the new pencil-beam dual-energy X-ray absorptiometry

International Nuclear Information System (INIS)

Choi, Dongil; Kim, Deog-Yoon; Han, Chung Soo; Kim, Seonwoo; Bok, Hae Sook; Huh, Wooseong; Ko, Jae-Wook; Hong, Sung Hwa

2010-01-01

We evaluated the correlation of the absolute bone mineral density (BMD) values of the lumbar spine and standard sites of the proximal femur obtained from a Lunar Prodigy and the newly developed pencil-beam dual-energy X-ray absorptiometry (Dexxum). Between June 2008 and December 2008, 79 Korean volunteers were enrolled. Measurements were obtained on the same day using both densitometers. The absolute BMD values (g/cm 2 ) from the two densitometers were evaluated using Pearson's correlation analysis with Bonferroni's correction for the three clinically important sites. In order to evaluate precision, we performed duplicate Dexxum measurements, and calculated the within-subject coefficient of variation (WSCV). The Pearson's correlation coefficient (r) of BMD values for the total proximal femur, femoral neck, and lumbar spine by the two densitometers were 0.926, 0.948, and 0.955 respectively, and the null hypotheses of r = 0.8 were all rejected (p < 0.001 by one-sided Z-test with Fisher's z-transformation for each site). The T-scores (r ≥ 0.842) and Z-scores (r ≥ 0.709) also showed strong positive correlations. The duplicate BMD values of Dexxum showed a high level of precision (WSCV ≤ 4.27%). Dexxum measurements of BMD, T-scores, and Z-scores showed a strong linear correlation with those measured on Lunar Prodigy. (orig.)

Patient-specific core decompression surgery for early-stage ischemic necrosis of the femoral head.

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Wei Wang

Full Text Available Core decompression is an efficient treatment for early stage ischemic necrosis of the femoral head. In conventional procedures, the pre-operative X-ray only shows one plane of the ischemic area, which often results in inaccurate drilling. This paper introduces a new method that uses computer-assisted technology and rapid prototyping to enhance drilling accuracy during core decompression surgeries and presents a validation study of cadaveric tests.Twelve cadaveric human femurs were used to simulate early-stage ischemic necrosis. The core decompression target at the anterolateral femoral head was simulated using an embedded glass ball (target. Three positioning Kirschner wires were drilled into the top and bottom of the large rotor. The specimen was then subjected to computed tomography (CT. A CT image of the specimen was imported into the Mimics software to construct a three-dimensional model including the target. The best core decompression channel was then designed using the 3D model. A navigational template for the specimen was designed using the Pro/E software and manufactured by rapid prototyping technology to guide the drilling channel. The specimen-specific navigation template was installed on the specimen using positioning Kirschner wires. Drilling was performed using a guide needle through the guiding hole on the templates. The distance between the end point of the guide needle and the target was measured to validate the patient-specific surgical accuracy.The average distance between the tip of the guide needle drilled through the guiding template and the target was 1.92±0.071 mm.Core decompression using a computer-rapid prototyping template is a reliable and accurate technique that could provide a new method of precision decompression for early-stage ischemic necrosis.

Early cessation of pressure garment therapy results in scar contraction and thickening.

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Danielle M DeBruler

Full Text Available Pressure garment therapy is often prescribed to improve scar properties following full-thickness burn injuries. Pressure garment therapy is generally recommended for long periods of time following injury (1-2 years, though it is plagued by extremely low patient compliance. The goal of this study was to examine the effects of early cessation of pressure garment therapy on scar properties. Full-thickness burn injuries were created along the dorsum of red Duroc pigs. The burn eschar was excised and wound sites autografted with split-thickness skin. Scars were treated with pressure garments within 1 week of injury and pressure was maintained for either 29 weeks (continuous pressure or for 17 weeks followed by cessation of pressure for an additional 12 weeks (pressure released; scars receiving no treatment served as controls. Scars that underwent pressure garment therapy were significantly smoother and less contracted with decreased scar height compared to control scars at 17 weeks. These benefits were maintained in the continuous pressure group until week 29. In the pressure released group, grafts significantly contracted and became more raised, harder and rougher after the therapy was discontinued. Pressure cessation also resulted in large changes in collagen fiber orientation and increases in collagen fiber thickness. The results suggest that pressure garment therapy effectively improves scar properties following severe burn injury; however, early cessation of the therapy results in substantial loss of these improvements.

Early results of patellofemoral inlay resurfacing arthroplasty using the HemiCap Wave prosthesis.

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Patel, Akash; Haider, Zakir; Anand, Amarjit; Spicer, Dominic

2017-01-01

Common surgical treatment options for isolated patellofemoral osteoarthritis include arthroscopic procedures, total knee replacement and patellofemoral replacement. The HemiCap Wave patellofemoral resurfacing prosthesis is a novel inlay design introduced in 2009 with scarce published data on its functional outcomes. We aim to prospectively evaluate early functional outcomes and complications, for patients undergoing a novel inlay resurfacing arthroplasty for isolated patellofemoral arthrosis in an independent centre. From 2010 to 2013, 16 consecutive patients underwent patellofemoral resurfacing procedures using HemiCap Wave (Arthrosurface Inc., Franklin, Massachusetts, USA) for anterior knee pain with confirmed radiologically and/or arthroscopically isolated severe patellofemoral arthrosis. Standardized surgical technique, as recommended by the implant manufacturer, was followed. Outcome measures included range of movement, functional knee scores (Oxford Knee Score (OKS), Knee Injury and Osteoarthritis Outcome Score (KOOS) and Short Form-36 (SF-36)), radiographic disease progression, revision rates and complications. Eight men and eight women underwent patellofemoral HemiCap Wave resurfacing, with an average age of 63 years (range: 46-83). Average follow-up was 24.1 months (6-34). Overall, post-operative scores were excellent. There was a statistically significant improvement in the post-operative OKS, KOOS and SF-36 scores ( p patellofemoral resurfacing prosthesis has excellent early results in terms of functional outcomes, radiological outcomes and low complication rates. At the very least, early results show that the HemiCap Wave is comparable to more established onlay prostheses. The HemiCap Wave thus provides a safe and effective surgical option in the treatment of isolated patellofemoral osteoarthritis in selected patients.

Estudo anatômico do terço proximal do fêmur: impacto femoroacetabular e o efeito cam Anatomic study of the proximal third of the femur: femoroacetabular impact and the cam effect

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Pedro José Labronici

2009-04-01

Full Text Available OBJETIVO: Analisar as varia��ões anatômicas da extremidade proximal do fêmur que pudessem desenvolver o impacto femoroacetabular. MÉTODOS: Foram utilizados 199 espécimes anatômicos de fêmures esqueleticamente maduros. Os fêmures foram medidos para determinar o ângulo da anteversão do colo femoral, ângulo cervicodiafisário, esfericidade da cabeça femoral em ântero-posterior e súpero-inferior, ângulo entre a epífise e o colo femoral anterior, ângulo entre a epífise e o colo em perfil, distância em ântero-posterior a 5mm da junção cabeça e colo e distância em ântero-posterior da base do colo. RESULTADOS: Observou-se que o subgrupo com impacto apresentou diâmetro da junção a 5mm (p = 0,0001 e cam-cabeça (% (p = 0,0001 significativamente maiores e base-cam (% (p = 0,0001 significativamente menor que o subgrupo sem impacto. Identificou-se que cam-cabeça (% > 80 e base-cam (% OBJECTIVE: to analyze anatomical variations of the proximal end of femur that could cause a femoroacetabular impact. METHODS: 199 skeletically mature anatomical specimens of femurs were used. The femurs were measured in order to determine the anteversion angle of the femoral neck, neckshaft angle, sphericity of the femoral head at anteroposterior and superoinferior, angle between epiphysis and the anterior femoral neck, angle between epiphysis and the neck at lateral plane, anteroposterior distance at 5mm of the head and neck junction and anteroposterior distance of the neck base. RESULTS: we found that the impact subgroup presented a significantly larger junction diameter of 5mm (p = 0.0001 and cam-head (% (p= 0.0001, while base-cam (% (p = 0.0001 showed a significantly smaller diameter than the subgroup without impact. It was identified that cam-head (% > 80 e base-cam (% < 73 were identified as the optimal impact points. CONCLUSION: our study showed that the effect cam, caused by anatomical variations of the proximal femoral end focused the

A retrospective review of bone tunnel enlargement after anterior cruciate ligament reconstruction with hamstring tendons fixed with a metal round cannulated interference screw in the femur.

Science.gov (United States)

Kobayashi, Masahiko; Nakagawa, Yasuaki; Suzuki, Takashi; Okudaira, Shuzo; Nakamura, Takashi

2006-10-01

To assess bone tunnel enlargement after anterior cruciate ligament (ACL) reconstruction with the use of hamstring tendons fixed with a round cannulated interference (RCI) screw in the femur. A consecutive series of 30 ACL reconstructions performed with hamstring tendons fixed with an RCI screw in the femur and with staples via Leeds-Keio ligament in the tibia was retrospectively reviewed. The clinical outcome was evaluated through the Lysholm score. Anterior instability was tested by Telos-SE (Telos Japan, Tokyo, Japan) measurement. The location and angle of each femoral and tibial tunnel were measured with the use of plain radiographs, and bone tunnel enlargement greater than 2 mm detected any time 3, 6, 12, and 24 months postoperatively was defined as positive. Each factor (location and angle of the tunnels, sex, affected side, age, Lysholm score, and Telos-SE measurement) was compared between enlarged and nonenlarged groups. Positive enlargement of the bone tunnel (>2.0 mm) was observed in 36.7% (11 of 30) on the femoral side and 33.3% (10 of 30) on the tibial side, and in 6 knees of both sides. Half of patients (15 of 30) had an enlarged tunnel on the femoral or the tibial side until 1 year postoperatively. In most cases, enlargement reached maximum at 6 months postoperatively. Female patients tended to have an enlarged tunnel, especially on the femoral side (P < .05). Tunnel enlargement was not correlated with location and angle of the tunnels. Moreover, no difference was found in Lysholm score and Telos-SE measurement between enlarged and nonenlarged groups, although the nonenlarged group tended to exhibit higher Lysholm score and lesser instability. Bone tunnel enlargement of the femoral or tibial side was observed in half of patients (6 in both sides, 5 only in the femur, and 4 only in the tibia) after ACL reconstruction was performed with a hamstring tendon fixed with an RCI screw. Female patients had a greater chance for enlargement of the femoral tunnel

Treatment for Trochanteric Fracture of the Femur with Short Femoral Nail: A Comparison between the Asian Intramedullary Hip Screw (IMHS) and the Conventional IMHS.

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Kawaji, Hidemi; Uematsu, Takuya; Oba, Ryosuke; Satake, Yoshihiko; Hoshikawa, Naoya; Takai, Shinro

2016-01-01

We usually use short femoral nails for the treatment of trochanteric fracture of the femur. In this retrospective study, we investigated and compared the clinical results of the conventional intramedullary hip screw (IMHS) and the Asian IMHS, which is a redesigned version of the former. The subjects were 42 patients; 21 treated with the Asian IMHS and 21 were treated with the conventional IMHS. From the clinical records, we retrospectively investigated the patients' age, sex, in-hospital waiting period for operation, operating time, intraoperative blood loss, walking ability before fracture and at discharge, and complication pertaining to the operation. The 21 patients (4 men and 17 women) receiving the Asian IMHS and the 21 patients (5 men and 16 women) receiving the conventional IMHS did not differ significantly in mean age, sex ratio, preoperative waiting period, mean postoperative hospital stay, mean operation time, or mean intraoperative blood loss. Among patients receiving the Asian IMHS, the complications of intraoperative fractures of the femur developed in 3 patients and breakage of the implant occurred in 1 patient. No complications occurred in patients receiving the conventional IMHS. Compared with the conventional IMHS, the Asian IMHS is smaller, has increased variations in the shaft/neck angle of the lag screw, and has a titanium-alloy construction, allowing magnetic resonance imaging. The intraoperative fracture may have occurred because of the configuration of the distal interlocking screw in the Asian IMHS. Breakage of the implant likely occurred because the nail was too small in diameter, and too short in length for the unstable AO 31-A3 fracture. If careful attention is paid to the configuration of its distal interlocking screw intraoperatively and a nail of appropriate size is selected, the Asian IMHS is better suited than the conventional IMHS for treating Japanese patients, who generally have a small physique, because of its many variations in

Análise comparativa da resistência de fêmures de cães após a confecção de janelas ósseas circular e quadrada Comparative analysis of dog femur resistance after receiving circular and square holes

Directory of Open Access Journals (Sweden)

Olavo Pires de Camargo

2002-06-01

Full Text Available Com o objetivo de avaliar o enfraquecimento causado pela confecção de janela óssea cortical, os autores confeccionaram uma janela circular no osso cortical da diáfise de oito fêmures de carcaças de cães e uma janela quadrada nos oito pares destes fêmures, com diagonal semelhante ao diâmetro da janela circular contralateral. As peças anatômicas foram submetidas a teste de tensão torcional em uma máquina de ensaios mecânicos; obtendo-se o torque máximo e a rigidez à torção. Os resultados mostraram que, para o fêmur com janela circular, o torque máximo médio foi de 13,65 ± 5,12 Nm, e a rigidez média foi de 1,18 ± 0,45 Nm/grau, enquanto que para a janela quadrada o torque máximo médio foi de 13, 39 ± 5,23 Nm, e a rigidez média foi de 1,05 ± 0,41 Nm/grau. A resistência nos ossos com janela circular e quadrada submetidos à tensão torcional foi praticamente igual, fato este corroborado pela análise estatística que não revelou diferença significante (p = 0,05.With the purpose of evaluating the weakness caused by holes in the cortical bone, the authors performed circular holes in the diaphysis cortical bone of eight femurs from dog carcasses, and square holes in the diaphysis cortical bone of the contralateral femurs, the diagonals being similar to the diameters. The specimens were submitted to torsion stress test in a mechanical test machine to determine maximum torque and rigidity to torsion. Maximum mean torque for the femurs with circular holes was 13.65 ± 5.12 Nm and mean rigidity was 1.18 ± 0.45 Nm/degree, while the femurs with square holes showed maximum mean torque of 13.39 ± 5.23 Nm and mean rigidity of 1.05 ± 0.41 Nm/degree. The resistance to torsion stress in femurs with circular or square holes was very similar and the statistical analysis did not show a significant difference (p = 0.05.

A computer-aided system for automatic extraction of femur neck trabecular bone architecture using isotropic volume construction from clinical hip computed tomography images.

Science.gov (United States)

Vivekanandhan, Sapthagirivasan; Subramaniam, Janarthanam; Mariamichael, Anburajan

2016-10-01

Hip fractures due to osteoporosis are increasing progressively across the globe. It is also difficult for those fractured patients to undergo dual-energy X-ray absorptiometry scans due to its complicated protocol and its associated cost. The utilisation of computed tomography for the fracture treatment has become common in the clinical practice. It would be helpful for orthopaedic clinicians, if they could get some additional information related to bone strength for better treatment planning. The aim of our study was to develop an automated system to segment the femoral neck region, extract the cortical and trabecular bone parameters, and assess the bone strength using an isotropic volume construction from clinical computed tomography images. The right hip computed tomography and right femur dual-energy X-ray absorptiometry measurements were taken from 50 south-Indian females aged 30-80 years. Each computed tomography image volume was re-constructed to form isotropic volumes. An automated system by incorporating active contour models was used to segment the neck region. A minimum distance boundary method was applied to isolate the cortical and trabecular bone components. The trabecular bone was enhanced and segmented using trabecular enrichment approach. The cortical and trabecular bone features were extracted and statistically compared with dual-energy X-ray absorptiometry measured femur neck bone mineral density. The extracted bone measures demonstrated a significant correlation with neck bone mineral density (r > 0.7, p computed tomography images scanned with low dose could eventually be helpful in osteoporosis diagnosis and its treatment planning. © IMechE 2016.

Early laparoendoscopic rendezvous for acute biliary pancreatitis: preliminary results.

Science.gov (United States)

Borzellino, G; Lombardo, F; Minicozzi, A M; Donataccio, M; Cordiano, C

2010-02-01

Early restored patency of the papilla has been hypothesized to reduce complications and mortality of acute biliary pancreatitis. The aim of this study was to evaluate the role of urgent laparoscopic cholecystectomy with intraoperative cholangiography and rendezvous when necessary in acute biliary pancreatitis natural history. Patients observed in the early stage of an acute biliary pancreatitis were included in the study. Operative risk assessment based on American Society of Anesthesiologists (ASA) score allowed the performance of urgent laparoscopic cholecystectomy within 72 h from onset of symptoms in 55 patients and a delayed intervention during the same admission in 21 patients. Intraoperative cholangiography was performed in all cases, and clearance of common bile duct was performed by flushing when possible, or rendezvous when necessary. Evolution of pancreatitis was evaluated with clinical and radiological monitoring. Urgent laparoscopic cholecystectomy was performed in all cases without conversion. At intraoperative cholangiography common bile duct was free in 25 patients, a papillary spasm was observed in 9, and common bile duct stones in 21 patients. Patency of the papilla was restored by flushing in 13 patients, while a rendezvous was necessary in 17 patients. The rate of organ failure and pancreatic necrosis was 1.8%, overall mortality was 1.8%, and overall morbidity 21.8%. No infectious complications of peripancreatic collections were observed. Urgent laparoscopic cholecystectomy with selective intraoperative rendezvous may be considered as a treatment option in the early stage of acute biliary pancreatitis.

Reverse Less Invasive Stabilization System (LISS) Plating for Proximal Femur Fractures in Poliomyelitis Survivors: A Report of Two Cases.

Science.gov (United States)

Yao, Chen; Jin, Dongxu; Zhang, Changqing

2017-11-15

BACKGROUND Poliomyelitis is a neuromuscular disease which causes muscle atrophy, skeletal deformities, and disabilities. Treatment of hip fractures on polio-affect limbs is unique and difficult, since routine fixation methods like nailing may not be suitable due to abnormal skeletal structures. CASE REPORT We report one femoral neck fracture and one subtrochanteric fracture in polio survivors successfully treated with reverse less invasive stabilization system (LISS) plating technique. Both fractures were on polio-affected limbs with significant skeletal deformities and low bone density. A contralateral femoral LISS plate was applied upside down to the proximal femur as an internal fixator after indirect or direct reduction. Both patients had uneventful bone union and good functional recovery. CONCLUSIONS Reverse LISS plating is a safe and effective technique to treat hip fractures with skeletal deformities caused by poliomyelitis.

Effect of alendronate on early bone loss of renal transplant recipients.

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Abediazar, S; Nakhjavani, M R

2011-03-01

Renal transplant recipients (RTRs) are at risk of developing osteoporosis and osteopenia due to underlying renal osteodystrophy, hypophosphatemia, and immunosuppression. This process occurs more frequently in the first year after renal transplantation (RTX), resulting in eventual bone loss and fractures. The purpose of this study was to evaluate the effect of low-dose alendronate to prevent early bone loss after RTX. We prospectively studied 43 successful RTR including 22 men and 21-women with a mean overall age of 39.16±11.73 years, mean body mass index of 23.6±3.73, and mean dialysis duration of 25.73±17.67 months. We matched them based on age and sex: the alendronate-treated group received vitamin D (Vit D) during the study plus 30 mg alendronate weekly from 1 month after RTX. The control group only received Vit D. We measured serum calcium, phosphate, alkaline phosphatase, blood urea, creatinine, and intact parathyroid hormone (iPTH) at the pretransplant baseline and monthly thereafter as well as BMD of the lumbar spine, femur, and radius pretransplant baseline versus 3 and 6 months after RTX. At 6 month after RTX, the lumbar BMD in the alendronate group increased significantly from 0.819±0.11 to 0.863±0.14 (Pbone loss and increase BMD immediately after RTX. Copyright © 2011. Published by Elsevier Inc.

A study of MR imaging of proximal femur injury in elderly patients

International Nuclear Information System (INIS)

Higa, Jun; Hamasaki, Naoto; Nakasone, Satoshi; Kanaya, Fuminori

2002-01-01

MR imaging is useful in the diagnosis of occult fractures and bone bruises. MR imaging at an early stage after injury was performed in 17 elderly patients with a clinical suspicion of hip fracture who had normal radiograms. Ten patients had positive findings on the MR imaging. In these ten patients, follow-up radiograms were taken three months later, and we compared early-stage MR images and radiographic findings at three months. Three patients showed geographic areas of low intensity on T1 and high intensity on T2-weighted images, also referred to as bone bruise, but one of them had osteosclerotic findings in radiograms. Seven patients showed linear areas on T1 or T2-weighted images. One of them received compression hip screw because of the displacement of the fracture. Three showed osteosclerotic findings and the other three showed normal findings in radiograms. Our results suggested that MR imaging at an early stage of the injury was useful to detect occult fractures and bone bruises; however, differentiation between the two was difficult. (author)

A study of MR imaging of proximal femur injury in elderly patients

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Higa, Jun; Hamasaki, Naoto; Nakasone, Satoshi [Okinawa Rehabilitation Center Hospital (Japan); Kanaya, Fuminori [Ryukyus Univ., Nishihara, Okinawa (Japan). School of Medicine

2002-09-01

MR imaging is useful in the diagnosis of occult fractures and bone bruises. MR imaging at an early stage after injury was performed in 17 elderly patients with a clinical suspicion of hip fracture who had normal radiograms. Ten patients had positive findings on the MR imaging. In these ten patients, follow-up radiograms were taken three months later, and we compared early-stage MR images and radiographic findings at three months. Three patients showed geographic areas of low intensity on T1 and high intensity on T2-weighted images, also referred to as bone bruise, but one of them had osteosclerotic findings in radiograms. Seven patients showed linear areas on T1 or T2-weighted images. One of them received compression hip screw because of the displacement of the fracture. Three showed osteosclerotic findings and the other three showed normal findings in radiograms. Our results suggested that MR imaging at an early stage of the injury was useful to detect occult fractures and bone bruises; however, differentiation between the two was difficult. (author)

Migration characteristics and early clinical results of the NANOS® short-stem hip arthroplasty.

Science.gov (United States)

Kaipel, Martin; Grabowiecki, Phillip; Sinz, Katrina; Farr, Sebastian; Sinz, Günter

2015-05-01

Femoral short stems promise essential advantages in total hip arthroplasty. Up to now, only short- and midterm clinical studies exist. Data on early stem migration that could predict later aseptic loosening at an early stage are rare. The purpose of this study was to assess migration patterns and clinical outcome 2 years after hip replacement by a metaphyseal anchored cementless short stem. Migration data and clinical results were prospectively assessed in 49 patients. Clinical outcome was measured using the Harris Hip Score (HHS). Migration analyses were performed using the computer-assisted Einzel-Bild-Roentgen-Analyse (EBRA) system. At 2 years after surgery, none of the implants needed revision, and HHS increased from 47.9 up to 98.1. Of 49 patients, 5 (10%) showed increased vertical stem migration (1.5 mm/2a) that might predict late aseptic loosening. Of 49 stems, 44 (90%) showed stable migration patterns indicating a beneficial long-term outcome. Results of this study confirm the excellent clinical data of previous works. Migration patterns strongly suggest that short-stem arthroplasty is not only an innovative but also a reliable strategy in total hip replacement.

Oceans Melting Greenland: Early Results from NASA's Ocean-Ice Mission in Greenland

DEFF Research Database (Denmark)

Fenty, Ian; Willis, Josh K.; Khazendar, Ala

2016-01-01

the continental shelf, and about the extent to which the ocean interacts with glaciers. Early results from NASA's five-year Oceans Melting Greenland (OMG) mission, based on extensive hydrographic and bathymetric surveys, suggest that many glaciers terminate in deep water and are hence vulnerable to increased...... melting due to ocean-ice interaction. OMG will track ocean conditions and ice loss at glaciers around Greenland through the year 2020, providing critical information about ocean-driven Greenland ice mass loss in a warming climate....

Results of hip arthroplasty using Paavilainen technique in patients with congenitally dislocated hip

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R. M. Tikhilov

2014-01-01

Full Text Available The purpose of the study was to analyze the medium- and long-term results of hip arthroplasty using Paavilainen technique in patients with the congenitally dislocated hip. Methods: From 2001 to 2012 180 operations were carried out were using the Paavilainen technique in 140 patients with high dislocation of the hip (Crowe IV. All patients were clinically evaluated using the Harris Hip Score (HHS, VAS and radiography. Statistical analysis was performed using the Pearson correlation coefficients, multiple regression analysis and classification trees analysis. Results: The average Harris score improved from preoperative 41.6 (40,3-43,5 to 79.3 (77,9-82,7 at final follow-up, and the difference was significant. Early complications were 9% (the most frequent were fractures of the proximal femur, later - 16.7% (pseudoarthrosis of the greater trochanter, 13.9%; disclocations-1,1%, aseptic loosening of the components - 1.7%, reoperation performed in 8.3% of cases. Such factors as age and limb length has statistically significant effect on functional outcomes. Established predictive model allows to get the best possible functional outcome in such patients with severe dysplasia. Conclusions: Total Hip arthroplasty using the Paavilainen technique is an effective method of surgical treatment in patients with the congenitally dislocated hip, but it is technically difficult operation with a high incidence of complications in comparison with standard primary total hip replacement.

The Use of Cryotherapy for Papilloma and Early Laryngeal Cancers: Long-term Results.

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Benninger, Michael S; Derakhshan, Adeeb; Milstein, Claudio F

2015-07-01

Retrospective chart review. To determine the efficacy of adjuvant cryotherapy in the treatment of early glottic cancer and laryngeal papillomatosis. The use of cryotherapy in conjunction with traditional modalities has recently been proposed to improve voice outcomes in patients with early laryngeal cancer as compared to pretreatment conditions. This study investigates its utility in improving oncological outcomes and decreasing recurrences of laryngeal papillomatosis. Patients with either early glottic cancer or laryngeal papillomatosis that received cryotherapy as part of their surgical regimen were investigated. All patients were seen at a large tertiary care center within a 10-year window. Demographic data were collected and all postoperative notes were reviewed. Recurrences of the laryngeal cancer were noted, as was the duration of time between successive papillomatosis operations. The charts of 54 glottic cancer and 29 papillomatosis patients that received cryotherapy were reviewed. One patient from the papillomatosis cohort was excluded from statistical analysis due to lack of follow-up. Overall, 16 (30%) of the laryngeal cancer patient experienced a malignant recurrence. The overall 5-year survival of these patients was 98% and the 5-year disease-free survival was 74%. The use of adjuvant cryotherapy in the treatment of laryngeal papillomatosis extended the duration of time between surgeries by an average of 79 days (P=.23). The use of adjuvant cryotherapy in the treatment of early glottic cancer does not improve the rate of carcinoma recurrences. Additionally, cryotherapy does not result in a statistically significant increase in the duration of disease-free period for laryngeal papillomatosis patients, although the observed increase may be clinically important. © The Author(s) 2015.

Photothermal tomography for the functional and structural evaluation, and early mineral loss monitoring in bones.

Science.gov (United States)

Kaiplavil, Sreekumar; Mandelis, Andreas; Wang, Xueding; Feng, Ting

2014-08-01

Salient features of a new non-ionizing bone diagnostics technique, truncated-correlation photothermal coherence tomography (TC-PCT), exhibiting optical-grade contrast and capable of resolving the trabecular network in three dimensions through the cortical region with and without a soft-tissue overlayer are presented. The absolute nature and early demineralization-detection capability of a marker called thermal wave occupation index, estimated using the proposed modality, have been established. Selective imaging of regions of a specific mineral density range has been demonstrated in a mouse femur. The method is maximum-permissible-exposure compatible. In a matrix of bone and soft-tissue a depth range of ~3.8 mm has been achieved, which can be increased through instrumental and modulation waveform optimization. Furthermore, photoacoustic microscopy, a comparable modality with TC-PCT, has been used to resolve the trabecular structure and for comparison with the photothermal tomography.

Fracture Union in Closed Interlocking Nail in Femoral Fracture

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R L Sahu

2010-09-01

Full Text Available INTRODUCTION: Fractures shaft femur is a major cause of morbidity and mortality in patients with lower extremity injuries. The objective of this study was to find out the outcome of Interlocking nail in fracture femur. METHODS: This study was conducted in the Department of Orthopaedic surgery in M. M. Medical College from July 2006 to November 2008. Seventy eight patients were recruited from Emergency and out patient department having closed fracture of femoral shaft. All patients were operated under general or spinal anesthesia. All patients were followed for nine months. RESULTS: Out of seventy eight patients, sixty nine patients underwent union in 90 to 150 days with a mean of 110.68 days. Touch down weight bearing was started on 2nd post-operative day. Complications found in four patients who had non-union, and five patients had delayed union which was treated with dynamization and bone graft. The results were excellent in 88.46% and good in 6.41% patients. CONCLUSIONS: We concluded that this technique is advantageous because of early mobilization (early weight bearing, less complication with good results and is economical. Keywords: close reamed interlocking nail, dynamization, femoral shaft fractures, union

Modified fixation with pinning and external fixation components for feline femur multiple-lined fracture: A case report

International Nuclear Information System (INIS)

Okamoto, Y.; Minami, S.; Matuhashi, A.

1992-01-01

A 3-year-old female Japanese domestic cat, weighing 3kg, was referred to us because of right hind leg lameness occuring for 3 days' duration. Radiography of the affected leg revealed severe femoral diaphysial comminuted fracture. The affected leg was treated using wire with an intramedullary Stainman pin being placed completely through the femur. After suturing the wound, both ends of the intramedullary pin exposed both proximally and distally were fixed with external fixation components (two double clamps, two single clamps, two short rods and one long rod) to prevent the pin from rotation. There was a slight gait problem due to the external apparatus and no post-operative infection. The function of the right hind leg gradually recovered. The intramedullary pin and external fixative apparatus were removed on the 52nd day after surgery. This modified fixation appears to offer versatility in the treatment of various fractures in smaller dogs and cats

Results of high energy x-ray therapy of gastric carcinoma, 3. Early gastric carcinoma (Tl carcinoma)

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Yamada, S; Asakawa, H; Otawa, H; Matsumoto, K [Miyagi Seijinbyo Center (Japan)

1981-11-01

A total of 25 cases with early gastric carcinoma, of which 10 cases were followed by gastrectomy, were given a combined radiotherapy with 5-Fu, Ft 207 or MFC at Miyagi Seijinbyo Center. Histologic examinations of biopsy specimens revealed the disappearance of cancer cells in five (42%) of 12 cases and those of serial specimens of the resected stomach showed the complete disappearance of cancer cells in three (27%) of 11 lesions (10 cases). Five year survival rate in 15 non-resected cases was only 30%. From these results, it was suggested that a combined radiotherapy of early gastric carcinoma should not be chosen as a curative treatment procedure but it might be valuable, if early carcinoma was thought to be inoperable because of other medical reasons.

Early biometric lag in the prediction of small for gestational age neonates and preeclampsia.

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Schwartz, Nadav; Pessel, Cara; Coletta, Jaclyn; Krieger, Abba M; Timor-Tritsch, Ilan E

2011-01-01

An early fetal growth lag may be a marker of future complications. We sought to determine the utility of early biometric variables in predicting adverse pregnancy outcomes. In this retrospective cohort study, the crown-rump length at 11 to 14 weeks and the head circumference, biparietal diameter, abdominal circumference, femur length, humerus length, transverse cerebellar diameter, and estimated fetal weight at 18 to 24 weeks were converted to an estimated gestational age using published regression formulas. Sonographic fetal growth (difference between each biometric gestational age and the crown-rump length gestational age) minus expected fetal growth (number of days elapsed between the two scans) yielded the biometric growth lag. These lags were tested as predictors of small for gestational age (SGA) neonates (≤10th percentile) and preeclampsia. A total of 245 patients were included. Thirty-two (13.1%) delivered an SGA neonate, and 43 (17.6%) had the composite outcome. The head circumference, biparietal diameter, abdominal circumference, and estimated fetal weight lags were identified as significant predictors of SGA neonates after adjusted analyses (P biometric lag variables and the development of preeclampsia. Routinely available biometric data can be used to improve the prediction of adverse outcomes such as SGA. These biometric lags should be considered in efforts to develop screening algorithms for adverse outcomes.

Surgical induction, histological evaluation, and MRI identification of cartilage necrosis in the distal femur in goats to model early lesions of osteochondrosis.

Science.gov (United States)

Tóth, F; Nissi, M J; Wang, L; Ellermann, J M; Carlson, C S

2015-02-01

Identify and interrupt the vascular supply to portions of the distal femoral articular-epiphyseal cartilage complex (AECC) in goat kids to induce cartilage necrosis, characteristic of early lesions of osteochondrosis (OC); then utilize magnetic resonance imaging (MRI) to identify necrotic areas of cartilage. Distal femora were perfused and cleared in goat kids of various ages to visualize the vascular supply to the distal femoral AECC. Vessels located on the axial aspect of the medial femoral condyle (MFC) and on the abaxial side of the lateral trochlear ridge were transected in eight 4- to 5-day-old goats to induce cartilage necrosis. Goats were euthanized 1, 2, 3, 4, 5, 6, 9, and 10 weeks post operatively and operated stifles were harvested. Adiabatic T1ρ relaxation time maps of the harvested distal femora were generated using a 9.4 T MR scanner, after which samples were evaluated histologically. Interruption of the vascular supply to the MFC caused lesions of cartilage necrosis in 6/8 goat kids that were demonstrated histologically. Adiabatic T1ρ relaxation time mapping identified these areas of cartilage necrosis in 5/6 cases. No significant findings were detected after transection of perichondrial vessels supplying the lateral trochlear ridge. Cartilage necrosis, characteristic of early OC, can be induced by interrupting the vascular supply to the distal femoral AECC in goat kids. The ability of high field MRI to identify these areas of cartilage necrosis in the AECC using the adiabatic T1ρ sequence suggests that this technique may be useful in the future for the early diagnosis of OC. Copyright © 2014 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Posttreatment biopsy results following interstitial brachytherapy in early-stage prostate cancer

International Nuclear Information System (INIS)

Prestidge, Bradley R.; Hoak, David C.; Grimm, Peter D.; Ragde, Haakon; Cavanagh, William; Blasko, John C.

1997-01-01

Purpose: To assess pathologic control rates for prostatic carcinoma as determined by postimplant prostate biopsy in a large series of consecutive patients who have received permanent interstitial brachytherapy using a contemporary transrectal ultrasound-directed, transperineal, computer generated, volume technique. Methods and Materials: Four hundred and two patients received permanent 125 I or 103 Pd interstitial brachytherapy as primary treatment for early stage prostatic carcinoma at the Northwest Tumor Institute between January 1988 and January 1994. Of these, 201 have consented to biopsy 12 or more months postimplant with a median follow-up of 40 months (range: 12-83 months). None had received homonal manipulation. A total of 361 biopsies was performed on 201 patients with a range of one to six annual biopsies per patient (91 received multiple, serial biopsies). Of the 161 patients more than 12 months postimplant who have not been biopsied, most have been unwilling or unable to submit to biopsy. Only six patients with biochemical progression have not been biopsied. There was no difference in the presenting characteristics or implant parameters between those patients biopsied and those that were not. One hundred and forty-three received 125 I (71%) prescribed to a MPD of 160 Gy with a median activity of 35.5 mCi, and 58 (29%) received 103 Pd prescribed to a MPD of 115 Gy with a median activity of 123 mCi. Multiple biopsies were performed under transrectal ultrasound guidance, and all specimens were classified as either negative, indeterminate, or positive. Results: At the time of last biopsy, 161 (80%) have achieved negative pathology, 34 (17%) remain indeterminate, and 6 (3%) have been positive. Only 2 of the 186 patients with a PSA < 4.0 ng/ml at the time of biopsy were positive. Among those 33 indeterminate patients with a subsequent biopsy, 28 have converted to negative, 2 to positive, and 3 remain unchanged to date. Conclusions: These data demonstrate at

A Prospective Study of Early Loaded Single Implant-Retained Mandibular Overdentures: Preliminary One-Year Results

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Ali M. El-Sheikh

2012-01-01

Full Text Available Purpose. To investigate the predictability of simplifying mandibular overdenture treatment using one-stage surgery and early prosthetic loading of a single implant. Materials and Methods. Twenty edentulous patients with problematic existing mandibular dentures were treated. A single implant with a chemically modified surface (SLActive, Straumann AG, Basel, Switzerland was placed into the mandibular midline. The patients were recalled at 3, 6 and 12 months. Clinical assessments and marginal bone loss using standardized radiographs were recorded. All complications, failures and maintenance were noted. Visual analog-scale questionnaires were used to record patient satisfaction in five categories. ANOVA was used to determine differences between means of marginal bone loss and different categories of patient staisfaction (=0.05. Results. The 20 early loaded implants were all surviving at the 12-month recall. All implants showed less than 1 mm of marginal bone loss by the end of the 1-year with a significant increase during the follow-up period. Few prosthetic problems were reported. Patient satisfaction was high with a significant increase in all comfort and functional parameters. Conclusions. These preliminary 1-year results indicate that early loading of a single chemically modified surface implant used to retain a mucosa-borne mandibular overdenture is a safe, reliable, and cost-effective treatment.

3D perfusion bioreactor-activated porous granules on implant fixation and early bone formation in sheep.

Science.gov (United States)

Ding, Ming; Henriksen, Susan S; Martinetti, Roberta; Overgaard, Søren

2017-11-01

Early fixation of total joint arthroplasties is crucial for ensuring implant survival. An alternative bone graft material in revision surgery is needed to replace the current gold standard, allograft, seeing that the latter is associated with several disadvantages. The incubation of such a construct in a perfusion bioreactor has been shown to produce viable bone graft materials. This study aimed at producing larger amounts of viable bone graft material (hydroxyapatite 70% and β-tricalcium-phosphate 30%) in a novel perfusion bioreactor. The abilities of the bioreactor-activated graft material to induce early implant fixation were tested in a bilateral implant defect model in sheep, with allograft as the control group. Defects were bilaterally created in the distal femurs of the animals, and titanium implants were inserted. The concentric gaps around the implants were randomly filled with either allograft, granules, granules with bone marrow aspirate or bioreactor-activated graft material. Following an observation time of 6 weeks, early implant fixation and bone formation were assessed by micro-CT scanning, mechanical testing, and histomorphometry. Bone formations were seen in all groups, while no significant differences between groups were found regarding early implant fixation. The microarchitecture of the bone formed by the synthetic graft materials resembled that of allograft. Histomorphometry revealed that allograft induced significantly more bone and less fibrous tissue (p formation was observed in all groups, while the bioreactor-activated graft material did not reveal additional effects on early implant fixation comparable to allograft in this model. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 2465-2476, 2017. © 2016 Wiley Periodicals, Inc.

GLOBULAR CLUSTER POPULATIONS: FIRST RESULTS FROM S{sup 4}G EARLY-TYPE GALAXIES

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Zaritsky, Dennis [Steward Observatory, University of Arizona, 933 North Cherry Avenue, Tucson, AZ 85721 (United States); Aravena, Manuel [Núcleo de Astronomía, Facultad de Ingeniería, Universidad Diego Portales, Avenida Ejército 441, Santiago (Chile); Athanassoula, E.; Bosma, Albert [Aix Marseille Université, CNRS, LAM (Laboratoire d' Astrophysique de Marseille) UMR 7326, F-13388 Marseille (France); Comerón, Sébastien; Laine, Jarkko; Laurikainen, Eija; Salo, Heikki [Astronomy Division, Department of Physics, P.O. Box 3000, FI-90014 University of Oulu (Finland); Elmegreen, Bruce G. [IBM T. J. Watson Research Center, 1101 Kitchawan Road, Yorktown Heights, NY 10598 (United States); Erroz-Ferrer, Santiago; Knapen, Johan H. [Instituto de Astrofísica de Canarias, Vía Lácteas, E-38205 La Laguna (Spain); Gadotti, Dimitri A.; Muñoz-Mateos, Juan Carlos [European Southern Observatory, Casilla 19001, Santiago 19 (Chile); Hinz, Joannah L. [MMT Observatory, P.O. Box 210065, Tucson, AZ 85721 (United States); Ho, Luis C. [Kavli Institute for Astronomy and Astrophysics, Peking University, Beijing 100871 (China); Holwerda, Benne [Leiden Observatory, University of Leiden, Niels Bohrweg 4, NL-2333 Leiden (Netherlands); Sheth, Kartik, E-mail: dennis.zaritsky@gmail.com [National Radio Astronomy Observatory/NAASC, 520 Edgemont Road, Charlottesville, VA 22903 (United States)

2015-02-01

Using 3.6 μm images of 97 early-type galaxies, we develop and verify methodology to measure globular cluster populations from the S{sup 4}G survey images. We find that (1) the ratio, T {sub N}, of the number of clusters, N {sub CL}, to parent galaxy stellar mass, M {sub *}, rises weakly with M {sub *} for early-type galaxies with M {sub *} > 10{sup 10} M {sub ☉} when we calculate galaxy masses using a universal stellar initial mass function (IMF) but that the dependence of T {sub N} on M {sub *} is removed entirely once we correct for the recently uncovered systematic variation of IMF with M {sub *}; and (2) for M {sub *} < 10{sup 10} M {sub ☉}, there is no trend between N {sub CL} and M {sub *}, the scatter in T {sub N} is significantly larger (approaching two orders of magnitude), and there is evidence to support a previous, independent suggestion of two families of galaxies. The behavior of N {sub CL} in the lower-mass systems is more difficult to measure because these systems are inherently cluster-poor, but our results may add to previous evidence that large variations in cluster formation and destruction efficiencies are to be found among low-mass galaxies. The average fraction of stellar mass in clusters is ∼0.0014 for M {sub *} > 10{sup 10} M {sub ☉} and can be as large as ∼0.02 for less massive galaxies. These are the first results from the S{sup 4}G sample of galaxies and will be enhanced by the sample of early-type galaxies now being added to S{sup 4}G and complemented by the study of later-type galaxies within S{sup 4}G.

Is Early Appropriate Care of axial and femoral fractures appropriate in multiply-injured elderly trauma patients?

Science.gov (United States)

Reich, M S; Dolenc, A J; Moore, T A; Vallier, H A

2016-09-26

Previous work established resuscitation parameters that minimize complications with early fracture management. This Early Appropriate Care (EAC) protocol was applied to patients with advanced age to determine if they require unique parameters to mitigate complications. Between October 2010 and March 2013, 376 consecutive skeletally mature patients with unstable fractures of the pelvis, acetabulum, thoracolumbar spine, and/or proximal or diaphyseal femur fractures were treated at a level I trauma center and were prospectively studied. Patients aged ≤30 years (n = 114), 30 to 60 years (n = 184), and ≥60 years (n = 37) with Injury Severity Scores (ISS) ≥16 and unstable fractures of the pelvis, acetabulum, spine, and/or diaphyseal femur were treated within 36 h, provided they showed evidence of adequate resuscitation. ISS, Glasgow Coma Scale (GCS), and American Society of Anesthesiologists (ASA) classification were determined. Lactate, pH, and base excess (BE) were measured at 8-h intervals. Complications included pneumonia, pulmonary embolism (PE), acute renal failure, acute respiratory distress syndrome (ARDS), multiple organ failure (MOF), deep vein thrombosis, infection, sepsis, and death. Patients ≤30 years old (y/o) were more likely to sustain gunshot wounds (p = 0.039), while those ≥60 y/o were more likely to fall from a height (p = 0.002). Complications occurred at similar rates for patients ≤30 y/o, 30 to 60 y/o, and ≥60 y/o. There were no differences in lactate, pH, or BE at the time of surgery. For patients ≤30 y/o, there were increased overall complications if pH was <7.30 (p = 0.042) or BE <-6.0 (p = 0.049); patients ≥60 y/o demonstrated more sepsis if BE was <-6.0 (p = 0.046). EAC aims to definitively manage axial and femoral shaft fractures once patients have been adequately resuscitated to minimize complications. EAC is associated with comparable complication rates in young and elderly

Early results from the Whisper instrument on Cluster: An overview

DEFF Research Database (Denmark)

Decreau, P.M.E.; Fergeau, P.; Krasnoselskikh, V.

2001-01-01

The Whisper instrument yields two data sets: (i) the electron density determined via the relaxation sounder, and (ii) the spectrum of natural plasma emissions in the frequency band 2-80 kHz. Both data sets allow for the three-dimensional exploration of the magnetosphere by the Cluster mission...... the drift velocity of density structures. Wave observations are also of crucial interest for studying small-scale structures, as demonstrated in an example in the fore-shock region. Early results from the Whisper instrument are very encouraging, and demonstrate that the four-point Cluster measurements...... largely overcomes the limited telemetry allocation. The natural emissions are usually related to the plasma frequency, as identified by the sounder, and the combination of an active sounding operation and a passive survey operation provides a time resolution for the total density determination of 2.2 s...

Attitudes of the German general population toward early diagnosis of dementia--results of a representative telephone survey.

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Tobias Luck

Full Text Available BACKGROUND: Early detection of dementia has clearly improved. Even though none of the currently available treatments for the most common form of dementia, Alzheimer's dementia, promises a cure, early diagnosis provides several benefits for patients, caregivers, and health care systems. This study aimed to describe attitudes toward early diagnosis of dementia in the German general population. METHODS: A representative telephone survey of the German population aged 18+ years (n = 1,002 was conducted in 2011. RESULTS: The majority of respondents (69% would be willing to be examined for early diagnosis of dementia. Almost two thirds reported that they would prefer their general practitioner (GP as the first source of professional help. More than half of the respondents (55% stated their belief that dementia could be prevented. Respondents mostly indicated psychosocial prevention options. CONCLUSIONS: Our findings suggest that the general population in Germany is very open to early diagnosis of dementia; however, this seems connected with large expectations on the effectiveness of prevention options. Dementia awareness campaigns may be employed to carefully inform the public about the prevention options currently available and their efficacy. To exploit GPs' potential as a gatekeeper for early detection of dementia, their ability to identify patients with antecedent and mild stages of the disease must be improved.

OUTCOME OF UNCEMENTED UNIPOLAR HEMIARTHROPLASTY IN FRACTURE NECK OF FEMUR, IN GERIATRIC PATIENTS IN RELATION TO BONE QUALITY

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Mehraj Din

2015-09-01

Full Text Available BACKGROUND: Osteoporosis plays an important role in pathogenesis of fracture neck of femur in mobile elderly. Hemiarthroplasty is most common mode of management of femoral neck fractures in elderly in developing world. We report the outcome of uncemented hemiarthropl asty in elderly patients with a femoral neck fracture in relation to bone quality of patient as estimated by Dual energy x ray absorptiometry (DEXA scan. MATERIALS AND METHODS: 75 uncemented hemiarthroplasties for femoral neck fractures were performed in elderly patients more than 70 years of age between August 2008 and April 2012. The clinical, radiological results and bone mineral density of 65 hips in 65 patients who could be followed up were analyzed. For all cases Austin Moore prosthesis was implanted . RESULTS: The mean age of the patients was 79.96±7.21 years ( 7 1 to 96 years. 44 patients were women and 21 were men. Average duration of follow - up was 18.59±11.53 months ( R ange 4 to 44 months. The mean Harris Hip Score in patients with osteopenia was 80 .29±13.29 and in patients with osteoporosis it was 79.96 ± 11.67 at the time of the last follow - up. There was no significant difference in mean Harris hi p score in osteoporotic and non - osteoporotic patient’s p value 0.923. Out of 65 patients whose results were assessed in our study 48 patients (73.8% had osteoporosis and 17 patients (26.1% had Osteopenia. None of the patients in our study had a normal bone density. The mean T Score as measured on DEXA scan was - 3.74±1.57. CONCLUSION: Uncemented hemiarthro plasty for elderly patients more than 70 years of age with a femoral neck fracture showed satisfactory short - term results with no relationship to the bone quality

Early mobilisation versus plaster immobilisation of simple elbow dislocations: Results of the FuncSiE multicentre randomised clinical trial

NARCIS (Netherlands)

G.I.T. Iordens (Gijs); E.M.M. van Lieshout (Esther); N.W.L. Schep (Niels); J. de Haan (Jeroen); W.E. Tuinebreijer (Wim); D. Eygendaal (Denise); E.F. van Beeck (Ed); P. Patka (Peter); M.H.J. Verhofstad (Michiel); D. den Hartog (Dennis); R.S. Breederveld (Roelf S.); M.W.G.A. Bronkhorst (Maarten); M.R. de Vries (Mark); B.J. Dwars (Boudewijn); R. Haverlag (Robert); S.A.G. Meylaerts (Sven); J.W. Mulder (Jan-Willem); K.J. Ponsen (Kees-jan); W.H. Roerdink (Herbert); G.R. Roukema (Gert); I.B. Schipper (Inger); M.A. Schouten (Michel); J.B. Sintenie (Jan Bernard); S. Sivro (Senail); J.G.H. van den Brand (Johan); F.M. van der Linden (Frits); H.G.W.M. Meulen (Hub); E.J.M.M. Verleisdonk (Egbert); J.P.A.M. Vroemen (Jos); M. Waleboer (Marco); W.J. Willems (Jaap)

2017-01-01

textabstractBackground/aim To compare outcome of early mobilisation and plaster immobilisation in patients with a simple elbow dislocation. We hypothesised that early mobilisation would result in earlier functional recovery. Methods From August 2009 to September 2012, 100 adult patients with a

Effect of Hind-Limb Suspension and X-Ray Irradiation on the Mechanical and Chemical Properties of Rat Femur and Tibia Bones

Science.gov (United States)

Heacox, Hayley; Hill, Brent; Mehta, Rahul; Barajas, Jordan; Freyaldenhoven, Sidney; Dobretsov, Max; Chowdhury, Parimal

It is known that space conditions such as microgravity and cosmic radiation have detrimental effects on the skeletal system of humans, such as decreased bone mineral density. This research studies the changes in mechanical properties, elasticity, and chemical properties, calcium and phosphorus content, of rat femur and tibia bones when exposed to hind-limb suspension and x-ray irradiation, simulated microgravity and cosmic radiation. It is hypothesized that if microgravity and cosmic radiation lead to decreased bone mineral density, then these conditions will produce weakened bones, lower elastic moduli and abnormal concentrations of calcium and phosphorus, as compared to bones not subject to these conditions. A technique known as three-point bending was employed to estimate the Young's (elastic) modulus for the leg bones. To investigate the chemical nature of the bones, a Scanning Electron Microscope (SEM) was utilized to take cross-sectional images and to perform energy dispersive x-ray spectroscopy. Ultimately, the results produced by this research will aid in quantifying the effects of spaceflight and may be used in developing a treatment to counteract such effects. This work supported by a RID and CRP Grant from Arkansas Space Grant Consortium.

Massage therapy during early postnatal life promotes greater lean mass and bone growth, mineralization, and strength in juvenile and young adult rats.

Science.gov (United States)

Chen, H; Miller, S; Shaw, J; Moyer-Mileur, L

2009-01-01

The objects of this study were to investigate the effects of massage therapy during early life on postnatal growth, body composition, and skeletal development in juvenile and young adult rats. Massage therapy was performed for 10 minutes daily from D6 to D10 of postnatal life in rat pups (MT, n=24). Body composition, bone area, mineral content, and bone mineral density were measured by dual energy X-ray absorptiometry (DXA); bone strength and intrinsic stiffness on femur shaft were tested by three-point bending; cortical and cancellous bone histomorphometric measurements were performed at D21 and D60. Results were compared to age- and gender-matched controls (C, n=24). D21 body weight, body length, lean mass, and bone area were significantly greater in the MT cohort. Greater bone mineral content was found in male MT rats; bone strength and intrinsic stiffness were greater in D60 MT groups. At D60 MT treatment promoted bone mineralization by increasing trabecular mineral apposition rate in male and endosteal mineral surface in females, and also improved micro-architecture by greater trabeculae width in males and decreasing trabecular separation in females. In summary, massage therapy during early life elicited immediate and prolonged anabolic effects on postnatal growth, lean mass and skeletal developmental in a gender-specific manner in juvenile and young adult rats.

Disruption of the Sec24d gene results in early embryonic lethality in the mouse.

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Andrea C Baines

Full Text Available Transport of newly synthesized proteins from the endoplasmic reticulum (ER to the Golgi is mediated by the coat protein complex COPII. The inner coat of COPII is assembled from heterodimers of SEC23 and SEC24. Though mice with mutations in one of the four Sec24 paralogs, Sec24b, exhibit a neural tube closure defect, deficiency in humans or mice has not yet been described for any of the other Sec24 paralogs. We now report characterization of mice with targeted disruption of Sec24d. Early embryonic lethality is observed in mice completely deficient in SEC24D, while a hypomorphic Sec24d allele permits survival to mid-embryogenesis. Mice haploinsufficient for Sec24d exhibit no phenotypic abnormality. A BAC transgene containing Sec24d rescues the embryonic lethality observed in Sec24d-null mice. These results demonstrate an absolute requirement for SEC24D expression in early mammalian development that is not compensated by the other three Sec24 paralogs. The early embryonic lethality resulting from loss of SEC24D in mice contrasts with the previously reported mild skeletal phenotype of SEC24D deficiency in zebrafish and restricted neural tube phenotype of SEC24B deficiency in mice. Taken together, these observations suggest that the multiple Sec24 paralogs have developed distinct functions over the course of vertebrate evolution.

Financial aspects of arthroplasty options for intra-capsular neck of femur fractures: a cost analysis study to review the financial impacts of implementing NICE guidelines in the NHS organisations.

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Horriat, S; Hamilton, P D; Sott, A H

2015-02-01

To review the financial aspects of implementing the latest NICE guideline for neck of femur fracture (CG124), which recommends offering Total Hip Replacement (THR) as an alternative to hemiarthroplasty (HA) for patients, who are independently mobile before injury, not cognitively impaired and well enough to tolerate the operation. Between April 2011 and April 2013 data collected from our Hip Fracture database (NHFD) showed that by following the latest NICE guideline (CG124), out of 840 patients, 176 patients (21%) should be considered for THR rather than HA. Individual procedure costs were calculated by considering cost of implants and consumables (extracted from providers' published catalogues) added to the cost of running operating theatre for each operation. We then used the national tariff for each procedure using relevant HRG codes to calculate the total cost and the income to the Trust. Our data indicated that by implementing the latest NICE guideline (CG124), 37.1% of patients with intra-capsular fracture neck of femur (IC-NOF fracture) would be eligible for THR rather than HA. Although performing cemented THR was the more expensive procedure, our calculation shows that despite increased cost of performing the operation, Trusts can increase their net income by £300-600 (depending on their market force factor) per patient using correct HRG coding and National Tariff. Utilising 2012-13 National Tariff, performing a cemented THR instead of a HA for patients with IC-NOF fracture, as recommended by the latest NICE guideline (CG124) can increase the Trust's revenue per patient in a predictable way. This practice not only results in potentially better patient outcomes but also can increase financial reward and potential for reinvestment in all hip fracture units in the UK. Copyright © 2014 Elsevier Ltd. All rights reserved.

Post-weaning high-fat diet results in growth cartilage lesions in young male rats.

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Samuel S Haysom

Full Text Available To determine if a high-fat diet (HF from weaning would result in a pro-inflammatory state and affect joint cartilage, we fed male rats either HF or Chow diet post-weaning, and voluntary wheel exercise (EX or cage only activity (SED after 9 weeks of age. At 17 weeks body composition, plasma biomarkers and histomorphology scores of femoro-tibial cartilages of HF-SED, HF-EX, Chow-SED and Chow-EX groups were compared. Food intake and activity were not significantly different between groups. HF diet resulted in significantly higher weight gain, %fat, fat:lean ratio, and plasma leptin, insulin and TNFα concentrations, with significant interactions between diet and exercise. No abnormal features were detected in the hyaline articular cartilage or in the metaphyseal growth plate in all four groups. However, collagen type X- positive regions of retained epiphyseal growth cartilage (EGC was present in all HF-fed animals and significantly greater than that observed in Chow-fed sedentary rats. Most lesions were located in the lateral posterior aspect of the tibia and/or femur. The severity of lesions was greater in HF-fed animals. Although exercise had a significantly greater effect in reducing adiposity and associated systemic inflammation in HF-fed rats, it had no effect on lesion incidence or severity. Lesion incidence was also significantly associated with indices of obesity and plasma markers of chronic inflammation. Clinically, EGC lesions induced by HF feeding in rats from very early in life, and possibly by insufficient activity, is typical of osteochondrosis in animals. Such lesions may be the precursor of juvenile osteochondritis dissecans requiring surgery in children/adolescents, conservative management of which could benefit from improved understanding of early changes in cellular and gene expression.

Fraturas proximais do fêmur em idosos: qual o melhor tratamento? Proximal fracture of the femur on the elderly: what's the best treatment?

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Lygia Paccini Lustosa

2009-01-01

Full Text Available As fraturas proximais do fêmur em idosos representam um sério problema dentro do contexto da saúde pública, devido aos elevados custos econômicos para o tratamento e as suas consequências, assim como pela alta taxa de morbidade e mortalidade. O objetivo desse estudo foi discutir quais os tratamentos mais indicados para esse tipo de fratura, em idosos, por meio de uma revisão da literatura. As bases de dados pesquisadas foram MEDLINE, COCHRANE e PEDro. Os critérios de inclusão foram estudos publicados nos últimos sete anos; nos idiomas português, inglês e espanhol; realizados em seres humanos, sem distinção de gênero e com idade maior que 60 anos; estudos com desenho metodológico de ensaios clínicos, ensaios clínicos aleatorizados e revisões sistemáticas com e sem meta-análise. Foram encontrados sete artigos e após a análise pode se afirmar que não existe um tratamento específico para as fraturas proximais do fêmur em idosos. O tratamento normalmente indicado na maioria dessas fraturas é cirúrgico e requer envolvimento fisioterápico para uma reabilitação adequada. Apesar da dificuldade de comparação entre os estudos, foi observado que uma equipe de profissionais da saúde parece promover uma reabilitação mais efetiva, além de prevenir complicações.The proximal fractures of the femur on the elderly represent a serious problem inside the public health context, because of the high economic costs needed for the treatment and it's consequence, as the high taxes of morbidity and mortality. The goal of this study was to discuss, through a literature revision, which is the most indicated treatment for the proximal fractures of the femur, on the elderly. The researched data bases were MEDLINE, COCHRANE and PEDro. The inclusion criterions were published studies on the last seven years, only on the Portuguese, English and Spanish languages, accomplished on human beings, with no genre distinction and with ages above 60

Investigations into the visualisation of osseous and hyaline cartilaginous surface structures of the femural head using X-ray computed tomography. Untersuchung der Visualisierbarkeit knoecherner und hyalin knorpeliger Oberflaechenstrukturen des caput femoris mit Roentgen-Computertomographie

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Laemmermann, G.

1989-03-06

This study investigates into the extent to which fine osseous structures in the head of the femur and hyaline cartilaginous surfaces of the hip joint are accessible to X-ray computed tomography as a method of diagnosis. At first, a true model of the femural head (post-mortem preparation embedded in methylacrylate) was tomographed to compare the sectional displays thus obtained with hard-microtome sections of similar thickness made at the same levels. This permitted preliminary evaluations to be carried out and confirmed that those structures can be visualised by high-resolution CT (1 mm sections). Methods using high-resolution sectional imaging have a role in examinations of congruence in the the hip joint. Particularly useful here are three-dimensional displays of osseous and cartilaginous surfaces of the joint parts examined. Further research is needed until a more refined method of reconstruction can be made available, the usefulness of which in actual practice will depend on the degree of geometrical congruence achieved between a patient's joint and its display on the screen. (orig./GDG).

THE INFLUENCE OF COMPUTER-ASSISTED SURGERY ON CLINICAL AND RADIOGRAPHIC OUTCOMES OF PERIАRTICULAR FEMUR AND TIBIA OSTEOTOMIES IN OSTEOARTHRITIC PATIENTS (REVIEW

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P. G. Kochergin

2017-01-01

Full Text Available Nowadays the clinical application of digital technologies became a growing trend at every stage of orthopedic patient treatment: from diagnostic procedures and pre-operative planning to intra-operative control of surgical manipulations and evaluation of final results later. The aim of thi sresearch was to analyze the studies dedicated to application of computer-assisted surgery (CAS for femur and tibial osteotomies in patients with gonarthrosis. The hypothesis was that CAS improves the precision of leg alignment correction in frontal and sagittal planes that positively influencing both functional result of treatment and longevity of clinical effect. The PubMed, PubMedCentral, GoogleScholar and eLIBRARY searched for relevant studies using following key words: knee, osteoarthritis, gonarthrosis, osteotomy, CAS, navigation and its russian analogs. The majority of publications favored CAS in comparison to traditional osteotomy techniques both for leg alignment and tibial slope control. Despite generally researchers paid less attention to functional results after CASosteotomies than to precision of surgical manipulations it is possible of confirm that there is strong tendency to better knee scores after navigation while the difference is not always statistically significant. Rare publications dedicated to long term results favor CAS: 10 years survival rate is 97% that correspond to outcomes of modern total knee arthroplasty. Hence, the current literature confirms the hypothesis of our study and don’t reveal increase of complications rate associated with CAS.

Resultados do tratamento das fraturas da diáfise do fêmur ipsilaterais às do colo ou transtrocantérica Outcomes in treatment of diaphiseal femur fractures ipsilateral to the neck or transtrocanteric fracture

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Nelson Astur Neto

2010-01-01

implant, used were evaluated, both at the time and retrospectively, based on the patients' records. The mean follow-up time was 48 months. RESULTS: All the trochanteric fractures consolidated without residual deformities. Of the femoral neck fractures, three (30% presented delayed consolidation and two consolidated with in varus deformity. Two patients had delayed diaphyseal consolidation. All the ssociated diaphyseal/trochanteric fractures had good or excellent functional outcomes. Of the associated neck fractures, seven (70% had excellent or good results, two had regular results, and one had a bad result. CONCLUSIONS: The association of diaphyseal with trochanteric femur fractures showed better radiographic and functional results, with less complications, than the association of diaphyseal and femoral neck fractures.

2D-3D shape reconstruction of the distal femur from stereo X-Ray imaging using statistical shape models

DEFF Research Database (Denmark)

Baka, N.; Kaptein, B. L.; de Bruijne, Marleen

2011-01-01

Three-dimensional patient specific bone models are required in a range of medical applications, such as pre-operative surgery planning and improved guidance during surgery, modeling and simulation, and in vivo bone motion tracking. Shape reconstruction from a small number of X-ray images is desired...... as it lowers both the acquisition costs and the radiation dose compared to CT. We propose a method for pose estimation and shape reconstruction of 3D bone surfaces from two (or more) calibrated X-ray images using a statistical shape model (SSM). User interaction is limited to manual initialization of the mean...... pose estimation of ground truth shapes as well as 3D shape estimation using a SSM of the whole femur, from stereo cadaver X-rays, in vivo biplane fluoroscopy image-pairs, and an in vivo biplane fluoroscopic sequence. Ground truth shapes for all experiments were available in the form of CT segmentations...

Plate fixation in periprosthetic femur fractures Vancouver type B1-Trochanteric hook plate or subtrochanterical bicortical locking?

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Lenz, Mark; Stoffel, Karl; Kielstein, Heike; Mayo, Keith; Hofmann, Gunther O; Gueorguiev, Boyko

2016-12-01

Proximal plate fixation in periprosthetic femur fractures can be improved by plate anchorage in the greater trochanter (lateral tension band principle) or bicortical locking screw placement beside the prosthesis stem in an embracement configuration. Both concepts were compared in a biomechanical test using a femoral hook plate (hook) or a locking attachment plate (LAP). After bone mineral density (BMD) measurement in the greater trochanter, six pairs of fresh frozen human femora were assigned to two groups and instrumented with cemented hip endoprostheses. A transverse osteotomy was set distal to the tip of the prosthesis, simulating a Vancouver B1 fracture. Each pair was instrumented using a plate tensioner with either hook or LAP construct. Cyclic testing (2Hz) with physiologic profile and monotonically increasing load was performed until catastrophic failure. Plate stiffness was compared in a four-point-bending-test. Paired student's-t-test was used for statistical evaluation (pTrochanteric fixation is highly BMD dependent and may be restricted to major greater trochanteric involvement requiring stabilization. Copyright © 2016 Elsevier Ltd. All rights reserved.

Quantitative computed tomography derived structural geometric accuracy using custom built anthropometric phantom of the proximal femur

International Nuclear Information System (INIS)

Khoo, B.C.C.; Price, R.; Hicks, N.

2011-01-01

Full text: Material and structural properties influence bone strength. Structural strength may be determined through imaging methods, though currently there is no commercially available phantom to assess structural geometrical (SG) accuracy. This paper describes the design of an anthropometric SG phantom of the proximal femur and the performance testing on quantitative computed tomography (QCT) derived SG outcomes. Aims of study were to determine accuracy of QCT-derived SG outcomes and its effects from kYp. The phantom consists of three basic components; femoral head, a modular and interchangeable neck insert and shaft. The interchangeable neck modules were designed with different cortical thickness and shape. QCT scans were performed with Mindways QA (Mindways Software Inc., USA) phantom, then with anthropometric phantom in water bath together with Mindways calibration phantom. All QCT scans were done on Philips 64 MDCT (Philips Healthcare, USA). Three neck modules were selected and scanned. Each neck module was repeated scanned five times at 120 mAs, 0.67 mm slice thickness and 0.33 mm increment and at 80, 120 and 140 kYps. SG parameters analysed included bone mineral density(aBMD) and outer-diameter (OD).

Early magnetic resonance imaging and histologic findings in a model of avascular necrosis of femoral head

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Nakamura, Takuya [Kanazawa Univ. (Japan). School of Medicine

1997-12-01

The present study was performed to examine early MR images and histologic findings using a canine model of avascular necrosis of femoral head (ANFH). The ANFH model was surgically induced. At three days, 1, 2 and 4 weeks after surgery, the proximal femurs were excised. MR images were obtained in 4 dogs at 3 days and 7 dogs at each of the other intervals. Histologic examinations were performed on 7 dogs at each interval. Three days after surgery, MR showed almost no abnormal findings. Histologic changes included edematous bone marrow and bleeding in the bone marrow in some regions. One week after surgery, empty lacunae in trabecular bones and immature fibrous tissues in the bone marrow were seen in some cases, but appositional bone was not yet apparent. In only one case, abnormal MR findings -a ringlike pattern- were seen. Two weeks after surgery, 4 cases showed appositional bones on histology and abnormalities on MR images. Four weeks after surgery, fibrous tissues had matured and appositional bones had increased. Therefore, all 7 cases showed MR imaging abnormalities. Abnormal MR images included a ringlike pattern, and homogeneous and inhomogeneous patterns. These results indicated that MR imaging shows abnormality 2 weeks after surgery at the latest. (author)

Intra-articular Physeal Fractures of the Distal Femur: A Frequently Missed Diagnosis in Adolescent Athletes.

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Pennock, Andrew T; Ellis, Henry B; Willimon, Samuel C; Wyatt, Charles; Broida, Samuel E; Dennis, M Morgan; Bastrom, Tracey

2017-10-01

Intra-articular physeal fractures of the distal femur are an uncommon injury pattern, with only a few small case series reported in the literature. To pool patients from 3 high-volume pediatric centers to better understand this injury pattern, to determine outcomes of surgical treatment, and to assess risk factors for complications. Case series; Level of evidence, 4. A multicenter retrospective review of all patients presenting with an intra-articular physeal fracture between 2006 and 2016 was performed. Patient demographic and injury data, surgical data, and postoperative outcomes were documented. Radiographs were evaluated for fracture classification (Salter-Harris), location, and displacement. Differences between patients with and without complications were compared by use of analysis of variance or chi-square tests. A total of 49 patients, with a mean age of 13.5 years (range, 7-17 years), met the inclusion criteria. The majority of fractures were Salter-Harris type III fractures (84%) involving the medial femoral condyle (88%). Football was responsible for 50% of the injuries. The initial diagnosis was missed in 39% of cases, and advanced imaging showed greater mean displacement (6 mm) compared with radiographs (3 mm). All patients underwent surgery and returned to sport with "good to excellent" results after 2 years. Complications were more common in patients with wide-open growth plates, patients with fractures involving the lateral femoral condyle, and patients who were casted ( P < .05). Clinicians evaluating skeletally immature athletes (particularly football players) with acute knee injuries should maintain a high index of suspicion for an intra-articular physeal fracture. These fractures are frequently missed, and advanced imaging may be required to establish the diagnosis. Leg-length discrepancies and angular deformities are not uncommon, and patients should be monitored closely. Surgical outcomes are good when fractures are identified, with high rates

Vascularised and modified lower-leg rotationplasty for the treatment of severe infection and bone loss of the proximal femur: a case report.

Science.gov (United States)

Fischer, Sebastian; Hirche, Christoph; Heppert, Volkmar G; Grützner, Paul A; Kneser, Ulrich; Kremer, Thomas

2017-09-19

We report a reconstructive case in a paraplegic patient, who suffers from a severe proximal femur infection. Aiming at the preservation of the capacity to remain in a seated position to operate a wheelchair, lower leg rotationplasty was considered suitable for reconstruction. Due to severe infection and subclinical femoral artery stenosis, rotationplasty was supercharged by the inferior epigastric artery. Furthermore, extensor tendons of the foot were attached to the acetabulum to facilitate stability of the neo-hip joint. Follow-up examination 1 year after surgery revealed no complications and a satisfied patient. Especially in paraplegic patients, lower leg rotationplasty is a possible treatment option for severe femoral infection. Supercharging provides well-vascularised tissue to the former infection site and improves wound healing.

Selecting boundary conditions in physiological strain analysis of the femur: Balanced loads, inertia relief method and follower load.

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Heyland, Mark; Trepczynski, Adam; Duda, Georg N; Zehn, Manfred; Schaser, Klaus-Dieter; Märdian, Sven

2015-12-01

Selection of boundary constraints may influence amount and distribution of loads. The purpose of this study is to analyze the potential of inertia relief and follower load to maintain the effects of musculoskeletal loads even under large deflections in patient specific finite element models of intact or fractured bone compared to empiric boundary constraints which have been shown to lead to physiological displacements and surface strains. The goal is to elucidate the use of boundary conditions in strain analyses of bones. Finite element models of the intact femur and a model of clinically relevant fracture stabilization by locking plate fixation were analyzed with normal walking loading conditions for different boundary conditions, specifically re-balanced loading, inertia relief and follower load. Peak principal cortex surface strains for different boundary conditions are consistent (maximum deviation 13.7%) except for inertia relief without force balancing (maximum deviation 108.4%). Influence of follower load on displacements increases with higher deflection in fracture model (from 3% to 7% for force balanced model). For load balanced models, follower load had only minor influence, though the effect increases strongly with higher deflection. Conventional constraints of fixed nodes in space should be carefully reconsidered because their type and position are challenging to justify and for their potential to introduce relevant non-physiological reaction forces. Inertia relief provides an alternative method which yields physiological strain results. Copyright © 2015 IPEM. Published by Elsevier Ltd. All rights reserved.

Total resection of any segment of the lateral meniscus may cause early cartilage degeneration: Evaluation by magnetic resonance imaging using T2 mapping.

Science.gov (United States)

Murakami, Koji; Arai, Yuji; Ikoma, Kazuya; Kato, Kammei; Inoue, Hiroaki; Nakagawa, Shuji; Fujii, Yuta; Ueshima, Keiichiro; Fujiwara, Hiroyoshi; Kubo, Toshikazu

2018-06-01

The aim of this study was to perform quantitative evaluation of degeneration of joint cartilage using T2 mapping in magnetic resonance imaging (MRI) after arthroscopic partial resection of the lateral meniscus.The subjects were 21 patients (23 knees) treated with arthroscopic partial resection of the lateral meniscus. MRI was performed for all knees before surgery and 6 months after surgery to evaluate the center of the lateral condyle of the femur in sagittal images for T2 mapping. Ten regions of interest (ROIs) on the articular cartilage were established at 10-degree intervals, from the point at which the femur shaft crossed the lateral femoral condyle joint to the articular cartilage 90° relative to the femur shaft. Preoperative and postoperative T2 values were evaluated at each ROI. Age, sex, body mass index, femorotibial angle, Tegner score, and amount of meniscal resection were evaluated when the T2 value increased more than 6% at 30°.T2 values at approximately 10 °, 20 °, 30 °, 40 °, 50 °, and 60 ° degrees relative to the anatomical axis of the femur were significantly greater postoperatively (3.1, 3.6, 5.5, 4.4, 5.0, 6.4%, respectively) than preoperatively. A >6% increase at 30° was associated with total resection of any segment of the meniscus.Degeneration of the articular cartilage, as shown by the disorganization of collagen arrays at positions approximately 10 °, 20 °, 30 °, 40 °, 50 °, and 60 ° relative to the anatomical axis of the femur, may start soon after arthroscopic lateral meniscectomy. Total resection of any segment of the lateral meniscus may cause T2 elevation of articular cartilage of lateral femoral condyle.

EFEK PEMBERIAN SPILANTHES ACMELLA DAN LATIHAN FISIK TERHADAP JUMLAH SEL OSTEOBLAS FEMUR MENCIT YANG DIINDUKSI DEKSAMETASON

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Hening Laswati

2015-05-01

pembentukan tulang karena fraksi tersebut banyak mengandung senyawa turunan amida dan sesquiterpena. Kesimpulan penilitian ini menunjukan adanya efek additive ekstrak etanol 70% dari Spilanthes Acmella pada latihan fiik dengan meningkatkan jumlah sel osteoblas.Kata kunci: Spilanthes acmella, osteoporosis sekunder, osteoblasAbstractStudy was conducted to analyse the anti-osteoporosis effect of Spilanthes acmella plant in vivo on osteoblast cell trabecular bone of femur male mice with dexamethasone- induced osteoporosis. This study using a post test control group design, 60 male healthy mice (>5 months old were randomizely devided into 10 groups, there are healthy control group (without induction dexamethaxone, and osteoporosis groups (induction with dexamethaxone. The positive control receive suspension alendronat suspension and the exercise group walking using mice treadmill 10m/minute, 5-12 minutes 3 times a week,the combination group of 70% extract ethanol and exercise, the butanol, hexane, etil asetat and water fraction group. The study conducted for 4 weeks. Glucocorticoid-induced osteoporosis is leading cause of secondary osteoporosis and an increase in fracture risk. There were clinical evidence suggest a role for phytoestrogen in the treatment of post-menopausal osteoporosis. Spilanthes acmella, or already known by public society as Legetan, include in Asteracea family, is one of Indonesia medicinal plants that contain of polyphenol and flvonoids. Previously in vitro study showed that buthanol and water fraction from this plant have increased alkaline phosphatase that known as marker of bone formation.The results showed that 70% ethanol extract of Spilanthes acmella that combined by physical exercise increasing osteoblast cells signifiantly than only 70% ethanol extract or physical exercise. Additionally hexane, ethyl acetate and water fractions from Spilanthes acmella also increasing osteoblast cells signifiantly. Non-polar fraction is a potential fraction of bone

Association of insulin resistance with near peak bone mass in the femur and lumbar spine of Korean adults aged 25-35: The Korean National Health and Nutrition Examination Survey 2008-2010.

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Min Soo Choo

Full Text Available This study aimed to evaluate the relationship between insulin resistance and the bone mineral density (BMD of femur and lumbar spine in Korean adults who are expected to exhibit near peak bone mass.Data from the Korean National Health and Nutrition Examination Survey 2008-2010 were analyzed. A total of 2,750 participants aged 25-35 years were included. Insulin resistance was assessed using a homeostatic model assessment of insulin resistance (HOMA-IR and serum fasting insulin.In a multivariate linear regression analysis, the HOMA-IR was significantly inversely associated with the BMD of the total hip (TH, β = -0.052, P = 0.002, femoral neck (FN, β = -0.072, P<0.001, femoral trochanter (FTr, β = -0.055, P = 0.003, femoral intertrochanter (FITr, β = -0.041, P = 0.015, and lumbar spine (LS, β = -0.063, P = 0.001 among all study subjects after adjustment for gender, age, height, weight, whole body fat mass percentage, systolic blood pressure, diastolic blood pressure, total cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, vitamin D, smoking, alcohol intake, physical activity, education level, and household income in both genders as well as labor, the use of oral contraceptives, and age at menarche in females. The serum fasting insulin was significantly inversely associated with the BMD of the TH (β = -0.055, P = 0.001, FN (β = -0.072, P<0.001, FTr (β = -0.055, P = 0.003, FITr (β = -0.045, P = 0.009, and LS (β = -0.064, P = 0.001 among all subjects in a multivariate linear regression analysis.Our results suggest that insulin resistance may be independently and inversely associated with the near peak bone mass of the femur and lumbar spine.

Early Period Results and Clinical Characteristics of Upper Gastrointestinal Endoscopy in Sivrihisar State Hospital

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Ozgur Turk

2014-12-01

Full Text Available Aim: Our aim was to identify the characteristics of the patient that performed upper gastrointestinal endoscopy in a new established endoscopy unit of a state hospital. We want to present the spectrum of gastrointestinal diseases in our hospitals region. Material and Method: We analyzed patients upper endoscopy results according to age, sex, complaints, clinical characteristics, type of anesthesia, and the necessity of biopsy. We reviewed 256 patients data between 2013 December-2014 July. All endoscopies were performed by same surgeon. Results: The highest complaint was epigastric pain (n=112, 43, 8%. Other complaints were followed as dyspepsia (n=84, 32.8%, heartburn (n=42, 16.4%, nausea (n=4, 1.6%, vomiting (n=2, 0.8%, dysphagia (n=6, 2.3%. We determined 218 gastritis (85.2%, 64 hiatal hernia (25%, 120 esophagitis (46.9%, 76 duodenitis (29.7%, 4 gastric ulcer (1.6%, 18 duodenal ulcers (7%, 20 bile reflux (7.8%, 26 Gastro esophageal reflux disease (GERD in patients (10.2%. 10 patients reported as normal (3.9%. Biopsy was performed in 186 of the patients. Discussion: Endoscopy can become an early diagnostic examination by increasing the availability of endoscopy. Also alarm symptoms should not be ignored and endoscopy should perform immediately in symptomatic patients. As an early result of upper gastrointestinal endoscopies that performed in this study; gastritis, esophagitis, duodenitis and hiatal hernia are common gastrointestinal diseases in our region.

SPECTROSCOPIC ANALYSIS OF METAL-POOR STARS FROM LAMOST: EARLY RESULTS

International Nuclear Information System (INIS)

Li, Hai-Ning; Zhao, Gang; Wang, Liang; Wang, Wei; Yuan, Hailong; Christlieb, Norbert; Zhang, Yong; Hou, Yonghui

2015-01-01

We report on early results from a pilot program searching for metal-poor stars with LAMOST and follow-up high-resolution observation acquired with the MIKE spectrograph attached to the Magellan II telescope. We performed detailed abundance analysis for eight objects with iron abundances [Fe/H] < -2.0, including five extremely metal-poor (EMP; [Fe/H] < -3.0) stars with two having [Fe/H] < -3.5. Among these objects, three are newly discovered EMP stars, one of which is confirmed for the first time with high-resolution spectral observations. Three program stars are regarded as carbon-enhanced metal-poor (CEMP) stars, including two stars with no enhancement in their neutron-capture elements, which thus possibly belong to the class of CEMP-no stars; one of these objects also exhibits significant enhancement in nitrogen, and is thus a potential carbon and nitrogen-enhanced metal-poor star. The [X/Fe] ratios of the sample stars generally agree with those reported in the literature for other metal-poor stars in the same [Fe/H] range. We also compared the abundance patterns of individual program stars with the average abundance pattern of metal-poor stars and find only one chemically peculiar object with abundances of at least two elements (other than C and N) showing deviations larger than 0.5 dex. The distribution of [Sr/Ba] versus [Ba/H] agrees that an additional nucleosynthesis mechanism is needed aside from a single r-process. Two program stars with extremely low abundances of Sr and Ba support the prospect that both main and weak r-processes may have operated during the early phase of Galactic chemical evolution. The distribution of [C/N] shows that there are two groups of carbon-normal giants with different degrees of mixing. However, it is difficult to explain the observed behavior of the [C/N] of the nitrogen-enhanced unevolved stars based on current data

Bone Marrow Stromal Cells Contribute to Bone Formation Following Infusion into Femoral Cavities of a Mouse Model of Osteogenesis Imperfecta

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Li, Feng; Wang, Xujun; Niyibizi, Christopher

2010-01-01

Currently, there are conflicting data in literature regarding contribution of bone marrow stromal cells (BMSCs) to bone formation when the cells are systemically delivered in recipient animals. To understand if BMSCs contribute to bone cell phenotype and bone formation in osteogenesis imperfecta bones (OI), MSCs marked with GFP were directly infused into the femurs of a mouse model of OI (oim). The contribution of the cells to the cell phenotype and bone formation was assessed by histology, immunohistochemistry and biomechanical loading of recipient bones. Two weeks following infusion of BMSCs, histological examination of the recipient femurs demonstrated presence of new bone when compared to femurs injected with saline which showed little or no bone formation. The new bone contained few donor cells as demonstrated by GFP fluorescence. At six weeks following cell injection, new bone was still detectable in the recipient femurs but was enhanced by injection of the cells suspended in pepsin solublized type I collagen. Immunofluorescence and immunohistochemical staining showed that donor GFP positive cells in the new bone were localized with osteocalcin expressing cells suggesting that the cells differentiated into osteoblasts in vivo. Biomechanical loading to failure in thee point bending, revealed that, femurs infused with BMSCs in PBS or in soluble type I collagen were biomechanically stronger than those injected with PBS or type I collagen alone. Taken together, the results indicate that transplanted cells differentiated into osteoblasts in vivo and contributed to bone formation in vivo; we also speculate that donor cells induced differentiation or recruitment of endogenous cells to initiate reparative process at early stages following transplantation. PMID:20570757

Femoral bone strength in large theropod dinosaurs: A study by genus

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Lee, Scott

2015-03-01

The locomotion of bipedal theropod dinosaurs is controlled by the strength of the femur to resist bending torques (caused by the foot striking the ground and the action of muscles on the femur). The section modulus at the narrowest part measures the ability of the femur to resist such torques. We present the results of our study of the femoral section moduli for six genus of large theropods: Tyrannosaurus, Nanotyrannus, Gorgosaurus, and Albertosaurus of the Late Cretaceous, Acrocanthosaurus of the Early Cretaceous, and Allosaurus of the Late Jurassic. These animals had femora of lengths between 65 and 134 cm. The corresponding section moduli varied between 23 and 570 cm3. Some species of Tyrannosaurus, Gorgosaurus, Allosaurus, and Albertosaurus had femora with lengths in the same 75 to 90 cm range. The section moduli of these animals are all in the same range, showing that the animals had the same abilities of locomotion. That is, Allosaurus of the Late Jurassic could locomote just as well as the Late Cretaceous Tyrannosaurus, Gorgosaurus, and Albertosaurus. There is no evidence that these later theropods had evolved to be any faster than similarly-sized theropods living about 80 million years earlier.

Esophagographic findings of early esophageal cancer : comparison with pathologic results

International Nuclear Information System (INIS)

Chung, Jae Joon; Kim, Choong Bai; Kim, Ho Guen; Kim, Myeong Jin; Lee, Jong Tae; Yoo, Hyung Sik

1998-01-01

The purpose of this study is to investigate the esophagographic findings of early esophageal cancer (EEC), and to compare these with the pathologic results, and to thus determine the most useful method of esophagography for detection of EEC. We examined 18 patients (M:F=16:2) with pathologically proven EEC; 17 cases were squamous cell carcinoma and one was adenocarcinoma. Tumor size, shape and location were evaluated by esophagography and the findings were compared with the pathologic results. The tumors were 0.5 - 7 cm in size; all except two were smaller than 4 cm. Twelve were located in the middle esophagus, five cases in the lower esophagus and one case in the upper esophagus; in ten cases, the margin was ill-defined. Esophagography showed that eight cases were of the superficial depressed type, seven were the superficial elevated type, and three were the tumorous type. All 18 cases were detected by double contrast study, but mucosal relief study and barium filling study revealed only ten and eight cases, respectively; for the detection of EEC double contrast study was thus the most useful. EEC was commonly demonstrated in the middle esophagus with an ill-defined margin; it was of the superficial depressed or elevated type. For the detection of EEC, double contrast study was the most useful. (author). 14 refs., 1 tab., 5 figs

Intercalary defects reconstruction of the femur and tibia after primary malignant bone tumour resection. A series of 13 cases.

Science.gov (United States)

Brunet, O; Anract, P; Bouabid, S; Babinet, A; Dumaine, V; Toméno, B; Biau, D

2011-09-01

Performing intercalary segment reconstruction after malignant bone tumour resection results in both mechanical and biological challenges. Fixation must be solid enough to avoid short-term or mid-term mechanical failure. The use of an allograft or autograft must ensure long-term survival of the reconstruction. The goal of this study was to analyse the clinical and radiological outcomes of these reconstructions. Thirteen patients were operated on eight femurs and five tibias. The median age was 20 years old (range 14-50). The most common diagnosis was osteosarcoma. The median resection length was 15cm (Q1-Q3: 6-26). A plate was used for fixation in nine cases and an intramedullary locked nail in four cases. An isolated bone autograft was used in two cases, an isolated bone allograft in one case, a dual autograft-allograft composite in six cases, and vascularised fibula and allograft combination in four cases. The cumulative probability of union was 46% (95% CI: 0-99%) at 1 year; at the final follow-up, union was achieved in 12 patients (92%). Because of non-unions, 13 iterative procedures were needed to obtain these results. A non-displaced fracture of a cuboid-shaped tibial graft occurred in one patient, which was treated conservatively. Three infections occurred. The results of intercalary segmental defects reconstruction after bone tumour resection were good, both from an oncologic and radiological point-of-view. One or more iterative procedures are sometimes needed to finally obtain bone union. We prefer to use a free rectangular cuboidal tibial graft since reconstruction with a vascularised autograft is technically more difficult. The choice of fixation methods is still controversial and no approach was found to be superior. Level IV. Retrospective study. Copyright © 2011. Published by Elsevier Masson SAS.

The advantages of tomosynthesis for evaluating bisphosphonate-related atypical femur fractures compared to radiography.

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Petraszko, Andrew; Siegal, Daniel; Flynn, Michael; Rao, Sudhaker D; Peterson, Ed; van Holsbeeck, Marnix

2016-05-01

To investigate the advantages of using tomosynthesis (TS) compared to radiographs in the detection, characterization, and follow-up of bisphosphonate-related atypical femur fractures (BP-AFF). Eight patients were identified retrospectively who underwent TS for radiographic findings suspicious for BP-AFF. Two radiologists independently interpreted 15 radiographs and 16 TS examinations, indicating the presence or absence of the following: (1) cortical "beaking" on radiographs, (2) radiolucent fracture line on radiographs, and (3) fracture lucency on TS corresponding to the site of radiographic abnormality. Radiation dose data were calculated for radiographs and TS using Monte Carlo analysis. There was agreement on 100 % of radiographs regarding the presence or absence of a cortical beak. Regarding the presence or absence of a fracture lucency, there was agreement on 100 % of TS examinations (Kappa = 1.0) and 73 % of radiographs (Kappa = 0.40 ± 0.24). For the 46 % of radiographs in which one or both radiologists did not visualize a fracture line, there was 100 % agreement for the presence of a fracture line on the corresponding TS. The interobserver agreement for fracture line detection was significantly higher for TS than for radiographs (p = 0.012). The effective radiation dose using TS was approximately 96 % lower compared to radiography. TS outperformed radiographs in the detection and characterization of BP-AFF. TS may also have advantages over radiography for BP-AFF follow-up through its unique ability to visualize fracture healing with lower effective radiation doses to the patient.

Fractures of the proximal femur: correlation with vitamin D receptor gene polymorphism

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A.C. Ramalho

1998-07-01

Full Text Available Fractures are the feared consequences of osteoporosis and fractures of the proximal femur (FPF are those that involve the highest morbidity and mortality. Thus far, evaluation of bone mineral density (BMD is the best way to determine the risk of fracture. Genetic inheritance, in turn, is one of the major determinants of BMD. A correlation between different genotypes of the vitamin D receptor (VDR and BMD has been recently reported. On this basis, we decided to determine the importance of the determination of VDR genotype in the presence of an osteoporotic FPF in a Brazilian population. We studied three groups: group I consisted of 73 elderly subjects older than 65 years (78.5 ± 7.2 years hospitalized for nonpathological FPF; group II consisted of 50 individuals older than 65 years (72.9 ± 5.2 years without FPF and group III consisted of 98 young normal Brazilian individuals aged 32.6 ± 6.6 years (mean ± SD. Analysis of VDR gene polymorphism by restriction fragment length polymorphism (RFLP was performed by PCR amplification followed by BsmI digestion of DNA isolated from peripheral leukocytes. The genotype distribution in group I was 20.5% BB, 42.5% Bb and 37% bb and did not differ significantly from the values obtained for group II (16% BB, 36% Bb and 48% bb or for group III (10.2% BB, 47.6% Bb and 41.8% bb. No differences in genotype distribution were observed between sexes or between the young and elderly groups. We conclude that determination of VDR polymorphism is of no practical use for the prediction of FPF. Other nongenetic factors probably start to affect bone mass, the risk to fall and consequently the occurrence of osteoporotic fractures with advancing age.

Pre-operative urinary tract infection: is it a risk factor for early surgical site infection with hip fracture surgery? A retrospective analysis.

Science.gov (United States)

Yassa, Rafik Rd; Khalfaoui, Mahdi Y; Veravalli, Karunakar; Evans, D Alun

2017-03-01

The aims of the current study were to determine whether pre-operative urinary tract infections in patients presenting acutely with neck of femur fractures resulted in a delay to surgery and whether such patients were at increased risk of developing post-operative surgical site infections. A retrospective review of all patients presenting with a neck of femur fracture, at a single centre over a one-year period. The hospital hip fracture database was used as the main source of data. UK University Teaching Hospital. All patients ( n  = 460) presenting across a single year study period with a confirmed hip fracture. The presence of pre-operative urinary tract infection, the timing of surgical intervention, the occurrence of post-operative surgical site infection and the pathogens identified. A total of 367 patients were operated upon within 24 hours of admission. Urinary infections were the least common cause of delay. A total of 99 patients (21.5%) had pre-operative urinary tract infection. Post-operatively, a total of 57 (12.4%) patients developed a surgical site infection. Among the latter, 31 (54.4%) did not have a pre-operative urinary infection, 23 (40.4%) patients had a pre-operative urinary tract infection, 2 had chronic leg ulcers and one patient had a pre-operative chest infection. Statistically, there was a strong relationship between pre-operative urinary tract infection and the development of post-operative surgical site infection ( p -value: 0.0005). The results of our study indicate that pre-operative urinary tract infection has a high prevalence amongst those presenting with neck of femur fractures, and this is a risk factor for the later development of post-operative surgical site infection.

Management of Very Early-onset Fetal Growth Restriction: Results from 92 Consecutive Cases.

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Hoellen, Friederike; Beckmann, Annika; Banz-Jansen, Constanze; Weichert, Jan; Rody, Achim; Bohlmann, Michael K

2016-01-01

To evaluate management of early-onset intrauterine growth restriction (IUGR) and to define outcome according to obstetric setting. During an 11-year period (2000-2011), data of patients presenting with IUGR and preterm delivery of less than 30 weeks of gestation at a tertiary perinatal center were retrospectively reviewed. A total of 92 pregnancies were investigated. Delivery was indicated for fetal reasons in 38 out of 92 patients. Sixteen children of our cohort died within one year post partum, out of which eight had suffered from severe early-onset IUGR causing iatrogenic preterm delivery. Concerning the fetal outcome, gestational age at delivery and antenatal exposure to corticosteroids were found to be crucial. In some cases, respiratory distress syndrome prophylaxis and a "wait and see" approach to management in favor of a prolongation of the pregnancy might be favorable. Randomized prospective trials in early-onset IUGR with threatened preterm deliveries are needed in order to define guidelines for an individually tailored management of early-onset preterm infants. Copyright © 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

Assessment of polycaprolacton (PCL) nanocomposite scaffold compared with hydroxyapatite (HA) on healing of segmental femur bone defect in rabbits.

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Eftekhari, Hadi; Jahandideh, Alireza; Asghari, Ahmad; Akbarzadeh, Abolfazl; Hesaraki, Saeed

2017-08-01

Segmental bone loss due to trauma, infection, and tumor resection and even non-union results in the vast demand for replacement and restoration of the function of the lost bone. The objective of this study is to utilize novel inorganic-organic nanocomposites for biomedical applications. Biodegradable implants have shown great promise for the repair of bone defects and have been commonly used as bone substitutes, which traditionally would be treated using metallic implants. In this study, 45 mature male New Zealand white rabbits 6-8 months and weighting 3-3.5 kg were examined. Rabbits were divided into three groups. Surgical procedures were done after an intramuscular injection of Ketamine 10% (ketamine hydrochloride, 50 mg/kg), Rompun 5% (xylazine, 5 mg/kg). Then an approximately 6 mm diameter - 5 mm cylinder bone defect was created in the femur of one of the hind limbs. After inducing the surgical wound, all rabbits were colored and randomly divided into three experimental groups of nine animals each: Group 1 received medical pure nanocomposite polycaprolactone (PCL) granules, Group 2 received hydroxyapatite and Group 3 was a control group with no treatment. Histopathological evaluation was performed on days 15, 30 and 45 after surgery. On day 45 after surgery, the quantity of newly formed lamellar bone in the healing site in PCL group was better than onward compared with HA and control groups. Finally, nanocomposite PCL granules exhibited a reproducible bone-healing potential.

Total Hip Intraoperative Femur Fracture: Do the Design Enhancements of a Second-Generation Tapered-Wedge Stem Reduce the Incidence?

Science.gov (United States)

Colacchio, Nicholas D; Robbins, Claire E; Aghazadeh, Mehran S; Talmo, Carl T; Bono, James V

2017-10-01

Intraoperative femur fracture (IFF) is a well-known complication in primary uncemented total hip arthroplasty (THA). Variations in implant instrumentation design and operative technique may influence the risk of IFF. This study investigates IFF between a standard uncemented tapered-wedge femoral stem and its second-generation successor with the following design changes: size-specific medial curvature, proportional incremental stem growth, modest reduction in stem length, and distal lateral relief. A single experienced surgeon's patient database was retrospectively queried for IFF occurring during primary uncemented THA using a standard tapered-wedge femoral stem system or a second-generation stem. All procedures were performed using soft tissue preserving anatomic capsule repair and posterior approach. The primary outcome measure was IFF. A z-test of proportions was performed to determine significant difference between the 2 stems with respect to IFF. Patient demographics, Dorr classification, and implant characteristics were also examined. Forty-one of 1510 patients (2.72%) who received a standard tapered-wedge femoral stem sustained an IFF, whereas 5 of 800 patients (0.63%) using the second-generation stem incurred an IFF. No other significant associations were found. A standard tapered-wedge femoral stem instrumentation system resulted in greater than 4 times higher incidence of IFF than its second-generation successor used for primary uncemented THA. Identifying risk factors for IFF is necessary to facilitate implant system improvements and thus maximize patient outcomes. Copyright © 2017. Published by Elsevier Inc.

proximal femur geometry in the adult kenyan femur and its

African Journals Online (AJOL)

Results: Mean femoral neck-shaft angle was found to be 129.21º, while the mean ... Mean femoral head diameter was 42.6mm, with mean diameter of the left side ..... The mode was ... Cooperman, D. and Grant, R.E. Evaluation ... application.

Differential population synthesis of early-type galaxies. III. Synthesis results

International Nuclear Information System (INIS)

Pickles, A.J.

1985-01-01

Synthesis results are presented for 12 elliptical and five lenticular galaxies which cover nearly a 6 mag range of absolute magnitude in the Fornax cluster (V = 1430 km s -1 ). The results of age, metallicity, and mass-to-light ratio (M/L) determinations are presented differentially as functions of galactic luminosity and morphology. Bright elliptical galaxies are well represented by main-sequence turnoff colors of (V-R)/sub c/roughly-equal0.37 and B-Vroughly-equal0.70, in good agreement with O'Connell's results for bright Virgo ellipticals. The relatively young main-sequence turnoff ages, of 6-10 Gyr for ellipticals of all luminosities, indicate that substantial star formation activity occurred in these galaxies for a period of 6dagger10 Gyr after the epoch of globular cluster formation. There is strong evidence for small amounts of current star formation in at least the brightest ellipticals of all luminosities, indicate that substantial star formation in at least the brightest ellipticals, variation in the amount of which may account for significant dispersion in the cluster U-V versus V color-magnitude relation. A metallicity gradient in [Fe/H] of at least 0.16 dex per absolute magnitude is derived, with the brightest ellipticals being 2 to 3 times more metal-rich than solar. The mean metallicities and turnoff ages of the faintest ellipticals are probably dependent on environment. Distance-independent upper limits to galaxy M/L ratios derived from the syntheses conform well with M/L ratios derived from velocity dispersion measurements and give no evidence for unseen mass in the nuclei of early type galaxies of any luminosity

Accelerated Hypofractionated Radiotherapy for Early-Stage Non-Small-Cell Lung Cancer: Long-Term Results

International Nuclear Information System (INIS)

Soliman, Hany; Cheung, Patrick; Yeung, Latifa; Poon, Ian; Balogh, Judith; Barbera, Lisa; Spayne, Jacqueline; Danjoux, Cyril; Dahele, Max; Ung, Yee

2011-01-01

Purpose: To retrospectively review the results of a single-institution series of accelerated hypofractionated radiotherapy for early-stage non-small-cell lung cancer (NSCLC) in patients who are medically inoperable or who refuse surgery. Methods and Materials: Peripherally located T1 to T3 N0 M0 tumors were treated with 48 to 60 Gy in 12 to 15 fractions between 1996 and 2007. No elective nodal irradiation was delivered. Patient, tumor, and treatment information was abstracted from the medical records. Results: A total of 124 tumors were treated in 118 patients (56 male and 62 female). Median age at diagnosis was 76.3 years (range, 49-90 years). In all, 113 patients (95.8%) were not surgical candidates because of medical comorbidities. The 2- and 5-year overall survival (OS) rates were 51.0% and 23.3%, respectively, and the 2- and 5-year cause-specific survival (CSS) rates were 67.6% and 59.8%, respectively. The 2- and 5-year actuarial local control (LC) rates were 76.2% and 70.1%, respectively. Univariate analysis revealed that tumor size less than 3cm compared with greater than 3 cm resulted in significantly improved OS (40.0% vs. 5.0% at 5 years; p = 0.0002), CSS (69.7% vs. 45.1% at 5 years; p = 0.0461), and a trend toward better LC (82.5% vs. 66.9% at 2 years, 76.6% vs. 60.8% at 5 years; p = 0.0685). Treatment was well tolerated and there were no treatment delays because of acute toxicity. Conclusions: Accelerated hypofractionated radiotherapy with 48 to 60 Gy using fractions of 4 Gy per day provides very good results for small tumors in medically inoperable patients with early-stage NSCLC.

Gracility of the modern Homo sapiens skeleton is the result of decreased biomechanical loading.

Science.gov (United States)

Ryan, Timothy M; Shaw, Colin N

2015-01-13

The postcranial skeleton of modern Homo sapiens is relatively gracile compared with other hominoids and earlier hominins. This gracility predisposes contemporary humans to osteoporosis and increased fracture risk. Explanations for this gracility include reduced levels of physical activity, the dissipation of load through enlarged joint surfaces, and selection for systemic physiological characteristics that differentiate modern humans from other primates. This study considered the skeletal remains of four behaviorally diverse recent human populations and a large sample of extant primates to assess variation in trabecular bone structure in the human hip joint. Proximal femur trabecular bone structure was quantified from microCT data for 229 individuals from 31 extant primate taxa and 59 individuals from four distinct archaeological human populations representing sedentary agriculturalists and mobile foragers. Analyses of mass-corrected trabecular bone variables reveal that the forager populations had significantly higher bone volume fraction, thicker trabeculae, and consequently lower relative bone surface area compared with the two agriculturalist groups. There were no significant differences between the agriculturalist and forager populations for trabecular spacing, number, or degree of anisotropy. These results reveal a correspondence between human behavior and bone structure in the proximal femur, indicating that more highly mobile human populations have trabecular bone structure similar to what would be expected for wild nonhuman primates of the same body mass. These results strongly emphasize the importance of physical activity and exercise for bone health and the attenuation of age-related bone loss.

Knee flexion with quadriceps cocontraction: A new therapeutic exercise for the early stage of ACL rehabilitation.

Science.gov (United States)

Biscarini, Andrea; Contemori, Samuele; Busti, Daniele; Botti, Fabio M; Pettorossi, Vito E

2016-12-08

Quadriceps strengthening exercises designed for the early phase of anterior cruciate ligament (ACL) rehabilitation should limit the anterior tibial translation developed by quadriceps contraction near full knee extension, in order to avoid excessive strain on the healing tissue. We hypothesize that knee-flexion exercises with simultaneous voluntary contraction of quadriceps (voluntary quadriceps cocontraction) can yield considerable levels of quadriceps activation while preventing the tibia from translating forward relative to the femur. Electromyographic activity in quadriceps and hamstring muscles was measured in 20 healthy males during isometric knee-flexion exercises executed near full knee extension with maximal voluntary effort of quadriceps cocontraction and external resistance (R) ranging from 0% to 60% of the 1-repetition maximum (1RM). Biomechanical modeling was applied to derive the shear (anterior/posterior) tibiofemoral force developed in each exercise condition. Isometric knee-flexion exercises with small external resistance (R=10% 1RM) and maximal voluntary effort of quadriceps cocontraction yielded a net posterior (ACL-unloading) tibial pull (P=0.005) and levels of activation of 32%, 50%, and 45% of maximum voluntary isometric contraction, for the rectus femoris, vastus medialis, and vastus lateralis, respectively. This exercise might potentially rank as one of the most appropriate quadriceps strengthening interventions in the early phase of ACL rehabilitation. Copyright © 2016 Elsevier Ltd. All rights reserved.

[Personalized cell therapy for early postoperative bullous keratopathy (experimental proof and clinical results)].

Science.gov (United States)

Kasparov, A A; Kasparova, Evg A; Fadeeva, L L; Subbot, A M; Borodina, N V; Kasparova, E A; Kobzova, M V; Musaeva, G M; Pavliuk, A S

2013-01-01

The article presents the results of a long-term research on development and clinical application of personalized cell therapy (PCT) for treatment of early postoperative (manifesting within the first 3 months after surgery) bullous keratopathy (BK). The method of intracameral PCT implies in vitro incubation of the patient's blood sample with poly(A:U) stimulator, separation of the serum with activated leukocytes, and injection of the final cell preparation into the anterior chamber. The fundamental part of the research was aimed at a detailed description of the cell preparation and investigation of its possible mechanisms of action. Cytokine and growth factor level in the cell preparation suggested that its high clinical efficacy might be due to its ability to improve regeneration of damaged corneal endothelium. The clinical study was conducted on a group of 52 patients with early BK. A significant effect (smoothing of the Descement's membrane folds, complete resorption of corneal edema, improvement of corneal transparency, reduction of corneal thickness and increase of visual acuity by 0.49 +/- 0.27) was achieved in 44.2% of patients, while partial effect was seen in 21.1% of patients. There was no clinical effect in 34.6% of patients. In those patients who developed significant or partial clinical effect after the PCT, many endotheliocytes appeared to have multiple nuclei (2 and more). In some patients polyploid nuclei persisted for 3-5 years after the treatment. Polyploidy results from incomplete mitosis which might be due to regenerative processes in the endothelium stimulated by the PCT. Obviously, high efficacy and relative simplicity of the method should promote its further clinical introduction.

Vitamin K3 increased BMD at 1 and 2 months post-surgery and the maximum stress of the middle femur in the rat.

Science.gov (United States)

Hong, You-jia; Liu, Sheng; Jiang, Ning-yi; Jiang, Sen; Liang, Jiu-gen

2015-02-01

The therapeutic effects of vitamin K3 (VK3) on osteoporosis are still unknown. In this study, we hypothesized that VK3 possesses therapeutic effects on osteoporosis; to verify this hypothesis, the ovariectomized rat was used as an osteoporosis model. Fifty-six Sprague-Dawley female rats aged 8 to 9 months were randomly assigned to 4 groups: sham surgery, ovariectomy with saline, ovariectomy with low-dose VK3, and ovariectomy with high-dose VK3. Intramuscular injection of VK3 was performed every other day beginning 1 month postoperatively. The therapeutic effects of VK3 on osteoporosis were evaluated by measurement of bone mineral density (BMD), bone biochemical markers, biomechanical properties, and bone morphometric parameters. The overall average BMD in VK3-treated groups increased to a level between those of the ovariectomy group and the sham surgery group. The procollagen I N-terminal peptide level peaked at 2 months after surgery in all groups except in the group that had undergone ovariectomy with low-dose VK3. The tartrate-resistant acid phosphatase 5b level increased more slowly at 4 months after surgery than at 2 months after surgery in the VK3-treated groups. The ovariectomy with high-dose VK3 group had the highest maximum stress of the middle femur of all groups. With VK3 treatment, the trabecular bone area percentage increased. All morphometric indicators for the middle tibia in the VK3-treated groups reached the levels found in the sham surgery group. In summary, VK3 therapy increased BMD at 1 and 2 months postsurgery and the maximum stress of the middle femur. In addition, VK3 therapy slowed the increase in bone turnover in ovariectomized rats. Furthermore, VK3 can improve morphometric indicators for the middle tibia. Our preliminary study indicates that VK3 has a potential therapeutic effect on osteoporosis and is worthy of further investigation. Copyright © 2015 Elsevier Inc. All rights reserved.

Early and late fracture following extensive limb lengthening in patients with achondroplasia and hypochondroplasia.

Science.gov (United States)

Kitoh, H; Mishima, K; Matsushita, M; Nishida, Y; Ishiguro, N

2014-09-01

Two types of fracture, early and late, have been reported following limb lengthening in patients with achondroplasia (ACH) and hypochondroplasia (HCH). We reviewed 25 patients with these conditions who underwent 72 segmental limb lengthening procedures involving the femur and/or tibia, between 2003 and 2011. Gender, age at surgery, lengthened segment, body mass index, the shape of the callus, the amount and percentage of lengthening and the healing index were evaluated to determine predictive factors for the occurrence of early (within three weeks after removal of the fixation pins) and late fracture (> three weeks after removal of the pins). The Mann‑Whitney U test and Pearson's chi-squared test for univariate analysis and stepwise regression model for multivariate analysis were used to identify the predictive factor for each fracture. Only one patient (two tibiae) was excluded from the analysis due to excessively slow formation of the regenerate, which required supplementary measures. A total of 24 patients with 70 limbs were included in the study. There were 11 early fractures in eight patients. The shape of the callus (lateral or central callus) was the only statistical variable related to the occurrence of early fracture in univariate and multivariate analyses. Late fracture was observed in six limbs and the mean time between removal of the fixation pins and fracture was 18.3 weeks (3.3 to 38.4). Lengthening of the tibia, larger healing index, and lateral or central callus were related to the occurrence of a late fracture in univariate analysis. A multivariate analysis demonstrated that the shape of the callus was the strongest predictor for late fracture (odds ratio: 19.3, 95% confidence interval: 2.91 to 128). Lateral or central callus had a significantly larger risk of fracture than fusiform, cylindrical, or concave callus. Radiological monitoring of the shape of the callus during distraction is important to prevent early and late fracture of lengthened

The effects of intraoperative positioning on patients undergoing early definitive care for femoral shaft fractures.

Science.gov (United States)

Apostle, K L; Lefaivre, K A; Guy, P; Broekhuyse, H M; Blachut, P A; O'Brien, P J; Meek, R N

2009-10-01

To determine if there is a difference in morbidity and mortality in orthopaedic trauma patients with femoral shaft fractures undergoing early definitive care with intramedullary (IM) nails in the supine versus the lateral position. Retrospective cohort study, single centered. One level 1 trauma center. Nine hundred eighty-eight patients representing 1027 femoral shaft fractures treated with IM nails were identified through a prospectively gathered database between 1987 and 2006. Antegrade IM nail insertion with reaming of the femoral canal in either the supine or lateral position. Mortality was the primary outcome. Admission to intensive care unit (ICU) was the secondary outcome measure and a surrogate measure of morbidity. Literature review was performed to identify factors shown to contribute to morbidity and mortality in orthopaedic trauma patients. Intraoperative position in either the supine or lateral position was added to this list. Logistic regression analysis was performed to determine the magnitude and effect of the independent variables on each of the study end points. To determine if a more significant trend toward less favorable outcomes was observed with increasing severity of injury, particularly injuries of the chest and thorax, subgroup analysis was performed for all those with a femur fracture and an Injury Severity Score > or =18 and all those with a femur fracture and an Abbreviated Injury Score chest > or =3. Intraoperative position in either the supine or lateral position was not a significant predictor of mortality or ICU admission for the original cohort or the subgroup of Injury Severity Score > or =18. However, for the subgroup of Abbreviated Injury Score chest > or =3, intraoperative positioning in the lateral position had a statistically significant protective effect against ICU admission (P = 0.044). For polytrauma patients with femoral shaft fractures, surgical stabilization using IM nails inserted with reaming of the femoral canal in

The Impact of Low-Dose Disease-modifying Anti-rheumatics Drugs (DMARDs) on Bone Mineral Density of Premenopausal Women in Early Rheumatoid Arthritis.

Science.gov (United States)

Rexhepi, Sylejman; Rexhepi, Mjellma; Sahatçiu-Meka, Vjollca; Mahmutaj, Vigan; Boshnjaku, Shkumbin

2016-04-01

Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by symmetrical polyarthritis and multisystemic involvement. The aim of this study was to assess the impact of low dose of methotrexate on bone mineral density (BMD) in patients with early rheumatoid arthritis (RA). This paper follows a retrospective study, which involves 60 female patients with early onset RA diagnosed according to the American Rheumatism Association Criteria (ACR/EULAR 2010). The patients were divided into two groups group I was composed of thirty patients treated with dose of 7.5 mg/weekly methotrexate (MTX), while group II included thirty patients treated with dose of 2 g/daily sulfasalazine (SSZ). The Disease Activity was measured by a combination of Erythrocyte Sedimentation Rate (ESR) and Disease Activity Score (DAS-28). Bone mineral density of the lumbar spine (L2-4), and femoral neck, was measured by dual energy X-ray absorptiometry (DEXA) (Stratos 800). Laboratory findings included: In this study, we found no negative effect on BMD in RA patients treated with low dose MTX in comparison to patients treated with SSZ. There was not observed significant difference in BMD of the lumbar spine, femur neck or trochanter, of MTX and SSZ patients in the pretreatment phase, nor after 12 months of treatment. No significant change in the biochemical parameters of the both groups. Based on the results of our study, low dose of methotrexate has no negative effect on BMD in premenopausal RA patients. We believe that these results might provide new insights and that further longitudinal studies with larger groups of premenopausal RA patients are required.