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Sample records for internal fixation due

  1. Comparison of Outcomes of Operatively Treated Bicondylar Tibial Plateau Fractures by External Fixation and Internal Fixation

    Directory of Open Access Journals (Sweden)

    CC Chan

    2012-03-01

    Full Text Available The outcome of bicondylar tibial plateau fractures treated with either external fixation (35 patients or internal fixation (24 patients was reviewed. Outcome measures included the Rasmussen score, clinical complications, development of osteoarthritis and the requirement for total knee replacement (TKR. Twenty-two (92% anatomical reductions were achieved in the internal fixation group compared to 27 (77% in the external fixation group. Infective complications were more common in the external fixation group (9 patients, 26% due to pin tract infection. There were no deep infections in the internal fixation group. The mean Rasmussen score was not significantly different (mean score 32 in external fixation and 29 in internal fixation between the two groups and the incidence of osteoarthritis was the same in both groups. Four patients in the external fixation group underwent a TKR compared to 5 patients in the internal fixation group. Bicondylar tibial plateau fractures have similar outcomes following external or internal fixation.

  2. Eighth international congress on nitrogen fixation

    Energy Technology Data Exchange (ETDEWEB)

    1990-01-01

    This volume contains the proceedings of the Eighth International Congress on Nitrogen Fixation held May 20--26, 1990 in Knoxville, Tennessee. The volume contains abstracts of individual presentations. Sessions were entitled Recent Advances in the Chemistry of Nitrogen Fixation, Plant-microbe Interactions, Limiting Factors of Nitrogen Fixation, Nitrogen Fixation and the Environment, Bacterial Systems, Nitrogen Fixation in Agriculture and Industry, Plant Function, and Nitrogen Fixation and Evolution.

  3. Arthroscopic-Assisted Open Reduction Internal Fixation.

    Science.gov (United States)

    Hamilton, Graham A; Doyle, Matthew D; Castellucci-Garza, Francesca M

    2018-04-01

    The indications for arthroscopy have expanded over the years. Arthroscopic-assisted open reduction internal fixation in the setting of acute trauma is gaining popularity with foot and ankle surgeons. It serves to facilitate direct visualization of fracture fragments and allows for precise articular reduction with minimal soft tissue insult. Current evidence reports a high incidence of chondral injury with ankle fractures. Arthroscopy performed at the time of open reduction internal fixation allows for joint inspection and potential treatment of these posttraumatic defects. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Eighth international congress on nitrogen fixation. Final program

    Energy Technology Data Exchange (ETDEWEB)

    1990-12-31

    This volume contains the proceedings of the Eighth International Congress on Nitrogen Fixation held May 20--26, 1990 in Knoxville, Tennessee. The volume contains abstracts of individual presentations. Sessions were entitled Recent Advances in the Chemistry of Nitrogen Fixation, Plant-microbe Interactions, Limiting Factors of Nitrogen Fixation, Nitrogen Fixation and the Environment, Bacterial Systems, Nitrogen Fixation in Agriculture and Industry, Plant Function, and Nitrogen Fixation and Evolution.

  5. Management of Postoperative Spondylodiscitis with and without Internal Fixation.

    Science.gov (United States)

    Wang, Xiang; Tao, Hairong; Zhu, Yanhui; Lu, Xiongwei; Hu, Xiaopeng

    2015-01-01

    Postoperative spondylodiscitis is relatively uncommon. This complication is associated with increased cost, and long-term of inability to work, and even morbidity. Although the majority of postoperative spondylodiscitis cases can be well managed by conservative treatment, postoperative spondylodiscitis after internal fixation and those cases that are unresponsive to the conservative treatment present challenges to the surgeon. Here, a review was done to analyze the treatment of postoperative spondylodiscitis with/without internal fixation. This review article suggested that majority of postoperative spondylodiscitis without internal fixation could be cured by conservative treatment. Either posterior or anterior debridement can be used to treat postoperative spondylodiscitis without internal fixation when conservative treatment fails. In addition, minimally invasive debridement and drainage may also be an alternative treatment. In case of postoperative spondylodiscitis after internal fixation, surgical treatment was required. In the cervical spine, it can be well managed by anterior debridement, removal of internal fixation, and reconstruction of the spinal stability by using bone grafting/cage/anterior plate. Postoperative spondylodiscitis after internal fixation is successfully managed by combined anterior debridement, fusion with posterior approach and removal of pedicle screw or extension of pedicle screw beyond the lesion site, in the thoracic and lumbar spine.

  6. Design and Optimization of Resorbable Silk Internal Fixation Devices

    Science.gov (United States)

    Haas, Dylan S.

    Limitations of current material options for internal fracture fixation devices have resulted in a large gap between user needs and hardware function. Metal systems offer robust mechanical strength and ease of implantation but require secondary surgery for removal and/or result in long-term complications (infection, palpability, sensitivity, etc.). Current resorbable devices eliminate the need for second surgery and long-term complications but are still associated with negative host response as well as limited functionality and more difficult implantation. There is a definitive need for orthopedic hardware that is mechanically capable of immediate fracture stabilization and fracture fixation during healing, can safely biodegrade while allowing complete bone remodeling, can be resterilized for reuse, and is easily implantable (self-tapping). Previous work investigated the use of silk protein to produce resorbable orthopedic hardware for non- load bearing fracture fixation. In this study, silk orthopedic hardware was further investigated and optimized in order to better understand the ability of silk as a fracture fixation system and more closely meet the unfulfilled market needs. Solvent-based and aqueous-based silk processing formulations were cross-linked with methanol to induce beta sheet structure, dried, autoclaved and then machined to the desired device/geometry. Silk hardware was evaluated for dry, hydrated and fatigued (cyclic) mechanical properties, in vitro degradation, resterilization, functionalization with osteoinductive molecules and implantation technique for fracture fixation. Mechanical strength showed minor improvements from previous results, but remains comparable to current resorbable fixation systems with the advantages of self-tapping ability for ease of implantation, full degradation in 10 months, ability to be resterilized and reused, and ability to release molecules for osteoinudction. In vivo assessment confirmed biocompatibility, showed

  7. Complications of internal fixation of maxillofacial fractures with microplates

    NARCIS (Netherlands)

    Schortinghuis, J; Bos, RRM; Vissink, A

    Purpose: The aim of this retrospective study was to evaluate the complications of open reduction and internal fixation of maxillofacial fractures with microplates. Patients and Methods: In 44 patients with maxillofacial trauma, fractures of the maxillofacial skeleton were treated by open reduction

  8. Functional Outcome of Internal Fixation of Radial and Ulna Fracture

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    mehrdad Mansouri

    2006-02-01

    Conclusion: Anatomic reduction and internal fixation is the standard method for treatment of fractures by displacing radios and ulna in adults. According to results, it seems more intension to motions specially pronation and muscle strengthening foream after surgery will have affect on improving patients’ function specially pronation and Grip strength.

  9. [Complex reconstruction with internal locking plate fixation for Charcot arthropathy].

    Science.gov (United States)

    Ramadani, F; Härägus, H; Radu, P; Trieb, K; Hofstaetter, S

    2015-01-01

    Osteosynthesis and reposition of the Charcot foot is challenging with respect to choice of a proper implant. There is currently no international consensus regarding the optimal implant. Locking plates seem to be an innovative and stable method for reconstruction. The aim of this work is to analyze bone fusion, complications, pseudoarthrosis, and patient satisfaction. This paper presents a retrospective analysis of 63 consecutive Charcot feet treated between 2004 and 2014. The mean follow-up time was 2.4 years. All Charcot feet treated between 2004 and 2014 were Sanders type II or III. A bony fusion was achieved in 50 % of the cases, 26 % had a functional pseudoarthrosis with intact implants and pain-free mobility, and 22 % showed no healing with broken implants. Conclusion Internal fixation with locking plates is superior to screw fixation only with regard to biomechanics. We prefer internal fixation plates to external fixation because of stability even in the case of pseudoathrosis and because of the learning curve.

  10. Fixation of Radiological Contamination; International Collaborative Development

    Energy Technology Data Exchange (ETDEWEB)

    Rick Demmer

    2013-03-01

    A cooperative international project was conducted by the Idaho National Laboratory (INL) and the United Kingdom’s National Nuclear Laboratory (NNL) to integrate a capture coating with a high performance atomizing process. The initial results were promising, and lead to further trials. The somewhat longer testing and optimization process has resulted in a product that could be demonstrated in the field to reduce airborne radiological dust and contamination.

  11. Internal Fixation of Open Ankle Fracture. Report of Two Cases

    OpenAIRE

    Yaniel Truffin Rodríguez; Juan C. Cabrera Suárez; Indira L. Gómez Gil; José Julio Requeiro Morejón

    2014-01-01

    Open ankle fracture is sporadically seen in the orthopedic practice. Its clinical course is subject to multiple factors, showing a propensity to cause ankle osteoarthritis over the years. Two cases treated at the Dr. Gustavo Aldereguía Lima University General Hospital in Cienfuegos are presented. The patients underwent emergency surgical treatment consisting of surgical cleaning of the open wound, reduction of the dislocation and internal fixation of the fracture. These cases are presented du...

  12. Comparison of internal fixation techniques in metacarpal fractures.

    Science.gov (United States)

    Black, D; Mann, R J; Constine, R; Daniels, A U

    1985-07-01

    A biomechanical study assessed quantitative differences in the stability that was obtained by five commonly used types of internal fixation employed in metacarpal fractures. The techniques included dorsal plating, dorsal plating combined with an interfragmentary lag screw, crossed Kirschner wires, a single intraosseous wire combined with a single oblique Kirschner wire, and a single intraosseous wire alone. Rigidity and strength in torsion and bending were determined after transverse osteotomy and fixation of the metacarpal were performed. The failure modes for each fixation technique were also observed and described. Significant differences in rigidity were found between the plated configurations (with or without an interfragmentary lag screw) and the wired configurations in both apex dorsal bending and axial torsion. The three wired configurations were not significantly different from each other except in torsion. Analysis of the bending moments that were required to produce both yield and failure in apex dorsal bending and also the energy absorbed to yield showed similar disparity between plated and wired techniques. For metacarpal fixation, dorsal plating with or without lag screws provides significantly more stability than do wired techniques and approaches that provided by intact bones.

  13. Management of Subcondylar Fracture through Intraoral Approach with Rigid Internal Fixation.

    Science.gov (United States)

    Patil, Ravi S; Gudi, Santosh S

    2011-09-01

    In Oral and Maxillofacial Surgery, the majority of the condylar fractures are treated by closed reduction with generally satisfactory long term results. But in such cases of closed reduction, patient will be uncomfortable owing to long term application of inter maxillary fixation (IMF). Where as, Disadvantages of extra oral open reduction and fixation of condylar fracture includes facial nerve damage, facial scars etc. which are surely eliminated by the intraoral reduction and rigid fixation. The present study was conducted to determine the efficacy of reduction and fixation of low sub-condylar fractures through intra-oral approach. In this study, ten patients with low sub-condylar fracture, reported to department of Oral and Maxillofacial Surgery. P.M.N.M. Dental College and Hospital Bagalkot were included. These patients were treated by open reduction and internal fixation through intra-oral approach. All the patients were evaluated postoperatively for mouth opening, occlusion and mandibular deviation with regular radiographic examination for 6 weeks. All operated patients followed for 6 weeks, maximum mouth opening was more than 40 mm in seven patients (range from 40 to 50 mm) and less than 40 mm in three patients. Occlusion was satisfactory in all and none of the patients showed deviation of mandible on mouth opening. Statistical analysis showed that postoperative mouth opening was significant ('t' value = 7.88, 'P' = (0.000) value = 1.96, 'P' value (0.081), 0.05]. For occlusion standard photographs were obtained at sixth week and found minor occlusal corrections in two patients are treated by elastic traction for few days. Open reduction with internal fixation through intraoral approach has proved to be safe for early function and also effective by avoiding the patient discomfort due to long term intermaxillary fixation, psychological effect, facial nerve damage, facial scar and weight loss.

  14. Open reduction and internal fixation: Screw injury - Retrospective study

    Directory of Open Access Journals (Sweden)

    Preetha Balaji

    2017-01-01

    Full Text Available Background/Aims: Open reduction and internal fixation (ORIF is a standard surgical procedure in jaw trauma and in orthognathic surgery. Insertion of screws is a significant risk for accidental tooth root injury with varying outcomes. Contrary evidences are found in literature due to a variety of study designs. This study was undertaken to address the lacunae and possibly estimate the difference in occurrence of tooth damage during or after ORIF between trauma and planned osteotomies. Materials and Methods: In this retrospective study, the data of ORIF in either trauma or orthognathic surgery fulfilling inclusion and exclusion criteria were collected and analyzed. Results: There were 1632 patients fulfilling the inclusion and exclusion criteria and formed the study group, of which 663 were in orthognathic surgery, of whom 210 had bimaxillary orthognathic surgery. In the trauma group, 358 patients had fractures involving both jaws whereas 272 had maxilla alone and 339 had mandibular fractures alone. On comparing the outcome, of the 9073 screws studied, 93.40% were not involved in any contact with the teeth, 6.3% were in category of potential hits (near apices or the root surfaces, and only 0.28% had evidence of root damage with the screws. It is observed that molar and premolar had a significant difference in terms of the type of surgery (P ≤ 0.05 whereas canine (P = 0.75 and incisor (P = 0.67 showed no statistical difference. Conclusion: ORIF when used as mentioned is a safe way for the management of fractures. The incidence of root injury is not uncommon but can be avoided with careful planning and execution.

  15. Arthroscopic internal fixation of osteochondritis dissecans of the femoral head.

    Science.gov (United States)

    Matsuda, Dean K; Safran, Marc R

    2013-05-01

    Osteochondritis dessicans of the femoral head is an uncommon problem. Limited literature reports the incidence of osteochondritis dessicans and its treatment. The surgical technique used and outcomes for a 40-year-old man with symptomatic femoral head osteochonditis dissecans who was treated 11 years previously with retrograde drilling and hip arthroscopy are discussed.Despite temporary symptomatic improvement without subchondral collapse after his index procedure, increasing pain a decade later was thought to be caused by a large apical osteochondritic fragment and chondrolabral dysfunction from femoroacetabular impingement. Acetabuloplasty of acetabular overcoverage permitted arthroscopic internal fixation of the bone fragment by improving screw trajectory. Labral refixation and femoroplasty were subsequently performed. At 18-month follow-up, his nonarthritic hip score improved from 53 to 76 and his osteochondritic lesion had healed radiographically.Although clinical improvement with radiographic union has been reported following open screw fixation of femoral head osteochondritis dissecans, to the authors' knowledge this is the first published case with a similar outcome using arthroscopic techniques. Clinical improvement and union of even long-standing osteochondritis dissecans of the femoral head may occur with arthroscopic fragment fixation. Hip arthroscopy may play significant therapeutic and diagnostic roles in the treatment of this condition while offering a less invasive alternative to open osteosynthesis. Copyright 2013, SLACK Incorporated.

  16. Internal fixation of severe maxillofacial fractures in dogs.

    Science.gov (United States)

    Arzi, Boaz; Verstraete, Frank J M

    2015-05-01

    To describe internal fixation for maxillofacial fractures using titanium miniplates and report outcome in 7 dogs. Prospective case series. Skeletally mature dogs (n = 7) with maxillofacial fractures. After CT evaluation of fracture configuration, using a combination of extraoral and intraoral approaches as needed, non-locking titanium miniplates were contoured to match the normal anatomy of the fractured bones. Plates were secured using non-locking titanium screws and then covered with a soft-tissue envelope followed by routine intraoral and extraoral closure. Fractures healed rapidly after reconstruction with immediate return to normal function and occlusion. Follow-up time of up to 94 months indicated excellent long-term function and general lack of complications. One dog developed nasal aspergillosis 1.5 years after surgery and the miniplates were removed without adverse consequences. Internal fixation for maxillofacial reconstruction using titanium miniplates is an excellent solution for the treatment of comminuted and displaced maxillofacial fractures in dogs. © Copyright 2014 by The American College of Veterinary Surgeons.

  17. Biomechanical stability of a supra-acetabular pedicle screw Internal Fixation device (INFIX vs External Fixation and plates for vertically unstable pelvic fractures

    Directory of Open Access Journals (Sweden)

    Vigdorchik Jonathan M

    2012-09-01

    Full Text Available Abstract Background We have recently developed a subcutaneous anterior pelvic fixation technique (INFIX. This internal fixator permits patients to sit, roll over in bed and lie on their sides without the cumbersome external appliances or their complications. The purpose of this study was to evaluate the biomechanical stability of this novel supraacetabular pedicle screw internal fixation construct (INFIX and compare it to standard internal fixation and external fixation techniques in a single stance pelvic fracture model. Methods Nine synthetic pelves with a simulated anterior posterior compression type III injury were placed into three groups (External Fixator, INFIX and Internal Fixation. Displacement, total axial stiffness, and the stiffness at the pubic symphysis and SI joint were calculated. Displacement and stiffness were compared by ANOVA with a Bonferroni adjustment for multiple comparisons Results The mean displacement at the pubic symphysis was 20, 9 and 0.8 mm for external fixation, INFIX and internal fixation, respectively. Plate fixation was significantly stiffer than the INFIX and external Fixator (P = 0.01 at the symphysis pubis. The INFIX device was significantly stiffer than external fixation (P = 0.017 at the symphysis pubis. There was no significant difference in SI joint displacement between any of the groups. Conclusions Anterior plate fixation is stiffer than both the INFIX and external fixation in single stance pelvic fracture model. The INFIX was stiffer than external fixation for both overall axial stiffness, and stiffness at the pubic symphysis. Combined with the presumed benefit of minimizing the complications associated with external fixation, the INFIX may be a more preferable option for temporary anterior pelvic fixation in situations where external fixation may have otherwise been used.

  18. Biomechanical stability of a supra-acetabular pedicle screw internal fixation device (INFIX) vs external fixation and plates for vertically unstable pelvic fractures.

    Science.gov (United States)

    Vigdorchik, Jonathan M; Esquivel, Amanda O; Jin, Xin; Yang, King H; Onwudiwe, Ndidi A; Vaidya, Rahul

    2012-09-27

    We have recently developed a subcutaneous anterior pelvic fixation technique (INFIX). This internal fixator permits patients to sit, roll over in bed and lie on their sides without the cumbersome external appliances or their complications. The purpose of this study was to evaluate the biomechanical stability of this novel supraacetabular pedicle screw internal fixation construct (INFIX) and compare it to standard internal fixation and external fixation techniques in a single stance pelvic fracture model. Nine synthetic pelves with a simulated anterior posterior compression type III injury were placed into three groups (External Fixator, INFIX and Internal Fixation). Displacement, total axial stiffness, and the stiffness at the pubic symphysis and SI joint were calculated. Displacement and stiffness were compared by ANOVA with a Bonferroni adjustment for multiple comparisons The mean displacement at the pubic symphysis was 20, 9 and 0.8 mm for external fixation, INFIX and internal fixation, respectively. Plate fixation was significantly stiffer than the INFIX and external Fixator (P = 0.01) at the symphysis pubis. The INFIX device was significantly stiffer than external fixation (P = 0.017) at the symphysis pubis. There was no significant difference in SI joint displacement between any of the groups. Anterior plate fixation is stiffer than both the INFIX and external fixation in single stance pelvic fracture model. The INFIX was stiffer than external fixation for both overall axial stiffness, and stiffness at the pubic symphysis. Combined with the presumed benefit of minimizing the complications associated with external fixation, the INFIX may be a more preferable option for temporary anterior pelvic fixation in situations where external fixation may have otherwise been used.

  19. Influence of internal fixation systems on radiation therapy for spinal tumor.

    Science.gov (United States)

    Li, Jingfeng; Yan, Lei; Wang, Jianping; Cai, Lin; Hu, Dongcai

    2015-07-08

    In this study, the influence of internal fixation systems on radiation therapy for spinal tumor was investigated in order to derive a theoretical basis for adjustment of radiation dose for patients with spinal tumor and internal fixation. Based on a common method of internal fixation after resection of spinal tumor, different models of spinal internal fixation were constructed using the lumbar vertebra of fresh domestic pigs and titanium alloy as the internal fixation system. Variations in radiation dose in the vertebral body and partial spinal cord in different types of internal fixation were studied under the same radiation condition (6 MV and 600 mGy) in different fixation models and compared with those irradiated based on the treatment planning system (TPS). Our results showed that spinal internal fixation materials have great impact on the radiation dose absorbed by spinal tumors. Under the same radiation condition, the influence of anterior internal fixation material or combined anterior and posterior approach on radiation dose at the anterior border of the vertebral body was the greatest. Regardless of the kinds of internal fixation method employed, radiation dose at the anterior border of the vertebral body was significantly different from that at other positions. Notably, the influence of posterior internal fixation material on the anterior wall of the vertebral canal was the greatest. X-ray attenuation and scattering should be taken into consideration for most patients with bone metastasis that receive fixation of metal implants. Further evaluation should then be conducted with modified TPS in order to minimize the potentially harmful effects of inappropriate radiation dose.

  20. A new adhesive technique for internal fixation in midfacial surgery

    Directory of Open Access Journals (Sweden)

    Riediger Dieter

    2008-05-01

    Full Text Available Abstract Background The current surgical therapy of midfacial fractures involves internal fixation in which bone fragments are fixed in their anatomical positions with osteosynthesis plates and corresponding screws until bone healing is complete. This often causes new fractures to fragile bones while drilling pilot holes or trying to insert screws. The adhesive fixation of osteosynthesis plates using PMMA bone cement could offer a viable alternative for fixing the plates without screws. In order to achieve the adhesive bonding of bone cement to cortical bone in the viscerocranium, an amphiphilic bone bonding agent was created, analogous to the dentin bonding agents currently on the market. Methods The adhesive bonding strengths were measured using tension tests. For this, metal plates with 2.0 mm diameter screw holes were cemented with PMMA bone cement to cortical bovine bone samples from the femur diaphysis. The bone was conditioned with an amphiphilic bone bonding agent prior to cementing. The samples were stored for 1 to 42 days at 37 degrees C, either moist or completely submerged in an isotonic NaCl-solution, and then subjected to the tension tests. Results Without the bone bonding agent, the bonding strength was close to zero (0.2 MPa. Primary stability with bone bonding agent is considered to be at ca. 8 MPa. Moist storage over 42 days resulted in decreased adhesion forces of ca. 6 MPa. Wet storage resulted in relatively constant bonding strengths of ca. 8 MPa. Conclusion A new amphiphilic bone bonding agent was developed, which builds an optimizied interlayer between the hydrophilic bone surface and the hydrophobic PMMA bone cement and thus leads to adhesive bonding between them. Our in vitro investigations demonstrated the adhesive bonding of PMMA bone cement to cortical bone, which was also stable against hydrolysis. The newly developed adhesive fixing technique could be applied clinically when the fixation of osteosynthesis plates

  1. Internal Fixation of Cervical Fractures in Three Horses.

    Science.gov (United States)

    Rossignol, Fabrice; Brandenberger, Olivier; Mespoulhes-Rivière, Céline

    2016-01-01

    To describe the surgical treatment outcome of cervical fractures in 3 horses. Case report. Three client-owned horses with cervical vertebral fractures. Three horses were refered for neck stiffness, pain, and ataxia after a cervical trauma because of a fall. Radiographic examination showed an oblique displaced fracture of the caudal aspect of the body of the second cervical vertebra (C2) in horse 1, an oblique displaced fracture of the caudal aspect of C4 involving the disc between C4 and C5 in horse 2, and a displaced transverse fracture of the body of the axis (C2) extending to the lateral arches and involving the vertebral canal in horse 3. In horse 1, the fracture was reduced and stabilized using a 14-hole narrow DCP plate, applied ventrally, and fixed with cancellous screws. A cervical fusion was performed. In horses 2 and 3, fracture fixation was performed using a 5-hole narrow LCP and 5 mm locking screws. All horses showed improvement and returned to full activity. The fracture healed in all horses. Internal fixation of cervical fracture in these horses was associated with minimal complications, and was associated with healing and a highly functional outcome in all horses. The LCP was preferred and would be recommended for ventral stabilization of selected cases of vertebral fractures. © Copyright 2015 by The American College of Veterinary Surgeons.

  2. A comparative study of internal fixation and intermaxillary fixation on bone repair of mandibular fractures through radiographic subtraction.

    Science.gov (United States)

    Queiroz, Christiano Sampaio; Sarmento, Viviane Almeida; de Azevedo, Roberto Almeida; de Oliveira, Thaís Feitosa Leitão; Bastos, Luana Costa

    2014-07-01

    Conventional radiographic evaluation of fracture healing is not a reliable method, because it depends on the examinator's experience and the quality of the exam. Therefore, serial images differing in density, contrast and geometrical projection can lead to a misdiagnosis on the postoperative fracture healing. Even in good quality images, little changes in calcified tissues often can't be visualized, because of its little sensibility and because of the limited human sight. The use of more sensitive and objective methods could increase the accuracy of this evaluation. This study intended to compare, by digitalized panoramic radiography, the mandible fracture healing after two different types of treatment: open reduction with internal fixation (group 1) and closed reduction with intermaxillary fixation (group 2). It was taken three postoperative radiographs (within a week, a month and three months after treatment), which were digitalized (600 dpi, 8 bits) and adjusted in brightness and size in Photoshop software. Then these images were evaluated by digital subtraction in ImageTool software. The results revealed greater areas of new bone formation in the internal fixation group, in all the evaluated times. Thus, open reduction with internal fixation resulted in more rapid fracture healing than closed reduction with intermaxillary fixation. Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  3. Removal of internal fixation--the effect on patients' complaints: a study of 66 cases of removal of internal fixation after malleolar fractures

    DEFF Research Database (Denmark)

    Jacobsen, S; Honnens de Lichtenberg, M; Jensen, C M

    1994-01-01

    typically soreness over implant and cicatrix, reduced movement of the ankle joint, and strain-related pain. About 75% of these patients reported improvement after removal. The AO mode of fixation, i.e., typically by lateral semitubular plating and transsyndesmotic screw and a medial screw or pins......To estimate the effect of removal of internal fixation after treatment of malleolar fractures on postoperatively presented complaints, we retrospectively evaluated 66 patients by their records and by personal questionnaires. Of all the patients, 89.4% had one or more complaints. These were...... period. We conclude that removal of internal fixation after malleolar fractures is indicated when common types of complaints are presented....

  4. A novel fixation system for sacroiliac dislocation fracture: internal fixation system design and biomechanics analysis.

    Science.gov (United States)

    Dawei, Tian; Na, Liu; Jun, Lei; Wei, Jin; Lin, Cai

    2013-02-01

    Although there were many different types of fixation techniques for sacroiliac dislocation fracture, the treat remained challenging in posterior pelvic ring injury. The purpose of this study was to evaluate the biomechanical effects of a novel fixation system we designed. 12 human cadavers (L3-pelvic-femora) were used to compare biomechanical stability after reconstruction on the same specimens in four conditions: (1) intact, (2) cable system, (3) plate-pedicle screw system, and (4) cable system and plate-pedicle screw combination system (combination system). Biomechanical testing was performed on a material testing machine for evaluating the stiffness of the pelvic fixation construct in compression and torsion. The cable system and plate-pedicle screw system alone may be insufficient to resist vertical shearing and rotational loads; however the combination system for unstable sacroiliac dislocation fractures provided significantly greater stability than single plate-pedicle or cable fixation system. The novel fixation system for unstable sacroiliac dislocation fractures produced sufficient stability in axial compression and axial rotation test in type C pelvic ring injuries. It may also offer a better solution for sacroiliac dislocation fractures. Copyright © 2012 Elsevier Ltd. All rights reserved.

  5. Aramid-epoxy composite internal fixation plates: a pilot study.

    Science.gov (United States)

    Cochran, G V; Palmieri, V R; Zickel, R E

    1994-09-01

    Mechanical tests were conducted on an aramid-epoxy composite laminate in vitro and in vivo to determine its suitability for internal fixation plates. This material, fashioned into blank test coupons the size of the standard 4-hole AO-ASIF plates, had a tensile modulus of elasticity significantly lower than bone. In three-point bending, blank test coupons exhibited a low yield strength that would limit utility in significant load-bearing situations, but changes in the layer configuration of the composite could be expected to improve this characteristic. Under destructive loads, these specimens appeared to be less subject to catastrophic failure than carbon fibre composites. Using 4-hole test coupons fastened to a plastic tube simulating bone, four-point bending tests showed that strain-shielding was significantly reduced by aramid composite relative to carbon fibre composite or metal plates. Finally, in-vivo tests on canine femora demonstrated that aramid composite plates were well tolerated and caused less strain shielding during weightbearing, but significant differences in cortical atrophy and porosity beneath steel versus aramid plates were not apparent. Although the plates were relatively flexible, they could not be preformed during surgery like a metal plate. Copyright © 1994. Published by Elsevier Ltd.

  6. The knee: internal fixation techniques for osteochondritis dissecans.

    Science.gov (United States)

    Grimm, Nathan L; Ewing, Christopher K; Ganley, Theodore J

    2014-04-01

    For the athlete with a newly diagnosed osteochondritis dissecans of the knee, the first step in formulating a treatment plan is determining the stability of the lesion. When the lesion is found to be unstable but salvageable, several methods for fixation are available. Fixation of osteochondritis dissecans in the athletic population has been described and each has its own advantages and disadvantages. Determining the most appropriate method for fixation depends on several variables and should include the athlete's level of play, sport, and overall goals. Copyright © 2014 Elsevier Inc. All rights reserved.

  7. Necrotizing fasciitis after internal fixation of fracture of femoral trochanteric ? ??

    OpenAIRE

    Santos, Leandro Em?lio Nascimento; Pires, Robinson Esteves Santos; Figueiredo, Leonardo Brand?o; Soares, Eduardo Augusto Marques

    2014-01-01

    Necrotizing fasciitis is a rare and potentially lethal soft tissue infection. We report a case of trochanteric femur fracture in a patient who underwent fracture fixation and developed necrotizing fasciitis. A literature review on the topic will be addressed.

  8. External Fixation versus two-stage Open Reduction Internal Fixation of distal intra-articular Tibia fractures; a Systematic Review

    DEFF Research Database (Denmark)

    Ladeby Erichsen, Julie; Jensen, Carsten; Damborg, Frank Lindhøj

    (>18 years) were included for review. 3071 studies were identified and screened by two independent authors according to the PRISMA guidelines. Cochrane Risk of bias Tool for RCT and non-randomised studies (ROBIN-1) were used to assess risk of bias. Results: One RCT study and four cohort studies......Background: Distal Intra-Articular Tibia Fractures (DIATF) is challenging to treat and severe loss of physical function affecting working abilities has been reported. Aim: To investigate differences in physical function and complications following DIATF surgery with two-stage Open Reduction...... Internal Fixation (ORIF) or External Fixation (EF). Method : A search was conducted using PUBMED, Embase, Cochrane Central, Open Grey, Orthopaedic Proceedings and WHO International Clinical Trials Registry Platform. Studies with level of evidence I-IV comparing EF with two-stage ORIF of DIATF in patients...

  9. Treatment of Early Post-Op Wound Infection after Internal Fixation

    Science.gov (United States)

    2016-10-01

    Award Number: W81XWH-10-2-0133 TITLE: Treatment of Early Post -op Wound Infection after Internal Fixation PRINCIPAL INVESTIGATOR: William...14Sep2016 4. TITLE AND SUBTITLE Treatment of Early Post -Op Wound Infection after Internal 5a. CONTRACT NUMBER W81XWH-10-2-0133 Fixation 5b. GRANT...Approved for public release; distribution unlimited 13. SUPPLEMENTARY NOTES 14. ABSTRACT Severe fractures are common in modern warfare with fractures

  10. Dyaphiseal open fractures of the forearm follows internal or external fixation

    International Nuclear Information System (INIS)

    Gomez Aya, Oscar Andres; Bocanegra Navia, Sergio; Suarez Romero, Fabio

    2001-01-01

    The treatment of dyaphiseal open fractures of the forearm follows internal or external fixation. However, the effectivity of both approaches remains controversial. The aim of this descriptive, Wais study, to assess the osteosynthesis by limited approach (internal fixation) as treatment of this type of fractures. Between 1996 and 1999, 22 patients with open dyaphiseal forearm fractures caused by gunshot and treated with this technique were analyzed. The men age was 26.8 years. There were 13 patients with type lllA and 9 patients with type lllB fractures. The mean of comminution was 6.34 mm. Additionally; the mean of quirurgical rinses was 3.7. The complications were: superficial infections, insufficient osteosynthesis and pseudoarthrosis. According to a functional scale the outcomes were, excellent good acceptable and bad. Within parenthesis are the numbers of patients. On the other hand, there were nineteen successful bone consolidations. The observed relative success of the limited approach, with 17 excellent-good cases and 79 bone consolidating, can be explained by the avoiding of unnecessary manipulation of the fractures area which promotes consolidation and reduces infection risk. Moreover the acceptable functional recovery, the absence of complications due to the technique and the restrained use of bone grafts make this technique highly performable

  11. Postoperative complications after closed calcaneus fracture treated by open reduction and internal fixation: a review.

    Science.gov (United States)

    Yu, Xiao; Pang, Qing-Jiang; Chen, Liang; Yang, Chang-Chun; Chen, Xian-Jun

    2014-02-01

    To review postoperative complications reported after closed calcaneus fracture treated by open reduction and internal fixation (ORIF). Postoperative complications reported in the literature between 1995 and 2012 were identified. Papers were retrieved from publicly available databases and included in this study if they met the following criteria: clinical research of cases of closed calcaneus fracture treated by ORIF; ≥10 cases; detailed information about complications, treatment and follow up. Twenty-one clinical reports were analysed (2046 cases). Reported complications (and incidence rates) were: infection and skin flap necrosis (13.6%); neurovascular injury (2.8%); post-traumatic arthritis (1.2%); malreduction/implant problems (0.8%); nonunion (0.1%). Postoperative complications after closed calcaneus fracture are common clinical problems that cannot always be avoided. They can even be life altering, due to the requirement for long-term treatment or amputation and their economic impact on the patient. Complications should be diagnosed and treated promptly, to achieve satisfactory outcomes. Nonsurgical treatment (e.g. local wound care, drugs or physical therapy) can be attempted. If such measures fail, surgical treatment (e.g. debridement, skin flap transplantation, implant removal, re-opening of the reduction and internal fixation or subtalar joint arthrodesis) should be considered.

  12. History of internal fixation (part 1): early developments with wires and plates before World War II.

    Science.gov (United States)

    Hernigou, Philippe; Pariat, Jacques

    2017-06-01

    Though the date at which an orthopaedic implant was first used cannot be ascertained with any certainty, the fixation of bone fracture using an iron wire was reported for the first time in a French manuscript in 1775. The first techniques of operative fracture treatment were developed at the end of the 18th and in the beginning of the 19th centuries. The use of cerclage wires to fix fractures was the most frequent fixation at this time. The French Berenger-Feraud (1832-1900) had written the first book on internal fixation. However internal fixation of fractures could not become a practical method before Lister had ensured the safety of open reduction and internal fixation in the treatment of fractures. Lister is not only the father of asepsis; he also used metal wires to fix even closed fractures. The first internal fixation by means of a plate and screws was described by Carl Hansmann in 1858 in Hamburg. Nevertheless, Arbuthnot Lane (1892) and Albin Lambotte (1905) are considered to be the founders of this method, which was further developed by Sherman in the first part of the 20th century.

  13. Internal dosimetric evaluation due to uranium aerosols

    International Nuclear Information System (INIS)

    Garcia Aguilar Juan; Delgado Avila Gustavo

    1991-01-01

    The present work has like object to carry out the internal dosimetric evaluation to the occupationally exposed personnel, due to the inhalation of aerosols of natural uranium and enriched in the pilot plant of nuclear fuel production of the National Institute of Nuclear Research

  14. Management of open fractures using a noncontact locking plate as an internal fixator

    Directory of Open Access Journals (Sweden)

    Azad Yildirim

    2017-01-01

    Conclusions: This case series demonstrates that an “internal fixator technique” is an acceptable alternative to the management of open fractures of the femur or tibia in adult patients. The NC-LP method provided opportunities to achieve a stable fixation with noncontact between the implant and the bone tissues, and the fractures were sufficiently stabilized to allow union with a low complication rate.

  15. [Case-control study on effects of external fixation combined with limited internal fixation for the treatment of Pilon fractures of Rüedi-Allgower type III].

    Science.gov (United States)

    Duan, Da-Peng; You, Wu-Lin; Ji, Le; Zhang, Yong-Tao; Dang, Xiao-Qian; Wang, Kun-Zheng

    2014-01-01

    To analyze the effects of three surgical operations in the treatment of Pilon fracture of Rüedi-Allgower type III, and put forward the best therapeutic method. The clinical data of 33 patients with Pilon fracture who received surgical operations (plaster immobilization group, 10 cases; distal tibia anatomical plate group, 11 cases; external fixation with limited internal fixation group, 12 cases) from October 2009 to January 2012 were analyzed. There were 5 males and 5 females, ranging in age from 24 to 61 years in the plaster immobilization group. There were 7 males and 4 females, ranging in age from 21 to 64 years in the distal tibia anatomical plate group. There were 7 males and 5 females, ranging in age from 23 to 67 years in the external fixation with limited internal fixation group. The Ankle X-ray of Pilon fracture after operation, ankle score, early and late complications were collected. Bourne system was used to evaluate ankle joint function. After 8 months to 3 years follow-up, it was found that three kinds of treatment had significant differences in the outcomes and complications (P external fixation with limited internal fixation group got the best results. The number of anatomic reduction cases in the external fixation with limited internal fixation group (7 cases) and the distal tibia anatomical plate group (8 cases) was more than the plaster immobilization group (2 cases). According to the ankle score, 8 patients got an excellent result, 3 good and 1 poor in the limited internal fixation group ,which was better than those of distal tibia anatomical plate group (5 excellent, 4 good and 2 poor) and the plaster immobilization group (3 excellent, 4 good and 3 poor). The number of early and late complications in the external fixation with limited internal fixation group was more than those in the plaster immobilization group and the distal tibia anatomical plate group (Pexternal fixation with limited internal fixation in the treatment of Pilon fracture

  16. Review of techniques for monitoring the healing fracture of bones for implementation in an internally fixated pelvis.

    Science.gov (United States)

    Wong, Lydia Chwang Yuh; Chiu, Wing Kong; Russ, Matthias; Liew, Susan

    2012-03-01

    Sacral fractures from high-impact trauma often cause instability in the pelvic ring structure. Treatment is by internal fixation which clamps the fractured edges together to promote healing. Healing could take up to 12 weeks whereby patients are bedridden to avoid hindrances to the fracture from movement or weight bearing activities. Immobility can lead to muscle degradation and longer periods of rehabilitation. The ability to determine the time at which the fracture is stable enough to allow partial weight-bearing is important to reduce hospitalisation time. This review looks into different techniques used for monitoring the fracture healing of bones which could lead to possible methods for in situ and non-invasive assessment of healing fracture in a fixated pelvis. Traditional techniques being used include radiology and CT scans but were found to be unreliable at times and very subjective in addition to being non in situ. Strain gauges have proven to be very effective for accurate assessment of fracture healing as well as stability for long bones with external fixators but may not be suitable for an internally fixated pelvis. Ultrasound provides in situ monitoring of stiffness recovery but only assesses local fracture sites close to the skin surface and has only been tested on long bones. Vibration analysis can detect non-uniform healing due to its assessment of the overall structure but may suffer from low signal-to-noise ratio due to damping. Impedance techniques have been used to assess properties of non-long bones but recent studies have only been conducted on non-biological materials and more research needs to be done before it can be applicable for monitoring healing in the fixated pelvis. Copyright © 2011 IPEM. Published by Elsevier Ltd. All rights reserved.

  17. Biomechanical Evaluation of the MACSTL Internal Fixator for Thoracic Spinal Stabilisation

    Directory of Open Access Journals (Sweden)

    R. Veselý

    2008-01-01

    Full Text Available Unstable fractures of the thoracic spine in humans represent a serious social and economic issue. They may lead to persistent consequences and chronic disease. The anatomical and biomechanical characteristics of the thoracic spine are different from all the other spinal parts due to its higher mobility. The vertebrae of the chest area are less mobile, conferring a higher degree of rigidity to the spine. To destabilize this relatively rigid system, a considerable force is necessary. The treatment of unstable spinal fractures is solely surgical. The decompression of the spinal canal with reposition and stabilisation of the fracture is indicated urgently. This intervention is performed mostly from the posterior approach in the first phase. However, the anterior spinal column is the structure responsible for the stability of the spine. Therefore, the recent advances in spine surgery focus on this area of expertise. For this reason, we carried out a bio-mechanical study aimed at assessing the effectiveness of two surgical tactics used. The study consisted of comparative experiments performed by computer-aided device on segments of pig cadavers (n = 5. The experiment involved a comparison of segments of the thoracic spine under the following conditions: an anatomically intact segment, a spine segment with an artificially created anterior instability, and a segment with an applied internal fixator. The experiment compared the mechanical characteristics of these segments. The experiment has demonstrated that after application of the internal fixator used for stabilisation of the injured anterior spinal column at defined pre-loading of 200 N, the stability of damaged spinal segment in torsion increased twofold. It was also verified that sufficient stability can be ensured using the Modular Anterior Construct System (MACSTL implant for ventral stabilisation of thoracic spine unstable injuries. Endoscopic application of this implant represents an

  18. External versus internal fixation for bicondylar tibial plateau fractures: systematic review and meta-analysis.

    Science.gov (United States)

    Metcalfe, David; Hickson, Craig J; McKee, Lesley; Griffin, Xavier L

    2015-12-01

    It is uncertain whether external fixation or open reduction internal fixation (ORIF) is optimal for patients with bicondylar tibial plateau fractures. A systematic review using Ovid MEDLINE, Embase Classic, Embase, AMED, the Cochrane Library, Open Grey, Orthopaedic Proceedings, WHO International Clinical Trials Registry Platform, Current Controlled Trials, US National Institute for Health Trials Registry, and the Cochrane Central Register of Controlled Trials. The search was conducted on 3rd October 2014 and no language limits were applied. Inclusion criteria were all clinical study designs comparing external fixation with open reduction internal fixation of bicondylar tibial plateau fractures. Studies of only one treatment modality were excluded, as were those that included unicondylar tibial plateau fractures. Treatment effects from studies reporting dichotomous outcomes were summarised using odds ratios. Continuous outcomes were converted to standardized mean differences to assess the treatment effect, and inverse variance methods used to combine data. A fixed effect model was used for meta-analyses. Patients undergoing external fixation were more likely to have returned to preinjury activities by six and twelve months (P = 0.030) but not at 24 months follow-up. However, external fixation was complicated by a greater number of infections (OR 2.59, 95 % CI 1.25-5.36, P = 0.01). There were no statistically significant differences in the rates of deep infection, venous thromboembolism, compartment syndrome, or need for re-operation between the two groups. Although external fixation and ORIF are associated with different complication profiles, both are acceptable strategies for managing bicondylar tibial plateau fractures.

  19. A meta-analysis of external fixation versus open reduction and internal fixation for complex tibial plateau fractures.

    Science.gov (United States)

    Zhao, Xing-Wen; Ma, Jian-Xiong; Ma, Xin-Long; Jiang, Xuan; Wang, Yin; Li, Fei; Lu, Bin

    2017-03-01

    Both external fixation (ExFx) and open reduction and internal fixation(ORIF) were used to treat complex tibial plateau fractures, but it was not sure which one was better. So we did this meta-analysis to evaluate the outcomes of ExFx and ORIF in managing complex tibial plateau fractures. Articles published before August 5, 2016 were selected from PubMed, Cochrane library, and some other electronic database. Relevant journals were also searched manually with no language limited. Two independent reviewers searched and assessed the literature. A fixed effect model was initially used for meta-analyses with RevMan 5.3. When compared with ORIF, cases undergoing ExFx were more likely to return to the preinjury state at the early stage, but no difference in the later period of follow-up. However, ExFx group had higher infection rate (OR 1.98, 95% CI 1.08-3.63, P = 0.03), higher venous thromboembolism rate (OR 1.56, 95% CI 0.49-4.96, P = 0.45), higher re-operation rate (OR 0.87, 95% CI 0.47-1.62, P = 0.66) and lower compartment syndrome rate (OR 0.61, 95% CI 0.12-3.22, P = 0.56), lower TKA rate (OR 0.51, 95% CI 0.20-1.34, P = 0.17). There were no statistically significant differences in the rate of deep infection, venous thromboembolism, compartment syndrome and VTE between the two groups. Although external fixation may offer some advantages, both were acceptable strategies in managing complex tibial plateau fractures. According to our analysis results, we strongly recommend that selection of definitive fixators should base on the fracture patterns, soft-tissue condition as well as the injury stages in clinical practice. More important, further multicentered, randomized controlled studies should be implemented to get a more reliable and clear result. Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  20. Functional Outcome After Successful Internal Fixation Versus Salvage Arthroplasty of Patients With a Femoral Neck Fracture

    NARCIS (Netherlands)

    Zielinski, Stephanie M.; Keijsers, Noël L.; Praet, Stephan F. E.; Heetveld, Martin J.; Bhandari, Mohit; Wilssens, Jean Pierre; Patka, Peter; van Lieshout, Esther M. M.; Swiontkowski, Marc; Devereaux, Philip J.; Guyatt, Gordon; Jeray, Kyle; Liew, Susan; Schemitsch, Emil H.; Thabane, Lehana; Walter, Stephen; Sprague, Sheila; Scott, Taryn; Swinton, Marilyn; Viveiros, Helena; Heels-Ansdell, Diane; Zhou, Qi; Buckingham, Lisa; Duraikannan, Aravin; Maddock, Deborah; Agel, Julie; Rangan, Amar; Hanusch, Birgit; Della Rocca, Gregory J.; Haverlag, Robert; Slobogean, Gerard; Katz, Jeffrey; Gillespie, Brenda; Greendale, Gail A.; Guy, Pierre; Hartman, Curtis; Rubin, Craig; Waddell, James; McCormack, Robert; Apostle, Kelly; Boyer, Dory; Moola, Farhad; Perey, Bertrand; Stone, Trevor; Viskontas, Darius; Lemke, H. Michael; Zomar, Mauri; Moon, Karyn; Moon, Raely; Oatt, Amber; Buckley, Richard E.; Duffy, Paul; Korley, Robert; Puloski, Shannon; Johnston, Kelly; Powell, James; Carcary, Kimberly; Sanders, David; Lawendy, Abdel; Tiezer, Christina; Stephen, David; Kreder, Hans; Jenkinson, Richard; Nousiainene, Markku; Axelrod, Terry; Murnaghan, John; Nam, Diane; Richards, Robin; Rodriguez-Elizalde, Sebastian; Wadey, Veronica; Yee, Albert; Milner, Katrine; Kunz, Monica; Macnevin, Melanie; Cagaanan, Ria; Bicknell, Ryan; Yach, Jeff; Bardana, Davide; Wood, Gavin; Harrison, Mark; Yen, David; Lambert, Sue; Howells, Fiona; Ward, Angela; Coles, Chad; Leighton, Ross; Biddulph, Michael; Johnston, David; Glazebrook, Mark; Alexander, David; Coady, Cathy; Dunbar, Michael; Trask, Kelly; MacDonald, Shelley; Dobbin, Gwen; Ahn, Henry; Hall, Jeremy A.; McKee, Michael D.; Whelan, Daniel B.; Nauth, Aaron; Vicente, Milena; Wild, Lisa; Khan, Ryan; Hidy, Jennifer; Zalzal, Paul; Brien, Heather; Naumetz, V.; Weening, Brad; Simunovic, Nicole; Wai, Eugene K.; Papp, Steve; Gofton, Wade T.; Liew, Allen; Kingwell, Stephen P.; Roffey, Darren M.; Borsella, Vivian; Avram, Victoria; Oliver, Todd M.; Jones, Vicki; Jones, Clifford; Ringler, James; Endres, Terrence; Sietsema, Debra L.; Jeray, Kyle J.; Broderick, J. Scott; Goetz, David R.; Pace, Thomas B.; Schaller, Thomas M.; Porter, Scott E.; Tanner, Stephanie L.; Snider, Rebecca G.; Nastoff, Lauren A.; Bielby, Shea A.; Marcantonio, Andrew J.; Iorio, Richard; Garfi, John; Prayson, Michael J.; Laughlin, Richard; Rubino, Joseph; May, Jedediah; Rieser, Geoffrey Ryan; Dulaney-Cripe, Liz; Gayton, Chris; Switzer, Julie A.; Cole, Peter A.; Anderson, Sarah A.; Lafferty, Paul M.; Li, Mengnai; Ly, Thuan V.; Marston, Scott B.; Foley, Amy L.; Vang, Sandy; Wright, David M.; Vallier, Heather A.; Dolenc, Andrea; Robinson, Chalitha; Gorczyca, John T.; Gross, Jonathan M.; Humphrey, Catherine A.; Kates, Stephen; Noble, Krista; McIntyre, Allison W.; Pecorella, Kaili; Shaer, James; Schrickel, Tyson; Hileman, Barbara; Davis, Craig A.; Weinerman, Stewart; Weingarten, Peter; Stull, Philip; Lindenbaum, Stephen; Hewitt, Michael; Schwappach, John; Baker, Janell K.; Mehta, Samir; Esterhai, John; Ahn, Jaimo; Horan, Annamarie D.; McGinnis, Kelly; Kaminiski, Christine A.; Kowalski, Brynn N.; Cannada, Lisa K.; Karges, David; Hill, Leslie; Tarkin, Ivan; Siska, Peter; Gruen, Gary; Evans, Andrew; Farrell, Dana J.; Irrgang, James; Luther, Arlene; Keeve, Jonathan P.; Anderson, Christopher G.; McDonald, Michael D.; Hoffman, Jodi M.; Jenkins, Mark; Dumais, Jules; Romero, Amanda W.; Hsu, Joseph R.; Ficke, James; Charlton, Michael; Napierala, Matthew; Fan, Mary; Cross, William W.; Cass, Joseph R.; Sems, Stephen A.; Torchia, Michael E.; Scrabeck, Tyson; Sagebien, Carlos A.; Butler, Mark S.; Monica, James T.; Seuffert, Patricia; Brennan, Michael L.; Probe, Robert; Kile, Evelyn; Mills, Kelli; Clipper, Lydia; Yu, Michelle; Erwin, Katie; Tornetta, Paul; Carlisle, Hope; Silva, Heather; Archdeacon, Michael; Finnan, Ryan; Le, Toan; Wyrick, John; Hess, Shelley; McBeth, Jessica; Aurang, Kamran; Zohman, Gary; Peterson, Brett; Huff, Roger B.; Baele, Joseph; Weber, Timothy; Edison, Matt; Schmidt, Andrew H.; Westberg, Jerald R.; DePaolo, Charles J.; Alosky, Rachel; Shell, Leslie E.; Hampton, Lynne; Shepard, Stephanie; Nanney, Tracy; Cuento, Claudine; Shively, Karl; Ertl, Janos P.; Mullis, Brian; Parr, J. Andrew; Worman, Ripley; Frizzell, Valda; Moore, Molly M.; Tobias, Erin; Thomas, Emily; Cantu, Robert V.; Henderson, Eric R.; Eickhoff, Linda S.; Zamorano, David P.; Pourmand, Deeba; Lawson, Deanna; Hammerberg, E. Mark; Stahel, Philip; Hak, David; Mauffrey, Cyril; Gibula, Douglas; Gissel, Hannah; Henderson, Corey; Crist, Brett D.; Murtha, Yvonne M.; McPherson, Melinda; Anderson, Linda K.; Dohm, Michael P.; Linehan, Colleen; Pilling, Lindsey; Horwitz, Daniel; Strohecker, Kent; Lewis, Courtland G.; Caminiti, Stephanie; Sullivan, Raymond J.; Roper, Elizabeth; Obremsky, William; Kregor, Philip; Richards, Justin E.; Stringfellow, Kenya; Goslings, J. Carel; Ponsen, Jan; Bronkhorst, Maarten W. G. A.; Guicherit, Onno R.; Eversdijk, Martin G.; Peters, Rolf; den Hartog, Dennis; van Waes, Oscar J. F.; Oprel, Pim; de Rijcke, Piet A. R.; Koppert, Cees L.; Buijk, Steven E.; Groenendijk, Richard P. R.; Dawson, Imro; Tetteroo, Geert W. M.; Bruijninckx, Milko M. M.; Doornebosch, Pascal G.; de Graaf, Eelco J. R.; Visser, Gijs A.; Stockman, Heyn; Silvis, Rob; Snellen, Jaap P.; Rijbroek, Bram; Scheepers, Joris J. G.; Vermeulen, Erik G. J.; Siroen, Michel P. C.; Vuylsteke, Ronald; Brom, Hans L. F.; Rijna, Herman; Roukema, Gert R.; Josaputra, Hong; Keller, Paul; de Rooij, Peter D.; Kuiken, Hans; Boxma, Han; Clefken, Berry I.; Liem, Ronald; Rhemrev, Steven J.; Bosman, Coks H. R.; de Mol van Otterloo, Alexander; Hoogendoorn, Jochem; de Vries, Alexander C.; Meylaerts, Sven A. G.; Poolman, Rudolf W.; Simons, Maarten P.; van der Heijden, Frank H. W. M.; Willems, W. Jaap; de Meulemeester, Frank R. A. J.; van der Hart, Cor P.; Turckan, Kahn; Festen, Sebastiaan; de Nies, Frank; Out, Nico J. M.; Bosma, Jan; van der Elst, Maarten; van der Pol, Carmen C.; van't Riet, Martijne; Karsten, Tom M.; de Vries, Mark; Stassen, Laurents P. S.; Schep, Niels W. L.; Schmidt, G. Ben; Hoffman, W. H.; Segers, Michiel J. M.; Zijl, Jacco A. C.; Verhoeven, Bart; Smits, Anke B.; de Vries, Jean Paul P. M.; Fioole, Bram; Hoeven, Henk van der; Theunissen, Evert B. M.; de Vries Reilingh, Tammo S.; Govaert, Lonneke; Wittich, Philippe; de Brauw, Maurits; Wille, Jan; Go, Peter M. N. Y. M.; Ritchie, Ewan D.; Wessel, Ronald N.; Hammacher, Eric R.; Verhofstad, Michiel H. J.; Meijer, Joost; van Egmond, Teun; van der Brand, Igor; van der Vis, Harm; Campo, Martin; Verhagen, Ronald; Albers, Albert Robert; Zurcher, Arthur W.; von Kampen, Albert; Biert, Jan; van Vugt, Arie B.; Edwards, Michael J. R.; Blokhuis, Taco J.; Frölke, Jan Paul M.; Geeraedts, Leo M. G.; Gardeniers, Jean W. M.; Tan, Edward T. C. H.; Poelhekke, Lodewijk M. S. J.; de Waal Malefijt, Maarten C.; Schreurs, Bart; Simmermacher, Rogier K. J.; van Mulken, Jeroen; van Wessem, Karlijn; van Gaalen, Steven M.; Leenen, Luke P. H.; Bedi, Harvinder; Carr, Ashley; Chia, Andrew; Csongvay, Steven; Curry, Hamish; Doig, Stephen; Donohue, Craig; Edwards, Elton; Etherington, Greg; Gong, Andrew; Jain, Arvind; Li, Doug; Miller, Russell; Moaveni, Ash; Russ, Matthias; Ton, Lu; Wang, Otis; Murdoch, Zoe; Sage, Claire; Frihagen, Frede; Clarke-Jenssen, John; Hjorthaug, Geir; Ianssen, Torben; Amundsen, Asgeir; Brattgjerd, Jan Egil; Borch, Tor; Bøe, Berthe; Flatøy, Bernhard; Hasselund, Sondre; Haug, Knut Jørgen; Hemlock, Kim; Hoseth, Tor Magne; Jomaas, Geir; Kibsgård, Thomas; Kristiansen, Bjorn; Lona, Tarjei; Moatshe, Gilbert; Müller, Oliver; Molund, Marius; Nicolaisen, Tor; Nilsen, Fredrik; Rydinge, Jonas; Smedsrud, Morten; Stødle, Are; Trommer, Axel; Ugland, Stein; Vesterhus, Elise Berg; Brekke, Anne Christine; Sharma, Ateet; Sanghavi, Amir; Tetsworth, Kevin; Geoff, Donald; Weinrach, Patrick; yang, Steven; Halliday, Brett; Gervais, Trevor; Holt, Michael; Flynn, Annette; Prasad, Amal Shankar; Mishra, Vimlesh; Gupta, Ajay; Jain, Niraj; Bahatia, Mahesh; Arora, Vinod; Bhatia, Mahesh; Sundaresh, D. C.; Khanna, Angshuman; Rai, Anil; Pirpiris, Marinis; Love, David; Bucknill, Andrew; Farrugia, Richard J.; Dadi, Akhil; Palla, Naveen; Rai, B. Sachidananda; Rajakumar, Janakiraman; Cherian, Joe Joseph; Olakkengil, Davy J.; Sharma, Gaurav

    2014-01-01

    Objectives: To determine patient independency, health-related and disease-specific quality of life (QOL), gait pattern, and muscle strength in patients after salvage arthroplasty for failed internal fixation of a femoral neck fracture. Design: Secondary cohort study to a randomized controlled trial.

  1. Femoral neck shortening after internal fixation of a femoral neck fracture

    NARCIS (Netherlands)

    Zielinski, Stephanie M.; Keijsers, Noël L.; Praet, Stephan F. E.; Heetveld, Martin J.; Bhandari, Mohit; Wilssens, Jean Pierre; Patka, Peter; van Lieshout, Esther M. M.; Devereaux, Philip J.; Guyatt, Gordon; Jeray, Kyle; Liew, Susan; Richardson, Martin J.; Schemitsch, Emil H.; Swiontkowski, Marc; Tornetta, Paul; Walter, Stephen; Sprague, Sheila; Simunovic, Helena Viveiros Nicole; Heels-Ansdell, Diane; Buckingham, Lisa; Duraikannan, Aravin; Swiontkowski, Marc F.; Agel, Julie; Goslings, J. Carel; Haverlag, Robert; Ponsen, Kees Jan; Bronkhorst, Maarten W. G. A.; Guicherit, O. R.; Eversdijk, Martin G.; Peters, Rolf; den Hartog, Dennis; van Waes, Oscar J. F.; Oprel, Pim; de Rijcke, Piet A. R.; Koppert, C. L.; Buijk, Steven E.; Groenendijk, Richard P. R.; Dawson, I.; Tetteroo, G. W. M.; Bruijninckx, Milko M. M.; Doornebosch, Pascal G.; de Graaf, E. J. R.; Gasthuis, Kennemer; Visser, Gijs A.; Stockmann, Heyn; Silvis, Rob; Snellen, J. P.; Rijbroek, A.; Scheepers, Joris J. G.; Vermeulen, Erik G. J.; Siroen, M. P. C.; Vuylsteke, Ronald; Brom, H. L. F.; Ryna, H.; Roukema, Gert R.; Josaputra, H.; Keller, Paul; de Rooij, P. D.; Kuiken, Hans; Boxma, Han; Cleffken, Barry I.; Liem, Ronald; Rhemrev, Steven J.; Bosman, C. H. R.; van Otterloo, Alexander de Mol; Hoogendoorn, Jochem; de Vries, Alexander C.; Meylaerts, Sven A. G.; Poolman, Rudolf W.; Simons, Maarten P.; van der Heijden, Frank H. W. M.; Willems, W. J.; de Meulemeester, Frank R. A. J.; van der Hart, Cor P.; Turckan, Kahn; Festen, Sebastiaan; de Nies, F.; Out, Nico J. M.; Bosma, J.; van der Elst, Maarten; van der Pol, Carmen C.; van 't Riet, Martijne; Karsten, T. M.; de Vries, M. R.; Stassen, Laurents P. S.; Schep, Niels W. L.; Schmidt, G. B.; Hoffman, W. H.; Segers, Michiel J. M.; Zijl, Jacco A. C.; Verhoeven, Bart; Smits, Anke B.; de Vries, J. P. P. M.; Fioole, Bram; van der Hoeven, H.; Theunissen, Evert B. M.; de Vries Reilingh, Tammo S.; Govaert, Lonneke; Wittich, Philippe; de Brauw, Maurits; Wille, Jan; Go, Peter M. N. Y. M.; Ritchie, Ewan D.; Wessel, R. N.; Hammacher, Eric R.; Verhofstad, Michiel H. J.; Meijer, Joost; van Egmond, Teun; van der Brand, Igor; van der Vis, Harm M.; Campo, Martin; Verhagen, Ronald; Albers, G. H. R.; Zurcher, A.; van Kampen, A.; Biert, Jan; van Vugt, Arie B.; Edwards, Michael J. R.; Blokhuis, Taco J.; Frölke, Jan Paul M.; Geeraedts, L. M. G.; Gardeniers, J. W. M.; Tan, Edward T. C. H.; Poelhekke, L. M. S. J.; de Waal Malefijt, M. C.; Schreurs, Bart; Simmermacher, Rogier K. J.; van Mulken, Jeroen; van Wessem, Karlijn; van Gaalen, Steven M.; Leenen, Luke P. H.; Frihagen, Frede; Nordsletten, Lars; Stoen, Ragnhild Oydna; Brekke, Kine; Tetsworth, Kevin; Weinrauch, Patrick; Pincus, Paul; Donald, Geoff; yang, Steven; Halliday, Brett; Gervais, Trevor; Holt, Michael; Flynn, Annette; Pirpiris, Marinis; Love, David; Bucknill, Andrew; Farrugia, Richard J.; Dowrick, Adam; Donohue, Craig; Bedi, Harvinder; Li, Doug; Edwards, Elton; Csongvay, Steven; Miller, Russell; Wang, Otis; Chia, Andrew; Jain, Arvind; Mammen, Mathan; Murdoch, Zoe; Sage, Claire; Kumar, Anil; Pankaj, Amite; Singh, Ajay Pal; Pesantez, Rodrigo; Martinez, Adriana; Novoa, Catherine; Buckley, Richard E.; Duffy, Paul; Korley, Robert; Johnston, Kelly; Puloski, Shannon; Carcary, Kimberly; Avram, Victoria; Bicknell, Ryan; Yach, Jeff; Bardana, Davide; Lambert, Sue; Sanders, David W.; Howard, Jamie; Macleod, Mark; Bartly, C. T.; Tieszer, Christina; Peterson, Devin; Zalzal, Paul; Maumetz, Victor; Brien, Heather; Weening, Brad; Wai, Eugene K.; Roffey, Darren; McCormack, Robert; Stone, Trevor; Perey, Bertrand; Viskontas, Darius; Boyer, Dory; Perey, Bert; Zomar, Mauri; Moon, Karyn; Oatt, Amber; McKee, Michael; Hall, Jeremy; Ahn, Henry; Vicente, Milena R.; Wild, Lisa M.; Kreder, Hans J.; Stephen, David J. G.; Nousianinen, Markku; Cagaanan, Ria; Kunz, Monica; Syed, Khalid; Azad, Tania; Coles, Chad; Leighton, Ross; Johnstone, David; Glazebrook, Mark; Alexander, David; Trask, Kelly; Dobbin, Gwendolyn; Oliver, Todd M.; Jones, Vicky; Ronan, James; Brown, Desmond T.; Carlilse, Hope; Shaughnessy, Lisa; Schwappach, John; Davis, Craig A.; Weingarten, Peter; Weinerman, Stewart; Newman, Heike; Baker, Janell; Browner, Kieran; Hurley, Meghan; Zura, Robert; Manson, Maria J.; Goetz, David; Broderick, Scott J.; Porter, Scott; Pace, Thomas; Tanner, Stephanie L.; Snider, Becky; Schmidt, Andrew H.; Haas, Jonathan; Templeman, David; Westberg, Jerald R.; Mullis, Brian; Ertl, J. P.; Shively, Karl; Frizzel, Valda; Marcantonio, Andrew J.; Iorio, Richard; Lobo, Margaret; Kain, Michael; Specht, Lawrence; Garfi, John; Prayson, Michael J.; Davis, Craig; Laughlin, Richard; Rubino, Joe; Lawless, Mathew; DiPaola, Matt; Gaydon, Chris; Dulaney, Liz; Vallier, Heather A.; Wilber, John; Sontich, John; Patterson, Brendan; Dolenc, Andrea; Robinson, Chalitha; Wilber, Roger; DePaolo, Charles J.; Alosky, Rachel; Shell, Leslie E.; Keeve, Jonathan P.; Anderson, Chris; McDonald, Michael; Hoffman, Jodi; Baele, Joseph; Weber, Tim; Edison, Matt; Musapatika, Dana; Jones, Clifford; Ringler, James; Endres, Terrance; Gelbke, Martin; Jabara, Michael; Sietsema, Debra L.; Engerman, Susan M.; Switzer, Julie A.; Li, Mangnai; Marston, Scott; Cole, Peter; Vang, Sandy X.; Foley, Amy; McBeth, Jessica; Comstock, Curt; Ziran, Navid; Shaer, James; Hileman, Barbara; Karges, David; Cannada, Lisa; Kuldjanov, Djoldas; Watson, John Tracy; Mills, Emily; Simon, Tiffany; Abdelgawad, Amr; Shunia, Juan; Jenkins, Mark; Zumwalt, Mimi; Romero, Amanda West; Lowe, Jason; Goldstein, Jessica; Zamorano, David P.; Lawson, Deanna; Archdeacon, Michael; Wyrick, John; Hampton, Shelley; Lewis, Courtland G.; Ademi, Arben; Sullivan, Raymond; Caminiti, Stephanie; Graves, Matthew; Smith, Lori; Della Rocca, Gregory J.; Crist, Brett D.; Murtha, Yvonne; Anderson, Linda K.; Kliewer, Toni K.; McPherson, Melinda K.; Sullivan, Kelly M.; Sagebien, Carlos; Seuffert, Patricia; Mehta, Samir; Esterhai, John; Ahn, Jaimo; Tjoumakaris, Fotios; Horan, Annamarie D.; Kaminski, Christine; Tarkin, Ivan; Siska, Peter; Luther, Arlene; Irrgang, James; Farrell, Dana; Gorczyca, John T.; Gross, Jonathan M.; Kates, Stephen Lloyd; Colosi, Jen; Hibsch, Nancy; Noble, Krista; Agarwal, Animesh; Wright, Rebecca; Hsu, Joseph R.; Ficke, James R.; Napierala, Matthew A.; Charlton, Michael T.; Fan, Mary K.; Obremskey, William T.; Richards, Justin E.; Robinson, Kenya; Carroll, Eben; Kulp, Brenda

    2013-01-01

    This study assesses femoral neck shortening and its effect on gait pattern and muscle strength in patients with femoral neck fractures treated with internal fixation. Seventy-six patients from a multicenter randomized controlled trial participated. Patient characteristics and Short Form 12 and

  2. Management of intra-articular fracture of calcaneus by combined percutaneous and minimal internal fixation.

    Science.gov (United States)

    Lamichhane, A; Mahara, D

    2013-01-01

    Fractures of the calcaneus are among the most challenging for the orthopaedic surgeon. The treatment of the intra-articular calcaneum fracture remains controversial due to complications and complexity of surgical anatomy. Treatment of calcaneal fracture ranges from non-operative treatment to operative. We present intraarticular fracture of calcaneus treated by combined percutaneous and minimal internal fixation. All cases evaluated either by X-ray or CT scan. All fractures were sanders two or three type evaluated by CT scan and either joint depression or tongue type fracture by X-ray. Lateral approach was used, posterior facet was exposed, reduced and fixed with one 4 mm canulated cancellous screws and 2 axial pins percutaneously from tuberosity. Clinical evaluation of the outcomes was done by modified Rowe Score. Out of 22 patients, 14 were male and 8 cases were female. Average age of the patients was 30.5 yrs (15-63 yrs). Mode of the injury was RTA in 6 cases and fall from height in 16 cases. There was no soft tissue problem in any patient. All fractures united without secondary displacement in an average of 8 weeks. Average duration of follow up was 26 months (6-37 months). Average Modified Rowe Score was 80 (Range 55-95). Ten patients had excellent, 10 had good and 2 had satisfactory outcome. Intra-articular fracture of the calcaneus can be well managed by minimal opening at the fracture and fixation by single cancellous screw and 2 axial k-wires, so minimizes complications and results in comparable outcomes.

  3. LCP external fixation - External application of an internal fixator: two cases and a review of the literature

    Directory of Open Access Journals (Sweden)

    Wong Merng-Koon

    2010-03-01

    Full Text Available Abstract The locking compression plate (LCP is an angle-stable fixator intended for intracorporeal application. In selected cases, it can be applied externally in an extracorporeal location to function as a monolateral external fixator. We describe one patient with Schatzker V tibial plateau fracture and one patient with Gustillo IIIB open tibia shaft fracture treated initially with traditional external fixation for whom exchange fixation with externally applied LCPs was performed. The first case went on to bony union while the second case required bone grafting for delayed union. Both patients found that the LCP external fixators facilitated mobilization and were more manageable and aesthetically acceptable than traditional bar-Schanz pin fixators.

  4. REVERSE ENGINEERING OF THE MITKOVIC TYPE INTERNAL FIXATOR FOR LATERAL TIBIAL PLATEAU

    Directory of Open Access Journals (Sweden)

    Nikola Vitković

    2015-12-01

    Full Text Available In orthopaedic surgery it is very important to use proper fixation techniques in the treatment of various medical conditions, i.e. bone fractures or other traumas. If an internal fixation method, such as plating, is required, it is possible to use Dynamic Compression Plates (DCP or Locking Compression Plates (LCP and their variants. For DCP implants it is important to match the patient's bone shape with the most possible accuracy, so that the most frequent implant bending is applied in the surgery. For LCP implants it is not so important to match the patient’s bone shape, but additional locking screw holes are required. To improve the geometrical accuracy and anatomical correctness of the shape of DCP and to improve the LCP geometric definition, new geometrical modelling methods for the Mitkovic type internal fixator for Lateral Tibia Plateau are developed and presented in this research. The presented results are quite promising; it can be concluded that these methods can be applied to the creation of geometrical models of internal fixator customized for the given patient or optimized for a group of patients with required geometrical accuracy and morphological correctness.

  5. Numerical-experimental study of internal fixation system "Dufoo" for vertebral fractures.

    Science.gov (United States)

    Nieto-Miranda, J Jesús; Faraón-Carbajal Romero, Manuel; Sánchez-Aguilar, Jons

    2012-01-01

    We describe a numerical experimental study of the stress generated by the internal fixation system "Dufoo" used in the treatment of vertebral fractures with the purpose of validating the numerical model of human lumbar vertebrae under the main physiological loads that the human body is exposed to in this area. The objective is to model and numerically simulate the elements of the musculoskeletal system to collect the stresses generated and other parameters that are difficult to measure experimentally in the thoracic lumbar vertebrae. We used an internal fixator "Dufoo" and vertebrae L2-L3-L4 specimens from pig and human. The system uses a total L3 corpectomy. The fixator acts as a mechanical bridge implant from L2 to L4. Numerical analysis was performed using the finite element method (FEM). For the experimental study, reflective photoelasticity and extensometry were used. Torsion and combined loads generate the main displacements and stresses in the study system, determining that the internal fixation carries out part of the function of the damaged organ structure when absorbing the stresses presented by applied loads. Numerical analysis allows great freedom in the management of the variables involved in the developed models using radiological images. Geometric models are obtained and are entered into FEM programs that allow testing using parameters that, under actual conditions, may not be easily carried out, allowing to comprehensively determine the biomechanical behavior of the coupled system of study.

  6. When do anterior external or internal fixators provide additional stability in an unstable (Tile C) pelvic fracture? A biomechanical study.

    Science.gov (United States)

    Mcdonald, E; Theologis, A A; Horst, P; Kandemir, U; Pekmezci, M

    2015-12-01

    This study aimed at evaluating the additional stability that is provided by anterior external and internal fixators in an unstable pelvic fracture model (OTA 61-C). An unstable pelvic fracture (OTA 61-C) was created in 27 synthetic pelves by making a 5-mm gap through the sacral foramina (posterior injury) and an ipsilateral pubic rami fracture (anterior injury). The posterior injury was fixed with either a single iliosacral (IS) screw, a single trans-iliac, trans-sacral (TS) screw, or two iliosacral screws (S1S2). Two anterior fixation techniques were utilized: external fixation (Ex-Fix) and supra-acetabular external fixation and internal fixation (In-Fix); supra-acetabular pedicle screws connected with a single subcutaneous spinal rod. The specimens were tested using a nondestructive single-leg stance model. Peak-to-peak (P2P) displacement and rotation and conditioning displacement (CD) were calculated. The Ex-Fix group failed in 83.3 % of specimens with concomitant single-level posterior fixation (Total: 15/18-7 of 9 IS fixation, 8 of 9 TS fixation), and 0 % (0/9) of specimens with concomitant two-level (S1S2) posterior fixation. All specimens with the In-Fix survived testing except for two specimens treated with In-Fix combined with IS fixation. Trans-sacral fixation had higher pubic rotation and greater sacral and pubic displacement than S1S2 (p pelvic fracture (OTA 61-C), anterior fixation with an In-Fix was biomechanically superior to an anterior Ex-Fix in the setting of single-level posterior fixation. There was no biomechanical difference between the In-Fix and Ex-Fix when each was combined with two levels of posterior sacral fixation.

  7. Internal fixation of an oblique femoral fracture in a German ...

    African Journals Online (AJOL)

    A 6 month old puppy with oblique femoral fracture on the right hind limb was treated by surgical manipulation which required internal stabilization using a lagscrew fixed in a craniocaudual direction, and a bone plate fixed laterally. Bone healing occurred without complications and the dog's limb was restored to its normal ...

  8. An Overview of Internal Fixation Implant Metallurgy and Galvanic Corrosion Effects.

    Science.gov (United States)

    Koh, Justin; Berger, Aaron; Benhaim, Prosper

    2015-08-01

    Orthopedic and hand surgery implants for internal fixation of fractures have evolved substantially over the past 50 years. Newer metal compositions have been used, and new standards have been applied to older alloys, resulting in modern implants with unique physical properties and better clinical performances. Conventional wisdom has long dictated that implanting different metals should be avoided, but few guidelines exist regarding the safety of using in proximity implant systems of dissimilar metals. To better characterize the landscape of internal fixation implant metallurgy, we have compiled the recommendations and conclusions of the currently available and pertinent literature. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  9. Lengthening z-osteotomy of the fibula to correct persistent talar shift following open reduction internal fixation of ankle fractures.

    Science.gov (United States)

    Thangarajah, Tanujan; Lakdawala, Ayaz; Battaloglu, Emir; Malik, Atul; Tillu, Abhay

    2012-04-01

    In cases where ankle fracture union has been compromised by persistent syndesmotic diastasis following open reduction internal fixation, both external rotation and shortening of the fibula have been identified as prominent features. This study reports a technique that uses a z-osteotomy to achieve both lengthening and internal rotation of the fibula to correct persistent talar shift following ankle fracture fixation. Four patients with persistent talar shift following open reduction internal fixation for an ankle fracture received z-osteotomy of the fibula to achieve both lengthening and internal rotation. At the latest clinic review, all 4 ankles exhibited satisfactory clinical and radiological union. All patients have returned to full mobility and are satisfied with the outcome. This study demonstrates the effectiveness of lengthening z-osteotomy of the fibula in correcting persistent talar shift following internal fixation of ankle fractures. Therapeutic Level V.

  10. Humeral repair in birds by guided tissue regeneration and external and internal associated fixation techniques

    International Nuclear Information System (INIS)

    Delogu, M.

    1993-01-01

    Ten pigeons (Columba livia domestic form) with humeral diaphyseal fracture were treated with external and internal fixation techniques (Boston technique and intamedullary pin). Longitudinal space was intentionally left between fracture surfaces during osteosynthesis. This space was filled with bovine lyophilized collagen, set around an intramedullary pin, in five samples. Ossification process was checked by radiography every seven days. Results show the utility of this technique in pneumatic bird bones. In fact, shortening control and callus formation facility were observed [it

  11. Enhancement of Apoptosis by Titanium Alloy Internal Fixations during Microwave Treatments for Fractures: An Animal Study.

    Directory of Open Access Journals (Sweden)

    Gang Wang

    Full Text Available Microwaves are used in one method of physical therapy and can increase muscle tissue temperature which is useful for improving muscle, tendon and bone injuries. In the study, we sought to determine whether titanium alloy internal fixations influence apoptosis in tissues subjected to microwave treatments at 2,450 MHz and 40 W during the healing of fractures because this issue is not yet fully understood.In this study, titanium alloy internal fixations were used to treat 3.0-mm transverse osteotomies in the middle of New Zealand rabbits' femurs. After the operation, 30-day microwave treatments were applied to the 3.0 mm transverse osteotomies 3 days after the operation. The changes in the temperatures of the muscle tissues in front of the implants or the 3.0 mm transverse osteotomies were measured during the microwave treatments. To characterize the effects of titanium alloy internal fixations on apoptosis in the muscles after microwave treatment, we performed TUNEL assays, fluorescent real-time (quantitative PCR, western blotting analyses, reactive oxygen species (ROS detection and transmission electron microscopy examinations.The temperatures were markedly increased in the animals with the titanium alloy implants. Apoptosis in the muscle cells of the implanted group was significantly more extensive than that in the non-implanted control group at different time points. Transmission electron microscopy examinations of the skeletal muscles of the implanted groups revealed muscular mitochondrial swelling, vacuolization. ROS, Bax and Hsp70 were up-regulated, and Bcl-2 was down-regulated in the implanted group.Our results suggest that titanium alloy internal fixations caused greater muscular tissue cell apoptosis following 2,450 MHz, 40 W microwave treatments in this rabbit femur fracture models.

  12. Open Reduction and Internal Fixation of a Fracture-dislocation of the Ankle

    OpenAIRE

    Yaniel Truffin Rodriguez; José Julio Requeiro Molina; Gerardo Águila Tejeda

    2015-01-01

    Open reduction and internal fixation of the fracture-dislocation of the ankle with plates, screws and Kirschner wires is a well-defined treatment method. This paper presents the management of a fracture-dislocation of the right ankle in a 33-year-old female patient stabilized by using a one-third tubular plate, screws, and Kirschner wires with tension-band wires. Results were satisfactory.

  13. Fracture fixation in the operative management of hip fractures (FAITH): an international, multicentre, randomised controlled trial

    OpenAIRE

    Nauth, A. (Aaron); Creek, A.T. (Aaron T.); Zellar, A. (Abby); Lawendy, A.-R. (Abdel-Rahman); Dowrick, A. (Adam); Gupta, A. (Ajay); Dadi, A. (Akhil); Kampen, A.; Yee, A. (Albert); Vries, Alexander; de Mol van Otterloo, A. (Alexander); Garibaldi, A. (Alisha); Liew, A. (Allen); McIntyre, A.W. (Allison W.); Prasad, A.S. (Amal Shankar)

    2017-01-01

    textabstractBackground Reoperation rates are high after surgery for hip fractures. We investigated the effect of a sliding hip screw versus cancellous screws on the risk of reoperation and other key outcomes. Methods For this international, multicentre, allocation concealed randomised controlled trial, we enrolled patients aged 50 years or older with a low-energy hip fracture requiring fracture fixation from 81 clinical centres in eight countries. Patients were assigned by minimisation with a...

  14. Autologous bone graft versus demineralized bone matrix in internal fixation of ununited long bones

    OpenAIRE

    Rubenbauer Bianka; Löffler Thomas; Zaspel Johannes; Wittmann Alexandra; Pieske Oliver; Trentzsch Heiko; Piltz Stefan

    2009-01-01

    Abstract Background Non-unions are severe complications in orthopaedic trauma care and occur in 10% of all fractures. The golden standard for the treatment of ununited fractures includes open reduction and internal fixation (ORIF) as well as augmentation with autologous-bone-grafting. However, there is morbidity associated with the bone-graft donor site and some patients offer limited quantity or quality of autologous-bone graft material. Since allogene bone-grafts are introduced on the marke...

  15. Antegrade-retrograde opposing lag screws for internal fixation of simple displaced talar neck fractures.

    Science.gov (United States)

    Abdelkafy, Ashraf; Imam, Mohamed Abdelnabi; Sokkar, Sherif; Hirschmann, Michael

    2015-01-01

    The talar neck is deviated medially with reference to the long axis of the body of the talus. In addition, it deviates plantarward. The talar neck fracture line is sometimes observed to be oriented obliquely (not perpendicular to the long axis of the talar neck). This occurs when the medially deviated talar neck strikes the horizontally oriented anterior lower tibial edge. Internal fixation of a simple displaced talar neck fracture usually requires 2 lag screws. Because the fracture line is obliquely oriented, a better method for positioning the screws perpendicular to the fracture line is to place them in a reversed direction to provide maximum interfragmentary compression at the fracture site, which could increase the likelihood of absolute stability with subsequent improvement in the incidence of fracture union and a reduction of complications, such as avascular necrosis of the body of the talus. Two lag screws are used, with the first inserted from posteriorly to anteriorly (perpendicular to the fracture line) using a medial approach after medial malleolar chevron osteotomy. The second screw is inserted from anteriorly to posteriorly (perpendicular to the fracture line) using an anterolateral approach. Both screw heads should be countersunk. A series of 8 patients underwent this form of internal fixation for talar neck fracture repair, with satisfactory functional outcomes. In conclusion, the use of antegrade-retrograde opposing lag screws is a reasonable method of internal fixation for simple displaced talar neck fractures. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  16. Quality of life following total hip arthroplasty in patients with acetabular fractures, previously managed by open reduction and internal fixation

    Directory of Open Access Journals (Sweden)

    Prasoon Kumar

    2016-08-01

    Conclusion: From this study it is inferred that the functional outcome of THR and quality of life in patients who had acetabular fractures and were initially managed by open reduction and internal fixation is good.

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

    Directory of Open Access Journals (Sweden)

    TONG Da-ke

    2012-02-01

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

  18. Internal fixation and muscle pedicle bone grafting in femoral neck fractures

    Directory of Open Access Journals (Sweden)

    Gupta A

    2008-01-01

    Full Text Available Background: The treatment of displaced intracapsular femoral neck fracture is still an unsolved problem. Non-union and avascular necrosis are the two main complications of this fracture, especially if patient presents late. Muscle pedicle bone grafting has been advocated to provide additional blood supply. We present analysis of our 32 cases of displaced femoral neck fracture treated by internal fixation and quadratus femoris based muscle pedicle bone grafting. Materials and Methods: Open reduction and internal fixation with muscle pedicle grafting was done in 32 patients. The age of patients varied from 14-62 years (average age 45 years with male to female ratio of 13:3. Twenty-nine fractures were more than three weeks old. All the cases were treated by Meyers′ procedure. The fracture was internally fixed after open reduction and then a muscle pedicle graft was applied. It was supplemented by cancellous bone graft in seven cases. Fixation was done by parallel cancellous lag screws ( n = 19, crossed Garden′s screws ( n = 7, parallel Asnis screws ( n = 5 and Moore′s pin ( n = 1.Quadratus femoris muscle pedicle graft was used in 32 cases. In the initial 12 cases the graft was fixed with circumferential proline sutures, but later, to provide a secure fixation, the graft was fixed with a cancellous screw ( n = 20. Postoperative full weight bearing was deferred to an average of 10 weeks. Results: Union was achieved in 26/29 (89.65% cases which could be followed for an average period of 3.4 years, (2-8.5 years with good functional results and had the ability to squat and sit cross-legged. Results were based on hip rating system given by Salvatti and Wilson. The results were excellent in 15 cases, good in four cases, fair in four cases and poor in six cases. Complications were avascular necrosis ( n = 2, transient foot drop ( n = 2, coxa-vara ( n = 1 and temporary loss of scrotal sensation ( n = 1. Conclusion: Muscle pedicle bone grafting with

  19. Internal Fixation of Complicated Acetabular Fractures Directed by Preoperative Surgery with 3D Printing Models.

    Science.gov (United States)

    Liu, Zhao-Jie; Jia, Jian; Zhang, Yin-Guang; Tian, Wei; Jin, Xin; Hu, Yong-Cheng

    2017-05-01

    The purpose of this article is to evaluate the efficacy and feasibility of preoperative surgery with 3D printing-assisted internal fixation of complicated acetabular fractures. A retrospective case review was performed for the above surgical procedure. A 23-year-old man was confirmed by radiological examination to have fractures of multiple ribs, with hemopneumothorax and communicated fractures of the left acetabulum. According to the Letounel and Judet classification, T-shaped fracture involving posterior wall was diagnosed. A 3D printing pelvic model was established using CT digital imaging and communications in medicine (DICOM) data preoperatively, with which surgical procedures were simulated in preoperative surgery to confirm the sequence of the reduction and fixation as well as the position and length of the implants. Open reduction with internal fixation (ORIF) of the acetabular fracture using modified ilioinguinal and Kocher-Langenbeck approaches was performed 25 days after injury. Plates that had been pre-bent in the preoperative surgery were positioned and screws were tightened in the directions determined in the preoperative planning following satisfactory reduction. The duration of the operation was 170 min and blood loss was 900 mL. Postoperative X-rays showed that anatomical reduction of the acetabulum was achieved and the hip joint was congruous. The position and length of the implants were not different when compared with those in preoperative surgery on 3D printing models. We believe that preoperative surgery using 3D printing models is beneficial for confirming the reduction and fixation sequence, determining the reduction quality, shortening the operative time, minimizing preoperative difficulties, and predicting the prognosis for complicated fractures of acetabulam. © 2017 Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.

  20. [Application of the internal fixation of posterior fibula plate for the treatment of ankle fractures].

    Science.gov (United States)

    Xu, Shuo-gui; Wu, Ya-le; Zhang, Chun-cai; Pan, Si-hua

    2008-09-01

    To explore a new method for the treatment of ankle joint fractures, and to evaluate its therapeutic effects. Among 42 patients with ankle joint fractures, 34 patients had complete data for analysis, 19 patients were male and 15 patients were female, ranging in age from 21 to 61 years, with an average of 37 years. According to Weber-AO classification, there are 28 patients of B-type and 6 patients of C-type. The Baird and Jackson Rating System was used to evaluate therapeutic effects, and the relationship between the final function and fracture type, fracture fixation and, the time of functional training after operation were analyzed. Thirty-four patients with ankle joint fractures of B and C type were treated with internal fixation of posterior fibula plate to avoid injury of articular facet by the nails. The patients combined with the fractures of posterior malleolus were treated with fixation of both fibula and posterior malleolus through the same incision. All the patients were followed up ranging from 1.2 to 3.2 years, with an average of 1.8 years. According to evaluation criterion, 24 patients got an excellent result, 6 good and 4 fair, the excellent and good rate was 88.2%. The internal fixation of posterior fibula plate, as a treatment for ankle joint fractures, successfully avoids the injury of articular facet by the nails. Not only does it enhance the pullout strength of the nails, but it is able to treat the fracture of lateral malleolus and posterior malleolus with a single incision. It has provided a new way for the treatment of ankle fractures.

  1. Open Reduction and Internal Fixation of displaced Supracondylar Fractures of Humerus with Crossed K-wires via Medial Approach

    Directory of Open Access Journals (Sweden)

    S Hussain

    2014-07-01

    Full Text Available This study aimed at evaluating the medial approach for open reduction and internal fixation of Gartland type 3 displaced supracondylar fractures of humerus in children. A prospective, single centre study of on displaced supracondylar humerus fractures in 42 children was carried out at our institute. All fractures were managed with open reduction and internal fixation with crossed K-wires via medial approach. The mean follow-up was 12 months and patients were assessed according to Flynn’s criteria. No patients had post-operative ulnar nerve injury. Cubitus varus was not seen in any patient. Superficial pin tract infection occurred in three patients that subsided with anti-septic dressings and antibiotics. No deep infection occurred. 88.09 % patients showed satisfactory results as per Flynn’s criteria. The medial approach provides an excellent view of the supracondylar area. The approach is convenient due to a lower risk for ulnar nerve injury and better acceptability of the medial incisional scar.

  2. [Case-control study on T-shaped locking internal fixation and external fixation for the treatment of dorsal Barton's fracture].

    Science.gov (United States)

    Chen, Huan-qing; Wen, Xi-le; Li, Yang-ming; Wen, Cong-you

    2015-06-01

    To compare clinical effect of T-shaped locking internal fixation and external fixation in treating dorsal Barton's fracture,and investigate selective strategy of internal fixation. From January 2008 to January 2013, 100 patients with dorsal Barton's fracture were randomly divided into two groups. In treatment group, there were 30 males and 20 females with an average age of (33.8±3.6) years old;30 cases were type B, 20 cases were type C;and treated with T-shaped locking internal fixation. In control group, there were 32 male and 18 females with an average age of (32.9±3.4) years old; 29 cases were type B, 21 cases were type C; and treated with external fixation. Volar tilt, ulnar deviation and radial height at 3 months after operation were detected and compared between two groups. Mechara functional evaluation were used to evaluate postoperative clinical effects. Clinical cure time, postoperative complications,joint mobility and function score were recorded and compared between two groups. In treatment group,volar tilt was (11.9±2.7)°, ulnar deviation was (20.8+ 2.9)°,and radial height was (10.9±1.8) mm; while volar tilt was (9.1±1.6)°, ulnar deviation was (17.1±2.9)°, and radial height was (8.1±1.5) mm in control group. Treatment group was better than control group in volar tilt, ulnar deviation and radial height. Clinical cure time in treatment group was(12.0±2.3) weeks, shorter than control group (18.0±4.1) weeks. The incidence of complications in treatment group was lower than control group. According to Mehara functional evaluation,20 cases got excellent results, 25 good, 3 moderate and 2 poor in treatment group; 16 cases got excellent results, 14 good, 10 moderate and 10 poor in control group. Treatment group was better than control group in clinical effects. T-shaped locking internal fixation with postoperative functional exercise for the treatment of dorsal Barton's fracture fits for biomechanics demands,and has advantages of stable fixation

  3. Evaluation of changes in anthropometric indexes due to intermaxillary fixation following facial fractures

    Directory of Open Access Journals (Sweden)

    Javad Yazdani

    2016-12-01

    Full Text Available Background. One of the treatment modalities for facial fractures is closed reduction technique, but treatment with intermaxillary fixation (IMF interferes with normal nutrition, and malnutrition can affect the patient’s recovery. Anthropometric measurements such as skinfold thickness and body mass index (BMI are universal indexes for diagnosing malnutrition. Therefore, in this study we explain how treatment with IMF changes the anthropometric indexes. Methods. In this study 60 patients were treated with 4 weeks of IMF. Skinfold thickness and BMI of these patients were measured and compared before and after the treatment. Results. Patients’ weight, BMI and skinfold thickness decreased during the IMF period, and this decrease was statistically significant (P < 0.01. Conclusion. Although no severe and acute malnutrition was seen among our patients, IMF led to mild to moderate malnutrition in some cases, making it necessary to use nutritional supplements.

  4. Internal fixation of the fibula in ankle fractures: a prospective, randomized and comparative study: plating versus nailing.

    Science.gov (United States)

    Asloum, Y; Bedin, B; Roger, T; Charissoux, J-L; Arnaud, J-P; Mabit, C

    2014-06-01

    Open reduction and internal plate fixation of the fibula is the gold standard treatment for ankle fractures. The aim of this study was to perform a prospective randomized study to compare bone union, complications and functional results of two types of internal fixation of the fibula (plating and the Epifisa FH intramedullary nail). Inclusion criteria were: closed fractures, isolated displaced fractures of the lateral malleolus, inter- and supra-tubercular bimalleolar fractures, and trimalleolar fractures. This study included 71 patients (mean age 53 ± 19): plate fixation group (n=35) and intramedullary nail fixation group (n=36). In seven cases, intramedullary nailing was technically impossible and was converted to plate fixation (the analysis of this sub-group was performed independently). Two patients died and two patients were lost to follow-up. The final comparative series included 32 cases of plate fixation and 28 cases of intramedullary nail fixation. Union, postoperative complications and Kitaoka and Olerud-Molander functional scores were analyzed after one year of follow-up. There was no significant difference in the rate of union (P=0.5605) between the two types of fixation. There were significantly fewer complications (7% versus 56%) and better functional scores (96 versus 82 for the Kitaoka score; 97 versus 83 for the Olerud-Molander score) with intramedullary nailing than with plate fixation. Intramedullary nailing of the lateral malleolus in non-comminuted ankle fractures without syndesmotic injury is a reproducible technique with very few complications that provides better functional results than plate fixation. II (randomized prospective study). Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  5. Open reduction and internal fixation of posterior pilon fractures with buttress plate.

    Science.gov (United States)

    Chen, Da-Wei; Li, Bing; Aubeeluck, Ashwin; Yang, Yun-Feng; Zhou, Jia-Qian; Yu, Guang-Rong

    2014-01-01

    Posterior pilon fractures are rare injuries and have not yet gained well recognition. The purpose of this study was to present the treatment outcome for patients with posterior pilon fractures treated with buttress plate. In this retrospective study we identified patients with posterior pilon fractures of the distal tibia who had undergone open reduction and internal fixation at our institute. Between January 2007 and December 2009, 10 patients (mean age, 46.5 years) who had undergone buttress plating via either a posterolateral approach or a dual posterolateral-posteromedial approach, were selected. All 10 patients were available for follow-up. The clinical outcome was evaluated with the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the visual analogue scale (VAS). The radiological evaluation was performed using the osteoarthritis-score (OA-score). Satisfactory reduction and stable fixation were accomplished in all patients. At a mean follow-up of 36.2 months, all patients had good radiological results and showed satisfactory clinical recovery. The mean AOFAS sore was 87.8, the mean OA-score was 0.6, and the mean VAS scores during rest, active motion, and weight-bearing walking were 0.6, 0.8, and 1.4, respectively. Buttress plating for posterior pilon fractures gave satisfactory clinical outcomes. It also ensured rigid fixation which in turn enabled earlier postoperative mobilization. Level of Evidence IV, Retrospective Study.

  6. Interpretation of Post-operative Distal Humerus Radiographs After Internal Fixation: Prediction of Later Loss of Fixation

    NARCIS (Netherlands)

    Claessen, F.M.; Stoop, N.; Doornberg, J.N.; Guitton, T.G.; Bekerom, M.P. van den; Ring, D.; Biert, J.; et al.,

    2016-01-01

    PURPOSE: Stable fixation of distal humerus fracture fragments is necessary for adequate healing and maintenance of reduction. The purpose of this study was to measure the reliability and accuracy of interpretation of postoperative radiographs to predict which implants will loosen or break after

  7. Efficacy of Routine Postoperative CT Scan After Open Reduction and Internal Fixation of the Acetabulum.

    Science.gov (United States)

    Archdeacon, Michael T; Dailey, Steven K

    2015-08-01

    The purpose of this study was to evaluate the efficacy of routine postoperative computed tomography (CT) scan after open reduction and internal fixation of acetabular fractures. Retrospective review of prospectively collected acetabulum fracture database. Level I trauma center. A total of 606 consecutive patients underwent surgical fixation of 612 acetabular fractures. All patients were evaluated with intraoperative fluoroscopy in addition to 3 standard plain radiographs (AP pelvis and two 45 degrees oblique Judet views). Reduction and fixation were believed to be adequate and definitive before exiting the operative suite based on these imaging modalities. Axial postoperative CT scan of the pelvis was obtained in 563 of the patients (93%) after 569 operative cases. Revision acetabular surgery based on routine postoperative CT scan findings. There were no significant differences between index and revision surgery groups regarding age, gender, body mass index, fracture pattern, mechanism of injury, or surgical approach (P > 0.05). Evaluation of 563 postoperative CT scans of the pelvis resulted in revision acetabular surgery for 2.5% of patients (n = 14). There were 6 (1.1%) cases of intraarticular hardware not recognized on the intraoperative fluoroscopy or pelvic radiographs. Four patients (0.7%) had residual intraarticular osteochondral fragments deemed too large to leave in the hip joint. There were 3 cases (0.5%) of unacceptable malreduction, and 1 case (0.2%) of both malreduction and an intraarticular osteochondral fragment. A small percentage of patients (2.5%) will benefit from a routine CT scan after acetabular fracture fixation. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

  8. Minimally invasive anterior pelvic internal fixation: An anatomic study comparing Pelvic Bridge to INFIX.

    Science.gov (United States)

    Reichel, Lee M; MacCormick, Lauren M; Dugarte, Anthony J; Rizkala, Amir R; Graves, Sara C; Cole, Peter A

    2018-02-01

    Anterior external fixation for pelvic ring fractures has shown to effectively improve stability and reduce mortality. However, these fixators can be associated with substantial morbidity such as pin tract infection, premature loss of fixation, and decreased quality of life in patients. Recently, two new methods of subcutaneous anterior pelvic internal fixation have been developed; the INFIX and the Pelvic Bridge. These methods have the purported advantages of lower wound complications, less surgical site pain, and improved quality of life. We sought to investigate the measured distances to critical anatomic structures, as well as the qualitative and topographic differences notable during implantation of both devices in the same cadaveric specimen. The Pelvic Bridge and INFIX were implanted in eleven fresh cadavers. Distances were then measured to: the superficial inguinal ring, round ligament, spermatic cord, lateral femoral cutaneous nerve (LFCN), femoral nerve, femoral artery, and femoral vein. Observations regarding implantation and topography were also recorded. The INFIX had greater measured distances from all structures except for the LFCN, in which its proximity placed this structure at risk. Neither device appears to put other critical structures at risk in the supine position. Significant implantation and topographic differences exist between the devices. The INFIX application lacked "safety margins" concerning the LFCN in 10/11 (90.9%) specimens, while Pelvic Bridge placement lacked "safety margins" with regard to the right superficial ring (1/11, 9%) and the right spermatic cord (1/11, 9%). Both the Pelvic Bridge and INFIX lie at safe distances from most critical pelvic structures in the supine position, though INFIX application places the LFCN at risk. Copyright © 2017 Elsevier Ltd. All rights reserved.

  9. End-stage hindfoot arthrosis: outcomes of tibiocalcaneal fusion using internal and Ilizarov fixation.

    Science.gov (United States)

    Crawford, Brooke; Watson, J Tracy; Jackman, James; Fissel, Brian; Karges, David E

    2014-01-01

    End-stage post-traumatic pantalar arthrosis from ankle, pilon, and talus fractures has often been complicated by infection, bone loss, and a soft tissue deficit. Patients can present with neuropathy, diabetes, tobacco use, and previously failed arthrodesis. Fusion in this population has been challenging, with nonunion rates up to 30%, often leading to amputation. We reviewed the results of a standardized protocol that combined simultaneous internal fixation with the Ilizarov technique to achieve fusion in high-risk patients. With institutional review board approval, a retrospective review of the patients treated with simultaneous internal fixation and an Ilizarov frame was undertaken. The records and radiographs allowed identification of the comorbidities and the presence or absence of successful fusion. Complications were acknowledged and treated. Fifteen patients had undergone the procedure. The mean follow-up period was 27.9 (range 9 to 67) months. Thirteen patients (86.67%) had had previous fusion failure. Twelve patients (80%) had developed post-traumatic arthrosis, 5 (33.33%) of whom had open injuries. All patients had 1 comorbidity, and 10 (66.67%) had multiple, including rheumatoid arthritis, diabetes (types 1 and 2), and smoking. Four patients (26.67%) presented with deep infection and bone loss. Union was achieved in 11 (73.33%), with 12 (80%) patients experiencing profound pain relief. Seven patients (46.67%) required symptomatic hardware removal. Three patients (20%) eventually underwent below-the-knee amputation for recalcitrant nonunion. Statistically significant correlations were found between smoking and wound infection and revision and between nonunion and amputation. Our results have indicated that combined internal fixation with Ilizarov application can provide a strong surgical option for the management of end-stage, pantalar arthritis. More studies are needed to compare the cohort outcomes and gait analysis in these patients with those who have

  10. Outcome of open reduction and internal fixation of intraarticular calcaneal fracture fixed with locking calcaneal plate

    Directory of Open Access Journals (Sweden)

    Jain Saurabh

    2013-12-01

    Full Text Available 【Abstract】Objective: Debate continues regarding the management of calcaneal fractures, between open re- duction and internal fixation and closed treatment. Hence we aim at evaluating the radiological and functional out- comes of open reduction and internal fixation in displaced joint depression type of calcaneal fractures fixed with lock- ing calcaneal plate. Methods: In this series, 28 patients (26 unilateral and 2 bilateral with joint depression type of calcaneal fractures as per Essex-Lopresti classification system were operated on with locking calcaneal plate within 3 weeks of injury. Patients were evaluated in terms of associated injuries and X-rays of anteroposterior, lateral and axial views of the calcaneum. CT scan was done to assess the amount of com- minution and articular depression. Patients were followed up clinically and radiologically at least for 1 year. Radiologi- cal assessment was done by Bohler’s angle and Gissane’s angle along with measurement of calcaneal height and width. Functional outcome was assessed using the American Or- thopaedics Foot and Ankle Society (AOFAS scale. Results: At average follow-up of 14.5 months, average AOFAS score was 86.3 (range 66 to 97, with 86% having excellent to good results and 2 (7.7% and 1 (3.7% having fair and poor results respectively. All patients had stable ankle joint with all having dorsiflexion and plantar flexion more than 30°. Average subtalar range of motion was 17°. The mean Bohler’s angle, mean Gissane’s angle, calcaneal height and width were 25.47°, 121.3°, 4.32 cm and 3.81cm respectively at final follow-up. Three patients had flap ne- crosis at incision site and one had superficial and deep infection. Subtalar arthritis was seen in 5 patients, whereas sural nerve hypoaesthesia in 1 patient. None of the patients had compartment syndrome, heel pad problems, peroneal tendinitis, reflex sympathetic dystropy or implant failure. Conclusion: Open reduction and

  11. Promising Effect Of Intraarticular Ropivacaine In Femoral Neck Fractures Treated With Internal Fixation (Best Poster Award)

    DEFF Research Database (Denmark)

    Bech, Rune Dueholm

    2008-01-01

     Promising Effect Of Intraarticular Ropivacaine In Femoral Neck Fractures Treated With Internal Fixation Rune Bech*, Jens Lauritsen*+,Tine Dimon*, Ole Ovesen*, Claus Emmeluth, Søren Overgaard*. *:Dept. Ortopaedic Surgery, Odense University Hospital, +:Institute of Public Health-dept. biostatistics...... underwent osteosynthesis with 2 canulated hip screws and were prescribed regular paracetamol and supplementary opioid rescue analgesia as necessary. Pilot group: 11 patients received one peroperative (30 mL=100 mg) and 6 postoperative bolus installations  (10 mL=100 mg) of open label Ropivacaine through...

  12. Proximal femoral reconstruction for failed internal fixation of a bisphosphonate-related femur fracture

    Directory of Open Access Journals (Sweden)

    Rishabh G. Jethanandani, BSE

    2016-12-01

    Full Text Available We present a case of a bisphosphonate-related femur fracture in an elderly woman, who failed treatment with both cephalomedullary nail and proximal femoral locking plate, leading to successful treatment with total hip arthroplasty. Hardware failure should be included in the differential of patients with previous internal fixation of bisphosphonate-related femur fracture that present with hip or groin pain. Arthroplasty can be an acceptable salvage option in an active elderly patient with a bisphosphonate-related femur fracture.

  13. [Iindividual choice of distal fibula internal fixation for ankle fractures in elderly].

    Science.gov (United States)

    Tang, Yang-Hua; Zeng, Lin-Ru; Xin, Da-Wei; Yue, Zhen-Shuang; Hu, Zhong-Qing; Xu, Can-da

    2016-12-25

    To explore individual choice and therapeutic effect of distal fibula internal fixation in treating ankle fractures in elderly. From May 2012 to April 2015, 68 elderly patients with ankle fractures were treated by surgical operation, included 37 males and 31 females with an average of 69.2 years old ranging from 62 to 81 years. According to Danis-Weber classification, there were 19 cases belong to type A, 31 cases belong to type B, and 18 cases belong to type C. According to Lange-Hanson classification, 22 cases were supinatio-extorsion, 18 were pronate-extorsion, 19 were supinatio-adduction, and 9 were pronate-abduction. All patients were performed individyually with different internal fixation methods for the treatment of distal fibula fracture according to different types of fracture. Clinical results were evaluated based on clinical examination, radiographic evaluation and AOFAS score. Twelve patients were treated with Herbert screw, 7 cases with Kirschner wire tension band, 5 cases with 1/3 tube plate, 6 cases with reconstruction plate, 17 cases with fibular end dissection steel plate composite, and 21 cases with distal fibula anatomic locking plate. All patients were followed up from 12 to 26 months with an average of 17.7 months. The operative incision of all patients were primary healed. And there was no bone nonunion, ankle instability, internal fixation loosening and fracture occurred. Fracture healing time ranged from 2.7 to 4 months with an average of 3.2 months, and had significant differences among different groups( P 0.05). Dorsal stretch was 6° to 18° with an average of 15°, plantar flexion ranged from 26°to 47° with an average of 37°. AOFAS score at the latest following-up was 88.4±4.3, 34 patients got an excellent result, 30 good and 4 fair. Good clinical results could be obtained by using individualized internal fixation for distal fibula fracture for the treatment of the ankle fractures in elderly.

  14. Treatment of irreducible old atlantoaxial subluxation with cable-dragged reduction and cantilever beam internal fixation.

    Science.gov (United States)

    Liu, Xi; Liu, Hao; Li, Tao; Gong, Quan; Song, Yueming; Liu, Limin; Shi, Rui; Zhao, Xiaodan; Zhang, Wenli; Feng, Ganjun; Wang, Beiyu

    2011-07-01

    Retrospective case series study of surgical outcome for 21 atlantoaxial subluxation patients treated with a new technique, called cable-dragged reduction/cantilever beam internal fixation. Surgery was performed by a single surgeon. To describe and evaluate the cable-dragged reduction/cantilever beam internal fixation technique for the treatment for old atlantoaxial subluxation irreducible by traction. Management of old atlantoaxial subluxation has always been a difficult task. A more effective way to achieve surgical reduction is needed. Twenty one patients, aged 31.6 ± 13.3 years (range, 11-67 years), 17 men and four women, with atlantoaxial subluxation that failed to be reduced after 10 to 111 days in traction, underwent posterior cable-dragged reduction/cantilever beam internal fixation surgery. Frankel classification of neural function before surgery was the following: Frankel B, four patients; Frankel C, five patients; Frankel D, four patients; and Frankel E, eight patients. Plain radiographs, computed tomographic three-dimensional reconstructive images and magnetic resonance images of the cervical spine were obtained at 3, 6, and 12 months after surgery, and each year thereafter. No patient was lost to follow-up, and the follow-up time ranged from 6 months to 4 years. Rate of reduction and C1∼3 fusion, as well as improvement of neural function, were recorded and analyzed. The average follow-up period was 13.2 months. Radiographic evaluation of the group at follow-up showed 16 complete and five partial reductions, and satisfactory decompression and C1∼3 fusion in all cases. Neural function at the end of the follow-up was Frankel B still in one patient, Frankel C in seven patients, and Frankel E in 13 patients. Cable-dragged reduction/cantilever beam internal fixation is almost as effective for reduction as anterior release but is less invasive and risky. It has similar operative time and blood loss to occipitocervical fusion but avoids arthrodesis of

  15. The quality of life after a femoral neck fracture in elderly patients: a comparative study between internal fixation and arthroplasties

    Directory of Open Access Journals (Sweden)

    Dennis Sansanovicz

    2017-01-01

    Full Text Available Introduction: The femoral neck fracture is a frequent pathology in the elderly population, with about of 100,000 cases per year in Brazil. The surgical treatment by internal fixation or arthroplastic hip replacement is advocated today. The non-surgical treatment is reserved for cases of exception. Objective: To compare the quality of patient postoperative life treated for femoral neck fracture by two different techniques: hip arthroplasty and internal fixation. Methods: Through the SF-36 questionnaire, we study the quality of life of 60 patients with more than 65 years, treated between 2004 and 2012 in our service. Half of the patients was submitted to internal fixation and the other half to the arthroplastic replacement. Results: Higher averages in the large majority of the parameters of the questionnaire were obtained by the group which was carried out by internal fixation, but without statistical significance in most of these differences. Some international reports indicate that patients who have suffered a fracture of the femoral neck and were treated with internal fixation may recover the quality of life they had before the fracture. Paradoxically, there is a growing trend among orthopedic surgeons to perform a hip replacement surgery in these cases. Conclusion: Further studies are needed to define which is the best surgical treatment option.

  16. [Clinical observation of dynamic cervical implant (DCI) internal fixation in the surgical treatment of cervical spondylosis].

    Science.gov (United States)

    Li, Zhong-hai; Hou, Shu-xun; Li, Li; Yu, Shun-zhi; Hou, Tie-sheng

    2014-12-01

    To investigate the early clinical effects and radiological outcome of dynamic cervical implant (DCI) internal fixation in treating cervical spondylosis, and evaluate its safety and efficiency. From June 2009 to December 2011, 19 patients with cervical spondylosis correspond to the indication of DCI internal fixation in the study, including 5 cases of cervical spondylotic myelopathy and 14 cases of cervical spondylotic radiculopathy. There were 8 males and 11 females, aged from 35 to 54 years with a mean of 43.2 years. Pathological segments included C3,4 in 1 case, C4,5 in 6, C5,6 in 6, C6,7 in 4, C3,4 and C5,6, C6,7 in 2. All patients were treated with anterior discectomy and decompression and DCI internal fixation, meanwhile, 2 cases of them with anterior cervical corpectomy and fusion plate fixation. Clinical evaluation included Modified Japanese orthopedics association (mJOA), neck disability index (NDI), visual analogue scale (VAS) score and patient satisfaction index (PSI) at pre-operation and final follow-up. Radiographic evaluation included flexion/extension lateral view at operative level and adjacent segment. The adjacent level degeneration was analyzed according to Miyazaki classification on MRI images. All patients were followed up from 12 to 42 months with an average of 19.8 months. Preoperative mJOA score was 13.6±1.1 and at final follow-up was 16.3±1.2 with improvement rate of 85.0%. Preoperative VAS,NDI was 6.6± 1.4, 17.1±7.4 and at final follow-up was 1.4±0.8, 6.1±3.9, respectively; there was statistical significance in all above-mentioned results between preoperative and final follow-up (P0.05). Preoperative DHI at operation level was (6.3±1.1) mm and final follow-up was (7.1±0.8) mm, there was statistical significance in DHI between preoperative and final follow-up (Pspondylosis with dynamic cervical implant can got satisfactory outcome in early follow-up. Activity of operative segment obtain reservation in some degree. The incidence of

  17. The functional outcome of surgically treated unstable pelvic ring fractures by open reduction, internal fixation

    Directory of Open Access Journals (Sweden)

    Kaykhosro Mardanpour

    2011-07-01

    Full Text Available Background:Unstable Pelvic fracture,a result of high energy antero-posterior compression injury, has been managed based on internal fixation and open reduction. The mode of fixation in Unstable Pelvic fracture has, however, been a subject of controversy and some authors have proposed a need to address the issue of partial breach of the pelvic ring elements in these injuries. This study was performed to evaluate the functional and radiological results of treatment of pelvic ring fractures by open reduction, internal fixation. Methods: Thirty eight patients with unstable pelvic fractures, treated from 2002 to2008 were retrospectively reviewed. The mean age of patients’ was 37 years old (range 20 to 67. Twenty six patients were men and 12 women. The most common cause was a road traffic accident (N=37, 97%. There were 11 type-C and 27 type-B fractures according to Tile’s classification. Thirty six patients sustained additional injuries. The most prevalent additional injuries were lower extremity fractures. Open reduction, internal fixation as a definite management was applied for all patients. Quality of reduction was graded according to the grades proposed by Matta and Majeed’s score was used to assess the clinical outcome. The mean period of follow-up was 25 months (ranged from 6 to 109 months. About 81.6% of patients had either good or excellent radiological reduction. Results: The functional outcome was excellent in 66%, good in 15%, fair in 11% and poor in 7% of the patients. There were 4 postoperative infections. No sexual function problem was reported. Nerve deficits recovered completely in 2 and partially in 3 of 11 patients with preoperative neurologic deficiency. There was no significant relation between functional outcome and the site of fracture Conclusion: Unstable pelvic ring fracture injuries should be managed surgically by rigid stabilization that must be carried out as soon as the general ndition of the patient permits, and

  18. The anterior subcutaneous internal fixator (ASIF) for unstable pelvic ring fractures: clinical and radiological mid-term results.

    Science.gov (United States)

    Müller, Franz Josef; Stosiek, Wolfgang; Zellner, Michael; Neugebauer, Rainer; Füchtmeier, Bernd

    2013-11-01

    The purpose of this study was to determine the outcome of unstable type C pelvic fractures treated with posterior stabilisation and the anterior subcutaneous internal fixator (ASIF). Altogether, 36 consecutive patients were treated for unstable type C pelvic ring fractures using posterior stabilisation and ASIF. After a minimum of 18 months, the clinical and radiological outcome was retrospectively investigated. Overall, three patients (8.3%) died, and 31 patients (86%) were available for follow-up after a mean of 4.5 years. Thirty of 31 patients (97%) showed radiographic bone consolidation of both the posterior and anterior pelvic ring. Only one non-union and two infections due to the anterior device were observed. The total German pelvic outcome score showed an excellent or good rating for 64.5% of the patients, and a fair or poor for 35.5%. The SF-12 questionnaire showed a significantly reduced total score for physical and mental health compared to a general reference population. The ASIF represents an innovative surgical procedure for the treatment of type C pelvic ring fractures. In the medium term, patient satisfaction was high and the complication rate was low, despite the small number of patients. More cases must be investigated before the procedure can be recommended in general, possibly replacing the external fixator for the treatment of pelvic ring fractures in the future.

  19. Operative treatment of early infection after internal fixation of limb fractures (exclusive of severe open fractures).

    Science.gov (United States)

    Bonnevialle, P

    2017-02-01

    Early infection after open reduction and internal fixation (ORIF) of a limb bone is defined as bacteriologically documented, deep and/or superficial surgical-site infection (SSI) diagnosed within 6months after the surgical procedure. This interval is arbitrarily considered sufficient to obtain fracture healing. The treatment of early infection after ORIF should be decided by a multidisciplinary team. The principles are the same as for revision arthroplasty. Superficial SSIs should be differentiated from deep SSIs, based on the results of bacteriological specimens collected using flawless technique. A turning point in the local microbial ecology occurs around the third or fourth week, when a biofilm develops around metallic implants. This biofilm protects the bacteria. The treatment relies on both non-operative and operative measures, which are selected based on the time to occurrence of the infection, condition of the soft tissues, and stage of bone healing. Both the surgical strategy and the antibiotic regimen should be determined during a multidisciplinary discussion. When treating superficial SSIs after ORIF, soft-tissue management is the main challenge. The treatment differs according to whether the hardware is covered or exposed. Defects in the skin and/or fascia can be managed using reliable reconstructive surgery techniques, either immediately or after a brief period of vacuum-assisted closure. In deep SSIs, deciding whether to leave or to remove the hardware is difficult. If the hardware is removed, the fracture site can be stabilised provisionally using either external fixation or a cement rod. Once infection control is achieved, several measures can be taken to stimulate bone healing before the end of the classical 6-month interval. If the hardware was removed, then internal fixation must be performed once the infection is eradicated. Copyright © 2016. Published by Elsevier Masson SAS.

  20. 2000 Volvo Award winner in biomechanical studies: Monitoring in vivo implant loads with a telemeterized internal spinal fixation device.

    Science.gov (United States)

    Rohlmann, A; Graichen, F; Weber, U; Bergmann, G

    2000-12-01

    Implant loads were measured in 10 patients using telemeterized internal spinal fixation devices. To determine the postoperative temporal course of implant loads. Little information exists regarding the temporal course of loads on internal spinal fixation devices. The telemeterized internal spinal fixator allows the measurement of three force components and three moments acting in the fixator. Implant loads were determined in up to 20 measuring sessions for different activities, including walking, standing, sitting, lying in the supine position, and lifting an extended leg while in the supine position. Implant loads often increased shortly after anterior interbody fusion was performed. Several patients retained the same high level even after fusion had taken place. This explains the reason why screw breakage sometimes occurs more than half a year after implantation. The time of fusion could not be pinpointed from the loading curves. The results show that fixators may be highly loaded even after fusion has occurred. A flexion bending moment acts on the implant even with the body in a relaxed lying position. This means that already shortly after the anterior procedure, the shape of the spine is not neutral and unloaded, but slightly deformed, which loads the fixators. Pedicle screw breakage more than half a year after insertion does not prove that anterior interbody fusion has not occurred.

  1. Clinical use of computed tomography and surface markers to assist internal fixation within the equine hoof.

    Science.gov (United States)

    Gasiorowski, Janik C; Richardson, Dean W

    2015-02-01

    To describe clinical use of computed tomography (CT) and hoof surface markers to facilitate internal fixation within the confines of the hoof wall. Retrospective case series. Horses (n = 16) that had CT-guided internal fixation of the distal phalanx (DP) or distal sesamoid bone (DSB). Drill bit entry point and direction were planned from CT image series performed on hooves with grids of barium paste dots at proposed entry and projected exit sites. Post-implantation CT images were obtained to check screw position and length as well as fracture reduction. Imaging, reduction, and surgical and general anesthesia times were evaluated. Outcome was recorded. Screw position and length were considered near optimal in all horses, with no consequential malposition of bits or screws. Fracture reduction was evident in all cases. Preoperative planning times (at least 2 CT image acquisitions and grid creation) ranged from 10 to 20 minutes. Surgery time ranged from 45 to 90 minutes (mean, 61 minutes) and general anesthesia time ranged from 115 to 220 minutes (mean, 171 minutes). The combination of CT and surface marker grids allowed accurate positioning of screws in clinical DP and DSB fractures. The technique was simple and rapid. An aiming device is useful for the technique. © Copyright 2014 by The American College of Veterinary Surgeons.

  2. Time to internal fixation of femoral neck fractures in patients under sixty years--does this matter in the development of osteonecrosis of femoral head?

    Science.gov (United States)

    Razik, Fathima; Alexopoulos, Anastasia-Stefania; El-Osta, Bassel; Connolly, Michelle J; Brown, Ashley; Hassan, Soueid; Ravikumar, Kasetti

    2012-10-01

    Osteonecrosis of femoral head remains a major complication of femoral neck fractures. It has been postulated that early internal fixation drastically reduces the incidence of osteonecrosis of the femoral head. However, there is a paucity of literature looking at the effect of time delay to internal fixation on the development of this late complication. In this study, we aim to assess the effect of time delay and method of internal fixation on the development of osteonecrosis in those less than 60 years of age. We retrospectively analysed 92 patients less than 60 years of age who presented with intracapsular neck of femur fractures that underwent internal fixation between 1999 and 2009. Of the 92 intracapsular fractures, 50 underwent fixation using cannulated screws, 32 using a dynamic hip screw, and ten using a dynamic hip screw with a derotation screw. In total, 13 patients (14.1 %) developed osteonecrosis of the femoral head, the highest incidence being in the cannulated screw fixation group with an osteonecrosis rate of 24 %. We did not find the time delay to internal fixation to be a significant predictor of the development of osteonecrosis. Our study demonstrated that the method of internal fixation rather than delay in internal fixation was more predictive of osteonecrosis of the femoral head. We did not find support to the current belief that early surgical fixation of neck of femur fractures reduces the risk of osteonecrosis in patients less than 60 years.

  3. Distal Radius Fracture Treated by Internal Fixation with Plates, Screws and the RALCA® External Mini-fixator

    OpenAIRE

    Rafael López Cuellar; Yaniel Truffin Rodríguez; Yudit Pérez Álvarez

    2016-01-01

    Distal radius fractures are very common in medical practice. In our service, we may not have the most widely used devices for fixation of these fractures at a given moment. For this reason, we must consider all possible combinations within our power to correct them since most of the time, it is impossible to maintain a fracture reduction using a single technique. We present the case of a 24-year-old female patient treated at the Dr. Gustavo Aldereguía Lima University General Hospital in Cienf...

  4. [Choices of the internal fixation and approaches on unstable pelvic ring fractures].

    Science.gov (United States)

    Bi, Da-Wei; Zu, Gang; Han, Lei; Chen, Yi-Min; Ma, Hai-Tao; Hu, Gang-Feng; Zhu, Yuan

    2017-03-25

    To discuss the suitable surgical approach and the internal fixation of unstable pelvic pelvic fractures. From May 2010 to May 2015, 45 patients with unstable pelvic fractures were treated with different approaches and fixations, including 38 males and 7 females with an average age of 45 years ranging from 21 to 61 years. The course was within 2 weeks. According to Young-Burg classification, 23 patients were lateral compression injuries, 6 patients were vertical shearing injuries, 16 patients were anterior-posterior compression injuries. All patients had hip pain and limitation of motion, the X-rays showed the pelvic ring fracture. All wounds healed well without complications, 45 cases were followed up for a mean period of 13 months (ranged 9 to 21 months). Patients with hip pain had a good postoperative pain relief. The post-operative X-rays showed the reduction was satisfied and the pelvic ring shaped well. According to Majeed standards, the final follow-up score was 93.5±11.6, 35 cases got excellent results, 8 were good, 2 were fare. The unstable pelvic and acetabular fractures are always with compound injury. Beside the reduction, to decrease the second surgery trauma should take into consideration as well, the intra-articular reduction and the stability of the pelvic were especially valued, so combined the different approach with minimal invasive technique can get good clinical result.

  5. The timing of bone SPECT to predict osteonecrosis after internal fixation of femur neck fractures.

    Science.gov (United States)

    Kim, Ji Wan; Ryu, Jin-Sook; Baek, Sora; Byun, Seong-Eun; Chang, Jae Suk

    2017-05-01

    Bone SPECT can be used after a femur neck fracture to assess the circulation of the femoral head in the immediate postoperative period because the blood supply is one of the major factors affecting bone uptake of radiotracer on bone scintigraphy. The purpose of our present study was to investigate whether osteonecrosis of the femoral head (OFH) after internal fixation of femoral neck fracture could be predicted by early and late bone SPECT. This retrospective cohort study enrolled 44 patients (33 women; mean age, 66.9 years) who underwent surgical fixation for femoral neck fractures. Early and late bone SPECT images were obtained within 2 weeks postoperatively and at 3 months postoperatively. Patients were followed up for a minimum of 24 months (average, 34 months). OFH developed in 9 out of 44 patients but no patient showed nonunion. Seventeen patients with normal femoral head uptake on early bone SPECT were healed. Of 27 patients with decreased femoral head uptake on early bone SPECT, 2 patients developed OFH on radiography before 3 months postoperatively, 18 patients recovered to normal uptake on the late SPECT, and the remaining 7 patients still showed decreased uptake on the late SPECT at 3 months postoperatively. All of these 7 cases finally developed OFH on radiography. Bone SPECT can reliably predict the possibility of OFH with after femoral neck fracture at least 3 months after surgery, while early bone SPECT showed low specificity. Clinical. Copyright © 2016 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

  6. Distal radioulnar joint instability (Galeazzi type injury) after internal fixation in relation to the radius fracture pattern.

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    Korompilias, Anastasios V; Lykissas, Marios G; Kostas-Agnantis, Ioannis P; Beris, Alexandros E; Soucacos, Panayiotis N

    2011-05-01

    The purpose of this study was to classify Galeazzi type injuries and determine the association of residual instability after rigid fixation with the fracture pattern of the shaft of the radius, using a system that is based on anatomic landmarks of the radial shaft. The clinical records of 95 patients (72 men and 23 women) with Galeazzi type injuries requiring open reduction and internal fixation of the fractures were retrospectively reviewed. The mean follow-up was 6.8 years (range, 18 mo to 11 y) after injury. Sixty-nine fractures occurred in the distal third of the radial shaft (type I), 17 fractures were in the middle third (type II), and 9 fractures were in the proximal third of the shaft of the radius (type III). Gross instability of the distal radioulnar joint (DRUJ) was determined intraoperatively by manipulation after radial fixation as compared to the uninjured side. Forty patients had DRUJ instability after internal fixation and were treated with temporary pinning with a K-wire placed transversely proximal to the sigmoid notch. Distal radioulnar joint instability after internal fixation was recorded in 37 type I fractures, 2 type II fractures, and 1 type III fracture. Distal radioulnar joint instability following radial shaft fracture fixation is significantly higher in patients with type I fractures than in patients with type II or type III fractures. The location of the radius fracture can be sufficiently used for preoperative estimation of percentage chance of potential DRUJ instability after fracture fixation. Copyright © 2011 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  7. Osteosynthesis of ununited femoral neck fracture by internal fixation combined with iliac crest bone chips and muscle pedicle bone grafting

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    D D Baksi

    2016-01-01

    Full Text Available Background: Ununited femoral neck fracture is seen commonly in developing countries due to delayed presentation or failure of primary internal fixation. Such fractures, commonly present with partial or total absorption of femoral neck, osteonecrosis of femoral head in 8-30% cases with upward migration of trochanter posing problem for osteosynthesis, especially in younger individuals. Several techniques for treatment of such conditions are described like osteotomies or nonvascularied cortical or cancellous bone grafting provided varying degrees of success in terms of fracture union but unsatisfactory long term results occurred due to varying incidence of avascular necrosis (AVN of femoral head. Moreover, in presence of AVN of femoral head neither free fibular graft nor cancellous bone graft is satisfactory. The vascularied bone grafting by deep circumflex iliac artery based on iliac crest bone grafting, free vascularied fibular grafting and muscle pedicle periosteal grafting showed high incidence of success rate. Osteosynthesis is the preferred treatment of choice in ununited femoral neck fracture in younger individuals. Materials and Methods: Of the 293 patients operated during the period from June 1977 to June 2009, 42 were lost to followup. Seven patients with gluteus medius muscle pedicle bone grafting (MPBG were excluded. Thus, out of 244 patients, 208 (85.3% untreated nonunion and 36 (14.7% following failure of primary internal fixation were available for studies. Time interval between the date of injury and operation in untreated nonunion cases was mean 6.5 months and in failed internal fixation cases was mean 11.2 months. Ages of the patients varied from 16 to 55 years. Seventy patients had partial and 174 had subtotal absorption of the femoral neck. Evidence of avascular necrosis (AVN femoral head was found histologically in 135 (54.3% and radiologically in 48 (19.7% patients. The patients were operated by open reduction of fracture

  8. First metatarsophalangeal joint arthrodesis: a new technique of internal fixation by using memory compression staples.

    Science.gov (United States)

    Choudhary, Rakesh K; Theruvil, Bipin; Taylor, Graeme R

    2004-01-01

    A prospective clinical study of first metatarsophalangeal joint arthrodesis using memory compression staples is presented. In 27 patients, 30 feet underwent surgery. There were 24 women and 3 men, with a mean age of 61.2 years. Two memory compression staples were used at right angles to each other to achieve compression at the fusion site. Postoperatively, patients were allowed full weightbearing in a rigid-soled shoe. Subjective assessment was performed with a standard questionnaire, which included questions regarding level of pain, ambulation, and patient satisfaction. Objective assessment was performed by a clinical and included a radiographic examination. There was a postoperative reduction in the pain score from 4.6 to 1.6 (P memory compression staples for the internal fixation of first metatarsophalangeal joint arthrodesis. The implant is low profile, and postoperative cast immobilization is not required. The use of this device has a predictable success rate comparable to previously reported methods.

  9. What is the best internal fixation in pelvic fracture models with open-book injury and anterior sacroiliac joint disruption?

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    Ismail H. Dilogo

    2015-12-01

    Full Text Available Background: The best operative management for open-book pelvic injury with anterior sacroiliac disruption (OTA/AO B1.1 classification is still debated. This biomechanical study aimed to find the best internal fixation technique for such injury. Methods: Open-book injury with anterior sacroiliac joint disruption was simulated on 25 artificial pelvic bones. Twenty five artificial pelvic bones were divided into 5 groups (n=5 /group and fixated with five different fixation techniques: 1. 1SP+1IS; 2. 2SP; 3. 2SP+2SIP; 4. 1SP+2IS S1, and 5. 1SP+1IS S1+S2. Biomechanical properties of each fixation technique were assessed using Tensilon® RTF-1310 to measure the resistance to translation and load to failure. Data were statistically analyzed using one-way ANOVA followed by post-hoc Bonferroni test.Results: The highest mean load to failure of axial forces (1490.36 N was achieved by the fixation technique using one symphyseal plate and two iliosacral screws located at S1 dan S2. The addition of one iliosacral screw significantly increased the mean load to failure for axial compression (p<0.05.Conclusion: The addition of sacroiliac joint posterior fixation, either with plate or screw, will increase the fixation biomechanical strength. Single symphyseal plate and two iliosacral screws on S1 and S2 provided the best mechanical resistance to axial loading. Thus, it can be concluded that such fixation technique is best for open-book pelvic injury with anterior sacroiliac disruption.

  10. Orthopedic infections in equine long bone fractures and arthrodeses treated by internal fixation: 192 cases (1990-2006).

    Science.gov (United States)

    Ahern, Benjamin J; Richardson, Dean W; Boston, Raymond C; Schaer, Thomas P

    2010-07-01

    To determine the rate of postoperative infection (POI) for internal fixation repaired equine long bone fractures and arthrodeses and identify associated risk factors. Case series. Horses (n=192) with fracture repair of the third metacarpal and metatarsal bones, radius, ulna, humerus, tibia, and femur, or arthrodesis with internal fixation. Medical records (1990-2006) were reviewed for signalment, anatomic location, fracture classification and method of repair, technique and surgical duration, bacterial species isolated, postoperative care, onset of POI, and outcome. Of 192 horses (171 [89%] closed, 21 [11%] open fractures), 157 (82%) were discharged from the hospital. Infection occurred in 53 (28% horses), of which 31 (59%) were discharged. Repairs without POI were 7.25 times more likely to be discharged from the hospital. Closed fractures were 4.23 times more likely to remain uninfected and 4.59 times more likely to be discharged from the hospital compared with open fractures. Closed reduction and internal fixation was associated with a 2.5-fold reduction in rate of POI and a 5.9 times greater chance for discharge from the hospital compared with open reduction and internal fixation. Females had a strong trend for increased POI when compared with colts and stallion but not geldings. Overall rate of POI was 28%. Fracture classification, method of repair, gender, and surgical duration were significant risk factors.

  11. Arthroscopic assisted reduction and internal fixation of lateral femoral epiphyseal injury in adolescent soccer player: a report of one case.

    Science.gov (United States)

    Lee, Yong Seuk; Jung, Young Bok; Ahn, Jin Hwan; Shim, Jong Seop; Nam, Dae Cheol

    2007-06-01

    Ligament injuries are more common than fractures in adolescents. We operated on an adolescent soccer player, who had a lateral femoral epiphyseal injury using arthroscopic-assisted reduction and percutaneous internal fixation. During second-look arthroscopy 2 years after the first operation, there was articular cartilage congruity, without any visible step-off. The axial alignment did not reveal any residual valgus deformity.

  12. The effect of internal fixation lamp on anterior chamber angle width measured by anterior segment optical coherence tomography.

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    Nakamine, Sakari; Sakai, Hiroshi; Arakaki, Yoshikuni; Yonahara, Michiko; Kaiya, Tadayoshi

    2018-01-01

    To study the effect of the internal fixation lamp on anterior chamber width measured by anterior segment optical coherence tomography. In a prospective cross sectional observational study, consecutive 22 right eyes of 22 patients (4 men and 18 women) with suspected primary angle closure underwent swept source domain anterior segment optical coherence tomography (AS-OCT), (CASIA SS-1000, Tomey, Nagoya, Japan). Anterior chamber parameters of angle opening distance (AOD), trabecular-iris angle (TIA), angle recess area (ARA) at 500 or 750 µm from scleral spur and pupil diameter were measured by AS-OCT in a three-dimensional mode in 4 quadrants (superior, inferior, temporal and nasal) in dark room setting both with and without internal fixation lamp. Anterior segment parameters of AOD 500 in superior, inferior and temporal quadrants, AOD 750 at superior and nasal, TIA 500 at superior, and inferior and TIA 750 at superior and nasal, and ARA 500 or 750 at superior and inferior with internal fixation lamp were greater and the pupil diameter was significantly (all P chamber angle is narrow but open, it is recommended that the internal fixation lamp be turned off to ensure a clear indication as to whether the angle is open or closed in the dark.

  13. A biomechanic comparison of an internal radiocarpal-spanning 2.4-mm locking plate and external fixation in a model of distal radius fractures.

    Science.gov (United States)

    Wolf, Jonathon C; Weil, Wayne M; Hanel, Douglas P; Trumble, Thomas E

    2006-12-01

    To compare the biomechanic stability of distal radius fracture fixation with a new internal radiocarpal-spanning 2.4-mm locking plate, which acts as an internal distal radius fixator, versus a standard distal radius external fixator. The number of locking screws necessary for adequate fracture fixation was also assessed. Ten cadaveric specimens were mounted in a loading fixture with cables attached to the 2 flexor and 3 extensor wrist tendons. A 1-cm osteotomy was created to simulate an unstable distal radius fracture. The radiocarpal-spanning locking plate was fixed to the radius and index metacarpal with 4 screws proximally and 4 distally. The specimen was incrementally loaded through the tendons. Motion at the fracture site was determined. Screws were sequentially removed from the construct, the specimen was again incrementally loaded, and fracture motion was measured. The fixation was then changed to an external fixator, and the loading tests were repeated. Fracture fixation with the radiocarpal-spanning 2.4-mm locking plate was significantly more stable with 4 screws proximally and 4 screws distally (4 x 4) and with the 3 x 3 configuration than with the external fixator in both flexion and extension. The 4 x 4 screw configuration was not significantly different from the 3 x 3 screw configuration. The 4 x 4 screw configuration was significantly more stable than the 2 x 2 and 1 x 1 screw configurations in both flexion and extension. All internal fixator configurations and the external fixator showed more fracture displacement at increasingly higher loads. Fracture fixation with the new internal radiocarpal-spanning 2.4-mm locking plate is more stable than with a standard distal radius external fixator. Only three 2.4-mm locking screws proximally and three 2.4-mm locking screws distally are required for adequate fixation of the locking spanning plate.

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

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    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.

  15. Fractures of the posterior wall of the acetabulum: treatment using internal fixation of two parallel reconstruction plates.

    Science.gov (United States)

    Li, Heng; Yang, Honghang; Wang, Dan; Xu, Yi; Min, Jikang; Xu, Xuchun; Li, Zhanchun; Yuan, Yongjian

    2014-04-01

    Our aim was to evaluate the efficacy of the treatment method using internal fixation of parallel reconstruction plates for the posterior wall of the acetabulum fractures. Randomised, prospective. Level I trauma centre. 57 patients with posterior wall fractures of the acetabulum in our department from 2007 to 2010 were treated operatively using this technique. internal fixation of two parallel reconstruction plates was used in this study. One of the plates was near the border of acetabulum. The other was parallel to the former one and was located to stress concentrated area. The clinical outcome was evaluated using the clinical grading system and radiological outcome was evaluated according to the criteria described by Matta. In addition, complications were researched in this study. The percentages of the clinical excellent-to-good and fair-to-poor results were 93.0% and 7%, respectively. We found that clinical outcome had no correlation with age, operation time from injury to operation, nor had correlation with hip dislocation, comminuted fracture condition and marginal compression fracture. Anatomical reduction was significantly correlated with excellent-to-good clinical outcome. Necrosis of the femoral head and heterotopic ossification were prone to decline the outcome of acetabular fractures despite good fracture reduction. the internal fixation of two parallel reconstruction plates facilitated rigid fixation and avoided fracture fragment injury, was an effective and reliable alternative method to treat fractures of the posterior wall of the acetabulum. Copyright © 2013 Elsevier Ltd. All rights reserved.

  16. 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.

  17. 2-octyl-cyanoacrylate glue for fixation of STSG in genitourinary tissue defects due to Fournier gangrene: a preliminary trial.

    Science.gov (United States)

    Sivrioğlu, Nazan; Irkören, Saime; Ceylan, Ender; Sonel, Ali Murat; Copçu, Eray

    2013-05-01

    In these reported cases, we observed the outcomes of skin take and wound healing using 2-octyl-cyanoacrylate glue, which was used as tissue glue in the reconstruction of complex genital skin loss due to fournier gangrene. Fifteen patients with Fournier's gangrene were treated in this study. After initial surgical debridement, all defects were repaired using STSG. In this method a thin layer of 2-octyl-cyanoacrylate was dripped on the recipient site immediately before graft application. All wounds were followed up postoperatively and observed for evidence of graft take, seroma or hematoma formation, drainage, and infection. Patient and physician satisfaction were also determined. Grafts were completely accepted in all fifteen patients. None of the patients had wound infection, seroma, hematoma, or other complications. Use of 2-octyl-cyanoacrylate glue (Glueseal) for STSG fixation in complex genital skin defects after Fournier gangrene may be an acceptable alternative to conventional surgical closure with a good cosmetic outcome. Further studies are needed to confirm our initial success with this approach.

  18. Combined circular external fixation and open reduction internal fixation with pro-syndesmotic screws for repair of a diabetic ankle fracture

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    Zacharia Facaros

    2010-10-01

    Full Text Available The surgical management of ankle fractures among the diabetic population is associated with higher complication rates compared to the general population. Efforts toward development of better methods in prevention and treatment are continuously evolving for these injuries. The presence of peripheral neuropathy and the possible development of Charcot neuroarthropathy in this high risk patient population have stimulated much surgical interest to create more stable osseous constructs when open reduction of an ankle fracture/dislocation is required. The utilization of multiple syndesmotic screws (pro-syndesmotic screws to further stabilize the ankle mortise has been reported by many foot and ankle surgeons. In addition, transarticular Steinmann pins have been described as an adjunct to traditional open reduction with internal fixation (ORIF of the ankle to better stabilize the talus, thus minimizing risk of further displacement, malunion, and Charcot neuroarthropathy. The authors present a unique technique of ORIF with pro-syndesmotic screws and the application of a multi-plane circular external fixator for management of a neglected diabetic ankle fracture that prevented further deformity while allowing a weight-bearing status. This technique may be utilized for the management of complex diabetic ankle fractures that are prone to future complications and possible limb loss.

  19. Quality of life in treatment of mandibular fractures using closed reduction and maxillomandibular fixation in comparison with open reduction and internal fixation--a randomized prospective study.

    Science.gov (United States)

    Omeje, Kevin U; Rana, Majeed; Adebola, Adetokunbo R; Efunkoya, Akinwale A; Olasoji, Hector O; Purcz, Nicolai; Gellrich, Nils-Claudius; Rana, Madiha

    2014-12-01

    Treatment of mandibular fractures by open reduction and internal fixation (ORIF) is often assumed to be superior to treatment by close reduction and maxillomandibular fixation (MMF) because patients managed by ORIF seem to be rehabilitated earlier according to functional and social aspects. This assumption is often from surgeon's perspective, not taking into account patient's view point. This study highlights a comparative assessment between ORIF and MMF from the patients' perspective. Fifty six patients with mandibular fractures within the tooth bearing areas of the mandible were prospectively studied in a randomized controlled pattern for postoperative Quality of Life (QoL) after ORIF versus MMF. Both groups were analyzed preoperatively, at 1 day, 6 and 8 weeks regarding their QoL using the General Oral Health Assessment Index questionnaire (GOHAI). No significant statistical difference was found between the groups regarding overall QoL. Patients managed by MMF were more affected by psychosocial and physical domains whereas patients managed by ORIF were more affected by the pain domain. The results demonstrate that the treatment affects the psychosocial, physical and pain domain differentially. When both treatments are possible the patient's should be enlightened on the advantages and disadvantages of both treatment modalities to guide their choice of treatment. Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  20. Is arthroscopic assisted percutaneous screw fixation as good as open reduction and internal fixation for the treatment of displaced intra-articular calcaneal fractures?

    Science.gov (United States)

    Yeap, Ewe Juan; Rao, Jaynesthra; Pan, Chee Huan; Soelar, Shahrul Aiman; Younger, Alistair S E

    2016-09-01

    This study compares the outcomes of calcaneal fracture surgery after open reduction internal fixation and plating (ORIF) versus arthroscopic assisted percutaneous screw fixation (APSF). Group I (N=12) underwent ORIF. Group II (N=15) underwent APSF. Anthropometric data, pre and post-operative stay, complications and duration off work were recorded in this retrospective case cohort study. Radiographs were analyzed for Bohler's, Gissane's angle and Sanders' classification. AOFAS Hindfoot and SF 36 scores were collected at final follow-up. Anthropometric data, Bohler's and Gissane's angles, AOFAS and SF 36 scores were not significantly different. Pre-operative duration was 12.3 days in ORIF and 6.9 days in APSF. Post-operative duration was 7.3 days vs 3.8 days. Duration off work was 6.2 months vs 2.9 months. The APSF group was able to have surgery earlier, go home faster, and return to work earlier. This study was not powered to demonstrate a difference in wound complication rates. Copyright © 2015 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  1. [Nylon fixation at the internal and external canthus combined with skin graft for recurrent lower eyelids ectropion].

    Science.gov (United States)

    Yu, Li; Wang, Jiaqi

    2015-01-01

    To investigate the long-time effects of nylon fixation at the internal and external canthus combined with skin graft for recurrent lower eyelids ectropion. Under local anesthesia, the cicatricial contraction was released to repostion the lower eyelid. Then nylon thread was implanted in the fascial tissue at the upper margin of tarsus and was fixed on the periosteum at the internal and external canthus. The skin graft was applied on the wound of lower eyelids. 12 patients with lower eyelids ectropion at 19 sides were treated with primary healing. The patients were followed up for 6-24 months. All cases were satisfied with functional and cosmetic results. No complication and no recurrence happened. The technique of nylon fixation at the internal and external canthus combined with skin graft is an effective method for recurrent lower eyelids ectropion.

  2. [Healing of spiral fractures in the sheep tibia comparing different methods--osteosynthesis with internal fixation, interlocking nailing and dynamic compression plate].

    Science.gov (United States)

    Seibold, R; Schlegel, U; Kessler, S B; Cordey, J; Perren, S M; Schweiberer, L

    1995-12-01

    The healing process of spiral fractures of the sheep tibia was investigated in an experiment with simulated clinical conditions. The effects of conventional internal fixation techniques with the DCP and the intramedullary nail are compared with those of internal fixation with the spine fixator. The internal fixation techniques are described in terms of their bending stiffness when mounted on the fractured bone. The in vivo investigation was documented clinically and radiographically and the post mortem specimens were evaluated histologically. The bending stiffness of the healed bone was assessed in relation to the contralateral side. After application of the DCP, primary healing took place and extensive transcortical necrosis occurred in the implant bed. Intramedullary nailing led to secondary healing and to necrosis of the inner cortex close to the endosteum. After internal fixation with the spine fixator, gap healing took place and no cortical necrosis was observed. The clinical course was generally good after all procedures. The histological evaluation shows that damage to the vascularity of the bone can only be avoided by using the spine fixator. This principle seems to be appropriate for the purposes of biological internal fixation.

  3. Bio-Environment-Induced Degradation and Failure of Internal Fixation Implants

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    Yan Zhou

    2015-10-01

    Full Text Available Internal fixations provide fast healing but their failure remains problematic to patients. Here, we report an experimental study in failure of three typical cases of metals: a bent intramedullary stainless steel nail, a broken exterior pure Ti plate, and a broken intramedullary stainless steel nail. Characterization of the bent nail indicates that those metals are vulnerable to corrosion with the evidence of increased surface roughness and embrittlement. Depredated surface of the Ti plate resulted debris particles in the surrounding tissue of 15.2 ± 6.5 μm in size. Nanoparticles were observed in transmission electron microscope. The electron diffraction pattern of the debris indicates a combination of nanocrystalline and amorphous phases. The failure mode of the broken nail made of stainless steel was found to be fatigue initiated from the surface. This study clearly shows the biological-attack induced surface degradation resulting in debris and fatigue. Future design and selection of implant materials should consider such factors for improvement.

  4. Combined fixation, intern and external, in proximal complex fractures of the tibia

    International Nuclear Information System (INIS)

    Quintero Laverde, Jaime; Lozano Ortiz, Victor Hugo; Rojas Duque, Guillermo

    2002-01-01

    Between August of 1997 and December of 2001, they were treated in the orthopedics department and traumatology of the Hospital Clinica San Rafael, 16 patients with proximal complex fractures of the tibia, using internal fixation with plate in the lateral column and an unilateral external fixer, for the medial column. It carries out a clinical and radiological pursuit with average of 27 months (minimum 4.5, maximum 40 months). In 15 patients (93,7%) it was obtained a primary consolidation and 1 case (6,2%) it presented retard in the consolidation being necessary the placement of bony implants. in 2 cases (12,5%) there was superficial infection, one in the itinerary of the nails and another in area of superficial necrosis in soft fabrics in a closed fracture. single 1 case (6,2) it presented deep infection, which, it improve with bony curettage and antibiotics. In the final radiographic evaluation, 2 cases (12,5%) they presented depression of the lateral plate; according to the functional scale of Rasmussen excellent results were obtained (27 to 30 points) in 11 cases (68,7%) and good (20 to 26 points) in 5 cases (31,2%). The radiographic results and functional global they suggest that the combination of a technique less invasive in this area criticizes, it represents a good alternative for the treatment of the proximal complex fractures of the tibia

  5. Multiple Rib Nonunion: Open Reduction and Internal Fixation and Iliac Crest Bone Graft Aspirate.

    Science.gov (United States)

    Kaplan, Daniel J; Begly, John; Tejwani, Nirmal

    2017-08-01

    Rib fractures are a common chest injury that can typically be treated nonoperatively. However, a percentage of these will go on to nonunion, either because of unique characteristics of the fracture itself or because of a variety of poor healing factors of the host. If a patient has continued symptomology beyond 3 months, surgeons may consider operative management. Although isolated resection of fibrous scar tissue from the nonunion site may be sufficient in some cases, it may also be necessary to provide additional structural integrity to the rib depending on the extent of the fracture pattern and resection. This goal can be achieved operatively with rib plating and bone grafting to promote healing. This video demonstrates the use of plating in the treatment of rib nonunion. It begins with relevant background information on rib fractures and nonunions, then details the approach, open reduction and internal fixation of 3 ribs using plates and bone graft aspirate. Pearls and pitfalls are included during the surgical technique aspect of the video to both help guide surgeons new to the procedure and provide potentially advantageous technical details to more experienced surgeons.

  6. Posterior Cruciate Ligament Tibial Avulsion treated with Open Reduction and Internal Fixation

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    Lee WXP

    2015-07-01

    Full Text Available The optimal treatment for thoracolumbar fractures (TLF without neurological deficit remains controversial. Majority of the systematic reviews and meta-analyses have evaluated open operative approaches but have yet to compare the outcomes of minimally invasive percutaneous pedicle fixation (MIPPF versus non-operative treatment. A retrospective cohort study was performed to compare clinical and radiological outcomes between MIPPF and conservative groups for TLF AO Type A1 to Type B2 during a 2-year follow-up period. Pre-operative plain and CT films were evaluated and decision made for short segment (non-fusion MIPPF. Patients who refused operation were treated conservatively with three months of body cast, brace, or corset. MIPPF group showed earlier Visual Analog Score (VAS improvement at six months post-injury (0 vs 6.0- p0.050. MIPPF as a method of internal bracing can be pursued in the treatment of TLF, with larger future cohorts and RCTs being called for to support and explore new findings.

  7. Pitfalls associated with open reduction and internal fixation of fractured ribs.

    Science.gov (United States)

    Sarani, Babak; Schulte, Leah; Diaz, Jose J

    2015-12-01

    Rib fracture is exceedingly common and remains a leading cause of death in patients with chest injury. Probability of death increases by 19% with each broken rib, and the probability of death increases further with age. Treatment is centered on pain control and early mobilization to provide adequate pulmonary hygiene. Multimodality interventions, such as incentive spirometry, postural changes, and coughing, are pivotal in minimizing the risk of pneumonia and death. Recently, many studies have found mortality benefit to operation fixation (ORIF) of ribs in select patients. However, this procedure remains underutilized partly due to lack of familiarity with its technique and pitfalls by trauma surgeons, in particular. Whereas there are publications on operative technique, there are no studies describing pitfalls associated with this procedure. The purpose of this paper is to describe pitfalls on the technical aspects of ORIF of the ribs based on the medical literature where possible and based on our experience in instances where peer reviewed evidence is lacking. The paper is not meant to serve as a protocol for managing rib fractures. Copyright © 2015 Elsevier Ltd. All rights reserved.

  8. Treatment of stress fracture of the olecranon in throwing athletes with internal fixation through a small incision

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    Fujioka Hiroyuki

    2012-12-01

    Full Text Available Abstract The present study is a report of retrospective case series of stress fracture of the olecranon. Six patients presented posterior elbow pain in throwing in baseball and softball, but fracture was not diagnosed in radiographs. We detected stress fracture of the olecranon using computed tomographic (CT scan and treated the patient with internal fixation with a headless cannulated double threaded screw through a small skin incision. All patients returned to competitive level without elbow complaints after the operation. When throwing athletes present with unusual posterior elbow pain and no significant findings on radiographs, a CT scan examination should be performed. We recommend surgical treatment of internal fixation with a screw through a small skin incision, as a good option for stress fracture of the olecranon in order to allow early return to sports activity in competitive athletes.

  9. Os acromiale open reduction and internal fixation: a review of iliac crest autogenous bone grafting and local bone grafting.

    Science.gov (United States)

    Atinga, Mordicai; Gregor, Reinhold; Selvaraj, Karthik M; Hong, Thin F

    2018-01-17

    Symptomatic os acromiale are fairly uncommon, and treatment has included fragment excision, decompression, and open reduction and internal fixation. Nonunion rates as high as 40% have been reported after fixation of os acromiale. This study assessed whether union of an os acromiale could be reliably achieved without the use of an iliac crest bone graft. This was a retrospective study of 32 consecutive shoulders that were treated with screw fixation and a local bone graft or iliac crest bone graft. The mean age was 50.3 years (range, 21-74 years), and the mean follow-up was 46.9 months (range, 12-120 months). Fusion was assessed clinically and radiologically. All 32 os acromiale were fused by 3 months on x-ray imaging. There were 18 shoulders in the iliac crest bone graft group and 14 in the local bone graft group. Rotator cuff repairs were performed concomitantly in 25 patients. Hardware was removed in 4 patients, a seroma was drained in 1 patient, and a superficial infection occurred in 1 patient. This is the largest study of os acromiale fixation using screws and a tension band to our knowledge. We report a 100% union rate using this technique, with 13% requiring hardware removal and the occurrence of 1 superficial infection. This study shows a local bone graft is as effective as iliac crest bone graft in achieving fusion. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  10. Thirty cases of distal humerus intra-articular fractures treated by open reduction and internal fixation: A 3-year review

    Directory of Open Access Journals (Sweden)

    Ajit Swamy

    2012-01-01

    Full Text Available Introduction: Fractures of the distal humerus involving articular surface remains one of the challenging situations for any orthopedic surgeon. Congruent articular reconstruction is mandatory for an acceptable functional recovery. Materials and Methods: This was a case series of 30 patients of distal humeral intraarticular fractures treated by open reduction and internal fixation and followed up at the end of 3 years.Fractures were classified according to AO [Arbeitsgemeinschaft für Osteosynthesefragen] and the results were evaluated using Cassebaums rating system, and other parameters. Results: Majority of the patients had a favourable outcome.There was no neurovascular complications and majority had a sound union. One case developed postoperative infection. Two cases resulted in nonunion. Conclusion: Open reduction and internal fixation with congruent articular reconstruction in young patients resulted in acceptable and good functional recovery. This was achieved with the use of recent AO ASIF plates. [AO/ASIF - Arbeitsgemeinschaft fuer Osteosynthesefragen - Association for the Study of Internal Fixation].

  11. Internal Fixation of Transverse Patella Fractures Using Cannulated Cancellous Screws with Anterior Tension Band Wiring

    Directory of Open Access Journals (Sweden)

    Khan I

    2016-07-01

    Full Text Available Aims: To evaluate the effectiveness and safety of anterior tension band wiring technique using two cannulated cancellous screws in patients with transverse (AO34-C1 or transverse with mildly comminuted (AO34-C2 patellar fractures. Materials and Methods: This is a prospective study of 25 patients with transverse fracture or transverse fracture with mildly comminuted patella fractures. All the patients were treated with open reduction and internal fixation using two parallel cannulated screws and 18G stainless steel wire as per the tension band principle. Results: There were eighteen males (72% and seven females (28%. The age group ranged from 24 to 58 years, with mean age of 38 years. The most common mode of injury was fall (72% followed by road traffic accident (20% and violent quadriceps contraction (8%. Transverse fracture was present in 60% and transverse fracture with mild comminution in 40% of patients. Mean time to achieve union was 10.7 weeks (range 8-12 weeks. Mean ROM at three months was 113.8 degree (90-130 and at final follow up this improved to 125.4 degrees (range 100-140. There was one case of knee stiffness and no case of implant failure was observed. Patients were evaluated using Bostman scoring, the mean score at three months being 26.04 which improved to 27.36 at the end of final follow up at one year. Conclusion: Cannulated cancellous screws with anterior tension band wiring is a safe, reliable and reproducible method in management of transverse patellar fractures, with less chances of implant failure and soft tissue irritation.

  12. Internal fixation of proximal fractures of the 2nd and 4th metacarpal and metatarsal bones using bioabsorbable screws.

    Science.gov (United States)

    Mageed, M; Steinberg, T; Drumm, N; Stubbs, N; Wegert, J; Koene, M

    2018-03-01

    Fractures involving the proximal one-third of the splint bone are relatively rare and are challenging to treat. A variety of management techniques have been reported in the literature. The aim of this retrospective case series was to describe the clinical presentation and evaluate the efficacy of bioabsorbable polylactic acid screws in internal fixation of proximal fractures of the 2nd and 4th metacarpal and metatarsal bones in horses. The medical records, diagnostic images and outcome of all horses diagnosed with a proximal fracture of the splint bones and treated with partial resection and internal fixation of the proximal stump using bioabsorbable polylactic acid screws between 2014 and 2015 were reviewed. Eight horses met the inclusion criteria. The results showed that there were no complications encountered during screw placement or postoperatively. Six horses returned to full work 3 months after the operation and two horses remained mildly lame. On follow-up radiographs 12 months postoperatively (n = 2) the screws were not completely absorbed. The screws resulted in a cone-shaped radiolucency, which was progressively replaced from the outer margins by bone sclerosis. The use of bioabsorbable screws for fixation of proximal fractures of the splint bone appears to be a safe and feasible technique and may offer several advantages over the use of traditional metallic implants. © 2018 Australian Veterinary Association.

  13. Open reduction and internal fixation aided by intraoperative 3-dimensional imaging improved the articular reduction in 72 displaced acetabular fractures

    DEFF Research Database (Denmark)

    Eckardt, Henrik; Lind, Dennis; Toendevold, Erik

    2015-01-01

    . Patients and methods - We operated on 72 acetabular fractures using intraoperative 3D imaging and compared the operative results, duration of surgery, and complications with those for 42 consecutive acetabular fracture operations conducted using conventional fluoroscopic imaging. Postoperative reduction......Background and purpose - During acetabular fracture surgery, the acetabular roof is difficult to visualize with 2-dimensional fluoroscopic views. We assessed whether intraoperative 3-dimensional (3D) imaging can aid the surgeon to achieve better articular reduction and improve implant fixation...... was evaluated on reconstructed coronal and sagittal images of the acetabulum. Results - The fracture severity and patient characteristics were similar in the 2 groups. In the 3D group, 46 of 72 patients (0.6) had a perfect result after open reduction and internal fixation, and in the control group, 17 of 42 (0...

  14. Application of IMF screws to assist internal rigid fixation of jaw fractures: our experiences of 168 cases.

    Science.gov (United States)

    Bai, Zhenxi; Gao, Zhibiao; Xiao, Xia; Zhang, Wenjuan; Fan, Xing; Wang, Zhaoling

    2015-01-01

    Intermaxillary fixation (IMF) screws were first introduced to achieve IMF as a kind of bone borne appliance for jaw fractures in 1989. Because this method can overcome many disadvantages associated with tooth borne appliance, IMF screws have been popularly used for jaw fractures since then. From March 2011 to February 2014, we treated 168 cases with single or multiple jaw fractures by open reduction and a total of 705 IMF screws were intraoperatively applied in all the cases to achieve IMF and maintain dental occlusion as an adjuvant to open reduction. The numbers, implantation sites and complications of IMF screws were retrospectively analyzed. In our experience, we found that IMF screws were important to assist open reduction of jaw fractures but their roles should be objectively assessed and the reliability of open reduction and internal rigid fixation must be emphasized. Much attention should be paid when implanting.

  15. Outcome of Internal Fixation and Corticocancellous Grafting of Symphysis Pubis Diastasis Which Developed after Malunion of Pubic Rami Fracture.

    Science.gov (United States)

    Bombaci, Hasan

    2017-06-01

    We report a case of pubic symphysis diastasis, which was initially asymptomatic; however, it became symptomatic with urinary incontinence during pregnancy. The patient was treated with open reduction and internal fixation of the symphysis pubis. A corticocancellous autograft was used for filling the gap which remained despite bilateral compression of the iliac bones. We obtained satisfactory outcome in terms of symptoms at the 3 years' follow-up; however, there was instability findings in the X-rays with broken screws. We conclude that asymptomatic pubic symphysis diastasis might be symptomatic after additional trauma (such as pregnancy) in the following days, if it was unstable in the very beginning of injury. Fixation of old pubic symphysis diastasis with reconstruction plate by filling the gap by using corticocancellous autograft, might not prevent ultimate implant failure if the symphysis pubis diastasis is part of an unstable pelvic fracture in the very beginning.

  16. Ti-24Nb-4Zr-8Sn Alloy Pedicle Screw Improves Internal Vertebral Fixation by Reducing Stress-Shielding Effects in a Porcine Model.

    Science.gov (United States)

    Qu, Yang; Zheng, Shuang; Dong, Rongpeng; Kang, Mingyang; Zhou, Haohan; Zhao, Dezhi; Zhao, Jianwu

    2018-01-01

    To ensure the biomechanical properties of Ti-24Nb-4Zr-8Sn, stress-shielding effects were compared between Ti-24Nb-4Zr-8Sn and Ti-6Al-4V fixation by using a porcine model. Twelve thoracolumbar spines (T12-L5) of 12-month-old male pigs were randomly divided into two groups: Ti-24Nb-4Zr-8Sn (EG, n = 6) and Ti-6Al-4V (RG, n = 6) fixation. Pedicle screw was fixed at the outer edge of L4-5 vertebral holes. Fourteen measuring points were selected on the front of transverse process and middle and posterior of L4-5 vertebra. Electronic universal testing machine was used to measure the strain resistance of measuring points after forward and backward flexion loading of 150 N. Meanwhile, stress resistance was compared between both groups. The strain and stress resistance of measurement points 1, 2, 5, 6, 9, and 10-14 in Ti-24Nb-4Zr-8Sn fixation was lower than that of Ti-6Al-4V fixation after forward and backward flexion loading ( P Ti-24Nb-4Zr-8Sn fixation than that of Ti-6Al-4V fixation ( P Ti-24Nb-4Zr-8Sn internal fixation were less than that of Ti-6Al-4V internal fixation. These results suggest that Ti-24Nb-4Zr-8Sn elastic fixation has more biomechanical goals than conventional Ti-6Al-4V internal fixation by reducing stress-shielding effects.

  17. Clinical effects of internal fixation for ulnar styloid fractures associated with distal radius fractures: A matched case-control study.

    Science.gov (United States)

    Sawada, Hideyoshi; Shinohara, Takaaki; Natsume, Tadahiro; Hirata, Hitoshi

    2016-11-01

    Ulnar styloid fractures are often associated with distal radius fractures. However, controversy exists regarding whether to treat ulnar styloid fractures. This study aimed to evaluate clinical effects of internal fixation for ulnar styloid fractures after distal radius fractures were treated with the volar locking plate system. We used prospectively collected data of distal radius fractures. 111 patients were enrolled in this study. A matched case-control study design was used. We selected patients who underwent fixation for ulnar styloid fractures (case group). Three control patients for each patient of the case group were matched on the basis of age, sex, and fracture type of distal radius fractures from among patients who did not undergo fixation for ulnar styloid fractures (control group). The case group included 16 patients (7 men, 9 women; mean age: 52.6 years; classification of ulnar styloid fractures: center, 3; base, 11; and proximal, 2). The control group included 48 patients (15 men, 33 women; mean age: 61.1 years; classification of ulnar styloid fractures: center, 10; base, 31; and proximal, 7). For radiographic examination, the volar tilt angle, radial inclination angle, and ulnar variance length were measured, and the union of ulnar styloid fractures was judged. For clinical examination, the range of motions, grip strength, Hand20 score, and Numeric Rating Scale score were evaluated. There was little correction loss for each radiological parameter of fracture reduction, and these parameters were not significantly different between the groups. The bone-healing rate of ulnar styloid fractures was significantly higher in the case group than in the control group, but the clinical results were not significantly different. We revealed that there was no need to fix ulnar styloid fractures when distal radius fractures were treated via open reduction and internal fixation with a volar locking plate system. Copyright © 2016 The Japanese Orthopaedic Association

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

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    Milenković Saša

    2013-01-01

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

  19. Autologous bone graft versus demineralized bone matrix in internal fixation of ununited long bones.

    Science.gov (United States)

    Pieske, Oliver; Wittmann, Alexandra; Zaspel, Johannes; Löffler, Thomas; Rubenbauer, Bianka; Trentzsch, Heiko; Piltz, Stefan

    2009-12-15

    Non-unions are severe complications in orthopaedic trauma care and occur in 10% of all fractures. The golden standard for the treatment of ununited fractures includes open reduction and internal fixation (ORIF) as well as augmentation with autologous-bone-grafting. However, there is morbidity associated with the bone-graft donor site and some patients offer limited quantity or quality of autologous-bone graft material. Since allogene bone-grafts are introduced on the market, this comparative study aims to evaluate healing characteristics of ununited bones treated with ORIF combined with either iliac-crest-autologous-bone-grafting (ICABG) or demineralized-bone-matrix (DBM). From 2000 to 2006 out of sixty-two consecutive patients with non-unions presenting at our Level I Trauma Center, twenty patients had ununited diaphyseal fractures of long bones and were treated by ORIF combined either by ICABG- (n = 10) or DBM-augmentation (n = 10). At the time of index-operation, patients of the DBM-group had a higher level of comorbidity (ASA-value: p = 0.014). Mean duration of follow-up was 56.6 months (ICABG-group) and 41.2 months (DBM-group). All patients were clinically and radiographically assessed and adverse effects related to bone grafting were documented. The results showed that two non-unions augmented with ICABG failed osseous healing (20%) whereas all non-unions grafted by DBM showed successful consolidation during the first year after the index operation (p = 0.146). No early complications were documented in both groups but two patients of the ICABG-group suffered long-term problems at the donor site (20%) (p = 0.146). Pain intensity were comparable in both groups (p = 0.326). However, patients treated with DBM were more satisfied with the surgical procedure (p = 0.031). With the use of DBM, the costs for augmentation of the non-union-site are more expensive compared to ICABG (calculated difference: 160 euro/case). Nevertheless, this study demonstrated that the

  20. Incidence and risk factors for surgical site infection after open reduction and internal fixation of tibial plateau fracture: A systematic review and meta-analysis.

    Science.gov (United States)

    Shao, Jiashen; Chang, Hengrui; Zhu, Yanbin; Chen, Wei; Zheng, Zhanle; Zhang, Huixin; Zhang, Yingze

    2017-05-01

    This study aimed to quantitatively summarize the risk factors associated with surgical site infection after open reduction and internal fixation of tibial plateau fracture. Medline, Embase, CNKI, Wanfang database and Cochrane central database were searched for relevant original studies from database inception to October 2016. Eligible studies had to meet quality assessment criteria according to the Newcastle-Ottawa Scale, and had to evaluate the risk factors for surgical site infection after open reduction and internal fixation of tibial plateau fracture. Stata 11.0 software was used for this meta-analysis. Eight studies involving 2214 cases of tibial plateau fracture treated by open reduction and internal fixation and 219 cases of surgical site infection were included in this meta-analysis. The following parameters were identified as significant risk factors for surgical site infection after open reduction and internal fixation of tibial plateau fracture (p operative time (OR 2.15; 95% CI 1.53-3.02), tobacco use (OR 2.13; 95% CI 1.13-3.99), and external fixation (OR 2.07; 95% CI 1.05-4.09). Other factors, including male sex, were not identified as risk factors for surgical site infection. Patients with the abovementioned medical conditions are at risk of surgical site infection after open reduction and internal fixation of tibial plateau fracture. Surgeons should be cognizant of these risks and give relevant preoperative advice. Copyright © 2017. Published by Elsevier Ltd.

  1. The biomechanical evaluation of polyester as a tension band for the internal fixation of patellar fractures.

    LENUS (Irish Health Repository)

    McGreal, G

    2012-02-03

    We use a braided polyester suture in place of cerclage wire in tension band fixations. The objective of this study was to test the biomechanical properties of this technique. Sixteen cadaveric patellae were fractured and repaired by modified tension band fixation. Eight were fixed using eighteen gauge stainless steel wire as a tension band and eight using braided polyester. All specimens were subjected to tensile testing. Polyester was 75.0% as strong as wire. For dynamic testing, the patellae of seven cadaveric knees were fractured and then fixed with polyester tension bands. These were mounted in a device capable of extending the knees from 90 degrees to neutral against an applied force. None of the fixations failed. Three of the specimens fixed using 18 gauge stainless steel wire were compared with three fixed using polyester over 2000 cycles of knee flexion and extension. Polyester performed as well as wire. We conclude that polyester is an acceptable alternative to wire in tension band fixation.

  2. A solar cycle of spacecraft anomalies due to internal charging

    Directory of Open Access Journals (Sweden)

    G. L. Wrenn

    Full Text Available It is important to appreciate how the morphology of internal charging of spacecraft systems, due to penetrating electrons, differs from that of the more common surface charging, due to electrons with lower energy. A specific and recurrent anomaly on a geostationary communication satellite has been tracked for ten years so that solar cycle and seasonal dependencies can be clearly established. Concurrent measurements of sunspot number, solar wind speed and 2-day >2 MeV electron fluence are presented to highlight pertinent space weather relationships, and the importance of understanding the complex particle interaction processes involved.

    Key words. Magnetospheric physics (energetic particles; trapped; solar wind – magnetosphere interactions – space plasma physics (spacecraft sheaths, wakes, charging

  3. History of internal fixation with plates (part 2): new developments after World War II; compressing plates and locked plates.

    Science.gov (United States)

    Hernigou, Philippe; Pariat, Jacques

    2017-07-01

    The first techniques of operative fracture with plates were developed in the 19th century. In fact, at the beginning these methods consisted of an open reduction of the fracture usually followed by a very unstable fixation. As a consequence, the fracture had to be opened with a real risk of (sometimes lethal) infection, and due to unstable fixation, protection with a cast was often necessary. During the period between World Wars I and II, plates for fracture fixation developed with great variety. It became increasingly recognised that, because a fracture of a long bone normally heals with minimal resorption at the bone ends, this may result in slight shortening and collapse, so a very rigid plate might prevent such collapse. However, as a consequence, delayed healing was observed unless the patient was lucky enough to have the plate break. One way of dealing with this was to use a slotted plate in which the screws could move axially, but the really important advance was recognition of the role of compression. After the first description of compression by Danis with a "coapteur", Bagby and Müller with the AO improved the technique of compression. The classic dynamic compression plates from the 1970s were the key to a very rigid fixation, leading to primary bone healing. Nevertheless, the use of strong plates resulted in delayed union and the osteoporosis, cancellous bone, comminution, and/or pathological bone resulted in some failures due to insufficient stability. Finally, new devices represented by locking plates increased the stability, contributing to the principles of a more biological osteosynthesis while giving enough stability to allow immediate full weight bearing in some patients.

  4. Comparative study on three surgical techniques for intra-articular calcaneal fractures: open reduction with internal fixation using a plate, external fixation and minimally invasive surgery

    Directory of Open Access Journals (Sweden)

    Missa Takasaka

    2016-06-01

    Full Text Available ABSTRACT OBJECTIVE: To evaluate, compare and identify the surgical technique with best results for treating intra-articular calcaneal fractures, taking into account postoperative outcomes, complications and scoring in the Aofas questionnaire. METHODS: This was a retrospective study on 54 patients with fractures of the calcaneus who underwent surgery between 2002 and 2012 by means of the following techniques: (1 open reduction with extended L-shaped lateral incision and fixation with double-H plate of 3.5 mm; (2 open reduction with minimal incision lateral approach and percutaneous fixation with wires and screws; and (3 open reduction with minimal incision lateral approach and fixation with adjustable monoplanar external fixator. RESULTS: Patients treated using a lateral approach, with fixation using a plate had a mean Aofas score of 76 points; those treated through a minimal incision lateral approach with screw and wire fixation had a mean score of 71 points; and those treated through a minimal incision lateral approach with an external fixator had a mean score of 75 points. The three surgical techniques were shown to be effective for treating intra-articular calcaneal fractures, without any evidence that any of the techniques being superior. CONCLUSION: Intra-articular calcaneal fractures are complex and their treatment should be individualized based on patient characteristics, type of fracture and the surgeon's experience with the surgical technique chosen.

  5. Internal fixation of displaced inferior pole of the patella fractures using vertical wiring augmented with Krachow suturing.

    Science.gov (United States)

    Oh, Hyoung-Keun; Choo, Suk-Kyu; Kim, Ji-Wan; Lee, Mark

    2015-12-01

    We present the surgical technique of separate vertical wiring for displaced inferior pole fractures of the patella combined with Krachow suture and report the surgical outcomes. Between September 2007 to May 2012, 11 consecutive patients (mean age, 54.6 years) with inferior pole fractures of the patella (AO/OTA 34-A1) were retrospectively enrolled in this study. Through longitudinal incision, all patients underwent open reduction and internal fixation by separate vertical wiring combined with Krackow suture. The range of motion, loss of fixation, and Bostman score were primary outcome measures. The union time was 10 weeks after surgery on average (range: 8-12). No patient had nonunion, loss of reduction and wire breakage. There was no case of wound problem and irritation from the implant. At final follow-up, the average range of motion arc was 129.4° (range: 120-140). The mean Bostman score at last follow-up was 29.6 points (range: 28-30) and graded excellent in all cases. Separate vertical wiring combined with Krackow suture for inferior pole fractures of the patella is a useful technique that is easy to perform and can provide stable fixation with excellent results in knee function. Copyright © 2015 Elsevier Ltd. All rights reserved.

  6. Continuous lumbar plexus block for acute postoperative pain management after open reduction and internal fixation of acetabular fractures.

    Science.gov (United States)

    Chelly, Jacques E; Casati, Andrea; Al-Samsam, Tameem; Coupe, Kevin; Criswell, Allen; Tucker, Jeffery

    2003-05-01

    To assess the efficacy of postoperative continuous lumbar plexus blocks for postoperative pain control in patients undergoing open reduction and internal fixation of an acetabular fracture. Twenty-six patients who underwent open reduction and internal fixation of an acetabular fracture. DESIGN/PERSPECTIVE: According to a case-control study design, patients were divided into 2 groups: Group 1 (n = 13) received postoperatively a continuous lumbar plexus block with 0.2% ropivacaine (10 mL/hr for 48 hours), and group 2 (n = 13) received postoperatively patient-controlled analgesia with morphine (1 mg; lock-out time, 10 minutes; total 6 mg/hr). Postoperative morphine consumption, time to unassisted ambulation, and clinical and radiographic outcomes. No significant differences in demographics, surgical procedure, or duration of surgery were reported between the two groups. The lumbar plexus catheter group showed a lower requirement for morphine in the postanesthesia care unit (6 mg [0-14 mg]) and during the first 2 days (20 mg [6-55 mg] on day 1 and 29 mg [4-56 mg] on day 2) than the control group (51 mg [20-100 mg] on day 1 and 50 mg [10-93 mg] on day 2) (P = 0.001 and P = 0.021). Effective unassisted ambulation was recovered earlier in patients with the lumbar plexus catheter (3 days; range 2-4 days) than in the control group (4 days; range 3-7 days) (P = 0.015). Continuous lumbar plexus block represents an interesting alternative for postoperative pain control in patients undergoing open reduction and internal fixation of an acetabular fracture.

  7. Diagnostic delay in malignant pleural mesothelioma due to physicians fixation on history with non-exposure to asbestos

    DEFF Research Database (Denmark)

    Madsen, Poul Henning; Laursen, Christian B.; Davidsen, Jesper Rømhild

    2013-01-01

    assessment of all available information is of utmost importance, as fixation on single details can be misguiding with inappropriate consequences in both the diagnostic and therapeutic approach. This case report presents how an atypical medical history led to a delay in the diagnosis of malignant pleural......To establish the diagnosis of virtually any disease, the clinician must combine a variety of information. Often emphasised in this context is thorough medical history-taking including information on exposure to factors leading to or being associated with the disease in question. Continuous...

  8. A randomised prospective study of two different combined internal and external fixation techniques for distal tibia shaft fractures.

    Science.gov (United States)

    Sun, Liao-Jun; Yu, Xian-Bin; Dai, Cheng-Qian; Hu, Wei; Guo, Xiao-Shan; Chen, Hua

    2014-12-01

    External fixation combined with limited open reduction and internal fixation (EF + LORIF) is a well-accepted and effective method for distal tibia shaft fractures, but it was also related to complications. The objective of this study was to compare external fixation combined with closed reduction and internal fixation (EF + CRIF) with EF + LORIF in the treatment of distal tibia shaft fractures, and explore the benefits and defects of these two techniques. Fifty-six patients were randomised to operative stabilisation either by an external fixator combined with two closed titanium elastic nails or by external fixation combined with limited open reduction and internal fixation. Pre-operative variables included the patients’ age, sex, the affected side, cause of injury, Tscherne classification of soft tissue injury, fracture pattern, and time from injury to surgery. Peri-operative variables were the operating time and the radiation time. Postoperative variables were wound problems and other complications, union time, time of recovery to work, the functional American Orthopaedic Foot and Ankle surgery (AOFAS) score. There was no significant difference in the mean operating time (72.6 ± 11.5 vs. 78.5 ± 16.4 min, P = 0.125), the time to union (21.2 ± 11.0 vs. 22.5 ± 12.3 weeks, P = 0.678), the time of recovery to work (25.0 ± 14.5 vs. 26.4 ± 13.6 weeks, P = 0.711), pin track infection (3/28 vs. 4/28, P = 1.000), delayed union (2/28 vs. 3/28, P = 1.000), pain (38.3 ± 1.6 vs. 38.7 ± 1.5, P = 0.339), function (44.4 ± 6.0 vs. 45.0 ± 5.5, P = 0.698), and total AOFAS scores (91.5 ± 7.4 vs. 93.4 ± 6.8, P = 0.322) between the two groups. However, the mean radiation time was longer in the EF + CRIF group than in the EF + LORIF group (2.0 ± 1.2 vs. 0.3 ± 0.1 min, P alignment was obtained in 50 patients (22 in EF + CRIF vs. 28 in EF + LORIF, P = 0.023). Two cases with EF + CRIF had a 6 degrees of recurvatum deformity and four had 6–9 degrees of valgus deformity

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

    DEFF Research Database (Denmark)

    Niemeyer, Philipp; Schmal, Hagen; Hauschild, Oliver

    2010-01-01

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

  10. Posterior Decompression, Lumber Interbody Fusion and Internal Fixation in the Treatment of Upper Lumbar Intervertebral Disc Herniation

    Directory of Open Access Journals (Sweden)

    DONG Zhan

    2014-12-01

    Full Text Available Objective: To assess the clinical outcomes of posterior decompression, interbody fusion and internal fixationfor the treatment of the upper lumbar intervertebral disc herniation. Methods: Twelve patients with the upper lumbar intervertebral disc herniation were treated by posterior decompression, interbosy fusion and internal fixation. The time of the operation, the amount of bleeding and the clinical efficacy were evaluated. Results: The time of operation was (143±36 min and the amount of bleeding during operation was (331.5±47.9 mL. There was no spinal cord and injuries, nerve injury, epidural damage and leakage of cerebrospinal fluid. All patients were followed up for 10~19 months with the average being 12.6 months. The functional scoring of Japanese Orthopedic Association (JOA before the operation was (11.4±3.3 scores and final score after follow-up was (22.9±3.1 scores and there were statistical difference (P<0.01. Lumber interbody fusion of all patients completed successfully and the good rate after the operation was 91.7%. Conclusion: Posterior decompression, interbody fusion and internal fixation for the treatment of the upper lumbar intervertebral disc herniation was characterized by full exposure, safety and significant efficacy.

  11. Evaluation of the trauma and bone metabolism after internal absorbable screw and metal screw fixation treatment of tibia-fibula fracture

    Directory of Open Access Journals (Sweden)

    Guang-Bin Yuan

    2017-03-01

    Full Text Available Objective: To study the trauma and bone metabolism after internal absorbable screw and metal screw fixation treatment of tibia-fibula fracture. Methods: 78 patients with tibia-fibula fracture who received internal fixation surgery in our hospital between May 2013 and October 2015 were selected and randomly divided into absorbable group and metal group (n=39 who accepted internal absorbable screw fixation and internal metal screw fixation respectively. 3 d after operation, serum was collected to determine the levels of inflammatory factors, pain mediators, stress hormones and bone metabolism indexes. Results: Serum inflammatory mediators procalcitonin (PCT, Resistin, C-reactive protein (CRP, interleukin-6 (IL-6, and tumor necrosis factor-α (TNF-α, pain mediators substance P (SP, prostaglandin E2 (PGE2 and NPY, stress hormones norepinephrine (NE, epinephrine (E and cortisol (Cor as well as bone resorption marker molecules C-terminal telopeptides of type I collagen (CTX-I and C-terminal telopeptides of type II collagen (CTX-II levels of absorbable group were significantly lower than those of metal group (P<0.05 while bone formation marker molecules N-MID osteocalcin (N-MID and N-terminal propeptide of procollagen type I (PINP levels were significantly higher than those of metal group (P<0.05. Conclusions: The trauma degree of internal absorbable screw fixation treatment of tibia-fibula fracture is weaker than that of internal metal screw fixation, and the bone metabolism activity is better than that of internal metal screw fixation.

  12. Surgical site infection after open reduction and internal fixation of tibial plateau fractures.

    Science.gov (United States)

    Lin, Shishui; Mauffrey, Cyril; Hammerberg, E Mark; Stahel, Philip F; Hak, David J

    2014-07-01

    The aim of this study was to identify risk factors for surgical site infections and to quantify the contribution of independent risk factors to the probability of developing infection after definitive fixation of tibial plateau fractures in adult patients. A retrospective analysis was performed at a level I trauma center between January 2004 and December 2010. Data were collected from a review of the patient's electronic medical records. A total of 251 consecutive patients (256 cases) were divided into two groups, those with surgical site infections and those without surgical site infections. Preoperative and perioperative variables were compared between these groups, and risk factors were determined by univariate analyses and multivariate logistic regression. Variables analyzed included age, gender, smoking history, diabetes, presence of an open fracture, presence of compartment syndrome, Schatzker classification, polytrauma status, ICU stay, time from injury to surgery, use of temporary external fixation, surgical approach, surgical fixation, operative time, and use of a drain. The overall rate of surgical site infection after ORIF of tibial plateau fractures during the 7 years of this study was 7.8% (20 of 256). The most common causative pathogens was Staphylococcus aureus (n=15, 75%). Independent predictors of surgical site infection identified by multivariate analyses were open tibial plateau fracture (odds ratio=3.9; 95% CI=1.3-11.6; p=0.015) and operative time (odds ratio=2.7; 95% CI=1.6-4.4; psite infection. Both open fracture and operative time are independent risks factors for postoperative infection.

  13. Development of biodegradable polycaprolactone film as an internal fixation material to enhance tendon repair: an in vitro study.

    Science.gov (United States)

    Hu, Jian-Zhong; Zhou, Yong-Chun; Huang, Li-Hua; Lu, Hong-Bin

    2013-08-19

    Current tendon repair techniques do not provide sufficient tensile strength at the repair site, and thus early active motion rehabilitation after tendon repair is discouraged. To enhance the post-operative tensile strength, we proposed and tested an internal fixation technique using a polycaprolactone (PCL) biofilm. PCL was chosen for its good biocompatibility, excellent mechanical strength, and an appropriate degradation time scale. PCL biofilms were prepared by a modified melt-molding/leaching technique, and the physical and mechanical properties and in vitro degradation rate were assessed. The pore size distribution of the biofilm and the paratenon of native tendons were observed using scanning electron microscopy. Next, we determined whether this biofilm could enhance the tensile strength of repaired tendons. We performed tensile tests on rabbit Achilles tendons that were first lacerated and then repaired: 1) using modified Kessler suture combined with running peripheral suture ('control' group), or 2) using biofilm to wrap the tendon and then fixation with sutures ('biofilm' group). The influence of different repair techniques on tendon tensile strength was evaluated by mechanical testing. The novel biofilm had supple texture and a smooth surface. The mean thickness of the biofilm was 0.25 mm. The mean porosity of the biofilm was 45.3%. The paratenon of the rabbit Achilles tendon had pores with diameters ranging from 1 to 9 μm, which were similar to the 4-12 μm diameter pores in the biofilm cross-section. The weight loss of the biofilms at 4 weeks was only 0.07%. The molecular weight of PCL biofilms did not change after immersion in phosphate buffered saline for 4 weeks. The failure loads of the biofilm were similar before (48 ± 9 N) and after immersion (47 ± 7 N, P > 0.1). The biofilm group had ~70% higher mean failure loads and 93% higher stiffness compared with the control group. We proposed and tested an internal fixation technique

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

    Directory of Open Access Journals (Sweden)

    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

  15. Assessment of leukemia caused deaths due to internal radiation exposure

    International Nuclear Information System (INIS)

    Raicevic, J.J.

    2002-01-01

    A problem of finding the number of cancers, which are developed due to internal exposure to radioactive material, is not a trivial task. This problem is generally rather complex, because in case of protracted exposures, latency period may exceed the time of an individual's natural death, i.e. the age at death due to 'natural causes'. In this paper the model for calculating risk caused by an internal exposure (inhalation or ingestion of radioactive material) is modeled as a continuous irradiation till the end of an individual's life, taking into account natural deaths in the observed population. The basic tool in constructing the model were risk coefficients per unit dose, developed earlier [1]. Since an important role in radiation exposure of the people in South Serbia may play internal exposure to depleted uranium (DU), which was extensively used during the NATO bombing of Yugoslavia, the leukemia was chosen as a stochastic effect which is to be considered. For this purpose, some different (artificial) amounts of DU intake were assumed. In order to present the continuous exposure of the whole population living on the contaminated area, the model separately considers those born after the environmental contamination. Therefore, the overall population is divided into two parts: the one which was alive at the time of the release, (LG-Living Generation), and the second one, born after that (FG- Following Generations). The paper primarily intends to present the model for risk calculation for the LG part of population. However, just for the purpose of demonstration of the overall risk model, the contribution of the FG is added to get an overall risk assessment for the case of leukaemia's deaths. Besides cumulative number of cases, which are usually calculated by other models, this model is able to assess differential values, what means it is able to predict the number of cases within a certain specified age and/or time intervals. According to results obtained by the

  16. [Case control study on therapeutic effects of dynamic external fixtor combined with limited internal fixation and cross K-wires fixation for the treatment of Pilon fractures of the proximal interphalangeal joint].

    Science.gov (United States)

    Miao, Dao-yi; Yang, Guo-jing; Zhang, Ling-zhou; Wu, Jian-wei

    2015-10-01

    To compare the clinical effects and safety of dynamic external fixtor combined with limited internal fixation and cross K-wires fixation for the treatment of close Pilon fractures of the proximal interphalangeal joint. From June 2012 to June 2014, totally 41 patients (45 fingers) with close interphalangeal joint Pilon fracture were treated by dynamic external fixtor combined with limited internal fixation or cross K-wires fixation, and all the patients were followed up. In the dynamic external fixtor combined with limited internal fixation group (group A), there were 21 patients with 22 fingers, including 12 males and 9 females, with an average of (30.6±5.6) years old. In the cross K-wires fixation group (group B), there were 20 patients with 23 fingers, including 11 males and 9 females, with an average of (30.1±5.3) years old. Regular re-examination of X-ray was performed to evaluate the active range of joint motion, fracture healing time, infection rate and postoperative joint motion pain. According to the evaluation criteria of upper extremity function issued by the Hand Surgery Society of Chinese Medical Association, the excellent and good cases of group A was up to 19 and 13 for group B. The evaluation results has significant differences (Z=2.558, P=0.011). The excellent and good rate of group A was obviously higher than that of group B. The average bone union time of group A was (7.9±2.1) weeks, and (8.1±2.3) weeks for group B. There was no significant difference on the mean healing time (t=-0.304, P=0.762). The infection fingers of group A was 5, and 1 for group B. The difference between the results was statistically significant (χ2=3.287, Pexternal fixtor combined with limited internal fixation is a reliable and effective method to treat Pilon fractures of the proximal interphalangeal joint. It allows early postoperative functional rehabilitation and restores the joint function.

  17. Does perioperative systemic infection or fever increase surgical infection risks after internal fixation of femur and tibia fractures in an intensive care polytrauma unit?

    Science.gov (United States)

    Large, Thomas M; Alton, Timothy B; Patton, Daniel J; Beingessner, Daphne

    2013-10-01

    We hypothesized that internal fixation procedures performed on trauma intensive care unit (ICU) patients with systemic infections, some also febrile, would be at increased risk for deep infection. A total of 128 patients (mean age, 37.4 years; mean Injury Severity Score [ISS], 34.7) admitted to the ICU with 179 femur or tibia fractures developed systemic infections. Systemic infections included sepsis, pneumonia, urinary tract infections, abdominal infections, and wound infections remote to the fracture. Of the fractures, 33 open and 146 closed underwent 150 intramedullary and 29 plate fixation procedures. Data were gathered regarding antibiotic use, systemic infection timing in relation to the date of fixation, and whether fever (>38.2°C) was present within 24 hours of fixation. Patients were followed up for a mean of 491 days. Twenty-eight procedures were performed a mean of 4.7 days after the diagnosis of a systemic infection, and 151 were performed a mean of 9.3 days before the diagnosis. Forty-five procedures were performed in patients who were febrile within 24 hours. Of the 179 procedures, 10 (5.6%) developed a deep infection. Four patients' implant infection was potentially hematogenously seeded with the same organism as their systemic infection. Neither the timing of the systemic infection in relation to the fixation procedure nor the presence of fever within 24 hours of fixation, days of preoperative antibiotics, location of the fracture, type of fixation (intramedullary nail vs. plate fixation), or type of systemic infection was significantly associated with the development of an infection. The only significant risk factor for developing an orthopedic infection was an open fracture (p close conjunction to the diagnosis of systemic infection led to a 5.6% infection rate, which compares favorably with historic infection rates for fixation of open or closed tibia and femur fractures. Therapeutic, level IV.

  18. Open reduction and internal fixation aided by intraoperative 3-dimensional imaging improved the articular reduction in 72 displaced acetabular fractures

    Science.gov (United States)

    Eckardt, Henrik; Lind, Dennis; Toendevold, Erik

    2015-01-01

    Background and purpose — During acetabular fracture surgery, the acetabular roof is difficult to visualize with 2-dimensional fluoroscopic views. We assessed whether intraoperative 3-dimensional (3D) imaging can aid the surgeon to achieve better articular reduction and improve implant fixation. Patients and methods — We operated on 72 acetabular fractures using intraoperative 3D imaging and compared the operative results, duration of surgery, and complications with those for 42 consecutive acetabular fracture operations conducted using conventional fluoroscopic imaging. Postoperative reduction was evaluated on reconstructed coronal and sagittal images of the acetabulum. Results — The fracture severity and patient characteristics were similar in the 2 groups. In the 3D group, 46 of 72 patients (0.6) had a perfect result after open reduction and internal fixation, and in the control group, 17 of 42 (0.4) had a perfect result. The mean difference in postoperative articular incongruity was 0.5 mm (95% CI: 0.4–0.7). In 29 of 72 operations, the intraoperative 3D scans led to intraoperative correction of the reduction and an improved result. The duration of surgery and infection rate were similar in the 2 groups. Interpretation — Intraoperative 3D imaging, which is not time-consuming, allowed the surgeon to correct malreductions and screw placement in 29 of 72 operations, leading to better articular reduction and more precise screw placement than in operations where conventional fluoroscopic imaging was used to control the reduction. PMID:26012545

  19. Clinical efficacy of open reduction and semirigid internal fixation in management of displaced pediatric mandibular fractures: A series of 10 cases and surgical guidelines

    Directory of Open Access Journals (Sweden)

    Samir Joshi

    2015-01-01

    Full Text Available Aim: To evaluate the efficacy of open reduction and semirigid internal fixation in the management of displaced pediatric mandibular fractures. Method: Ten patients with displaced mandibular fractures treated with 1.5 mm four holed titanium mini-plate and 4 mm screws which were removed within four month after surgery. Results: All cases showed satisfactory bone healing without any growth disturbance. Conclusion: Open reduction and rigid internal fixation (ORIF with 1.5 mm titanium mini- plates and 4 mm screws is a reliable and safe method in treatment of displaced paediatric mandibular fractures.

  20. Percutaneous internal fixation of proximal fifth metatarsal jones fractures (Zones II and III) with Charlotte Carolina screw and bone marrow aspirate concentrate: an outcome study in athletes.

    Science.gov (United States)

    Murawski, Christopher D; Kennedy, John G

    2011-06-01

    Internal fixation is a popular first-line treatment method for proximal fifth metatarsal Jones fractures in athletes; however, nonunions and screw breakage can occur, in part because of nonspecific fixation hardware and poor blood supply. To report the results from 26 patients who underwent percutaneous internal fixation with a specialized screw system of a proximal fifth metatarsal Jones fracture (zones II and III) and bone marrow aspirate concentrate. Case series; Level of evidence, 4. Percutaneous internal fixation for a proximal fifth metatarsal Jones fracture (zones II and III) was performed on 26 athletic patients (mean age, 27.47 years; range, 18-47). All patients were competing at some level of sport and were assessed preoperatively and postoperatively using the Foot and Ankle Outcome Score and SF-12 outcome scores. The mean follow-up time was 20.62 months (range, 12-28). Of the 26 fractures, 17 were traditional zone II Jones fractures, and the remaining 9 were zone III proximal diaphyseal fractures. The mean Foot and Ankle Outcome Score significantly increased, from 51.15 points preoperatively (range, 14-69) to 90.91 at final follow-up (range, 71-100; P fixation of proximal fifth metatarsal Jones fractures, with a Charlotte Carolina screw and bone marrow aspirate concentrate, provides more predictable results while permitting athletes a return to sport at their previous levels of competition, with few complications.

  1. Percutaneous internal fixation with Y-STRUT® device to prevent both osteoporotic and pathological hip fractures: a prospective pilot study.

    Science.gov (United States)

    Cornelis, François H; Tselikas, Lambros; Carteret, Thibault; Lapuyade, Bruno; De Baere, Thierry; Le Huec, Jean Charles; Deschamps, Frédéric

    2017-02-09

    We studied Y-STRUT® (Hyprevention, France), a new percutaneous internal fixation device, in combination with bone cementoplasty to prevent hip fracture. Between February 2013 and February 2015, a total of 16 femoral necks in 4 osteoporotic and 12 oncologic patients have been considered for prophylactic consolidation in this prospective multicentre pilot study involving 4 different hospitals. These consolidations were performed percutaneously under fluoroscopic guidance using Y-STRUT®, a dedicated internal fixation device. For osteoporotic patients, orthopaedic surgeons performed the prophylactic consolidations immediately after surgical treatment of a hip fracture (same anaesthesia) in the opposite side. For oncologic patients, without current hip fracture but considered at risk (Mirels score ≥8), interventional radiologists performed the procedures. We report the preliminary results of feasibility, safety and tolerance of these preventive consolidations using Y-STRUT®. Four patients (mean 83 years old) had prophylactic consolidation because of a severe osteoporosis (mean T-score -3.30) resulting in first hip fractures. Ten patients (mean 61 years old) were treated because of impending pathological fractures (mean Mirels score 9) related to femoral neck osteolytic metastases. All the procedures were performed with success. Wound healing was achieved in all cases with no access site complication. Radiographic exams performed at 3 months follow-up revealed that Y-STRUT® was well integrated in the bone. For the osteoporotic cohort, mean pain was 0.9 ± 0.7 at 3 weeks. For the oncologic cohort, it decreases from 3.6 ± 2.9 at baseline to 2.4 ± 0.9 at 2 months. Preliminary results demonstrate the feasibility and safety of Y-STRUT® implantation as well as the tolerance of the device.

  2. Efficacy of open reduction and internal fixation with a miniplate and hollow screw in the treatment of Lisfranc injury

    Directory of Open Access Journals (Sweden)

    Li Baoliang

    2015-07-01

    Full Text Available Purpose: To investigate efficacy of open reduction and internal fixation with the miniplate and hollow screw in the treatment of Lisfranc injury. Methods: Ten cases of Lisfranc injury treated by open reduction, miniplate and hollow screw in our hospital were retrospectively analyzed. There were 6 males and 4 females with age ranging from 25 to 45 years (mean 32 years. Among them, one case was classified as Type A, six Type B and three Type C. Injury mechanism included road traffic accidents (3 cases, fall from height (5 cases and hit by heavy object (2 cases. All injuries were closed without cerebral trauma or other complicated injuries. The time interval between injury and operation was 6e10 days (average 6.6 days. Postoperatively, the foot function was assessed using Visual Analogue Scales (VAS and American Orthopaedic Foot and Ankle Society (AOFAS Scales. Healing time and complications were observed. Results: All patients were followed up for 18e24 months (average 20 months. Anatomic reduction was achieved in all patients on images. There was statistical significance between preoperative score (7.89 ± 0.34 and score at postoperative 8 weeks (0.67 ± 0.13. According to the AOFAS score, 5 cases were defined as excellent, 3 cases as good and 2 cases as fair. During follow-up, there was no wound infection or complications except for osteoarthritis in 2 cases. Healing time ranged from 3 to 6 months with an average of 3.6 months. Conclusion: Anatomical reduction of Lisfranc injury can be achieved by open reduction and internal fixation with the miniplate and hollow screw. Normal structure of Lisfranc joint is regained to a great extent; injured ligaments were also repaired. Therefore, this method offers excellent curative effect and can avoid postoperative complications and improve the patients' quality of life.

  3. Internal fixation versus conservative treatment for elderly patients with a trochanteric hip fracture in conjunction with post-stroke hemiplegia.

    Science.gov (United States)

    Li, Kainan; Zheng, Yingjie

    2016-10-01

    To retrospectively evaluated Gamma nail internal fixation in the treatment of elderly patients with post-stroke hemiplegia experiencing trochanteric hip fracture. The patients were obtained consecutively from January 2005 to December 2010 with inclusion criteria. The total number was 138 and allocated to two groups: treated with the Gamma nail (n=72,group A) and continuous skin traction (n=66,group B). Preoperative variables including patient age, gender, duration of cerebrovascular accident, duration of hypertension, ASA risk score, Harris hip score and fracture type were recorded and compared. After treatment, time of patients activity on the bed, ambulation time, Harris hip score, mortality, complications were recorded and used to compare the outcomes. (1) Follow-up was undertaken from 3 to 10 years, with an average of 5.8 years. (2) No statistical difference in preoperative variables was found between the 2 groups. (3) two groups had statistical significance (P=0.000) in the time of patients activity on the bed and ambulation time and group A can activities on the bed and ambulates earlier. (4) There were significant differences between 2 groups in Harris hip score at 1 and 3 years and group A was significantly higher than group B. (5) there were statistically significant differences in mortality of 3 years, 5 years and 10 years and the group B was significantly higher than the group A. (6) There was a statistical significance in complications between 2 groups and group B was higher than group A. Major complications in group A were pain, lag screw cut out, implant infection and distal femoral fractures caused by fall after the surgery. On elderly patients with trochanteric hip fracture on the hemiplegic lower side, Gamma nail internal fixation treatment can achieve better effect, patients can be early activity, fewer complications, and less mortality. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. An in vivo evaluation of PLLA/PLLA-gHA nano-composite for internal fixation of mandibular bone fractures.

    Science.gov (United States)

    Peng, Weihai; Zheng, Wei; Shi, Kai; Wang, Wangshu; Shao, Ying; Zhang, Duo

    2015-11-09

    Internal fixation of bone fractures using biodegradable poly(L-lactic-acid) (PLLA)-based materials has attracted the attention of many researchers. In the present study, 36 male beagle dogs were randomly assigned to two groups: PLLA/PLLA-gHA (PLLA-grafted hydroxyapatite) group and PLLA group. PLLA/PLLA-gHA and PLLA plates were embedded in the muscular bags of the erector spinae and also implanted to fix mandibular bone fractures in respective groups. At 1, 2, 3, 6, 9, and 12 months postoperatively, the PLLA/PLLA-gHA and PLLA plates were evaluated by adsorption and degradation tests, and the mandibles were examined through radiographic analysis, biomechanical testing, and histological analysis. The PLLA/PLLA-gHA plates were non-transparent and showed a creamy white color, and the PLLA plates were transparent and faint yellow in color. At all time points following surgery, adsorption and degradation of the PLLA/PLLA-gHA plates were significantly less than those of the PLLA plates, and the lateral and longitudinal bending strengths of the surgically treated mandibles of the beagle dogs in the PLLA/PLLA-gHA group were significantly greater than those of the PLLA group and reached almost the value of intact mandibles at 12 months postoperatively. Additionally, relatively rapid bone healing was observed in the PLLA/PLLA-gHA group with the formation of new lamellar bone tissues at 12 months after the surgery. The PLLA/PLLA-gHA nano-composite can be employed as a biodegradable material for internal fixation of mandibular bone fractures.

  5. Return to Sports and Physical Activities After Open Reduction and Internal Fixation of Lisfranc Injuries in Recreational Athletes.

    Science.gov (United States)

    Mora, Allan David; Kao, Mark; Alfred, Terrence; Shein, Gregory; Ling, Jeff; Lunz, David

    2018-03-01

    The purpose of this study was to assess participation in sport and physical activity following open reduction and internal fixation of a Lisfranc injury in a cohort of recreational athletes. This study identified all adult patients aged 55 years or younger who presented with a Lisfranc injury and underwent open reduction and internal fixation (ORIF) using a Lisfranc screw combined with bridge plating technique. Sports and physical activity participation was assessed with a new sports-specific, patient-administered questionnaire. Clinical outcomes were assessed with the Foot and Ankle Outcome Score (FAOS). Thirty-three patients qualified for the study (21 men/12 women). Mean age and follow-up were 31.2 (range, 18-55) years and 2.9 (range, 1.5-5.4) years, respectively. Postoperatively, 31 patients (94%) were able to return to some form of sport. Twenty-two patients (66%) returned to playing sport at or above their preinjury level. Of the 11 patients who played less sport, 6 had ongoing pain, and the remaining 5 were asymptomatic but were participating less frequently because of other lifestyle reasons. In addition, of the 33 patients, 11 (33%) had some degree of ongoing pain that might limit their ability to return to sports and physical activities. There was strong correlation between overall FAOS and the Sports Questionnaire. Most patients who sustained a Lisfranc injury could return to sport and physical activity after ORIF. Patients should be counseled preoperatively that about 1 in 3 might experience continued pain at the injury site Level of Evidence: Level IV, retrospective case series.

  6. Efficacy of open reduction and internal fixation with a miniplate and hollow screw in the treatment of Lisfranc injury.

    Science.gov (United States)

    Li, Bao-Liang; Zhao, Wen-Bo; Liu, Lei; Huang, Fu-Guo; Wang, Guang-Lin; Fang, Yue

    2015-01-01

    To investigate efficacy of open reduction and internal fixation with the miniplate and hollow screw in the treatment of Lisfranc injury. Ten cases of Lisfranc injury treated by open reduction, miniplate and hollow screw in our hospital were retrospectively analyzed. There were 6 males and 4 females with age ranging from 25 to 45 years (mean 32 years). Among them, one case was classified as Type A, six Type B and three Type C. Injury mechanism included road traffic accidents (3 cases), fall from height (5 cases) and hit by heavy object (2 cases). All injuries were closed without cerebral trauma or other complicated injuries. The time interval between injury and operation was 6-10 days (average 6.6 days). Postoperatively, the foot function was assessed using Visual Analogue Scales (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) Scales. Healing time and complications were observed. All patients were followed up for 18-24 months (average 20 months). Anatomic reduction was achieved in all patients on images. There was statistical significance between preoperative score (7.89 ± 0.34) and score at postoperative 8 weeks (0.67 ± 0.13). According to the AOFAS score, 5 cases were defined as excellent, 3 cases as good and 2 cases as fair. During follow-up, there was no wound infection or complications except for osteoarthritis in 2 cases. Healing time ranged from 3 to 6 months with an average of 3.6 months. Anatomical reduction of Lisfranc injury can be achieved by open reduction and internal fixation with the miniplate and hollow screw. Normal structure of Lisfranc joint is regained to a great extent; injured ligaments were also repaired. Therefore, this method offers excellent curative effect and can avoid postoperative complications and improve the patients' quality of life.

  7. The treatment of intra-articular calcaneus fractures with severe soft tissue damage with a hinged external fixator or internal stabilization: long-term results.

    Science.gov (United States)

    Besch, Lutz; Waldschmidt, Jan Soeren; Daniels-Wredenhagen, Mark; Varoga, Deike; Mueller, Michael; Hilgert, Ralf-Erik; Mathiak, Guenther; Oestern, Stefanie; Lippross, Sebastian; Seekamp, Andreas

    2010-01-01

    We developed a hinged external fixator for the treatment of dislocated intra-articular calcaneus fractures with severe soft tissue damage. The external fixation was performed with a known external fixator system. The screw insertion points were biomechanically tested by defining a virtual rotation axis through the center of the talus to allow early active motion in the ankle joint. Long-term follow-up was performed after an average of 7.3 years. Results were graded with the American Orthopaedic Foot and Ankle Society (AOFAS) score. Radiographs were reviewed according to Sanders classification. Four open fractures and 33 cases with extremely swollen soft tissue, blisters, or compartment syndromes were treated. In 24 cases (64.9%), the hinged fixator was the final method of treatment (group I). A change to open reduction with internal fixation was performed in 13 fractures (35.1%) when soft tissue problems were minimal (group II). There were no late amputations, osteomyelitis, or malunions. According to Sanders classification, group I consisted of 14 type II, 8 type III, and 2 type IV fractures. Pin loosening or pin infection was seen in 4 cases, but there was no redislocation. The Böhler's angle improved in 43%, gaps in the posterior facet were closed in 41%, and any shortening or deviation of the axis was corrected in 82% of the cases. The AOFAS score for the group averaged 66.5. According to Sanders classification, group II consisted of 8 type II and 5 type III fractures. The Böhler's angle improved in 88%, and gaps in the posterior facet were closed in 87%. Any shortening or deviation of the axis was corrected in 95%, and the AOFAS score averaged 61.3. Significant differences in patient outcome scores between open reduction with internal fixation and hinged fixator were not found. P value was > .05. The hinged external fixator frame can be used in all calcaneus fracture types without soft tissue limitation. The hinged fixator allows early movement in the ankle

  8. Open Reduction with Internal Fixation of Mandibular Angle Fractures: A Retrospective Study.

    Science.gov (United States)

    Bouchard, Carl; Mansouri, Masoud

    2017-01-01

    The goal of this project was to report the complications associated with mandibular angle fractures and identify variables affecting their occurrence. We retrospectively reviewed the charts of patients with a mandibular angle fracture treated at the Centre hospitalier universitaire de Québec between 2009 and 2013. Seventy-eight patients (73 males) aged 15-59 years (mean 25.2 years) met our inclusion criteria. A wisdom tooth was present in 85.9% (n = 67) of the cases and it was removed 62.7% (n = 42) of the time. Thirty-four patients (43.6%) had other mandibular fractures. Most fractures were fixated with a sagittal split osteotomy plate (n = 32; 41.0%) or a 2.0-mm plate on the lateral aspect of the mandible (n = 20; 25.6%). The overall complication rate was 42.3% (n = 33); of these 37.2% were infections, 26.9% involved plate removal and 6.4% were associated with non-union. Older patients had more infections (p = 0.03) and more plates removed (p = 0.03). When a wisdom tooth was extracted, more infections (p = 0.04) and overall complications (p = 0.02) were observed. This study confirms that, when treating a mandibular angle fracture in a healthy patient, it may be beneficial to leave a wisdom tooth in the line of fracture in place, if there is no indication to remove it.

  9. DEGRADATION OF AND TISSUE REACTION TO BIODEGRADABLE POLY(L-LACTIDE) FOR USE AS INTERNAL-FIXATION OF FRACTURES - A STUDY IN RATS

    NARCIS (Netherlands)

    BOS, RRM; ROZEMA, FR; BOERING, G; NIJENHUIS, AJ; PENNINGS, AJ; NIEUWENHUIS, P; JANSEN, HWB; Verweij, A.B.

    Samples of high-molecular-weight poly (L-lactide) (PLLA) (MBAR(v) = 9.0 x 10(5)), a biomaterial developed for plates and screws used in internal fixation of jaw fractures, were implanted subcutaneously in the backs of rats to study tissue reaction to PLLA and to follow the degradation process. The

  10. Effects of three-dimensional navigation on intraoperative management and early postoperative outcome after open reduction and internal fixation of displaced acetabular fractures

    DEFF Research Database (Denmark)

    Oberst, Michael; Hauschild, Oliver; Konstantinidis, Lukas

    2012-01-01

    BACKGROUND: This study was conducted to evaluate whether intraoperative procedure and/or early postoperative results after open reduction and internal fixation (ORIF) of displaced acetabulum fractures are influenced by the use of a three-dimensional (3D) image intensifier in combination with a na...

  11. Low complications after minimally invasive fixation of calcaneus fracture.

    Science.gov (United States)

    Ene, R; Popescu, D; Panaitescu, C; Circota, G; Cirstoiu, M; Cirstoiu, C

    2013-03-15

    Calcaneus fractures are still a delicate point regarding the indication for osteosynthesis. Knowing the skin's poor vascularisation of the back foot, the purpose of this study is to present the benefits of proper surgical options between an open and invasive osteosynthesis with anatomical reduction and internal fixation or minimally invasive approach preserving the quality of the soft parts. 66 interventions that targeted reduction and internal fixation of calcaneus fractures were performed between 2009-2012, in the Orthopaedic and Traumatology Department of Bucharest Emergency University Hospital. 29 cases underwent open reduction and internal fixation with plates and screws or Kirschner wires, and 37 cases underwent a minimally invasive reduction and Essex Lopresti osteosynthesis technique. No patient who underwent a minimally invasive reduction had skin lesions, but showed pain due to osteoarthritis lesions that appeared in the subtalar joint. 4 of them, who underwent open reduction and internal fixation had postoperative wound infections and skin necrosis.

  12. CLINICAL AND FUNCTIONAL OUTCOME OF DISTAL RADIUS FRACTURES MANAGED BY LIGAMENTOTAXIS AND/OR PERCUTANEOUS PINNING VERSUS OPEN REDUCTION & INTERNAL FIXATION BY BUTTRESS PLATES

    Directory of Open Access Journals (Sweden)

    Biju

    2015-05-01

    Full Text Available INTRODUCTI ON: We studied the clinical and functional outcome of distal radius fractures managed by ligamentotaxis and/or percutaneous pinning versus open reduction & internal fixation by buttress plates. METHODS : This prospective study was conducted during Aug 2012 to October 2014. All skeletally matured patients were having both Intra articular and extra articular Closed Distal Radius fractures were studied. Treatment was done either external fixator supplemented with k wires or internal fixation with plate and screws. The radiographic evaluation included radial length, palmar tilt, any evidence of jointincongruity and radio ulnar joint instability and arthritis. The assessments that were made includes Subjective assessment – pain, numbness, weakness of hand, stiffness, OBJECTIVE : R ange of motion measured by hand held goniometer, Measurement of grip strength done by commercially available hand dynamometer. Unaffected hand served as control. RESULTS : Male patients (85.46% outnumbered female patients (14.54% in incidence. The incidence of distal ra dius fractures was common between the ages of 20 to 40 years. Left sided fractures were more common (52.73%. Type III was most common type of fracture (Frykman’s Classification, accounting for 29% of all fractures.25 cases were treated by external fixati on and 30 cases were treated by open reduction and buttress plating. The results were evaluated by using STEWART ET AL anatomical and functional scoring system. The average range of movement at the knee joint was Dorsiflexion 70*, Palmar Flexion 65*, Ulnar Deviation 25*, Radial Deviation 15*, Supination 70*, Pronation 65*. Most common early complication was pin tract infection. Based on the stewar et al scoring, 4(7.27% had excellent, 43(78.18% had good, 7(12.72% had fair, 1(1.81% had poor results. CONC LUSION : We observed that both fixations were equally same, there is no superiority with over the other. The incidence of complications in

  13. [Clinical and radiographic evaluation of open reduction and internal fixation with headless compression screws in treatment of lisfranc joint injuries].

    Science.gov (United States)

    Zhang, Hui; Min, Li; Wang, Guanglin; Liu, Lei; Fang, Yue; Tu, Chongqi

    2013-10-01

    To evaluate the clinical and radiographic outcomes of headless compression screws for Lisfranc joint injuries. A retrospective analysis was made on clinical data of 34 patients (36 feet) with Lisfranc joint injuries who underwent open reduction and internal fixation with headless compression screws between January 2006 and January 2012. There were 22 males (24 feet) and 12 females (12 feet), aged 21-73 years (mean, 38.9 years). The causes of injury included traffic accident in 16 cases (17 feet), falling from height in 11 cases (12 feet), crushing in 5 cases (5 feet), and sports in 2 cases (2 feet). Of them, there were 19 cases (20 feet) of closed injury and 15 cases (16 feet) of open injury; there were 7 cases (8 feet) of pure dislocations of tarsometatarsal joints and ligamentous Lisfranc injuries (LD), 22 cases (23 feet) of Lisfranc joint fracture dislocations (LFD), 5 cases (5 feet) of combined Chopart-LFD (CLFD). According to Myerson classification, 5 cases (5 feet) were rated as type A, 7 cases (8 feet) as type B1, 14 cases (15 feet) as type B2, 5 cases (5 feet) as type C1, and 3 cases (3 feet) as type C2. Associated fractures included 12 cases (13 feet) of metatarsal shaft fracture, 4 cases (4 feet) of cuboid fracture, 4 cases (4 feet) of navicular bone fracture, 6 cases (7 feet) of coneiform bone fracture/dislocation, 8 cases (10 feet) of ipsilateral lower limb multiple fracture, and 4 cases (4 feet) of contralateral lower limb multiple fracture. The clinical outcomes were evaluated according to American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue scale (VAS) score. Postoperative X-ray films were taken to assess the reduction, internal fixation, and the foot arch height. All patients were followed up 1 year to 5 years and 2 months (mean, 3.5 years). X-ray films showed anatomical reduction in 31 cases (33 feet, 91.7%). At last follow-up, AOFAS score and VAS score averaged 80.6 (range, 60-100) and 2.3 (range, 0-6), respectively; the

  14. Open reduction and Internal Fixation of Displaced Proximal Humerus Fractures with AO Stainless Steel T-Plate

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    Hussain S

    2014-03-01

    Full Text Available Background: Proximal humeral fractures are considered the last unsolved fractures in orthopaedics. The treatment is controversial and various operative modalities have been reported in the literature. The aim of the present study was to evaluate functional outcome and complication rate after open reduction and internal fixation of displaced proximal humerus fractures by proximal humerus AO stainless steel Tplate. Twenty-five (25 patients with displaced proximal humerus fractures treated with proximal humerus T-plate between May 2005 and June 2008 were included in the study. Fractures were classified according to the Neer classification into displaced 2-part, 3-part, and 4-part fractures. Patients were followed-up for a minimum period of two years. Functional evaluation was done according to the Neer scoring system. Scores were compared with other studies in the literature using similar implant. Twenty patients had 2-part fracture, four had 3-part fracture, and one had 4-part fracture. Eighty-eight [88% (n = 22] patients had good to excellent result, eight [8% (n = 2] had fair, and four [4% (n = 1] had poor result. Difference in Neer’s score between 2-part and 3-part fractures was not significant. Complications encountered in this series were screw backout in 8% (n = 2, superficial infection in 12% (n= 3, and avascular necrosis in 4% (n = 1 of cases. We conclude that proximal humerus AO T- plate is a cheap and easily available implant, aspects which are particularly relevant in third world countries like India. It gives reliable fixation for 2-part and 3-part fractures. Its use in more complicated fracture patterns of 4-part fractures is not recommended.

  15. FUNCTIONAL OUTCOME OF INTERNAL FIXATION FOR DISPLACED INTRA-ARTICULAR CALCANEAL FRACTURE

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    Saket Jati

    2016-12-01

    Full Text Available BACKGROUND There are always difference of opinion in the importance of Bohler’s angle in evaluating the severity of displaced intra-articular calcaneal fractures and predicting the functional outcome following surgical fixation. The purpose of this research, the relationship exists between Bohler’s angle and the injury severity of displaced calcaneal fractures and between surgical improvement of Bohler’s angle and its practical outcome. MATERIALS AND METHODS Patients were treated surgically for unilateral closed displaced intra-articular calcaneal fractures from May 2014 to October 2016 were identified. The Bohler’s angles of bilateral calcaneus were measured and was compared to the dimension of the uninjured foot was used as its normal control. The difference in the value of Bohler’s angle measured preoperatively or after surgery between the angle of the damaged foot and that of the contralateral calcaneus was calculated, respectively. The change in Bohler’s angle by ratio was calculated by dividing the variation in the value of Bohler’s angle between bilateral calcaneus by its typical control. The injury severity was assessed according to Sanders classification. The functional outcomes were assessed using American Orthopaedic Foot and Ankle Society hindfoot scores. RESULTS 30 patients were included into the study with a mean follow-up duration of 30 months. According to Sanders classification, the fracture pattern included 12 type II, 10 type III and 8 type IV fractures. According to American Orthopaedic Foot and Ankle Society hindfoot scoring system, the excellent, good, fair and poor results were achieved in 10, 8, 4 and 2 patients, respectively. The preoperative Bohler’s angle, difference value of Bohler’s angle between bilateral calcaneus and change in Bohler’s angle by ratio each has a significant relationship with Sanders classification (P=0.003; P=0.004; P=0.005, respectively, however, is not correlated with

  16. Open reduction and internal fixation of mandibular angle fractures: does the transbuccal technique produce fewer complications after treatment than the transoral technique?

    Science.gov (United States)

    Wan, Kenneth; Williamson, Raymond A; Gebauer, Dieter; Hird, Kathryn

    2012-11-01

    The study's purpose was to answer the following clinical question: in patients with mandibular angle fractures requiring open reduction and internal fixation, do those who have fixation screws inserted using a transbuccal approach compared with those with fixation screws inserted using a transoral approach have fewer complications after treatment? The investigators hypothesized that the transoral approach was associated with a higher risk of complications. A multicenter retrospective cohort study was performed in patients who had open reduction and internal fixation of mandibular angle fractures from 2008 to 2010 within Western Australia. Patients were divided into transbuccal and transoral groups and then further subdivided into groups with and without fixation failures (primary outcome variable) and statistically compared. Binary logistic regression was used to control for possible confounders, which included patient gender, age, a wisdom tooth within the fracture not extracted, dental caries, partial dentition, bilateral/unilateral fractures, and smoking. In total 597 patients were in the study. Sixteen percent of patients in the transoral group had complications after treatment versus 10% in the transbuccal group. For the transoral technique, the odds of having fixation failure was 1.71 times greater than with the transbuccal technique (95% confidence interval, 1.02 to 2.93; P = .04). Incidences of all complication variables (hardware loosening/fracturing, wound dehiscence, secondary infection, surgery redo, nonunion/malunion of fracture, and removal of plate) were lower in the transbuccal group apart from plate fracture. The transbuccal technique was associated with fewer complications after treatment compared with the transoral technique. Crown Copyright © 2012. Published by Elsevier Inc. All rights reserved.

  17. [Treatment of open tile type C pelvic fractures by open reduction and internal fixation through anterior and posterior approaches at early stage].

    Science.gov (United States)

    Li, Baichuan

    2014-05-01

    To explore the effectiveness of open reduction and internal fixation through anterior and posterior approaches in treatment of open Tile type C pelvic fractures at early stage. Between January 2009 and April 2012, 12 patients with open Tile C pelvic fractures were treated. There were 7 males and 5 females, aged 6-53 years (median, 31 years). Of 12 cases, 4 were classified as Tile type C1, 6 as Tile type C2, and 2 as Tile type C3; 5 were rated as Gustilo type II and 7 as Gustilo type III. The injury severity score was 18-57 (mean, 37.2). The interval of injury and admission ranged from 15 minutes to 3 days (median, 50 minutes). The debridement and external fixation were performed at first stage; then open reduction and internal fixation were used through anterior approach (reconstruction plate) and posterior approach (cannulated lag screws). The vacuum sealing drainage was performed during treatment until the wounds healed. Delayed healing of incison was obtained in 12 cases because of wound infection. Anatomical reduction or approximate anatomical reduction was achieved in all 12 cases. The patients were followed up 3-39 months (median, 18 months). No loosening of internal fixation or fracture displacement was observed during follow-up. The fracture healing time was 7-13 weeks (mean, 9.7 weeks). At last follow-up, according to the Matta standard, the outcome was excellent in 10 cases and good in 2 cases; according to Majeed score, the results were excellent in 9 cases, good in 1, and poor in 2. Early internal fixation operation of open Tile type C pelvic fractures can effectively restore the pelvic anatomical structure and stability, reduce the complication, and achieve satisfactory effectiveness.

  18. Fracture fixation in the operative management of hip fractures (FAITH): an international, multicentre, randomised controlled trial

    NARCIS (Netherlands)

    Nauth, A. (Aaron); Creek, A.T. (Aaron T.); Zellar, A. (Abby); Lawendy, A.-R. (Abdel-Rahman); Dowrick, A. (Adam); Gupta, A. (Ajay); Dadi, A. (Akhil); A. van Kampen (A.); Yee, A. (Albert); A.C. de Vries (Alexander); de Mol van Otterloo, A. (Alexander); Garibaldi, A. (Alisha); Liew, A. (Allen); McIntyre, A.W. (Allison W.); Prasad, A.S. (Amal Shankar); Romero, A.W. (Amanda W.); Rangan, A. (Amar); Oatt, A. (Amber); Sanghavi, A. (Amir); Foley, A.L. (Amy L.); Karlsten, A. (Anders); Dolenc, A. (Andrea); Bucknill, A. (Andrew); Chia, A. (Andrew); Evans, A. (Andrew); Gong, A. (Andrew); Schmidt, A.H. (Andrew H.); Marcantonio, A.J. (Andrew J.); Jennings, A. (Andrew); Ward, A. (Angela); Khanna, A. (Angshuman); Rai, A. (Anil); Smits, A.B. (Anke B.); Horan, A.D. (Annamarie D.); Brekke, A.C. (Anne Christine); Flynn, A. (Annette); Duraikannan, A. (Aravin); Stødle, A. (Are); van Vugt, A.B. (Arie B.); Luther, A. (Arlene); Zurcher, A.W. (Arthur W.); Jain, A. (Arvind); Amundsen, A. (Asgeir); Moaveni, A. (Ash); Carr, A. (Ashley); Sharma, A. (Ateet); Hill, A.D. (Austin D.); Trommer, A. (Axel); Rai, B.S. (B. Sachidananda); Hileman, B. (Barbara); Schreurs, B. (Bart); Verhoeven, B. (Bart); Barden, B.B. (Benjamin B.); Flatøy, B. (Bernhard); B.I. Cleffken (Berry); Bøe, B. (Berthe); Perey, B. (Bertrand); Hanusch, B.C. (Birgit C.); Weening, B. (Brad); B. Fioole (Bram); Rijbroek, B. (Bram); Crist, B.D. (Brett D.); Halliday, B. (Brett); Peterson, B. (Brett); Mullis, B. (Brian); Richardson, C.G. (C. Glen); Clark, C. (Callum); Sagebien, C.A. (Carlos A.); C. van der Pol (Carmen); Bowler, C. (Carol); Humphrey, C.A. (Catherine A.); Coady, C. (Catherine); Koppert, C.L. (Cees L.); Coles, C. (Chad); Tannoury, C. (Chadi); DePaolo, C.J. (Charles J.); Gayton, C. (Chris); Herriott, C. (Chris); Reeves, C. (Christina); Tieszer, C. (Christina); Dobb, C. (Christine); Anderson, C.G. (Christopher G.); Sage, C. (Claire); Cuento, C. (Claudine); Jones, C.B. (Clifford B.); Bosman, C.H.R. (Coks H.R.); Linehan, C. (Colleen); C.P. van der Hart (Cor P.); Henderson, C. (Corey); Lewis, C.G. (Courtland G.); Davis, C.A. (Craig A.); Donohue, C. (Craig); Mauffrey, C. (Cyril); Sundaresh, D.C. (D. C.); Farrell, D.J. (Dana J.); Whelan, D.B. (Daniel B.); Horwitz, D. (Daniel); Stinner, D. (Daniel); Viskontas, D. (Darius); Roffey, D.M. (Darren M.); Alexander, D. (David); Karges, D.E. (David E.); Hak, D. (David); Johnston, D. (David); Love, D. (David); Wright, D.M. (David M.); Zamorano, D.P. (David P.); Goetz, D.R. (David R.); Sanders, D. (David); Stephen, D. (David); Yen, D. (David); Bardana, D. (Davide); Olakkengil, D.J. (Davy J); Lawson, D. (Deanna); Maddock, D. (Deborah); Sietsema, D.L. (Debra L.); Pourmand, D. (Deeba); D. den Hartog (Dennis); Donegan, D. (Derek); D. Heels-Ansdell (Diane); Nam, D. (Diane); Inman, D. (Dominic); Boyer, D. (Dory); Li, D. (Doug); Gibula, D. (Douglas); Price, D.M. (Dustin M.); Watson, D.J. (Dylan J.); Hammerberg, E.M. (E. Mark); Tan, E.T.C.H. (Edward T.C.H.); E.J.R. de Graaf (Eelco); Vesterhus, E.B. (Elise Berg); Roper, E. (Elizabeth); Edwards, E. (Elton); E.H. Schemitsch (Emil); E.R. Hammacher (Eric); Henderson, E.R. (Eric R.); Whatley, E. (Erica); Torres, E.T. (Erick T.); Vermeulen, E.G.J. (Erik G.J.); Finn, E. (Erin); E.M.M. van Lieshout (Esther); Wai, E.K. (Eugene K.); Bannister, E.R. (Evan R.); Kile, E. (Evelyn); Theunissen, E.B.M. (Evert B.M.); Ritchie, E.D. (Ewan D.); Khan, F. (Farah); Moola, F. (Farhad); Howells, F. (Fiona); F. de Nies (Frank); F.H.W.M. van der Heijden (Frank); de Meulemeester, F.R.A.J. (Frank R.A.J.); F. Frihagen (Frede); Nilsen, F. (Fredrik); Schmidt, G.B. (G. Ben); Albers, G.H.R. (G.H. Robert); Gudger, G.K. (Garland K.); Johnson, G. (Garth); Gruen, G. (Gary); Zohman, G. (Gary); Sharma, G. (Gaurav); Wood, G. (Gavin); G.W.M. Tetteroo (Geert); Hjorthaug, G. (Geir); Jomaas, G. (Geir); Donald, G. (Geoff); Rieser, G.R. (Geoffrey Ryan); Reardon, G. (Gerald); Slobogean, G.P. (Gerard P.); G.R. Roukema (Gert); Visser, G.A. (Gijs A.); Moatshe, G. (Gilbert); Horner, G. (Gillian); Rose, G. (Glynis); Guyatt, G. (Gordon); Chuter, G. (Graham); Etherington, G. (Greg); Rocca, G.J.D. (Gregory J. Della); Ekås, G. (Guri); Dobbin, G. (Gwendolyn); Lemke, H.M. (H. Michael); Curry, H. (Hamish); H. Boxma (Han); Gissel, H. (Hannah); Kreder, H. (Hans); Kuiken, H. (Hans); H.L.F. Brom; Pape, H.-C. (Hans-Christoph); H.M. van der Vis (Harm); Bedi, H. (Harvinder); Vallier, H.A. (Heather A.); Brien, H. (Heather); Silva, H. (Heather); Newman, H. (Heike); H. Viveiros (Helena); van der Hoeven, H. (Henk); Ahn, H. (Henry); Johal, H. (Herman); H. Rijna; Stockmann, H. (Heyn); Josaputra, H.A. (Hong A.); Carlisle, H. (Hope); van der Brand, I. (Igor); I. Dawson (Imro); Tarkin, I. (Ivan); Wong, I. (Ivan); Parr, J.A. (J. Andrew); Trenholm, J.A. (J. Andrew); J.C. Goslings (Carel); Amirault, J.D. (J. David); Broderick, J.S. (J. Scott); Snellen, J.P. (Jaap P.); Zijl, J.A.C. (Jacco A.C.); Ahn, J. (Jaimo); Ficke, J. (James); Irrgang, J. (James); Powell, J. (James); Ringler, J.R. (James R.); Shaer, J. (James); Monica, J.T. (James T.); J. Biert (Jan); Bosma, J. (Jan); Brattgjerd, J.E. (Jan Egil); J.P.M. Frölke (Jan Paul); J.C. Wille (Jan); Rajakumar, J. (Janakiraman); Walker, J.E. (Jane E.); Baker, J.K. (Janell K.); Ertl, J.P. (Janos P.); de Vries, J.P.P.M. (Jean Paul P.M.); Gardeniers, J.W.M. (Jean W.M.); May, J. (Jedediah); Yach, J. (Jeff); Hidy, J.T. (Jennifer T.); Westberg, J.R. (Jerald R.); Hall, J.A. (Jeremy A.); van Mulken, J. (Jeroen); McBeth, J.C. (Jessica Cooper); Hoogendoorn, J. (Jochem); Hoffman, J.M. (Jodi M.); Cherian, J.J. (Joe Joseph); Tanksley, J.A. (John A.); Clarke-Jenssen, J. (John); Adams, J.D. (John D.); Esterhai, J. (John); Tilzey, J.F. (John F.); Murnaghan, J. (John); Ketz, J.P. (John P.); Garfi, J.S. (John S.); Schwappach, J. (John); Gorczyca, J.T. (John T.); Wyrick, J. (John); Rydinge, J. (Jonas); Foret, J.L. (Jonathan L.); Gross, J.M. (Jonathan M.); Keeve, J.P. (Jonathan P.); Meijer, J. (Joost); J.J. Scheepers (Joris J.); Baele, J. (Joseph); O'Neil, J. (Joseph); Cass, J.R. (Joseph R.); Hsu, J.R. (Joseph R.); Dumais, J. (Jules); Lee, J. (Julia); Switzer, J.A. (Julie A.); Agel, J. (Julie); Richards, J.E. (Justin E.); Langan, J.W. (Justin W.); Turckan, K. (Kahn); Pecorella, K. (Kaili); Rai, K. (Kamal); Aurang, K. (Kamran); Shively, K. (Karl); K.J.P. van Wessem; Moon, K. (Karyn); Eke, K. (Kate); Erwin, K. (Katie); Milner, K. (Katrine); K.J. Ponsen (Kees-jan); Mills, K. (Kelli); Apostle, K. (Kelly); Johnston, K. (Kelly); Trask, K. (Kelly); Strohecker, K. (Kent); Stringfellow, K. (Kenya); Kruse, K.K. (Kevin K.); Tetsworth, K. (Kevin); Mitchell, K. (Khalis); Browner, K. (Kieran); Hemlock, K. (Kim); Carcary, K. (Kimberly); Jørgen Haug, K. (Knut); Noble, K. (Krista); Robbins, K. (Kristin); Payton, K. (Krystal); Jeray, K.J. (Kyle J.); Rubino, L.J. (L. Joseph); Nastoff, L.A. (Lauren A.); Leffler, L.C. (Lauren C.); L.P. Stassen (Laurents); O'Malley, L.K. (Lawrence K.); Specht, L.M. (Lawrence M.); L. Thabane (Lehana); Geeraedts, L.M.G. (Leo M.G.); Shell, L.E. (Leslie E.); Anderson, L.K. (Linda K.); Eickhoff, L.S. (Linda S.); Lyle, L. (Lindsey); Pilling, L. (Lindsey); Buckingham, L. (Lisa); Cannada, L.K. (Lisa K.); Wild, L.M. (Lisa M.); Dulaney-Cripe, L. (Liz); L.M.S.J. Poelhekke; Govaert, L. (Lonneke); Ton, L. (Lu); Kottam, L. (Lucksy); L.P.H. Leenen (Luke); Clipper, L. (Lydia); Jackson, L.T. (Lyle T.); Hampton, L. (Lynne); de Waal Malefijt, M.C. (Maarten C.); M.P. Simons; M. van der Elst (Maarten); M.W.G.A. Bronkhorst (Maarten); Bhatia, M. (Mahesh); M.F. Swiontkowski (Marc ); Lobo, M.J. (Margaret J.); Swinton, M. (Marilyn); Pirpiris, M. (Marinis); Molund, M. (Marius); Gichuru, M. (Mark); Glazebrook, M. (Mark); Harrison, M. (Mark); Jenkins, M. (Mark); MacLeod, M. (Mark); M.R. de Vries (Mark); Butler, M.S. (Mark S.); Nousiainen, M. (Markku); van ‘t Riet, M. (Martijne); Tynan, M.C. (Martin C.); Campo, M. (Martin); M.G. Eversdijk (Martin); M.J. Heetveld (Martin); Richardson, M. (Martin); Breslin, M. (Mary); Fan, M. (Mary); Edison, M. (Matt); Napierala, M. (Matthew); Knobe, M. (Matthias); Russ, M. (Matthias); Zomar, M. (Mauri); de Brauw, M. (Maurits); Esser, M. (Max); Hurley, M. (Meghan); Peters, M.E. (Melissa E.); Lorenzo, M. (Melissa); Li, M. (Mengnai); Archdeacon, M. (Michael); Biddulph, M. (Michael); Charlton, M. (Michael); McDonald, M.D. (Michael D.); McKee, M.D. (Michael D.); Dunbar, M. (Michael); Torchia, M.E. (Michael E.); Gross, M. (Michael); Hewitt, M. (Michael); Holt, M. (Michael); Prayson, M.J. (Michael J.); M.J.R. Edwards (Michael); Beckish, M.L. (Michael L.); Brennan, M.L. (Michael L.); Dohm, M.P. (Michael P.); Kain, M.S.H. (Michael S.H.); Vogt, M. (Michelle); Yu, M. (Michelle); M.H.J. Verhofstad (Michiel); Segers, M.J.M. (Michiel J.M.); M.J.M. Segers (Michiel); Siroen, M.P.C. (Michiel P.C.); M.R. Reed (Mike); Vicente, M.R. (Milena R.); M.M.M. Bruijninckx (Milko); Trivedi, M. (Mittal); M. Bhandari (Mohit); Moore, M.M. (Molly M.); Kunz, M. (Monica); Smedsrud, M. (Morten); Palla, N. (Naveen); Jain, N. (Neeraj); Out, N.J.M. (Nico J.M.); Simunovic, N. (Nicole); Simunovic, N. (Nicole); N.W.L. Schep (Niels); Müller, O. (Oliver); Guicherit, O.R. (Onno R.); O.J.F. van Waes (Oscar); Wang, O. (Otis); P. Doornebosch (Pascal); Seuffert, P. (Patricia); Hesketh, P.J. (Patrick J.); Weinrauch, P. (Patrick); Duffy, P. (Paul); Keller, P. (Paul); Lafferty, P.M. (Paul M.); Pincus, P. (Paul); P. Tornetta III (Paul); Zalzal, P. (Paul); McKay, P. (Paula); Cole, P.A. (Peter A.); de Rooij, P.D. (Peter D.); Hull, P. (Peter); Go, P.M.N.Y.M. (Peter M.N.Y.M.); P. Patka (Peter); Siska, P. (Peter); Weingarten, P. (Peter); Kregor, P. (Philip); Stahel, P. (Philip); Stull, P. (Philip); P. Wittich (Philippe); P.A.R. Rijcke (Piet); P.P. Oprel (Pim); Devereaux, P.J. (P. J.); Zhou, Q. (Qi); Lee Murphy, R. (R.); Alosky, R. (Rachel); Clarkson, R. (Rachel); Moon, R. (Raely); Logishetty, R. (Rajanikanth); Nanda, R. (Rajesh); Sullivan, R.J. (Raymond J.); Snider, R.G. (Rebecca G.); Buckley, R.E. (Richard E.); Iorio, R. (Richard); Farrugia, R.J. (Richard J); Jenkinson, R. (Richard); Laughlin, R. (Richard); R.P.R. Groenendijk (Richard); Gurich, R.W. (Richard W.); Worman, R. (Ripley); Silvis, R. (Rob); R. Haverlag (Robert); Teasdall, R.J. (Robert J.); Korley, R. (Robert); McCormack, R. (Robert); Probe, R. (Robert); Cantu, R.V. (Robert V.); Huff, R.B. (Roger B.); R.K.J. Simmermacher; Peters, R. (Rolf); Pfeifer, R. (Roman); Liem, R. (Ronald); Wessel, R.N. (Ronald N.); Verhagen, R. (Ronald); Vuylsteke, R. (Ronald); Leighton, R. (Ross); McKercher, R. (Ross); R.W. Poolman (Rudolf); Miller, R. (Russell); Bicknell, R. (Ryan); Finnan, R. (Ryan); Khan, R.M. (Ryan M.); Mehta, S. (Samir); Vang, S. (Sandy); Singh, S. (Sanjay); Anand, S. (Sanjeev); Anderson, S.A. (Sarah A.); Dawson, S.A. (Sarah A.); Marston, S.B. (Scott B.); Porter, S.E. (Scott E.); Watson, S.T. (Scott T.); S. Festen (Sebastiaan); Lieberman, S. (Shane); Puloski, S. (Shannon); Bielby, S.A. (Shea A.); Sprague, S. (Sheila); Hess, S. (Shelley); MacDonald, S. (Shelley); Evans, S. (Simone); Bzovsky, S. (Sofia); Hasselund, S. (Sondre); Lewis, S. (Sophie); Ugland, S. (Stein); Caminiti, S. (Stephanie); Tanner, S.L. (Stephanie L.); S.M. Zielinski (Stephanie); Shepard, S. (Stephanie); Sems, S.A. (Stephen A.); Walter, S.D. (Stephen D.); Doig, S. (Stephen); Finley, S.H. (Stephen H.); Kates, S. (Stephen); Lindenbaum, S. (Stephen); Kingwell, S.P. (Stephen P.); Csongvay, S. (Steve); Papp, S. (Steve); Buijk, S.E. (Steven E.); S. Rhemrev (Steven); Hollenbeck, S.M. (Steven M.); van Gaalen, S.M. (Steven M.); Yang, S. (Steven); Weinerman, S. (Stuart); Subash, (); Lambert, S. (Sue); Liew, S. (Susan); S.A.G. Meylaerts (Sven); Blokhuis, T.J. (Taco J.); de Vries Reilingh, T.S. (Tammo S.); Lona, T. (Tarjei); Scott, T. (Taryn); Swenson, T.K. (Teresa K.); Endres, T.J. (Terrence J.); Axelrod, T. (Terry); van Egmond, T. (Teun); Pace, T.B. (Thomas B.); Kibsgård, T. (Thomas); Schaller, T.M. (Thomas M.); Ly, T.V. (Thuan V.); Miller, T.J. (Timothy J.); Weber, T. (Timothy); Le, T. (Toan); Oliver, T.M. (Todd M.); T.M. Karsten (Thomas); Borch, T. (Tor); Hoseth, T.M. (Tor Magne); Nicolaisen, T. (Tor); Ianssen, T. (Torben); Rutherford, T. (Tori); Nanney, T. (Tracy); Gervais, T. (Trevor); Stone, T. (Trevor); Schrickel, T. (Tyson); Scrabeck, T. (Tyson); Ganguly, U. (Utsav); Naumetz, V. (V.); Frizzell, V. (Valda); Wadey, V. (Veronica); Jones, V. (Vicki); Avram, V. (Victoria); Mishra, V. (Vimlesh); Yadav, V. (Vineet); Arora, V. (Vinod); Tyagi, V. (Vivek); Borsella, V. (Vivian); W.J. Willems (Jaap); Hoffman, W.H. (W. H.); Gofton, W.T. (Wade T.); Lackey, W.G. (Wesley G.); Ghent, W. (Wesley); Obremskey, W. (William); Oxner, W. (William); Cross, W.W. (William W.); Murtha, Y.M. (Yvonne M.); Murdoch, Z. (Zoe)

    2017-01-01

    textabstractBackground Reoperation rates are high after surgery for hip fractures. We investigated the effect of a sliding hip screw versus cancellous screws on the risk of reoperation and other key outcomes. Methods For this international, multicentre, allocation concealed randomised controlled

  19. Fracture fixation in the operative management of hip fractures (FAITH) : an international, multicentre, randomised controlled trial

    NARCIS (Netherlands)

    Nauth, Aaron; Creek, Aaron T.; Zellar, Abby; Lawendy, Abdel Rahman; Dowrick, Adam; Gupta, Ajay; Dadi, Akhil; van Kampen, Albert; Yee, Albert; de Vries, Alexander C.; de Mol van Otterloo, Alexander; Garibaldi, Alisha; Liew, Allen; McIntyre, Allison W.; Prasad, Amal Shankar; Romero, Amanda W.; Rangan, Amar; Oatt, Amber; Sanghavi, Amir; Foley, Amy L.; Karlsten, Anders; Dolenc, Andrea; Bucknill, Andrew; Chia, Andrew; Evans, Andrew; Gong, Andrew; Schmidt, Andrew H.; Marcantonio, Andrew J.; Jennings, Andrew; Ward, Angela; Khanna, Angshuman; Rai, Anil; Smits, Anke B; Horan, Annamarie D.; Brekke, Anne Christine; Flynn, Annette; Duraikannan, Aravin; Stødle, Are; van Vugt, Arie B.; Luther, Arlene; Zurcher, Arthur W.; Jain, Arvind; Amundsen, Asgeir; Moaveni, Ash; Carr, Ashley; Sharma, Ateet; Hill, Austin D.; Trommer, Axel; Rai, B. Sachidananda; Hileman, Barbara; Schreurs, Bart; Verhoeven, Bart A N; Barden, Benjamin B.; Flatøy, Bernhard; Cleffken, Berry I.; Bøe, Berthe; Perey, Bertrand; Hanusch, Birgit C.; Weening, Brad; Fioole, Bram; Rijbroek, Bram; Crist, Brett D.; Halliday, Brett; Peterson, Brett; Mullis, Brian; Richardson, C. Glen; Clark, Callum; Sagebien, Carlos A.; van der Pol, Carmen C.; Bowler, Carol; Humphrey, Catherine A.; Coady, Catherine; Koppert, Cees L.; Coles, Chad; Tannoury, Chadi; DePaolo, Charles J.; Gayton, Chris; Herriott, Chris; Reeves, Christina; Tieszer, Christina; Dobb, Christine; Anderson, Christopher G.; Sage, Claire; Cuento, Claudine; Jones, Clifford B.; Bosman, Coks H.R.; Linehan, Colleen; van der Hart, Cor P.; Henderson, Corey; Lewis, Courtland G.; Davis, Craig A.; Donohue, Craig; Mauffrey, Cyril; Sundaresh, D. C.; Farrell, Dana J.; Whelan, Daniel B.; Horwitz, Daniel; Stinner, Daniel; Viskontas, Darius; Roffey, Darren M.; Alexander, David; Karges, David E.; Hak, David; Johnston, David; Love, David; Wright, David M.; Zamorano, David P.; Goetz, David R.; Sanders, David; Stephen, David; Yen, David; Bardana, Davide; Olakkengil, Davy J.; Lawson, Deanna; Maddock, Deborah; Sietsema, Debra L.; Pourmand, Deeba; Den Hartog, Dennis; Donegan, Derek; Heels-Ansdell, Diane; Nam, Diane; Inman, Dominic; Boyer, Dory; Li, Doug; Gibula, Douglas; Price, Dustin M.; Watson, Dylan J.; Hammerberg, E. Mark; Tan, Edward C T H; de Graaf, Eelco J.R.; Vesterhus, Elise Berg; Roper, Elizabeth; Edwards, Elton; Schemitsch, Emil H.; Hammacher, Eric R.; Henderson, Eric R.; Whatley, Erica; Torres, Erick T.; Vermeulen, Erik G.J.; Finn, Erin; Van Lieshout, Esther M M; Wai, Eugene K.; Bannister, Evan R.; Kile, Evelyn; Theunissen, Evert B.M.; Ritchie, Ewan D.; Khan, Farah; Moola, Farhad; Howells, Fiona; de Nies, Frank; van der Heijden, Frank H.W.M.; de Meulemeester, Frank R.A.J.; Frihagen, Frede; Nilsen, Fredrik; Schmidt, G. Ben; Albers, G. H.Robert; Gudger, Garland K.; Johnson, Garth; Gruen, Gary; Zohman, Gary; Sharma, Gaurav; Wood, Gavin; Tetteroo, Geert W.M.; Hjorthaug, Geir; Jomaas, Geir; Donald, Geoff; Rieser, Geoffrey Ryan; Reardon, Gerald; Slobogean, Gerard P.; Roukema, Gert R.; Visser, Gijs A.; Moatshe, Gilbert; Horner, Gillian; Rose, Glynis; Guyatt, Gordon; Chuter, Graham; Etherington, Greg; Rocca, Gregory J.Della; Ekås, Guri; Dobbin, Gwendolyn; Lemke, H. Michael; Curry, Hamish; Boxma, Han; Gissel, Hannah; Kreder, Hans; Kuiken, Hans; Brom, Hans L.F.; Pape, Hans Christoph; van der Vis, Harm M.; Bedi, Harvinder; Vallier, Heather A.; Brien, Heather; Silva, Heather; Newman, Heike; Viveiros, Helena; van der Hoeven, Henk; Ahn, Henry; Johal, Herman; Rijna, Herman; Stockmann, Heyn; Josaputra, Hong A.; Carlisle, Hope; van der Brand, Igor; Dawson, Imro; Tarkin, Ivan; Wong, Ivan; Parr, J. Andrew; Trenholm, J. Andrew; Goslings, J Carel; Amirault, J. David; Broderick, J. Scott; Snellen, Jaap P.; Zijl, Jacco A.C.; Ahn, Jaimo; Ficke, James; Irrgang, James; Powell, James; Ringler, James R.; Shaer, James; Monica, James T.; Biert, Jan; Bosma, Jan; Brattgjerd, Jan Egil; Frölke, Jan Paul M.; Wille, Jan; Rajakumar, Janakiraman; Walker, Jane E.; Baker, Janell K.; Ertl, Janos P.; De Vries, Jean-Paul P. M.; Gardeniers, Jean W.M.; May, Jedediah; Yach, Jeff; Hidy, Jennifer T.; Westberg, Jerald R.; Hall, Jeremy A.; van Mulken, Jeroen; McBeth, Jessica Cooper; Hoogendoorn, Jochem M; Hoffman, Jodi M.; Cherian, Joe Joseph; Tanksley, John A.; Clarke-Jenssen, John; Adams, John D.; Esterhai, John; Tilzey, John F.; Murnaghan, John; Ketz, John P.; Garfi, John S.; Schwappach, John; Gorczyca, John T.; Wyrick, John; Rydinge, Jonas; Foret, Jonathan L.; Gross, Jonathan M.; Keeve, Jonathan P.; Meijer, Joost; Scheepers, Joris J.G.; Baele, Joseph; O'Neil, Joseph; Cass, Joseph R.; Hsu, Joseph R.; Dumais, Jules; Lee, Julia; Switzer, Julie A.; Agel, Julie; Richards, Justin E.; Langan, Justin W.; Turckan, Kahn; Pecorella, Kaili; Rai, Kamal; Aurang, Kamran; Shively, Karl; van Wessem, Karlijn; Moon, Karyn; Eke, Kate; Erwin, Katie; Milner, Katrine; Ponsen, Kees Jan; Mills, Kelli; Apostle, Kelly; Johnston, Kelly; Trask, Kelly; Strohecker, Kent; Stringfellow, Kenya; Kruse, Kevin K.; Tetsworth, Kevin; Mitchell, Khalis; Browner, Kieran; Hemlock, Kim; Carcary, Kimberly; Jørgen Haug, Knut; Noble, Krista; Robbins, Kristin; Payton, Krystal; Jeray, Kyle J.; Rubino, L. Joseph; Nastoff, Lauren A.; Leffler, Lauren C.; Stassen, Laurents P.S.; O'Malley, Lawrence K.; Specht, Lawrence M.; Thabane, Lehana; Geeraedts, Leo M.G.; Shell, Leslie E.; Anderson, Linda K.; Eickhoff, Linda S.; Lyle, Lindsey; Pilling, Lindsey; Buckingham, Lisa; Cannada, Lisa K.; Wild, Lisa M.; Dulaney-Cripe, Liz; Poelhekke, Lodewijk M.S.J.; Govaert, Lonneke; Ton, Lu; Kottam, Lucksy; Leenen, Luke P.H.; Clipper, Lydia; Jackson, Lyle T.; Hampton, Lynne; de Waal Malefijt, Maarten C.; Simons, Maarten P.; van der Elst, Maarten; Bronkhorst, Maarten W.G.A.; Bhatia, Mahesh; Swiontkowski, Marc; Lobo, Margaret J.; Swinton, Marilyn; Pirpiris, Marinis; Molund, Marius; Gichuru, Mark; Glazebrook, Mark; Harrison, Mark; Jenkins, Mark; MacLeod, Mark; de Vries, Mark R.; Butler, Mark S.; Nousiainen, Markku; van ‘t Riet, Martijne; Tynan, Martin C.; Campo, Martin; Eversdijk, Martin G.; Heetveld, Martin J.; Richardson, Martin; Breslin, Mary; Fan, Mary; Edison, Matt; Napierala, Matthew; Knobe, Matthias; Russ, Matthias; Zomar, Mauri; de Brauw, Maurits; Esser, Max; Hurley, Meghan; Peters, Melissa E.; Lorenzo, Melissa; Li, Mengnai; Archdeacon, Michael; Biddulph, Michael; Charlton, Michael R; McDonald, Michael D.; McKee, Michael D.; Dunbar, Michael; Torchia, Michael E.; Gross, Michael; Hewitt, Michael; Holt, Michael; Prayson, Michael J.; Edwards, Michael J R; Beckish, Michael L.; Brennan, Michael L.; Dohm, Michael P.; Kain, Michael S.H.; Vogt, Michelle; Yu, Michelle; Verhofstad, Michiel H J; Segers, Michiel J M; Segers, Michiel J M; Siroen, Michiel P.C.; Reed, Mike; Vicente, Milena R.; Bruijninckx, Milko M.M.; Trivedi, Mittal; Bhandari, Mohit; Moore, Molly M.; Kunz, Monica; Smedsrud, Morten; Palla, Naveen; Jain, Neeraj; Out, Nico J.M.; Simunovic, Nicole; Simunovic, Nicole; Schep, Niels W. L.; Müller, Oliver; Guicherit, Onno R.; Van Waes, Oscar J.F.; Wang, Otis; Doornebosch, Pascal G.; Seuffert, Patricia; Hesketh, Patrick J.; Weinrauch, Patrick; Duffy, Paul; Keller, Paul; Lafferty, Paul M.; Pincus, Paul; Tornetta, Paul; Zalzal, Paul; McKay, Paula; Cole, Peter A.; de Rooij, Peter D.; Hull, Peter; Go, Peter M.N.Y.M.; Patka, Peter; Siska, Peter; Weingarten, Peter; Kregor, Philip; Stahel, Philip; Stull, Philip; Wittich, Philippe; de Rijcke, Piet A.R.; Oprel, Pim; Devereaux, P. J.; Zhou, Qi; Lee Murphy, R.; Alosky, Rachel; Clarkson, Rachel; Moon, Raely; Logishetty, Rajanikanth; Nanda, Rajesh; Sullivan, Raymond J.; Snider, Rebecca G.; Buckley, Richard E.; Iorio, Richard; Farrugia, Richard J.; Jenkinson, Richard; Laughlin, Richard; Groenendijk, Richard P R; Gurich, Richard W.; Worman, Ripley; Silvis, Rob; Haverlag, Robert; Teasdall, Robert J.; Korley, Robert; McCormack, Robert; Probe, Robert; Cantu, Robert V.; Huff, Roger B.; Simmermacher, Rogier K J; Peters, Rolf; Pfeifer, Roman; Liem, Ronald; Wessel, Ronald N.; Verhagen, Ronald; Vuylsteke, Ronald J C L M; Leighton, Ross; McKercher, Ross; Poolman, Rudolf W; Miller, Russell; Bicknell, Ryan; Finnan, Ryan; Khan, Ryan M.; Mehta, Samir; Vang, Sandy; Singh, Sanjay; Anand, Sanjeev; Anderson, Sarah A.; Dawson, Sarah A.; Marston, Scott B.; Porter, Scott E.; Watson, Scott T.; Festen, Sebastiaan; Lieberman, Shane; Puloski, Shannon; Bielby, Shea A.; Sprague, Sheila; Hess, Shelley; MacDonald, Shelley; Evans, Simone; Bzovsky, Sofia; Hasselund, Sondre; Lewis, Sophie; Ugland, Stein; Caminiti, Stephanie; Tanner, Stephanie L.; Zielinski, Stephanie M.; Shepard, Stephanie; Sems, Stephen A.; Walter, Stephen D.; Doig, Stephen; Finley, Stephen H.; Kates, Stephen; Lindenbaum, Stephen; Kingwell, Stephen P.; Csongvay, Steve; Papp, Steve; Buijk, Steven E.; Rhemrev, Steven J.; Hollenbeck, Steven M.; van Gaalen, Steven M.; Yang, Steven; Weinerman, Stuart; Lambert, Sue; Liew, Susan; Meylaerts, Sven A.G.; Blokhuis, Taco J.; de Vries Reilingh, Tammo S.; Lona, Tarjei; Scott, Taryn; Swenson, Teresa K.; Endres, Terrence J.; Axelrod, Terry; van Egmond, Teun; Pace, Thomas B.; Kibsgård, Thomas; Schaller, Thomas M.; Ly, Thuan V.; Miller, Timothy J.; Weber, Timothy; Le, Toan; Oliver, Todd M.; Karsten, Tom M.; Borch, Tor; Hoseth, Tor Magne; Nicolaisen, Tor; Ianssen, Torben; Rutherford, Tori; Nanney, Tracy; Gervais, Trevor; Stone, Trevor; Schrickel, Tyson; Scrabeck, Tyson; Ganguly, Utsav; Naumetz, V.; Frizzell, Valda; Wadey, Veronica; Jones, Vicki; Avram, Victoria; Mishra, Vimlesh; Yadav, Vineet; Arora, Vinod; Tyagi, Vivek; Borsella, Vivian; Willems, W. Jaap; Hoffman, W. H.; Gofton, Wade T.; Lackey, Wesley G.; Ghent, Wesley; Obremskey, William; Oxner, William; Cross, William W.; Murtha, Yvonne M.; Murdoch, Zoe

    2017-01-01

    Background Reoperation rates are high after surgery for hip fractures. We investigated the effect of a sliding hip screw versus cancellous screws on the risk of reoperation and other key outcomes. Methods For this international, multicentre, allocation concealed randomised controlled trial, we

  20. International outbreak of Salmonella Oranienburg due to German chocolate.

    Science.gov (United States)

    Werber, Dirk; Dreesman, Johannes; Feil, Fabian; van Treeck, Ulrich; Fell, Gerhard; Ethelberg, Steen; Hauri, Anja M; Roggentin, Peter; Prager, Rita; Fisher, Ian S T; Behnke, Susanne C; Bartelt, Edda; Weise, Ekkehard; Ellis, Andrea; Siitonen, Anja; Andersson, Yvonne; Tschäpe, Helmut; Kramer, Michael H; Ammon, Andrea

    2005-02-03

    This report describes a large international chocolate-associated Salmonella outbreak originating from Germany. We conducted epidemiologic investigations including a case-control study, and food safety investigations. Salmonella (S.) Oranienburg isolates were subtyped by the use of pulsed-field gel electrophoresis (PFGE). From 1 October 2001 through 24 March 2002, an estimated excess of 439 S. Oranienburg notifications was registered in Germany. Simultaneously, an increase in S. Oranienburg infections was noted in other European countries in the Enter-net surveillance network. In a multistate matched case-control study in Germany, daily consumption of chocolate (matched odds ratio [MOR]: 4.8; 95% confidence interval [CI]: 1.3-26.5), having shopped at a large chain of discount grocery stores (MOR: 4.2; CI: 1.2-23.0), and consumption of chocolate purchased there (MOR: 5.0; CI: 1.1-47.0) were associated with illness. Subsequently, two brands from the same company, one exclusively produced for that chain, tested positive for S. Oranienburg. In two other European countries and in Canada chocolate from company A was ascertained that also contained S. Oranienburg. Isolates from humans and from chocolates had indistinguishable PFGE profiles. No source or point of contamination was identified. Epidemiological identification of chocolate as a vehicle of infections required two months, and was facilitated by proxy measures. Despite the use of improved production technologies, the chocolate industry continues to carry a small risk of manufacturing Salmonella-containing products. Particularly in diffuse outbreak-settings, clear associations with surrogates of exposure should suffice to trigger public health action. Networks such as Enter-net have become invaluable for facilitating rapid and appropriate management of international outbreaks.

  1. International outbreak of Salmonella Oranienburg due to German chocolate

    Directory of Open Access Journals (Sweden)

    Weise Ekkehard

    2005-02-01

    Full Text Available Abstract Background This report describes a large international chocolate-associated Salmonella outbreak originating from Germany. Methods We conducted epidemiologic investigations including a case-control study, and food safety investigations. Salmonella (S. Oranienburg isolates were subtyped by the use of pulsed-field gel electrophoresis (PFGE. Results From 1 October 2001 through 24 March 2002, an estimated excess of 439 S. Oranienburg notifications was registered in Germany. Simultaneously, an increase in S. Oranienburg infections was noted in other European countries in the Enter-net surveillance network. In a multistate matched case-control study in Germany, daily consumption of chocolate (matched odds ratio [MOR]: 4.8; 95% confidence interval [CI]: 1.3–26.5, having shopped at a large chain of discount grocery stores (MOR: 4.2; CI: 1.2–23.0, and consumption of chocolate purchased there (MOR: 5.0; CI: 1.1–47.0 were associated with illness. Subsequently, two brands from the same company, one exclusively produced for that chain, tested positive for S. Oranienburg. In two other European countries and in Canada chocolate from company A was ascertained that also contained S. Oranienburg. Isolates from humans and from chocolates had indistinguishable PFGE profiles. No source or point of contamination was identified. Epidemiological identification of chocolate as a vehicle of infections required two months, and was facilitated by proxy measures. Conclusions Despite the use of improved production technologies, the chocolate industry continues to carry a small risk of manufacturing Salmonella-containing products. Particularly in diffuse outbreak-settings, clear associations with surrogates of exposure should suffice to trigger public health action. Networks such as Enter-net have become invaluable for facilitating rapid and appropriate management of international outbreaks.

  2. Stabilization of the lower thoracic and lumbar spine with the internal spinal skeletal fixation system. Indications, techniques, and first results of treatment.

    Science.gov (United States)

    Aebi, M; Etter, C; Kehl, T; Thalgott, J

    1987-01-01

    Since 1984, 30 patients with burst fractures of the lower thoracic and lumbar spine were treated with AO internal spinal skeletal fixation system. All patients in this series had a minimum follow-up of 12 months. This new instrumentation is a posterior intrapedicular system developed by Dick in 1982. It allows stable fixation that is limited only to adjacent spinal segments. The internal fixator permits reduction in all three planes. Independently, it is possible to add distraction or compression to the involved segments. It also is able to reduce effectively the "middle column" which is thought to be accomplished by "ligamentotaxis." In this series there were 16 neurologically intact patients and 14 with partial or complete neurologic injury. There were two minor instrumentation loosenings early in the series. Most patients in this series had a near-anatomic reduction of all three columns in the involved segment. It was also possible to re-establish the normal lordosis of the lumbar spine. The device provided sufficient rigid fixation for rapid postoperative mobilization in a light external orthosis.

  3. External fixation of “intertrochanteric” fractures

    Directory of Open Access Journals (Sweden)

    Naseem ul Gani

    2009-08-01

    Full Text Available In developing countries, due to limited availability of modern anesthesia and overcrowding of the hospitals with patients who need surgery, high-risk patients with “intertro-chanteric” fractures remain unsuitable for open reduction and internal fixation. The aim of this study was to analyze the results of external fixation of “intertro-chanteric” fractures in high-risk geriatric patients in a developing country. The results of 62 ambulatory high-risk geriatric patients with a mean age of 70 years (range 58-90 years with “intertrochanteric” fractures, in whom external fixation was performed, are reported. Eight patients died during follow-up due to medical causes unrelated to the surgical procedure. So only 54 patients were available for final assessment. Procedure is simple, performed under local anesthesia, requires less time for surgery and is associated with less blood loss. Good fixation and early ambulation was achieved in most of the patients. Average time to union was 14 weeks. Thirty-one patients developed superficial pin tract infection and 28 patients had average shortening of 15 mm due to impaction and varus angulation. Functional outcome was assessed using Judet’s point system. Good to excellent results were achieved in 44 patients. This study demonstrated that external fixation of “intertrochantric” fractures performed under local anesthesia offers significant advantage in ambulatory high-risk geriatric patients especially in a developing country.

  4. Biomechanical comparison of three types of internal fixation in a type C zone II pelvic fracture model

    Science.gov (United States)

    Wu, Tao; Chen, Wei; Li, Xu; Zhang, Qi; Lv, Hong-Zhi; Zhang, Ying-Ze

    2015-01-01

    Objective: This study aimed to compare the stability of Tile C pelvic fractures fixed with two iliosacral (IS) screws, tension band plate (TBP), and minimally invasive adjustable plate (MIAP). Methods: Six embalmed specimens of adult pelvis were used. The soft tissue was removed from the specimens, but spines from the fourth lumbar vertebra to the proximal one-third of both femurs were retained. The pubic symphysis, bilateral sacroiliac joints and ligaments, bilateral hip joints, bilateral sacrotuberous ligaments, and bilateral sacrospinous ligaments were intact. Tile C pelvic fractures were created on the specimens. The symphysis pubis was fixed with a plate, and the fracture on the posterior pelvic ring was fixed with three types of internal fixation in a randomized block design. The specimens were placed in a biomechanical machine at a standing neutral posture. A cyclic vertical load of up to 500N was applied, and displacement was recorded. Shifts in the fracture gap were measured by a grating displacement sensor. Results: Under different vertical loads, the shift in the fracture gap and displacement of the pelvic fractures fixed with two IS screws were similar to those in fractures fixed with MIAP. However, the shift in the fracture gap and displacement of fractures fixed with MIAP was significantly smaller than those of fractures fixed with TBP. Conclusion: The stability of the Tile C pelvic fractures fixed with MIAP was similar to that of fractures fixed with IS screws. MIAP performed better than TBP under vertical load. PMID:25932113

  5. Wedgeless 'V' shaped distal femoral osteotomy with internal fixation for genu valgum in adolescents and young adults.

    Science.gov (United States)

    Gupta, Vikas; Kamra, Gaurav; Singh, Davinder; Pandey, Ketan; Arora, Sumit

    2014-06-01

    The treatment of angular malalignment includes restoration of normal mechanical axis alignment and joint orientation.The supracondylar wedgeless distal femoral 'V' osteotomy, as a treatment modality, is sparsely explored in the literature. This study was conducted at a tertiary level teaching referral hospital from October 2010 to September 2012. Forty six lower limbs (in 30 patients) were operated with a wedgeless 'V' osteotomy that was fixed with a buttress 'L' plate. The pre-operative deformity, post-operative correction and knee range of movement were noted. Mobilisation was started at 3 weeks after surgery and full weight-bearing was allowed at 3 months. The knee score by Bostman et al. was used for functional outcome. The mean age of the patients in our study was 16.9 years (range: 15 years to 23 years). The patients were followed up for a mean period of 19.8 months (range, 15 months to 29 months). The mean radiological tibiofemoral angle was 22.2 degrees (range, 16 degrees to 29 degrees) before surgery, that improved to a mean postoperative value of 5.1 degrees (range, 0 degrees to 10 degrees) (p p p V' shaped osteotomy is a simple procedure for the correction of genu valgum in individuals nearing skeletal maturity and is easy to perform. It has the advantage of being wedgeless as it does not cause limb length discrepancy. Internal fixation helps in early rehabilitation after surgery.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  7. Antimicrobial prophylaxis in open reduction and internal fixation of compound mandibular fractures: a collaborative regional audit of outcome.

    Science.gov (United States)

    Singh, Rabindra P; Carter, Lachlan M; Whitfield, Paul H

    2013-07-01

    We conducted a regional 2-stage prospective audit involving 5 different maxillofacial units in the Yorkshire region of the UK to evaluate the effectiveness of perioperative antimicrobial prophylaxis in the treatment of mandibular fractures. In the first stage (145 patients) we surveyed current practice concerning antimicrobial prophylaxis and found out the current infection rate after open reduction and internal fixation (ORIF) of mandibular fractures. In the second stage (157 patients) we implemented a common antimicrobial protocol in all units and recorded the infection rates using the new regimen. In the first stage a wide range of antimicrobial prophylaxis was used in different units. The agreed perioperative antimicrobial protocol in the second stage was to begin amoxicillin or clarithromycin and metronidazole intravenously on admission and include 2 postoperative doses. The infection rates were 10.3% and 8.9%, respectively, and the difference between the two groups was not significant (χ(2)=0.051, df=1, p=0.83). The infection rate in the Yorkshire region was similar to results from other centres. We recommend short perioperative antimicrobial prophylaxis with a maximum of 2 postoperative doses after ORIF of mandibular fractures. Copyright © 2012 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  8. A biomechanical experiment and clinical study of the use of figure of eight plus circular wiring fixation for the treatment of olecranon fractures.

    Science.gov (United States)

    Wang, Wulian; Wu, Guangwen; Shen, Fuer; Zhang, Yiyuan; Liu, Xianxiang

    2012-12-01

    The aim of the present study was to evaluate the stability of the figure of eight plus circular wiring fixation technique compared with four common internal fixation techniques and to provide experimental data for the selection of internal fixation techniques clinically. A total of 20 fresh cadaveric elbow joints were used as transverse, oblique and comminuted olecranon fracture models. Five techniques of internal fixation were investigated: circular wiring, figure of eight wiring, circular plus figure of eight wiring, Kirschner wire (K-wire) and screw fixation. The elbow joints were flexed at 90°. The fixation performance was tested using a high-precision displacement sensor. Displacement-load curves revealed that the strength of internal fixation was weakest when using circular wiring alone and that circular wiring plus figure of eight wiring fixation was stronger than that of figure of eight wiring or screw fixation. The difference was statistically significant (Pwiring plus figure of eight wiring fixation and K-wire fixation in the transverse and oblique fracture models (P>0.05). However, figure of eight plus circular wiring fixation was superior to K-wire fixation in the comminuted fracture model, with a tensile force of 67.42±2.17 vs. 58.52±2.17 N, respectively (Pwiring plus figure of eight wiring fixation recovered and 108 were included in the follow-up for an average of 12 months. The rate of excellent/fairly good recovery was 98.10%. Due to its reliability, simple surgery, lower invasiveness and lower cost, figure of eight plus circular wiring fixation is an ideal choice for the internal fixation of olecranon fractures, particularly comminuted fractures, compared with circular wiring, figure of eight wiring or screw fixation.

  9. In vitro biomechanical evaluation of internal fixation techniques on the canine lumbosacral junction.

    Science.gov (United States)

    Early, Peter; Mente, Peter; Dillard, Stacy; Roe, Simon

    2015-01-01

    Few biomechanical studies have evaluated the effect of internal stabilization techniques after decompressive surgery on the stability of the canine lumbosacral junction. The purpose of this canine cadaver study is to evaluate the stability of the canine lumbosacral (LS) spine in flexion and extension following laminectomy and discectomy and then stabilization with each of the three techniques: pins and polymethylmethacrylate (P/PMMA), two dorsal locking plates (SOP) or bilateral transarticular facet screws (FACET).Using a cantilever biomechanical system, bending moments were applied to the LS and range of motion (ROM) was recorded via a rotational potentiometer. With 3 Nm, the ROM (n = 4 in each group) for P/PMMA, SOP and FACET were 1.92 ± 0.96°, 2.56 ± 0.55°and 3.18 ± 1.14°, respectively. With moments up to 35 Nm, the P/PMMA specimens appeared stable. Sacroiliac motion in the SOP and FACET groups invalidated further comparisons. Each of the stabilization techniques (P/PMMA, SOP, and FACET) significantly decreased the range of motion in flexion and extension for low bending moments.

  10. [Auxiliary cerclage-wiring in internal fixation of displaced acetabular fractures].

    Science.gov (United States)

    Erichsen, C J; von Rüden, C; Hierholzer, C; Bühren, V; Woltmann, A

    2015-01-01

    Displaced fractures of the acetabulum involving the quadrilateral plate continue to be a surgical challenge. In this study, we describe our operation technique of auxiliary acetabular cerclage-wiring combined with plate osteosynthesis and present our results as well as short-term outcome. All patients aged 18 years and older treated with auxiliary cerclage-wiring between 2007 and 2012 were included in this study. Fractures were classified according to Letournel. Cerclage wiring was used when reposition and retention of the fracture was insufficient with plates and screws alone. Short-term outcome was evaluated by the German Short Musculoskeletal Functional Assessment (SMFA-D) questionnaire. Data from 23 patients were collected. The follow-up period was 7 months (range 2-23 months). Of the 23 patients, 22 showed excellent fracture reduction and retention. One patient had to undergo revision surgery due to loss of reposition. Patients showed good functional outcome. Auxiliary acetabular cerclage-wiring is a safe and effective method for fracture reduction and retention especially in displaced acetabular fractures involving the quadrilateral plate.

  11. Effects of Low-Dose Microwave on Healing of Fractures with Titanium Alloy Internal Fixation: An Experimental Study in a Rabbit Model

    Science.gov (United States)

    Zhang, Han; Fu, Tengfei; Jiang, Lan; Bai, Yuehong

    2013-01-01

    Background Microwave is a method for improving fracture repair. However, one of the contraindications for microwave treatment listed in the literature is surgically implanted metal plates in the treatment field. The reason is that the reflection of electromagnetic waves and the eddy current stimulated by microwave would increase the temperature of magnetic implants and cause heat damage in tissues. Comparing with traditional medical stainless steel, titanium alloy is a kind of medical implants with low magnetic permeability and electric conductivity. But the effects of microwave treatment on fracture with titanium alloy internal fixation in vivo were not reported. The aim of this article was to evaluate the security and effects of microwave on healing of a fracture with titanium alloy internal fixation. Methods Titanium alloy internal fixation systems were implanted in New Zealand rabbits with a 3.0 mm bone defect in the middle of femur. We applied a 30-day microwave treatment (2,450MHz, 25W, 10 min per day) to the fracture 3 days after operation. Temperature changes of muscle tissues around implants were measured during the irradiation. Normalized radiographic density of the fracture gap was measured on the 10th day and 30th day of the microwave treatment. All of the animals were killed after 10 and 30 days microwave treatment with histologic and histomorphometric examinations performed on the harvested tissues. Findings The temperatures did not increase significantly in animals with titanium alloy implants. The security of microwave treatment was also supported by histology of muscles, nerve and bone around the implants. Radiographic assessment, histologic and histomorphometric examinations revealed significant improvement in the healing bone. Conclusion Our results suggest that, in the healing of fracture with titanium alloy internal fixation, a low dose of microwave treatment may be a promising method. PMID:24086626

  12. Mini-plate versus Kirschner wire internal fixation for treatment of metacarpal and phalangeal fractures in Chinese Han population: a meta-analysis.

    Science.gov (United States)

    Xu, Jiaming; Zhang, Changqing

    2014-04-11

    This meta-analysis aimed to compare the therapeutic effect of mini-plate versus Kirschner wire (K-wire) internal fixation on the treatment of metacarpal and phalangeal fractures among Chinese Han population. Databases of China National Knowledge Infrastructure (CNKI), Wanfang, Chinese VIP, PubMed, and Embase were retrieved for studies on mini-plate (case group) versus K-wire (control group) internal fixation for the treatment of metacarpal and phalangeal fractures among Chinese Han population. The odds ratio (OR) and standardized mean difference (SMD) at 95% confidence interval (CI) were used for estimating the effects of dichotomous data and continuous data, respectively. All statistical analyses were performed by Review Manager 5.2 software. A total of 18 studies involving 1,375 metacarpal or phalangeal fracture patients (709 cases and 666 controls) were included in the meta-analysis. There were significant differences in fracture healing time (SMD = -1.28; 95% CI: -1.81, -0.76), postoperative infection rate (OR = 0.25; 95% CI: 0.16, 0.39), complication incidence (OR = 0.24; 95% CI: 0.15, 0.38), and surgery time (SMD = 1.57; 95% CI: 0.76, 2.37) between the case and the control group, while no significant difference was found in hospital stays between these two groups (SMD = 0.43; 95% CI: -0.34, 1.20; P = 0.27). For the treatment of metacarpal or phalangeal fracture among Chinese Han population, mini-plate has advantages of shorter healing time and lower infection rate and complication incidence compared with K-wire internal fixation, while a longer surgery time than K-wire. In conclusion, mini-plate is prior than K-wire internal fixation for the treatment of metacarpal or phalangeal fracture among Chinese Han population.

  13. In vitro evaluation of allogeneic bone screws for use in internal fixation of transverse fractures created in proximal sesamoid bones obtained from equine cadavers.

    Science.gov (United States)

    Sasaki, Naoki; Takakuwa, Jun; Yamada, Haruo; Mori, Ryuji

    2010-04-01

    To evaluate effectiveness of allogeneic bone screws and pins for internal fixation of midbody transverse fractures of equine proximal sesamoid bones (PSBs) in vitro. 14 forelimbs from cadavers of 3-year-old Thoroughbreds. Allogeneic cortical bone fragments were collected from the limbs of a male Thoroughbred, and cortical bone screws were prepared from the tissue by use of a precision desktop microlathe programmed with the dimensions of a metal cortical bone screw. A midbody transverse osteotomy of each PSB was performed by use of a bone-shaping oscillating saw and repaired via 1 of 3 internal fixation techniques: 1 allogeneic bone screw with 1 allogeneic bone pin (type I; n = 6 PSBs), 2 allogeneic bone screws (type II; 8), or 1 stainless steel cortical bone screw (control repair; 6). Mechanical tension measurements were obtained by use of a commercially available materials testing system. Mean +/- SD tensile strength (TS) was 668.3 +/- 216.6 N for type I repairs, 854.4 +/- 253.2 N for type II repairs, and 1,150.0 +/- 451.7 N for control repairs. Internal fixation of PSB fractures by the use of allogeneic bone screws and bone pins was successful. Although mean TS of control repairs with stainless steel cortical bone screws was greater than the mean TS of type I and type II repairs, the difference between type II and control repairs was not significant. Allogeneic screws may advance healing and result in fewer complications in a clinical setting.

  14. Evaluation of Outcomes of Open Reduction and Internal Fixation Surgery in Patients with Type C Distal Humeral Fractures

    Directory of Open Access Journals (Sweden)

    Mohammadhadi Nouraei

    2018-01-01

    Full Text Available Background: In this study, functional state of patients with Type C distal humerus fractures undergone surgical plating was evaluated 6 and 12 months after the surgery in order to record postsurgical factors such as pain level and job/performance satisfaction. Materials and Methods: In this cross-sectional study, 46 patients with humerus fractures were recruited and their ability to do daily tasks, presence of degenerative changes, stability of elbow joint, and range of motion was evaluated. For assessment of response to surgery, Mayo score was used. Results: Among 46 patients, 45 (97.8% of them had joint stability. Evaluation of postsurgical complications showed that six subjects (13% had no complications, but superficial infection was observed in 12 (26.1% subjects. Neuromuscular disorders in ulnar nerve were present in 11 subjects (23.9%, recurrent articular bursitis of elbow joint in 6 subjects (13%, stiffness of elbow joint in 29 subjects (63%, nonunion of fracture in 3 subjects (6.5%, and myositis ossification in 4 (8.7% subjects. Furthermore, 18 (39.1% patients presented with more than one (2–4 complications. Conclusion: Open reduction and internal fixation surgery with dual plating is the method of choice for treatment of Type C distal humeral fractures. Evaluation of long-term outcomes of this surgery could be done via several different questionnaires as many studies suggest. This study demonstrated that the outcomes of this surgery in Isfahan, Iran, have been noticeably inferior compared to results of the studies in other parts of the world.

  15. Surgical site infection in orthopedic implants and its common bacteria with their sensitivities to antibiotics, in open reduction internal fixation

    International Nuclear Information System (INIS)

    Shah, M.Q.; Zardad, M.S.; Khan, A.; Ahmed, S.; Awan, A. S.; Mohammad, T.

    2017-01-01

    Surgical site infection in orthopaedic implants is a major problem, causing long hospital stay, cost to the patient and is a burden on health care facilities. It increases rate of non-union, osteomyelitis, implant failure, sepsis, multiorgan dysfunction and even death. Surgical site infection is defined as pain, erythema, swelling and discharge from wound site. Surgical site infection in orthopaedic implants is more challenging to the treating orthopaedic surgeon as the causative organism is protected by a biofilm over the implant's surface. Antibiotics cannot cross this film to reach the bacteria's, causing infection. Method: This descriptive case series study includes 132 patients of both genders with ages between 13 years to 60 years conducted at Orthopaedic Unit, Ayub Medical College, Abbottabad from 1st October 2015 to 31st March 2016. Patients with close fractures of long bones were included in the study to determine the frequency of surgical site infection in orthopaedic implants and the type of bacteria involved and their sensitivity to various antibiotics. All implants were of stainless steel. The implants used were Dynamic hip screws, Dynamic compression screws, plates, k-wires, Interlocking nails, SIGN nails, Austin Moore prosthesis and tension band wires. Pre-op and post-op antibiotics used were combination of Sulbactum and Cefoperazone which was given 1 hour before surgery and continued for 72 hours after surgery. Patients were followed up to 4 weeks. Pus was taken on culture stick, from those who developed infection. Results were entered in the pro forma. Results: A total of 132 patients of long bone fractures, who were treated with open reduction and internal fixation, were studied. Only 7 patients developed infection. Staphylococcus Aureus was isolated from all 7 patients. Staphylococcus aureus was sensitive to Linezolid, Fusidic Acid, and vancomycin. Cotrimoxazole, tetracycline, Gentamycin and Clindamycin were partially effective

  16. Single-Incision Carpal Tunnel Release and Distal Radius Open Reduction and Internal Fixation: A Cadaveric Study.

    Science.gov (United States)

    Gaspar, Michael P; Sessions, Blane A; Dudoussat, Bryan S; Kane, Patrick M

    2016-08-01

    The safety of surgical approaches for single- versus double-incision carpal tunnel release in association with distal radius open reduction and internal fixation remains controversial. The purpose of this study was to identify critical structures to determine if a single-incision extension of the standard flexor carpi radialis (FCR) approach can be performed safely. Nine cadaveric arms with were dissected under loupe magnification, utilizing a standard FCR approach. After the distal radius exposure was complete, the distal portion of the FCR incision was extended to allow release of the carpal tunnel. Dissection of critical structures was performed, including the recurrent thenar motor branch of the median nerve, the palmar cutaneous branch of the median nerve (PCBm), the palmar carpal and superficial palmar branches of the radial artery, and proximally the median nerve proper. The anatomic relationship of these structures relative to the surgical approach was recorded. Extension of the standard FCR approach as described in this study did not damage any critical structure in the specimens dissected. The PCBm was noted to arise from the radial side of the median nerve an average of 6.01cm proximal to the proximal edge of the transverse carpal ligament. The PCBm became enveloped in the layers of the antebrachial fascia and the transverse carpal ligament at the incision site, protecting it from injury. The recurrent motor branch of the median nerve, branches of the radial artery and the median nerve proper were not at risk during extension of the FCR approach to release the carpal tunnel. Extension of the standard FCR approach to include carpal tunnel release can be performed with minimal risk to the underlying structures. This exposure may offer benefits in both visualization and extent of carpal tunnel release.

  17. Distal tibial fractures: evaluation of different fixation techniques.

    Science.gov (United States)

    Jöstl, Julian; Tiefenböck, Thomas Manfred; Hofbauer, Marcus; Winnisch, Markus; Lang, Nikolaus; Hajdu, Stefan; Sarahrudi, Kambiz

    2017-03-01

    The purpose of this study was the comparison of the most commonly used surgical techniques (external fixation, intramedullary nailing, and plate fixation) for the treatment of distal tibial fractures (AO/OTA classification 42-A, B, C or 43-A, B1). A retrospective cohort study of patients who underwent surgical treatment for distal tibial fractures between 1992 and 2011 was performed. A total of 93 patients (52 male/41 female) met inclusion criteria. Statistically significant differences were found regarding the consolidation time of the intramedullary-nailing (147.32 ± 91.16 days) and the plate-fixation group (135.75 ± 110.75 days) versus the external-fixation group (163.12 ± 96.79 days; P = 0.001; P = 0.01). Significant differences were also observed in the range of motion (ROM) of the ankle joint in the intramedullary-nailing and plate-fixation group versus the ROM in the external-fixation group (P = 0.044; P = 0.025). The overall complication rate was 13/93 (14 %). Out of 66 patients treated with intramedullary nailing, 8 (12 %) suffered from complications. Out of the 15 patients treated with plate and 12 patients with external fixation, 2 (13 %) and 3 (25 %) showed complications, respectively. Our results demonstrate advantages in terms of shorter mobilization time and a better ROM of the ankle joint for intramedullary nailing and plate fixation compared with external fixation. Due to our results, we suggest internal fixation (intramedullary nailing or plate fixation) whenever patient's condition and the local fracture situation allow it.

  18. [Femoral and sciatic nerve blocks for open reduction and internal fixation of a femoral condylar fracture in a patient with post-polio syndrome].

    Science.gov (United States)

    Nagaoka, Takehiko; Mizuno, Ju; Ino, Kentaro; Yoshimura, Tatsuya; Sakamoto, Hidetoshi; Morita, Shigeho

    2011-08-01

    The post polio symdrome (PPS) refers to the development of delayed neuromuscular symptoms among survivors, years after the initial presentation of acute poliomyelitis. The symptoms of PPS vary widely and include flaccid palsy, muscle weakness, scoliosis, osteoarthritis, gait disturbance, sleep apnea syndrome (SAS), dysphagia, chronic lung dysfunction, and others. We report the successful combination of peripheral nerve blocks, femoral and sciatic nerve blocks, for surgery on the lower extremity in a patient with PPS. A 51-year-old man with continuous positive airway pressure therapy for restrictive ventilatory impairment due to scoliosis and SAS as part of the PPS was scheduled for open reduction and internal fixation (OR-IF) for a right femoral condylar fracture. Respiratory function tests demonstrated a vital capacity (VC) 1.41l (41% predicted). Arterial blood gas analysis on room air was; pH 7.376, PaCO2 55.0 mmHg, and PaO2 77.9 mmHg. With the patient in the supine position, ultrasound-guided right femoral nerve block in the infra-inguinal region was performed using 1.5% mepivacaine 10 ml and 0.75% ropivacaine 5 ml, followed by sciatic nerve block in the popliteal fossa using 1.5% mepivacaine 8 ml and 0.75% ropivacaine 4 ml in the prone position. OR-IF of the fractured femoral condyle was then successfully performed with propofol under spontaneous ventilation. Postoperatively, there were no adverse events; respiratory function was adequate, and his pain was within manageable bounds. Femoral and sciatic nerve blocks are safe and effective anesthetic methods for lower extremity surgery in patients with restrictive ventilatory impairment and hypercapnia due to scoliosis and SAS as PPS.

  19. [Surgical treatment with cable dragged reduction and cantilever beam internal fixation by posterior approach for odontoid fracture associated with atlantoaxial dislocation].

    Science.gov (United States)

    Yang, Qi-Yua; Feng, Jing; Luo, Xiao-Li; Yang, Wen-Dong; Li, Ying-Bo; Fan, Bin; Feng, Zhi; Lai, Xian-Jin

    2016-10-25

    To explore the clinical effects of surgical treatment with cable dragged reduction and cantilever beam internal fixation by posterior approach for odontoid fracture associated with atlantoaxial dislocation. The clinical data of 12 patients with odontoid fracture associated with atlantoaxial dislocation from January 2008 to December 2013 were retrospectively analyzed. There were 8 males and 4 females, ranging in age from 21 to 53 years with an average of 37.2 years. Eleven cases were fresh fracture and 1 case was old fracture, all patients complicated with atlantoaxial anterior dislocation. According to Anderson-D' Alonzo typing method modified by Grauer, 3 cases were type IIA, 5 cases were type IIB, 3 cases were type IIC, and 1 case was type IIIA. All patients underwent surgical treatment with cable dragged reduction and cantilever beam internal fixation by posterior approach. JOA score and ADI method were respectively used to evaluate the nerve function and reductive condition of atlantoaxial dislocation. All patients were followed up from 6 months to 2 years with an average of 1 year and 3 months. At 1 week, 6 months after operation, and final follow up, JOA scores were 13.2±1.3, 13.5±1.4, 14.3±1.5, respectively, and these data were obviously better than that of preoperative 8.3±1.4( P dragged reduction and cantilever beam internal fixation by posterior approach for odontoid fracture associated with atlantoaxial dislocation is a good method, with advantage of firm fixation and high safety. It could obtain good clinical effects.

  20. Treatment of type II odontoid fracture with a novel technique: Titanium cable-dragged reduction and cantilever-beam internal fixation.

    Science.gov (United States)

    Zhu, Ce; Wang, Lei; Liu, Hao; Song, Yueming; Liu, Limin; Li, Tao; Gong, Quan

    2017-11-01

    Surgical methods for type II odontoid fracture can be classified into 2 main groups: anterior or posterior approach. A more effective way to achieve bone fusion with the lowest possible surgical risk is needed. Therefore, the aim of our study was to describe and evaluate a novel technique, cable-dragged reduction/cantilever beam internal fixation for the treatment of type II odontoid fracture.This was a retrospective study enrolled 34 patients underwent posterior cable-dragged reduction/cantilever-beam internal fixation surgery. Medical records, rates of reduction, the location of the instrumentation and fracture healing during follow-up were analyzed. Once fracture healing was obtained, instrumentation was removed. Neck pain (scored using a visual analog scale [VAS]), neck stiffness, patient satisfaction, and neck disability index (NDI) were recorded before and after removing the instrumentation during follow-up.The mean duration of follow up was 22.8 ± 5.3 months. There was no iatrogenic damage to nerves or blood vessels. Radiographic evaluation showed complete reduction in the 20 patients with fracture displacement and satisfactory fracture healing in all 34 cases. Titanium cable breakage was observed in 4 patients after fracture healing. After removal of instrumentation, significant improvements were seen in neck-pain VAS score, neck stiffness, patient satisfaction, and NDI (all P dragged reduction/cantilever-beam internal fixation was an optimal salvage maneuver to conventional surgical methods such as anterior screw fixation and C1-C2 screw-rod system. The operative difficulty and incidence of nerve and vascular injury were reduced. Its major disadvantage is the exposure and screw-setting at C3, which is left intact in traditional surgery, and it is suitable only for patients with intact C1 posterior arches.

  1. Primary open reduction and internal fixation with headless compression screws in the treatment of Chinese patients with acute Lisfranc joint injuries.

    Science.gov (United States)

    Zhang, Hui; Min, Li; Wang, Guang-Lin; Huang, Qiang; Liu, Kai; Liu, Lei; Tu, Chongqi; Pei, Fu-Xing

    2012-05-01

    Although primary open anatomic reduction and stable internal fixation has become a standard treatment principle of Lisfranc joint injuries, there are still some debates existed among surgeons as to the most appropriate treatment of this injury. The aim of this cohort study was to analyze the early (mean, 3.2 years) clinical and radiographic outcomes of one surgeon's experience associated with a standardized protocol of open reduction and internal fixation using headless compression screws (HCS) in a consecutive series of Chinese patients with Lisfranc joint injuries. This study is to retrospectively evaluate the clinical and radiographic outcomes of a series of Chinese patients with Lisfranc joint injuries that underwent open reduction and internal fixation with HCS. There were 29 patients (30 feet) included in our study. The average score of American Orthopaedic Foot and Ankle Society Midfoot score and the Visual Analog Pain Scale were 80.6 and 2.4 points at the final follow-up point, respectively. Anatomic initial reduction was obtained in 26 patients (27 feet, 90%). At the last follow-up point, only one case had the loss of reduction. Posttraumatic osteoarthritis was observed in 10 patients (10 feet, 33%), and 2 of them (2 feet, 7%) were scheduled for arthrodesis because of persistent pain. Our results have shown that fixation of an unstable tarsometatarsal joint with AO 3.0 mm HCS can provide the firm stability, the precise reduction of the joint, and satisfactory short-term clinical and radiographic outcomes without any screw breakage, although posttraumatic osteoarthritis in the midfoot is still a significant challenge for orthopedic surgeons.

  2. Short-Term Therapeutic Efficacy of the Isobar TTL Dynamic Internal Fixation System for the Treatment of Lumbar Degenerative Disc Diseases.

    Science.gov (United States)

    Qian, Jiale; Bao, Zhaohua; Li, Xuefeng; Zou, Jun; Yang, Huilin

    2016-07-01

    At present, posterior interbody fusion surgery with pedicle internal fixation is the gold standard for the treatment of lumbar degenerative disc diseases. However, an increasing number of studies have shown that because fused lumbar vertebrae lose their physiological activity, the compensatory range of motion (ROM) of the adjacent levels increases. To address this issue, dynamic internal fixation systems have been developed. Our goal was to investigate the short-term therapeutic efficacy of the Isobar TTL dynamic internal fixation system for the treatment of lumbar degenerative disc diseases and its effect on the ROM of the surgical segments. Retrospective Evaluation. Tertiary hospital setting in China. Twenty-four lumbar degenerative disc disease patients who underwent posterior lumbar decompression and single-segment Isobar TTL dynamic internal fixation at our hospital between January 2013 and July 2014 were retrospectively analyzed. The preoperative and one month, 3 month, and 12 month postoperative visual analog scale (VAS) pain scores, Japanese Orthopedic Association (JOA) scores, and Oswestry Disability Index (ODI) scores were observed and recorded to assess the clinical therapeutic effect; the lumbar ROM was measured preoperatively and at the last follow-up to evaluate the preservation of functional movement in the dynamically stabilized segment. All patients underwent the operation successfully without complications during hospitalization and were followed for 12 to 27 months, with an average of 18 months. The patients' preoperative and one month, 3 month, and 12 month postoperative VAS scores were 6.42 ± 0.72, 1.71 ± 0.86, 1.38 ± 0.65, and 1.37 ± 0.58, respectively, and their JOA scores were 9.54 ± 1.89, 21.21 ± 1.98, 22.50 ± 1.47, and 23.46 ± 1.32, respectively. The preoperative ODI score was 42.04 ± 2.63; the one month, 3 month, and 12 month postoperative ODI scores were 22.79 ± 1.61, 18.63 ± 1.61, and 15.08 ± 1.21, respectively. These

  3. Skeletal stability in orthognathic surgery: evaluation of methods of rigid internal fixation after counterclockwise rotation in patients with class II deformities.

    Science.gov (United States)

    Rocha, Vanessa Álvares de Castro; Neto, Antonio Irineu Trindade; Rebello, Iêda Margarida Crusoé Rocha; de Souza, Gustavo Mota Mascarenhas; Esteves, Lucas Senhorinho; dos Santos, Jean Nunes; Zanetta-Barbosa, Darceny; do Prado, Célio Jesus

    2015-10-01

    Our aim was to assess the influence of internal fixation in skeletal stability on patients who had had counterclockwise rotation of the maxillomandibular complex and mandibular advancement procedures. We studied 60 records of 20 patients (14 female, 6 male), mean (range) age at operation 29 (16-50) years. The mean (range) postoperative follow-up was 15 (8-24) months. Sixty standard lateral cephalometric radiographs were randomly traced and digitised by one senior radiologist to estimate surgical and postoperative changes. Patients were divided into two groups, the first group (n=10) of which had fixation with only 2.0 system plates (2 plates with monocortical screws alone) and the second (n=10) of which had hybrid fixation (1 plate with monocortical screws and 2 or 3 bicortical bone screws). During operation the change in the mean occlusal plane with counterclockwise rotation was 9.4° (range -17.3 to -2.5mm). The maxilla moved forward and upward. All the anterior mandibular measurements had advanced horizontally, the mean (range) being 17 (6.4 to 9.9) mm for the pogonion, and 17.6 (6.0 to 30.7) mm for the menton. At the longest follow-up period, there were significant long-term changes, but these were clinically acceptable (stability or in the magnitude of the advancement and stability. Copyright © 2015 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  4. Features of Three- and Four-Part Proximal Humeral Fractures and Outcome of Internal Fixation Using the Philos® Locking Plate

    Directory of Open Access Journals (Sweden)

    Ali Sadighi

    2017-03-01

    Full Text Available Background: Proximal humeral fractures are among common types of fractures and remain a challenging issue for surgical management. This study aimed to assess the clinical outcomes and complication rates of three- vs. four-part proximal humeral fractures, treated with internal fixation using the Philos® plate. Material and Methods: In this cohort study, a total of 30 consecutive patients with three-part or four-part proximal humeral fractures based on the Neer classification were included. Surgical treatment was performed with open reduction and internal fixation using the Philos® plate. The constant score was evaluated 6 months later in follow-up. The P<0.05 was considered significant. Results: Four-part fractures were mainly caused by trauma from above, while insults of opposite direction were responsible for more than half of 3 part fractures (P=0.01. Open fractures were only observed in patients with a four-part fracture (P=0.018. No significant differences were noticed regarding gender, cause, and side of the fracture. The presence of other fractures, fracture of the implant, reduction loss, avascular necrosis (AVN of humerus head, rotator cuff injury, and revision surgery were significantly higher in patients with four-part fractures. The mean constant score was 81.40±11.61 and 65.09±16.09 for three-part and four-part fractures, respectively (P=0.006. Conclusion: Open reduction and internal fixation with Philos® plate yield acceptable results in both types of fractures, however, the prognosis of this intervention is poorer four-part fractures.

  5. Risk stratification for avascular necrosis of the femoral head after internal fixation of femoral neck fractures by post-operative SPECT/CT

    Energy Technology Data Exchange (ETDEWEB)

    Han, Sang Won; Oh, Min Young; Yoon, Seok Ho; Kim, Jin Soo; Chang, Jae Suk; Ryu, Jin Sook [Asan Medical CenterUniversity of Ulsan College of Medicine, Seoul (Korea, Republic of); Kim, Ji Wan [Dept. of Orthopedic Surgery, Haeundae Paik Hospital, Inje University, Busan (Korea, Republic of)

    2017-03-15

    Avascular necrosis (AVN) of the femoral head is a major complication after internal fixation of a femoral neck fracture and determines the functional prognosis. We investigated postoperative bone single-photon emission computed tomography/computed tomography (SPECT/CT) for assessing the risk of femoral head AVN. We retrospectively reviewed 53 consecutive patients who underwent bone SPECT/CT within 2 weeks of internal fixation of a femoral neck fracture and follow-up serial hip radiographs over at least 12 months. Nine patients developed femoral head AVN. In 15 patients who showed normal uptake on immediate postoperative SPECT/CT, no AVN occurred, whereas 9 of 38 patients who showed cold defects of the femoral head later developed AVN. The negative predictive value of immediate postoperative SPECT/CT for AVN was 100 %, whereas the positive predictive value was 24 %. Among 38 patients with cold defects, 1 developed AVN 3 months postoperatively. A follow-up bone SPECT/CT was performed in the other 37 patients at 2–10 months postoperatively. The follow-up bone SPECT/CT revealed completely normalized femoral head uptake in 27, partially normalized uptake in 8, and persistent cold defects in 2 patients. AVN developed in 3.7 % (1/27), 62.5 % (5/8), and 100 % (2/2) of each group, respectively. According to the time point of imaging, radiotracer uptake patterns of the femoral head on postoperative bone SPECT/CT indicate the risk of AVN after internal fixation of femoral neck fractures differently. Postoperative bone SPECT/CT may help orthopedic surgeons determine the appropriate follow-up of these patients.

  6. Brachial plexus compression due to subclavian artery pseudoaneurysm from internal jugular vein catheterization

    Directory of Open Access Journals (Sweden)

    T N Mol

    2017-01-01

    Full Text Available Internal jugular vein (IJV catheterization has become the preferred approach for temporary vascular access for hemodialysis. However, complications such as internal carotid artery puncture, vessel erosion, thrombosis, and infection may occur. We report a case of brachial plexus palsy due to compression by right subclavian artery pseudoaneurysm as a result of IJV catheterization in a patient who was under maintenance hemodialysis.

  7. Comprehensive comparing percutaneous endoscopic lumbar discectomy with posterior lumbar internal fixation for treatment of adjacent segment lumbar disc prolapse with stable retrolisthesis: A retrospective case-control study.

    Science.gov (United States)

    Sun, Yapeng; Zhang, Wei; Qie, Suhui; Zhang, Nan; Ding, Wenyuan; Shen, Yong

    2017-07-01

    The study was to comprehensively compare the postoperative outcome and imaging parameter characters in a short/middle period between the percutaneous endoscopic lumbar discectomy (PELD) and the internal fixation of bone graft fusion (the most common form is posterior lumbar interbody fusion [PLIF]) for the treatment of adjacent segment lumbar disc prolapse with stable retrolisthesis after a previous lumbar internal fixation surgery.In this retrospective case-control study, we collected the medical records from 11 patients who received PELD operation (defined as PELD group) for and from 13 patients who received the internal fixation of bone graft fusion of lumbar posterior vertebral lamina decompression (defined as control group) for the treatment of the lumbar disc prolapse combined with stable retrolisthesis at Department of Spine Surgery, the Third Hospital of Hebei Medical University (Shijiazhuang, China) from May 2010 to December 2015. The operation time, the bleeding volume of perioperation, and the rehabilitation days of postoperation were compared between 2 groups. Before and after surgery at different time points, ODI, VAS index, and imaging parameters (including Taillard index, inter-vertebral height, sagittal dislocation, and forward bending angle of lumbar vertebrae) were compared.The average operation time, the blooding volume, and the rehabilitation days of postoperation were significantly less in PELD than in control group. The ODI and VAS index in PELD group showed a significantly immediate improving on the same day after the surgery. However, Taillard index, intervertebral height, sagittal dislocation in control group showed an immediate improving after surgery, but no changes in PELD group till 12-month after surgery. The forward bending angle of lumbar vertebrae was significantly increased and decreased in PELD and in control group, respectively.PELD operation was superior in terms of operation time, bleeding volume, recovery period, and financial

  8. Comprehensive comparing percutaneous endoscopic lumbar discectomy with posterior lumbar internal fixation for treatment of adjacent segment lumbar disc prolapse with stable retrolisthesis

    Science.gov (United States)

    Sun, Yapeng; Zhang, Wei; Qie, Suhui; Zhang, Nan; Ding, Wenyuan; Shen, Yong

    2017-01-01

    Abstract The study was to comprehensively compare the postoperative outcome and imaging parameter characters in a short/middle period between the percutaneous endoscopic lumbar discectomy (PELD) and the internal fixation of bone graft fusion (the most common form is posterior lumbar interbody fusion [PLIF]) for the treatment of adjacent segment lumbar disc prolapse with stable retrolisthesis after a previous lumbar internal fixation surgery. In this retrospective case-control study, we collected the medical records from 11 patients who received PELD operation (defined as PELD group) for and from 13 patients who received the internal fixation of bone graft fusion of lumbar posterior vertebral lamina decompression (defined as control group) for the treatment of the lumbar disc prolapse combined with stable retrolisthesis at Department of Spine Surgery, the Third Hospital of Hebei Medical University (Shijiazhuang, China) from May 2010 to December 2015. The operation time, the bleeding volume of perioperation, and the rehabilitation days of postoperation were compared between 2 groups. Before and after surgery at different time points, ODI, VAS index, and imaging parameters (including Taillard index, inter-vertebral height, sagittal dislocation, and forward bending angle of lumbar vertebrae) were compared. The average operation time, the blooding volume, and the rehabilitation days of postoperation were significantly less in PELD than in control group. The ODI and VAS index in PELD group showed a significantly immediate improving on the same day after the surgery. However, Taillard index, intervertebral height, sagittal dislocation in control group showed an immediate improving after surgery, but no changes in PELD group till 12-month after surgery. The forward bending angle of lumbar vertebrae was significantly increased and decreased in PELD and in control group, respectively. PELD operation was superior in terms of operation time, bleeding volume, recovery period

  9. A new type of defecation disorder due to insufficient fixation of the rectum to the sacrum is improved by rectopexy: A report of three cases

    Directory of Open Access Journals (Sweden)

    Wataru Sumida

    2016-07-01

    Full Text Available Chronic constipation is the most common clinical disorder in children. However, some cases of constipation do not meet the criteria defined by Rome III. We encountered such defecation disorders in three patients who presented with constipation as a chief complaint along with excessive strain and bleeding hemorrhoids during defecation despite normal stools. Contrast enema revealed that the rectum was separated from the sacrum in each patient, which may have been caused by insufficient fixation of the rectum. Conservative treatment with laxatives and suppositories failed to achieve improvement. Therefore, all underwent a laparoscopic rectopexy. After surgery, each patient was able to evacuate without strain and the hemorrhoids disappeared. Insufficient fixation of the rectum should be considered as a potential cause of defecation disorders. Rectopexy is effective for this type of defecation disorder.

  10. Finite element analysis of a bone healing model: 1-year follow-up after internal fixation surgery for femoral fracture.

    Science.gov (United States)

    Jiang-Jun, Zhou; Min, Zhao; Ya-Bo, Yan; Wei, Lei; Ren-Fa, Lv; Zhi-Yu, Zhu; Rong-Jian, Chen; Wei-Tao, Yu; Cheng-Fei, Du

    2014-03-01

    Finite element analysis was used to compare preoperative and postoperative stress distribution of a bone healing model of femur fracture, to identify whether broken ends of fractured bone would break or not after fixation dislodgement one year after intramedullary nailing. Method s: Using fast, personalized imaging, bone healing models of femur fracture were constructed based on data from multi-slice spiral computed tomography using Mimics, Geomagic Studio, and Abaqus software packages. The intramedullary pin was removed by Boolean operations before fixation was dislodged. Loads were applied on each model to simulate a person standing on one leg. The von Mises stress distribution, maximum stress, and its location was observed. Results : According to 10 kinds of display groups based on material assignment, the nodes of maximum and minimum von Mises stress were the same before and after dislodgement, and all nodes of maximum von Mises stress were outside the fracture line. The maximum von Mises stress node was situated at the bottom quarter of the femur. The von Mises stress distribution was identical before and after surgery. Conclusion : Fast, personalized model establishment can simulate fixation dislodgement before operation, and personalized finite element analysis was performed to successfully predict whether nail dislodgement would disrupt femur fracture or not.

  11. Relationship between screw sagittal angle and stress on endplate of adjacent segments after anterior cervical corpectomy and fusion with internal fixation: a Chinese finite element study.

    Science.gov (United States)

    Zhang, Yu; Tang, Yibo; Shen, Hongxing

    2017-12-01

    In order to reduce the incidence of adjacent segment disease (ASD), the current study was designed to establish Chinese finite element models of normal 3rd~7th cervical vertebrae (C3-C7) and anterior cervical corpectomy and fusion (ACCF) with internal fixation , and analyze the influence of screw sagittal angle (SSA) on stress on endplate of adjacent cervical segments. Mimics 8.1 and Abaqus/CAE 6.10 softwares were adopted to establish finite element models. For C4 superior endplate and C6 inferior endplate, their anterior areas had the maximum stress in anteflexion position, and their posterior areas had the maximum stress in posterior extension position. As SSA increased, the stress reduced. With an increase of 10° in SSA, the stress on anterior areas of C4 superior endplate and C6 inferior endplate reduced by 12.67% and 7.99% in anteflexion position, respectively. With an increase of 10° in SSA, the stress on posterior areas of C4 superior endplate and C6 inferior endplate reduced by 9.68% and 10.22% in posterior extension position, respectively. The current study established Chinese finite element models of normal C3-C7 and ACCF with internal fixation , and demonstrated that as SSA increased, the stress on endplate of adjacent cervical segments decreased. In clinical surgery, increased SSA is able to play important role in protecting the adjacent cervical segments and reducing the incidence of ASD.

  12. Mechanical Comparison of Headless Screw Fixation and Locking Plate Fixation for Talar Neck Fractures.

    Science.gov (United States)

    Karakasli, Ahmet; Hapa, Onur; Erduran, Mehmet; Dincer, Cemal; Cecen, Berivan; Havitcioglu, Hasan

    2015-01-01

    For talar neck fractures, open reduction and internal fixation have been thought to facilitate revascularization and prevent osteonecrosis. Newer screw systems allow for placement of cannulated headless screws, which provide compression by virtue of a variable pitch thread. The present study compared the biomechanical fixation strength of cannulated headless variable-pitch screw fixation and locking plate fixation. A reproducible talar neck fracture was created in 14 fresh cadaver talar necks. Talar head fixation was then performed using 2 cannulated headless variable-pitch 4-mm/5-mm diameter (4/5) screws (Acutrak; Acumed, Hillsboro, OR) and locking plate fixation. Headless variable-pitch screw fixation had lower failure displacement than did locking plate fixation. No statistically significant differences were found in failure stiffness, yield stiffness (p = .655), yield load (p = .142), or ultimate load between the 2 fixation techniques. Cannulated headless variable-pitch screw fixation resulted in better failure displacement than locking plate fixation in a cadaveric talus model and could be considered a viable option for talus fracture fixation. Headless, fully threaded, variable-pitch screw fixation has inherent advantages compared with locking plate fixation, because it might cause less damage to the articular surface and can compress the fracture for improved reduction. Additionally, plate fixation can increase the risk of avascular necrosis owing to the wider incision and dissection of soft tissues. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  13. Surgical Site Infections after Open Reduction Internal Fixation for Trauma in Low and Middle Human Development Index Countries: A Systematic Review.

    Science.gov (United States)

    McQuillan, Thomas J; Cai, Lawrence Z; Corcoran-Schwartz, Ian; Weiser, Thomas G; Forrester, Joseph D

    2018-01-17

    Musculoskeletal trauma represents a large source of morbidity in low and middle human development index countries (LMHDICs). Open reduction and internal fixation (ORIF) of traumatic long bone fractures definitively manages these injuries and restores function when conducted safely and effectively. Surgical site infections (SSIs) are a common complication of operative fracture fixation, although the risks of infection are ill-defined in LMHDIC. This study reviewed systematically all studies describing SSI after ORIF in LMDHICs. Studies were reviewed based on their qualitative characteristics, after which a quantitative synthesis of weighted pooled infection rates based on available patient-level data was performed to estimate published incidence of SSI. Forty-two studies met criteria for qualitative review and 32 studies comprising 3,084 operations were included in the quantitative analysis. Among 3,084 operations, the weighted pooled SSI rate was 6.4 infections per 100 procedures (95% confidence interval [CI] 4.6-8.2 infections per 100 procedures). Higher rates of infection were noted among the sub-group of open fractures (95% CI 13.9-23.0 infections per 100 procedures). Lower extremity injuries and procedures utilizing intra-medullary nails also had slightly higher rates of infection versus upper extremity procedures and other fixation devices. Reported rates of SSI after ORIF are higher in LMHDICs, and may be driven by high rates of infection in the sub-group of open fractures. This study provides a baseline SSI rate obtained from literature produced from LMHDICs. Infection rates are highly dependent on fracture sub-types.

  14. Internal fixation of mandibular angle fractures using one miniplate in Greek children: a 5-year retrospective study.

    Science.gov (United States)

    Iatrou, Ioannis; Theologie-Lygidakis, Nadia; Tzermpos, Fotios; Kamperos, Georgios

    2015-01-01

    Treatment modalities of mandibular angle fractures (MAFs) have been analyzed in several studies mainly referring to adult populations. The aim of this study was to retrospectively present and discuss our experience and literature findings regarding the treatment of MAFs in children. Data were retrieved from the files of the Oral and Maxillofacial department, at the Children's Hospital ''P. & A. Kyriakou'' of Athens, during a 5 years period (2009-2013). Demographic features, treatment methods, outcome and follow-up of all patients with mandibular angle fractures were recorded. 6 boys, 5-14 years old (mean age 10 years), were included in the study. They were all treated intraorally with open reduction and fixation via one monocortical titanium plate osteosynthesis at the external oblique line of the mandible, followed by 1 week of intermaxillary fixation (IMF). Plates were removed 3-12 months post-operatively. Follow-up period ranged from 12 to 18 months (mean 14.7 months). All fractures healed uneventfully and the patients tolerated well both the operation and the post-operative period. Osteosynthesis via intraoral approach combined with short duration IMF is adequate in treating MAFs in children. Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  15. Complex behavior of internal collapse due to self-generated radial electric field

    Energy Technology Data Exchange (ETDEWEB)

    Matsumoto, Taro; Tokuda, Shinji; Kishimoto, Yasuaki; Takizuka, Tomonori [Japan Atomic Energy Research Inst., Naka, Ibaraki (Japan). Naka Fusion Research Establishment; Naitou, Hiroshi [Department of Electical and Electronic Engineering, Yamaguchi University, Ube, Yamaguchi (Japan)

    2000-07-01

    The density gradient effect is taken into account in the gyro-kinetic nonlinear simulation of the kinetic m=1 internal kink mode to clarify the nonlinear behavior of the internal collapse. Even when the density gradient is not so large enough to change the process of the full reconnection, the later process is changed considerably due to the self-generated radial electric field. The nonlinear growth of the 0/0 mode after the internal collapse violates the symmetrical flow of the parallel current, restricting the secondary reconnection. (author)

  16. C1-C2 transarticular screw fixation for atlantoaxial instability due to rheumatoid arthritis: a seven-year analysis of outcome.

    LENUS (Irish Health Repository)

    Nagaria, Jabir

    2009-12-15

    STUDY DESIGN.: Observational study. Retrospective analysis of prospectively collected data. OBJECTIVE.: The purpose of this article was to report long-term (minimum 7 years) clinical and radiologic outcome of our series of patients with Rheumatoid Arthritis who underwent transarticular screw fixation to treat atlantoaxial subluxation. SUMMARY OF BACKGROUND DATA.: The indications for intervention in patients with atlantoaxial instability are pain, myelopathy, and progressive neurologic deficit. The various treatment options available for these patients are isolated C1-C2 fusion, occipitocervical fusion with or without transoral surgery. Review of current literature suggests that C1-C2 transarticular screw fixation has significant functional benefits, although there is discrepancy in this literature regarding improvement in function following surgery. METHODS.: Myelopathy was assessed using Ranawat myelopathy score and Myelopathy Disability Index. Pain scores were assessed using Visual Analogue Scale. The radiologic imaging was assessed and the following data were extracted; atlanto-dens interval, space available for cord, presence of signal change on T2 weighted image, and fusion rates. RESULTS.: Thirty-seven patients, median age 56, were included in the study. Average duration of neck symptoms was 15.8 months. Average duration of rheumatoid arthritis before surgery was 20.6 years. Preoperative symptoms: suboccipital pain in 26 patients; neck pain, 32; myelopathy, 22; and 5 were asymptomatic. After surgery: suboccipital pain, 2; neck pain, 3; and myelopathy, 10. Ninety percent patients with neck and suboccipital pain improved after surgery in their Visual Analogue pain scores, with all of them having >50% improvement in VAS scores (6.94-2.12 [P < 0.05]).Preoperative Ranawat grade was as follows: grade 1 in 15 patients, grade 2 in 7, and grade 3a in 14, grade 3b in 1.After surgery: grade 1 in 27 patients, grade 2 in 7, grade 3a in 1, and grade 3b in 2. The mean

  17. Three phase bone scintigraphy with (99m)Tc-MDP and serological indices in detecting infection after internal fixation in malunion or nonunion traumatic fractures.

    Science.gov (United States)

    Yang, Fang; Yang, Zheng; Feng, Jin; Zhang, Lianna; Ma, Daqing; Yang, Jigang

    2016-01-01

    To evaluate the diagnostic efficacy of technetium-99m-methylene diphosphonate ((99m)Tc-MDP) three phase bone scintigraphy in detecting infection in malunion or nonunion traumatic fractures after internal fixation. One hundred and eighty four patients with malunion or nonunion fractures after internal fixation (130 men and 54 women; age range, 16-79 years) underwent (99m)Tc-MDP three phase bone scintigraphy (3PBS). They were divided into the infection group (n=96) and the control group without infection (n=88) based on the final diagnosis after operation. The sensitivity, specificity, accuracy, positive prediction value (PPV) and negative prediction value (NPV) were calculated and compared. All patients carried out other laboratory tests related to infection such as complete serum blood cells count, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). The (99m)Tc-MDP 3PBS for the blood flow phase showed sensitivity, specificity, accuracy, positive predictive value and negative predictive value, 91.7% (88/96), 72.7% (64/88), 82.6% (152/184), 78.6% (88/112) and 88.9% (64/72), respectively and for the blood pool phase, 93.8% (90/96), 61.4% (54/88), 78.3% (144/184), 72.6% (90/124) and 90.0% (54/60) respectively. The semiquantitative indices of the ratio between the abnormal and the normal region of interest (ROI), called by us the A/N ratio, for both blood flow and blood pool phases as estimated between the infection group and the control group were statistically different. It is the opinion of the authors that (99m)Tc-MDP 3PBS provided high predictive values in diagnosing infection in patients with malunion or nonunion traumatic fractures after internal fixation. The diagnostic value of blood flow and blood pool phases estimated of the 3PBS was better than the laboratory indices: white blood cell counts, CRP, and ESR.

  18. Treatment of Atypical Ulnar Fractures Associated with Long-Term Bisphosphonate Therapy for Osteoporosis: Autogenous Bone Graft with Internal Fixation

    Directory of Open Access Journals (Sweden)

    Yohei Shimada

    2017-01-01

    Full Text Available Long-term bisphosphonate use has been suggested to result in decreased bone remodelling and an increased risk of atypical fractures. Fractures of this nature commonly occur in the femur, and relatively few reports exist to show that they occur in other bones. Among eight previous reports of atypical ulnar fractures associated with bisphosphonate use, one report described nonunion in a patient who was treated with cast immobilization and another described ulna nonunion in one of three patients, all of whom were treated surgically with a locking plate. The remaining two surgical patients achieved bone union uneventfully following resection of the osteosclerotic lesion and iliac bone grafting before rigid fixation. We hypothesized that the discontinuation of bisphosphonate therapy, the use of teriparatide treatment, and low-intensity pulsed ultrasound (LIPUS might have been associated with fracture healing.

  19. Impact of increased ultraviolet-B radiation stress due to stratospheric ozone depletion on N2 fixation in traditional African commercial legumes

    International Nuclear Information System (INIS)

    Chimphango, S.B.M.; Musil, C.F.; Dakora, F.D.

    2004-01-01

    Reports of diminished nodule formation and nitroge-nase activity in some Asian tropical legumes exposed to above-ambient levels of ultraviolet-B (UV-B: 280-315nm) radiation have raised concerns as to the impact of stratospheric ozone depletion on generally poorly developed traditional African farming systems confronted by the high cost and limited availability of chemical fertilisers. These rely on N 2 -fixing legumes as the cheapest source of N for maintaining soil fertility and sustainable yields in the intrinsically infertile and heterogeneous African soils. In view of this, we examined the effects of supplemental UV-B radiation approximating 15% and 25% depletions in the total ozone column on N 2 fixation in eight traditional African commercial legume species representing crop, forest, medicinal, ornamental and pasture categories. In all categories examined, except medicinal, supplemental UV-B had no effect on root non-structural carbohydrates, antho-cyanins and flavonoids, known to signal Rhizobiaceae micro-symbionts and promote nodule formation, or on nodule mass, activity and quantities of N fixed in different plant organs and whole plants. In contrast, in the medicinal category Cyclopia maculata (Honeybush) a slow growing commercially important herbal beverage with naturally high flavonoid concentrations, displayed decreased nodule activity and quantities of N fixed in different plant organs and whole plants with increased UV-B. This study's findings conclude negligible impacts of ozone depletion on nitrogen fixation and soil fertility in most traditional African farming systems, these limited to occasional inhibition of nodule induction in some crops. (author)

  20. EGFRvIII escapes down-regulation due to impaired internalization and sorting to lysosomes

    DEFF Research Database (Denmark)

    Grandal, Michael V; Zandi, Roza; Pedersen, Mikkel W

    2007-01-01

    proteins, we have investigated the down-regulation of EGFRvIII and compared it to that of EGFR. We show that, in contrast to EGFR, EGFRvIII is inefficiently degraded. EGFRvIII is internalized, but the internalization rate of the mutated receptor is significantly less than that of unstimulated EGFR....... Moreover, internalized EGFRvIII is recycled rather than delivered to lysosomes. EGFRvIII binds the ubiquitin ligase c-Cbl via Grb2, whereas binding via phosphorylated tyrosine residue 1045 seems to be limited. Despite c-Cbl binding, the receptor fails to become effectively ubiquitinylated. Thus, our...... results suggest that the long lifetime of EGFRvIII is caused by inefficient internalization and impaired sorting to lysosomes due to lack of effective ubiquitinylation....

  1. Surface and Internal Waves due to a Moving Load on a Very Large Floating Structure

    Directory of Open Access Journals (Sweden)

    Taro Kakinuma

    2012-01-01

    Full Text Available Interaction of surface/internal water waves with a floating platform is discussed with nonlinearity of fluid motion and flexibility of oscillating structure. The set of governing equations based on a variational principle is applied to a one- or two-layer fluid interacting with a horizontally very large and elastic thin plate floating on the water surface. Calculation results of surface displacements are compared with the existing experimental data, where a tsunami, in terms of a solitary wave, propagates across one-layer water with a floating thin plate. We also simulate surface and internal waves due to a point load, such as an airplane, moving on a very large floating structure in shallow water. The wave height of the surface or internal mode is amplified when the velocity of moving point load is equal to the surface- or internal-mode celerity, respectively.

  2. Arterial Injury to the Profunda Femoris Artery following Internal Fixation of a Neck of Femur Fracture with a Compression Hip Screw

    Directory of Open Access Journals (Sweden)

    Simon Craxford

    2013-01-01

    Full Text Available We report the case of an 82-year-old woman who developed extensive proximal thigh swelling and persistent anaemia following internal fixation of an extracapsular neck of femur fracture with a dynamic hip screw (DHS. This was revealed to be a pseudoaneurysm of a branch of profunda femoris artery on angiography. Her case was further complicated by a concurrent pulmonary embolism (PE. She underwent endovascular coil embolisation of the pseudoaneurysm. An IVC filter was inserted and the patient was fully anticoagulated once it had been ensured that there was no active bleeding. In this case, we review the potential for anatomical variations in the blood supply to this region and discuss treatment options for a complicated patient. We recommend that a pseudoaneurysm should be part of a differential diagnosis for postoperative patients with anaemia refractory to blood transfusion so as not to miss this rare but potentially serious complication.

  3. Treatment of complex osteoarticular injuries of the elbow with external unilateral articulated fixator

    International Nuclear Information System (INIS)

    Cuellar Gallo, Lazaro; Portilla Carrillo, Armando; Calderon Uribe, Oscar; Calvache Currea, Gustavo Adolfo; Satizabal Azuero, Carlos Arnulfo

    2001-01-01

    Previous observations suggest that conventional treatment of complex injuries about the elbow such as open; reduction and internal Fixation might lead, to bad functional outcome. The authors present a descriptive, observational and prospective study of a series of cases, on 8 patients, average age 37.8 years (25-28 years) 6 men and 2 women with complex injury of the elbow. Due to trauma which etiology is summarized as follows intraarticular comminuted open fracture secondary to gunshot wound 5 patients (62.5%); luxofracture 2 patients (25%), lntraarticular comminuted closed fracture 1 patient (12.5%). The patients where followed for 8 to 20 months. Were performed en 75% of patients open reduction, internal fixation of radial resection of radial head en 25% when comminute fracture of the head was found. All patients were treated with an external unilateral articulated fixation on the elbow, in order to protect the internal fixation, allow early joint motion and give early mobility. All patients were evaluated with Mayo scale, obtaining good results, with externals fixation treatment. In one case (12.5%) a dyaphiseal fracture of the humerus, occurred as an inherent complication secondary to the use of the external fixation, after it's withdrawal. This patient was treated with open reduction and internal fixation of the fracture, without significant impairment of the final result. Early results suggest that the use of unilateral articulated external fixator for the treatment of complex fractures about the elbow has great advantages over the other treatment techniques, such as the early motion of the elbow, dynamic protection of the internal fixation and preservation of the articulate stability, even when ligament injury is present

  4. Axillary nerve lesions after open reduction and internal fixation of proximal humeral fractures through an extended lateral deltoid-split approach: electrophysiological findings.

    Science.gov (United States)

    Westphal, Thomas; Woischnik, Stephan; Adolf, Daniela; Feistner, Helmut; Piatek, Stefan

    2017-03-01

    Axillary nerve injuries after shoulder surgery are rare. In most studies, the frequency of injury is usually determined using clinical examinations, but results from intraoperative neuromonitoring studies have revealed higher than expected rates. Few studies have investigated this topic. Our aim was to determine the frequency of axillary nerve lesions after open reduction and internal fixation of proximal humeral fractures by using electrophysiological assessments and to provide a review of the relevant literature. This was a retrospective cohort study of 76 consecutive patients who received open reduction and internal fixation of a proximal humeral fracture using a locking plate through a deltoid-splitting approach. We performed a clinical and electrophysiological examination at a minimum follow-up time of 12 months. Functional results were assessed according to the Constant-Murley and Disabilities of the Arm, Shoulder and Hand scores. Electrophysiological examinations comprised electromyography, electroneurography, and motor and somatosensory evoked potentials. The main outcome was the frequency of axillary nerve lesions. Forty patients were monitored for an average of 28 months. The mean raw Constant-Murley score was 61 points, the age- and gender-adjusted score was 71%, and the mean Disabilities of the Arm, Shoulder and Hand score was 33 points. Neurapraxia occurred in 1 patient, axonotmesis with incomplete reinnervation occurred in 3, and complete reinnervation occurred in 3. The latter group was classified as having a temporary axillary nerve lesion. The 10% rate of permanent axillary nerve lesions in our cohort is higher than expected based on the clinical examination. Electrophysiological assessment is therefore more appropriate to detect axillary nerve injuries. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  5. Posterior reduction and internal fixation with posterior cranial fossa cranioectomy decompression for Chiari malformation type Ⅰ with basilar invagination, atlantoaxial subluxation, and syringomyelia

    Directory of Open Access Journals (Sweden)

    HU Peng

    2012-08-01

    Full Text Available Background Chiari malformation type Ⅰ(CM-Ⅰ is one of the soft tissue anomalies in craniovertebral junction (CVJ. This kind of soft tissue anomaly usually develops with bone anomaly, such as atlantoaxial subluxation, basilar invagination, platybasia, C1 assimilation, etc. For these complex combined anomalies, the treatment remains unaddressed. This study was performed to evaluate the effect of posterior reduction and internal fixation with posterior cranial fossa cranioectomy decompression for Chiari malformation type Ⅰ with basilar invagination, atlantoaxial subluxation, and syringomyelia. Methods Patients with basilar invagination and atlantoaxial subluxation treated from July 2004 to September 2011 were reviewed. Including criterions were made to screen matching patients. Including patients were retrospectively analyzed on both clinical outcomes and radiographical results. Japanese Orthopaedic Association (JOA score was used to evaluate the clinical outcomes, while the syrinx maximum size was measured on transverse view of MRI T2 image. The results were analyzed by SPSS 17.0 using t -text. Significant difference was considered when P ≤ 0.05. Results Fourteen patients met the including criterions, including 4 male patients and 10 female patients, with a mean age of 31.86 ± 11.36 (standard deviation, range: 17-51 years. Mean JOA score preoperatively of 14 patients was 13.07 ± 1.59 (standard deviation, while that was 15.57 ± 1.02 (standard deviation postoperatively (t = 9.946, P = 0.000. The mean syrinx size was (7.05 ± 1.98 mm (standard deviation, while that was (2.21 ± 1.91 mm (standard deviation postoperatively (t = 7.271, P = 0.000. There were no procedure-related morbidity or mortality happened. Conclusion Direct posterior reduction and internal fixation with posterior cranial fossa cranioectomy decompression can obviously improve the clinical outcomes and shrink syrinx for patients suffered from Chiari malformation typeⅠ with

  6. Scattering factor evaluation for internal dose assessment due to 60Co

    International Nuclear Information System (INIS)

    Gautam, Y.P.; Kumar, A.; Sharma, S.; Sharma, A.K.; Dube, B.; Hegde, A.G.

    2008-01-01

    Guidelines for the assessment of internal doses from monitoring suggest default measurement of uncertainties (i.e. lognormal scattering factor, SF) to be used for different types of monitoring data. In this paper, SF values have been evaluated for internal contamination due to 60 Co in two cases using whole body counting data. SF values of 1.04 and 1.03 were obtained for case I and II respectively while SF value of 1.03 was obtained using bioassay data for case I. SF evaluated is in good agreement with the default values given by IDEAS guidelines. (author)

  7. Internal fixation of S1-S3 iliosacral screws and pubic screw as the best configuration for unstable pelvic fracture with unilateral vertical sacral fracture (AO type C1.3).

    Science.gov (United States)

    Dilogo, Ismail Hadisoebroto; Satria, Oryza; Fiolin, Jessica

    2017-01-01

    Although internal fixation is the definitive treatment in unstable pelvic fractures with disruption of the anterior arch and a vertical fracture of the sacrum (AO type C1.3), there have been no agreement of the best technique of internal fixation yet. We aimed to derive comparable objective data on stiffness and load to failure in this type of fracture fixations. Synbone was modified into AO type C1.3 fracture model, while treatments were divided into six internal fixation treatment groups using tension band plate (TBP), symphysis pubis plate (SP) with iliosacral screw at S1 and S2 (IS S1-S2), pubic screw (PS) with iliosacral TBP, PS and IS S1-S2, SP and IS S1-S3, PS and S1-S3 and finally PS and IS S1-S3. Sensor was applied to detect the shifting and rotation of fracture fragments. Mechanical strength test conducted with the application of axial force on the sacrum vertebra (S1). The highest translational stiffness was observed in the group IS S1-S3 + PS (830.36 N/mm, p = 0.031) and there was no difference on the rigidity of the rotation between the groups posterior fixation using IS S1-S2 and IS S1-S3 ( p = 0.51). Meanwhile the highest load to failure was found in group IS S1-S3 + PS (1522.20 N). PS provided advantages compared to the use of plate. Group of PS and S1-S3 IS is the configuration of internal fixation with best translational and rotational stiffness and the largest load to failure compared to other techniques in AO type C1.3 fracture.

  8. Open reduction and internal fixation of acetabulum fractures: does timing of surgery affect blood loss and OR time?

    Science.gov (United States)

    Dailey, Steven K; Archdeacon, Michael T

    2014-09-01

    The purpose of this study was to investigate the timing of surgical intervention for fractures of the acetabulum and its influence on perioperative factors. Retrospective review. Level I trauma center. Two hundred eighty-eight consecutive patients who sustained either posterior wall (PW), associated both column (ABC), or anterior column posterior hemitransverse (ACPHT) acetabulum fractures were included in the study. One hundred seventy-six PW fractures were treated through a Kocher-Langenbeck approach, and 112 ABC/ACPHT fractures were treated through an anterior intrapelvic approach. Estimated blood loss (EBL), operative time. EBL (800 vs. 400 mL), operative time (270 vs.154 minutes), and hospital stay (11 vs. 7 days) were greater for the ABC/ACPHT fractures compared with the PW fractures. When comparing early (≤48 hours) versus late (>48 hours) treatment of PW fractures, there was no difference in EBL (400 vs. 400 mL, P = 0.37) or operative time (150 vs. 156 minutes, P = 0.50). In comparison of early versus late treatment of ABC/ACPHT fractures, no significant difference was noted in EBL (725 vs. 800 mL, P = 0.30) or operative time (258.5 vs. 272 minutes, P = 0.21). We found no advantage or disadvantage in terms of EBL or operative time for early (≤48 hours) versus late (>48 hours) fixation for either PW or ABC/ACPHT acetabular fractures. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

  9. Mechanistic modeling of the loss of protein sieving due to internal and external fouling of microfilters.

    Science.gov (United States)

    Bolton, Glen R; Apostolidis, Alex J

    2017-09-01

    Fed-batch and perfusion cell culture processes used to produce therapeutic proteins can use microfilters for product harvest. In this study, new explicit mathematical models of sieving loss due to internal membrane fouling, external membrane fouling, or a combination of the two were generated. The models accounted for membrane and cake structures and hindered solute transport. Internal membrane fouling was assumed to occur due to the accumulation of foulant on either membrane pore walls (pore-retention model) or membrane fibers (fiber-retention model). External cake fouling was assumed to occur either by the growth of a single incompressible cake layer (cake-growth) or by the accumulation of a number of independent cake layers (cake-series). The pore-retention model was combined with either the cake-series or cake-growth models to obtain models that describe internal and external fouling occurring either simultaneously or sequentially. The models were tested using well-documented sieving decline data available in the literature. The sequential pore-retention followed by cake-growth model provided a good fit of sieving decline data during beer microfiltration. The cake-series and cake-growth models provided good fits of sieving decline data during the microfiltration of a perfusion cell culture. The new models provide insights into the mechanisms of fouling that result in the loss of product sieving. © 2017 American Institute of Chemical Engineers Biotechnol. Prog., 33:1323-1333, 2017. © 2017 American Institute of Chemical Engineers.

  10. Histological evaluation of frakture healing after unreamed nail versus fixateur intern osteosynthesis of simple mid-shaft tibia fractures in sheep

    OpenAIRE

    Teschner, Steffi

    2010-01-01

    Introduction: Complication of conventional open reduction and internal fixation of fraktures are believed to be in part due to disruption of perfusion by the surgical approach and/or implant. Recently, an internal fixator has been developed wtch has only punctual contact to the periosteum and does not further damage the fracture healing process. Furthermore, the internal fixator can be applied through minimal invasive approach. This study compares the ease of fracture healing ater internal fi...

  11. Preliminary experience with biodegradable implants for fracture fixation

    Directory of Open Access Journals (Sweden)

    Dhillon Mandeep

    2008-01-01

    Full Text Available Background: Biodegradable implants were designed to overcome the disadvantages of metal-based internal fixation devices. Although they have been in use for four decades internationally, many surgeons in India continue to be skeptical about the mechanical strength of biodegradable implants, hence this study. Materials and Methods: A prospective study was done to assess the feasibility and surgeon confidence level with biodegradable implants over a 12-month period in an Indian hospital. Fifteen fractures (intra-articular, metaphyseal or small bone fractures were fixed with biodegradable implants. The surgeries were randomly scheduled so that different surgeons with different levels of experience could use the implants for fixation. Results: Three fractures (one humeral condyle, two capitulum, were supplemented by additional K-wires fixation. Trans-articular fixator was applied in two distal radius and two pilon fractures where bio-pins alone were used. All fractures united, but in two cases the fracture displaced partially during the healing phase; one fibula due to early walking, and one radius was deemed unstable even after bio-pin and external fixator. Conclusions: Biodegradable -implants are excellent for carefully selected cases of intra-articular fractures and some small bone fractures. However, limitations for use in long bone fractures persist and no great advantage is gained if a "hybrid" composite is employed. The mechanical properties of biopins and screws in isolation are perceived to be inferior to those of conventional metal implants, leading to low confidence levels regarding the stability of reduced fractures; these implants should be used predominantly in fracture patterns in which internal fixation is subjected to minimal stress.

  12. Response of ENSO amplitude to global warming in CESM large ensemble: uncertainty due to internal variability

    Science.gov (United States)

    Zheng, Xiao-Tong; Hui, Chang; Yeh, Sang-Wook

    2017-08-01

    El Niño-Southern Oscillation (ENSO) is the dominant mode of variability in the coupled ocean-atmospheric system. Future projections of ENSO change under global warming are highly uncertain among models. In this study, the effect of internal variability on ENSO amplitude change in future climate projections is investigated based on a 40-member ensemble from the Community Earth System Model Large Ensemble (CESM-LE) project. A large uncertainty is identified among ensemble members due to internal variability. The inter-member diversity is associated with a zonal dipole pattern of sea surface temperature (SST) change in the mean along the equator, which is similar to the second empirical orthogonal function (EOF) mode of tropical Pacific decadal variability (TPDV) in the unforced control simulation. The uncertainty in CESM-LE is comparable in magnitude to that among models of the Coupled Model Intercomparison Project phase 5 (CMIP5), suggesting the contribution of internal variability to the intermodel uncertainty in ENSO amplitude change. However, the causations between changes in ENSO amplitude and the mean state are distinct between CESM-LE and CMIP5 ensemble. The CESM-LE results indicate that a large ensemble of 15 members is needed to separate the relative contributions to ENSO amplitude change over the twenty-first century between forced response and internal variability.

  13. Single‑incision technique for the internal fixation of distal fractures of the tibia and fibula: a combined anatomic and clinical study.

    Science.gov (United States)

    Yu, Baoqing; Huang, Gan; George, Josiah T; Li, Wenrui; Pan, Sihua; Zhou, Haiyan

    2013-12-01

    To present a novel single anterior-lateral approach for the treatment of distal tibia and fibula fracture via anatomical study and primary clinical application in order to minimize soft tissue complications. Both a gross anatomic cadaver and retrospective studies of the single-incision technique in patients recruited between June 2004 and January 2010. Level I trauma center. Twenty-six legs of 14 adult human cadavers and clinical recruitment of 49 patients (29 males, 20 females) with a mean age of 37.6 years (range 11-68) with fracture of distal 1/3 tibia and fibula. A single anterior-lateral incision technique for open reduction and internal fixations of distal tibia and fibula fractures. To identify the anatomic structures at risk in the anterolateral aspect of the lower leg and explicit the safe dissection distance from the extensor digitorum longus (EDL) to tibia and fibula, 26 legs of 14 adult human embalmed specimens were recruited in the anatomical study with the distance between the EDL and the anterior edge of the distal thirds of the tibia, as well as the distance between the EDL and the anterior edge of the distal thirds of the fibula were measured, and their mutual relationships to the surrounding anatomical structures described. Mean average standard deviations were also calculated. As for the clinical study, the quality of bone union and soft tissue healing were noted. The mean distances between the distal tibia and the EDL were measured to be 2.96 ± 0.46 cm (proximal), 1.85 ± 0.25 cm (middle), and 2.15 ± 0.30 cm (distal), and that between the fibula and the EDL were 1.82 ± 0.28 cm (proximal), 2.09 ± 0.31 cm (middle), and 2.30 ± 0.27 cm (distal), which means the safe gap from the distal tibia to EDL was 1.6-3.4 cm and from the EDL to fibula was 1.5-2.6 cm. The anterior tibial vein and artery and the deep fibular nerve lie on the anterior interosseous membrane over the lateral surface of the distal tibia were excellently visualized. Review of

  14. [One-stage operation for pelvis and acetabular fractures combined with Morel-Lavallée injury by internal fixation associated with vacuum sealing drainage].

    Science.gov (United States)

    Wei, Dan; Wang, Yue; Yuan, Jiabin; Tang, Xiaoming; Zhang, Bin; Lu, Bing; Tan, Bo

    2014-01-01

    To investigate the methods and effectiveness of one-stage operation for pelvis and acetabular fractures combined with Morel-Lavallée injury by internal fixation associated with vacuum sealing drainage (VSD). Between June 2008 and October 2012, 15 cases of pelvis and acetabular fractures combined with Morel-Lavallée injury were treated. There were 5 males and 10 females, aged from 18 to 67 years (mean, 36.8 years). Fractures were caused by traffic accident in 11 cases and crashing injury of heavy object in 4 cases. The time from injury to hospitalization was 3 hours to 9 days (mean, 5.4 days). Morel-Lavallée injury located in the above posterior superior iliac spine in 4 cases, greater trochanter in 7 cases, and anterior proximal thigh in 4 cases. In 10 cases complicated by pelvic fracture, there were 1 case of anteroposterior compression type, 3 cases of lateral compression type, 5 cases of vertical shear type, and 1 case of compound injury type; in 5 cases complicated by acetabular fracture, there were 1 case of transverse fracture, 1 case of posterior wall and posterior column fracture, 1 case of transverse acetabulum plus posterior wall fracture, and 2 cases of both columns fracture. Open reduction and internal fixation were used to treat pelvic and acetabular fractures, and VSD to treat Morel-Lavallée injury. When the drainage volume was less than 20 mL/d, interrupted wound suture or free skin grafting was performed. The hospitalization time was 16-31 days (mean, 20.8 days). Thirteen cases were followed up 4-16 months (mean, 7.8 months). The healing time of Morel-Lavallée injury was 16-36 days after operation (mean, 21.3 days). All the wounds had primary healing, and no infection occurred. The X-ray films showed that all fractures healed, with a mean healing time of 13.6 weeks (range, 11-18 weeks). At 6.5 months after operation, according to Majeed function scoring system in 8 cases of pelvic fracture, the results were excellent in 5 cases, good in 2 cases

  15. Internal dose assessment due to large area contamination: Main lessons drawn from the Chernobyl accident

    International Nuclear Information System (INIS)

    Andrasi, A.

    1997-01-01

    The reactor accident at Chernobyl in 1986 beside its serious and tragic consequences provided also an excellent opportunity to check, test and validate all kind of environmental models and calculation tools which were available in the emergency preparedness systems of different countries. Assessment of internal and external doses due to the accident has been carried out for the population all over Europe using different methods. Dose predictions based on environmental model calculation considering various pathways have been compared with those obtained by more direct monitoring methods. One study from Hungary and one from the TAEA is presented shortly. (orig./DG)

  16. Internal dose assessment due to large area contamination: Main lessons drawn from the Chernobyl accident

    Energy Technology Data Exchange (ETDEWEB)

    Andrasi, A. [KFKI Atomic Energy Research Inst., Budapest (Hungary)

    1997-03-01

    The reactor accident at Chernobyl in 1986 beside its serious and tragic consequences provided also an excellent opportunity to check, test and validate all kind of environmental models and calculation tools which were available in the emergency preparedness systems of different countries. Assessment of internal and external doses due to the accident has been carried out for the population all over Europe using different methods. Dose predictions based on environmental model calculation considering various pathways have been compared with those obtained by more direct monitoring methods. One study from Hungary and one from the TAEA is presented shortly. (orig./DG)

  17. [Comparision of clinical effects between one-stage anterior and posterior approach in treating thoracolumbar tuberculosis with debridement and internal fixation].

    Science.gov (United States)

    Lin, Bin; Dai, Li-Lin; Chen, Zhi-da; Zheng, Yong

    2017-09-25

    To compare the outcomes of surgical operation by posterior or anterior approach only for thoracolumbar tuberculosis. The clinical data of 97 patients with thoracolumbar tuberculosis underwent debridement and internal fixation from January 2005 to December 2014 were retrospectively analyzed. The study included 59 males and 38 females, with a mean age of 53.7 years ranged from 20 to 68 years. The course of disease was from 1 to 13 months with an average of (6.9±2.3) months. Among these patients, 43 cases were treated through one-stage anterior approach (anterior approach group) and 54 cases were treated through posterior approach (posterior approach group). The clinical data and imaging data of 97 cases were analyzed, including the operation time, intraoperative and postoperative blood loss, postoperative hospitalization time, complications, visual analogue scale(VAS), Oswestry Disability Index(ODI), Frankle grade, bone fusion time, and corrective rate of Cobb angle. Operation time, intraoperative and postoperative blood loss, postoperative hospitalization time, complication rate, and corrective rate of Cobb angle were(174.4±9.9) min, (885.0±95.7) ml, (103.2±11.5) ml, (15.1±0.7) d, 9.3%, (73.4±3.2)% in posterior group respectively, while in anterior approach group were(229.5±15.2) min, (1326.0±113.5) ml, (153.2±16.7) ml, (19.0±0.8) d, 16.3%, (62.3±2.5)%, respectively, and there was significant difference between two groups. There was no significant difference in graft bone fusion between two groups. Postoperative VAS, ODI, Frankel grade of all patients were obviously improved, but there was no significant difference between two groups. Thoracolumbar tuberculosis could be cured by one-stage anterior or posterior approach with debridement, bone grafting and internal fixation, but posterior approach has advantages of less trauma and better deformity correction.

  18. Therapeutic efficacy of pedicle screw-rod internal fixation after one-stage posterior transforaminal lesion debridement and non-structural bone grafting for tuberculosis of lumbar vertebra

    Directory of Open Access Journals (Sweden)

    Jia-ming LIU

    2015-11-01

    Full Text Available Objective To evaluate the efficacy and safety of pedicle screw-rod internal fixation after one-stage posterior transforaminal lesion debridement and non-structural bone grafting in the treatment of tuberculosis of mono-segmental lumbar vertebra. Methods From January 2010 to April 2013, 21 patients (9 males and 12 females with an average age of 49.1 years with mono-segmental tuberculosis of lumbar vertebra underwent surgery in our hospital were included. Eight patients had neurological deficit. The focus of tuberculosis was located on one side of the vertebral body, and all the patients had obvious signs of bone destruction on CT and MRI. All the patients were given anti-tuberculosis chemotherapy for 2-3 weeks before surgery. The local bone chips and autologous iliac cancellous bone were used as the intervertebral bone graft. Postoperative plain radiographs and CT were obtained to evaluate the fusion rate and degree of lumbar lordosis. The visual analogue scale score (VAS, erythrocyte sedimentation rate (ESR, and C-reactive protein (CRP before and after operation, and at final follow-up date were recorded. Results All the patients were followed up for 25.3±4.2 months. The mean operation time was 157±39 minutes, and the average blood loss was 470±143ml. The fusion rate of the interbody bone graft was 95.2%, with an average fusion period of 6.1±2.5 months. The neurological function was improved by 100%, and no severe complication or neurological injury occured. The preoperative and postoperative lordosis angles of the lumbar spine were 21.4°±5.7° and 33.6°±3.1°, respectively, and it was 31.3°±2.7° at the final follow up. The preoperative and postoperative VAS scores were 7.8±2.6 and 2.4±1.7 respectively, and it was 0.9±0.7 at the final follow up. The ESR and CRP were significantly decreased 3 months after surgery, and they became normal at 6 months. Conclusion Pedicle screw-rod internal fixation after one-stage posterior

  19. Usefulness of three-dimensional transesophageal echocardiography for diagnosis of hemolytic anemia due to inverted internal felt strip after surgery for aortic dissection.

    Science.gov (United States)

    Oda, Takeshi; Yasunaga, Hiroshi; Zaima, Yasuyuki; Arimura, Akiko; Imai, Shinichi; Kanamoto, Ryo; Fukuda, Hayato; Nakamura, Eiji; Tashiro, Hideki; Aoyagi, Shigeaki

    2017-04-01

    Felt strips are widely used for reinforcement of the aortic stump in surgery for aortic dissection (AD). Postoperative hemolytic anemia (HA) due to an inverted internal felt strip at the aortic stump fixation for AD is extremely rare. A 70-year-old woman underwent ascending aorta replacement for acute type A AD, where both proximal and distal anastomotic sites were reinforced with Teflon felt strips. A week later, macroscopic hematuria and HA emerged. Three-dimensional transesophageal echocardiography (3D-TEE) demonstrated that the proximal inner felt strip turned up and protruded into the aortic inner lumen. At redo surgery, which was performed 2 weeks after the initial surgery, the findings of 3D-TEE were confirmed, and the inverted internal felt strip was replaced with a bovine pericardial strip. The findings of HA disappeared immediately after the second surgery. 3D-TEE is a very informative, valuable modality for accurate diagnosis that leads to a safe surgery.

  20. Percutaneous reduction and screw fixation of fracture neck talus.

    Science.gov (United States)

    Abdelgaid, Sherif Mohamed; Ezzat, Farid Fouad

    2012-12-01

    Fracture neck talus is a rare fracture represents about 1% of all fractures and usually due to high energy trauma. These fractures are usually associated with compromised soft tissues, concomitant skeletal fractures, or life threatening injuries. Talus has a tenuous blood supply which is affected by fracture displacement. Urgent fracture reduction±fracture fixation is mandatory. The associated injuries may make the conventional open reduction and internal fixation is impossible to be done in urgent base as it may impacts the already tenuous blood supply of talus increasing the risk of AVN and non union. Percutaneous fracture reduction and fixation can overcome this problem, and decrease complications associated with conventional open reduction and internal fixation. Between 2006 and 2008, 16 patients with talar neck fractures were operated on by percutaneous reduction of fracture and percutaneous fixation with 3.5mm cannulated screws. Injuries were classified according to modified Hawkins classification system. Patients were followed up over an average of 48 months. 87.5% of the patients were satisfied and resumed their preoperative activities. The mean AOFAS Hind Foot Scale was 89.25 points (range: 74-100) and no poor outcomes. Although the number of patients in this study is small, the results showed that, percutaneous reduction and fixation is a good treatment modality in treatment of fracture neck talus, especially in cases with increased risk of soft tissue complications and open reduction should be resort only when percutaneous reduction was failed. Copyright © 2012 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  1. The cement-augmented transiliacal internal fixator (caTIFI): an innovative surgical technique for stabilization of fragility fractures of the pelvis.

    Science.gov (United States)

    Schmitz, Paul; Baumann, Florian; Grechenig, Stephan; Gaensslen, Axel; Nerlich, Michael; Müller, Michael B

    2015-10-01

    Analyzing the different age groups in a population who suffered a pelvic ring fracture it becomes obvious that there are important differences between the pelvic ring lesions of an elderly patient compared to a young adult concerning trauma mechanism, fracture pattern and therapeutic options. In the elderly patient it is very important to achieve maximum of stability if surgery is necessary in order to avoid early failure of the ostheosynthesis under mobilization with full weight bearing. 15 patients (14 female) with fragility fractures of the pelvis that required surgical stabilization were eligible to participate in this study from December 2012 to December 2014. Such details were documented and analysed as patient demographics, mechanism of injury, fracture classification, operative treatment and postoperative radiological parameters of achieved bone-implant interface. The average age of the patients was 79.9 years (SD 9.0 years). According to Rommens five patients had a fragility fracture of the pelvis Type II-c, one a Type III-c, six a Type IV-b and three a Type IV-c. Four patients were treated by a cement augmented transiliac internal fixation (caTIFI). Seven patients received a cement augmented iliolumbar fixation. In all these patients the Schanz screws applied to the ilium were placed in an oblique dorsoventral direction into the supraacetabular bone canal (mean length of screws 100 ± 20mm, max. 135 mm, min. 70 mm). Even though in four patients the iliosacral joint was hit tangential and one cortex perforation without any cement leakage appeared no revision surgery was necessary. Overall the clinical findings including mobilisation with full weight bearing showed a sufficient mechanically stability in all patients. The focus of this study was to describe the modified surgical technique of the caTIFI with placing the Schanz screws from the posterior superior iliac spine to the anterior inferior iliac spine into the supraacetabular bone canal. Usage of

  2. Femoral artery thrombosis after internal fixation of a transverse acetabular fracture in a patient with osteogenesis imperfecta type I

    Directory of Open Access Journals (Sweden)

    Morgan Steven J

    2008-01-01

    Full Text Available Abstract Osteogenesis imperfecta is a genetic disorder characterized by increased susceptibility to fractures and vascular injuries due to connective tissue fragility. In this case report, we present a patient with osteogenesis imperfecta type I who sustained a transverse fracture of the right acetabulum while transferring from bed to chair. The fracture was repaired through an ilioinguinal approach. During the surgery, an iatrogenic injury to the femoral artery and vein occurred. This intraoperative complication was salvaged by immediate vascular repair. We discuss the possible causes of iatrogenic vascular injuries in patients with osteogenesis imperfecta. Orthopaedic surgeons should be aware of this potentially devastating complication in this particular patient cohort.

  3. Latarjet Fixation

    Science.gov (United States)

    Alvi, Hasham M.; Monroe, Emily J.; Muriuki, Muturi; Verma, Rajat N.; Marra, Guido; Saltzman, Matthew D.

    2016-01-01

    Background: Attritional bone loss in patients with recurrent anterior instability has successfully been treated with a bone block procedure such as the Latarjet. It has not been previously demonstrated whether cortical or cancellous screws are superior when used for this procedure. Purpose: To assess the strength of stainless steel cortical screws versus stainless steel cannulated cancellous screws in the Latarjet procedure. Study Design: Controlled laboratory study. Methods: Ten fresh-frozen matched-pair shoulder specimens were randomized into 2 separate fixation groups: (1) 3.5-mm stainless steel cortical screws and (2) 4.0-mm stainless steel partially threaded cannulated cancellous screws. Shoulder specimens were dissected free of all soft tissue and a 25% glenoid defect was created. The coracoid process was osteomized, placed at the site of the glenoid defect, and fixed in place with 2 parallel screws. Results: All 10 specimens failed by screw cutout. Nine of 10 specimens failed by progressive displacement with an increased number of cycles. One specimen in the 4.0-mm screw group failed by catastrophic failure on initiation of the testing protocol. The 3.5-mm screws had a mean of 274 cycles (SD, ±171 cycles; range, 10-443 cycles) to failure. The 4.0-mm screws had a mean of 135 cycles (SD, ±141 cycles; range, 0-284 cycles) to failure. There was no statistically significant difference between the 2 types of screws for cycles required to cause failure (P = .144). Conclusion: There was no statistically significant difference in energy or cycles to failure when comparing the stainless steel cortical screws versus partially threaded cannulated cancellous screws. Clinical Relevance: Latarjet may be performed using cortical or cancellous screws without a clear advantage of either option. PMID:27158630

  4. Feasibility study of international cooperation on the chemical CO2 fixation and effective utilization technology in FY 1996; 1996 nendo kagakuteki CO2 koteika yuko riyo gijutsu ni kakawaru kokusai kyoryoku kanosei chosa

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-03-01

    In this survey, candidate organizations to cooperate internationally in the development of chemical CO2 fixation technologies have been selected, and possible forms of the cooperation each organization would participate in have been examined. The chemical CO2 fixation technology project of RITE (Research Institute of Innovation Technology for the Earth) involves the essential themes of CO2 separation membrane technology, catalytic hydrogenation reaction technology, and hydrogen production/supply technology, as well as the overall system. Through the arrangement, 19 international research institutes were selected as the potential candidates for international research cooperation. Either direct visit or questionnaire by mail was conducted to these institutes. The purposes of international cooperation in each of essential study theme are to review the possibility of improving technologies in each theme by introducing new technologies, and to review the possibilities of promoting practical implementation of chemical CO2 fixation system. The research institutes to be reviewed as partners for joint research are summarized. 10 figs., 16 tabs.

  5. Report on survey of international cooperation possibility on chemical CO2 fixation and utilization technology in FY 1997; 1997 nendo chosa hokokusho (kagakuteki CO2 koteika yuko riyo gijutsu ni kakawaru kokusai kyoryoku kanosei chosa)

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-03-01

    This survey focused on the end of the more promising companion and promoting the international cooperation on chemical CO2 fixation and utilization technology. As a result, the way of the carrying-forward of the international cooperation with more than one companion could be arranged beforehand. It led to getting an arrangement about a secrecy agreement respectively with Lurgi company and ABB company in Europe, and to providing a catalyst sample developed by RITE to implement an examination by the other party and to show related technical information. In addition, it concluded a cooperation agreement about a total system of the chemical CO2 fixation and utilization technology and methanol synthesis with ZSW. In Australia, negotiation about international cooperation with CSIRO which is a federal research organization and CRC (Cooperative Research Centre) for renewable energy has been started. The ideal circumstances are being ready for the chemical CO2 fixation project for which the international cooperation with the country where the natural energy is rich like Australia is essential when coming to practical use. To do alternating current with further high density in the following year it is desired to build a concrete study cooperation system. 1 fig., 4 tabs.

  6. Flexible fixation and fracture healing

    DEFF Research Database (Denmark)

    Schmal, Hagen; Strohm, Peter C; Jaeger, Martin

    2011-01-01

    External and internal fixators use bone screws that are locked to a plate or bar to prevent periosteal compression and associated impairment of blood supply. Both osteosynthesis techniques rely on secondary bone healing with callus formation with the exception of compression plating of simple...

  7. Polymeric media for tritium fixation. Supplement I

    International Nuclear Information System (INIS)

    Franz, J.A.; Burger, L.L.

    1976-01-01

    Procedures for the fixation of tritium as TH or THO in two different polymeric media are described. The complete procedure for THO fixation in a polyureylene-polyurethane polumer, including polymer molding procedures and leach tests is presented. The catalytic tritiation of polystyrene under very mild conditions using a rhodium catalyst is also described. Thermal stabilities and cost estimates for the polymers examined under this program are discussed. Organic polymers were found to have attractive features for the fixation and storage of concentrated tritium wastes due to the convenience of fixation procedures and favorable properties of the resulting media

  8. Analytical model of cracking due to rebar corrosion expansion in concrete considering the structure internal force

    Directory of Open Access Journals (Sweden)

    Xiangyue Lin

    2017-12-01

    Full Text Available Based on the assumptions of uniform corrosion and linear elastic expansion, an analytical model of cracking due to rebar corrosion expansion in concrete was established, which is able to consider the structure internal force. And then, by means of the complex variable function theory and series expansion technology established by Muskhelishvili, the corresponding stress component functions of concrete around the reinforcement were obtained. Also, a comparative analysis was conducted between the numerical simulation model and present model in this paper. The results show that the calculation results of both methods were consistent with each other, and the numerical deviation was less than 10%, proving that the analytical model established in this paper is reliable.

  9. [Analysis of degradation failure of poly L-lactic acid fixators used in meniscus tears].

    Science.gov (United States)

    Ceyhan, Taşkin; Aşik, Mehmet; Atalar, Ata Can; Apohan, Nilhan Kayaman

    2008-01-01

    Biodegradable poly L-lactic acid (PLLA) fixators used in the repair of meniscal tears may cause adverse reactions inside the knee due to delayed degradation. This study was designed to determine the reasons for late degradation of PLLA fixators. Three unused and three used meniscal PLLA fixators (BioStinger) were analyzed. The latter were removed from three patients due to persisting symptoms within six months after knee arthroscopy. Fourier transform infrared (FTIR) spectroscopy was performed and external and internal surfaces of the samples were examined by scanning electron microscopy (SEM) and X-ray fluoroscopy (XRF). Chemical structural analyses of two samples (one from each group) were made by 1H-nuclear magnetic resonance (1H-NMR) spectroscopy. Degradation times of two samples (one from each group) by oxidative hydrolysis in hydrogen peroxide solution were recorded. Chemical structure of used and unused fixators did not differ in FTIR analysis. With increasing temperatures, unused and used fixators showed degradation with and without melt flow, respectively. In SEM analysis, inner sections of unused fixators were homogeneous, whereas those of the used ones exhibited crystals which were found to be sodium and potassium chloride salts in XRF analysis. The 1H-NMR spectrum of used and unused samples showed the normal pattern of lactic acid polymer. The unused and used fixators degraded in hydrogen peroxide solution in 10 days and 30 days, respectively. Both fixators had the same chemical structure in FTIR and NMR analyses. Formation of salt crystals seemed to be the most important cause of degradation failure, while changes in the physical properties of fixators were thought to be associated with delayed degradation.

  10. [Three cases of internal carotid artery dissection due to trivial trauma].

    Science.gov (United States)

    Hayashi, Kentaro; Kitagawa, Naoki; Hiu, Takeshi; Morofuji, Yoichi; Suyama, Kazuhiko; Ochi, Akira; Nagata, Izumi

    2007-12-01

    Three cases of internal carotid artery (ICA) dissection due to trivial trauma were reported. A 14-year-old, previously healthy, girl developed left hemiparesis after jogging. MRI sh owed cerebral infarction in the right basal ganglia and the MR angiography (MRA) revealed luminal narrowing of the right ICA as well as pseudolumen at the origin of the right ICA. She was treated with antithrombotic therapy. Follow-up MRA demonstrated normal signal in the right ICA. A 23-year-old woman admitted to the hospital because of minor facial injury due to a traffic accident. Although she had no apparent symptom, follow-up CT, one day after presentation,. showed cerebral infarction in the right basal ganglia. Angiography showed diminished luminal diameter of the right ICA. She was treated with antithrombotic therapy and follow-up angiography showed reconstitution of normal lumina of the right ICA. A 34-year-old woman was referred to our hospital because of transient ischemic attack following swimming. Neurological examination was normal and MRI did not show any ischemic lesion. MRA revealed diminished signal in the left ICA as well as string and pearl sign at the origin of the left ICA. She was treated with antithrombotic therapy, and follow-up angiography showed normalization of the left ICA. Cervical ICA dissection due to trivial trauma usually appears as an eccentric tapered stenosis arising at the origin of the ICA and resolves with complete or excellent recovery in most cases. Surgical or endovascular treatment should be reserved for patients who have persistent symptoms of ischemia despite adequate antithrombotic treatment.

  11. Epistaxis and pituitary apoplexy due to ruptured internal carotid artery aneurysm embedded within pituitary adenoma.

    Science.gov (United States)

    Peng, Zesheng; Tian, Daofeng; Wang, Hongliu; Kong, Derek Kai; Zhang, Shenqi; Liu, Baohui; Deng, Gang; Xu, Zhou; Wu, Liquan; Ji, Baowei; Wang, Long; Cai, Qiang; Li, Mingchang; Wang, Junmin; Zhang, Aimin; Chen, Qianxue

    2015-01-01

    Epistaxis due to ruptured internal carotid artery (ICA) aneurysm embedded within a pituitary adenoma (PA) has seldom been reported in the literature. Here we want to elaborate the incidence, mechanisms, clinical manifestations, and treatment strategy for this condition. The first survived case of a patient with epistaxis and pituitary apoplexy due to ruptured aneurysm embedded within PA was reported and the literature was reviewed. A 53-year-old male patient presented to our institution with sudden onset epistaxis and progressive vision loss. Neurological examination revealed bilateral ptosis and dilated unresponsive pupils. A CT scan showed a large mass in the pituitary fossa with bony erosion. MRI revealed a large pituitary tumor and abnormal signal intensity in the tumor. No aneurysm was noted during the pre-operative MR angiography. Abundant arterial bleeding suddenly occurred during urgent transsphenoidal surgery. Digital subtraction angiography confirmed the presence of a 14 mm unexpected saccular aneurysm of right ICA in the cavernous sinus with the dome protruding into the sella turcica. Balloon test occlusion of the right ICA was undertaken and permanent occlusion was performed. The patient recovered well and received bromocriptine and thyroid hormone replacement therapy during the follow-up period. At 14-month followup, the patient had no neurological deficits, no features of ischaemia relating to the right ICA therapeutic occlusion. Our case indicated that epistaxis and pituitary apoplexy could be due to the rupture of an ICA aneurysm embedded in a PA. Clinical suspicion should remain high when evaluating any case of epistaxis and pituitary apoplexy. Optimal treatment should take into consideration individual features of the tumor, aneurysm, and patient. Making the correct diagnosis as well as identifying an appropriate management strategy is critical in the care of such patients.

  12. Femoral Reconstruction Using External Fixation

    Directory of Open Access Journals (Sweden)

    Yevgeniy Palatnik

    2011-01-01

    Full Text Available Background. The use of an external fixator for the purpose of distraction osteogenesis has been applied to a wide range of orthopedic problems caused by such diverse etiologies as congenital disease, metabolic conditions, infections, traumatic injuries, and congenital short stature. The purpose of this study was to analyze our experience of utilizing this method in patients undergoing a variety of orthopedic procedures of the femur. Methods. We retrospectively reviewed our experience of using external fixation for femoral reconstruction. Three subgroups were defined based on the primary reconstruction goal lengthening, deformity correction, and repair of nonunion/bone defect. Factors such as leg length discrepancy (LLD, limb alignment, and external fixation time and complications were evaluated for the entire group and the 3 subgroups. Results. There was substantial improvement in the overall LLD, femoral length discrepancy, and limb alignment as measured by mechanical axis deviation (MAD and lateral distal femoral angle (LDFA for the entire group as well as the subgroups. Conclusions. The Ilizarov external fixator allows for decreased surgical exposure and preservation of blood supply to bone, avoidance of bone grafting and internal fixation, and simultaneous lengthening and deformity correction, making it a very useful technique for femoral reconstruction.

  13. The application of closed reduction internal fixation and iliac bone block grafting in the treatment of acute displaced femoral neck fractures.

    Directory of Open Access Journals (Sweden)

    Zhiyong Li

    Full Text Available OBJECTIVE: This study aimed to evaluate the preliminary clinical and radiographic outcomes of acute displaced femoral neck fracture treated by closed reduction and internal fixation (CRIF with free iliac bone block grafting with comparison to a routine protocol of CRIF without bone grafting. METHODS: From December 2008 to February 2010, 220 adult patients with acute displaced femoral neck fractures were enrolled in this study. In study group, there were 124 patients (57 males, 67 females with a mean age of 44.8 years (range, 20-64 years. There were 70 transcervical fractures and 54 subcapital fractures. The patients were treated by CRIF and free iliac bone block grafting. The control group consisted of 96 adult patients (46 males, 50 females with a mean age of 46.3 years (range, 23-64 years. There were 61 transcervical fractures and 35 subcapital fractures. The patients in control group were treated by CRIF without bone grafting. RESULTS: In study group, 112 patients were followed up for an average of 27.4 months (range, 24-34 months. All fractures healed within 5 months. However, 10 patients presented AVN of the femoral heads. The mean Harris score was 88.6 (range, 41-100. In control group, 68 patients were followed up for an average of 31.2 months (range, 24-42 months. The rates of AVN of the femoral head and fracture nonunion in control group were 26.5% (18/68 and 16.2% (11/68, respectively, significantly higher than those in study group (both P<0.05. The mean Harris score in control group was 83.8 (41-100, significantly lower than that in study group (P<0.05. CONCLUSION: Acute displaced femoral neck fractures can be treated by CRIF and free iliac bone block grafting in a minimally invasive manner. This technique can guarantee uneventful fracture healing and significantly reduce the rate of femoral head osteonecrosis.

  14. High failure rate after internal fixation and beneficial outcome after arthroplasty in treatment of displaced femoral neck fractures in patients between 55 and 70 years.

    Science.gov (United States)

    Bartels, Stefan; Gjertsen, Jan-Erik; Frihagen, Frede; Rogmark, Cecilia; Utvåg, Stein Erik

    2018-02-01

    Background and purpose - The treatment of patients between 55 and 70 years with displaced intracapsular femoral neck fracture remains controversial. We compared internal fixation (IF), bipolar hemiarthroplasty (HA) and total hip arthroplasty (THA) in terms of mortality, reoperations and patient-reported outcome by using data from the Norwegian Hip Fracture Register. Patients and methods - We included 2,713 patients treated between 2005 and 2012. 1,111 patients were treated with IF, 1,030 with HA and 572 patients with THA. Major reoperations (defined as re-osteosynthesis, secondary arthroplasty, exchange, or removal of prosthesis components and Girdlestone procedure), patient-reported outcome measures (satisfaction, pain, and health-related quality of life (EQ5D) after 4 and 12 months), 1-year mortality, and change in treatment methods over the study period were investigated. Results - Major reoperations occurred in 27% after IF, 3.8% after HA and 2.8% after THA. 549 patients (20% of total study population) answered both questionnaires. Compared with IF, patients treated with THA were more satisfied after 4 and 12 months, reported less pain after 4 months and 12 months, had a higher EQ5D-index score after 4 months and 12 months, and EQ-VAS score after 4 months. Compared with IF, patients treated with HA were more satisfied and reported less pain after 4 months. EQ5D-index and EQ-VAS were similar. Patients treated with HA had higher 1-year mortality and had more comorbidities than both the THA and IF group. All these differences were statistically and clinically significant. Interpretation - This study showed high reoperation rate after IF and better patient-reported outcome after both THA and HA with medium follow-up. Patients selected for HA represented a frailer group than patients treated with THA or IF.

  15. Extraction of light trapped due to total internal reflection using porous high refractive index nanoparticle films.

    Science.gov (United States)

    Mao, Peng; Sun, Fangfang; Yao, Hanchao; Chen, Jing; Zhao, Bo; Xie, Bo; Han, Min; Wang, Guanghou

    2014-07-21

    TiO₂ nanoparticle layers composed of columnar TiO₂ nanoparticle piles separated with nanoscale pores were fabricated on the bottom surface of the hemispherical glass prism by performing gas phase cluster beam deposition at glancing incidence. The porosity as well as the refractive index of the nanoparticle layer was precisely tuned by the incident angle. Effective extraction of the light trapped in the substrate due to total internal reflection with the TiO₂ nanoparticle layers was demonstrated and the extraction efficiency was found to increase with the porosity. An enhanced Rayleigh scattering mechanism, which results from the columnar aggregation of the nanoparticles as well as the strong contrast in the refractive index between pores and TiO₂ nanoparticles in the nanoporous structures, was proposed. The porous TiO₂ nanoparticle coatings were fabricated on the surface of GaN LEDs to enhance their light output. A nearly 92% PL enhancement as well as a 30% EL enhancement was observed. For LED applications, the enhanced light extraction with the TiO₂ nanoparticle porous layers can be a supplement to the microscale texturing process for light extraction enhancement.

  16. Nonlinear internal wave at the interface of two-layer liquid due to a moving hydrofoil

    Science.gov (United States)

    Wang, Zhen; Wu, Changhong; Zou, Li; Wang, Qianxi; Ding, Qi

    2017-07-01

    This paper is concerned with the internal wave at the interface of two layers of liquids due to a hydrofoil in the lower layer liquid. The two-layer fluid is assumed moving parallel to the interface at different velocities. The stratified flow is modeled based on the incompressible potential flow theory, with the nonlinear boundary conditions at the interface. Boundary integral equations are formulated for the fully nonlinear interfacial wave generated by the hydrofoil. The numerical model results in a set of nonlinear algebra equations, which are solved using the quasi-Newton method. We show that the quasi-Newton method is more efficient than Newton's method, which is often used for solving these types of equations in the literature. The wave profiles were analyzed in terms of the location and thickness of the hydrofoil, the Froude number, and the ratio of the densities of the two fluids. The computations show that the interfacial wave amplitude showed a trend first of increase and then of decrease with the distance between the hydrofoil and the still interface.

  17. Quantifying uncertainty due to internal variability using high-resolution regional climate model simulations

    Science.gov (United States)

    Gutmann, E. D.; Ikeda, K.; Deser, C.; Rasmussen, R.; Clark, M. P.; Arnold, J. R.

    2015-12-01

    The uncertainty in future climate predictions is as large or larger than the mean climate change signal. As such, any predictions of future climate need to incorporate and quantify the sources of this uncertainty. One of the largest sources comes from the internal, chaotic, variability within the climate system itself. This variability has been approximated using the 30 ensemble members of the Community Earth System Model (CESM) large ensemble. Here we examine the wet and dry end members of this ensemble for cool-season precipitation in the Colorado Rocky Mountains with a set of high-resolution regional climate model simulations. We have used the Weather Research and Forecasting model (WRF) to simulate the periods 1990-2000, 2025-2035, and 2070-2080 on a 4km grid. These simulations show that the broad patterns of change depicted in CESM are inherited by the high-resolution simulations; however, the differences in the height and location of the mountains in the WRF simulation, relative to the CESM simulation, means that the location and magnitude of the precipitation changes are very different. We further show that high-resolution simulations with the Intermediate Complexity Atmospheric Research model (ICAR) predict a similar spatial pattern in the change signal as WRF for these ensemble members. We then use ICAR to examine the rest of the CESM Large Ensemble as well as the uncertainty in the regional climate model due to the choice of physics parameterizations.

  18. Intrascleral IOL Fixation.

    Science.gov (United States)

    Jacob, Soosan

    2017-01-01

    Intrascleral sutureless intraocular lens (IOL) fixation utilizes direct haptic fixation within the sclera in eyes with deficient capsular support. This has advantages of long-term stability, good control of tilt and decentration, and lesser pseudophakodonesis. This review summarizes various techniques for intrascleral haptic fixation, results, complications, adaptations in special situations, modifications of the technique, combination surgeries, and intrascleral capsular bag fixation techniques (glued capsular hook). Copyright 2017 Asia-Pacific Academy of Ophthalmology.

  19. Accelerated rehabilitation compared with a standard protocol after distal radial fractures treated with volar open reduction and internal fixation: a prospective, randomized, controlled study.

    Science.gov (United States)

    Brehmer, Jess L; Husband, Jeffrey B

    2014-10-01

    There are relatively few studies in the literature that specifically evaluate accelerated rehabilitation protocols for distal radial fractures treated with open reduction and internal fixation (ORIF). The purpose of this study was to compare the early postoperative outcomes (at zero to twelve weeks postoperatively) of patients enrolled in an accelerated rehabilitation protocol with those of patients enrolled in a standard rehabilitation protocol following ORIF for a distal radial fracture. We hypothesized that patients with accelerated rehabilitation after volar ORIF for a distal radial fracture would have an earlier return to function compared with patients who followed a standard protocol. From November 2007 to November 2010, eighty-one patients with an unstable distal radial fracture were prospectively randomized to follow either an accelerated or a standard rehabilitation protocol after undergoing ORIF with a volar plate for a distal radial fracture. Both groups began with gentle active range of motion at three to five days postoperatively. At two weeks, the accelerated group initiated wrist/forearm passive range of motion and strengthening exercises, whereas the standard group initiated passive range of motion and strengthening at six weeks postoperatively. Patients were assessed at three to five days, two weeks, three weeks, four weeks, six weeks, eight weeks, twelve weeks, and six months postoperatively. Outcomes included Disabilities of the Arm, Shoulder and Hand (DASH) scores (primary outcome) and measurements of wrist flexion/extension, supination, pronation, grip strength, and palmar pinch. The patients in the accelerated group had better mobility, strength, and DASH scores at the early postoperative time points (zero to eight weeks postoperatively) compared with the patients in the standard rehabilitation group. The difference between the groups was both clinically relevant and statistically significant. Patients who follow an accelerated rehabilitation

  20. Bohler's angle's role in assessing the injury severity and functional outcome of internal fixation for displaced intra-articular calcaneal fractures: a retrospective study.

    Science.gov (United States)

    Su, Yanling; Chen, Wei; Zhang, Tao; Wu, Xingwang; Wu, Zhanpo; Zhang, Yingze

    2013-09-24

    Controversy exits over the role of Böhler's angle in assessing the injury severity of displaced intra-articular calcaneal fractures and predicting the functional outcome following internal fixation. This study aims to investigate whether a correlation exists between Böhler's angle and the injury severity of displaced calcaneal fractures, and between surgical improvement of Böhler's angle and functional outcome. Patients treated operatively for unilateral closed displaced intra-articular calcaneal fractures from January 1, 2004 to March 31, 2008 were identified. The Böhler's angles of both calcaneus were measured, and the measurement of the uninjured foot was used as its normal control. The difference in the value of Böhler's angle measured preoperatively or postoperatively between the angle of the injured foot and that of the contralateral calcaneus were calculated, respectively. The change in Böhler's angle by ratio was calculated by dividing the difference value of Böhler's angle between bilateral calcaneus by its normal control. The injury severity was assessed according to Sanders classification. The functional outcomes were assessed using American Orthopaedic Foot & Ankle Society hindfoot scores. 274 patients were included into the study with a mean follow-up duration of 71 months. According to Sanders classification, the fracture pattern included 105 type II, 121 type III and 48 type IV fractures. According to American Orthopaedic Foot & Ankle Society hindfoot scoring system, the excellent, good, fair and poor results were achieved in 104, 132, 27, and 11 patients, respectively. The preoperative Böhler's angle, difference value of Böhler's angle between bilateral calcaneus, and change in Böhler's angle by ratio each has a significant correlation with Sanders classification (rs=-0.178, P=0.003; rs=-0.174, P=0.004; rs=-0.172, P=0.005, respectively), however, is not correlated with functional outcome individually. The three postoperative measurements

  1. Bohler’s angle’s role in assessing the injury severity and functional outcome of internal fixation for displaced intra-articular calcaneal fractures: a retrospective study

    Science.gov (United States)

    2013-01-01

    Background Controversy exits over the role of Böhler’s angle in assessing the injury severity of displaced intra-articular calcaneal fractures and predicting the functional outcome following internal fixation. This study aims to investigate whether a correlation exists between Böhler’s angle and the injury severity of displaced calcaneal fractures, and between surgical improvement of Böhler’s angle and functional outcome. Methods Patients treated operatively for unilateral closed displaced intra-articular calcaneal fractures from January 1, 2004 to March 31, 2008 were identified. The Böhler’s angles of both calcaneus were measured, and the measurement of the uninjured foot was used as its normal control. The difference in the value of Böhler’s angle measured preoperatively or postoperatively between the angle of the injured foot and that of the contralateral calcaneus were calculated, respectively. The change in Böhler’s angle by ratio was calculated by dividing the difference value of Böhler’s angle between bilateral calcaneus by its normal control. The injury severity was assessed according to Sanders classification. The functional outcomes were assessed using American Orthopaedic Foot & Ankle Society hindfoot scores. Results 274 patients were included into the study with a mean follow-up duration of 71 months. According to Sanders classification, the fracture pattern included 105 type II, 121 type III and 48 type IV fractures. According to American Orthopaedic Foot & Ankle Society hindfoot scoring system, the excellent, good, fair and poor results were achieved in 104, 132, 27, and 11 patients, respectively. The preoperative Böhler’s angle, difference value of Böhler’s angle between bilateral calcaneus, and change in Böhler’s angle by ratio each has a significant correlation with Sanders classification (rs=−0.178, P=0.003; rs=−0.174, P=0.004; rs=−0.172, P=0.005, respectively), however, is not correlated with functional outcome

  2. Open reduction and internal fixation of displaced intraarticular fractures of the calcaneus - influence of type of fracture and congruency of the subtalar joint upon functional result

    Directory of Open Access Journals (Sweden)

    Matej Andoljšek

    2005-11-01

    Full Text Available Background: More and more, open reduction and internal fixation (ORIF followed by early motion are advocated for displaced intraarticular fractures of the calcaneus. In prospective study the author asked, what are the results of ORIF with the calcaneal plate in intraarticular fractures of the calcaneus, and whether type of fracture and/or congruity in the subtalar joint influence these results.Methods: Forty-three intraarticular fractures of the calcaneus (30 Type II, 10 Type III and 3 Type IV according to Sanders classification were operated through extensile lateral approach. After reduction of the subtalar joint and restoration of the calcaneus shape, the fracture was fixed with the calcaneal plate. Mostly, surgery was delayed for a few days until soft tissues recuperate. Motion of the ankle and the subtalar joint was encouraged immediately, partial weight bearing after 6–8 weeks and full weight bearing after 3–4 month. After surgery, subtalar joint was found congruent in 33 (77% and non-congruent (within 2 mm in ten fractures.Results: Functional results of 36 fractures with a representative type distribution were evaluated 12 to 61 months postinjury. Functional results were satisfactory in 31 fractures (86% and not satisfactory in five (14%. All fractures with unsatisfactory results were comminutive (Type III or IV. Four fractures with congruent joint had unsatisfactory, and eight of nine fractures with uncongruent joint had satisfactory result. Statistically, functional results of the comminuted fractures were significantly worse. However, functional results of fractures with non-congruent joint were comparable to the results of fractures with congruent joint and analysis of variance showed that interaction of these two factors was not important.Conclusions: This prospective study confirms that ORIF enables satisfactory results in majority of displaced intraarticular fractures of the calcaneus. It also confirms that comminution in the

  3. High incidence of osteochondral lesions after open reduction and internal fixation of displaced ankle fractures: Medium-term follow-up of 100 cases.

    Science.gov (United States)

    Regier, Marc; Petersen, Jan Philipp; Hamurcu, Ahmet; Vettorazzi, Eik; Behzadi, Cyrus; Hoffmann, Michael; Großterlinden, Lars G; Fensky, Florian; Klatte, Till Orla; Weiser, Lukas; Rueger, Johannes M; Spiro, Alexander S

    2016-03-01

    The incidence of osteochondral lesions (OCLs) in association with displaced ankle fractures has only been examined in two previous studies. In both studies magnetic resonance imaging (MRI) was performed prior to open reduction and internal fixation (ORIF). Because MRI may overdiagnose or overestimate the extent of OCLs in an acute trauma setting the aim of this study was to determine the incidence of OCLs after ORIF of displaced ankle fractures using MRI at medium-term follow-up, and to analyse if the severity of fracture or the clinical outcome correlates with the incidence of OCLs. Following institutional review board approval a total of 100 patients (mean age, 41.3 years; range, 17.9-64.3 years) with a displaced ankle fracture who had undergone ORIF according to the AO principles were included in this study. The American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score was used to quantify the clinical outcome and MR images were evaluated for OCLs of the talus and distal tibia after a mean of 34.5 months (range, 17.5-54.1 months). OCLs were found in 40.4% of the patients. Logistic regression revealed a significant correlation between the severity of fracture and the incidence of OCLs. Patients with a trimalleolar fracture (p=0.04) or an ankle fracture dislocation (p=0.003) had a significantly higher risk for developing an OCL compared to those with a type B fracture. Logistic regression also demonstrated a significant correlation between the clinical outcome (AOFAS score) and the incidence of OCLs (p=0.01). The risk for developing an OCL increases up to 5.6% when the AOFAS score decreases by one point. OCLs were frequently found in association with acute ankle fractures at medium-term follow-up, and the severity of fracture was associated with an increased number of OCLs. Considering the disadvantages of MRI including the high cost and limited availability, the results of this study may help to explain why anatomic surgical realignment of displaced

  4. internal radiation dose assessment due to ionizing radio contaminants in some local foodstuffs

    International Nuclear Information System (INIS)

    AbdElKader, F.M.

    1996-01-01

    Over the last 30 years, radioactivity has been monitored in foodstuffs in Egypt. The present work deals with the radioactivity monitored during two years (1990 - 1992) at eight major Egyptian governorates. Sampled food items were selected to cover most foodstuffs eaten by egyptian population according to their habits. The daily food consumption by egyptian population and the constituents of such consumption were estimated according to published international data and knowledge of the different feeding habits of the egyptians. About 1200 samples were collected from the markets of the main city of each governorate and prepared for counting according to the egyptian kitchen habits. The counting systems used in determination and indentification of radionuclides were : a 3 inch HPGe detector attached to 800 channel MCA and PC and a 3 inch phoswich detector attached to an anticoincidence circuit for low beta / gamma counting. The gamma spectroscopy system was calibrated using isotopic solution mixture while the low beta counting system was calibrated using H CI. Counting time for the first system was 20 - 72 hours and for the second system was half to one hour. The main radionuclides identified in foodstuffs were Cs - 137 and K - 40 . The radioactivity concentration of Cs - 137 was found to be in the range between 1.0 Bq / Kg for macaroni and 3.5 Bq / Kg for nile beans. The K - 40 concentration range between 19 Bq / Kg for macaroni to 363 Bq / Kg for nile beans. The population weighted values in case of Cs - 137 was found as 3.56 Bq /d and for K - 40 was 188 Bq /d. The resulted effective dose due to food intake was found be 16 . 4 U Sv /a for Cs-137 and 354 μSv / a for K -40 . This value for Cs - 137 is found in the exemption limit while that of K -40 is twice the published value. This may depend on the egyptian feeding habit which depends mainly on wheat (bread) and nile beans which are very rich in potassium.The resulted collective dose was found to be : 21323 person

  5. On the Internal Structure of Mobile Barchan Sand Dunes due to Granular Processes

    Science.gov (United States)

    Vriend, N. M.; Arran, M.; Louge, M. Y.; Hay, A. G.; Valance, A.

    2017-12-01

    In this work, we visualize the internal structure of mobile barchan desert dunes at the avalanche scale. We reveal an intriguing history of dune building using a novel combination of local sand sampling and advanced geophysical techniques resulting in high resolution measurements of individual avalanche events. Due to progressive rebuilding, granular avalanching, erosional and depositional processes, these marching barchan dunes are reworked every few years and a characteristic zebra-pattern (figure 1a), orientated parallel to the slipface at the angle of repose, appears at regular intervals. We present scientific data on the structure obtained from several mobile barchan dunes of different sizes during recent desert field campaigns (2014, 2015, 2017) in a mobile barchan dune field in Qatar (25.01°N, 51.34°E in the AlWakrah municipality). The site has been equipped with a weather station and has been regularly visited by a multidisciplinary research team in recent years (e.g. [1]). By applying high-frequency (1200 MHz) ground penetrating radar (GPR) transects across the midline (figure 1b) we map the continuous evolution of this cross-bedding at high resolution deep within the dune. The GPR reveals a slope reduction of the slipface near the base of the dune; evidence of irregular wind reversals; and the presence of a harder aeolian cap around the crest and extending to the brink. The data is supplemented with granulometry from layers stabilized by dyed water injection and uncovered by excavating vertical walls perpendicular to old buried avalanches. We attribute visible differences in water penetration between adjacent layers to fine particle segregation processes in granular avalanches. This work was made possible by the support of NPRP grant 6-059-2-023 from the Qatar National Research Fund to MYL and AGH, and a Royal Society Dorothy Hodgkin Research Fellowship to NMV. We thank Jean-Luc Métayer for performing detailed particle size distribution measurements

  6. Observation of sound focusing and defocusing due to propagating nonlinear internal waves.

    Science.gov (United States)

    Luo, J; Badiey, M; Karjadi, E A; Katsnelson, B; Tskhoidze, A; Lynch, J F; Moum, J N

    2008-09-01

    Fluctuations of the low frequency sound field in the presence of an internal solitary wave packet during the Shallow Water '06 experiment are analyzed. Acoustic, environmental, and on-board ship radar image data were collected simultaneously before, during, and after a strong internal solitary wave packet passed through the acoustic track. Preliminary analysis of the acoustic wave temporal intensity fluctuations agrees with previously observed phenomena and the existing theory of the horizontal refraction mechanism, which causes focusing and defocusing when the acoustic track is nearly parallel to the front of the internal waves [J. Acoust. Soc. Am., 122(2), pp. 747-760 (2007)].

  7. A Predictive Model for Life Assessment of Automotive Exhaust Mufflers Subject to Internal Corrosion Failure due to Exhaust Gases Condensation

    OpenAIRE

    Nazir, H.; Khan, Zulfiqar Ahmad; Stokes, K.

    2016-01-01

    A study has been presented of pitting corrosion on internal walls of automotive exhaust muffler due to exhaust gases condensation. The problem mainly exists in the rear section of exhaust system close to tail end pipe such as muffler, especially when the temperature of muffler does not go up during short distance run or winter. The water vapor condenses on the muffler's inner wall in the form of water droplets. The dissolution of corrosive gases which are coming from internal combustion of en...

  8. Use of the TRPV1 Agonist Capsaicin to Provide Long-Term Analgesia in a Rat Limb Fracture/Open Repair, Internal Fixation Model

    Science.gov (United States)

    2012-10-01

    model for acute traumatic femoral fracture followed by repair via intramedullary nail fixation that closely mimics what happens in real-world...Y, Friedman RJ, Parent T, Draughn RA. Production of a standard closed fracture in the rat tibia . J Orthop Trauma 8 (2004): 687-95. 2. Anand U, Otto...comminuted, or too distal of a fracture , or if the fracture was not able to be reduced and fixed via an intramedullary nail . Methods: 30 male Sprague

  9. Kennedy Space Center Fixation Tube (KFT)

    Science.gov (United States)

    Richards, Stephanie E.; Levine, Howard G.; Romero, Vergel

    2016-01-01

    Experiments performed on the International Space Station (ISS) frequently require the experimental organisms to be preserved until they can be returned to earth for analysis in the appropriate laboratory facility. The Kennedy Fixation Tube (KFT) was developed to allow astronauts to apply fixative, chemical compounds that are often toxic, to biological samples without the use of a glovebox while maintaining three levels of containment (Fig. 1). KFTs have been used over 200 times on-orbit with no leaks of chemical fixative. The KFT is composed of the following elements: a polycarbonate main tube where the fixative is loaded preflight, the sample tube where the plant or other biological specimens is placed during operations, the expansion plug, actuator, and base plug that provides fixative containment (Fig. 2). The main tube is pre-filled with 25 mL of fixative solution prior to flight. When actuated, the specimen contained within the sample tube is immersed with approximately 22 mL (+/- 2 mL) of the fixative solution. The KFT has been demonstrated to maintain its containment at ambient temperatures, 4degC refrigeration and -100 C freezing conditions.

  10. Health risks in international container and bulk cargo transport due to volatile toxic compounds

    DEFF Research Database (Denmark)

    Baur, Xaver; Budnik, Lygia T; Zhao, Zhiwei

    2015-01-01

    To ensure the preservation and quality of the goods, physical (i.e. radiation) or chemical pest control is needed. The dark side of such consents may bear health risks in international transport and production sharing. In fact, between 10% and 20% of all containers arriving European harbors were...

  11. Absence of internal tidal beams due to non-uniform stratification

    NARCIS (Netherlands)

    Gerkema, T.; van Haren, H.

    2012-01-01

    A linear internal-tide generation model is applied to the Faeroe–Shetland Channel, using observed profiles of stratification. Several degrees of simplification are considered: 1) uniform, i.e. constant N; 2) vertically varying N (z); 3) the full N(x, z) and associated geostrophic background flows.

  12. Open reduction and internal fixation of OTA type C2-C4 fractures of the calcaneus with a triple-plate technique.

    Science.gov (United States)

    Brunner, Alexander; Müller, Jochen; Regazzoni, Pietro; Babst, Reto

    2012-01-01

    The purpose of this study was to present a surgical technique of open reduction and internal fixation of displaced intra-articular calcaneal fractures with 3 AO mini-fragment plates and to evaluate the clinical and radiological outcome of a consecutive group of patients after a mean follow-up of 41.7 months. A series of 54 patients (16 women and 38 men) with 62 calcaneal fractures were treated over a period of 6.5 years. Forty-five patients with 50 calcaneal fractures were completely clinically and radiologically followed up. Clinical follow-up included assessment of range of motion, pain according to a visual analogue scale, the American Orthopaedic Foot and Ankle Society hindfoot score, and the short-form 36 health survey. Radiological follow-up included plain axial and lateral radiographs and measurement of the Böhler's angle and Gissane's angle. Independent Student's t test and paired Student's t test were used alongside the chi-square test to compare clinical and radiological data and score values between different groups of patients. Eleven patients showed breakage of the osteosynthesis material during the healing process and 2 patients sustained deep wound infection requiring revision surgery. At the final follow-up all fractures had healed. The average range of motion was supination 26.4° (range 0° to 50°; SD 11.6°), pronation 15.4° (range 0° to 30°; SD 6.4°), dorsal extension 14.3° (range -10° to 30°; SD 8.0°), and plantarflexion 39.6° (range 20° to 65°; SD 11.7°). Patients with OTA type C4 fractures achieved significantly lower supination (p fracture types. The mean visual analog scale pain score was 3.6 (range 0 to 8; SD 2.3) points, average American Orthopaedic Foot and Ankle Society hindfoot score was 70.8 (range 33 to 100; SD 17.1) points, and the mean short-form 36 score was 60.98 (range 22.9 to 93.0; SD 18.4) points. The mean postoperative Böhler's angle was 28.9° (range 8° to 38°; SD 7.1°), which decreased to 23.6° (range 4

  13. Internal pressure changes of liquid filled shipping casks due to thermal environment

    International Nuclear Information System (INIS)

    Jackson, J.E.

    1978-01-01

    A discussion of the significance of internal pressure calculations in liquid filled shipping casks subjected to a high temperature thermal environment is presented. Some basic thermodynamic relationships are introduced and discussed as they apply to the two-phase mixture problem encountered with liquid filled casks. A model of the liquid filled cask is developed and the assumptions and limitations of the mathematical model are discussed. A relationship is derived which can be used to determine internal cask pressures as a function of initial thermodynamic loading conditions, initial fluid volume ratio and final mixture temperature. The results for water/air filled casks are presented graphically in a parametric form. The curves presented are particularly useful for preliminary design verification purposes. A qualitative discussion of the use of the results from an error analysis aspect is presented. Some pressure calculation problems frequently seen by NRC for liquid filled cask designs are discussed

  14. Internal friction due to domain-wall motion in martensitically transformed A15 compounds

    International Nuclear Information System (INIS)

    Snead, C.L. Jr.; Welch, D.O.

    1985-01-01

    A lattice instability in A15 materials in some cases leads to a cubic-to-tetragonal martensitic transformation at low temperatures. The transformed material orients in lamellae with c axes alternately aligned along the directions producing domain walls between the lamellae. An internal-friction (delta) feature below T/sub m/ is attributed to stress-induced domain-wall motion. The magnitude of the friction increases as temperature is lowered below T/sub m/ as (1-c/a) increases, and behaves as (1-c/a) 2 from T/sub m/ down to the superconducting critical temperature where the increasing tetragonality is inhibited. The effect of strain in the lattice is to decrease the domain-wall internal friction, but not affect T/sub m/. Neutron-induced disorder and the addition of some third-elements in alloying decrease both delta and T/sub m/, with some elements reducing only the former. Less than 1 at. % H is seen to completely suppress both delta and T/sub m. Martensitically transformed V 2 Zr demonstrates low-temperature internal-friction and modulus behavior consists with easy β/m wall motion relative to the easy m/m motion of the A15's. For the V 2 Zr, a peak in delta is observed, qualitatively in agreement with expected β/m wall motion

  15. Pipeline's natural frequency response due to internal pressure effect

    Energy Technology Data Exchange (ETDEWEB)

    Massa, Andre L.L.; Guevara Junior, Nestor O. [Suporte - Consultoria e Projetos Ltda., Rio de Janeiro, RJ (Brazil); Galgoul, Nelson S. [Universidade Federal Fluminense (UFF), Niteroi, RJ (Brazil); Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ (Brazil); Fernandes, Antonio C.; Coelho, Fabio M. [Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ (Brazil). Coordenacao de Programas de Pos-graduacao de Engenharia

    2009-12-19

    A few years ago, a discussion about how internal pressure is treated in submarine pipelines has taken place. Galgoul et al (2004) have pointed out the conservatism of the latest recommendations for pipeline free-span evaluations associated to the way the axial force is considered in the determination of the pipeline natural frequency. Fyrileiv and Collberg (2005) have also discussed this point in defense of the effective axial force concept and its use in the natural frequency determination. In order to contribute to this aspect, an experimental test has been performed with a fully embedded pipeline which was pressurized. The main object consists in showing that the pipe is under tension (and not under compression) and, as a consequence, it is the authors' intention to prove that the natural frequency increases instead of reducing when the internal pressure is incremented. In addition to the test, a finite element model has been presented where this internal pressure effect is taken into account as it actually is (and not as an axial force) in order to show the real behavior of the wall stresses. Static analyses, as well as modal and transient analysis have been performed in order to compare theoretical results with the experimental test conducted. (author)

  16. Internal friction due to domain-wall motion in martensitically transformed A15 compounds

    Energy Technology Data Exchange (ETDEWEB)

    Snead, C.L. Jr.; Welch, D.O.

    1985-01-01

    A lattice instability in A15 materials in some cases leads to a cubic-to-tetragonal martensitic transformation at low temperatures. The transformed material orients in lamellae with c axes alternately aligned along the <100> directions producing domain walls between the lamellae. An internal-friction (delta) feature below T/sub m/ is attributed to stress-induced domain-wall motion. The magnitude of the friction increases as temperature is lowered below T/sub m/ as (1-c/a) increases, and behaves as (1-c/a)/sup 2/ from T/sub m/ down to the superconducting critical temperature where the increasing tetragonality is inhibited. The effect of strain in the lattice is to decrease the domain-wall internal friction, but not affect T/sub m/. Neutron-induced disorder and the addition of some third-elements in alloying decrease both delta and T/sub m/, with some elements reducing only the former. Less than 1 at. % H is seen to completely suppress both delta and T/sub m. Martensitically transformed V/sub 2/Zr demonstrates low-temperature internal-friction and modulus behavior consists with easy ..beta../m wall motion relative to the easy m/m motion of the A15's. For the V/sub 2/Zr, a peak in delta is observed, qualitatively in agreement with expected ..beta../m wall motion.

  17. Ratios between effective doses for tomographic and mathematician models due to internal exposure of photons

    International Nuclear Information System (INIS)

    Lima, F.R.A.; Kramer, R.; Khoury, H.J.; Santos, A.M.; Loureiro, E.C.M.

    2005-01-01

    The development of new and sophisticated Monte Carlo codes and tomographic human phantoms or voxels motivated the International Commission on Radiological Protection (ICRP) to revise the traditional models of exposure, which have been used to calculate effective dose coefficients for organs and tissues based on mathematician phantoms known as MIRD5. This paper shows the results of calculations using tomographic phantoms MAX (Male Adult voXel) and FAX (Female Adult voXel), recently developed by the authors as well as with the phantoms ADAM and EVA, of specific genres, type MIRD5, coupled to the EGS4 Monte Carlo and MCNP4C codes, for internal exposure with photons of energies between 10 keV and 4 MeV to several organs sources. Effective Doses for both models, tomographic and mathematician, will be compared separately as a function of the Monte Carlo code replacement, of compositions of human tissues and the anatomy reproduced through tomographs. The results indicate that for photon internal exposure, the use of models of exposure based in voxel, increases the values of effective doses up to 70% for some organs sources considered in this study, when compared with the corresponding results obtained with phantoms of MIRD-5 type

  18. Sutureless Intrascleral Fixated Intraocular Lens Implantation.

    Science.gov (United States)

    Karadag, Remzi; Celik, Haci Ugur; Bayramlar, Huseyin; Rapuano, Christopher J

    2016-08-01

    To review sutureless intrascleral intraocular lens (IOL) fixation methods. Review of published literature. Sutureless intrascleral IOL fixation methods are newer and have been developed to eliminate the suture-related complications of sutured scleral fixation methods such as suture-induced inflammation or infection and IOL dislocation or subluxation due to suture degradation or suture breakage. Sutureless intrascleral fixation methods aim for intrascleral haptic fixation to achieve stability of the IOL. Various methods of sutureless scleral fixation have been described. Using a needle, a blade, or a trochar, sclerostomies are created in all techniques for intraocular access. Some surgeons prefer to create scleral tunnels, whereas others use scleral flaps for scleral fixation of haptics. The stability of IOLs is attained by the scar tissue formed around the haptics. Short-term results of these new methods are acceptable; studies including more cases with longer follow-up are needed to determine their long-term success. [J Cataract Refract Surg. 2016;32(9):586-597.]. Copyright 2016, SLACK Incorporated.

  19. Guide to radiation fixatives

    International Nuclear Information System (INIS)

    Tawil, J.J.; Bold, F.C.

    1983-11-01

    This report identifies and then characterizes a variety of substances available in the market place for potential effectiveness as a fixative on radiologically contaminated surfaces. The substances include both generic chemicals and proprietary products. In selecting a fixative for a particular application, several attributes of the fixative may be relevant to the choice. These attributes include: toxicity, durability, and cleanliness and removability. In addition to the attributes of the fixative, one should also take into account certain characteristics of the site to be treated. These characteristics relate to climate, nature of the surface, use to which the treated surface will be put, subsequent cleanup operations, and type of neighboring surfaces. Finally, costs and potential environmental effects may influence the decision. A variety of fixatives are evaluated with respect to these various attributes and summarized in a reference table

  20. Guide to radiation fixatives

    Energy Technology Data Exchange (ETDEWEB)

    Tawil, J.J.; Bold, F.C.

    1983-11-01

    This report identifies and then characterizes a variety of substances available in the market place for potential effectiveness as a fixative on radiologically contaminated surfaces. The substances include both generic chemicals and proprietary products. In selecting a fixative for a particular application, several attributes of the fixative may be relevant to the choice. These attributes include: toxicity, durability, and cleanliness and removability. In addition to the attributes of the fixative, one should also take into account certain characteristics of the site to be treated. These characteristics relate to climate, nature of the surface, use to which the treated surface will be put, subsequent cleanup operations, and type of neighboring surfaces. Finally, costs and potential environmental effects may influence the decision. A variety of fixatives are evaluated with respect to these various attributes and summarized in a reference table.

  1. Synchronization of two Hodgkin-Huxley neurons due to internal noise

    International Nuclear Information System (INIS)

    Casado, Jose Manuel

    2003-01-01

    It is well known that a strong coupling can synchronize a population of nonlinear oscillators. This fact has deep implications for the current understanding of information processing by the brain. The focus of this Letter is on the role of conductance noise on a system of two coupled Hodgkin-Huxley neurons in the so-called excitable region, where both neurons are at rest in the absence of noise. It is shown that, in this region, conductance noise allows the neurons to achieve both frequency and phase synchronization. This suggests that internal noise could play a role in the emergence of synchronous neural activity in populations of weakly coupled neurons

  2. Linked linear mixed models: A joint analysis of fixation locations and fixation durations in natural reading.

    Science.gov (United States)

    Hohenstein, Sven; Matuschek, Hannes; Kliegl, Reinhold

    2017-06-01

    The complexity of eye-movement control during reading allows measurement of many dependent variables, the most prominent ones being fixation durations and their locations in words. In current practice, either variable may serve as dependent variable or covariate for the other in linear mixed models (LMMs) featuring also psycholinguistic covariates of word recognition and sentence comprehension. Rather than analyzing fixation location and duration with separate LMMs, we propose linking the two according to their sequential dependency. Specifically, we include predicted fixation location (estimated in the first LMM from psycholinguistic covariates) and its associated residual fixation location as covariates in the second, fixation-duration LMM. This linked LMM affords a distinction between direct and indirect effects (mediated through fixation location) of psycholinguistic covariates on fixation durations. Results confirm the robustness of distributed processing in the perceptual span. They also offer a resolution of the paradox of the inverted optimal viewing position (IOVP) effect (i.e., longer fixation durations in the center than at the beginning and end of words) although the opposite (i.e., an OVP effect) is predicted from default assumptions of psycholinguistic processing efficiency: The IOVP effect in fixation durations is due to the residual fixation-location covariate, presumably driven primarily by saccadic error, and the OVP effect (at least the left part of it) is uncovered with the predicted fixation-location covariate, capturing the indirect effects of psycholinguistic covariates. We expect that linked LMMs will be useful for the analysis of other dynamically related multiple outcomes, a conundrum of most psychonomic research.

  3. Development of methodologies for internal exposure assessment due to the radiopharmaceutical 18FDG

    International Nuclear Information System (INIS)

    Lacerda, Isabelle Viviane Batista de

    2013-01-01

    The production of 18 F has increased in the last decade. It is produced basically for the synthesis of 18 F- fluorodeoxyglucose ( 18 FDG), the main radiopharmaceutical used in PET (Positron Emission Tomography) scans. The growth in the frequency of these tests resulted in rise of the number of occupationally exposed individuals (OEI) to the radionuclide 18 F as 18 FDG, increasing thereby the probability of its accidental incorporation. This study aimed to implement optimized techniques for assessing internal exposures of individuals occupationally exposed through both in vivo and in vitro bioassay methods during production and handling of 18 FDG at the Divisao de Producao de Radiofarmacos (DIPRA), Centro Regional de Ciencias Nucleares do Nordeste (CRCN-NE/CNEN). The in vivo monitoring was conducted at the Laboratorio de Dosimetria Interna, Divisao de Laboratorios Tecnico-Cientificos (DILAB). For this bioassay method, measurements were done with a 3x3' NaI(Tl) scintillation detector coupled to Genie 2000 software. The calibration of the system was performed with a brain phantom containing a standard liquid source of 22 Na to simulate a contaminated individual. The calibration of the HPGe coaxial detector for in vitro monitoring was performed at the Laboratorio de Medidas de Atividade de Radionuclideos (DIPRA/CRCN-NE/CNEN) with a standard source of 22 Na. Base on the calibration factors, it was possible to determine the minimum detectable activities (MDA) for the systems by using direct measurements and simulation of uncontaminated urine. Then, through the biokinetic models published by ICRP 106 and edited by the AIDE software (version 6.0), it was possible to estimate the minimum detectable effective dose (MDED), which evaluates the detection sensitivity of the techniques developed. The MDED was estimated for in vivo and in vitro measurements performed 2.4 hours after the occurrence of incorporation by ingestion, since this is the period of higher retention fraction

  4. Oscillation of a rigid catenary riser due to the internal two-phase flow

    Energy Technology Data Exchange (ETDEWEB)

    Bordalo, Sergio N.; Morooka, Celso K.; Cavalcante, Cesar C.P. [Universidade Estadual de Campinas (UNICAMP), SP (Brazil); Matt, Cyntia G.C.; Franciss, Ricardo [PETROBRAS, Rio de Janeiro, RJ (Brazil). Centro de Pesquisas

    2008-07-01

    Production of petroleum reservoirs from deep and ultra-deep waters is of paramount importance in Brazil, and several researches are necessary to develop appropriated equipment and risers for those operational conditions. Risers are suspended pipes used to transport the petroleum fluids between the seabed and the floating production unit. The structural flexibility of riser's lines is conferred by its length when compared with the diameter, characterizing it as a slender body. The risers are submitted to large static and dynamic loads originated from its own weight, waves, currents, platform motions and the internal flow. These loadings may threaten, by fatigue, the structural integrity of the system, compromising its useful life, and so they must be considered in the riser's project. There is a large amount of knowledge in the literature about the effects of external loadings on these systems, but the effect of the internal flow remains vastly unexplored. The variation of the flow mass and momentum inside the riser causes a dynamic loading on this system, originating an oscillatory motion. Furthermore, the gas-liquid two-phase flow may assume several flow patterns (bubble, slug, intermittent or annular), each one possessing completely different characteristics. In this work, the influence of the internal flow on the oscillatory motion (whipping motion) of catenary risers is analyzed. To provide a better understanding of this physical phenomenon, a scaled apparatus was designed and built. The material used to manufacture the riser's model was a flexible silicone tube, and air and water were used to simulate the two-phase flow. The instrumentation used to measure the fluids flow rates and the sustaining force at the top of the model was installed in the apparatus. A video acquisition system was used to determine the displacements, and frequency spectrum, of color targets positioned throughout the model, under several flow conditions. The flow patterns

  5. Pars plana vitrectomy for retinal detachment due to internal posterior ophthalmomyiasis after cataract extraction.

    Science.gov (United States)

    Billi, B; Lesnoni, G; Audisio, P; Giuliano, M A; Rossi, T; Costi, E; Stirpe, M

    1997-04-01

    The authors report a case of posterior internal ophthalmomyiasis causing vitreous haemorrhage and retinal detachment after uncomplicated cataract extraction. The patient suffered an abrupt vitreous haemorrhage 9 days after ECCE and posterior chamber IOL implantation. After 2 months the haemorrhage did not clear up and a retinal detachment arose. The patient underwent encircling scleral buckle, pars plana vitrectomy and fluid-gas exchange. In course of intervention the surgeon removed from the vitreous chamber a 14-mm-long round worm subsequently identified as a dipterous larva of the Sarcophagidae family. The patient showed no sign of subretinal tracking or retinal breaks or holes. The sclerocorneal surgical wound seems the most likely site of entrance of the parasite, and this would then be the first reported case of myiasis with no RPE tracking.

  6. Open reduction and internal fixation versus casting for highly comminuted and intra-articular fractures of the distal radius (ORCHID: protocol for a randomized clinical multi-center trial

    Directory of Open Access Journals (Sweden)

    Seiler Christoph

    2011-03-01

    Full Text Available Abstract Background Fractures of the distal radius represent the most common fracture in elderly patients, and often indicate the onset of symptomatic osteoporosis. A variety of treatment options is available, including closed reduction and plaster casting, K-wire-stabilization, external fixation and open reduction and internal fixation (ORIF with volar locked plating. The latter is widely promoted by clinicians and hardware manufacturers. Closed reduction and cast stabilization for six weeks is a simple, convenient, and ubiquitously available intervention. In contrast, ORIF requires hospitalization, but allows for functional rehabilitation. Given the lack of randomized controlled trials, it remains unclear whether ORIF leads to better functional outcomes one year after injury than closed reduction and casting. Methods/Design ORCHID (Open reduction and internal fixation versus casting for highly comminuted intra-articular fractures of the distal radius is a pragmatic, randomized, multi-center, clinical trial with two parallel treatment arms. It is planned to include 504 patients in 15 participating centers throughout Germany over a three-year period. Patients are allocated by a central web-based randomization tool. The primary objective is to determine differences in the Short Form 36 (SF-36 Physical Component Score (PCS between volar locked plating and closed reduction and casting of intraarticular, comminuted distal radius fractures in patients > 65 years of age one year after the fracture. Secondary outcomes include differences in other SF-36 dimensions, the EuroQol-5D questionnaire, the Disability of the Arm, Shoulder, and Hand (DASH instrument. Also, the range of motion in the affected wrist, activities of daily living, complications (including secondary ORIF and revision surgery, as well as serious adverse events will be assessed. Data obtained during the trial will be used for later health-economic evaluations. The trial architecture

  7. External fixation of the pelvic ring: an experimental study on the role of pin diameter, pin position, and parasymphyseal fixator pins

    NARCIS (Netherlands)

    Ponsen, Kees-Jan; Joosse, Pieter; Hoek van Dijke, Gilbert A.; Snijders, Chris J.

    2007-01-01

    BACKGROUND: The mechanical properties of current external fixator systems for unstable (type C) pelvic ring fractures are inferior to internal fixation, and are not optimal for definitive treatment. We explored methods to increase stability of external fixator constructs. METHODS: An experimental

  8. Constituents' formal participation in the due process of international accounting standard setting: A longitudinal analysis of stakeholder and geographical diversity

    OpenAIRE

    Jorissen, Ann; Lybaert, Nadine; Orens, Raf; Van der Tas, Leo

    2011-01-01

    Since IOSCO’s decision (May, 2000) to accept IASs for cross-border listing and since governments started to hand over accounting standard setting authority to the International Accounting Standards Board (IASB) (EU Regulation EC N° 1606/2002, Australia FRC July 2002), the IASB is well under way to become the global accounting standard setter. For the IASB, being a private organization, widespread constituents’ participation in its due process of standard setting is a key element to reinforce...

  9. Biomechanical study of posterior wall acetabular fracture fixation using acetabular tridimensional memory alloy-fixation system.

    Science.gov (United States)

    Xin-wei, Liu; Shuo-gui, Xu; Chun-cai, Zhang; Qing-ge, Fu; Pan-feng, Wang

    2010-05-01

    We developed the acetabular tridimensional memory alloy-fixation system (ATMFS), which is made of NiTi shape memory alloy, according to the specific mechanical properties of biological memory material, nitinol alloy and measured distribution of contact area and pressure between the acetabulum and the femoral head of cadaveric pelvis. Six formalin-preserved cadaveric pelvis were used for this investigation. Pressure-sensitive film was used to measure contact area and pressure within the anterior, superior, and posterior regions of the acetabulum. The pelvis were loaded under the following four conditions: (1) intact; (2) following a creation posterior wall fracture defect; (3) following reduction and standard internal fixation with reconstruction plate; (4) following reduction and internal fixation with a new shape memory alloy device named ATMFS. A posterior wall fracture was created along an arc of 40-90 degrees about the acetabular rim. Creation of a posterior wall defect resulted in increased load in the superior acetabulum (1422N) as compared to the intact condition (762N, P=0.007). Following reduction and internal fixation, the load distributed to the superior acetabulum (1486N) was not statistically different from the defect condition. Following the fixation with ATMFS, the load seen at the superior region of the actabulum (936N) was less than fixation with reconstruction plate and was not different from intact state (P=0.4). These data indicate that the use of ATMFS as a fracture internal fixation device resulted a partial restoration of joint loading parameters toward the intact state. ATMFS fixation may result in a clinical benefit. Copyright 2010 Elsevier Ltd. All rights reserved.

  10. Estimating the Need for Medical Intervention due to Sleep Disruption on the International Space Station

    Science.gov (United States)

    Myers, Jerry G.; Lewandowski, Beth E.; Brooker, John E.; Hurst, S. R.; Mallis, Melissa M.; Caldwell, J. Lynn

    2008-01-01

    During ISS and shuttle missions, difficulties with sleep affect more than half of all US crews. Mitigation strategies to help astronauts cope with the challenges of disrupted sleep patterns can negatively impact both mission planning and vehicle design. The methods for addressing known detrimental impacts for some mission scenarios may have a substantial impact on vehicle specific consumable mass or volume or on the mission timeline. As part of the Integrated Medical Model (IMM) task, NASA Glenn Research Center is leading the development of a Monte Carlo based forecasting tool designed to determine the consumables required to address risks related to sleep disruption. The model currently focuses on the International Space Station and uses an algorithm that assembles representative mission schedules and feeds this into a well validated model that predicts relative levels of performance, and need for sleep (SAFTE Model, IBR Inc). Correlation of the resulting output to self-diagnosed needs for hypnotics, stimulants, and other pharmaceutical countermeasures, allows prediction of pharmaceutical use and the uncertainty of the specified prediction. This paper outlines a conceptual model for determining a rate of pharmaceutical utilization that can be used in the IMM model for comparison and optimization of mitigation methods with respect to all other significant medical needs and interventions.

  11. Asynchronous partial contact motion due to internal resonance in multiple degree-of-freedom rotordynamics.

    Science.gov (United States)

    Shaw, A D; Champneys, A R; Friswell, M I

    2016-08-01

    Sudden onset of violent chattering or whirling rotor-stator contact motion in rotational machines can cause significant damage in many industrial applications. It is shown that internal resonance can lead to the onset of bouncing-type partial contact motion away from primary resonances. These partial contact limit cycles can involve any two modes of an arbitrarily high degree-of-freedom system, and can be seen as an extension of a synchronization condition previously reported for a single disc system. The synchronization formula predicts multiple drivespeeds, corresponding to different forms of mode-locked bouncing orbits. These results are backed up by a brute-force bifurcation analysis which reveals numerical existence of the corresponding family of bouncing orbits at supercritical drivespeeds, provided the damping is sufficiently low. The numerics reveal many overlapping families of solutions, which leads to significant multi-stability of the response at given drive speeds. Further, secondary bifurcations can also occur within each family, altering the nature of the response and ultimately leading to chaos. It is illustrated how stiffness and damping of the stator have a large effect on the number and nature of the partial contact solutions, illustrating the extreme sensitivity that would be observed in practice.

  12. Determination of internal radiation dose due to intake of polonium 210 and lead 210 via smoking

    International Nuclear Information System (INIS)

    Al-Masri, M. S.; Kharita, M.H.; Nashawati, A.; Amin, Y.; Al-Akel, B.

    2004-12-01

    In this study, 18 kind of cigarettes and five kinds of molasses consumed by Syrians were collected and analyzed for radioactivity in order to estimate the internal radiation dose caused by 210 Po and 210 Pb intake. Polonium 210 and lead 210 concentrations varied between 4 and 16.4 m Bq/cigarette, while 210 Po distribution ratios in different parts of consumed cigarette were %12, %73, %1.6 in ash, smoke and filter, respectively. In addition, annual intake of 210 Po by a main smoker was varied between 4.4 and 18 Bq/year assuming that the main smoker breathes about 15% of the total 210 Po present in tobacco. Using the values of the annual intake, annual equivalent radiation dose caused by smoking has reached 178 μSv/year. Moreover, mean concentration of 210 Po in nonsmokers and smokers bloods has reached 130 and 97 mBq/l, respectively, while the mean value of 210 Po concentration was relatively higher and reached 176 and 155 mBq/l in smokers and non smoker bloods, respectively (Authors)

  13. [Ilizarov fixation of supramalleolar fractures].

    Science.gov (United States)

    Mseddi, M B E; Mseddi, M; Siala, A; Dahmene, J; Ben Hamida, R; Ben Ayeche, M

    2005-02-01

    Supramalleolar fractures are generally considered to be a difficult surgical challenge because they occur in a area where the tibia lies superficially with a precarious blood supply to the skin, exposing to the risk of infection and necrosis after internal fixation. These fractures are also situated close to the tibiotalar joint making centromedullary nailing difficult, even with distal locking. The Ilizarov external fixator could be an attractive alternative in this indication. We report a series of 17 supramalleolar fractures in 17 patients, 14 men and 3 women, treated with the Ilizarov external fixator between 1991 and 2001. Most were traffic accident victims and most had complex fractures resulting from high-energy trauma. There were many associated lesions. Fractures were open in ten patients. The Ilizarov fixator was used as the first intention treatment in seven patients and as a second line treatment in ten. The system allowed early weight bearing in all patients. Tolerance was generally good with a relatively low rate of superficial pin track infections (two cases). There was one case of osteitis which developed in a patient with an open fracture. There were no thromboembolic complications and no nerve involvement. Bone healing was achieved within three months in thirteen patients. There were three cases of late healing which were treated by the ascension technique using a cancellous graft and fibular osteotomy. The overall healing rate with this method was 94%. The one case of nonunion was successfully treated with an inter tibiofibular graft. The overall functional outcome was satisfactory in 76% of the patients, based on the Alho-Klemm criteria. Axial deformation predominated in the frontal plane: three patients had > 10 degrees varus in one case. These results could be improved by better operative technique. We advocate installing the patient in the supine position with transcalcaneal traction allowing good restitution of the leg axis. The assembly

  14. Fixação interna de fragmento osteocondral originado de osteocondrite dissecante do joelho Internal fixation of osteochondral fragment originated fro dissecting knee osteochondritis

    Directory of Open Access Journals (Sweden)

    Carlos Eduardo Sanches Vaz

    2008-01-01

    Full Text Available O tratamento da osteocondrite dissecante do joelho com lesão tipo cratera associada a corpo livre intra-articular pode ser realizado pela fixação do fragmento osteocondral no seu local de origem. No entanto, existem controvérsias quanto à indicação e eficácia deste procedimento, principalmente quando o corpo livre está solto por tempo prolongado, já que existem relatos na literatura demonstrando deterioração do revestimento condral do mesmo diretamente relacionado com o intervalo decorrente de sua soltura. Relatamos um caso em que, apesar do fragmento osteocondral estar livre na articulação por aproximadamente cinco semanas, a sua fixação não trouxe complicações e resultou em cicatrização completa da lesão. Nós concluímos que, principalmente nos casos onde a lesão osteocondral no côndilo femoral envolve a superfície de carga, quando então o descarte do fragmento geralmente resultaria em mau prognóstico, as possíveis complicações da fixação tardia são compensadas pelos benefícios obtidos pela redução do fragmento osteocondral no local de origem, resultando na recuperação da congruência articular e possivelmente evitando um processo degenerativo articular precoce.The treatment of dissecting knee osteochondritis with crater-like lesion associated to intra-articular loose body can be provided by fixating the osteochondral fragment on its original site. However, there is some concern about the efficacy of this approach, since some reports have shown that the cartilage layer in osteochondral loose bodies that have been detached for a long time becomes deteriorated. We report a case where while the osteochondral loose body was detached for as long as five weeks, the fixation to the osteochondral defect was uneventful and resulted in a completely healed lesion. We concluded that, especially in cases in which the lesion involves a weight-bearing area of the knee with a detached osteochondral fragment, when the

  15. Reinforced fixation of distal fibula fractures in elderly patients; A meta-analysis of biomechanical studies.

    Science.gov (United States)

    Dingemans, Siem A; Lodeizen, Olivia A P; Goslings, J Carel; Schepers, Tim

    2016-07-01

    There is an increasing incidence of fragility fractures of the ankle in the elderly population. The open reduction and internal fixation of these fractures is challenging, due to reduced bone stock quality as a result of osteoporosis. Biomechanical studies have shown contradicting results using reinforced constructions in the fixation of fibular fractures. We therefore performed a meta-analysis of biomechanical studies on reinforced fixation of distal fibular fractures. A literature search was conducted utilizing three online databases considering biomechanical testing of different fixation techniques of distal fibular fractures. A meta-analysis was performed on two biomechanical outcome measures; torsional stiffness and torque to failure. In a total number of 13 studies 8 different reinforcement techniques were identified. Of these studies, six compared locked lateral plating with conventional lateral plating. There were no statistically significant differences between the locking and non-locking lateral plate for torque to failure or torsional stiffness. Locked plating strength was independent from bone mineral density in four studies. An antiglide plate proved to be biomechanically superior compared to a lateral plate in one study and to a locked plate in another. Locked lateral plates are not biomechanically superior to conventional lateral plates. However the strength of locked plating may be independent of bone mineral density and could make this technique more suitable in the fixation of severe osteoporotic fractures. Copyright © 2016 Elsevier Ltd. All rights reserved.

  16. CSF coccidioides complement fixation

    Science.gov (United States)

    Skip navigation U.S. National Library of Medicine The navigation menu has been collapsed. ... of this page: //medlineplus.gov/ency/article/003526.htm CSF coccidioides complement fixation test To use the sharing features ...

  17. Histoplasma complement fixation

    Science.gov (United States)

    Skip navigation U.S. National Library of Medicine The navigation menu has been collapsed. ... this page: //medlineplus.gov/ency/article/003527.htm Histoplasma complement fixation To use the sharing features on this page, ...

  18. Development of a Method to Assess the Radiation Dose due to Internal Exposure to Short-lived Radioactive Materials

    International Nuclear Information System (INIS)

    Benmaman, D.; Koch, J.; Ribak, J.

    2014-01-01

    Work with radioactive materials requires monitoring of the employees' exposure to ionizing radiation. Employees may be exposed to radiation from internal and/or external exposure. Control of external exposure is mostly conducted through personal radiation dosimeters provided to employees. Control of internal exposure can be performed by measuring the concentration of radioactive substances excreted in urine or through whole-body counting in which the entire body or target organs are scanned with a sensitive detector system (1). According to the regulations in Israel an employee that may be internally exposed must undergo an exposure control at least once every three months. The idea lying behind the control of internal exposure by urine testing is that if radioactive material has penetrated into the employee body, it can be detected even if the test is performed once every three months. A model was fitted for each element describing its dispersion in the body and its excretion therefrom (2). By means of this model, one can estimate the activity that entered the body and calculate the resulting radiation dose to which the worker was exposed. There is a problem to implement this method when it comes to short-lived radioactive materials, for which it is very likely that the material that penetrated into the body has decayed and cannot be detected by testing once every three months. As a result, workers with short-lived radioactive materials are presently not monitored for internal exposure, in contradiction to the requirements of the Safety at Work Regulations. The purpose of the study is to develop an alternative method to assess the amount of radioactive material absorbed in the body and the resulting radiation dose due to internal exposure of workers to short-lived radioactive materials

  19. Analysis and an overview of fixators in medicine and the methods of processing materials for producing fixators

    Directory of Open Access Journals (Sweden)

    Dalibor Milojko Đenadić

    2013-06-01

    Full Text Available The fixator is a medical device that provides support to fractured biological structures. Metal biomaterials are mainly used for replacing broken or damaged hard tissues such as bones because of their high strenght, toughness and corrosion resistance. Materials such as stainless steel, titanium and aluminium alloys (Ti-6Al-4V, cobalt and chromium alloys, composite materials and other biocompatible materials are used in orthopedy for the stabilization of connective tissue injuries or as a substitute for the bone tissues. Fixators are classified according to the place of installation to external and internal fixators. Widely used medical fixators are pins, rods plates, screws, pipes, wires, nails and external fixators. Conventional and non-conventional methods of processing are used in the production process for all types of fixators. Introduction Fixators are medical devices manufactured to support damaged biological structures. In the field of orthopedic surgery that deals with skeletal disorders such as bone, spine, joints, muscles and tendons injuries and diseases, various metals, titanium and cobalt alloys etc. are used to stabilize the supporting tissue injuries or as a substitute for bone tissues. Metallic implants are frequently used in orthopedic surgery as joint prosthesis (hip, knee and elbow fracture fixation devices (plates, screws, external fixators and devices for the fixation of the spine. In principle, fixators are devided into external and internal ones, depending on the place of installation (outside or inside the body. The most common types of medical fixators are pins, rods and plates. This paper presents some of the most common materials used for the production of fixators, their processing and possibilties of use in medicine for various purposes. Types of fixators and materials used for their production Nowadays, biocompatible materials are usually used for the production of fixators and implants. These materials show good

  20. SIGN HIP CONSTRUCT: ACHIEVING HIP FRACTURE FIXATION ...

    African Journals Online (AJOL)

    elderly has made stable reduction and internal fixation the preferred treatment. .... anaemia, 1 had concomitant spine injury, and another had widespread ... infection (1.5%) and 8 cases of varus collapse (11.8%). (Table 4). Table 3. Stable versus unstable fracture and mechanism of injury. Type of fracture. MTA. No. (%). Fall.

  1. Unstable fragility fractures of the ankle in the elderly; Transarticular Steinmann pin or external fixation

    NARCIS (Netherlands)

    Meijer, R. P. J.; Halm, J. A.; Schepers, T.

    2017-01-01

    Because of poor skin conditions and comorbidity, open reduction and internal fixation in ankle fractures is frequently contra-indicated in the elderly. This study reports the results of two temporary fixation types in fragility fractures in the older patient: transarticular Steinmann pin fixation

  2. Application of a shape-memory alloy internal fixator for treatment of acetabular fractures with a follow-up of two to nine years in China

    Science.gov (United States)

    Liu, Xinwei; Xu, Shuogui; Su, Jiacan; Yu, Baoqing

    2009-01-01

    Displaced acetabular fractures should be treated surgically. Over the past decade, surgical approaches to the acetabulum and the surgical technique for repair of common fracture patterns have advanced. Excellent outcomes after repair of these injuries can be achieved. The aim of this study was to assess the medium-term results of reconstruction of acetabular fractures by using shape-memory alloy designed by the authors. This is a retrospective review conducted at a level 1 trauma centre. From October 1999 to July 2009, 19 patients with acetabular fractures were treated with our patented Ni-Ti shape-memory alloy acetabular tridimensional memory alloy-fixation system (ATMFS). The ATMFS device was cooled with ice before implantation and then warmed to 40–50°C after implantation to produce balanced axial and compression forces that would stabilise the fracture three dimensionally. Our results are as follows; according to the D’Aubigne−Postel scoring system: Fifteen cases out of 19 (79%) achieved excellent or good clinical results. In two patients, late complications included avascular necrosis of the femoral head (ANFH) associated with posterior dislocation of the hip joint two years after the operation. We also observed two cases of grade II or III ectopic ossification, with good hip function, and one case of traumatic arthritis. In conclusion, these results demonstrate the effectiveness of the ATMFS device for the management of acetabular fracture. The device provides continuous compression of the fracture with minimal disruption to the local blood supply. PMID:20012433

  3. Percutaneous pin fixation of Gartland Type III supraconylar fractures ...

    African Journals Online (AJOL)

    The remaining three (7.5%) had poor results due to varus deformity that neededcorrective surgery. One case of pin tract infection was recorded. The average hospital stay was 1.2 days. The study confirmed that percutaneous pin fixation is an effective, minimally invasive and safe method of fixation of these difficult fractures ...

  4. Il problema dei debiti internazionali nel periodo tra le due guerre mondiali. (The international debt problem in the interwar period

    Directory of Open Access Journals (Sweden)

    M. DE CECCO

    2013-12-01

    Full Text Available Grande attenzione è stata recentemente dedicata al problema attuale del debito del terzo mondo e le sue implicazioni per il sistema bancario internazionale . Una rassegna di eventi simili a volte precedenti in passato dimostra che gli operatori dei mercati finanziari internazionali hanno la memoria corta , poiché la maggior parte degli aspetti della crisi si sono verificati in passato. Questo è confermato dal considerare il problema del debito internazionale tra la prima e la seconda guerra mondiale . La principale differenza tra allora e adesso è che il periodo tra le due guerre fu un periodo di transizione da un sistema di commercio dominato daòòa sterlina ad uno dominato  dal dollaro statunitense . Molti dei problemi di oggi derivano da questa continua dominazione dollaroConsiderable attention has recently been paid to the current problem of third world debt and its implications for the international banking system. A review of similar events at previous times in the past shows that operators in international financial markets have very short memories, since most of the aspects of the current crisis have occurred in the past. This is borne out by considering the international debt problem between the first and second world wars. The major difference between then and now is that the interwar period was a time of transition from a sterling-dominated trading system to one dominated by the US dollar. Many of today's problems stem from this continuing dollar domination.JEL: N24

  5. Pure dysarthria and dysarthria-facial paresis syndrome due to internal capsule and/or corona radiata infarction.

    Science.gov (United States)

    Tanaka, Koji; Yamada, Takeshi; Torii, Takako; Yoshimura, Takeo; Takase, Kei-ichiro; Togao, Osamu; Wakata, Yoshifumi; Hiwatashi, Akio; Nakashima, Naoki; Kira, Jun-ichi; Murai, Hiroyuki

    2015-10-07

    Pure dysarthria (PD) and dysarthria-facial paresis syndrome (DFP) mainly result from lenticulostriate artery territory infarction. PD and DFP are rare clinical entities, often grouped without distinction. The purpose of this study was to examine clinical and radiographic differences between PD and DFP due to unilateral internal capsule and/or corona radiata infarction. Using a database that included consecutive patients with ischemic stroke admitted to the neurological stroke units of three hospitals within 7 days from onset between September 2011 and April 2014, we retrospectively extracted first-ever stroke patient data, who presented with PD or DFP with a single ischemic lesion localized in the internal capsule and/or corona radiata. Patients with weakness, ataxia, sensory deficit, or cortical symptoms were excluded. Ischemic lesion volume was calculated by the ABC/2 method on diffusion-weighted imaging (DWI). DWI images were normalized and superimposed to the template for PD and DFP. We compared patients' characteristics between PD and DFP. A total of 2126 patients, including 65 patients (3.1%) with PD or DFP, were registered. Of these, 13 PD patients and 18 patients with DFP due to unilateral internal capsule and/or corona radiata infarction were included for analysis. Compared with DFP patients, PD patients had longer onset-to-door time (median 37.5 vs. 10.8 h, p = 0.031), shorter vertical length (C component) of ischemic lesions (median 12.0 vs. 18.8 mm, p = 0.007), and smaller ischemic lesion volume (median 285 vs. 828 mm(3), p = 0.023). Ischemic lesions causing PD were located more frequently in the left hemisphere than DFP (92% vs. 56%, p = 0.045). The superimposed lesion pattern indicated that DFP had lesions more medial and involving posterior portions of the putamen and the caudate body, as well as more of the genu and posterior limb of the internal capsule, than PD. Ninety days after onset, symptoms disappeared in 21 (72%) out of 29 patients. In

  6. Temporising external fixation of calcaneus fractures prior to definitive plate fixation: a case series.

    Science.gov (United States)

    Farrell, Brian M; Lin, Carol A; Moon, Charles N

    2015-09-01

    Surgical management of calcaneus fractures is technically demanding and has a high risk of wound complications. These fractures are traditionally managed with splinting until swelling has subsided, which can take weeks and leaves the fracture fragments displaced. We describe a novel protocol for the management of displaced intraarticular calcaneus fractures that utilises a temporising external fixator and staged conversion to plate fixation through a sinus tarsi approach. The goal of this technique was to enable earlier treatment with open reduction and internal fixation, minimise the amount of manipulation required at the time of definitive fixation and reduce the wound complication rate seen with the traditional extensile approach. The records of patients with displaced calcaneus fractures from 2010-2014 were reviewed retrospectively. A total of nine patients with 10 calcaneus fractures were treated using this protocol. All patients underwent ankle-spanning medial external fixation within 48 hours after injury. Patients underwent conversion to open plate fixation through a sinus tarsi approach when skin turgor had returned to normal. Time to surgery, infection rate, wound complications, radiographic alignment, and time to radiographic union were recorded. The average Bohler's angle improved from 13.2 (range -2 to 34) degrees preoperatively to 34.3 (range 26 to 42) degrees postoperatively. The average time from external fixation to conversion to internal fixation was 4.8 (range 3 to 7) days. There were no immediate post-surgical complications. The average time to weight-bearing was 8.5 weeks. The average time to radiographic union was 9.5 (range 8 to 12) weeks. There were no infections or wound complications at the time of last follow-up. Early temporising external fixation for the acute management of displaced calcaneus fractures is a safe and effective method to reduce and stabilise the foot and may decrease the time to definitive fixation. There were no

  7. Improving carbon fixation pathways

    Energy Technology Data Exchange (ETDEWEB)

    Ducat, DC; Silver, PA

    2012-08-01

    A recent resurgence in basic and applied research on photosynthesis has been driven in part by recognition that fulfilling future food and energy requirements will necessitate improvements in crop carbon-fixation efficiencies. Photosynthesis in traditional terrestrial crops is being reexamined in light of molecular strategies employed by photosynthetic microbes to enhance the activity of the Calvin cycle. Synthetic biology is well-situated to provide original approaches for compartmentalizing and enhancing photosynthetic reactions in a species independent manner. Furthermore, the elucidation of alternative carbon-fixation routes distinct from the Calvin cycle raises possibilities that novel pathways and organisms can be utilized to fix atmospheric carbon dioxide into useful materials.

  8. Assessment of the influence of Laser phototherapy on the bone repair process of complete fractures in tibiae of rabbits stabilized with semi-rigid internal fixation treated with or without MTA graft: a histological study

    Science.gov (United States)

    Soares, Luiz G. P.; Silva, Aline C. P.; Silva, Anna Paula L. T.; Neves, Bruno Luiz R. C.; Santos, Nicole R. S.; dos Santos, Jean N.; Pinheiro, Antonio L. B.

    2016-03-01

    Beside biomaterials, Laser phototherapy has shown positive effects as auxiliary therapy in bone repair process, especially when involving large bone losses. The aim of this histological study was to evaluate, by light microscopy, the influence of laser phototherapy on the repair of complete tibial fractures in rabbits treated or not with semi-rigid internal fixation and Mineral Trioxide Aggregate - MTA graft. Twelve Rabbits were randomly divided into four groups with three animals each. After general anesthesia, complete fractures were created in one tibia with a carborundum disk. All animals (groups I-IV) had the fracture stabilized with semi-rigid fixation (wire osteosynthesis - WO). Group I was routinely fixed with WO; groups II and IV fracture was filled by blood clot and MTA implant. In Groups III and IV fracture was filled by blood clot and further irradiated with laser (λ780 nm, 70 mW, CW, Φ = 0.04 cm2, 20.4 J/cm2, per session, t = 300s, 142.8 J/cm2 per treatment). The phototherapy protocol was applied immediately after the surgery and repeated each 48 hours during 15 days. Animal death occurred on the 30th postoperative day. After removal of the specimens, the samples were routinely processed, stained with HE and evaluated by light microscopy. Histologically, the group treated with MTA graft and irradiated with laser showed the fracture filled by a more organized and mature trabecular bone, when compared with all other groups. From the results of the present study, it may be concluded that the association of Laser phototherapy + MTA graft in fractures treated with WO improved bone repair when compared with fractures treated only with WO.

  9. Abatement of Thermal Noise due to Internal Damping in 2D Oscillators with Rapidly Rotating Test Masses

    Science.gov (United States)

    Pegna, R.; Nobili, A. M.; Shao, M.; Turyshev, S. G.; Catastini, G.; Anselmi, A.; Spero, R.; Doravari, S.; Comandi, G. L.; de Michele, A.

    2011-11-01

    Mechanical oscillators can be sensitive to very small forces. Low frequency effects are up-converted to higher frequency by rotating the oscillator. We show that for 2-dimensional oscillators rotating at frequency much higher than the signal the thermal noise force due to internal losses and competing with it is abated as the square root of the rotation frequency. We also show that rotation at frequency much higher than the natural one is possible if the oscillator has 2 degrees of freedom, and describe how this property applies also to torsion balances. In addition, in the 2D oscillator the signal is up-converted above resonance without being attenuated as in the 1D case, thus relaxing requirements on the read out. This work indicates that proof masses weakly coupled in 2D and rapidly rotating can play a major role in very small force physics experiments.

  10. Fixation of displaced subcapital femoral fractures. Compression screw fixation versus double divergent pins.

    Science.gov (United States)

    Christie, J; Howie, C R; Armour, P C

    1988-03-01

    One hundred and twenty-seven consecutive patients with displaced subcapital fractures of the femoral neck (Garden Grade III or IV) all under 80 years of age and independently mobile, were randomly allocated to fixation with either double divergent pins or a single sliding screw-plate device. The incidence of non-union and infection in the sliding screw-plate group was significantly higher, and we believe that when internal fixation is considered appropriate multiple pinning should be used. Mobility after treatment was disappointing in about half of the patients, and we feel that internal fixation can only be justified in patients who are physiologically well preserved and who maintain a high level of activity.

  11. Update: Biological Nitrogen Fixation.

    Science.gov (United States)

    Wiseman, Alan; And Others

    1985-01-01

    Updates knowledge on nitrogen fixation, indicating that investigation of free-living nitrogen-fixing organisms is proving useful in understanding bacterial partners and is expected to lead to development of more effective symbioses. Specific areas considered include biochemistry/genetics, synthesis control, proteins and enzymes, symbiotic systems,…

  12. External transpedicular spine fixation in severe spondylodiscitis – salvage procedure

    Directory of Open Access Journals (Sweden)

    Spalteholz, Matthias

    2013-11-01

    Full Text Available Specific and non-specific infections of the spine are rare. Due to their potential for severe instabilities, deformities and the impairment of neurological structures, the treatment is often prolonged and needs an interdisciplinary management. The clinical presentation is uncharacteristic, therefore diagnosis is often delayed. There are no prospective randomized studies for therapy recommendation. The surgical concept includes eradication of the infection and the reliable stabilization of involved segments. This concept is successful in most cases of endogenous vertebral osteomyelitis. The therapy of the exogenous spine infections after macro and micro surgery is more difficult, due to the critical wound situation and the involvement of the posterior parts of the spine. In these cases, infection-associated instability of the anterior part is complicated by critical posterior wound conditions.We present three cases of severe exogenous vertebral infections, where temporary external transpedicular spine fixation was used for salvage procedure, till soft tissue conditions have permitted a definitive internal stabilization.

  13. Posterior transodontoid fixation: A new fixation (Kotil technique

    Directory of Open Access Journals (Sweden)

    Kadir Kotil

    2011-01-01

    Full Text Available Anterior odontoid screw fixation or posterior C1-2 fusion techniques are routinely used in the treatment of Type II odontoid fractures, but these techniques may be inadequate in some types of odontoid fractures. In this new technique (Kotil technique, through a posterior bilateral approach, transarticular screw fixation was performed at the non-dominant vertebral artery (VA side and posterior transodontoid fixation technique was performed at the dominant VA side. C1-2 complex fusion was aimed with unilateral transarticular fixation and odontoid fixation with posterior transodontoid screw fixation. Cervical spinal computed tomography (CT of a 40-year-old male patient involved in a motor vehicle accident revealed an anteriorly dislocated Type II oblique dens fracture, not reducible by closed traction. Before the operation, the patient was found to have a dominant right VA with Doppler ultrasound. He was operated through a posterior approach. At first, transarticular screw fixation was performed at the non-dominant (left side, and then fixation of the odontoid fracture was achieved by directing the contralateral screw (supplemental screw medially and toward the apex. Cancellous autograft was scattered for fusion without the need for structural bone graft or wiring. Postoperative cervical spinal CT of the patient revealed that stabilization was maintained with transarticular screw fixation and reduction and fixation of the odontoid process was achieved completely by posterior transodontoid screw fixation. The patient is at the sixth month of follow-up and complete fusion has developed. With this new surgical technique, C1-2 fusion is maintained with transarticular screw fixation and odontoid process is fixed by concomitant contralateral posterior transodontoid screw (supplemental screw fixation; thus, this technique both stabilizes the C1-2 complex and fixes the odontoid process and the corpus in atypical odontoid fractures, appearing as an

  14. Improving carbon fixation pathways.

    Science.gov (United States)

    Ducat, Daniel C; Silver, Pamela A

    2012-08-01

    A recent resurgence in basic and applied research on photosynthesis has been driven in part by recognition that fulfilling future food and energy requirements will necessitate improvements in crop carbon-fixation efficiencies. Photosynthesis in traditional terrestrial crops is being reexamined in light of molecular strategies employed by photosynthetic microbes to enhance the activity of the Calvin cycle. Synthetic biology is well-situated to provide original approaches for compartmentalizing and enhancing photosynthetic reactions in a species independent manner. Furthermore, the elucidation of alternative carbon-fixation routes distinct from the Calvin cycle raises possibilities that novel pathways and organisms can be utilized to fix atmospheric carbon dioxide into useful materials. Copyright © 2012 Elsevier Ltd. All rights reserved.

  15. Brow lift fixation.

    Science.gov (United States)

    Gold, Alan H; Bernard, Robert W; Hamas, Robert S; McKinney, Peter; Paul, Malcolm D

    2003-05-01

    One of the more difficult and controversial aspects of forehead and brow lift is fixation with control and stabilization of the result. Aesthetic Surgery Journal has invited Robert W. Bernard, MD; Robert S. Hamas, MD; Peter McKinney, MD; and Malcolm D. Paul, MD to share their preferred brow lift techniques. Here are their responses to questions posed by "Comparing Notes" editor, Alan H. Gold, MD. (Aesthetic Surg J 2003;23:217-219.).

  16. Improving Carbon Fixation Pathways

    OpenAIRE

    Ducat, Daniel C.; Silver, Pamela A.

    2012-01-01

    A recent resurgence in basic and applied research on photosynthesis has been driven in part by recognition that fulfilling future food and energy requirements will necessitate improvements in crop carbon-fixation efficiencies. Photosynthesis in traditional terrestrial crops is being reexamined in light of molecular strategies employed by photosynthetic microbes to enhance the activity of the Calvin cycle. Synthetic biology is well-situated to provide original approaches for compartmentalizing...

  17. CARBON DIOXIDE FIXATION.

    Energy Technology Data Exchange (ETDEWEB)

    FUJITA,E.

    2000-01-12

    Solar carbon dioxide fixation offers the possibility of a renewable source of chemicals and fuels in the future. Its realization rests on future advances in the efficiency of solar energy collection and development of suitable catalysts for CO{sub 2} conversion. Recent achievements in the efficiency of solar energy conversion and in catalysis suggest that this approach holds a great deal of promise for contributing to future needs for fuels and chemicals.

  18. Numerical Methods for the Analysis of Power Transformer Tank Deformation and Rupture Due to Internal Arcing Faults

    Science.gov (United States)

    Yan, Chenguang; Hao, Zhiguo; Zhang, Song; Zhang, Baohui; Zheng, Tao

    2015-01-01

    Power transformer rupture and fire resulting from an arcing fault inside the tank usually leads to significant security risks and serious economic loss. In order to reveal the essence of tank deformation or explosion, this paper presents a 3-D numerical computational tool to simulate the structural dynamic behavior due to overpressure inside transformer tank. To illustrate the effectiveness of the proposed method, a 17.3MJ and a 6.3MJ arcing fault were simulated on a real full-scale 360MVA/220kV oil-immersed transformer model, respectively. By employing the finite element method, the transformer internal overpressure distribution, wave propagation and von-Mises stress were solved. The numerical results indicate that the increase of pressure and mechanical stress distribution are non-uniform and the stress tends to concentrate on connecting parts of the tank as the fault time evolves. Given this feature, it becomes possible to reduce the risk of transformer tank rupture through limiting the fault energy and enhancing the mechanical strength of the local stress concentrative areas. The theoretical model and numerical simulation method proposed in this paper can be used as a substitute for risky and costly field tests in fault overpressure analysis and tank mitigation design of transformers. PMID:26230392

  19. Numerical Methods for the Analysis of Power Transformer Tank Deformation and Rupture Due to Internal Arcing Faults.

    Directory of Open Access Journals (Sweden)

    Chenguang Yan

    Full Text Available Power transformer rupture and fire resulting from an arcing fault inside the tank usually leads to significant security risks and serious economic loss. In order to reveal the essence of tank deformation or explosion, this paper presents a 3-D numerical computational tool to simulate the structural dynamic behavior due to overpressure inside transformer tank. To illustrate the effectiveness of the proposed method, a 17.3 MJ and a 6.3 MJ arcing fault were simulated on a real full-scale 360MVA/220kV oil-immersed transformer model, respectively. By employing the finite element method, the transformer internal overpressure distribution, wave propagation and von-Mises stress were solved. The numerical results indicate that the increase of pressure and mechanical stress distribution are non-uniform and the stress tends to concentrate on connecting parts of the tank as the fault time evolves. Given this feature, it becomes possible to reduce the risk of transformer tank rupture through limiting the fault energy and enhancing the mechanical strength of the local stress concentrative areas. The theoretical model and numerical simulation method proposed in this paper can be used as a substitute for risky and costly field tests in fault overpressure analysis and tank mitigation design of transformers.

  20. Numerical Methods for the Analysis of Power Transformer Tank Deformation and Rupture Due to Internal Arcing Faults.

    Science.gov (United States)

    Yan, Chenguang; Hao, Zhiguo; Zhang, Song; Zhang, Baohui; Zheng, Tao

    2015-01-01

    Power transformer rupture and fire resulting from an arcing fault inside the tank usually leads to significant security risks and serious economic loss. In order to reveal the essence of tank deformation or explosion, this paper presents a 3-D numerical computational tool to simulate the structural dynamic behavior due to overpressure inside transformer tank. To illustrate the effectiveness of the proposed method, a 17.3 MJ and a 6.3 MJ arcing fault were simulated on a real full-scale 360MVA/220kV oil-immersed transformer model, respectively. By employing the finite element method, the transformer internal overpressure distribution, wave propagation and von-Mises stress were solved. The numerical results indicate that the increase of pressure and mechanical stress distribution are non-uniform and the stress tends to concentrate on connecting parts of the tank as the fault time evolves. Given this feature, it becomes possible to reduce the risk of transformer tank rupture through limiting the fault energy and enhancing the mechanical strength of the local stress concentrative areas. The theoretical model and numerical simulation method proposed in this paper can be used as a substitute for risky and costly field tests in fault overpressure analysis and tank mitigation design of transformers.

  1. A comparative study in fixation methods of medial malleolus fractures between tension bands wiring and screw fixation.

    Science.gov (United States)

    Mohammed, Ayyoub A; Abbas, Khalid Ahmed; Mawlood, Ammar Salah

    2016-01-01

    The aim of this study is to compare two methods of internal fixations of fractured medial malleolus which are simple screw fixation and tension band wiring. Over 5 years we grouped 20 patients with fractured medial malleolus into two groups of operative treatments, group1 treated by malleolar screw fixation and group2 by tension band wiring. The patients were with same age group, gender, fracture type, and etiology. We use statistical analysis for make a comparative study between the two ways of surgical treatment. The mean time for radiologic bone union was 11.8 weeks in group1 patients and 9.4 weeks in group2 patients (P = 0.03). No patients had any sign of fixation failure or Kirschner wires migration. According to the modified ankle scoring system of Olerud and Molander, excellent and good results were achieved in 80 % in group1 patients and 90 % in group2 patients (P = 0.049). Tension-band wiring may be better treatment option for internal fixation of medial malleolar fractures than screw fixation. From these findings we recommend a further randomized clinical trial of larger number of cases and longer follow-up duration in order to regard tension-band wiring a better operative option for fixation of medial malleolar fractures.

  2. Fixation principles in metaphyseal bone--a patent based review.

    Science.gov (United States)

    Curtis, R; Goldhahn, J; Schwyn, R; Regazzoni, P; Suhm, N

    2005-03-01

    Osteoporotic changes start in cancellous bone due to the underlying pathophysiology. Consequently, the metaphyses are at a higher risk of "osteoporotic" fracture than the diaphysis. Furthermore, implant purchase to fix these fractures is also affected by the poor bone quality. In general, researchers and developers have worked on three different approaches to address the problem of fractures to osteoporotic bone: adapted anchoring techniques, improved load distribution as well as transfer with angular stable screws, and augmentation techniques using bone substitutes. A patent-based review was performed to evaluate which ideas were utilized to improve fixation in osteoporotic, metaphyseal bone, especially in the proximal femur, and to analyze whether the concept had entered clinical use. Anchoring devices that are either extramedullary or intramedullary have a long clinical history. However, demanding surgical techniques and complications, especially in poor quality bone, are justification that such implants and their corresponding surgical techniques need to be improved upon. Expanding elements have been evaluated in the laboratory. The results are promising and the potential of this approach has yet to be fully exploited in the clinics. Internal fixators with angular stable screws open the door for many new anchorage ideas and have great potential for further optimization of load distribution and transfer. Augmentation techniques may improve anchorage in osteoporotic bone. However, the properties of bone substitute materials will need to be modified and improved upon in order to meet the demanding requirements. If we summarise the development process and the clinical use of implants to date, we have to clearly state that more factors than simply biomechanical advantage will determine the clinical success of a new fixation principle or a new implant. Instead, fracture treatment of patients with osteoporosis really needs an interdisciplinary approach!

  3. Biomechanical Study of Acetabular Tridimensional Memoryalloy Fixation System

    Science.gov (United States)

    Liu, Xin-Wei; Xu, Shuo-Gui; Zhang, Yun-Tong; Zhang, Chun-Cai

    2011-07-01

    We developed the acetabular tridimensional memoryalloy fixation system (ATMFS), which is made of NiTi shape memory alloy, according to the specific mechanical properties of biological memory material, NiTi shape memory alloy and measured distribution of contact area and pressure between the acetabulum and the femoral head of cadaveric pelvis. Seven formalin-preserved cadaveric pelves were used for this investigation. Pressure-sensitive film was used to measure contact area and pressure within the anterior, superior, and posterior regions of the acetabulum. The pelves were loaded under the following four conditions: (1) intact; (2) following a creation posterior wall fracture defect; (3) following reduction and standard internal fixation with reconstruction plate; and (4) following reduction and internal fixation with a new shape memory alloy device named ATMFS. A posterior wall fracture was created along an arc of 40° to 90° about the acetabulur rim. Creation of a posterior wall defect resulted in increased load in the superior acetabulum (1485 N) as compared to the intact condition (748 N, P = 0.009). Following reduction and internal fixation, the load distributed to the superior acetabulum (1545 N) was not statistically different from the defect condition. Following the fixation with ATMFS, the load seen at the superior region of the actabulum (964 N) was familiar with fixation with reconstruction plate and was not different from intact state ( P = 0.45). These data indicate that the use of ATMFS as a fracture internal fixation device resulted a partial restoration of joint loading parameters toward the intact state. ATMFS fixation may result in a clinical benefit.

  4. A biomechanical experiment and clinical study of the use of figure of eight plus circular wiring fixation for the treatment of olecranon fractures

    OpenAIRE

    WANG, WULIAN; WU, GUANGWEN; SHEN, FUER; ZHANG, YIYUAN; LIU, XIANXIANG

    2012-01-01

    The aim of the present study was to evaluate the stability of the figure of eight plus circular wiring fixation technique compared with four common internal fixation techniques and to provide experimental data for the selection of internal fixation techniques clinically. A total of 20 fresh cadaveric elbow joints were used as transverse, oblique and comminuted olecranon fracture models. Five techniques of internal fixation were investigated: circular wiring, figure of eight wiring, circular p...

  5. Headspace analysis of foams and fixatives

    Energy Technology Data Exchange (ETDEWEB)

    Harper, Kyle [Savannah River Site (SRS), Aiken, SC (United States). Savannah River National Lab. (SRNL); Truong, Thanh-Tam [Savannah River Site (SRS), Aiken, SC (United States). Savannah River National Lab. (SRNL); Magwood, Leroy [Savannah River Site (SRS), Aiken, SC (United States). Savannah River National Lab. (SRNL); Peters, Brent [Savannah River Site (SRS), Aiken, SC (United States). Savannah River National Lab. (SRNL); Nicholson, James [Savannah River Site (SRS), Aiken, SC (United States). Savannah River National Lab. (SRNL); Washington, II, Aaron L. [Savannah River Site (SRS), Aiken, SC (United States). Savannah River National Lab. (SRNL)

    2017-07-27

    In the process of decontaminating and decommissioning (D&D) older nuclear facilities, special precautions must be taken with removable or airborne contamination. One possible strategy utilizes foams and fixatives to affix these loose contaminants. Many foams and fixatives are already commercially available, either generically or sold specifically for D&D. However, due to a lack of revelant testing in a radioactive environment, additional verification is needed to confirm that these products not only affix contamination to their surfaces, but also will function in a D&D environment. Several significant safety factors, including flammability and worker safety, can be analyzed through the process of headspace analysis, a technique that analyzes the off gas formed before or during the curing process of the foam/fixative, usually using gas chromatography-mass spectrometry (GC-MS). This process focuses on the volatile components of a chemical, which move freely between the solid/liquid form within the sample and the gaseous form in the area above the sample (the headspace). Between possibly hot conditions in a D&D situation and heat created in a foaming reaction, the volatility of many chemicals can change, and thus different gasses can be released at different times throughout the reaction. This project focused on analysis of volatile chemicals involved in the process of using foams and fixatives to identify any potential hazardous or flammable compounds.

  6. Locking plate fixation for proximal humerus fractures.

    LENUS (Irish Health Repository)

    Burke, Neil G

    2012-02-01

    Locking plates are increasingly used to surgically treat proximal humerus fractures. Knowledge of the bone quality of the proximal humerus is important. Studies have shown the medial and dorsal aspects of the proximal humeral head to have the highest bone strength, and this should be exploited by fixation techniques, particularly in elderly patients with osteoporosis. The goals of surgery for proximal humeral fractures should involve minimal soft tissue dissection and achieve anatomic reduction of the head complex with sufficient stability to allow for early shoulder mobilization. This article reviews various treatment options, in particular locking plate fixation. Locking plate fixation is associated with a high complication rate, such as avascular necrosis (7.9%), screw cutout (11.6%), and revision surgery (13.7%). These complications are frequently due to the varus deformation of the humeral head. Strategic screw placement in the humeral head would minimize the possibility of loss of fracture reduction and potential hardware complications. Locking plate fixation is a good surgical option for the management of proximal humerus fractures. Complications can be avoided by using better bone stock and by careful screw placement in the humeral head.

  7. A comparison of the open reduction-internal fixation and resection arthroplasty techniques in treatment of Mason Type 3 radial head fractures.

    Science.gov (United States)

    Akman, Yunus Emre; Sukur, Erhan; Circi, Esra; Ozyalvac, Osman Nuri; Ozyer, Fatih; Ozturkmen, Yusuf

    2017-03-01

    The aim of this study was to retrospectively compare a series of patients surgically treated with ORIF or early resection arthroplasty due to isolated comminuted radial head fractures. Between the years 2009 and 2013, 34 patients with isolated comminuted fractures of the radial head (Mason Type 3) had been operated (ORIF in 19 patients, resection arthroplasty in 15 patients). The mean age of the patients in the ORIF group was 38.5 years and 54 years in the resection group. The carrying angle (CA) and ulnar variance were measured bilaterally, and radiographs were reviewed for degenerative elbow arthritis. The Mayo elbow performance score, Turkish version of the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH-T) and visual analog scale (VAS) were used to evaluate the clinical results. The mean follow-up period in the ORIF group was 40.2 months and 44.4 months in the resection group. In the ORIF group, 11 patients were clinically rated excellent, six good, and two fair. In the resection group, seven patients had excellent, five had good, and two had fair scores. We did not find a statistically significant difference between the ORIF and resection groups regarding the clinical and radiological outcomes. With these short-term results, resection arthroplasty may be considered an effective method in the treatment of isolated comminuted radial head fractures, as it is less technically demanding and it also allows for early postoperative motion. However, the patients should be evaluated in detail, regarding ligamentous injuries prior to resection arthroplasty. Level III, Therapeutic study. Copyright © 2016 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

  8. Nitrogen fixation apparatus

    Science.gov (United States)

    Chen, Hao-Lin

    1984-01-01

    A method and apparatus for achieving nitrogen fixation includes a volumetric electric discharge chamber. The volumetric discharge chamber provides an even distribution of an electron beam, and enables the chamber to be maintained at a controlled energy to pressure (E/p) ratio. An E/p ratio of from 5 to 15 kV/atm of O.sub.2 /cm promotes the formation of vibrationally excited N.sub.2. Atomic oxygen interacts with vibrationally excited N.sub.2 at a much quicker rate than unexcited N.sub.2, greatly improving the rate at which NO is formed.

  9. Chlorophyll increase due to internal waves in the shelf-break of Gran Canaria Island (Canary Islands

    Directory of Open Access Journals (Sweden)

    Pablo Sangrà

    2001-07-01

    Full Text Available This paper shows observational evidence of internal wave generation and mixing in the southwest shelf-break region of Gran Canaria Island. Signals of periodic internal motion and related mixing events were detected through large pycnocline variations and subcritical gradient Richardson events. Broad areas of homogeneous dense water over the slope, where the vertical temperature field displays a wave-like pattern, provide further evidences of internal wave mixing in this region. The observed diapycnal chlorophyll transport matches with mixing events, suggesting a periodic nutrient supply to the euphotic zone through internal wave mixing. We postulate that internal wave mixing may be an important mechanism contributing to the biological enhancement reported southwest of Gran Canaria Island.

  10. Hybrid fixation in adult osteochondritis dissecans of the knee.

    Science.gov (United States)

    Chadli, L; Steltzlen, C; Toanen, C; Boisrenoult, P; Beaufils, P; Pujol, N

    2017-11-15

    Osteochondritis dissecans progresses to osteoarthritis if integration of the fragment is not obtained. The prognosis of osteochondritis dissecans is more severe in adults, as spontaneous integration due to physeal closure does not occur. Hybrid fixation consists in combining screw fixation of the fragment with mosaicplasty through the fragment to promote integration into the native condyle. We describe this technique with reference to 17 patients. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  11. Fractures of the Proximal Fifth Metatarsal: Percutaneous Bicortical Fixation

    OpenAIRE

    Mahajan, Vivek; Chung, Hyun Wook; Suh, Jin Soo

    2011-01-01

    Background Displaced intraarticular zone I and displaced zone II fractures of the proximal fifth metatarsal bone are frequently complicated by delayed nonunion due to a vascular watershed. Many complications have been reported with the commonly used intramedullary screw fixation for these fractures. The optimal surgical procedure for these fractures has not been determined. All these observations led us to evaluate the effectiveness of percutaneous bicortical screw fixation for treating these...

  12. Carbon emission offsets for aviation-generated emissions due to international travel to and from New Zealand

    International Nuclear Information System (INIS)

    Smith, Inga J.; Rodger, Craig J.

    2009-01-01

    International air transport emissions are not subject to liability under the Kyoto Protocol. However, pressure is mounting globally for international aviation to be included in post-Kyoto arrangements. In the absence of international collective action, a number of so-called carbon offsetting schemes have emerged that allow individual travellers and companies to compensate for their international air travel emissions. These schemes offer technological solutions, such as planting sink forests to sequester emissions. To consider the implications of future collective action, this paper presents a case study assessment of the physical feasibility of five schemes for all short duration journeys to and from New Zealand. This is the first comprehensive national-level case study assessment of competing offsetting options for international aviation emissions in the peer-reviewed literature. The CO 2 -e emissions produced by the air travel of international visitors to New Zealand, and for New Zealand residents travelling overseas, is calculated in this paper to be 7893 and 3948 Gg, respectively, in 2005. It is then shown that no single offsetting scheme targeted inside the country appears physically and/or politically realistic. This indicates the sheer size of these emissions, and the challenge that the international community faces for collective action on this matter. (author)

  13. Improvement of external fixator performance in type C pelvic ring injuries by plating of the pubic symphysis: An experimental study on 12 external fixators

    NARCIS (Netherlands)

    Ponson, K. J.; Hoek van Dijke, G. A.; Joosse, Pieter; Snijders, C. J.; Agnew, Samuel G.

    2002-01-01

    Background: In an earlier study, we introduced a pelvic ring stability criterion for weightbearing stabilization. In a loading test, however, current external fixation systems alone did not meet this criterion. Internal fixation of the dorsal ring can significantly increase stability, but the

  14. High frequency FEM-based power transformer modeling: Investigation of internal stresses due to network-initiated overvoltages

    Energy Technology Data Exchange (ETDEWEB)

    Bjerkan, E.; Hoeidalen, H.K. [Department of Electrical Power Engineering, NTNU (Norwegian University of Science and Technology), 7491 Trondheim (Norway)

    2007-09-15

    This paper presents a method of how to obtain both terminal and internal high frequency models of power transformers using FEM. The model is established from construction information and the approach implements frequency-dependent phenomena on a physical basis. Eddy current effects are represented accurately even with a relatively coarse mesh by using a frequency-dependent complex permeability representation for the core and windings. The model can be employed in EMTP-like programs for a variety of applications, such as analysis for FRA, internal/terminal stresses and transformer network interaction. Analyses of internal stresses are elucidated in this paper. (author)

  15. Guide for the putting int practice the control of internal contamination due to I-131 in hospitals

    International Nuclear Information System (INIS)

    1988-01-01

    The generalized use of radioactive installations in different branches of the Economy and Medicine makes essential the existence of a radiological surveillance systems that guarantees that exposure are kept within the limits established. Nuclear medicine workers in hospitals that handle I-131 constitutes a professional group that can be internally contaminated the aim of this guide is to give the entity the general instructions and the necessary methodology to fulfill the control of the internal contamination by this radionuclide

  16. Fixation Time for Evolutionary Graphs

    Science.gov (United States)

    Nie, Pu-Yan; Zhang, Pei-Ai

    Evolutionary graph theory (EGT) is recently proposed by Lieberman et al. in 2005. EGT is successful for explaining biological evolution and some social phenomena. It is extremely important to consider the time of fixation for EGT in many practical problems, including evolutionary theory and the evolution of cooperation. This study characterizes the time to asymptotically reach fixation.

  17. Complement fixation test to C burnetii

    Science.gov (United States)

    ... complement fixation test; Coxiella burnetii - complement fixation test; C burnetii - complement fixation test ... a specific foreign substance ( antigen ), in this case, C burnetii . Antibodies defend the body against bacteria, viruses, ...

  18. Cementless fixation in total knee arthroplasty: down the boulevard of broken dreams - affirms.

    Science.gov (United States)

    Ranawat, C S; Meftah, M; Windsor, E N; Ranawat, A S

    2012-11-01

    There has been a recent increase in interest for non-cemented fixation in total knee arthroplasty (TKA), however the superiority of cement fixation is an ongoing debate. Whereas the results based on Level III and IV evidence show similar survivorship rates between the two types of fixation, Level I and II evidence strongly support cemented fixation. United Kingdom, Australia, Sweden, and New Zealand registry data show lower failure rates and greater usage of cemented than non-cemented fixation. Case series studies have also indicated greater functional outcomes and lower revision rates among cemented TKAs. Non-cemented fixation involves more patellofemoral complications, including increased susceptibility to wear due to a thinner polyethylene bearing on the cementless metal-backed component. The combination of results from registry data, prospective randomised studies, and meta-analyses support the current superiority of cemented fixation in TKAs.

  19. Mini-Open Sinus Tarsi Approach with Percutaneous Screw Fixation of Displaced Calcaneal Fractures: A Prospective Computed Tomography-Based Study

    NARCIS (Netherlands)

    Nosewicz, Tomasz; Knupp, Markus; Barg, Alexej; Maas, Mario; Bolliger, Lilianna; Goslings, J. Carel; Hintermann, Beat

    2012-01-01

    Background: Open reduction and internal fixation (ORIF) of calcaneal fractures using an extended lateral approach results in soft tissue disruption and theoretically subtalar joint stiffness. A minimally invasive sinus tarsi approach for posterior facet exposure and percutaneous screw fixation of

  20. Artrodese do punho com fixação mínima preservando as articulações carpometacarpianas Wrist arthrodesis with minimal internal fixation preserving the carpometacarpal joints

    Directory of Open Access Journals (Sweden)

    Arlindo Gomes Pardini Júnior

    2010-01-01

    structures. In general, the results are very satisfactory, particularly for pain relief, and in the majority of cases, there is considerable functional improvement. Various techniques are described, with different methods of internal fixation, most of which include the carpometacarpal joints (CMJ in the fusion. The objective of this study is to evaluate the results of wrist arthrodesis through a technique which is simpler, more biological, more inexpensive, and does not involve the carpometacarpal joints. METHODS: 15 patients with wrist arthrodesis were evaluated (6 with sequelae of trauma, 4 Rheumatoid Arthritis, 3 Kienbock's grade IV, 1 Preiser and 1 panarthrosis. The technique consisted of the use of an iliac bone plate and internal fixation with Kirschner wires, avoiding the carpometacarpal joints. RESULTS: The evaluation was based on consolidation time (93% in 7 weeks; movements of the fingers and pronosupination; pinch and grasp strength; functional evaluation through the DASH questionnaire, pain and patient satisfaction. In general, the results were similar to those of other, more aggressive techniques, and the non-inclusion of the carpometacarpal joints did not affect the final result. CONCLUSION: wrist arthrodesis with fixation using Kirschner wires and the use of an iliac bone plate, preserving the carpometacarpal joints, gives good or excellent results which are similar to those of other techniques described. However it presents major advantages over other methods: it is less aggressive, less expensive, and does not have the inconvenience and complications associated the use of plates and screws.

  1. Influência do suporte e fixação anterior na resistência mecânica do fixador interno vertebral Influencia del soporte y de la fijación anterior sobre la resistencia mecánica del fijador interno vertebralartrodesis cervical anterior por hernia del disco cervica The influence of anterior reconstruction and fixation on the mechanical performance of an internal fixator

    Directory of Open Access Journals (Sweden)

    Gisele Cristina Ale dos Santos

    2009-03-01

    momento-flexor, la torción y la rigidez obtenidas a partir de la curva carga x deflexión de cada ensayo mecánico. RESULTADOS: fue observado que la colocación del soporte y de la fijación anterior aumentaron la resistencia mecánica en los ensayos de flexo-compresión. En los ensayos de flexión lateral fue observado aumento de la resistencia mecánica solamente con la fijación anterior. CONCLUSIÓN: en los ensayos de torción, el soporte anterior y la fijación anterior no aumentaron la resistencia mecánica del sistema de fijación vertebral.OBJECTIVE: evaluation of the mechanical stability of the internal vertebral fixation through the influence of the anterior load bearing reconstruction and stabilization. METHODS: cylindrical woods blocks were utilized as test bodies and were stabilized by an internal fixation. Three experimental groups were set according to the anterior reconstruction and fixation: group I - without anterior support; group II - with anterior support and group III - with support and anterior fixation. In an universal assay machine the wood block underwent to flexion-compression, lateral flexion and torsion mechanical assays, until ten assays of each modality were performed (flexion-compression, lateral compression and torsion in each experimental group, in a total of 90 mechanical assays. The studied mechanical proprieties were the flex moment, torsion moment and the stiffness, obtained through the load x deflection of each mechanical trial. RESULTS: it was observed that utilizing a support and anterior fixation there has been na increased mechanical stiffness in the flexion-compression mechanical assays. In the lateral flexion tests it was observed an increased rigidity only with the anterior fixation. CONCLUSION: with the torsion tests the anterior support and fixation did not increase the mechanical rigidity of the vertebral fixation system.

  2. Results of the Argentinian intercomparison on internal dosimetry – 2014. Interpretation of monitoring data for effective dose assessment due to internal exposure

    International Nuclear Information System (INIS)

    Rojo, A.M.; Puerta, N.; Gossio, S.; Gómez Parada, I.

    2015-01-01

    Internal dosimetry intercomparisons are essential for the verification of the models applied and the results consistency. To that aim, in 2014 the National Intercomparison Exercise was organized and coordinated by the Internal Dosimetry Laboratory of the Nuclear Regulatory Authority (ARN) of Argentina. Four simulated cases covering intakes of “1”3”1I, “1”3”7Cs and tritium were proposed. The exercise counted with the participation of four internal dosimetry services from the nuclear power plants (NA-SA CNA and NA-SA CNE) and the CNEA Atomic Centres: Bariloche (CAB) and Ezeiza (CAE). This report shows a complete analysis of the participant’s results in this exercise. (authors) [es

  3. First Case of Liver Abscess in Scandinavia Due to the International Hypervirulent Klebsiella Pneumoniae Clone ST23

    DEFF Research Database (Denmark)

    Gundestrup, Svend; Struve, Carsten; Stahlhut, Steen G

    2014-01-01

    This is the first case report from Scandinavia of a pyogenic liver abscess caused by a Klebsiella pneumoniae isolate belonging to the international hyper virulent clone ST23. The patient, an 85-year old Caucasian, had no history of foreign travel or any classical predisposing factors for infection...

  4. Pure dysarthria due to anterior internal capsule and/or corona radiata infarction: a report of five cases.

    Science.gov (United States)

    Ozaki, I; Baba, M; Narita, S; Matsunaga, M; Takebe, K

    1986-01-01

    Five cases with a sudden onset of dysarthria in the setting of hypertension are presented. No case had limb weakness or other neurological deficits. Computed tomographic scan demonstrated a small low density lesion in the anterior part of the internal capsule or the adjacent corona radiata. All cases showed a good recovery from dysarthria within two to four weeks. Images PMID:3806121

  5. Age and Educational Inequalities in Smoking Cessation Due to Three Population-Level Tobacco Control Interventions: Findings from the International Tobacco Control (ITC) Netherlands Survey

    Science.gov (United States)

    Nagelhout, Gera E.; Crone, Matty R.; van den Putte, Bas; Willemsen, Marc C.; Fong, Geoffrey T.; de Vries, Hein

    2013-01-01

    This study aimed to examine age and educational inequalities in smoking cessation due to the implementation of a tobacco tax increase, smoke-free legislation and a cessation campaign. Longitudinal data from 962 smokers aged 15 years and older were used from three survey waves of the International Tobacco Control (ITC) Netherlands Survey. The 2008…

  6. A Novel Handmade External Fixator for Phalangeal and Metacarpal Fractures

    Directory of Open Access Journals (Sweden)

    Davod Jafari

    2016-12-01

    Full Text Available Background The value of external fixation in complex hand injuries is well established. Expenses and technical difficulties of commercial mini external fixator sets have led to the innovation of handmade external fixators. These fixators are used as versatile facilities to treat certain hand fractures. Usually, these structures are made by k-wires crossed filled with cement plastic tube. However, these fixators have multiple deficiencies that should be addressed. Objectives In this study, we described in detail the surgical technique of a handmade concrete like mini external fixator and report its clinical use and results. Methods Our handmade external fixator was applied for 52 patients with 56 fractures. Only 5% of the fractures were closed, non-comminuted extra-articular, and the other 51 fractures were more complex injuries. The mean follow up time was 9.3 months. At the end of the follow up, radiologic and functional assessment (DASH: Disability of arm, shoulder and hand and TAM: Total active motion was evaluated. Results All 56 fractures were united completely. None of the cases experienced pin loosening or reduction loss. Of the fractures, 8.9% malunited due to fracture complexity. The mean dash score was 3.76. TAM was excellent in 45% of the fractures; it was good in 7% and fair in 4%. Conclusions This type of handmade external fixator is simple, lightweight, and cheap. Furthermore, all implements are readily available in most operating fields. The probability of loosening has been greatly diminished because of the concrete like structure. Easy and fast assembly and good clinical and functional results are the other advantages of this technique. Due to the less complication and benefits, this technique could be used for many phalangeal and metacarpal fractures with confidence.

  7. Late-Onset Massive Epistaxis due to a Ruptured Traumatic Internal Carotid Artery Aneurysm: A Case Report

    OpenAIRE

    Arai, Nobuhiko; Nakamura, Akiyoshi; Tabuse, Masanao; Miyazaki, Hiromichi

    2016-01-01

    A traumatic internal carotid artery (ICA) aneurysm is rare and difficult to treat. Trapping of ICA is commonly performed owing to the difficulty of directly approaching ICA aneurysms. Recently, coiling the aneurysm itself was recommended if possible. However, it is controversial which of methods are best to completely treat aneurysm. We present the case of a 74-year-old man, who had experienced a head injury 8 years previously, with recurrent severe epistaxis. An ICA aneurysm was detected on ...

  8. Regulatory guide relating to the determination of whole-body doses due to internal radiation exposure (principles and methods)

    International Nuclear Information System (INIS)

    Bogner, L.; Graffunder, H.; Henrichs, K.; Kraut, W.; Nosske, D.; Roth, P.; Sahre, P.

    1993-01-01

    This compilation defines the principles and methods to be applied for determining the doses emanating from internal radiation exposure in persons with dose levels exceeding the critical levels defined in the ''Regulatory guide for health physics controls''. The obligatory procedure is intended to guarantee that measurements and interpretations of personnel doses and intakes are done on a standardized basis by a standardized procedure, so as to obtain comparable results. (orig.) [de

  9. Analysis of internal crack propagation in silicon due to permeable pulse laser irradiation: study on processing mechanism of stealth dicing

    Science.gov (United States)

    Ohmura, Etsuji; Kawahito, Yuta; Fukumitsu, Kenshi; Okuma, Junji; Morita, Hideki

    2011-02-01

    Stealth dicing (SD) is an innovative dicing method developed by Hamamatsu Photonics K.K. In the SD method, a permeable nanosecond laser is focused inside a silicon wafer and scanned horizontally. A thermal shock wave propagates every pulse toward the side to which the laser is irradiated, then a high dislocation density layer is formed inside the wafer after the thermal shock wave propagation. In our previous study, it was concluded that an internal crack whose initiation is a dislocation is propagated when the thermal shock wave by the next pulse overlaps with this layer partially. In the experimental result, the trace that a crack is progressed gradually step by step was observed. In this study, the possibility of internal crack propagation by laser pulses was investigated. A two-dimensional thermal stress analysis based on the linear fracture mechanics was conducted using the stress distribution obtained by the axisymmetric thermal stress analysis. As a result, the validity of the hypothesis based on a heat transfer analysis result previously presented was supported. Also it was concluded that the internal crack is propagated by at least two pulses.

  10. Percutaneous Fixation of Anterior Column Acetabular Fracture in a Renal Transplant Recipient

    Directory of Open Access Journals (Sweden)

    Halil Ceylan

    2013-01-01

    Full Text Available Renal transplantation, performed per million population, ranges from 30 to 60 in developed countries. The transplanted kidney is generally placed in iliac fossa; therefore the treatment procedure of the pelvic trauma in these patients should be selected carefully. The gold standard technique for the treatment of displaced acetabulum fractures is open reduction and internal fixation. Our patient had received a living-related-donor renal transplant due to chronic renal failure. In the second year of transplantation, she had been injured in a motor-vehicle accident, and radiographs showed a right acetabular anterior column fracture and left pubic rami fractures. The patient was treated with percutaneous fixation techniques and at one year of postoperative period there was no evidence of degenerative signs and the clinical outcome was good. Beside having the advantage of avoiding dissection through the iliac fossa by the standard ilioinguinal approach, percutaneous techniques, with shorter surgical time, decreasing soft tissue disruption, and the potential for early discharge from hospital might be ideal for a renal transplant recipient carrying a higher risk of infection. Percutaneous fixation of selected acetabular fractures in a renal transplant recipient would presumably have the potential to decrease the morbidity associated with traditional open surgical procedures.

  11. Midterm results of biologic fixation or mosaicplasty and drilling in osteochondritis dissecans

    Directory of Open Access Journals (Sweden)

    Tuluhan Yunus Emre

    2011-01-01

    Conclusion: Biologic fixation or mosaicplasty and drilling as a technique to treatment of the lesion in OCD by osteochondral autograft transfer has resulted in good and excellent clinical outcomes in our patients and it is considered that providing blood flow to subchondral bone by circumferencial drilling leads to an increase in the robustness of biological internal fixation and shortens the duration of recovery.

  12. Percutaneous Intramedullary Screw Fixation of Distal Fibula Fractures: A Case Series and Systematic Review

    NARCIS (Netherlands)

    Loukachov, Vladimir V.; Birnie, Merel F. N.; Dingemans, Siem A.; de Jong, Vincent M.; Schepers, Tim

    2017-01-01

    The current reference standard for unstable ankle fractures is open reduction and internal fixation using a plate and lag screws. This approach requires extensive dissection and wound complications are not uncommon. The use of intramedullary screw fixation might overcome these issues. The aim of our

  13. Health problems associated with international travel: a case of cutaneous myiasis in China due to Cordylobia anthropophaga imported from Uganda.

    Science.gov (United States)

    Ruan, Wei; Feng, Yan; Zhang, Lingling; Sun, Jimin; Yao, Linong

    2014-12-01

    More affordable international travel, global trade and commerce, and the exporting of labor have all contributed to international population mobility. Furthermore, population migration leads to the incidence or recurrence of once-controlled diseases. Evidence shows that the popularity of travel can impact health through imported infections and illness. Imported cutaneous myiasis, a type of skin lesion, has attracted the attention of the current authors. This condition often occurs among travelers and it has been reported in several non-endemic countries. However, diagnosis of myiasis and identification of the larvae are difficult. Advances in molecular detection techniques could provide a new way to identify larvae. This study used sequencing of the 28S rRNA gene and morphology to identify the larva infesting the upper arm of a Chinese woman returning from Uganda. The larva was identified as Cordylobia anthropophaga (C. anthropophaga) and the sequences were submitted to GenBank (accession number: KM506761). As foreign interaction increases, imported health problems may become more common in China. Knowledge about various pathogens needs to be increased and molecular methods need to be used to accurately identify those pathogens.

  14. Adiabatic decay of internal solitons due to Earth's rotation within the framework of the Gardner-Ostrovsky equation

    Science.gov (United States)

    Obregon, Maria; Raj, Nawin; Stepanyants, Yury

    2018-03-01

    The adiabatic decay of different types of internal wave solitons caused by the Earth's rotation is studied within the framework of the Gardner-Ostrovsky equation. The governing equation describing such processes includes quadratic and cubic nonlinear terms, as well as the Boussinesq and Coriolis dispersions: (ut + c ux + α u ux + α1 u2 ux + β uxxx)x = γ u. It is shown that at the early stage of evolution solitons gradually decay under the influence of weak Earth's rotation described by the parameter γ. The characteristic decay time is derived for different types of solitons for positive and negative coefficients of cubic nonlinearity α1 (both signs of that parameter may occur in the oceans). The coefficient of quadratic nonlinearity α determines only a polarity of solitary wave when α1 0. It is found that the adiabatic theory describes well the decay of solitons having bell-shaped profiles. In contrast to that, large amplitude table-top solitons, which can exist when α1 is negative, are structurally unstable. Under the influence of Earth's rotation, they transfer first to the bell-shaped solitons, which decay then adiabatically. Estimates of the characteristic decay time of internal solitons are presented for the real oceanographic conditions.

  15. Bottom attenuation estimation using sound intensity fluctuations due to mode coupling by nonlinear internal waves in shallow water.

    Science.gov (United States)

    Grigorev, Valery A; Katsnelson, Boris G; Lynch, James F

    2016-11-01

    Analyses of fluctuations of low frequency signals (300 ± 30 Hz) propagating in shallow water in the presence of nonlinear internal waves (NIWs) in the Shallow Water 2006 experiment are carried out. Signals were received by a vertical line array at a distance of ∼20 km from the source. A NIW train was moving totally inside of the acoustic track, and the angle between the wave front of the NIW and the acoustic track in the horizontal plane was ∼10°. It is shown that the spectrum of the sound intensity fluctuations contains peaks corresponding to the coupling of pairs of propagating modes. Analysis of spectra at different hydrophone depths, and also summed over depth allows the authors to estimate attenuation in the bottom sediments.

  16. Biologic and biomechanic evaluation of posterior lumbar fusion in the rabbit. The effect of fixation rigidity.

    Science.gov (United States)

    Feighan, J E; Stevenson, S; Emery, S E

    1995-07-15

    The histologic and biomechanic characteristics of posterior lumbar fusion with varying rigidity of a novel internal fixation construct in the rabbit were analyzed. To evaluate this rabbit model for future studies of fusion augmentation. Previous studies in goats and dogs showed internal fixation enhances spinal arthrodesis. Twenty eight New Zealand white rabbits underwent a posterior midline fusion from L4 to L6. Some animals received autogenous iliac crest bone graft, stabilized by wiring the superior facets bilaterally, and supplementation with polymethylmethacrylate. The experimental groups were iliac crest bone graft with either no fixation, wire fixation, or wire and polymethylmethacrylate fixation; and no graft and either no fixation, wire fixation, or wire and polymethylmethacrylate fixation. Animals were killed 2 months after surgery, and the specimens were nondestructively tested biomechanically for stiffness in six modes (flexion, extension, left and right bending, compression, and torsion) and histologically for evidence of fusion, revascularization, and new bone formation. Fusions with either wire or wire and polymethylmethacrylate fixation were significantly stiffer than those without fixation (P < 0.05). There was no statistical difference between the iliac crest bone graft and wire group and the iliac crest bone graft, wire, and polymethylmethacrylate group in the modes tested. Nine of 14 motion segments receiving the stiffest construct (iliac crest bone graft, wire, and polymethylmethacrylate) had evidence of solid bony fusion. None of the 12 motion segments receiving iliac crest bone graft and wire had evidence of bony fusion, but five had a fibrocartilage union with some ossification present. Eight of 12 motion segments receiving iliac crest bone graft and no fixation had predominantly fibrous unions with some fibrocartilage, and only one motion segment of 12 showed bony fusion. This study suggests that more rigid fixation produces more successful

  17. Results of the regional intercomparison on internal dosimetry – 2013: Interpretation of monitoring data for effective dose assessment due to internal exposure

    International Nuclear Information System (INIS)

    Rojo, A.M.; Puerta, N.; Gossio, S.; Gómez Parada, I.

    2015-01-01

    Internal dosimetry intercomparisons are essential for the verification of the models applied and the results consistency. To that aim, the 1. Regional Intercomparison Exercise was organized in 2005 in the frame of the RLA 9/049. The results of this exercise led to the 2. Regional Intercomparison Exercise in 2013, which was organized in the frame of the RLA 9/066 and coordinated by Autoridad Regulatoria Nuclear (ARN) of Argentina. Four simulated cases covering intakes of “1”3”1I, “1”3”7Cs and Tritium were proposed. The exercise counted with the participation of 19 centres from 13 countries. This report shows a complete analysis of the participant’s results in this 2nd. exercise, useful to test their skills and acquired knowledge, particularly in applying the IDEAS guidelines. It is important to highlight the improvement in the general performance of the participants. (authors) [es

  18. 210Pb: bioaccumulation factor and internal radiation dose to the public due to consumption of seafood from Mumbai harbour bay

    International Nuclear Information System (INIS)

    Bangera, Vasanthi S.; Rudran, Kamala

    1999-01-01

    Marine organisms such as fishes, molluscs and crustaceans are known to accumulate 210 Pb. Distribution of 210 Pb in coastal marine organisms mainly fishes and shell fishes is studied. Concentration of 210 Pb obtained in muscle of common fishes (edible portion) varied from BDL to 9.71 ± 0.92 Bq kq -1 wet muscle. For fishes like Pampus argenteus (pomfret), Cynoglossus elongatus (sole), Rastrelliger kanagurta (mackerel), Harpoden nehereus (Bombay duck), Arius dussumieri (catfish), the concentration factors for 210 Pb in edible portion of fish from sea water works out to 10 1 to 10 3 . Radiation dose to the public has been evaluated on the basis of daily intake of 40 g of fish (15 kg y -1 ). Committed effective dose (CED) to 210 Pb due to consumption of seafood is calculated, CED varied from 2.5 x 10 -3 to 1.27 x 10 -1 mSv y -1 . (author)

  19. Internal radiation dose from 137Cs due to the consumption of mushrooms from a Mexican temperate mixed forest

    International Nuclear Information System (INIS)

    Gaso, M.I.; Segovia, N.; Cervantes, M.L.; Herrera, T.; Perez-Silva, E.; Acosta, E.

    2000-01-01

    137 Cs and 40 K specific activities were determined in soil samples and in different edible wild mushroom species collected from a temperate mixed forest located at the Nuclear Centre of Mexico and in several surrounding localities. The activity measurements were performed using HpGe detector. The aggregated transfer factors for 137 Cs in 21 local mushroom species collected from 1993 to 1997, showed differences as large as 3 orders of magnitude. The annual effective dose from 137 Cs due to the consumption of mushrooms was estimated to range between 0.22 and 1.2 μSv.y -1 depending on the method used for calculation. Using the geometric mean of the caesium concentration, the contribution of mushrooms represents 56% of the total 137 Cs dietary intake. (author)

  20. Late-Onset Massive Epistaxis due to a Ruptured Traumatic Internal Carotid Artery Aneurysm: A Case Report.

    Science.gov (United States)

    Arai, Nobuhiko; Nakamura, Akiyoshi; Tabuse, Masanao; Miyazaki, Hiromichi

    2017-01-01

    A traumatic internal carotid artery (ICA) aneurysm is rare and difficult to treat. Trapping of ICA is commonly performed owing to the difficulty of directly approaching ICA aneurysms. Recently, coiling the aneurysm itself was recommended if possible. However, it is controversial which of methods are best to completely treat aneurysm. We present the case of a 74-year-old man, who had experienced a head injury 8 years previously, with recurrent severe epistaxis. An ICA aneurysm was detected on computed tomography. The trapping and bypass was planned. However, sudden epistaxis occurred, we performed trapping to stop the bleeding and save his life. After the operation, no right ICA or aneurysm was detected. However, severe epistaxis recurred two months after the operation. In the second operation, a ligation of the common -/- external carotid artery and a severance of an ICA portion between the ophthalmic artery and the aneurysm were insufficient to stop the bleeding. This case indicates ICA trapping, even if a trapping portion is below an ophthalmic artery, is insufficient to treat an ICA aneurysm. ICA aneurysms should be suspected when a patient present with recurrent -/- massive epistaxis, who has a head injury history, even if it is far past.

  1. Biomechanical Comparison of External Fixation and Compression Screws for Transverse Tarsal Joint Arthrodesis.

    Science.gov (United States)

    Latt, L Daniel; Glisson, Richard R; Adams, Samuel B; Schuh, Reinhard; Narron, John A; Easley, Mark E

    2015-10-01

    which can be obtained with 3 headless compression screws. Screw and external fixator performance did not correlate with bone mineral density. This study supports the use of external fixation as an alternative method of generating compression to help stimulate fusion across the transverse tarsal joints. The findings provide biomechanical evidence to support the use of external fixation as a viable option in transverse tarsal joint fusion cases in which screw fixation has failed or is anticipated to be inadequate due to suboptimal bone quality. © The Author(s) 2015.

  2. Internal radiation dose to the public from polonium-210 due to consumption of seafood from Bombay-harbour bay

    International Nuclear Information System (INIS)

    Bangera, V.S.; Rudran, Kamala

    1995-01-01

    Marine organisms such as fishes, molluscs and crustaceans are known to accumulate 210 Po. Distribution of 210 Po in coastal marine organisms mainly fishes and shell fishes is studied. Concentration of 210 Po obtained in muscle of common fishes (edible portion) varied from 2.10 ± 0.11 to 21.90 ± 5.00 Bq kg -1 dry muscle (for fishes like Pampus argenteus (Pomfret), Cynoglossus elongatus (sole), Rastrelliger kanagurta (mackerel), Harpodon nehereus (Bombay duck) etc. Concentration factors for 210 Po in edible portion of fish from sea water works out to 10 3 to 10 4 . Radiation dose to the public has been evaluated on the basis of daily intake of 40 g of fish (15 kg y -1 ). Committed effective dose (CED) to 210 Po due to consumption of sea food is calculated, CED varied from 2.05 x 10 -3 to 4 x 10 -2 mSv y -1 . (author). 7 refs., 3 figs., 3 tabs

  3. The Ankle Injury Management (AIM) trial: a pragmatic, multicentre, equivalence randomised controlled trial and economic evaluation comparing close contact casting with open surgical reduction and internal fixation in the treatment of unstable ankle fractures in patients aged over 60 years.

    Science.gov (United States)

    Keene, David J; Mistry, Dipesh; Nam, Julian; Tutton, Elizabeth; Handley, Robert; Morgan, Lesley; Roberts, Emma; Gray, Bridget; Briggs, Andrew; Lall, Ranjit; Chesser, Tim Js; Pallister, Ian; Lamb, Sarah E; Willett, Keith

    2016-10-01

    Close contact casting (CCC) may offer an alternative to open reduction and internal fixation (ORIF) surgery for unstable ankle fractures in older adults. We aimed to (1) determine if CCC for unstable ankle fractures in adults aged over 60 years resulted in equivalent clinical outcome compared with ORIF, (2) estimate cost-effectiveness to the NHS and society and (3) explore participant experiences. A pragmatic, multicentre, equivalence randomised controlled trial incorporating health economic evaluation and qualitative study. Trauma and orthopaedic departments of 24 NHS hospitals. Adults aged over 60 years with unstable ankle fracture. Those with serious limb or concomitant disease or substantial cognitive impairment were excluded. CCC was conducted under anaesthetic in theatre by surgeons who attended training. ORIF was as per local practice. Participants were randomised in 1 : 1 allocation via remote telephone randomisation. Sequence generation was by random block size, with stratification by centre and fracture pattern. Follow-up was conducted at 6 weeks and, by blinded outcome assessors, at 6 months after randomisation. The primary outcome was the Olerud-Molander Ankle Score (OMAS), a patient-reported assessment of ankle function, at 6 months. Secondary outcomes were quality of life (as measured by the European Quality of Life 5-Dimensions, Short Form questionnaire-12 items), pain, ankle range of motion and mobility (as measured by the timed up and go test), patient satisfaction and radiological measures. In accordance with equivalence trial US Food and Drug Administration guidance, primary analysis was per protocol. We recruited 620 participants, 95 from the pilot and 525 from the multicentre phase, between June 2010 and November 2013. The majority of participants, 579 out of 620 (93%), received the allocated treatment; 52 out of 275 (19%) who received CCC later converted to ORIF because of loss of fracture reduction. CCC resulted in equivalent ankle

  4. Fixation of tibial plateau fractures with synthetic bone graft versus natural bone graft: a comparison study.

    LENUS (Irish Health Repository)

    Ong, J C Y

    2012-06-01

    The goal of this study was to determine differences in fracture stability and functional outcome between synthetic bone graft and natural bone graft with internal fixation of tibia plateau metaphyseal defects.

  5. Estimate of the internal doses received by the population of Bucharest due to 137 Cs and 90 Sr intake in the first five years after the Chernobyl accident

    International Nuclear Information System (INIS)

    Toader, Maria; Vasilache, R. A.

    1995-01-01

    The evolution of the 137 Cs and 90 Sr daily intake between April 1986 and March 1991 as well as the internal doses resulting from ingestion of contaminated food is presented for a group of adults living in Bucharest. The results indicate that the effective doses due to 137 Cs and 90 Sr dietary intake had the highest values in the first year after the Chernobyl accident, namely, 796 μSv as a result of 137 Cs dietary intake and 23 μSv as a result of the 90 Sr dietary intake. The effective doses committed annually due to the Caesium-137 dietary intake decreased very fast from 796 μSv committed in the first year after the accident to 7.3 μSv committed in the fifth year after the accident. Although the effective dose committed in the first year after the accident due to the Strontium-90 dietary intake was much smaller than the dose due to the Caesium-137 (23 μSv), the decrease was slower so that the effective dose committed in the fifth year after the accident due to the Strontium-90 dietary intake was 7.5 μSv. (authors)

  6. Experimental verification of segregation of carbon and precipitation of carbides due to deep cryogenic treatment for tool steel by internal friction method

    International Nuclear Information System (INIS)

    Li, Shaohong; Min, Na; Li, Junwan; Wu, Xiaochun; Li, Chenhui; Tang, Leilei

    2013-01-01

    This work presents an internal frictional behavior of cold work tool steel subjected to different heat treatment schedules to get insight related to segregation of carbon and refinement of carbide particles due to deep cryogenic treatment. The temperature dependence of internal friction was used to describe the variation of carbon concentration in solid solution of the martensite matrix in successive tempering steps. The results indicate that the carbon atoms segregated to nearby defects forming atomic clusters producing strong interactions, including interstitial carbon atoms themselves and between the interstitial carbon atoms with time-dependent strain field of dislocations because of lattice shrinking and thermodynamic instability of martensite during the deep cryogenic treatment. The clusters act as and grow into nuclei for the formation of fine carbide particle on subsequent tempering that was verified by analyses of TEM micrographs

  7. Intraosseous fixation compared to plantar plate fixation for first metatarsocuneiform arthrodesis: a cadaveric biomechanical analysis.

    Science.gov (United States)

    Roth, Klaus Edgar; Peters, Jennifer; Schmidtmann, Irene; Maus, Uwe; Stephan, Daniel; Augat, Peter

    2014-11-01

    Metatarsocuneiform (MTC) fusion is a treatment option for management of hallux valgus. We compared the biomechanical characteristics of an internal fixation device with plantar plate fixation. Seven matched pairs of feet from human cadavers were used to compare the intramedullary (IM) device plus compression screw to plantar plate combined with a compression screw. Specimen constructs were loaded in a cyclic 4-point bending test. We obtained initial/final stiffness, maximum load, and number of cycles to failure. Bone mineral density was measured with peripheral quantitative computed tomography. Performance was compared using time to event analysis with number of cycles as time variable, and a proportional hazard model including shared frailty model fitted with treatment and bone mineral density as covariates. On average the plates failed after 7517 cycles and a maximum load of 167 N, while the IM-implants failed on average after 2946 cycles and a maximum load of 69 N. In all pairs the 1 treated with IM-implant failed earlier than the 1 treated with a plate (hazard ratio for IM-implant versus plate was 79.9 (95% confidence interval [6.1, 1052.2], P = .0009). The initial stiffness was 131 N/mm for the plantar plate and 43.3 N/mm for the IM implant. Initial stiffness (r = .955) and final stiffness (r = .952) were strongly related to the number of cycles to failure. Bone mineral density had no effect on the number of cycles to failure. Plantar plate fixation created a stronger and stiffer construct than IM fixation. A stiffer construct can reduce the risk of nonunion and shorten the period of non-weight-bearing. © The Author(s) 2014.

  8. [Three-dimensional finite element investigation of lateral mass screw fixation and transarticular screw fixation in lower cervical spine].

    Science.gov (United States)

    Duan, Yang; Jin, Anmin; Zhang, Hui; Min, Shaoxiong; Hu, Konghe

    2010-12-01

    To establish sophisticated three-dimensional finite element model of the lower cervical spine and reconstruct lower cervical model by different fixation systems after three-column injury, and to research the stress distribution of the internal fixation reconstructed by different techniques. The CT scan deta were obtained from a 27-year-old normal male volunteer. Mimics 10.01, Geomagic Studio10.0, HyperMesh10.0, and Abaqus 6.9.1 softwares were used to obtain the intact model (C3-7), the model after three-column injury, and the models of reconstructing the lower cervical spine after three-column injury through different fixation systems, namely lateral mass screw fixation (LSF) and transarticular screw fixation (TSF). The skull load of 75 N and torsion preload of 1.0 N*m were simulated on the surface of C3. Under conditions of flexion, extension, lateral bending, and rotation, the Von Mises stress distribution regularity of internal fixation system was evaluated. The intact model of C3-7 was successfully established, which consisted of 177 944 elements and 35 668 nodes. The results of the biomechanic study agreed well with the available cadaveric experimental data, suggesting that they were accord with normal human body parameters and could be used in the experimental research. The finite element models of the lower cervical spine reconstruction after three-column injury were established. The stress concentrated on the connection between rod and screw in LSF and on the middle part of screw in TSF. The peak values of Von Mises stress in TSF were higher than those in LSF under all conditions. For the reconstruction of lower cervical spine, TSF has higher risk of screw breakage than LSF.

  9. Intermittent internal fixation with a locking plate to preserve epiphyseal growth function during limb-salvage surgery in a child with osteosarcoma of the distal femur: a case report.

    Science.gov (United States)

    Mei, Jiong; Ni, Ming; Jia, Guang-Yao; Chen, Yan-Xi; Zhu, Xiao-Zhong

    2015-05-01

    Limb shortening is a problem associated with surgery for osteosarcoma of the lower extremity in adolescents, as the tumors frequently occur near the epiphysis. Herein we report the use of a less invasive stabilization system (LISS) and an intermittent fixation method to preserve the growth function of epiphysis in an 11-year-old patient with an osteosarcoma of the distal femur.The 11-year-old male presented with left knee enlargement and pain for 2 weeks, and magnetic resonance imaging (MRI) and biopsy were consistent with osteosarcoma of the left distal femur. After preoperative chemotherapy, en bloc tumor resection was performed with margins based on MRI findings preserving the epiphyseal growth plate, the tumor cavity was filled with inactivated bone and bone cement, and a LISS was used to stabilize the femur. Aggressive postoperative chemotherapy was given. Approximately 105 weeks after surgery radiography showed that the distal end of the plate had moved superior to the epiphysis along with bone growth. Locking screws were placed in the distal part of the LISS plate to stabilize the re-implanted bone, and external fixation was not needed.The patient was able to walk with the crutches 1 week postoperatively, and bear weight on the extremity 6 weeks postoperatively. At 6 years after surgery, the patient's height had increased 52 cm, shortening of the affected limb was only 1 cm, and the circumference of the affected limb was 2 cm smaller than that of the contralateral limb. There was no significant discomfort in the affected limb, and there was no gait abnormality. The patient could jump and run, and could participate in sports including basketball and badminton to the same degree as his peers.In summary, the novel method of bone reconstruction and fixation provided good results in a child with an osteosarcoma of the distal femur. This fixation method preserves the osteogenic function of the epiphysis and restored bone integrity simultaneously, and

  10. Scleral Fixation of a One-Piece Toric Intraocular lens

    Science.gov (United States)

    Emanuel, Matthew E.; Randleman, J. Bradley; Masket, Samuel

    2013-01-01

    Purpose To describe a novel technique for toric intraocular lens (IOL) repositioning and fixation in the absence of adequate capsular support Methods Case report and literature review Results Two cases are presented with scleral fixation of a one-piece toric IOL (SN6AT series, Alcon Inc.) In both cases, toric IOLs initially placed within the capsular bag became decentered due to poor capsular support and/or posterior capsule rupture. To avoid the potential complications of lens explantation and maintain the astigmatic benefits of the toric IOL, scleral fixation of the lenses was performed. The Hoffman technique was used to create reverse scleral pockets without conjunctival dissection. A 10-0 suture was used to capture and then secure the lens haptics in a lasso-type fashion. Sutures were then buried within the previously created scleral pockets. Both patients had well centered lenses postoperatively and have remained stable at last follow-up, up to thirty months postoperatively. Conclusion In the absence of adequate capsular support, scleral fixation is a viable option for one-piece toric IOL fixation to avoid IOL explanation PMID:23380416

  11. Necessity for fibular fixation associated with distal tibia fractures.

    Science.gov (United States)

    Taylor, Benjamin C; Hartley, Brandi R; Formaini, Nathan; Bramwell, Thomas J

    2015-12-01

    Intramedullary (IM) nailing is a well-accepted treatment for distal third tibia fractures in combination with injury to the fibula. However, the indications for operative stabilisation of the fibula remain controversial. The authors performed a retrospective review on a consecutive series of patients who underwent intramedullary nailing of a non-comminuted distal third tibia fracture with or without fibular fixation at a Level I urban trauma centre. A review of surgical records identified 120 patients who initially were included in this study, while a total of 98 patients who met the inclusion criteria were included in the final analysis. Our results found no difference in the mean value of coronal and sagittal plane alignment in both the immediate post-operative and follow-up time periods. We also saw no statistically significant difference when comparing malalignment between patients treated with or without fibula fixation. There were no deep infections between the two groups. No significant differences were seen between the fibular fixation group and the non-fixation group. Distal screw removal due to prominence or pain was the most common reason for future surgery in both groups. These findings suggest that the addition of fibular fixation does not affect whether or not alignment is maintained in either the immediate post-operative or short-term follow-up period. Copyright © 2015 Elsevier Ltd. All rights reserved.

  12. Understanding Nitrogen Fixation

    Energy Technology Data Exchange (ETDEWEB)

    Paul J. Chirik

    2012-05-25

    synthesis of ammonia, NH{sub 3}, from its elements, H{sub 2} and N{sub 2}, via the venerable Haber-Bosch process is one of the most significant technological achievements of the past century. Our research program seeks to discover new transition metal reagents and catalysts to disrupt the strong N {triple_bond} N bond in N{sub 2} and create new, fundamental chemical linkages for the construction of molecules with application as fuels, fertilizers and fine chemicals. With DOE support, our group has discovered a mild method for ammonia synthesis in solution as well as new methods for the construction of nitrogen-carbon bonds directly from N{sub 2}. Ideally these achievements will evolve into more efficient nitrogen fixation schemes that circumvent the high energy demands of industrial ammonia synthesis. Industrially, atmospheric nitrogen enters the synthetic cycle by the well-established Haber-Bosch process whereby N{sub 2} is hydrogenated to ammonia at high temperature and pressure. The commercialization of this reaction represents one of the greatest technological achievements of the 20th century as Haber-Bosch ammonia is responsible for supporting approximately 50% of the world's population and serves as the source of half of the nitrogen in the human body. The extreme reaction conditions required for an economical process have significant energy consequences, consuming 1% of the world's energy supply mostly in the form of pollution-intensive coal. Moreover, industrial H{sub 2} synthesis via the water gas shift reaction and the steam reforming of methane is fossil fuel intensive and produces CO{sub 2} as a byproduct. New synthetic methods that promote this thermodynamically favored transformation ({Delta}G{sup o} = -4.1 kcal/mol) under milder conditions or completely obviate it are therefore desirable. Most nitrogen-containing organic molecules are derived from ammonia (and hence rely on the Haber-Bosch and H{sub 2} synthesis processes) and direct synthesis from

  13. A new treatment for avulsion fracture of the calcaneus using an Ilizarov external fixator.

    Science.gov (United States)

    Takahashi, Masayasu; Noda, Mitsuaki; Saegusa, Yasuhiro

    2013-11-01

    In the treatment of avulsion fractures of the posterior calcaneal tuberosity, open reduction and internal fixation are prone to several complications. We describe a new treatment using an Ilizarov external fixator, which can minimise the complications and achieve sufficient stability of the displaced fragment. A 55-year-old woman sustained an avulsion fracture of the calcaneus. Examination revealed the development of bruising with extremely taut skin over the posterior prominence of the displaced bone. Radiographs demonstrated grossly proximal displacement of the tuberosity fragment. Surgery was exclusively percutaneous using an Ilizarov external fixator. The displaced fragment was adequately reduced and stabilised. Progressive weight bearing in the equinus position was initiated at the third week after surgery and the external fixator was removed at the seventh week. There was no skin necrosis or loss of reduction while the fixator was maintained. Postoperative follow-up for 2 years revealed full recovery. Major postoperative complications after conventional open reduction and internal fixation include skin necrosis, skin irritation by metal implants and re-displacement of the reduced fragment. Our method of using an external fixator may decrease the incidence of these three complications. Skin incision and the risk of skin necrosis are inevitable during internal fixation. On the other hand, the use of an external fixator reduces or eliminates skin necrosis, as it is applied percutaneously for reduction and stabilisation of the fragment. External fixation is mostly recommended in cases of poor vascularity or bruising. In addition, skin irritation can be avoided upon removal of the external fixator. Re-displacement occurs occasionally as a serious complication in lag screw fixation, particularly in cases with poor purchase of the osteoporotic bone. Tension band wiring and application of an Ilizarov external fixator in avulsion fractures of the calcaneus can

  14. Clinical Comparison of Outcomes of Early versus Delayed Carotid Artery Stenting for Symptomatic Cerebral Watershed Infarction due to Stenosis of the Proximal Internal Carotid Artery

    Directory of Open Access Journals (Sweden)

    Huakun Liu

    2016-01-01

    Full Text Available The aim of this study was to compare the clinical outcomes of early versus delayed carotid artery stenting (CAS for symptomatic cerebral watershed infarction (sCWI patients due to stenosis of the proximal internal carotid artery. We retrospectively collected clinical data of those who underwent early or delayed CAS from March 2011 to April 2014. The time of early CAS and delayed CAS was within a week of symptom onset and after four weeks from symptom onset. Clinical data such as second stroke, the National Institutes of Health Stroke Scale (NHISS score, and modified Rankin Scale (mRS score and periprocedural complications were collected. The rate of second stroke in early CAS group is lower when compared to that of delayed CAS group. There was no significant difference regarding periprocedural complications in both groups. There was a significant difference regarding mean NHISS score 90 days after CAS in two groups. Early CAS group had a significant better good outcome (mRS score ≤ 2 than delayed CAS group. We suggest early CAS for sCWI due to severe proximal internal carotid artery stenosis as it provides lower rate of second stroke, comparable periprocedural complications, and better functional outcomes compared to that of delayed CAS.

  15. Mechanism of Radial Redistribution of Energetic Trapped Ions Due to m=2/n=1 Internal Reconnection in Joint European Torus Shear Optimized Plasmas

    Energy Technology Data Exchange (ETDEWEB)

    N.N. Gorelenkov; A. Gondhalekar; A.A. Korotkov; S.E. Sharapov; D. Testa; and Contributors to the EFDA-JET Workprogramme

    2002-01-18

    Internal radial redistribution of MeV energy ICRF-driven hydrogen minority ions was inferred from neutral particle analyzer measurements during large amplitude MHD activity leading to internal reconnection in Shear Optimized plasmas in the Joint European Torus (JET). A theory is developed for energetic ion redistribution during a reconnection driven by an m=2/n=1 internal kink mode. Plasma motion during reconnection generates an electric field which can change the energy and radial position of the energetic ions. The magnitude of ion energy change depends on the value of the safety factor at the plasma core from which the energetic ions are redistributed. A relation is found for corresponding change in canonical momentum. P(subscript phi), which leads to radial displacement of the ions. The model yields distinctive new features of energetic ion redistribution under such conditions. Predicted characteristics of ion redistribution are compared with the NPA measurements, and good correlation is found. Sometimes fast ions were transported to the plasma edge due to interaction with a long-lived magnetic island which developed after the reconnection and had chirping frequency in the laboratory frame. Convection of resonant ions trapped in a radially moving phase-space island is modeled to understand the physics of such events.

  16. Closed External Fixation for Failing or Failed Femoral Shaft Plating in a Developing Country.

    Science.gov (United States)

    Aliakbar, Adil; Witwit, Ibrahim; Al-Algawy, Alaa A Hussein

    2017-08-01

    Femoral shaft fractures are one of the common injuries that is treated by open reduction, with internal fixation by plate and screws or intramedullary nailing, which can achieve a high union rate. To evaluate the outcome of using closed external fixation to augment a failing plate; with signs of screw loosening and increasing bone/plate gap; a failed plate; broken plate; screws completely out of bone with redisplacement of fracture. A retrospective study on 18 patients, aged between 17-42 years, who presented between 6-18 weeks after initial surgical fixation, with pain, difficulty in limb function, deformity and abnormal movement at fracture site, was done. X-Rays showed plating failure with acceptable amount of callus, which unfortunately had refractured. Cases associated with infection and no radiological evidence of callus formation were excluded from this study. Closed reduction was done by manipulation, then fracture fixation by AO external fixator. The patients were encouraged for full weight bearing as early as possible with dynamization later on. Of the 18 patients who underwent external fixation after close reduction, 15 cases showed bone healing in a period between 11-18 weeks (mean of 14.27 weeks) with good alignment (Radiologically). Removal of external fixator was done followed by physical therapy thereafter. Closed external fixation for treatment of failing or failed femoral plating, achieves good success rate and has less complications, is a short time procedure, especially in a hospital with limited resources.

  17. [Biomechanical study on the posterior screw fixation in the lower cervical spine].

    Science.gov (United States)

    Lin, Hua-jie; Xu, Rong-min; Liu, Guan-yi

    2011-06-01

    So far, the fixation in the lower cervical spine through posterior approach technology has commonly been used, besides the lateral screw and pedicle screw techniques, transarticular screw and laminar screw techniques have being paid more attention recently. This article introduced four screw fixation ways in the lower cervical spine through posterior approach and reviewed the recent biomechanics studies of four screw fixation techniques. The biomechanics study includes stabilization, pollout strength, insertion technique, and screw characteristic and so on. Lateral screw and pedicle screw techniques have become an effective internal fixation way for the lower cervical spine instability because of their superior stabilization and higher pollout strength. Transarticular screw fixation has become a new way to fix the lower cervical spine through posterior approach, which has widely surgical indications. Besides, this technique is relatively safe, simple and has achieved favorable curative effect in clinic. Laminar screw fixation technique is rarely used in clinic, but the study of anatomy and biomechanics confirmed that this technique can be applied as a salvage technique in clinic. Above four techniques of the screw fixation in the lower cervical spine through posterior approach have advantages and disadvantages, respectively, and the application in clinic is different. Through the biomechanics study of these techniques will contribute to the development of the techniques of the screw fixation in the lower cervical spine through posterior approach and guide the clinical work effectively.

  18. Pars plana vitrectomy combined with internal limiting membrane peeling for recurrent macular edema due to branch retinal vein occlusion after antivascular endothelial growth factor treatments

    Directory of Open Access Journals (Sweden)

    Shirakata Y

    2016-02-01

    Full Text Available Yukari Shirakata,1 Kouki Fukuda,1 Tomoyoshi Fujita,1 Yuki Nakano,1 Hiroyuki Nomoto,2 Hidetaka Yamaji,3 Fumio Shiraga,4 Akitaka Tsujikawa1 1Department of Ophthalmology, Faculty of Medicine, Kagawa University, Miki-cho, 2Nomoto Eye Clinic, Himeji, 3Department of Ophthalmology, Shirai Eye Hospital, Mitoyo, 4Department of Ophthalmology, Okayama University, Okayama, Japan Purpose: To evaluate the anatomic and functional outcomes of pars plana vitrectomy combined with internal limiting membrane peeling for recurrent macular edema (ME due to branch retinal vein occlusion (BRVO after intravitreal injections of antivascular endothelial growth factor (anti-VEGF agents. Methods: Twenty-four eyes of 24 patients with treatment-naive ME from BRVO were treated with intravitreal injections of anti-VEGF agents. Recurred ME was treated with pars plana vitrectomy combined with internal limiting membrane peeling. Results: After the surgery, ME was significantly reduced at 1 month (P=0.031 and the reduction increased with time (P=0.007 at the final visit. With the reduction in ME, treated eyes showed a slow improvement in visual acuity (VA. At the final visit, improvement in VA was statistically significant compared with baseline (P=0.048. The initial presence of cystoid spaces, serous retinal detachment, or subretinal hemorrhage under the fovea, as well as retinal perfusion status, showed no association with VA improvement. However, the presence of epiretinal membrane showed a significant association with the visual recovery. Although eyes without epiretinal membrane showed visual improvement (-0.10±0.32 in logarithm of the minimum angle of resolution [logMAR], eyes with epiretinal membrane showed greater visual improvement (-0.38±0.12 in logMAR, P=0.012. Conclusion: For recurrent ME due to BRVO after anti-VEGF treatment, particularly when accompanied by epiretinal membrane, pars plana vitrectomy combined with internal limiting membrane peeling might be a

  19. Intraocular lens iris fixation. Clinical and macular OCT outcomes

    Science.gov (United States)

    2012-01-01

    Background To assess the efficacy, clinical outcomes, visual acuity (VA), incidence of adverse effects, and complications of peripheral iris fixation of 3-piece acrylic IOLs in eyes lacking capsular support. Thirteen patients who underwent implantation and peripheral iris fixation of a 3-piece foldable acrylic PC IOL for aphakia in the absence of capsular support were followed after surgery. Clinical outcomes and macular SD-OCT (Cirrus OCT; Carl Zeiss Meditec, Germany) were analyzed. Findings The final CDVA was 20/40 or better in 8 eyes (62%), 20/60 or better in 12 eyes (92%), and one case of 20/80 due to corneal astigmatism and mild persistent edema. No intraoperative complications were reported. There were seven cases of medically controlled ocular hypertension after surgery due to the presence of viscoelastic in the AC. There were no cases of cystoid macular edema, chronic iridocyclitis, IOL subluxation, pigment dispersion, or glaucoma. Macular edema did not develop in any case by means of SD-OCT. Conclusions We think that this technique for iris suture fixation provides safe and effective results. Patients had substantial improvements in UDVA and CDVA. This surgical strategy may be individualized however; age, cornea status, angle structures, iris anatomy, and glaucoma are important considerations in selecting candidates for an appropriate IOL fixation method. PMID:23050659

  20. Intraocular lens iris fixation. Clinical and macular OCT outcomes

    Directory of Open Access Journals (Sweden)

    Garcia-Rojas Leonardo

    2012-10-01

    Full Text Available Abstract Background To assess the efficacy, clinical outcomes, visual acuity (VA, incidence of adverse effects, and complications of peripheral iris fixation of 3-piece acrylic IOLs in eyes lacking capsular support. Thirteen patients who underwent implantation and peripheral iris fixation of a 3-piece foldable acrylic PC IOL for aphakia in the absence of capsular support were followed after surgery. Clinical outcomes and macular SD-OCT (Cirrus OCT; Carl Zeiss Meditec, Germany were analyzed. Findings The final CDVA was 20/40 or better in 8 eyes (62%, 20/60 or better in 12 eyes (92%, and one case of 20/80 due to corneal astigmatism and mild persistent edema. No intraoperative complications were reported. There were seven cases of medically controlled ocular hypertension after surgery due to the presence of viscoelastic in the AC. There were no cases of cystoid macular edema, chronic iridocyclitis, IOL subluxation, pigment dispersion, or glaucoma. Macular edema did not develop in any case by means of SD-OCT. Conclusions We think that this technique for iris suture fixation provides safe and effective results. Patients had substantial improvements in UDVA and CDVA. This surgical strategy may be individualized however; age, cornea status, angle structures, iris anatomy, and glaucoma are important considerations in selecting candidates for an appropriate IOL fixation method.

  1. Displaced avulsion fractures of the posterior cruciate ligament: Treated by stellate steel plate fixation.

    Science.gov (United States)

    Li, Lijun; Tian, Wei

    2015-01-01

    The open reduction with internal fixation is an effective approach for treatment of avulsion fracture of posterior cruciate ligament. The previously used internal fixation materials including hollow screws, absorbable screw, tension bands and sutures have great defects such as insufficient fixation strength, susceptibility to re-fracture, etc. Stellate steel plate is novel material for internal fixation which has unique gear-like structure design. We used stellate steel plate for treatment of displaced avulsion fractures of posterior cruciate ligament in this study. 14 patients (9 men, 5 women; aged, 19-35 years; mean age, 28 years) with displaced avulsion fractures of the tibial insertion of the posterior cruciate ligament were retrospectively analyzed between June 2009 and June 2011. The mean duration from injury to the operation was 8.3 days (range 6-15 days). All the patients were treated with open reduction and internal fixation of a stellate steel plate (DePuy, Raynham, MA 02767, USA). The Lysholm-Tegner knee function score criteria were used to analyze results. The mean followup was 24.6 months (range 18-32 months). After 6 months, all the fractures healed and knee joint activity was normal, with no knee stiffness or instability. The Lysholm-Tegner scores were 97.1 ± 1.7 points at the final followup. Owing to its unique gear structure, the stellate steel plate design can effectively fix an avulsion fracture block and it is a simple operation with short postoperative rehabilitation time and firm fixation.

  2. Evaluation on ultrasonic examination methods applied to Ni-base alloy weld including cracks due to stress corrosion cracking found in BWR reactor internal

    International Nuclear Information System (INIS)

    Aoki, Takayuki; Kobayashi, Hiroyuki; Higuchi, Shinichi; Shimizu, Sadato

    2005-01-01

    A Ni-base alloy weld, including cracks due to stress corrosion cracking found in the reactor internal of the oldest BWR in Japan, Tsuruga unit 1, in 1999, was examined by three (3) types of UT method. After this examination, a depth of each crack was confirmed by carrying out a little excavation with a grinder and PT examination by turns until each crack disappeared. Then, the depth measured by the former method was compared with the one measured by the latter method. In this fashion, performances of the UT methods were verified. As a result, a combination of the three types of UT method was found to meet the acceptance criteria given by ASME Sec.XI Appendix VIII, Performance Demonstration for Ultrasonic Examination Systems-Supplement 6. In this paper, the results of the UT examination described above and their evaluation are discussed. (author)

  3. Smaller Fixation Target Size Is Associated with More Stable Fixation and Less Variance in Threshold Sensitivity.

    Directory of Open Access Journals (Sweden)

    Kazunori Hirasawa

    Full Text Available The aims of this randomized observational case control study were to quantify fixation behavior during standard automated perimetry (SAP with different fixation targets and to evaluate the relationship between fixation behavior and threshold variability at each test point in healthy young participants experienced with perimetry. SAP was performed on the right eyes of 29 participants using the Octopus 900 perimeter, program 32, dynamic strategy. The fixation targets of Point, Cross, and Ring were used for SAP. Fixation behavior was recorded using a wearable eye-tracking glass. All participants underwent SAP twice with each fixation target in a random fashion. Fixation behavior was quantified by calculating the bivariate contour ellipse area (BCEA and the frequency of deviation from the fixation target. The BCEAs (deg2 of Point, Cross, and Ring targets were 1.11, 1.46, and 2.02, respectively. In all cases, BCEA increased significantly with increasing fixation target size (p < 0.05. The logarithmic value of BCEA demonstrated the same tendency (p < 0.05. A positive correlation was identified between fixation behavior and threshold variability for the Point and Cross targets (ρ = 0.413-0.534, p < 0.05. Fixation behavior increased with increasing fixation target size. Moreover, a larger fixation behavior tended to be associated with a higher threshold variability. A small fixation target is recommended during the visual field test.

  4. Cannulated screw fixation and plate fixation for displaced intra-articular calcaneus fracture: A meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Fan, Baoyou; Zhou, Xianhu; Wei, Zhijian; Ren, Yiming; Lin, Wei; Hao, Yan; Shi, Guidong; Feng, Shiqing

    2016-10-01

    Displaced intra-articular calcaneus fractures (DIACFs) are the most common type of calcaneus fracture. The differences in therapeutic effectiveness between cannulated screw fixation (CSF) and plate fixation are still unclear. Thus, in this meta-analysis, we evaluated the therapeutic effectiveness of these two fixation methods. We searched for all publications on DIACFs fixated with cannulated screws or plates in the following electronic databases: Pubmed, Cochrane, Embase and CNKI. Only randomized controlled studies were included. The Cochrane Handbook for Systematic Reviews of Interventions (version 5.1.0) was applied for analysis. The primary outcomes were American Orthopedic Foot and Ankle Society score (AOFAS), improvement of Bohler's angle, improvement of Gissane's angle and the width of the calcaneus. Outcomes were reported as the standard mean difference (SMD) or relative risk (RR) with the 95% confidence interval (CI). A random effects model was used to assess the pooled data. Five randomized controlled studies met our inclusion criteria, and a total of 707 patients were involved. There was no statistically significant difference between the cannulated screw fixation group and the plate fixation group in terms of excellent and good AOFAS scores (RR = 1.01, 95%CI 0.91 to 1.13, P = 0.79), improvement of Bohler's angle (SMD = 0.12, 95%CI -0.03 to 0.28, P = 0.12), improvement of Gissane's angle (SMD = 0.09, 95%CI -0.28 to 0.26, P = 0.30), or the width of the calcaneus (SMD = -0.07, 95%CI -0.24 to 0.10, p = 0.45). Compared with plate fixation, CSF showed a significant reduction in the duration of surgery (SMD = -1.74, 95%CI, -3.35 to -0.13, P = 0.03) and rate of complications (RR = 0.25, 95%CI, 0.15 to 0.44, P<0.00001). Cannulated screw fixation and plate fixation have similar fixation effectiveness and functional outcomes in the treatment of displaced intra-articular calcaneus fractures. Due to the shorter duration of surgery and

  5. Abnormal Fixational Eye Movements in Amblyopia.

    Science.gov (United States)

    Shaikh, Aasef G; Otero-Millan, Jorge; Kumar, Priyanka; Ghasia, Fatema F

    2016-01-01

    Fixational saccades shift the foveal image to counteract visual fading related to neural adaptation. Drifts are slow eye movements between two adjacent fixational saccades. We quantified fixational saccades and asked whether their changes could be attributed to pathologic drifts seen in amblyopia, one of the most common causes of blindness in childhood. Thirty-six pediatric subjects with varying severity of amblyopia and eleven healthy age-matched controls held their gaze on a visual target. Eye movements were measured with high-resolution video-oculography during fellow eye-viewing and amblyopic eye-viewing conditions. Fixational saccades and drifts were analyzed in the amblyopic and fellow eye and compared with controls. We found an increase in the amplitude with decreased frequency of fixational saccades in children with amblyopia. These alterations in fixational eye movements correlated with the severity of their amblyopia. There was also an increase in eye position variance during drifts in amblyopes. There was no correlation between the eye position variance or the eye velocity during ocular drifts and the amplitude of subsequent fixational saccade. Our findings suggest that abnormalities in fixational saccades in amblyopia are independent of the ocular drift. This investigation of amblyopia in pediatric age group quantitatively characterizes the fixation instability. Impaired properties of fixational saccades could be the consequence of abnormal processing and reorganization of the visual system in amblyopia. Paucity in the visual feedback during amblyopic eye-viewing condition can attribute to the increased eye position variance and drift velocity.

  6. Abnormal fixational eye movements in strabismus.

    Science.gov (United States)

    Ghasia, Fatema F; Otero-Millan, Jorge; Shaikh, Aasef G

    2018-02-01

    Fixational saccades are miniature eye movements that constantly change the gaze during attempted visual fixation. Visually guided saccades and fixational saccades represent an oculomotor continuum and are produced by common neural machinery. Patients with strabismus have disconjugate binocular horizontal saccades. We examined the stability and variability of eye position during fixation in patients with strabismus and correlated the severity of fixational instability with strabismus angle and binocular vision. Eye movements were measured in 13 patients with strabismus and 16 controls during fixation and visually guided saccades under monocular viewing conditions. Fixational saccades and intersaccadic drifts were analysed in the viewing and non-viewing eye of patients with strabismus and controls. We found an increase in fixational instability in patients with strabismus compared with controls. We also found an increase in the disconjugacy of fixational saccades and intrasaccadic ocular drift in patients with strabismus compared with controls. The disconjugacy was worse in patients with large-angle strabismus and absent stereopsis. There was an increase in eye position variance during drifts in patients with strabismus. Our findings suggest that both fixational saccades and intersaccadic drifts are abnormal and likely contribute to the fixational instability in patients with strabismus. Fixational instability could be a useful tool for mass screenings of children to diagnose strabismus in the absence of amblyopia and latent nystagmus. The increased disconjugacy of fixational eye movements and visually guided saccades in patients with strabismus reflects the disruption of the fine-tuning of the motor and visual systems responsible for achieving binocular fusion in these patients. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  7. Anterior double plating for rigid fixation of isolated tibiotalar arthrodesis.

    Science.gov (United States)

    Plaass, Christian; Knupp, Markus; Barg, Alexej; Hintermann, Beat

    2009-07-01

    Arthrodesis is the most common procedure used to treat end-stage osteoarthritis of the ankle, particularly in patients with difficult conditions such as poor bone quality. While many techniques are available to fuse the ankle, current recommendations favor the use of internal fixation with screws and/or plates. Despite of progress, the complication rate remains a major concern. Non-union is one difficult problem especially with difficult bone conditions, particularly the loss of bone stock on the talar side. Therefore, fusion of the tibiotalar joint is often extended to the talocalcaneal joint to provide sufficient stability. To preserve the subtalar joint, an anterior double plate system for rigid fixation of isolated tibiotalar arthrodesis was developed. This is a preliminary report on the clinical and radiological outcome with this technique. Twenty-nine patients (15 men, 14 women; one ankle per patient) were treated from October 2006 to September 2007. We converted 16 ankles with osteoarthritis and difficult bone conditions, four non-united ankle arthrodeses, and nine failed total ankle replacements to an isolated tibiotalar arthrodesis using anterior double plating. If necessary, we used solid allograft to fill bony defects. Outcomes included bone union as assessed by radiographs, pain as indicated by the American Orthopaedic Foot and Ankle Society scores, and patient satisfaction. Solid arthrodesis was achieved after an average of 12.3 (eight to 26) weeks in the 16 ankles without bone graft interposed between the tibia and talus, and 14.3 (range, 8 to 26) weeks in the 13 ankles with interpositional bone allograft. Radiographs showed that the position of arthrodesis obtained at the time of surgery did not change in any patient up to one year after surgery. The mean American Orthopaedic Foot and Ankle Society (AOFAS) Hindfoot Score increased from 37 (range, 20 to 63) preoperatively to 68 (range, 50 to 92) at the last followup. Twenty-seven patients (93%) were

  8. Overcoming fixation with repeated memory suppression.

    Science.gov (United States)

    Angello, Genna; Storm, Benjamin C; Smith, Steven M

    2015-01-01

    Fixation (blocks to memories or ideas) can be alleviated not only by encouraging productive work towards a solution, but, as the present experiments show, by reducing counterproductive work. Two experiments examined relief from fixation in a word-fragment completion task. Blockers, orthographically similar negative primes (e.g., ANALOGY), blocked solutions to word fragments (e.g., A_L_ _GY) in both experiments. After priming, but before the fragment completion test, participants repeatedly suppressed half of the blockers using the Think/No-Think paradigm, which results in memory inhibition. Inhibiting blockers did not alleviate fixation in Experiment 1 when conscious recollection of negative primes was not encouraged on the fragment completion test. In Experiment 2, however, when participants were encouraged to remember negative primes at fragment completion, relief from fixation was observed. Repeated suppression may nullify fixation effects, and promote creative thinking, particularly when fixation is caused by conscious recollection of counterproductive information.

  9. Influence of sizes of abutments and fixation screws on dental implant system: a non-linear finite element analysis.

    Science.gov (United States)

    Mao, Zhihong; Yi, Dake; Cao, Guo

    2017-08-28

    The purpose of this study is to discuss the influence of sizes of abutments and fixation screws on immediately loaded dental implants in mandibular bones using nonlinear finite element methods. Abutments with three unilateral wall thicknesses and fixation screws with three diameters are analyzed to compare the stresses and deformations under a vertical or oblique force of 130 N. The nonlinearity due to friction contacts between the fixation screw, the abutment, the implant, and the bone is taken into account. The results showed that improper sizes of abutments and fixation screws would increase the stress and deformation of the dental implant system. If possible, the diameter of fixation screw should not be smaller than Φ1.0 mm, the diameter between Φ1.0 mm and Φ1.2 mm is acceptable. The fixation screw diameter preferably exceeds Φ1.4 mm. The unilateral wall thickness >0.5 mm is optimal selection for abutments.

  10. Nitrogen fixation method and apparatus

    Science.gov (United States)

    Chen, H.L.

    1983-08-16

    A method and apparatus for achieving nitrogen fixation includes a volumetric electric discharge chamber. The volumetric discharge chamber provides an even distribution of an electron beam, and enables the chamber to be maintained at a controlled energy to pressure (E/p) ratio. An E/p ratio of from 5 to 15 kV/atm of O[sub 2]/cm promotes the formation of vibrationally excited N[sub 2]. Atomic oxygen interacts with vibrationally excited N[sub 2] at a much quicker rate than unexcited N[sub 2], greatly improving the rate at which NO is formed. 1 fig.

  11. Percutaneous Fixation of Displaced Calcaneal Fracture

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    Yeung Yip-Kan

    2011-06-01

    Conclusion: Percutaneous fixation of displaced tongue-type calcaneal fractures is an effective treatment with acceptable clinical outcome, short hospital stay, minimal skin complications, and quick recovery.

  12. Nitrogen Fixation in the Intertidal Sediments of the Yangtze Estuary: Occurrence and Environmental Implications

    Science.gov (United States)

    Hou, Lijun; Wang, Rong; Yin, Guoyu; Liu, Min; Zheng, Yanling

    2018-03-01

    Nitrogen fixation is a microbial-mediated process converting atmospheric dinitrogen gas to biologically available ammonia or other molecules, and it plays an important role in regulating nitrogen budgets in coastal marine ecosystems. In this study, nitrogen fixation in the intertidal sediments of the Yangtze Estuary was investigated using nitrogen isotope tracing technique. The abundance of nitrogen fixation functional gene (nifH) was also quantified. The measured rates of sediment nitrogen fixation ranged from 0.37 to 7.91 nmol N g-1 hr-1, while the abundance of nifH gene varied from 2.28 × 106 to 1.28 × 108 copies g-1 in the study area. The benthic nitrogen fixation was correlated closely to the abundance of nifH gene and was affected significantly by salinity, pH, and availability of sediment organic carbon and ammonium. It is estimated that sediment nitrogen fixation contributed approximately 9.3% of the total terrigenous inorganic nitrogen transported annually into the Yangtze estuarine and coastal environment. This result implies that the occurrence of benthic nitrogen fixation acts as an important internal source of reactive nitrogen and to some extent exacerbates nitrogen pollution in this aquatic ecosystem.

  13. Monoaxial external fixation of the calcaneus: An anatomical study assessing the safety of monoaxial pin insertion.

    Science.gov (United States)

    Thomson, Callum M; Esparon, Tom; Rea, Paul M; Jamal, Bilal

    2016-10-01

    The use of external fixation for intra-articular calcaneal fractures is increasing in popularity. Studies have shown fine wire and monoaxial external fixation to be a viable surgical alternative to more invasive methods of open reduction and internal fixation of the calcaneus. However, there is an absence of literature that quantifies the risk of pin insertion for monoaxial fixation. This study aimed to determine the safety of inserting monoaxial pins within the calcaneus to house the Orthofix Calcaneal Mini-Fixator. Five formalin embalmed cadaveric ankle and lower leg specimens were inserted with six monoaxial pins. Careful dissection then revealed the presence of the tendons of peroneus longus and brevis, the sural nerve and the small saphenous vein in relation to these pins. Measurements from each pin to each of these structures were made as the structures transected lines drawn from each pin to two palpable bony landmarks: the inferior tip of the lateral malleolus and the posterosuperior calcaneus. In doing this, the risk posed by each pin could be evaluated. We found that two particular pins, those used to hold the articular surface of the subtalar joint in a reduced position, posed a larger risk of injury to surrounding structures than the remaining pins. These findings therefore suggest that monoaxial fixation of the calcaneus using a six pin approach is a relatively safe method of rectifying calcaneal fractures and thus may serve as a welcome alternative to other methods of calcaneal fixation. Copyright © 2016 Elsevier Ltd. All rights reserved.

  14. Estimation of the internal radiation dose received by the adult population of Graz due to the contamination with radioactive iodine and cesium

    International Nuclear Information System (INIS)

    Rabitsch, H.; Kahr, G.

    1991-07-01

    During the first months following the fallout we have measured the activities of J-131 in some human thyroids. To study the long-term variation of radiocesium with time, we have observed the activity level of Cs-134 and Cs-137 in human muscle tissues over a period of 4 years. Simultaneously we have determined the activities of the naturally occuring potassium-40 in all samples, which were taken at forensic autopsies of persons deceased in the area of Graz. Comparisons of iodine and radiocesium activities measured in the samples with data obtained by other studies after nuclear weapon tests are given. Average individual thyroid dose was calculated to be 556.1 μSv. The main part of this thyroid dose is caused by the inhalation pathway. Effective individual dose equivalents originated by the radiocesium body content were calculated by means of time-integrated activities and the method of absorbed fractions. Dose estimations based on data of the Standard Man and a distribution factor of 0.7 was assumed with regards to the amount of radiocesium and K-40 in muscle mass. From the measurements, we have estimated a mean individual effective dose equivalent of 252.2 μSv due to internal exposure to radiocesium during the 4 years following the fallout. Estimated dose values are compared with predictions and the exposure caused by K-40. (Authors, shortened by Quittner)

  15. Age and educational inequalities in smoking cessation due to three population-level tobacco control interventions: findings from the International Tobacco Control (ITC) Netherlands Survey.

    Science.gov (United States)

    Nagelhout, Gera E; Crone, Matty R; van den Putte, Bas; Willemsen, Marc C; Fong, Geoffrey T; de Vries, Hein

    2013-02-01

    This study aimed to examine age and educational inequalities in smoking cessation due to the implementation of a tobacco tax increase, smoke-free legislation and a cessation campaign. Longitudinal data from 962 smokers aged 15 years and older were used from three survey waves of the International Tobacco Control (ITC) Netherlands Survey. The 2008 survey was performed before the implementation of the interventions and the 2009 and 2010 surveys were performed after the implementation. No significant age and educational differences in successful smoking cessation were found after the implementation of the three tobacco control interventions, although smokers aged 15-39 years were more likely to attempt to quit. Of the three population-level tobacco control interventions that were implemented simultaneously in the Netherlands, only the smoke-free legislation seemed to have increased quit attempts. The price increase of cigarettes may have been only effective in stimulating smoking cessation among younger smokers. Larger tax increases, stronger smoke-free legislation and media campaigns about the dangers of (second-hand) smoking are needed in the Netherlands.

  16. An integer programming model for distal humerus fracture fixation planning.

    Science.gov (United States)

    Maratt, Joseph D; Peaks, Ya-Sin A; Doro, Lisa Case; Karunakar, Madhav A; Hughes, Richard E

    2008-05-01

    To demonstrate the feasibility of an integer programming model to assist in pre-operative planning for open reduction and internal fixation of a distal humerus fracture. We describe an integer programming model based on the objective of maximizing the reward for screws placed while satisfying the requirements for sound internal fixation. The model maximizes the number of bicortical screws placed while avoiding screw collision and favoring screws of greater length that cross multiple fracture planes. The model was tested on three types of total articular fractures of the distal humerus. Solutions were generated using 5, 9, 21 and 33 possible screw orientations per hole. Solutions generated using 33 possible screw orientations per hole and five screw lengths resulted in the most clinically relevant fixation plan and required the calculation of 1,191,975 pairs of screws that resulted in collision. At this level of complexity, the pre-processor took 104 seconds to generate the constraints for the solver, and a solution was generated in under one minute in all three cases. Despite the large size of this problem, it can be solved in a reasonable amount of time, making use of the model practical in pre-surgical planning.

  17. Fixação interna de fratura de epífise proximal de tíbia em potro Internal fixation of the tibial proximal epiphyses fracture in a foal

    Directory of Open Access Journals (Sweden)

    Carlos Henrique Maciel Brunner

    2006-02-01

    Full Text Available A fratura Salter Harris tipo II ocorre comumente na epífise proximal de tíbia em potros e tem reparação difícil mas com o advento das técnicas de fixação interna, o prognóstico tem melhorado. No caso descrito, em um potro da raça árabe de 26 dias de idade, com fratura proximal de tíbia direita tipo Salter Harris II, foram utilizadas as placas de compressão para garantirem estabilização e aproximação dos fragmentos fraturados, porém com risco de ocasionar distúrbios no desenvolvimento esquelético. No caso relatado, através do controle radiológico, não foi evidenciada diminuição da radioluscência na região correspondente à cartilagem de conjugação proximal da tíbia. O artigo tem como objetivo discutir o tratamento empregado que se mostrou como alternativa viável pelo resultado favorável com bons resultados.The most frequent fracture is tibia’s proximal epiphysis in foals is Salter Harris type II although its difficult to repair. The development of the inner fixation technique has been made the prognosis better. The dynamic compression bone plate allow guaranteed reduction and stabilization of the bone’s fragments, but it can promote development disturbs. In this case, by the radiological control, it has not shown less radiolucency in the proximal tibia’s growth plate. The treatment used showed itself as a feasible alternative because of the favourable good results.

  18. The in situ morphology of microglia is highly sensitive to the mode of tissue fixation.

    Science.gov (United States)

    Cătălin, Bogdan; Stopper, Laura; Bălşeanu, Tudor-Adrian; Scheller, Anja

    2017-12-01

    Microglia are known as the most motile cells in the central nervous system (CNS). It was shown in vivo that they permanently scan their direct microenvironment and react to pathological conditions within minutes. Many studies of brain pathologies use fixed brain tissue to investigate cellular changes. Unfortunately, due to technical reasons, the time span between the induction of the fixation procedure (start of the perfusion) and the finally-fixed tissue lasts several minutes, giving time to microglia to start reacting to the ischemic conditions due to perfusion start. Here, we investigated the microglial changes generated by the fixation itself in TgH(CX3CR1-EGFP) mice with fluorescent labelled microglia using confocal laser scanning microscopy (CLSM) of fixed brain tissue as well as two-photon laser scanning microscopy (2P-LSM) during the perfusion of a living animal. We revealed the impact of fixation and buffer parameters on cell morphology. The largest morphological differences compared to physiological in vivo branch arborization were observed when the directly dissected brain was immersed in paraformaldehyde fixation solution overnight, without prior fixative perfusion of the animal. But even perfusion with a fixative, followed by post-fixation leads to small changes in microglial process length and number and could not be prevented when compared to physiological in vivo microglia morphology acquired using in vivo 2P-LSM. Interestingly, perfusion with different buffers either oxygenated artificial cerebrospinal fluid or phosphate buffered saline prior to perfusion-fixation showed minor microglia changes in arborization and/or number of processes. Fixation methods influence microglia morphology. Therefore, to define microglia activation states immunohistochemical stainings or genetic labelling of the cells have to be included in addition to morphological analysis. Copyright © 2017 Elsevier B.V. All rights reserved.

  19. Is prophylactic fixation a cost-effective method to prevent a future contralateral fragility hip fracture?

    Science.gov (United States)

    Faucett, Scott C; Genuario, James W; Tosteson, Anna N A; Koval, Kenneth J

    2010-02-01

    : A previous hip fracture more than doubles the risk of a contralateral hip fracture. Pharmacologic and environmental interventions to prevent hip fracture have documented poor compliance. The purpose of this study was to examine the cost-effectiveness of prophylactic fixation of the uninjured hip to prevent contralateral hip fracture. : A Markov state-transition model was used to evaluate the cost and quality-adjusted life-years (QALYs) for unilateral fixation of hip fracture alone (including internal fixation or arthroplasty) compared with unilateral fixation and contralateral prophylactic hip fixation performed at the time of hip fracture or unilateral fixation and bilateral hip pad protection. Prophylactic fixation involved placement of a cephalomedullary nail in the uninjured hip and was initially assumed to have a relative risk of a contralateral fracture of 1%. Health states included good health, surgery-related complications requiring a second operation (infection, osteonecrosis, nonunion, and malunion), fracture of the uninjured hip, and death. The primary outcome measure was the incremental cost-effectiveness ratio estimated as cost per QALY gained in 2006 US dollars with incremental cost-effectiveness ratios below $50,000 per QALY gained considered cost-effective. Sensitivity analyses evaluated the impact of patient age, annual mortality and complication rates, intervention effectiveness, utilities, and costs on the value of prophylactic fixation. : In the baseline analysis, in a 79-year-old woman, prophylactic fixation was not found to be cost-effective (incremental cost-effectiveness ratio = $142,795/QALY). However, prophylactic fixation was found to be a cost-effective method to prevent contralateral hip fracture in: 1) women 71 to 75 years old who had 30% greater relative risk for a contralateral fracture; and 2) women younger than age 70 years. Cost-effectiveness was greater when the additional costs of prophylaxis were less than $6000. However, for

  20. Early Onset Sixth-Nerve Palsy with Eccentric Fixation.

    Science.gov (United States)

    Nanda, Kaajal D; Lacey, Eve; Liasis, Alki; Nischal, Ken K

    2017-01-01

    To report four cases of early onset sixth-nerve palsy all of whom had eccentric fixation. A retrospective case note review was undertaken of all cases presenting to the senior author's private and NHS practice with early onset sixth palsy between 2006 and 2012. As well as demographic information, details of ophthalmic, orthoptic, electrophysiological examinations, and radiological investigations that were extracted from the records. Four children with unilateral or asymmetric early onset sixth-nerve palsy were identified, of which three were congenital. All four had MRI and only one had a normal MRI. Age at presentation ranged from 14-42 months, but all four had marked esotropia and poor visual acuities in the worst affected eye with eccentric fixation, which became more easily or only noticeable after surgical correction. Three patients with congenital sixth-nerve palsy underwent vertical muscle transposition with Botulinum Toxin A (BTXA) to the ipsilateral medial rectus, and two of these patients also had Foster sutures to the transposed vertical muscles. The fourth patient had unilateral medial rectus recession and lateral rectus resection. The mean preoperative measurement was 55 Δ ET (range 50-60 Δ ), and the mean postoperative measurement was 11 Δ ET (range 16XT-25ET) at near, and 2 Δ XT (range 15XT-14ET) at distance. We speculate that early onset paralytic strabismus due to congenital sixth-nerve palsy results in an inability to cross fixate which results in the development of eccentric fixation. Attempts to use reverse occlusion to negate the eccentric fixation failed. We therefore recommend early surgery for this condition to avoid this sequelae. © 2017 Board of regents of the University of Wisconsin System, American Orthoptic Journal, Volume 67, 2017, ISSN 0065-955X, E-ISSN 1553-4448.

  1. Intramedullary versus extramedullary fixation in the management of subtrochanteric femur fractures: a meta-analysis

    Directory of Open Access Journals (Sweden)

    Liu PC

    2015-04-01

    Full Text Available Pengcheng Liu,1,2,* Xing Wu,1,* Hui Shi,1,2 Run Liu,1 Hexi Shu,1 JinPeng Gong,1 Yong Yang,1 Qi Sun,1 Jiezhou Wu,1,2 Xiaoyang Nie,1 Ming Cai1 1Department of Orthopedics, Shanghai Tenth People’s Hospital, Tongji University, School of Medicine, Shanghai, 2First Clinical Medical College, Nanjing Medical University, Nanjing, People’s Republic of China *These authors contributed equally to this work Background: Intramedullary and extramedullary fixation methods are used in the management of subtrochanteric femur fractures. However, whether intramedullary or extramedullary fixation is the primary treatment for subtrochanteric femur fractures in adults remains debatable.Level of evidence: Meta-analyses of prospective studies, level I.Materials and methods: The Cochrane library, Embase, Google Scholar, and PubMed databases were searched separately for all relevant studies published before January 1, 2015. No language restriction was applied. Prospective randomized controlled trials that compared intramedullary or extramedullary internal fixation to repair subtrochanteric femur fractures in adults were included. We determined intraoperative data, postoperative complications, fracture fixation complications, wound infection, hospital stay days, and final outcome measures to assess the relative effects of different internal fixation methods for the treatment of subtrochanteric femur fractures in adults.Results: Six studies were included in our meta-analysis. The relative risks (RRs of revision rate was 83% lower (RR, 0.17, 95% confidence interval [CI], 0.05 to 0.60; P=0.006, fixation failure rate was 64% lower (RR, 0.36, 95% CI, 0.12 to 1.08; P=0.07, non-union rate was 77% lower (RR, 0.23, 95% CI, 0.07 to 0.81; P=0.02 in the intramedullary group compared with the extramedullary group. No significant differences were found between the intramedullary group and extramedullary group for intraoperative data, postoperative complications, wound infection

  2. EARLY RESULTS OF UNSTABLE DISTAL RADIUS FRACTURES- ORIF WITH LOCKING COMPRESSION PLATE VERSUS LIGAMENTOTAXIS WITH EXTERNAL FIXATORS

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    Mondeep Gayan

    2017-04-01

    Full Text Available BACKGROUND External Fixation (EF and Open Reduction and Internal Fixation (ORIF have been the traditional surgical modalities for unstable distal radius fractures. The Locking Compression Plates (LCP acting as “internal external fixators” are particularly valuable in difficult situations of fractures. We undertook a study to evaluate the outcome of unstable distal radius fractures treated with ORIF with LCP versus those treated by ligamentotaxis with external fixators. MATERIALS AND METHODS A comparative study was carried out in a tertiary care centre with 30 cases of unstable distal radius fractures (15 cases in each group. In one group, open reduction and internal fixation with distal radius volar locking compression plate was carried out and in the other group ligamentotaxis with external fixator was done. The patients were treated and followed up over a period of one and a half year between June 2011 to November 2012. The fractures were classified according to AO classification (Arbeitsgemeinschaft für Osteosynthesefragen: German for “Association for the Study of Internal Fixation” or AO. The functional results were evaluated at the end of 6 months according to Demerit point system of Gartland and Werley modified by Sarmiento (1975 and the anatomical results as per Lindstrom criteria (1959 modified by Sarmiento (1980. RESULTS Overall 86.66% (13 cases had good-to-excellent anatomical results in external fixator group as compared to 93.33% (14 cases in LCP group. The functional outcome was excellent in 80% (12 and good in 13.33% (2 cases in external fixator group as compared to 66.66% (10 excellent and 26.66% (4 good in LCP group. CONCLUSION Both open reduction and internal fixation with locking compression plate and ligamentotaxis with external fixators are good treatment modalities for unstable distal radius fractures. However, the choice should be guided by the fracture configuration, surgeons’ experience and patient’s profile.

  3. MODELING OF BONE FRAGMENTS FIXATION WITH AN EXTERNAL FIXATION DEVICE FOR BILATERAL ROTATION UNSTABLE PELVIC INJURIES B TYPE ACCORDING TO AO/ASIF CLASSIFICATION

    Directory of Open Access Journals (Sweden)

    V. G. Vinogradov

    2014-01-01

    Full Text Available Objective: to determine the stability of bone fragments fixation with an external fixation device in the simulation of bilateral partly unstable pelvic injuries of B type according to AO/ASIF classification and to identify the role of different fixation elements in the stability of fixation. Material and methods: the study was performed on the finite element model of a system “an external fixation device - pelvis” developed for a software package MSCNastran. Formation of a fracture of pubic and ischial pelvic bones was accomplished by means of rupture in the finite element network and decrease of elasticity modulus in the ilio-sacral joint on both sides up to 35 mm at the site of a fracture. Loads were carried on top of the body of the first sacral vertebra with a force of 500H.The second area of application of the load was from the bottom-up on the acetabular roof with a force of 250H. In this study the effect of different elements of an external fixation device on the stiffness of bone fragments fixation was evaluated. Symmetrical elements were removed both separately and together. As a result, the stiffness of a system decreased and the displacement at the fracture site increased. Conclusion: in a model of partly stable pelvic injuries accompanied by general rotation instability in the horizontal and sagittal planes to 35 mm, an external fixation device provided high stability of bone fragments (to 3 mm due to introduction of bone rods in the iliac wings with the obligatory introduction of the rod in the vertical branches of pubic bones and strengthening the anterior lower bar between the subsystems. What is more, installing the anterior upper bar or introduction of bone rods in the bodies of iliac bone are not necessary.

  4. Assessment of external and internal doses due to farming in high background radiation areas in old tin mining localities in Jos-plateau, Nigeria

    International Nuclear Information System (INIS)

    Jibiri, N.N.; Farai, I.P.; Alausa, S.K.

    2009-01-01

    Farming on soils situated in high background radiation areas can result to enhanced radiation exposure scenarios and pathways to humans. To assess the likely levels of exposures, farm soil samples were collected from different farmlands in three old tin mining localities (Bitsichi, Bukuru and Ropp) in Jos Plateau Nigeria, known for high radiations. The soil samples were analyzed for the activity concentrations of 226 Ra, 232 Th and 40 K, using gamma-ray spectroscopy. The outdoor annual effective dose rates were calculated using the activity concentrations of the radionuclides and were found to vary from 0.07 mSv to 2.02 mSv across the three localities. Considering dust generation from soil tillage and inadvertent ingestion of soil particles, the likely internal radiation hazards were estimated using conservative dust and soil loading factors. The total average annual effective dose rates due to 226 Ra and 232 Th that could result from dust inhalation and ingestion of soil particles were 16.9 μSv, 8.1 μSv and 8.8 μSv, respectively for Bitsichi, Bukuru and Ropp. Though these values are about 5% the outdoor exposures to the farmers in those farms and greater than 1 μSv y-1, from the point of view of radiation protection and risk, they are significant. It suffices to say, therefore, that the results of this study will create the possibility of the importance to evaluate the health risk among the farming population and workplace environments which often is not covered by regulations concerning health protection. (author)

  5. Complex tibial plateau fractures treated by hybrid external fixation system: A correlation of followup computed tomography derived quality of reduction with clinical results

    Directory of Open Access Journals (Sweden)

    Konstantinos Kateros

    2018-01-01

    Full Text Available Background: Tibial plateau fractures are common due to high energy injuries. The principles of treatment include respect for the soft tissues, restoring the congruity of the articular surface and reduction of the anatomic alignment of the lower limb to enable early movement of the knee joint. There are various surgical fixation methods that can achieve these principles of treatment. Recognition of the particular fracture pattern is important, as this guides the surgical approach required in order to adequately stabilize the fracture. This study evaluates the results of the combined treatment of external fixator and limited internal fixation along with the advantages using postoperative computed tomography (CT scan after implant removal. Materials and Methods: 55 patients with a mean age of 42 years (range 17–65 years with tibial plateau fracture, were managed in our institution between October 2010 and September 2013., Twenty fractures were classified as Schatzker VI and 35 as Schatzker V. There were 8 open fractures (2 Gustilo Anderson 3A and 6 Gustilo Anderson 2. All fractures were treated with closed reduction and hybrid external fixation (n = 21/38.2% or with minimal open reduction internal fixation and a hybrid system (n = 34/61.8%. After the removal of the fixators, CT-scan was programmed for all the cases, for correlation with the results. At final followup, the American Knee Society Score (AKSS was administered. Results: All patients were evaluated with a minimum of 12 months (range 12–21 months followup. Average time to union was 15.5 weeks (range 13–19 weeks. The postoperative joint congruity as evaluated in the postoperative CT-scan was 5° in 19 cases (35%. Patients with residual joint depression 4.5 mm displayed a 100% chance of getting poor-fair scores both in AKSS knee and AKSS function score. The association of a postoperative mechanical axis within 5° of the contralateral limb and improved knee scores was statistically

  6. External fixation for closed pediatric femoral shaft fractures: where are we now?

    Science.gov (United States)

    Kong, Heather; Sabharwal, Sanjeev

    2014-12-01

    Recent advances in external fixation technique and pin design have sought to minimize complications such as pin site infection and premature removal of the external fixator. Although newer forms of internal fixation have gained popularity, external fixation may still have a role in managing pediatric femoral shaft fractures. We sought to assess the time to healing, limb alignment, and complications observed in a cohort of pediatric patients with closed femoral shaft fractures who were treated with external fixation. Over a 15-year period, one surgeon treated 289 pediatric patients with femur fractures, 31 (11%) of whom received an external fixator. The general indications for use of an external fixator during the period in question included length-unstable fractures, metadiaphyseal location, refracture, and pathologic fracture. Six patients (19%) had inadequate followup data and four patients (13%) were treated with a combination of flexible intramedullary nails and external fixation, leaving 21 patients for analysis. Mean age at injury was 10 years (range, 6-15 years) and followup averaged 22 months (range, 5-45 months) after removal of the fixator. Radiographs were examined for alignment and limb length discrepancy. Complications were recorded from a chart review. Mean time in the fixator was 17 weeks (range, 9-24 weeks). One patient sustained a refracture and one patient with an isolated femur fracture had a leg length discrepancy > 2 cm. There were no pin site infections requiring intravenous antibiotics or additional surgery. One patient with Blount disease and previous tibial osteotomy developed transient peroneal nerve palsy. Despite improvements in pin design and predictable fracture healing, complications such as refracture and leg length discrepancy after external fixation of pediatric femoral shaft fractures can occur. However, external fixation remains a viable alternative for certain fractures such as length-unstable fractures, metadiaphyseal

  7. Dinitrogen fixation in aphotic oxygenated marine environments

    Directory of Open Access Journals (Sweden)

    Eyal eRahav

    2013-08-01

    Full Text Available We measured N2 fixation rates from oceanic zones that have traditionally been ignored as sources of biological N2 fixation; the aphotic, fully oxygenated, nitrate (NO3--rich, waters of the oligotrophic Levantine Basin (LB and the Gulf of Aqaba (GA. N2 fixation rates measured from pelagic aphotic waters to depths up to 720 m, during the mixed and stratified periods, ranged from 0.01 nmol N L-1 d-1 to 0.38 nmol N L-1 d-1. N2 fixation rates correlated significantly with bacterial productivity and heterotrophic diazotrophs were identified from aphotic as well as photic depths. Dissolved free amino acid amendments to whole water from the GA enhanced bacterial productivity by 2to 3.5 and N2 fixation rates by ~ 2 fold in samples collected from aphotic depths while in amendments to water from photic depths bacterial productivity increased 2 to 6 fold while N2 fixation rates increased by a factor of 2 to 4 illustrating that both BP an heterotrophic N2 fixation are carbon limited. Experimental manipulations of aphotic waters from the LB demonstrated a significant positive correlation between transparent exopolymeric particles (TEP concentration and N2 fixation rates. This suggests that sinking organic material and high carbon (C: nitrogen (N micro-environments (such as TEP-based aggregates or marine snow could support high heterotrophic N2 fixation rates in oxygenated surface waters and in the aphotic zones. Indeed, our calculations show that aphotic N2 fixation accounted for 37 to 75 % of the total daily integrated N2 fixation rates at both locations in the Mediterranean and Red Seas with rates equal or greater to those measured from the photic layers. Moreover, our results indicate that that while N2 fixation may be limited in the surface waters, aphotic, pelagic N2 fixation may contribute significantly to new N inputs in other oligotrophic basins, yet it is currently not included in regional or global N budgets.

  8. International

    International Nuclear Information System (INIS)

    Anon.

    1997-01-01

    This rubric reports on 10 short notes about international economical facts about nuclear power: Electricite de France (EdF) and its assistance and management contracts with Eastern Europe countries (Poland, Hungary, Bulgaria); Transnuclear Inc. company (a 100% Cogema daughter company) acquired the US Vectra Technologies company; the construction of the Khumo nuclear power plant in Northern Korea plays in favour of the reconciliation between Northern and Southern Korea; the delivery of two VVER 1000 Russian reactors to China; the enforcement of the cooperation agreement between Euratom and Argentina; Japan requested for the financing of a Russian fast breeder reactor; Russia has planned to sell a floating barge-type nuclear power plant to Indonesia; the control of the Swedish reactor vessels of Sydkraft AB company committed to Tractebel (Belgium); the renewal of the nuclear cooperation agreement between Swiss and USA; the call for bids from the Turkish TEAS electric power company for the building of the Akkuyu nuclear power plant answered by three candidates: Atomic Energy of Canada Limited (AECL), Westinghouse (US) and the French-German NPI company. (J.S.)

  9. Locked plating as an external fixator in treating tibial fractures: A PRISMA-compliant systematic review.

    Science.gov (United States)

    Luo, Peng; Xu, Ding; Wu, Jia; Chen, Yi-Heng

    2017-12-01

    This article is a systematic review of the published literature about the biomechanics, functional outcomes, and complications of a locked plate as an external fixator in treating tibial fractures. We searched the PubMed, Ovid Medline, Embase, ScienceDirect, and Cochrane Library databases to retrieve the relevant studies. Studies published in English and Chinese which assessed adult patients and more than 4 cases who had sustained any type of fresh tibial fracture treated with the external locking plate, provided that they reported functional outcomes, range of motion (ROM), union or complication rates, and the biomechanical studies of external locked plating are also included. The electronic search strategy revealed 248 studies, and 2 studies were identified as relevant through manual search of references. Finally, 12 studies were included in this systematic review. These consist of 3 pure biomechanical studies, 8 case series, and 1 study including both of biomechanics and case series. Due to the heterogeneity of biomechanical studies, we can only conclude that external locked plate shows inferior structural stiffness than internal locked plate. The clinical studies reported that external locked plating gave a satisfactory ROM of the knee and ankle, functional outcomes, union rate, and low complication rate. We can only conclude that external locked plate shows inferior structural stiffness than internal locked plate because of the heterogeneity of biomechanical studies. The clinical studies showed locked plating as an external fixator in treating tibial fractures can be considered as a safe and successful procedure. However, as yet, there is unconvincing evidence that it is superior to standard techniques with regards to clinical and functional outcomes. More and well-designed studies about this technique should be carried out.

  10. 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

  11. Design, fabrication and structural optimization of tubular Carbon/Kevlar®/PMMA/Graphene nanoplates composite for bone fixation prosthesis.

    Science.gov (United States)

    Nasiri, Fatemeh; Ajeli, Saeed; Semnani, Dariush; Jahanshahi, Mohsen; Emadi, Rahmatollah

    2018-03-22

    The present work is investigated mechanical properties of tubular carbon/Kevlar® composite coated with poly methyl methacrylate/Graphene nanoplates as used in internal fixation of bones. Carbon fibers are good candidates for developing high-strength biomaterials and due to better stress transfer and electrical properties, they can enhance tissue formation. In order to improve carbon brittleness, ductile Kevlar® was added to the composite. The tubular carbon/ Kevlar® composites have been prepared with tailorable braiding technology by changing fiber pattern and angle in composite structure and number of composite layers. Fuzzy analyses used for optimizing tailorable parameters of 80 prepared samples and then mechanical properties of selected samples are discussed from the viewpoint of mechanical properties required for bone fixation device. Experimental results showed that with optimizing braiding parameters the desired composite structure with mechanical properties close to bone properties could be produced. Results showed that carbon/Kevlar® braid's physical properties, fiber composite distribution and diameter uniformity resulted in matrix uniformity, which enhanced strength and modulus due to better ability for distributing stress on the composite. Finally, as graphene nanoplates demonstrated its potential properties to improve wound healing intended for bone replacement, so reinforcing PMMA matrix with graphene nanoplates enhanced the composite quality as an implant. © 2018 IOP Publishing Ltd.

  12. Revisiting the Humanisation of International Law: Limits and Potential : Obligations Erga Omnes, Hierarchy of Rules and the Principle of Due Diligence as the Basis for Further Humanisation

    NARCIS (Netherlands)

    V.P. Tzevelekos (Vassilis)

    2013-01-01

    textabstractThe article critically evaluates the theory of the humanisation of international law. First, it argues that despite human rights having impact on (other areas of) international law, this trend has in the past been somewhat inflated. A number of examples are given where human rights have

  13. Biomechanical Analysis of Latarjet Screw Fixation: Comparison of Screw Types and Fixation Methods.

    Science.gov (United States)

    Shin, Jason J; Hamamoto, Jason T; Leroux, Timothy S; Saccomanno, Maristella F; Jain, Akshay; Khair, Mahmoud M; Mellano, Christen R; Shewman, Elizabeth F; Nicholson, Gregory P; Romeo, Anthony A; Cole, Brian J; Verma, Nikhil N

    2017-09-01

    To compare the initial fixation stability, failure strength, and mode of failure of 5 different screw types and fixation methods commonly used for the classic Latarjet procedure. Thirty-five fresh-frozen cadaveric shoulder specimens were allocated into 5 groups. A 25% anteroinferior glenoid defect was created, and a classic Latarjet coracoid transfer procedure was performed. All grafts were fixed with 2 screws, differing by screw type and/or fixation method. The groups included partially threaded solid 4.0-mm cancellous screws with bicortical fixation, partially threaded solid 4.0-mm cancellous screws with unicortical fixation, fully threaded solid 3.5-mm cortical screws with bicortical fixation, partially threaded cannulated 4.0-mm cancellous screws with bicortical fixation, and partially threaded cannulated 4.0-mm captured screws with bicortical fixation. All screws were stainless steel. Outcomes included cyclic creep and secant stiffness during cyclic loading, as well as load and work to failure during the failure test. Intergroup comparisons were made by a 1-way analysis of variance. There were no significant differences among different screw types or fixation methods in cyclic creep or secant stiffness after cyclic loading or in load to failure or work to failure during the failure test. Post-failure radiographs showed evidence of screw bending in only 1 specimen that underwent the Latarjet procedure with partially threaded solid cancellous screws with bicortical fixation. The mode of failure for all specimens analyzed was screw cutout. In this biomechanical study, screw type and fixation method did not significantly influence biomechanical performance in a classic Latarjet procedure. When performing this procedure, surgeons may continue to select the screw type and method of fixation (unicortical or bicortical) based on preference; however, further studies are required to determine the optimal method of treatment. Surgeons may choose the screw type and

  14. Environmental and biogeochemical controls on N2 fixation in ombrotrophic peatlands

    Science.gov (United States)

    Zivkovic, T.; Moore, T. R.

    2017-12-01

    Northern peatlands have low atmospheric nitrogen (N) inputs and acquire N mostly via biological, microbially-driven N2-fixation. Little is known about rates and controls on N2-fixation in ombrotrophic bogs. We conducted two studies to test environmental and biogeochemical controls on N2-fixation. First, we used acetylene reduction assay (ARA) calibrated with 15N2 tracer to measure N2-fixation rates in three species of Sphagnum mosses along a hydrological gradient (beaver pond, hollow and hummock in bog margin and in bog) at Mer Bleue bog from June-October 2013 and May - November 2014. We tested the following controls: moisture availability, temperature, and PAR. The largest ARA rates throughout both seasons occurred in the pond in floating Sphagnum cuspidatum mats (50.3 ± 12.9 μmol m-2 d-1 Mean ± SE), which were up to 2.5 times larger than the rates found in the driest hummock site. There was a significant seasonal peak in both years in July and early August that coincided with the peak of the air temperature. In fact, 45% of the variance of N2 fixation rates over the two field seasons was explained by rain events, water table fluctuations and the surface peat temperature (multiple regression analysis, n = 539). Our results highlight the potential impact of climate change, namely negative effects due to potential droughts and positive effect of warming, on N2 fixation patterns in ombrotrophic peatlands. Secondly, we tested stoichiometric controls (Sphagnum tissue N and phosphorous (P) ratio) of N2-fixation. In a controlled environment, we selected eight study sites along a latitudinal gradient from temperate, boreal to subarctic zone in eastern Canada. We found that decreasing N:P ratio corresponded to increasing N2-fixation. N:P explained 65% of the variance in N2-fixation in hollows but only 20% in hummocks. Changes in neither N or P concentration alone explained the increase in N2-fixation better than N:P ratio. We interpret that the difference between

  15. Carbon dioxide fixation in isolated Kalanchoe chloroplasts

    Energy Technology Data Exchange (ETDEWEB)

    Levi, C.; Gibbs, M.

    1975-07-01

    Chloroplasts isolated from Kalanchoe diagremontiana leaves were capable of photosynthesizing at a rate of 5.4 ..mu..moles of CO/sub 2/ per milligram of chlorophyll per hour. The dark rate of fixation was about 1 percent of the light rate. A high photosynthetic rate was associated with low starch content of the leaves. Ribose 5-phosphate, fructose 1, 6-diphosphate, and dithiothreitol stimulated fixation, whereas phosphoenolpyruvate and azide were inhibitors. The products of CO/sub 2/ fixation were primarily those of the photosynthetic carbon reduction cycle. (auth)

  16. [Comparison between external fixator and DVR system for the treatment of AO type C distal radial fractures].

    Science.gov (United States)

    Zhang, Shai-Lin; Ji, Bin; Cheng, Xiang-Yu; Zhou, Qiang; Shi, Ji-Xiang; Pang, Jin-Hui

    2016-11-25

    To compare the clinical effects of external fixator versus DVR system for the treatment of AO type C distal radius fractures. The clinical data of 52 patients with type C distal radial fractures treated with external fixator or DVR system respectively from January 2009 to December 2013 were analyzed retrospectively. In DVR system group, 31 patients were treated by open reduction and internal fixation with DVR system, involved 11 males and 20 females, with an average age of(47.3±10.9) years ranging from 24 to 65 years;according to AO/ASIF classification, 12 cases were type C1, 15 cases were type C2, 4 cases were type C3. In external fixator group, 21 patients were treated by closed reduction and cross wrist external fixation, involved 8 males and 13 females, with an average age of (48.1±12.1) years ranging from 26 to 69 years; according to AO/ASIF classification, 7 cases were type C1, 11 cases were type C2, 3 cases were type C3. The postoperative images, wrist joint functions and Gartland-Wetley scores were evaluated and compared. Thirty-one patients in DVR system group were followed up for 20.4 months(ranged from 13 to 36 months) and in external fixator group 21 patients were followed up for 17.1 months (ranged from 11 to 33 months) respectively. X-rays showed all fractures healed. The palm dip and radial inclination in the DVR system group were significantly better than in the external fixator group( P 0.05). There was 1 case of wrist stiffness in the DVR system group; 2 cases of pin tract infection, 1 case of fixator loosening and 2 cases of wrist stiffness in the external fixator group. Clinical outcomes of DVR system fixation for type C distal radial fractures are better than that of external fixator fixation. However, DVR system fixation costs more and requires a secondary surgery to remove the internal fixation. The choices of surgical method depend on the clinical conditions of the patients.

  17. Evaluation and comparison of clinical results of femoral fixation devices in arthroscopic anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Aydin, Deniz; Ozcan, Mert

    2016-03-01

    Several femoral fixation devices are available for hamstring tendon autograft in anterior cruciate ligament (ACL) reconstruction, but the best technique is debatable. We hypothesised that different suspensory femoral fixation techniques have no superiority over each other. The aim of this study was to evaluate and compare the clinical results of different suspensory femoral fixation devices in arthroscopic ACL reconstruction. This was a Level III, retrospective, comparative study. A total of 100 consecutive patients who underwent arthroscopic ACL reconstruction in a single institution with a mean follow-up time of 40 months (12-67 months) were divided into three groups according to femoral fixation devices as 'Endobutton' (n=34), 'Transfix' (n=35) and 'Aperfix' (n=31). The length of painful period after surgery, time to return to work and sporting activities, final range of motion, anterior drawer and Lachman tests, knee instability symptoms, International Knee Documentation Committee (IKDC) subjective knee evaluation score, Short Form 36 (SF-36) score, Lysholm knee score and Tegner point of the patients were evaluated and compared between groups. There were no significant differences between the groups. All techniques led to significant recovery in knee instability tests and symptoms. In this study, the clinical results of different suspensory femoral fixation techniques were found to be similar. We believe that different femoral fixation techniques have no effect on clinical results provided that the technique is correctly applied. The surgeon must choose a technique appropriate to his or her experience. Copyright © 2015 Elsevier B.V. All rights reserved.

  18. Spinopelvic Dissociation: Comparison of Outcomes of Percutaneous versus Open Fixation Strategies

    Directory of Open Access Journals (Sweden)

    Jeffrey M. Pearson

    2018-01-01

    Full Text Available Introduction. Spinopelvic dissociation injuries are historically treated with open reduction with or without decompressive laminectomy. Recent technological advances have allowed for percutaneous fixation with indirect reduction. Herein, we evaluate outcomes and complications between patients treated with open reduction versus percutaneous spinopelvic fixation. Methods. Retrospective review of patients undergoing spinopelvic fixation from a single, level one trauma center from 2012 to 2017. Patient information regarding demographics, associated injuries, and treatment outcome measures was recorded and analyzed. All fractures were classified via the AO Spine classification system. Results. Thirty-one spinopelvic dissociations were identified: 15 treated with open and 16 with percutaneous techniques. The two treatment groups had similar preoperative characteristics including spinopelvic parameters (pelvic incidence and lumbar lordosis. Compared to open reduction internal fixation, percutaneous fixation of spinopelvic dissociation resulted in statistically significantly lower blood loss (171 cc versus 538 cc; p=0.0013. There were no significant differences in surgical site infections (p=0.48 or operating room time (p=0.66. Conclusion. Percutaneous fixation of spinopelvic dissociation is associated with significantly less blood loss. Treatment outcomes in terms of infection, length of stay, operative cost, and final alignment between the open and percutaneous group were similar.

  19. Vacuum suction fixation versus staple fixation in TAPP laparoscopic hernia repair: introduction of a new technique for mesh fixation.

    Science.gov (United States)

    Zhang, Guangyong; Zhang, Xiang; Zhan, Hanxiang; Hu, Sanyuan

    2016-01-01

    Proper mesh fixation is critical for successful TAPP laparoscopic hernia repair. Conventional mesh fixation may cause chronic neuralgia, groin paresthesia or other complications. This study aimed at introducing a new vacuum suction technique for mesh fixation and evaluating its efficacy and safety compared with traditional staple fixation way. Clinical data of 242 patients undergoing TAPP from July 2011 to March 2014 were retrospectively analyzed. Patients were divided into vacuum suction fixation group and staple fixation group. The operation time, hospital stay, complications, recurrence, visual analogue scale pain score and cost were evaluated. All surgeries were successful. The operation time of staple group was (42.34 ± 10.15) min for unilateral hernia and (64.08 ± 16.01) min for bilateral hernias. The postoperative hospital stay was (2.76 ± 0.84) days. One recurrence was observed (0.90%). For vacuum group, the operation time was (42.66 ± 7.76) min and (63.92 ± 10.49) min, and hospital stay was (2.60 ± 0.74) days. No recurrence was observed. There was no significant difference in recurrence, operation time, postoperative pain and hospital stay between two groups (P > 0.05). Average cost were (11,714 ± 726) RMB for vacuum group which was lower than staple group (14,837 ± 1568) RMB (P vacuum group, they were scrotal seroma (3.82%), temporary nerve paresthesia (3.05%), scrotal emphysema (1.53%) and uroschesis (1.53%). The incidence of scrotal emphysema was lower in vacuum group (P 0.05). Both techniques for mesh fixation are safe and effective. There is no significant difference in recurrence, operation time, postoperative pain or hospital stay. The vacuum suction fixation technique is more economical with lower incidence of scrotal emphysema.

  20. Comparison of lag screw versus buttress plate fixation of posterior malleolar fractures.

    Science.gov (United States)

    Erdem, Mehmet Nuri; Erken, H Yener; Burc, Halil; Saka, Gursel; Korkmaz, Mehmet Fatih; Aydogan, Mehmet

    2014-10-01

    The goal of this study was to report the results of selective open reduction and internal fixation of fractures of the posterior malleolus with a posterolateral approach and to compare the results of the 2 techniques. We prospectively evaluated 40 patients who underwent posterior malleolar fracture fixation between 2008 and 2012. The patients were treated with a posterolateral approach. We assigned alternating patients to receive plate fixation and the next screw fixation, consecutively, based on the order in which they presented to our institution. Fixation of the posterior malleolus was made with lag screws in 20 patients and a buttress plate in 20 patients. We used American Orthopaedic Foot and Ankle Society (AOFAS) scores, range of motion (ROM) of the ankle, and radiographic evaluations as the main outcome measurements. The mean follow-up was 38.2 (range, 24-51) months. Full union without any loss of reduction was obtained in 38 of the 40 patients. We detected a union with a step-off of 3 mm in 1 patient in the screw group and a step-off of 2 mm in 1 patient in the plate group. At the final follow-up, the mean AOFAS score of the patients regardless of fixation type was 94.1 (range, 85-100). The statistical results showed no significant difference between the patients regardless of the fixation type of the posterior malleolus in terms of AOFAS scores and ROM of the ankle (P > .05). Good (AOFAS score of 94/100) and equivalent (within 3 points) results were obtained using the 2 techniques (screws or plate) for fixation after open reduction of posterior malleolar fragments. Level II, prospective case series. © The Author(s) 2014.

  1. A Rare Presentation of Sciatic Palsy Due to Hematoma After Use of the Kocher-Langenbeck Approach to the Acetabulum.

    Science.gov (United States)

    Rog, Dominik; Basmajian, Hrayr G

    2015-03-25

    A delayed sciatic palsy caused by compression due to hematoma formation is a rare complication of total hip arthroplasty. We report the case of a twenty-seven-year-old man who underwent open reduction and internal fixation of transverse and posterior wall acetabular fractures with posterior hip dislocation and had development of a delayed sciatic palsy due to the formation of a hematoma five days after the procedure. A patient who presents with a delayed-onset sciatic palsy with signs and symptoms of a hematoma after an acetabular surgery represents a surgical emergency. Early recognition and urgent decompression offers the best chance of nerve recovery.

  2. Fixation of distal fibular fractures: A biomechanical study of plate fixation techniques.

    Science.gov (United States)

    Marvan, Jiri; Horak, Zdenek; Vilimek, Miloslav; Horny, Lukas; Kachlik, David; Baca, Vaclav

    2017-01-01

    Ankle fractures are complex injuries with variable prognoses that depend upon many factors. The aim of the treatment is to restore the ankle joint biomechanical stability with maximum range of motion. Most ankle fractures are fibular fractures, which have a typical oblique fracture line in the distal fibula located in the area of the tibiofibular syndesmosis. The aim of this study was to simulate numerically several fixation techniques of the distal fibular fractures, evaluate their stability, determine their impact on surrounding tissue load, and correlate the results to clinical treatment experience. The following three models of fibular fracture fixation were used: (a) plate fixation with three screws attached above/below and lag screws, (b) plate fixation with two screws attached above/below and lag screws, and (c) three lag screws only. All three fracture fixation models were analyzed according to their use in both healthy physiological bone and osteoporotic bone tissue. Based on the results of Finite Element Analysis for these simulations, we found that the most appropriate fixation method for Weber-B1 fibular fractures was an unlocked plate fixation using six screws and lag screws, both in patients with physiological and osteoporotic bone tissue. Conversely, the least appropriate fixation method was an unlocked plate fixation with four screws and lag screws. Although this fixation method reduces the stress on patients during surgery, it greatly increased loading on the bone and, thus, the risk of fixation failure. The final fixation model with three lag screws only was found to be appropriate only for very limited indications.

  3. Biomechanical effects of pedicle screw fixation on adjacent segments.

    Science.gov (United States)

    Kyaw, Thein Aung; Wang, Zhuo; Sakakibara, Toshihiko; Yoshikawa, Takamasa; Inaba, Tadashi; Kasai, Yuichi

    2014-07-01

    Various biomechanical investigations have attempted to clarify the aetiology of adjacent segment disease (ASD). However, no biomechanical study has examined in detail the deformation behaviour of the adjacent segments when both pure torque and an angular displacement load are applied to the vertebrae along multiple segments. The purpose of this study is to investigate the biomechanical effects of pedicle screw fixation on adjacent segments. Ten cadaveric lumbar spines (L2-L5) of boars were used. Control and fusion models were prepared by disc damage and pedicle screw fixation of each specimen, and then, bending and rotation tests were performed using a six-axis material tester. In the biomechanical tests regulated by an angular displacement load, the range of motion (ROM) of the cranial and caudal adjacent segments in antero-posterior flexion and lateral bending was increased by about 20 % (p fusion surgery as a mechanism to compensate for the ROM lost due to excessive fusion by pedicle screw fixation, so that a large torque may be applied to adjacent segments within a physiologically possible range, and it might gradually lead to a degenerative intervertebral disc or progression of spondylolisthesis in the adjacent segments.

  4. Biomechanics of intramedullary fracture fixation.

    Science.gov (United States)

    Kyle, R F

    1985-11-01

    Intramedullary rodding allows excellent control of bending forces on long bone fractures when adequate sized rods are used. This is made possible by reaming when necessary. Torsional stability is poor if adequate bone nail contact is not obtained and there is little bone fragment interdigitation. This can be optimized with the interlocking system, especially with proximal and distal fractures. Intramedullary rods allow transmission of compressive load so there must be adequate bone to bone contact without comminution to prevent shortening. If a great deal of comminution is present, an interlocking system must be used to resist compressive loads. The interlocked devices have not been proven to be a detriment to union and indeed are a semi-rigid fixation system when used in comminuted shaft fractures. The strength of an osteosynthesis with an intramedullary rod depends on the geometry of the rod and the geometry of the fracture complex. Both locked and nonlocked intramedullary rods perform extremely well when one understands the mechanical principles involved in intramedullary rodding and pays close attention to detail.

  5. Fixation probability on clique-based graphs

    Science.gov (United States)

    Choi, Jeong-Ok; Yu, Unjong

    2018-02-01

    The fixation probability of a mutant in the evolutionary dynamics of Moran process is calculated by the Monte-Carlo method on a few families of clique-based graphs. It is shown that the complete suppression of fixation can be realized with the generalized clique-wheel graph in the limit of small wheel-clique ratio and infinite size. The family of clique-star is an amplifier, and clique-arms graph changes from amplifier to suppressor as the fitness of the mutant increases. We demonstrate that the overall structure of a graph can be more important to determine the fixation probability than the degree or the heat heterogeneity. The dependence of the fixation probability on the position of the first mutant is discussed.

  6. Fixation of Selenium by Clay Minerals and Iron Oxides

    DEFF Research Database (Denmark)

    Hamdy, A. A.; Nielsen, Gunnar Gissel

    1977-01-01

    In studying Se fixation, soil components capable of retaining Se were investigated. The importance of Fe hydrous oxides in the fixation of Se was established. The clay minerals common to soils, such as kaolinite, montmorillonite and vermiculite, all exhibited Se fixation, but greater fixation...

  7. Displaced avulsion fractures of the posterior cruciate ligament: Treated by stellate steel plate fixation

    Directory of Open Access Journals (Sweden)

    Lijun Li

    2015-01-01

    Full Text Available Background: The open reduction with internal fixation is an effective approach for treatment of avulsion fracture of posterior cruciate ligament. The previously used internal fixation materials including hollow screws, absorbable screw, tension bands and sutures have great defects such as insufficient fixation strength, susceptibility to re-fracture, etc. Stellate steel plate is novel material for internal fixation which has unique gear-like structure design. We used stellate steel plate for treatment of displaced avulsion fractures of posterior cruciate ligament in this study. Materials and Methods: 14 patients (9 men, 5 women; aged, 19-35 years; mean age, 28 years with displaced avulsion fractures of the tibial insertion of the posterior cruciate ligament were retrospectively analyzed between June 2009 and June 2011. The mean duration from injury to the operation was 8.3 days (range 6-15 days. All the patients were treated with open reduction and internal fixation of a stellate steel plate (DePuy, Raynham, MA 02767, USA. The Lysholm-Tegner knee function score criteria were used to analyze results. Results: The mean followup was 24.6 months (range 18-32 months. After 6 months, all the fractures healed and knee joint activity was normal, with no knee stiffness or instability. The Lysholm-Tegner scores were 97.1 ± 1.7 points at the final followup. Conclusion: Owing to its unique gear structure, the stellate steel plate design can effectively fix an avulsion fracture block and it is a simple operation with short postoperative rehabilitation time and firm fixation.

  8. Hybrid fixation: evaluation of a novel technique in adult osteochondritis dissecans of the knee.

    Science.gov (United States)

    Lintz, Francois; Pujol, Nicolas; Pandeirada, Christophe; Boisrenoult, Philippe; Beaufils, Philippe

    2011-04-01

    Treatment of osteochondritis dissecans of the adult knee requires bone and cartilage integration of the loose fragment. Screw fixation provides primary stability but does not guarantee bony consolidation. Additional biological fixation using osteochondral grafts-hybrid fixation-could improve fragment integration. The study included seven patients [median age 21 years (15-29)] who underwent surgery for Bedouelle IIB or III osteochondritis dissecans of the medial femoral condyle. The technique involved metal screw fixation of the fragment. Mosaicplasty grafts were then press-fitted through the fragment. Cancellous autograft was utilized in the cases of subchondral bone loss. Patients were followed up clinically and radiologically (Hughston score). Screws were removed arthroscopically at 3 months and the cartilage graded using the International Cartilage Repair Society score. Fragment integration was evaluated by MRI Arthrogram (4 patients). Median follow-up was 27 months (7-35). Median clinical Hughston score was 2 (0-3) preoperatively and 4 (2-4) postoperatively. Median radiological Hughston score was 3 (2-4) and 4 (3-4). During arthroscopic removal of metalwork, osteochondritis fragments were well integrated in all cases. The International Cartilage Repair Society score was I in one patients, II in five, and III in one. Postoperative MRI arthrograms confirmed that cartilage and bone integration was complete. Isolated screw fixation of osteochondritis dissecans in adults provides poor bony integration. Mosaicplasty is an alternative but does not retain normal condylar anatomy. The hybrid fixation technique adds a biological "booster" to osteochondritis fixation, with excellent short-term outcome. Further studies are required to investigate the long-term results.

  9. Due diligence

    International Nuclear Information System (INIS)

    Sanghera, G.S.

    1999-01-01

    The Occupational Health and Safety (OHS) Act requires that every employer shall ensure the health and safety of workers in the workplace. Issues regarding the practices at workplaces and how they should reflect the standards of due diligence were discussed. Due diligence was described as being the need for employers to identify hazards in the workplace and to take active steps to prevent workers from potentially dangerous incidents. The paper discussed various aspects of due diligence including policy, training, procedures, measurement and enforcement. The consequences of contravening the OHS Act were also described

  10. Variable Nitrogen Fixation in Wild Populus.

    Directory of Open Access Journals (Sweden)

    Sharon L Doty

    Full Text Available The microbiome of plants is diverse, and like that of animals, is important for overall health and nutrient acquisition. In legumes and actinorhizal plants, a portion of essential nitrogen (N is obtained through symbiosis with nodule-inhabiting, N2-fixing microorganisms. However, a variety of non-nodulating plant species can also thrive in natural, low-N settings. Some of these species may rely on endophytes, microorganisms that live within plants, to fix N2 gas into usable forms. Here we report the first direct evidence of N2 fixation in the early successional wild tree, Populus trichocarpa, a non-leguminous tree, from its native riparian habitat. In order to measure N2 fixation, surface-sterilized cuttings of wild poplar were assayed using both 15N2 incorporation and the commonly used acetylene reduction assay. The 15N label was incorporated at high levels in a subset of cuttings, suggesting a high level of N-fixation. Similarly, acetylene was reduced to ethylene in some samples. The microbiota of the cuttings was highly variable, both in numbers of cultured bacteria and in genetic diversity. Our results indicated that associative N2-fixation occurred within wild poplar and that a non-uniformity in the distribution of endophytic bacteria may explain the variability in N-fixation activity. These results point to the need for molecular studies to decipher the required microbial consortia and conditions for effective endophytic N2-fixation in trees.

  11. Variable Nitrogen Fixation in Wild Populus.

    Science.gov (United States)

    Doty, Sharon L; Sher, Andrew W; Fleck, Neil D; Khorasani, Mahsa; Bumgarner, Roger E; Khan, Zareen; Ko, Andrew W K; Kim, Soo-Hyung; DeLuca, Thomas H

    2016-01-01

    The microbiome of plants is diverse, and like that of animals, is important for overall health and nutrient acquisition. In legumes and actinorhizal plants, a portion of essential nitrogen (N) is obtained through symbiosis with nodule-inhabiting, N2-fixing microorganisms. However, a variety of non-nodulating plant species can also thrive in natural, low-N settings. Some of these species may rely on endophytes, microorganisms that live within plants, to fix N2 gas into usable forms. Here we report the first direct evidence of N2 fixation in the early successional wild tree, Populus trichocarpa, a non-leguminous tree, from its native riparian habitat. In order to measure N2 fixation, surface-sterilized cuttings of wild poplar were assayed using both 15N2 incorporation and the commonly used acetylene reduction assay. The 15N label was incorporated at high levels in a subset of cuttings, suggesting a high level of N-fixation. Similarly, acetylene was reduced to ethylene in some samples. The microbiota of the cuttings was highly variable, both in numbers of cultured bacteria and in genetic diversity. Our results indicated that associative N2-fixation occurred within wild poplar and that a non-uniformity in the distribution of endophytic bacteria may explain the variability in N-fixation activity. These results point to the need for molecular studies to decipher the required microbial consortia and conditions for effective endophytic N2-fixation in trees.

  12. Maxwellian Eye Fixation during Natural Scene Perception

    Science.gov (United States)

    Duchesne, Jean; Bouvier, Vincent; Guillemé, Julien; Coubard, Olivier A.

    2012-01-01

    When we explore a visual scene, our eyes make saccades to jump rapidly from one area to another and fixate regions of interest to extract useful information. While the role of fixation eye movements in vision has been widely studied, their random nature has been a hitherto neglected issue. Here we conducted two experiments to examine the Maxwellian nature of eye movements during fixation. In Experiment 1, eight participants were asked to perform free viewing of natural scenes displayed on a computer screen while their eye movements were recorded. For each participant, the probability density function (PDF) of eye movement amplitude during fixation obeyed the law established by Maxwell for describing molecule velocity in gas. Only the mean amplitude of eye movements varied with expertise, which was lower in experts than novice participants. In Experiment 2, two participants underwent fixed time, free viewing of natural scenes and of their scrambled version while their eye movements were recorded. Again, the PDF of eye movement amplitude during fixation obeyed Maxwell's law for each participant and for each scene condition (normal or scrambled). The results suggest that eye fixation during natural scene perception describes a random motion regardless of top-down or of bottom-up processes. PMID:23226987

  13. Maxwellian Eye Fixation during Natural Scene Perception

    Directory of Open Access Journals (Sweden)

    Jean Duchesne

    2012-01-01

    Full Text Available When we explore a visual scene, our eyes make saccades to jump rapidly from one area to another and fixate regions of interest to extract useful information. While the role of fixation eye movements in vision has been widely studied, their random nature has been a hitherto neglected issue. Here we conducted two experiments to examine the Maxwellian nature of eye movements during fixation. In Experiment 1, eight participants were asked to perform free viewing of natural scenes displayed on a computer screen while their eye movements were recorded. For each participant, the probability density function (PDF of eye movement amplitude during fixation obeyed the law established by Maxwell for describing molecule velocity in gas. Only the mean amplitude of eye movements varied with expertise, which was lower in experts than novice participants. In Experiment 2, two participants underwent fixed time, free viewing of natural scenes and of their scrambled version while their eye movements were recorded. Again, the PDF of eye movement amplitude during fixation obeyed Maxwell’s law for each participant and for each scene condition (normal or scrambled. The results suggest that eye fixation during natural scene perception describes a random motion regardless of top-down or of bottom-up processes.

  14. Obstructed spinopelvic fixation in the setting of a triangular titanium sacroiliac fusion implant: a case description.

    Science.gov (United States)

    Laratta, Joseph L; Lin, James D; Shillingford, Jamal N; Hardy, Nathan E; Reddy, Hemant; Lehman, Ronald A

    2017-12-01

    Achieving lumbosacral fusion through spinopelvic fixation is an important and challenging aspect of spinal deformity surgery. Numerous instrumentation techniques are available, with iliac screws and S2-alar-iliac (SRAI) screws being most commonly used today. However, the increasing popularity of minimally invasive sacroiliac (SI) fusion as a common procedure performed for SI joint pain presents a distinct challenge in complex adult deformity cases requiring iliac screw fixation. We report a case of a 71-year-old female with a longstanding history of spinal deformity status-post T11-L5 fusion and a subsequent right-sided SI joint fusion who presented with sagittal imbalance. The SI joint fusion implant obstructed the pathway for spinopelvic fixation. Spinopelvic fixation was achieved by burring a pathway through the SI joint implant. The increasing popularity of minimally invasive SI fusion as a common procedure performed for SI joint pain presents a distinct challenge in complex adult deformity cases requiring iliac screw fixation. This is the first report in the literature describing a technique for spinopelvic fixation in the setting of screw obstruction due to an instrumented SI joint.

  15. Evaluation of internal dose to members of the public at the Kaiga site, India, due to the ingestion of primordial radionuclide 40K

    International Nuclear Information System (INIS)

    James, J. P.; Dileep, B. N.; Mulla, R. M.; Joshi, R. M.; Vishnu, M. S.; Nayak, P. D.; Ravi, P. M.; Sarkar, P. K.

    2013-01-01

    Four 220 MWe pressurised heavy water reactors are under operation at Kaiga in the state of Karnataka in India. Environmental radiological survey of the surrounding areas of the Kaiga site is carried out by Bhabha Atomic Research Centre, Mumbai. The estimated dose to the members of the public due to ingestion of radioactive isotope of potassium, a natural radionuclide, in the surroundings of the Kaiga site is 136 μSv (13.6 mrem) per year. The value indicates that the dose to the public due to operation of the nuclear reactors in Kaiga is insignificant in comparison with the dose due to unavoidable natural radioactivity. (authors)

  16. Posterior atlantoaxial fixation: a review of all techniques.

    Science.gov (United States)

    Huang, Da-Geng; Hao, Ding-Jun; He, Bao-Rong; Wu, Qi-Ning; Liu, Tuan-Jiang; Wang, Xiao-Dong; Guo, Hua; Fang, Xiang-Yi

    2015-10-01

    Posterior atlantoaxial fixation is an effective treatment for atlantoaxial instability. Great advancements on posterior atlantoaxial fixation techniques have been made in the past decades. However, there is no article reviewing all the posterior atlantoaxial fixation techniques yet. The aim was to review the evolution and advancements of posterior atlantoaxial fixation. This was a literature review. The application of all posterior fixation techniques in atlantoaxial stabilization, including wiring techniques, interlaminar clamp fixation, transarticular fixation, screw-plate systems, screw-rod systems, and hook-screw systems, are reviewed and discussed. Recent advancements on the novel technique of atlantoaxial fixation are described. The combination of the C1 and C2 screws in screw-rod systems are described in detail. All fixation techniques are useful. The screw-rod system appears to be the most popular approach. However, many novel or modified fixation methods have been introduced in recent years. Great advancements on posterior atlantoaxial fixation techniques have been made in the past decades. The wiring technique and interlaminar clamps technique have fallen out of favor because of the development of newer and superior fixation techniques. The C1-C2 transarticular screw technique may remain the gold standard for atlantoaxial fusion, whereas screw-rod systems, especially the C1 pedicle screw combined with C2 pedicle/pars screw fixation, have become the most popular fixation techniques. Hook-screw systems are alternatives for atlantoaxial fixation. Copyright © 2015 Elsevier Inc. All rights reserved.

  17. Clostridium perfringens infection complicating periprosthetic fracture fixation about the hip: successful treatment with early aggressive debridement.

    LENUS (Irish Health Repository)

    Baker, Joseph F

    2012-07-13

    Periprosthetic fracture and infection are both challenges following hip arthroplasty. We report the case of an 87 year old female who underwent open reduction and internal fixation of a periprosthetic femoral fracture. Her post-operative course was complicated by infection with Clostridium perfringens. Early aggressive antibiotic treatment and surgical debridement were successful, and allowed retention of the original components.

  18. Arthroscopic Bioabsorbable Screw Fixation of Unstable Osteochondritis Dissecans in Adolescents: Clinical Results, Magnetic Resonance Imaging, and Second-Look Arthroscopic Findings.

    Science.gov (United States)

    Chun, Keun Churl; Kim, Kwang Mee; Jeong, Ki Joon; Lee, Yong Chan; Kim, Jeong Woo; Chun, Churl Hong

    2016-03-01

    This study aimed to evaluate the clinical and radiological outcomes of arthroscopic bioabsorbable screw fixation in osteochondritis dissecans (OCD) in adolescent patients with unstable lesions causing pain. The study included 11 patients (10 males and 1 female) with OCD who underwent arthroscopic bioabsorbable screw fixation between July 2007 and February 2014 and were available for follow-up for more than 12 months. The mean age at diagnosis was 16.3 years (range, 11 to 19 years), and the average follow-up period was 51 months (range, 12 to 91 months). Clinical results were evaluated using the Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm knee score, and International Knee Documentation Committee (IKDC) score measured before surgery and at follow-up. Functional evaluation was made using the Tegner activity scale. Magnetic resonance imaging (MRI) and second-look arthroscopy were performed at the 12-month follow-up. Between the preoperative assessment and follow-up, improvements were seen in the KOOS (range, 44.9 to 88.1), Lysholm knee score (range, 32.6 to 82.8), and IKDC score (range, 40.8 to 85.6). The Tegner activity scale also improved from 2.8 to 6.1. Based on postoperative MRI, there were eight Dipaola grade I cases and three grade II cases. No complications due to fixation failure developed in any case. Second-look arthroscopy at 12 months postoperatively revealed that the lesion was covered with cartilage in all cases. For unstable OCD lesions causing pain in adolescents, arthroscopic bioabsorbable screw fixation provided favorable outcomes with reduced pain and restoration of movement. Therefore, it should be considered as an effective treatment for OCD.

  19. The effect of the association of near infrared laser therapy, bone morphogenetic proteins, and guided bone regeneration on tibial fractures treated with internal rigid fixation: a Raman spectroscopic study.

    Science.gov (United States)

    Lopes, Cibele B; Pacheco, Marcos T T; Silveira, Landulfo; Cangussú, Maria Cristina T; Pinheiro, Antonio L B

    2010-09-15

    Fractures have different etiology and treatment and may be associated or not to bone losses. Laser light has been shown to improve bone healing. We aimed to assess, through Raman spectroscopy, the level of CHA (approximately 958 cm(-1)) on complete fractures animals treated with IRF treated or not with Low Level Laser Therapy-LLLT and associated or not to BMPs and GBR. Complete tibial fractures were created on 15 animals that were divided into five groups. LLLT (Laser Unit, Kondortech, São Carlos, SP, Brazil, lambda790 nm, 4 J/cm(2)/point, 40 mW, phi approximately 0.5 cm(2), 16 J/cm(2) session) started immediately after surgery and repeated at 48 h interval (2 weeks). Animal death occurred after 30 days. Raman spectroscopy was performed at the surface of the fracture. Our results showed significant differences between the groups IRF + BL /IRF_NBL (p = 0.05); between all experimental groups and untreated bone; bone/IRF + BL; IRF + BL + Bio + GBR; IRF + BL + LLLT; IRF + BL + Bio + GBR + LLLT; IRF_NBL (p bone healing on fractured bones due to increased levels of CHA. (c) 2010 Wiley Periodicals, Inc.

  20. N2 production and fixation in deep-tier burrows of Squilla empusa in muddy sediments of Great Peconic Bay

    Science.gov (United States)

    Waugh, Stuart; Aller, Robert C.

    2017-11-01

    Global marine N budgets often show deficits due to dominance of benthic N2 production relative to pelagic N2 fixation. Recent studies have argued that benthic N2 fixation in shallow water environments has been underestimated. In particular, N2 fixation associated with animal burrows may be significant as indicated by high rates of N2 fixation reported in muddy sands populated by the ghost shrimp, Neotrypaea californiensis (Bertics et al., 2010). We investigated whether N2 fixation occurs at higher rates in the burrow-walls of the deep-burrowing ( 0.5-4 m) mantis shrimp, Squilla empusa, compared to ambient, estuarine muds and measured seasonal in-situ N2 concentrations in burrow-water relative to bottom-water. Acetylene reduction assays showed lower N2 fixation in burrow-walls than in un-populated sediments, likely due to inhibitory effects of O2 on ethylene production. Dissolved N2 was higher in burrow-water than proximate bottom-water at all seasons, demonstrating a consistent balance of net N2 production relative to fixation in deep-tier biogenic structures.

  1. Simultaneous occurrence of subarachnoid hemorrhage and epistaxis due to ruptured petrous internal carotid artery aneurysm. Association with transsphenoidal surgery and radiation therapy. Case report

    International Nuclear Information System (INIS)

    Endo, Hidenori; Fujimura, Miki; Inoue, Takashi; Matsumoto, Yasushi; Ogawa, Yoshikazu; Kawagishi, Jun; Jokura, Hidefumi; Shimizu, Hiroaki; Tominaga, Teiji

    2011-01-01

    A 62-year-old woman presented with simultaneous subarachnoid hemorrhage (SAH) and massive epistaxis. The patient had been treated for pituitary prolactinoma by two transsphenoidal surgeries, gamma knife radiosurgery, and conventional radiation therapy since age 43 years. Cerebral angiography showed left petrous internal carotid artery (ICA) aneurysm with slight stenosis on the adjacent left petrous ICA. She underwent superficial temporal artery-middle cerebral artery (STA-MCA) double anastomosis with endovascular internal trapping without complication the day after onset. Postoperative course was uneventful; the patient did not develop symptomatic vasospasm, recurrent epistaxis, or cerebrospinal fluid rhinorrhea. Postoperative angiography demonstrated complete disappearance of the aneurysm with patent STA-MCA anastomosis. The patient was discharged 2 months after surgery without neurological deficit. The present case is extremely rare with simultaneous onset of SAH and epistaxis caused by ruptured petrous ICA aneurysm. The transsphenoidal surgeries and radiation therapies might have been critical in the formation of the petrous ICA aneurysm. (author)

  2. Late extensor pollicis longus rupture following plate fixation in Galeazzi fracture dislocation.

    Science.gov (United States)

    Sabat, Dhananjaya; Dabas, Vineet; Dhal, Anil

    2014-07-01

    Late rupture of extensor pollicis longus (EPL) tendon after Galeazzi fracture dislocation fixation is an unknown entity though it is a well-established complication following distal radius fractures. We report the case of a 55-year old male who presented with late EPL tendon rupture 4 months following internal fixation of Galeazzi fracture dislocation with a Locking Compression Plate (LCP). He was managed with extensor indicis proprius (EIP) transfer to restore thumb extension. At 4 years followup, functional result of the transfer was good. We identify possible pitfalls with this particular patient and discuss how to avoid them in future.

  3. Late extensor pollicis longus rupture following plate fixation in Galeazzi fracture dislocation

    Directory of Open Access Journals (Sweden)

    Dhananjaya Sabat

    2014-01-01

    Full Text Available Late rupture of extensor pollicis longus (EPL tendon after Galeazzi fracture dislocation fixation is an unknown entity though it is a well-established complication following distal radius fractures. We report the case of a 55-year old male who presented with late EPL tendon rupture 4 months following internal fixation of Galeazzi fracture dislocation with a Locking Compression Plate (LCP. He was managed with extensor indicis proprius (EIP transfer to restore thumb extension. At 4 years followup, functional result of the transfer was good. We identify possible pitfalls with this particular patient and discuss how to avoid them in future.

  4. Outcomes after arthroscopic fixation of tibial eminence fractures with bioabsorbable nails in skeletally immature patients.

    Science.gov (United States)

    Momaya, Amit M; Read, Connor; Steirer, Megan; Estes, Reed

    2018-01-01

    The aim of this paper is to report the outcomes and any complications with arthroscopic bioabsorbable nail fixation of tibial eminence fractures in skeletally immature patients. We retrospectively reviewed all surgically treated tibial eminence fractures treated by a single surgeon and seven patients were identified with a minimum 2-year follow-up. Mean deficits of flexion and extension were minimal. Satisfactory Tegner levels, Lysholm knee scores, and International Knee Documentation Committee subjective scores were reported. Arthroscopic fixation of tibial eminence fractures with bioabsorbable nails yields satisfactory outcomes for this uncommon injury and obviates the need for future hardware removal.

  5. Graft fixation in cruciate ligament reconstruction.

    Science.gov (United States)

    Brand, J; Weiler, A; Caborn, D N; Brown, C H; Johnson, D L

    2000-01-01

    Cruciate ligament reconstruction has progressed dramatically in the last 20 years. Anatomic placement of ligament substitutes has fostered rehabilitation efforts that stress immediate and full range of motion, immediate weightbearing, neuromuscular strength and coordination, and early return to athletic competition (3 months). This has placed extreme importance on secure graft fixation at the time of ligament reconstruction. Current ligament substitutes require a bony or soft tissue component to be fixed within a bone tunnel or on the periosteum at a distance from the normal ligament attachment site. Fixation devices have progressed from metal to biodegradable and from far to near-normal native ligament attachment sites. Ideally, the biomechanical properties of the entire graft construct would approach those of the native ligament and facilitate biologic incorporation of the graft. Fixation should be done at the normal anatomic attachment site of the native ligament (aperture fixation) and, over time, allow the biologic return of the histologic transition zone from ligament to fibrocartilage, to calcified fibrocartilage, to bone. The purpose of this article is to review current fixation devices and techniques in cruciate ligament surgery.

  6. Solar Water Splitting and Nitrogen Fixation with Layered Bismuth Oxyhalides.

    Science.gov (United States)

    Li, Jie; Li, Hao; Zhan, Guangming; Zhang, Lizhi

    2017-01-17

    Hydrogen and ammonia are the chemical molecules that are vital to Earth's energy, environmental, and biological processes. Hydrogen with renewable, carbon-free, and high combustion-enthalpy hallmarks lays the foundation of next-generation energy source, while ammonia furnishes the building blocks of fertilizers and proteins to sustain the lives of plants and organisms. Such merits fascinate worldwide scientists in developing viable strategies to produce hydrogen and ammonia. Currently, at the forefronts of hydrogen and ammonia syntheses are solar water splitting and nitrogen fixation, because they go beyond the high temperature and pressure requirements of methane stream reforming and Haber-Bosch reaction, respectively, as the commercialized hydrogen and ammonia production routes, and inherit the natural photosynthesis virtues that are green and sustainable and operate at room temperature and atmospheric pressure. The key to propelling such photochemical reactions lies in searching photocatalysts that enable water splitting into hydrogen and nitrogen fixation to make ammonia efficiently. Although the past 40 years have witnessed significant breakthroughs using the most widely studied TiO 2 , SrTiO 3 , (Ga 1-x Zn x )(N 1-x O x ), CdS, and g-C 3 N 4 for solar chemical synthesis, two crucial yet still unsolved issues challenge their further progress toward robust solar water splitting and nitrogen fixation, including the inefficient steering of electron transportation from the bulk to the surface and the difficulty of activating the N≡N triple bond of N 2 . This Account details our endeavors that leverage layered bismuth oxyhalides as photocatalysts for efficient solar water splitting and nitrogen fixation, with a focus on addressing the above two problems. We first demonstrate that the layered structures of bismuth oxyhalides can stimulate an internal electric field (IEF) that is capable of efficiently separating electrons and holes after their formation and of

  7. Physiologic Functional Evaluation of Left Internal Mammary Artery Graft to Left Anterior Descending Coronary Artery Steal due to Unligated First Thoracic Branch in a Case of Refractory Angina

    Directory of Open Access Journals (Sweden)

    Fadi J. Sawaya

    2016-01-01

    Full Text Available Unligated side branches of the left internal mammary artery (LIMA have been described in the literature as a cause of coronary steal resulting in angina. Despite a number of studies reporting successful side branch embolization to relieve symptoms, this phenomenon remains controversial. Hemodynamic evidence of coronary steal using angiographic and intravascular Doppler techniques has been supported by some and rejected by others. In this case study using an intracoronary Doppler wire with adenosine, we demonstrate that a trial occlusion of the LIMA thoracic side branch with selective balloon inflation can confirm physiologic significant steal and whether coil embolization of the side branch is indicated.

  8. An outbreak due to peanuts in their shell caused by Salmonella enterica serotypes Stanley and Newport--sharing molecular information to solve international outbreaks.

    Science.gov (United States)

    Kirk, M D; Little, C L; Lem, M; Fyfe, M; Genobile, D; Tan, A; Threlfall, J; Paccagnella, A; Lightfoot, D; Lyi, H; McIntyre, L; Ward, L; Brown, D J; Surnam, S; Fisher, I S T

    2004-08-01

    Salmonellosis is a global problem caused by the international movement of foods and high incidence in exporting countries. In September 2001, in an outbreak investigation Australia isolated Salmonella Stanley from imported peanuts, which resulted in a wider investigation in Canada, England & Wales and Scotland. Patients infected with Salmonella serotypes known to be isolated from peanuts and reported to surveillance systems were interviewed to determine exposure histories. Tagged image file format (TIFF) images of pulsed-field gel electrophoresis (PFGE) patterns of Salmonella isolates were shared electronically amongst laboratories. Laboratories tested packets of 'Brand X' peanuts from various lots and product lines. In total, 97 cases of S. Stanley and 12 cases of S. Newport infection were found. Seventy-three per cent (71/97) of S. Stanley cases were in persons of Asian ethnicity. Twenty-eight per cent of cases recalled eating Brand X peanuts and a further 13% had peanuts in their house in the previous month or had eaten Asian-style peanuts. Laboratories isolated S. Stanley, S. Newport, S. Kottbus, S. Lexington and S. Unnamed from Brand X peanuts. Isolates of S. Stanley from peanuts and human patients were indistinguishable by PFGE. This international outbreak resulted from a product originating from one country affecting several others. Rapid sharing of electronic DNA images was a crucial factor in delineating the outbreak; multinational investigations would benefit from a harmonized approach.

  9. Biometric recognition via fixation density maps

    Science.gov (United States)

    Rigas, Ioannis; Komogortsev, Oleg V.

    2014-05-01

    This work introduces and evaluates a novel eye movement-driven biometric approach that employs eye fixation density maps for person identification. The proposed feature offers a dynamic representation of the biometric identity, storing rich information regarding the behavioral and physical eye movement characteristics of the individuals. The innate ability of fixation density maps to capture the spatial layout of the eye movements in conjunction with their probabilistic nature makes them a particularly suitable option as an eye movement biometrical trait in cases when free-viewing stimuli is presented. In order to demonstrate the effectiveness of the proposed approach, the method is evaluated on three different datasets containing a wide gamut of stimuli types, such as static images, video and text segments. The obtained results indicate a minimum EER (Equal Error Rate) of 18.3 %, revealing the perspectives on the utilization of fixation density maps as an enhancing biometrical cue during identification scenarios in dynamic visual environments.

  10. Ilizarov fixator in management of nonunited and infected tibial shaft fractures

    Directory of Open Access Journals (Sweden)

    Abhinay Singh

    2015-01-01

    Full Text Available Background: Management of nonunion with bony defect and infection in long bones is a challenging problem for orthopedic surgeons. Objectives: Evaluation of Ilizarov circular fixation method of treatment for the management of nonunited and infected fractures of tibia. Materials and Methods: This prospective study was conducted in a tertiary care hospital of eastern region of India on 30 subjects in a time span of 3 years after taking clearance of the Institutional Ethical Committee and informed consent of the patients. Results: All the patients had infected nonunion before undergoing Ilizarov procedure. Following initial injury, 22 patients were treated with external fixation and 8 cases were treated with internal fixation. At the time of presentation, 18 patients had infected gap nonunion, 5 patients had infected hypertrophic and 2 patients had atrophic nonunion. The Ilizarov fixator was kept for an average period of 303.7 days. Based on Association for the Study and Application of Methods of Ilizarov scoring system, bony and functional results were assessed. The bony result was excellent in 16 patients, good in eight, fair in four and poor in two. The functional result was excellent in 10 patients, good in 16, fair in two, poor in two. Conclusion: Ilizarov ring fixator still remains an excellent treatment modality for tibial nonunion with a defect, regarding bone union, deformity correction, infection eradication, limb-length achievement, and limb function.

  11. Pacemaker Implantation Associated Myocardial Micro-Damage: A Randomised Comparison between Active and Passive Fixation Leads.

    Science.gov (United States)

    Blažek, Patrick; Ferri-Certić, Jerko; Vražić, Hrvoje; Lennerz, Carsten; Grebmer, Christian; Kaitani, Kazuaki; Karch, Martin; Starčević, Boris; Semmler, Verena; Kolb, Christof

    2018-03-20

    Fixation of the pacemaker leads during pacemaker implantation leads to an increase of cardiac Troponin T (cTnT) that can be interpreted as a sign of minimal myocardial damage. This trial evaluates whether the mechanism type of lead fixation influences the magnitude of cTnT release. Patients having a de-novo cardiac pacemaker implantation or a lead revision were centrally randomized to receive either a ventricular lead with an active (screw) or passive (tine) fixation mechanism. High-sensitive Troponin T (hsTnT) was determined on the day of the procedure beforehand and on the following day. 326 Patients (median age (IQR) 75.0 (69.0-80.0) years, 64% male) from six international centers were randomized to receive ventricular leads with an active (n = 166) or passive (n = 160) fixation mechanism. Median (IQR) hsTnT levels increased by 0.009 (0.004-0.021) ng/ml in the group receiving screw-in ventricular leads and by 0.008 (0.003-0.030) ng/ml in the group receiving tined ventricular leads (n.s.). In conclusion pacemaker implantations are followed by a release of hsTnT. The choice between active or passive fixation ventricular leads does not have a significant influence on the extent of myocardial injury and the magnitude of hsTnT release.

  12. Fixation of supraglenoid tubercle fractures using distal femoral locking plates in three Warmblood horses.

    Science.gov (United States)

    Frei, Sina; Fürst, Anton E; Sacks, Murielle; Bischofberger, Andrea S

    2016-05-18

    Three horses that were presented with supraglenoid tubercle fractures were treated with open reduction and internal fixation using distal femoral locking plates (DFLP). Placing the DFLP caudal to the scapular spine in order to preserve the suprascapular nerve led to a stable fixation, however, it resulted in infraspinatus muscle atrophy and mild scapulohumeral joint instability (case 1). Placing the DFLP cranial to the scapular spine and under the suprascapular nerve resulted in a stable fixation, however, it resulted in severe atrophy of the supraspinatus and infraspinatus muscles and scapulohumeral joint instability (case 2). Placing the DFLP cranial to the scapular spine and slightly overbending it at the suprascapular nerve passage site resulted in the best outcome (case 3). Only a mild degree of supraspinatus and infraspinatus muscle atrophy was apparent, which resolved quickly and with no effect on scapulohumeral joint stability. In all cases, fixation of supraglenoid tubercle fractures using DFLP in slightly different techniques led to stable fixations with good long-term outcome. One case suffered from a mild incisional infection and plates were removed in two horses. Placement of the DFLP cranial to the scapular spine and slightly overbending it at the suprascapular nerve passage prevented major nerve damage. Further cases investigating the degree of muscle atrophy following the use of the DFLP placed in the above-described technique are justified to improve patient outcome.

  13. Central tarsal bone fractures in horses not used for racing: Computed tomographic configuration and long-term outcome of lag screw fixation

    OpenAIRE

    Gunst, S; Del Chicca, Francesca; Fürst, Anton; Kuemmerle, Jan M

    2016-01-01

    REASONS FOR PERFORMING STUDY: There are no reports on the configuration of equine central tarsal bone fractures based on cross-sectional imaging and clinical and radiographic long-term outcome after internal fixation. OBJECTIVES: To report clinical, radiographic and computed tomographic findings of equine central tarsal bone fractures and to evaluate the long-term outcome of internal fixation. STUDY DESIGN: Retrospective case series. METHODS: All horses diagnosed with a central tarsa...

  14. Enhanced diapycnal mixing due to near-inertial internal waves propagating through an anticyclonic eddy in the ice-free Chukchi Plateau

    Science.gov (United States)

    Kawaguchi, Yusuke

    2017-04-01

    The Arctic Ocean is known to be quiescent in terms of turbulent kinetic energy (TKE) associated with internal waves. To investigate the current state of TKE in the seasonally ice-free Chukchi Plateau, Arctic Ocean, we performed a three-week, fixed-point observation (FPO) using repeated microstructure, hydrographic, and current measurements in September 2014. During the FPO program, the microstructure observation detected noticeable peaks of TKE dissipation rate ɛ during the transect of an anticyclonic eddy moving across the FPO station. Particularly, ɛ had a significant elevation in the lower halocline layer, near the critical level, reaching the order of 10-8 W kg-1. The ADCP current displayed energetic near-inertial internal waves (NIWs) propagating via the stratification at the top and bottom of anticyclone. According to spectral analyses of horizontal velocity, the waves had almost downward energy propagation, and its current amplitude reached 10 cm s-1. The WKB scaling, incorporating vertical variations of relative vorticity, suggests that increased wave energy near the two pycnoclines was associated with diminishing group velocity at the corresponding depths. The fine-scale parameterization using observed near-inertial velocity and buoyancy frequency successfully reproduced the characteristics of observed ɛ,supporting that the near-inertial kinetic energy can be effectively dissipated into turbulence near the critical layer. According to a mixed-layer slab model, a rapidly moving storm that has passed over in the first week likely delivered the bulk of NIW kinetic energy, captured by the vortex, into the surface water.

  15. Biomechanical stability of intramedullary technique for fixation of joint depressed calcaneus fracture.

    Science.gov (United States)

    Nelson, Joshua D; McIff, Terence E; Moodie, Patrick G; Iverson, Jamey L; Horton, Greg A

    2010-03-01

    Internal fixation of the os calcis is often complicated by prolonged soft tissue management and posterior facet disruption. An ideal calcaneal construct would include minimal hardware prominence, sturdy posterior facet fixation and nominal soft tissue disruption. The purpose of this study was to develop such a construct and provide a biomechanical analysis comparing our technique to a standard internal fixation technique. Twenty fresh-frozen cadaver calcanei were used to create a reproducible Sanders type-IIB calcaneal fracture pattern. One calcaneus of each pair was randomly selected to be fixed using our compressive headless screw technique. The contralateral matched calcaneus was fixed with a nonlocking calcaneal plate in a traditional fashion. Each calcaneus was cyclically loaded at a frequency of 1 Hz for 4000 cycles using an increasing force from 250 N to 1000 N. An Optotrak motion capturing system was used to detect relative motion of the three fracture fragments at eight different points along the fracture lines. Horizontal separation and vertical displacement at the fracture lines was recorded, as well as relative rotation at the primary fracture line. When the data were averaged, there was more horizontal displacement at the primary fracture line of the plate and screw construct compared to the headless screw construct. The headless screw construct also had less vertical displacement at the primary fracture line at every load. On average those fractures fixed with the headless screw technique had less rotation than those fixed with the side plate technique. A new headless screw technique for calcaneus fracture fixation was shown to provide stability as good as, or better than, a standard side plating technique under the axial loading conditions of our model. Although further testing is needed, the stability of the proposed technique is similar to that typically provided by intramedullary fixation. This fixation technique provides a biomechanically stable

  16. Experimental assessment of a new direct fixation implant for artificial limbs

    NARCIS (Netherlands)

    Tomaszewski, P. K.; Lasnier, B.; Hannink, G.; Verkerke, G. J.; Verdonschot, N.

    An alternative to prosthetic socket rehabilitation of patients with transfemoral amputation is realized by means of direct skeletal fixation devices, offering significant improvements in mobility and comfort. However, strain shielding due to high stiffness of these metal-based implants causes

  17. Phosphate fixation and the response of maize to fertilizer phosphate in Kenyan soils

    NARCIS (Netherlands)

    Eijk, van der D.

    1997-01-01

    In tropical soils, plant growth is often limited by a low P availability. In addition, these soils often have high P-fixation capacities due to high amounts of iron and aluminum oxyhydroxides. Furthermore, small-scale farming systems in which subsistence crops are produced for local markets are

  18. Autosomal dominant stapes fixation, syndactyly, and symphalangism in a family with NOG mutation

    DEFF Research Database (Denmark)

    Westergaard-Nielsen, Marie; Amstrup, Tine; Wanscher, Jens Højberg

    2018-01-01

    bilateral conductive hearing loss. Three patients were treated with stapedectomy, on one or both ears, due to fixation of stapes. All the affected members had syndactyly and symphalangism. A not previously reported mutation in the NOG gene (c.688_699del, p.Cys230_Cys232delins11) was found to segregate...

  19. Influence of Formalin Fixation Prior to in vitro Ultrasound Examination of Porcine Arteries

    DEFF Research Database (Denmark)

    Wilhjelm, Jens E.; Vogt, Katja; Jespersen, Søren Kragh

    1996-01-01

    This paper reports on an investigation of the influence on the echosignal from porcine artery walls due to two different formalin fixationprocedures. The lumen diameter, the wall thickness and the mean echogenicitywere calculated. In general, the fixation resulted in a more rigid wall. Whileconve...

  20. Effects of Scene Properties and Emotional Valence on Brain Activations: A Fixation-Related fMRI Study

    Directory of Open Access Journals (Sweden)

    Michał Kuniecki

    2017-08-01

    Full Text Available Temporal and spatial characteristics of fixations are affected by image properties, including high-level scene characteristics, such as object-background composition, and low-level physical characteristics, such as image clarity. The influence of these factors is modulated by the emotional content of an image. Here, we aimed to establish whether brain correlates of fixations reflect these modulatory effects. To this end, we simultaneously scanned participants and measured their eye movements, while presenting negative and neutral images in various image clarity conditions, with controlled object-background composition. The fMRI data were analyzed using a novel fixation-based event-related (FIBER method, which allows the tracking of brain activity linked to individual fixations. The results revealed that fixating an emotional object was linked to greater deactivation in the right lingual gyrus than fixating the background of an emotional image, while no difference between object and background was found for neutral images. We suggest that deactivation in the lingual gyrus might be linked to inhibition of saccade execution. This was supported by fixation duration results, which showed that in the negative condition, fixations falling on the object were longer than those falling on the background. Furthermore, increase in the image clarity was correlated with fixation-related activity within the lateral occipital complex, the structure linked to object recognition. This correlation was significantly stronger for negative images, presumably due to greater deployment of attention towards emotional objects. Our eye-tracking results are in line with these observations, showing that the chance of fixating an object rose faster for negative images over neutral ones as the level of noise decreased. Overall, our study demonstrated that emotional value of an image changes the way that low and high-level scene properties affect the characteristics of

  1. Outcomes of Internal Fixation in a Combat Environment

    Science.gov (United States)

    2010-01-01

    Talus 4 0 4 Tibia 2 0 2 (20%), respectively. Sixteen (32%) fractures were open and 34 (68%) were closed (Table 2). The Gustillo and Anderson...JOURNAL OF SURGICAL ORTHOPAEDIC ADVANCES 5. Keeney, J. A., Ingari, J. V., Mentzer, K. D., et al. Closed intramedullary nailing of femoral shaft fractures ...78%) fractures healed without incidence (i.e., no postsurgical complications or additional proce- dures performed). One patient (2%) with a closed

  2. Indicators of outcome after internal fixation of complex acetabular ...

    African Journals Online (AJOL)

    T.A. El-khadrawe

    2012-01-23

    Jan 23, 2012 ... Avascular necrosis. 0. 0. Osteoarthritis. 14. 24.45. Early local complication versus outcome. No local complications. 17.00(7.00–18.00) z = А2.564 p = .01. Local complications. 12.00(6.00–15.00). Post-operative displacement versus arthritis. No arthritis. 2.00(00.00–10.00) mm z = А3.36 p = .001. Arthritis.

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

    DEFF Research Database (Denmark)

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

    1990-01-01

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

  4. Indications and outcome of Open Reduction and Internal Fixation of ...

    African Journals Online (AJOL)

    %), Malunion 57 (15.4%), Failed implant 13(3.5%), Delayed union 4(1.1%), open fracture 4(1.1%), and congenital pseudoarthrosis of the tibia 1(0.3%). The commonest bone involved was the femur 205(55.6%) followed by the tibia and fibula ...

  5. Dynamic analysis of double-row self-aligning ball bearings due to applied loads, internal clearance, surface waviness and number of balls

    Science.gov (United States)

    Zhuo, Yaobin; Zhou, Xiaojun; Yang, Chenlong

    2014-11-01

    In this paper, a three degrees of freedom (dof) model was established for a double-row self-aligning ball bearing (SABB) system, and was applied to study the dynamic behavior of the system during starting process and constant speed rotating process. A mathematical model was developed concerning stiffness and damping characteristics of the bearing, as well as three-dimensional applied load, rotor centrifugal force, etc. Balls and races were all considered as nonlinear springs, and the contact force between ball and race was calculated based on classic Hertzian elastic contact deformation theory and deformation compatibility theory. The changes of each ball's contact force and loaded angle of each row were taken into account. In order to solve the nonlinear dynamical equilibrium equations of the system, these equations were rewritten as differential equations and the fourth order Runge-Kutta method was used to solve the equations iteratively. In order to verify accuracy of the dynamical model and correctness of the numerical solution method, a kind of SABB-BRF30 was chosen for case studies. The effects of several important governing parameters, such as radial and axial applied loads, normal internal, inner and outer races waviness, and number of balls were investigated. These parametric studies led to a complete characterization of the shaft-bearing system vibration transmission. The research provided a theoretical reference for new type bearing design, shaft-bearing system kinetic analysis, optimal design, etc.

  6. Internal damping due to dislocation movements induced by thermal expansion mismatch between matrix and particles in metal matrix composites. [Al/SiC

    Energy Technology Data Exchange (ETDEWEB)

    Girand, C.; Lormand, G.; Fougeres, R.; Vincent, A. (GEMPPM, Villeurbanne (France))

    1993-05-01

    In metal matrix composites (MMCs), the mechanical 1 of the reinforcement-matrix interface is an important parameter because it governs the load transfer from matrix to particles, from which the mechanical properties of these materials are derived. Therefore, it would be useful to set out an experimental method able to characterize the interface and the adjacent matrix behaviors. Thus, a study has been undertaken by means of internal damping (I.D.) measurements, which are well known to be very sensitive for studying irreversible displacements at the atomic scale. More especially, this investigation is based on the fact that, during cooling of MMC's, stress concentrations originating from differences in coefficients of thermal expansion (C.T.E.) of matrix and particles should induce dislocation movements in the matrix surrounding the reinforcement; that is, local microplastic strains occur. Therefore, during I.D. measurements vs temperature these movements should contribute to MMCs I.D. in a process similar to those involved around first order phase transitions in solids. The aim of this paper is to present, in the case of Al/SiC particulate composites, new developments of this approach that has previously led to promising results in the case of Al-Si alloys.

  7. International distortions of competition under emissions trading due to differences in national permit allocation. Theory and empirical analysis of the EU-energy intensive industry

    International Nuclear Information System (INIS)

    Brockhagen, D.

    2004-03-01

    The first part develops a theory of distortions of competition among competing firms, induced by differences in the method and/or stringency of national allocation of greenhouse gas emission permits in an international emissions trading system. By applying neoclassical theory on output optimisation, price setting and other factors such as R and D expenditures, five potentially distorting effects are identified for perfect and imperfect markets,. The second part develops economic indicators and a two tier approach, which can be applied empirically, in order to test whether an industry is vulnerable to the potential effects found before. The third part applies the two tier approach empirically to four sectors of the energy intensive industry in the EU: steel making, cement, oil refining and electricity generation. The steel industry is the most vulnerable industry, followed by oil refining, whereas cement and electricity are not vulnerable. At a permit price of 20 euros/ton CO 2 , and with national allocations that differ more than 40% in terms of allowed emissions per ton product output, this thesis predicts that some steel makers would be forced out of the market. (author)

  8. The psychological impact of external fixation using the Ilizarov or Orthofix LRS method to treat tibial osteomyelitis with a bone defect.

    Science.gov (United States)

    Abulaiti, Alimujiang; Yilihamu, Yilizati; Yasheng, Tayierjiang; Alike, Yamuhanmode; Yusufu, Aihemaitijiang

    2017-12-01

    To examine the psychological impact of external fixation for a tibial bone defect due to osteomyelitis, and to compare the Orthofix limb reconstruction system (LRS) with the Ilizarov external fixator. The SCL-90-R questionnaire was administered at four different time points (before surgery, while patients wore the external fixation device, when the device was removed, and two to three months after). The scores at the four time points were compared, as were the two different methods of external fixation (Orthofix LRS vs. Ilizarov). The patients experienced a significant adverse impact on their mental health, with the worst outcomes at Time 2 (while wearing the external fixator), but with some negative effects still present even several months after removal of the fixation device. Although the Orthofix LRS and Ilizarov groups showed similar mental health scores at Time 1 (preoperatively) and Time 3 (upon removal of the fixation device), the Orthofix LRS was associated with better scores, specifically in the Hostility (Time 2), Phobic Anxiety (Time 2), Psychoticism (Times 2 and 4), and Other (Time 2) sub-scores, as well as the total score (Times 2 and 4). Although both Ilizarov and Orthofix LRS fixation resolved the bone defects, external fixation had a negative impact on the patients' mental health, which persisted even after removal of the devices. Although both methods led to negative effects on the patients' mental, the impact of the Orthofix LRS was less severe. Copyright © 2017. Published by Elsevier Ltd.

  9. Recent advances in fixation of the craniomaxillofacial skeleton.

    Science.gov (United States)

    Meslemani, Danny; Kellman, Robert M

    2012-08-01

    Fixation of the craniomaxillofacial skeleton is an evolving aspect for facial plastic, oral and maxillofacial, and plastic surgery. This review looks at the recent advances that aid in reduction and fixation of the craniomaxillofacial skeleton. More surgeons are using resorbable plates for craniomaxillofacial fixation. A single miniplate on the inferior border of the mandible may be sufficient to reduce and fixate an angle fracture. Percutaneous K-wires may assist in plating angle fractures. Intraoperative computed tomography (CT) may prove to be useful for assessing reduction and fixation. Resorbable plates are becoming increasingly popular in orthognathic surgery and facial trauma surgery. There are newer operative techniques for fixating the angle of the mandible. Also, the utilization of the intraoperative CT provides immediate feedback for accurate reduction and fixation. Prebent surgical plates save operative time, decrease errors, and provide more accurate fixation.

  10. Use of Spring Plates in Fixation of Comminuted Posterior Wall Acetabular Fractures.

    Science.gov (United States)

    Lee, Christopher; Johnson, Eric E

    2018-02-01

    Surgical management of comminuted posterior wall acetabular fractures with marginal fragments remains difficult. The purpose of this study was to evaluate the use of spring plates as adjunctive fixation in comminuted posterior wall acetabular fractures. A retrospective review of patients treated for posterior wall acetabular fractures with the use of customized spring plates as adjunctive fixation between 2000 and 2017 was performed. Patients were evaluated radiographically according to the grading criteria of Matta. Complications including subsequent revision surgery and hardware failure were recorded. Fifty-two patients underwent surgical fixation of posterior wall acetabular fractures with the use of customized 3.5-mm spring plates combined with posterior buttress compression plating over the spring plates as definitive fixation. Mean follow-up was 13.9 months (range: 3-140 months). Forty-two patients had radiographic grades of excellent, with 6 good, 1 fair, and 3 poor. There were no hardware complications. Five patients underwent revision surgery, including 4 patients (7.7%) who underwent a total hip arthroplasty due to advanced arthritis. The use of customized spring plates is a viable method of adjunctive fixation for comminuted posterior wall fractures with marginal fragmentation. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

  11. Nitrogen fixation in different chickpea cultivars as affected by iron application N-15 Technique

    International Nuclear Information System (INIS)

    Gadalla, A.M.; Soliman, S.M.; Abdelmonem, M.

    1995-01-01

    With development of new cultivars of winter chickpea, it became important to evaluate the potential of these cultivars to fix nitrogen from air, and the effect of different agronomic factors on this important process. Greenhouse experiment was conducted to screen five cultivars of chickpea for N 2- fixation ability as affected by iron application. These cultivars were Giza 1,2,531 and 88 as compared with L 3 which was developed from the genotype NEC 1055 by irradiation. N 2- fixation was estimated using N-15 technique. Plant materials were collected after 55 days from planing. Plants samples were analysed for total N-15 atom excess. Results show that Giza 88 gave the highest dry matter as well as nitrogen fixation. Nitrogen derived from air (NDFA) ranged from 27 to 50% due to variety difference and iron treatment. 1 fig., 3 tabs

  12. Sugar enrichment provides evidence for a role of nitrogen fixation in coral bleaching

    KAUST Repository

    Pogoreutz, Claudia

    2017-04-21

    The disruption of the coral-algae symbiosis (coral bleaching) due to rising sea surface temperatures has become an unprecedented global threat to coral reefs. Despite decades of research, our ability to manage mass bleaching events remains hampered by an incomplete mechanistic understanding of the processes involved. In this study, we induced a coral bleaching phenotype in the absence of heat and light stress by adding sugars. The sugar addition resulted in coral symbiotic breakdown accompanied by a fourfold increase of coral-associated microbial nitrogen fixatio